The URL can be used to link to this page

Home My WebLink About0023 SIMPSON AVENUE 9(R3 Si rrt psov-, 1::/-\/8-• ) , _ , 'it;L...Y-1-fle>t&.,-Iril eciarlAi'l-°42-n°(--' .. / I '• . .. :i .'ft., F r,.• a �I i ] x ,.• .. .. o oo • • • • • y r • • • • • • o • • r. • • II • • ^ 1 , r e . 5 • • • • • o • • • is ✓ + r • .� ..t try r i♦ - « a n ♦ • ''.:•� r ':r c Ord f �: l •- ' .. ,.S ', • • • • • r. r. • • • • • 4. r' • a , • • 73 cati,nin, • • • • • • • • • . 4 • • • • • • •• • • • • f • • • • • r • • • • • • . • • • • • r Ct . . , Jh i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map • 3 4. g" Parcel 00 t To' mj Or, BARNSTABLE Application # ,, L6� pp `� Health Division t; ''° 2 5 j 1 10: 7 Date Issued 2c511,. P Conservation Division Application Fee /� Planning Dept. ... ..� _ {{ Permit Fee l5-0� r1i.�'.t isEIOI�i Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address a 3 S ; mks a iv- v Village a�n,S'd'ab1e Owner taxi So+0 Address s G,M 3 Telephone }i'9 • 91814 p � 9 Permit Request f'cald "11 ,4e'DIcw to the a c, to S G aGi^ +k.0 1d lL5 '-+! R. l rStcLk1-L ' nc ; h e.k 4,nr��Nf (to kin • Square feet:` 1st floor:✓ existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 4-00 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Cl 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: 0 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 0 Commercial 0 Yes 'No If yes, site plan review# Current Use Proposed Use APPLICANT cgc INFORMATION 1.I (BUILDER OR HOMEOWNER) Name W it ta(fl C I k.ty 1/! r, c. Telephone Number 5,0$ 3 9$ 03 98 Address 7-- 1� N.v1.�4-,+n�1- A ve License #1 f= ( 0 4-774 S, Grego w+k PI ft 8 tL v6Y Home Improvement Contractor# T �3 Email Worker's Compensation # 14) C 0 gs5 q oq-0 o ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Yrrtnow�� SIGNATURE DATE 5 a`O `b FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE k. 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. 4t , [RISE\wit 5 Dupont Avenue I South Yarmouth,MA 02664 1508-568-1926. ENGINEERING www.RlSEengineering.com EfficiencyEffictencyEnergized, OWNER AUTHORIZATION FORM ,, Lucy Soto (Owner's Name) owner of the property located at: 23 Simpson Avenue (Property Address) Yarmouth, MA 02664 (Property Address) hereby authorize Cape Save (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. LucySoto Digitally signed by Lucy Soto Soto Date:.2016.05.12 14:29:46-04'00' Owner's Signature May 12, 2016 Date ACCDATE(MM(ODIYYYV) CERTIFICATE OF LIABILITY INSURANCE 4/12/2015 • 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 ACT.Risk Strategies C an NAME: '�' Cmp y Risk Strategies Company C ,E4. (781)986-4400 FAXmic,No):(781)963-4420 15 Pacelia Park Drive anlia6randolphcld@risk-strategies.com . Suite 240 INSURER(S)AFFORDING COVERAGE NAIC S Randolph MA 02368 INSURER A:Selective Ins., of America INSURED INSURERB Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc INSURERc:Star Insurance Co 7 D Huntington Ave INSURER D: • INSURERS: South Yarmouth MA 02664 • INSURER F: 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 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 SUER POLICY EFF POLICY EXP - - - - LTR TYPE OF INSURANCE INSD VIVO POLICY NUMBER. (MMIDDIYYYY) (MM/DOIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAE TO RENTED A CLAIMS-MADE X OCCUR - PREMISES Ea occurrence) $ 100,000 X 81994480 10/16/.2015 10/16/2016 MEDEXP(Anyoneperson) $ 10,000 PERSONAL&ADVINJ.JRY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X CT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X OS SCHEDULED AS8A46796600 11/6/2015 11/6/2016 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS %AUTOS (Per accident) X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS-LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTIONS 81L. S1994480 10/16/2016 10/16/2016 $ WORKERS COMPENSATION officers Included for X PER OTH ANDEMPLOYERS'LIABILITY • • YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Coverage E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N NIA L. (Mandatory In NH) VC085540700 4/9/2016 4/9/2017 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 I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace 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 THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Barnstable County 460 West Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 Michael Christian/CLC {�1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INSO25(201401) The Commonwealth of Massachusetts —=;iiitw. I Department of Industrial Accidents 1 Congress Street,Suite.100 eV=_ p' Boston,MA 02114-2017 ,, www.mass.gov/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):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth,MA 02664 Phone#:.508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): i ID I am a employer with 15 employees(full and/or part-time)." 7. E1 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] • 3.0 I am a homeowner doing all work myself [No workers'comp.insurance required.]t 9. Demolition 4.0 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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.ORoof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We area corporation and:its officers have exercised their right of exemption per Ma,c. 14.0 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 Co. Policy#or Self ins.Lic.# WC085540700 Expiration Date: 4/9/2017 Job Site Address: 23 Simpson Avenue _ City/State/Zip: Barnstable 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 under th pains and penalties of perjury that the information provided above is true and correct Signature: Date: 5/20/16 Phone#:508-398-0398 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#: =m • • ., . r _-- Q Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 t Type: Corporation t+ s t, - /..` Expiration: 3/14/2018 Tr# 419291 CAPE SAVE INC. 1`"; - ' '` WILLIAM McCLUSKEY '" - '; "-7 f}' t;xt p� >4? 7-D HUNTINGTON AVENUE t rn , SOUTH=YARMOUTH, MA 02664 ; ' ki- ; � EF _J Update Address and return card.Mark reason for change. —w,.'''-' Address ❑ Renewal 0 Employment ❑ Lost Card SCA1 0 20M-05/11 - "--- AC WO-Ma,LC9:.uicaet CAP�1lussadtcue License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g 7 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration %.171380 Type: Office of Consumer Affairs and Business Regulation a ? Expiration 3/14/2-018 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE SAVE INC. -- i2 WILLIAM MCCL'USKEYR i it, 7-D HUNTINGTON AVENUES • SOUTH YARMOUTH,MA'02664 Undersecretary Not valid i signature C) Massachusetts-Department of Public Safety Board of Building Regulations and Standards .1-uBNu uliririr ourier•iiirr oncumw •rcdvrac�-ma.,'-.' License: CSSL-102776 ' ,,i 1 WILLIAM J MC ON i o t` ' _ 37 NAUSET ROAD r=� West Yarmouth MA '- i, J�,,,.y "-11 ` Expiration Commissioner 06/28/2017