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Home My WebLink About0004 BEARSE ROAD i ��. Town of Barnstable Building Department Brian Florence, CBO Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.b amstable.ma.us Pre-application for Business Certificate Date ) 1 Map 31 Parcel �✓ Applicant Information Applicants Name z Applicants Address �� ,��S 2 )� }-�u�� ,,; Email Address 0 O Telephone Number SO -cqZC3 Listed ❑ Unlisted ❑ aw :D n: U J o w Business Information w z M U) M z O= Z New Business? -------------------- -------------------- , es No g D Dw Business is a registered corporation? _ _____•__ _____________. Yes , No Cr d Cc: Q If yes Name of Corporation ozm Q Does business operate under the registered corporate name? Yes CNoj H W 0- U9 � � Is the business a sole proprietorship or home occupation? ---'__-___ Yes No �D 00 If yes then a Home Occupation Registration is required—See Building Division Staff Name of Business p,�', ,n / � � e�� Cu a•�-� G'a I o c`S Business Address g2a:s r M/a1 OA601 Type of Business 1p;�_1_11141 roc, Buildi g C�o�missioner Office Use Only Conditions41 `t t (i'� X Id`� ! ro r Building Commissioner_ 1'< L� T-� Date f Ur Clerk Office Use Only Town of Barnstable Building Department = �oFTHE TOstt, Brian Florence,CBO o� Building Commissioner EAMSTABLB. « 200 Main Street,Hyannis,MA 02601 cuss �cb i639, �� R.R,w.town.barnstable.ma.us pTEp MA'1 A Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: �� Phone#: �4S"aSo8�a6 Address: L Village: Elyan ' Name of Business: r Type of Business: Map/Lot:INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular .matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. No`sip shall be displayed indicating the Customary Home Occupation. is listed or advertised as a business,the street address shall not be• • If the Customary Home Occupation included. • e Customary Home Occupation who is not a permanent resident of the No person shall be employed in th dwelling unit. 1,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Date: 7` IL1 Applicant: Romeoc.doc Rev.10/17 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel � � Application # � Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address :f- .23 era'' e 12�f Village Owner %�/�,�AZ�P--T- /V*9,l Address Telephone L;G�:,% ,�% .Permit Request �� `it�i? �'� i�. �i� ��✓ �/��/�5 -� � / Square.feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation TJConstruction Type491�� 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 9No On Old King'sC:7Highway: ❑Yes (ZkNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other w X Basement Finished Area (sq.ft.) Basement Unfinished Area (sq )' Number of Baths: Full: existing new Half: existing n6-* Number of Bedrooms: existing _new r 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 �� ,l�.si��. �� Telephone Number L�`3 ;?�7,SJ/;_7 1 jef Address /�^l/ �✓✓�,� �� License# /a ®1 4 D`® l� Home Improvement Contractor# Worker's Compensation #4n/�C1 .; ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ZSIGNATURE DATE ��//� FOR OFFICIAL-USE ONLY APPLICATION# _DATE ISSUED. MAP/'PARCEL NO. t ADDRESS VILLAGE OWNER f - DATE OF INSPECTION: AFOU F , FRAME r INSULATION FIREPLACE ELECTRICAL: . ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL - FINAL BUILDING- DATE CLOSED OUT , ASSOCIATION PLAN NO. f Hoysin ` Assistance Corporation Cape cod HOME OWNER WEATHERIZATION WORK PERMIT & FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. I _t'c��'?C: _ 4— 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: 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. I have read the provisions of this agreement as listed and freely give my consent. Home Owner: (Signature) fL.e - %=fig Agent: (signature) Date: ._.-._..._L-�....T� —= i ---- HAC approved Weatherization Company All Cape Energ Cape Cod Insulation Cape Save Efficient Buildings,LLC F.ro.ntier Energy Solutions ., , Lohr &,S.ons ;.. :..;.ResoIutio.n Energy } f 1 tG, �'lla�s:rc'Ituscft, - Deparolicol of Puhhc alct� J Board ul buififi11" Re"ulatuul.." anti "ltan(lar(Is Qonstrulction Supervisor License Licen '-CS 100988 r �+ HENRY CASSIDYu� ' 8 SHED ROW VVES�I- 'JARMOUTH, MA 02673 Expiration: 11/11/2013 ( ..uuni,siuucr Trrr: 7620 {I7'�e,a),i,(oeCII;�`I- 0 �%�l'LCri1 L°6?.-G�'�E'��1 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Roston, Massachusetts 02116 .Home Improvement Contractor Registration Registration: '153567 Type: Private Corporation Expiration. 12/15/Zbl4 TO 2D831 CAPF_ COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE --- .. .___.. ...... _ _..... _- SO. YARMOUTH, MA 02664 Update Address and return card. Mark rcasou I'm change. (� Address ❑ Renewal -� l;mployntunt L I.Lust Card • rr l(rir�iirr'irrlcrcl//t rr�`C.;/•(,FJd�1t'!'[[1.1r:��J zw\ Uriire of Consirmer Affairs Ji Busioess 12egulatioa, License or registration Valid for inclividul use only lItOME IMPROVEMENT CONTRACTOR before the expiration date. 1f found return to: 11 eyistration: 153567 Type: Office of Consumer Affairs and Business Regulation ;Expiration: 12/-15/2014 Private Corporatic•ii 10 Park Plaza-Suite 5170 Buslua,MA 02116 , �;Ai'(�%QI i nV`:�Ui_ATTON,ZINC. 18 1,TARI.)0N ORCLE — c ..,�1 i i1.I;N10111 f-I. MA 02664. --------- -- — - --- — -- ---------..._...__.-. Undersecretary of Vill witho t [lilt 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/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):, Me 1 71D(a Address: A C(/ y City/State/Zip: / 61.E a ) '44 4 Phone Are you an employer?Check the appropriate box: general contractor and I Type of project(required): l.❑ I am a employer with 4. ❑ I am a g employees(full and/or part-time).# have hired the sub-contractors 6 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.= 9. ❑ Building addition required.] 5 We are a corporation and its 10.❑ 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 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no 3a.❑ I am a homeowner acting as a employees. [No workers' 13.0-Other Z4��L_,l general contractor(refer to#4) comp.insurance requite.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensatiod�olicy 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-cons actom have employees,they mast provide their workers'comp.policy number. j I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:J �,c��/G Policy#or Self-ins. Lic.#: �� / Expiration Date: lvl�Z/24-- Job Site Address:_ 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 S250.00 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. I do hereby carhfy and 7the"paT* and enaldes of perjury that the inform4tion provided above is true and correct ( Da Phone � Fcial use only. Do not write in this area, to be completed by city or town ofciaL 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#: • f , o - v CAPECOD-27 MYOUNG CERTIFICATE OF LIABILITY INSURANCE DAT7 812 DIYYYY) 7/8/2013 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 License#PC-514062 CONTACT Margaret Young Rogers 8,Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 IAIC,No Ext: AIC No): South Dennis,MA 02660 E-MAIL m oun ro ers ra com ADDRESS: y g@ 9 9 y• INSURERS AFFORDING COVERAGE NAIC# INSURER A:PEERLESS INSURANCE COMPANY INSURED INSURER B:COMMERCE INSURANCE COMPANY Cape Cod Insulation,Inc. INSURERC:Evanston Insurance Company 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,MA 02664 INSURER E: r 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR p . POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CBP8263063 4/1/2013 4/1/2014 DAMAGE PREMISESE ao cane $ 100,000 CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY M PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1000 OOO Ea accident , $ , B ANY AUTO 13MMBCKVMK 4/1/2013 4/1/2014 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS _ X HIRED AUTOS X NON�OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT) $ X UMBRELLA LIAB I X IOCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-MADE XONJ453512 4/1/2013 4/1/2014 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION I TORY TATIT• OTH- AND EMPLOYERS'LIABILITYLIM D ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WCA00525904 6/30/2013 6/30/2014 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N f A ' (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yea,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD