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HomeMy WebLinkAbout0004 GENERAL PATTON DRIVE �G v. c B�� � / � -- Cape Save Inc. • 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 10-1-13 Town of Barnstable ea Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 4 General Patton Drive has been inspected by a certified Building Performance Institute (BPI)Inspector. Ceiling: R-38 cellulose(R-13 under deck) All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a`1 Parcel Ma � p Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee u Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 4 &enerfil Ago Village Owner e-tA I►C a (� G n±e_10 Address Telephone �11 ��5 0 8�H Permit Request R 4 R- 01011 R 1 B We tz -1- he Ab I c. -ftJd R,-30 A� lr�e w, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay tAJ Project Valuation 30 p Construction Type -� p Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting doametion. Dwelling Type: Single Family ❑uu Two Family ❑ Multi-Family (# units) Age of Existing Structure "1 Historic House: ❑Yes ❑ No On Old King's H!ghway: 2Yeso)b No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other 10 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 INo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) i l Name 11ra, Telephone Number 03 is Address - Ave, License # C 10 p1, 4 7_L 1 .5e Home Improvement Contractor# t 41 Worker's Compensation # r, 3353 ,q bg ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO l pf 11LOUV�II� SIGNATURE � DATE l FOR OFFICIAL USE ONLY F « APPLICATION# •i DATE ISSUED r MAP/PARCEL NO. 4 f 6 ADDRESS VILLAGE OWNER S 1 DATE OF INSPECTION: k ;k q,.FOUNDATION. FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL I PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT .�' $ J its v - ASSOCIATION PLAN NO. 101M Or. dVDA&Vat c r Housing Assistance Corporation Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT & FUEL RELEASE: PLEASE PILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. f _ " � l�i� 62 _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: / � r &751-'✓' ✓'y C ,P`i^J)4�rf l�/e��... /i .f.� 4.^'d [V The weatherization work done will be based on programmatic priorities and availability of p 9 p tY 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 thisagreement as listed and freely give my consent. Home Owner. (Signature) 07, 4 f. Date: _f ` ) Agent: (signature) Date: HAC approved Weatherization Company : Gc 56., v e All Cape Energy Cape Cod Insulatio Cape Save E icient Buildings,LLC FrontiefiEn.ergy.. Solutions.... Lour_.&.S.ons,. . Resolution Energy The Commonwealth o Massachusetts ` Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Awlicant Information Please Print Lep-ibly Name (Business/Organization/individual): Cape Save Inc. Address: 7D Huntington Ave City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-398-0398 Are you an employer? Check the appropriate box: Type of project(required): 1. ✓❑ l am a employer with 4. ❑ I am a general contractor and I 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 g. ❑ 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 1.❑ I am a homeowner doingall work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL c. 152, 12.❑ Roof repairs insurance required.] � §1(4) and we have no employees. [No workers' 13.❑✓ Other Insulation comp. insurance required.] *Any applicant that checks box 41 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. aContractors 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. 1 ain an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: Technology Insurance Company Policy#or Self-ins.Lic.#: TWC3353968 Expiration'Date: 04/09/2014 Job Site Address:_ `-^��'�� �°��n City/State/Zip:_ (11 Attach a copy of the workers' compensation policy declaration page(showing the policy numbe 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$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. I do herebffrti+under lire pains and enalties o er'_ that the in orination provided above is true and correct. - - 6 -.. - -- -- Signature- L�]Date 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#: f CERTIFICATE OF LIABILITY INSURANCE DATE i2013"Y' 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 poilcy(les) 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 endorsements. PRODUCER CONTACT NAME: Colleen Crowley Risk Strategies Company PHONE (781)986-4400 AC No):(781)963-4420 01C.No.15 Pacella Park Driveb-MAIL Suite 240 INSU S AFFORDING COVERAGE NAIC# Randolph MA 02368 iNSuRERA:Selective Insurance INSURED INSURERB:Safety Insurance Company 3618 Cape Save, Inc INSURER C:Technology Insurance Company 7 D Huntington Ave INSURER D: INSURER E: South Yarmouth bpi 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL134960509 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. LTR TYPE OF INSURANCE AIJUL S POLICY EFF POLICY EXP YM POLICY NUMBER MMIDDIYYYY) (MMIDD1YYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE Q OCCUR S199448001 0/16/2012 0/16/2013 MED EXP(Arty one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7X POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea COMBINED INEDaccident SINGLE LIMIT1,000,000 B ANY AUTO BODILY INJURY(Per person) $ TOS QED SUT CHEDULED 6208200 1/6/2012 1/6/2013 BODILY INJURY(Per accident) $ X HIRED AUTOS E NON-OMED PROPERTY DAMAGE AUTOS Per accident1 $ X Underinsured motorists]split $ 100 000 A X UMBRELLA LIAB X OCCUR 199448001 0/16/2012 0/16/2013 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAJMS-MADE AGGREGATE $ 1,000,000 DED I J RETENTION$ C WORKERS COMPENSATION Officers Excluded from 1hC STATU OTH- $ AND EMPLOYERS'LIABILITY Y f N X T ANY PROPRIETOR/PARTNER/EXECUTIVE Coverage OFFICER/MEMBER EXCLUDED? Y NIA E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) 3353968 /9/2013 /9/2014 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc., and Housing Assistance Corporation are listed as 1 additional insureds as respects General Liability as required by written contract. i CERTIFICATE HOLDER CANCELLATION (508)790—2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. 484 Main Street Hyannis, IA 02601-3698 AUTHORIZED REPRESENTATIVE chael Christian/CLC �' ACORD 25(2010t05) ©1988-2010 ACORD CORPORATION. All rights reserved. I1jMt1g, —A-1— TL_ A/�AO11—_�___,J r___ ______.--___,__ _r Massachusetts -Department of Public Safety ty board of Building Regulations and Standards Construction Supervisor SpecialtV "A ":_icense: CSSL-102776i/ WILLIAMJ MC C-LUSKEY-E ' 37 NAUSET ROAD = West Yarmouth MA 02673 xPiration 06128/2015 Commissioner Office of Consumer Affairs and eusness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration _ Registration: 171380 Type: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM McCLUSKEY = 7-D HUNTINGTON AVENUE - = SOUTH YARMOUTH, MA 02664 = _ Update Address and return card.Mark reason for change. - Address 7 Renewal Employment ;( Lost Card DPS-CAI 0 50M-04/04-G101216 ✓die Sumer affairs ll asiness Regulation. License or registration valid for individul use only Office of Consumer Affairs&B siuess Regulation. g n'HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - • Office of Consumer Affairs and Business Regulation '61 Registration: _ 171380 Type: I f=r Expiration: .3/14/2014 Corporation 10 Park Plaza-Suite 5170 > Boston,MA 02116 /�. CAht SAVE INC. =__ WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH;Mk-U2664 �— _- Undersecretary Not valid wit o signa