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HomeMy WebLinkAbout800 BEARSE'S WAY (28) all. R�` Oro/ 0�c c- i .. 4 s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a 7 Parcel 061 C Application Health Division Date Issued/10'457- 1Y Conservation Division Application Fee ® Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address EDO Bea r scG eL Village 4 O,n 4 L5 Owner_-S_6,a o Q Q ON eI I Address Telephone 508 5 a 4 Li 4�3 9 pp Permit Request -�i beTcSs 4o tke a4�c. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Ito 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: 0 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 0 new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ A ached 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) NameC C c�uve �U��li mcclmiovTelephone Number Address ` License# 111fr Home Improvement Contractor# Worker's Compensation # (U)W C2 5 2.3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO YQw-11� SIGNATURE DATE l r FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ` FRAME .t ..a. ..._ a lNSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING. DATE CLOSED OUT t t ASSOCIATION PLAN NO. rA of Housing Assistance kill Corporation Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE J' THE APPLICANT HOME OWNER. yf hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation ( herein after referred as "Agency" ) on the . property located at: 'EDO � - The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping & caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. have read the provisions of .this agreement as listed and freely give my consent. Home Owner(signature) + } f Home Owner email: Lt-ate,0444 Agent: (signature) `' Date: HAC approved Weatherization Compan Adam T Inc Ca a Save All Cape Energy Frontier nergy Solutions • Alternative Weatherization Lohr Home Improvement Building Science Construction Resolution Energy Cape Cod Insulation Tupper Construction 1`lhe Commanwealth Of Massachusetts Department of Industrial Accidents Office of�tfavestiga Ions 1 Congress Street,Suite 100 Boston,MA 02114=2017 ass Ad p - Affidavit:Workers'Com ensatron Insurance Affidav><t�.Builders/Contractors/Electricians/Plumbers Applicant Information Please Print:Legibl Name([usiness/Ehganization/Individual}: Cape 5W in[: Address: 70 Huntingfon Ave City/State/Zip: South Yarmouth.MA 02664 - Phone#: 508-398-0398 . Are you an employer?Check the appropriate box: `type of project(required):. 4. 1 am a general.contractor and.I 1.0 i am a employer tivtttt _ Q6. ❑New construction: employees,(full andlQr part-(ime).' have hired the sub-contractors 2.0 1 am,a sole proprietor or pat Tier- listed-.on the attached sheet.. 7. ❑Remodeling ship and have no employees These sub-contractor have g, ©Demolition. working for in an ca aci ernplpyees and,haveworkers' g y p ty• f. 9. ❑Building addition [No workers- comp.insurance comp=tnsurance i required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions: 3.0 I am.a homeowner doing all work, p eers have exercised their 1111 P-lumbing repairs or additions myself.[Novorkeis'comp.. night of exemption per MGL 12.❑Roof repairs. insurance required.]t C. 152, §1(4).and we:have no employees. [No workers' 13.0Other lnsuiafioh. comp, insurance required.] vAny applicanl thftt checks box?#- muse also fill out die section.beloa,shoeing their workers'compensation policy h,irortmtiom. t Homeowners who submit this affidavit indicating they are di ingall wok and then hire outside contractflrs must submit a new affidavit indicating such.. ,Contractois that check:ihis boxmust attached an additional slieet sho x'irsg the riaine of the sub-contractors andstate 4vheihet or not{hose ii iiiie5 haue employees. if the sub-contmctors their workers'comp:.poticy number_ 1 ain an a noMper that is providing workers co mpensation insurance f®r iffy employees._$elow is thgpoPicy.and jobsite inforination, Insurance Cornparty Name: Wesco Insurance Company Policy#or`Self--ins.Lic.# WWC3085633. . . __ ExpiratxonDate: 04/09/2015 Job Site Address: U C°A, City/State/Zip::. any l: Attach a copy of the vvorkers'compensation policy declara ion page(showing the policy nut;bet and expiration:date). Failure to secure coverage as required under Section_!-5A of MQL c.152 can lead to the;imposition of criminal penalties of a fine up to t.,500.04 andlor one-year in�prisonmertt,as well as civil penalties in the form of a STOP 1UORK OP2DER and a fine of up to$250.00 a day against the,=violator:. Be advised that a copy,of this statement maybe forwarded to the Qffice of Investigations of the DIA for insurance coverage verification. 1 dv hereby certi under the aims and 'enulties o er" that the in ortnation provided abax}e-is trt` and correct. - Signature:. Date Phone 9: 5Q9-39 -Q39 t3�ciul use only. Do mat write in this,areu,fv be cosrapleted b tit or torurr official: City or Town:, Permit/l�cense Issui ng Authiority(Ci ele one). 1.Board of Health 2;$.!01(9 Department,3.Citv/Town Clerk 4.Electrical inspector 5:Plumbing jnspector 6.Other Contact Persop: _ __ Phone:#: _ . r A0 CERTIFICATE OF LIABILITY INSURANCE 4DATEE 14i2o14 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 PROpUGER,A.AND THE':CERTIFICATEROLDER'. IMPORTANT: If the;certificate hoiden Is an ADDITIONAL INSURED, the.policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the poiley;certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder iri 11eu of such endorsements PR60UCEli;_ .. - NAME C- Colleen Crowley . .. Risk Strategies Company` PHONE (7gg)986-4400 -FAX No;7781)969-4420 15 'Pacella Park Drive :ecrowiey@risk-strategies,com Sixite 240 INSURERS AFFORDING COVERAGE NAIC# Randolph MA 02368 P INsuRERa Selective:.'Ins. of America INSURED; INSURFRB:Safety Insurance CapWanit 33618 Cape Save,: Inc INSURER c WesCO Insurance I Compaty 7 D Huntington,.Ave INS URERb:. INSURER E South Yarmouth MA 6266.4 INSURERF; COVERAGES CERTIFICATE NUMBER:CL1441475243 REVISION NU BERc 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 VVHICH. THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE'.AFFORDED BY THE POLICIES DESCRIBED HEREIN IS'SUBJECT 70 ALL THE TERMS; EXCLUSIONS AND CONDITIONS OF SUCH`POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.. INSR TYPE OFALML .... �..POLICYEFF- POLICY'.EXP . LTR POLICY.NUMBER - MMIDD MM/DD- LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurrence $ 100.,000 A C AIMS-MADE Q OCCUR 1994480 0/16/201'3 0/16/2014 MED EXP IAny one person) $ 10,000 _.. .. PERSONAL.&PDV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00.0 GENI AGGREGATE LIMIT APPLIES PER:; PRODUCTS-COMPIOPAGG $. . 2,006,000 POLtCYFXI PRO X,;LOC AUTOMOBILE LIABILITY a acc-EO SINGLE GL I I 1,000,000 ANY AUTO - BODILY-INJURY(Per pemon) $ $ Ix ALL OWNED XNAUTO .SCHEDULED 08200 1,/6/2013 r/6/20141 AUTOS S. BODILY INJURY.(Permeldent).$ NONaOWNED PFOP RTY DAMAGE HIRED.ALITOS •AUTO$ Peracadent' .X UMBRELLA U46 $ OCCUR. EACH OCCURRENCE $ 1,000,000 A EXCESSLIAB CLAIMS-MADE • AGGREGATE $ 1,OOQ,000 cea REfENT19R : Si 19944$:0 0/16/2019 011612014 _ _ . . _ C WORKERSCOMPENSATION -- - fficers Included For :WC STATU- OTH- - AND EMPLOYERS LIABILITY YIN - X R 1 TS ANY PROPRIETORIPARTNERIEXECiWTIVE overage E.L.EACH ACCIDENT $_ 500 000 OFFICERIMEMBER EXCLUDED? a'NIA (MandatoryinNH) 085633 /:9/2014 J9J2015 EL.DISEASE-.EA EMPLOYEE:$ 500,000 grs desafba under + , - RiPTION OF OPERATIONS below E.L.DISEASE-POLICY LMMIT $ 500,000 DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES"IACach ACOR0101,Addttlonal Remarks Schedule,if a spacesls required)' Issued as evidence of insurance. Issued as evidence of insurance. Thielsch Engineering.; Inc.. is listed a$ additional insured.as "respects General Liability as required: by written contract. CERTIFICATE HOLDER CANCELLATION - m3Ong@cape1'9htCompaCt.Org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE' THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE;POLICY PROVISIONS; Attn Margaret Song PO BOX 427/SCH AurkomwbREP.RESENrATIVE 3195 Main Street Barnstable;, MA ..02630 chael Christian/CLC, ACORD 25(2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025.(zoloo5i.or rThe.ACORD name and'lago are registered marks of ACORD Office,of Consumer Affairs and Buslrless`Regulation 10 Park Plaza"- Suite 5170 Boston;Massachusetts 02116 -Horne Improvement Cow nt actor Registration Registration 171380 Type .FCorporation Expiration 3/14/2016 Tr# 249649 CAPE SA^VE iNC. .; . w WILLIAM McCLUSKEY . � r q 7-D.HUNTINGTON AVENUE " SOUTH YARMOUTH. ,MA 02664 a t' s .Update Address'and return card.Mark reason for change Q Address `.Renewal Employment Lost Card SCA 1 ir.20M-05/1 t_., - - ze oonmzariioea�ll o�P/f/(�iaa ccluseGti Office of Consumer Affairs&Business Regulation i License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before theexpiration date If found return to egistration: 171380 . ;Type. .:; l Office of Consumer-Affair§and Business Regulation 10 Park Plaza-Surte 5170 Expiration 3/14/2016 Corporation ' Boston,MA 02116 t.:. CAPE SAVE INC: WILLIAM MCCLUSKEY f° a 7-D HUNTINGTON AVENUE , g i SOUTH YARMOUTH,MA 02664 Undersecretary. & Not vali ithout signature i Massachusetts-Department of Public Safety Board of Building Regulations and Standards., Construction Supomisor Specially m ;License CSSL-102776 WILL IAM J MC C USKEY' �r 37 NAUSET ROAD ., G West Yarmouth 1V3A 026713 Expiration Commissioner 06/28i2016 1 �