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HomeMy WebLinkAbout0011 JIB WAY _ � J� /,� J V �� l/�./ ����� CAPE COD INSULATION IIIAA11 1AA11Sf SUPIN010 SATT! OUT1141 INS WATION ' CIIIINOf 1-800-696-6611. Town of Barnstable BUILDING DEPT. _ Regulatory Services JAN 14 2016 Building Division 200 Main St Hyannis, MA 02601 TOWN OF 13ARNSTABLE Date: 1 '\Z' zo\6 Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance .Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village 5Ar aC'n c,vm:a� y y Insulation Installed: .Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) o< X) Slopes ( ) ( ) ( ) ( ) ( ) Floors Walls ( ) ( ) ( ) ( ) ( ) GIJo r k Jae e)CO Sincerely 2rHE ssi r, President Ins ation, Inc. I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I Parcel 7141tj OF 88A RNSTABLE Application #,2 Health Division Date Issued ) "(7UU !S_ Conservation Division Application Fee 2 Planning Dept. Permit Fee S 35. Date Definitive Plan Approved by Planning Board ` ` ` '? Historic - OKH _ Preservation/ Hyannis Project Street Address It Jib W Village qfuvw �5 Owner n& 05 Address Telephone Permit Request 4kW f� 110 aW ' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation � J�, (� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family tl' 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 o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameQ 1 � , eIephone Number D - 11� - i Ltd Address License # 0 0 q Home Improvement Contractor# I�✓ � 17 JI p 064 qoI Email Worker's Compensation # �V �� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJEC WILL BE TAKEN TO - ko-At 0 SIGNATURE DATE � FOR OFFICIAL USE ONLY L APPLICATION# L DATE ISSUED MAP/PARCEL NO. 4 i ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE 5,. ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. RISE ENGINEERING t OWNER AUTHORIZATION FORM I, I �"� (Owner's Name) owner of the property located at:' (Property Address) (Property Address) hereby authorize (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. �1 Owner's Signature ,�" ,; Dc�-• ��, �ors` Date RISE Engineering 6 Dupont Avenue South Yarmouth, MA 02664 J f Massachusetts Department of Public Safety �i Board of Building Regulations and Standards ^�^^ License: CS-100988 Construction Supervisor. HENRY E CASSIDY V4/ 8 SHED ROW � WEST YARMOUTH Expiration: Commissioner 11/11/2017 Office of Consumer Affairs and Busyness Regulation 10 Park Plaza - Suite 5170 , Boston, Massachusetts 02116 Home Improvement Co•. tractor Registration Registration: 153567 n� Type: Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE S0. YARMOUTH, MA 02664 Update Address and return card, Mark reason for change, scA i ;5 2OM-05n1 (] Address Renewal [] Employment Lost Cai .._. ..... ........ ...... .. ell;�iomr�r ovuve�r�C�o�C/f/lcv�da•o�ccdeGtd Office of Consumer Affairs& business Reguletlon License or registratlon valid for fndlvidul use only Vq OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistratlon; -1`53567 Type: Office of Consumer Affairs and Business Regulation xplration;; 12'(15(20:16 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION.; HENRY CASSIDY 18 REAROON CIRCt.F'; S0. YARMOUTH.MA 02664 .• ' Undersecretary N val4ut sign a ': The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _= 600 Washington Street :� .t• �� Boston, MA 02111 www,mass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual); Address: City/State/Zip: toflVt t Phone #: ;5 w Are you an employer? Check th appropriate box; . �, ;-• Type of project (required): 11-employees(full and/or partpart-time),*I am a employer with 1 -4.' Q 1 am a general contractor and 1 have.hired the sub-contractors 6. E],New construction. ' 2,❑ l am a sole proprietor or partner- listed on the attached sheet, T [] Remodeling shipand have no employees These sub-contractors have 8, E] Demolition working for me in any capacity, employees and have workers [No workers' comp, insurance comp. insurance•1 �': 9, []'Building addition - - � p• required,] 5. We are a corporation and its officers have exercised their 10,[].Electrical" repairs or additions ` 3,❑ [ am a homeowner doing all.work 11;❑ Pluri-tbing repairs or additions • myself. [No workers' comp, right of exemption per MGL 12.[l Roof repairs r, c, 152, ](4), and we have no insurance required,) • § O Other,� 'employees, [No workers' 13• comp, insurance required,) *Any applicant that checks box#d must also fill out the section below showing their workers'compensation policy information. .t Homeowners who submit this a-ffidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attgphed 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 ,jnformation, r' Insurance Company Name; 0 o Policy # or Self ins, Lie, #; t�iGl �r' Expiration Date: i Job Site Address: _- U� . City/State/Zip: Attach a copy of the workers' cori pensa ion policy declaration.page;(showing the policy nu r and expiration date), Failure to secure coverage as required under'Section 25A of MGL c, 152`ran lead to the imposition of criminal penalties of a fine up to $1,500,00 and/or one-year,i nprisonment,.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 dcopy of this statement may.be;forwarded to the Office of Investigations of the DIA for insura . covera e verification, 1 do hereby certify 'd the pat an penalties of perjury that the information provided above is true and correct, • r ' Si nature; : - Dater to Phone#: x 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 ('.nntact Percnn: pt n„e 44, CAPECOO.27 BDELAWRENC ACORC7`" CERTIFICATE OF LIABILITY INSURANCE. DATE30/20lYYYY,- THIS CERTIFICATE 11 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(les)must be endorsed, If•SUBROGATION IS WAIVED, sub)ect 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 CONTACT NAME; Rogers&Gray Insurance Agency, Inc, PHONE FA 434 Rle 134 Alc No; (877) 816.2156 South Dennis,MA 02660 EMAIL ADDRESS; INSURER S AFFORDING COVERAGE NAIC n, INSURER A;Peerless Insurance Company•see LIBERTY MUTUAL - INSURED INSURER B,ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation, Inc, INSURERC; 18 Reardon Circle INSURER D; South Yarmouth,MA 02664 — INSURER E; INSURER F i 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 PERIOC INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH"T49- 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 LTR POLICY NUMBER AOOL MMIOD MMIDDrYY P LIMITS A X COMMERCIAL GENERAL LIABILITY - EACH OCCVRRENCE $ 1,000,( CLAIMS-MADE 0 OCCUR CBP8263063 04/01/2016 04/0112016 -PREMISES £e occurrence $ 100,( MEO EXP Any one e(son) $ 5,( PERSONAL&ADV INJURY $ 1,000,( GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO' GENERAL AGGREGATE $ 2,000,( ❑JEGT ❑LOC PRODUCTS•COMPIOPAGO $ OTHER: AUTOMOBILE LIABILITY $ a eocl e"11 G IM ANY AUTO BODILY INJURY(Per pe(son) s ALL OWNED SCHEDULED _ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTOSEO PROPERT 0 AGE Per accident) $ UMBRELLA LIAR H2OCCUR $ " EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ CEO RETENTION$ WORKERS COMPENSATION $ ._ AND EMPLOYERS'LIABILITY ANY YIN STAT TE ORH• —_ B OFFICER/MEMBER/EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE a N/A WCE00431901 0613012016 0613012016 E.L.EACH ACCIDENT $ 1,000,E ' (Mandatory In NH) _ II yyes,describe under E.L.DISEASE•EA EMPLOYEE $ 1,000,I 0 SCRIPTIONOFOPE RATIONS.beloNv E.L.DISEASE•POLICY LIMIT $ 1,000,( DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLE$ ( CORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Hold. 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 Il• 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE ©1958.2014 ACORD CORPORATION, All rights reserved, ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Z Z Z Z N (D Q °o m c Q Q Q 3 o Q p tl F i a'` n Q o o• m 3 cu m o s 3' = -� o� m 4! IV N y O 3 = � T 1n O O O cD 3 m _ cD N ' �, Q m ! a v D ro EL m = i ° � 3 O O n P _ o D c Q :� f� ,� O n O ! / C O Z ' CA -o O, * w, m � � ..•�' = to :C� Q ^ D n D D D 7! Z FID 3 Q Q VI N N Vl $ N L :\j Z CA o FUk � COD � METHOD OF PROViCff�l;; :a 4 3 c THE PROPOSED 1..3 SANITARY WATER SUPPLY, SEWAGE DISPOSAL S� AND aRAli�'ACE IS HEREBY APPROVED TIC SYSTEM EM MUST BE � INFTALLED IN COMPLIANCE 1. r V&H ARTICLE 11 STATETOWN OF BARNSTAB-9 C SITARY CODE AND TOWN BOARD OF HEALTH R ULATIONS. y Q A LiLti;;`C INS i ALLER 1VlUS.T OBTAIN SEINACE ° D INSTALL 5YSTEW ° PERMIT. AN _114 1 1 1 10 De nis�nort Furniture Co. � 15843 one story No ................. Permit for .................................... single family dwelling ' --.--.------....—.---.—.....~----.— ' l Jib V�` Location .0. --.---��---.---------- / West Byannisport . ^ ` ^—^—'-------^--'--'—.---'--~—''.'' Dmnnianort f�--' �tu�oitxzre Co. ' "=."" .--.--.---_------------ �rao�� ' | Type of Construction -----——------- . / . ^----..------.---------.------ , p �7�Plot ---------. �� ---........----- / { ' ' ` ^ � Permit Granted ...... .��.—.--..lA 73 . ~ Date of Inspection 79 01 Dote Completed ' � | .. , / > rteLew . PERMIT REFUSED -----_---.--------.`--. 19 ` ~ —'-------'--'---------------' ----------------.—.—~—..�----- —.------.------.------------. � &001 .----------.—.--.---.----.---.— � Approved ................................................. lQ .' � . ^ ' ---------------~-----^^^^—^— - ' -------`---.-------.~—.—.--,.— - / _ J