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Home My WebLink About0062 KELLEY ROAD 6a /�'E/%y �d Cape Save Inq�WN OF BARNSTABLE 7-D Huntington Avenue South Yarmouth, Mj&tQ261 7M 9, 32 Tel: 508-398-0398 Fax: 508-398-0399 FV" S 1 7/16/14 Town of Barnstable 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 62 Kelley Road,Hyannis has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-49 cellulose Walls: R-13 dense packed cellulose Basement: R-19 fiberglass in box sill All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey e . 17 Town of Barnstable *Permit# Of THE Tpk ! Erpires 6 mont rsjtoat isst ate ' Regulatory Services Fee : 3ARTlsTABLE,, ..� M' Thomas F. Geiler,Director plfD MA'S p 1 Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnsta b 16.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Yalid without Red X-Press Imprint Map/parcel Number Property Address Al CIO esidential Value of Work �l ,l()o Minimum fee of$35.00 for work under S6000.00 Owner's Name &Addressmil{ Contractor's Name�� W Telephone.Number FXA Home Improvement Contractor License#(if applicable) �C 1 X-P E S PERMT Construction Supervisor's License#(if applicable) (A W1 ❑Workman's Compensation Insurance Check one: [71-� am a sole proprietor ' OVA OFF BARNSTABLE ❑ lam the Homeowner [?�—I have Worker's Compensation Insurance Insurance Company Name N550ci Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request (check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors E9,10R&p)acement Windows/doors/sliders. U-Value ,5z) (maximum .44)#of windows_ *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. GNATURE: Q`�- r The Common wealih ofMassachusetts , It �, Department of Industrial Accidents ' - ,0' ,I• r Office of Investigations II;11Y ;; t,, 600 Washington Street Boston, MA 02111 IN' www.mass. ov/dia Workers' Compensat ion Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please'Print=Le�ibly Name (Business/Organization/Indidi vidual): Address: d x.� wok., °"'c -Q)61A- City/State/Zip � �� LfA- Phone #: 144�9 [Eja an employer? Check the appropriate box: Type,of project(required): I. a employer with ' ' 4. ❑ I am a general contractor and I 6 ❑New construction loyees (full and/or part-time).* have hired the sub-contractors a sole proprietor or partner- listed on the attached sheet. t ?• ❑Remodeling and have no employees,r' These sub-contractors have 8. ❑ Demolition ing for me in any capacity. workers' comp. insurance. 9. ❑ Building addition workers' comp. insurance 5. ❑ We are a corporation and its ired.] - officers have exercised their 10.0 Electrical repairs or additions y} a homeowner doing all work nght.of exemption per MGL 1 l.❑ Plumbing repairs or additions lf [No workers'.comp. f'i c. 152, §1(4),and we have no 12.❑ Roof repairsance required.] t. employees. [No workers' 13.QOther ' comp. insurance required.] ' o Any applicant that checks box#I must also fill out he section below showing their workers'.compensation policy information. � Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: z: y Policy# or Self-ins. Lic. cc . ... (per j (l Expiration Date: �� 1 Job Site Address:&;) City/State/Zip: U"15 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 $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 her y certify under the pains and penalties o/'perjury that the information provided above is true and correct. ' "r Si atur, �Q —� Date: , t Phone FOther only. Do not write in this area, to be completed by city or town official n: Permit/License# ority (circle one): ealth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Massitchusetts- Department of Public Sxfctc Board of Building Regulations and Standards Construction Supervisor License License: CS 14007 Restricted to.. 00 i .r a ib xe. JOHN P DUNN , BOX 924/80 MARIE ANN TER CENTERVILLE, MA 02632 Expiration: 5/25/2012 ('ununissiunen Trt#: 24061 r x''w'` ;�+�raaR.o. a Y"7"A�,4:X.,.. YL'�*R^�417f•...,.:. >+r�'v..:_.;'} ^� �•_68P:eE,+n.�+%: License or registration valid for individul use only ,�r (✓��, to - beforethte IratlOt , • t'' r,«,: <., y ,r? x lv. m•S ".^ _ `' *"F d "s xflRCeOLCOOSUdIev A f81 8tB_sinessRem t .. .....'-• +"'t r. . ..... ` a P . n date. If foun - ._ ^'w r d return to: Ut 16 of Consumer Affairs and Business Regulation HOME IMPROVEMENT CONTRACTOR Type: 10 Park.Plaza-Suite 5170 Registration:, 01149 Boston,,mA 02116. Expiration: 6E25%2012 Individual } (s JO P.DUNN�90 .A ht?. John Dunn ( -� 80 MARIE ANN TEFL . { Not valid without signature 1 CENTERVILLE,MA0 ,��, Undersecretary } , '. �,c'M•1+,W«•^w. !r�'rr'�r-w�Nir } w.wwsv .0 .- .v.+r+ a r . rr+w , - t I Y j a r Town of Barnstable ` Regulatory Services Thomas F. Geller,Director o '�� h = - Building Division ti Tom Perry, Building Commissioner I 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us .p Oifce: 508-862-40 8 =" ! Fax: 508-790-6230 ' h i Property Owner Must - Complete and Sign This Section ff Using A Builder J , - Y I '` as Owner.of the'sub.'ect J property rizef'/ _ � to act on my behalf, hereby autho LP all matters relative to work authorized by this building permit application for. 4: Address of Job) i •r SigV&re of Owner a �= I PAut Name •�' t If Property Owner is applying forpemzit pleasecomplete. the Home owners.License Exemption Form on 'the reverse side. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division T � J Date Issued 'Z7-`�`'f f� Conservation Division Application FE)82 Planning Dept. Permit Fee t� 4 3 U l j Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address Village oLA A (S I Owner ��n ►e TO r-Jan Address U MP Telephone ' 6 $ 0 b3 0 Permit.Request R- 9 r,19 t�l_1�, ±0 liy, a'�1( P_ Q ter•k u rVol N r JsnejS e(%04 t 1 'Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new .Zoning District Flood Plain Groundwater Overlay Project Valuation 5000 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: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full 0 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 ?(No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) �� p �� 34� ��98 Name � G UI,� � Telephone Number Address +� LLicense # L l oUT t' b Home Improvement Contractor# a 13 3 Email Worker's Compensation # 11,1 R 6 B 9 A I? ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 1 OLV Me ,ih SIGNATURE DATE 4 F, ' r • FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP L PARCEL N0: r. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION E: FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DAT&CLOSED OUT AS, ON PLAN NO. F { Housing Assistance Corporation Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FITL OUT AND SIGN THIS FORK! IF YOU ARE ::.:..THE APPLICANT HOME OWNER.. I Dan 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: CDC 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, sidewall-s & basements; attic and other �ventiTation 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-thd`weatherized unit on azi 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) ' ( ojt Date. Agent: (si nature) Date: � - 'j s- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 _ Boston,MA 01114-201`7 www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Itidividual'). Cape Saye lnG, _ Address: 7D.Huntington Ave City/State/Zip: South Yarmouth, MA 02664 Phone'#: 508-398-0398 Are you an employer?Check t appropriate box: Type of project(required) r 4. I am a general contractor and I 1.❑✓ I am a employer with i g 6. ❑.New construction employees(full and/or part-time): have hired the sub-contractors ❑ 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 workingfor me in an capacity.. employees and have workers' o Y . 9. ❑Building addition [No workers' comp.insurance comp.insurance required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am-a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself.[No workers' comp: right of exemption per MGL 12.❑Roofzepairs insurance required.]t c. 152, §1(4)';and we;have no employees. [No workers' ✓'Other Insulation. 13.❑ comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy utlbfmation. t Homeowners who submit this affidavit indicating.they are doing all work and then hire outside contractors must submit anew affidavit.indicating such. Contractors that check this box must attached an additional sheet showing the.name of the sub-contractors and state wl etlier or.iioI ihtise entittes It2ve employees. If the sub-contractors have employees,.they must provide their workers'comp. oIicy number. p p " } P PP I am an employer'that is providing workers'eon:pensation insurance for my employees. Below is the policy and job site. information. Insurance Company Name: Wesco Insurance Company Po icy#or Self--ins.Lic.#: WW0085633 _ _ ExpirationDate: .04/09/20I5 Job Site Address: b l\ .C City/State/Zip:_ °inn is Attach a coP y of.the workers'eornpenLati6n policy declaration page(showing the policy number- nd expiration date). Failure to secure coverage as required touter Section 25A of MGL c. 152 can lead to the imposition of:eriminat;penalties of a fine up to-S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER acid a fine of up to$250.00 a day against the violator.. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for.insurance coverage verification: 1 do hereby certi under the ains and enalties o er' ,that the information provided above is true and correct. Sienature: Date U .Phone 4: 50$-398-0398- Ocia1 use.only. Do not write in this area,to be cvrnpleted by cif},or to►vn offciul. City or Town: _ :Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building,Department 3.CityfCown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other ContAet Person: __ _ Phone#: J DATE(MMIDD)WYY).. CERTIFICATE OF LIABILITY INSURANCE �.� 4/14/2014 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,AND1 THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder ls an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy;certain policies may.reguir9 an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements (PRODUCER CONTACT N - Colleen NAME: Crowley Risk Strategies Company PHONEL8191 V.. (781)986-4400 AlF No:(761)963-4420 15 Patella Park Drive t:4AAILAnDRrss. Sllste 240 INSURERS AFFORDING COVERAGE NAIL* ,Randolph MA 02368 INsuRERa:Selective. Ins. of America. k. INSURED INSURERB:Safety Insurance ccmPajim 33618 Cape Save, Inc INSURER c:Wesco Insurance Company 7 D Huntington Ave IlvsuRERo: INSURER E: South Yarmouth. MA 02664 1 INSURER`F COVERAGES CERTIFICATE NUMBER:CL1441475243 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.MAYHAVE'BEEN REDUCED BY PAID CLAIMS. 1NSR - ,...,_....ADDL POUCYEFF POUCYEXP.. _. LTR TYPE OF INSURANCE - POLICY NUMBER MMIDD - MMIDD. LIMITS GENERAL LIABILITY _.. .. _.. EACH OCCU RRENCE $ 1,000,O'O.O X COM MERCIAL GENERAL LIABILITY DAMAGE TO RENT PREMISES Eaoccurrence $ lOD,000 A CLAIMS 0ADE. ®OCCUR S1994M 0/16/2013 0/16/2014 MED EXP(Any one person) $ i0,000 PERSONAL 3 ADV INJURY $ 1,000,000 GENERAL AGGREGATE. $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO- Ex-1 LOC $ AUTOMOBILE LIABILITY Ea MINEDcciden GL LIMIT 1,000,000 B ANYAUTO BODILY.INJURY(Per,person) $ ALL 0 ED ,X SCHEDULED 208200 1/6/2013 1/6/2014 AUTOr BODILY INJURY(Peraccident) $ X HIREDAUTOS X AUTOSVW4ED PR�3PER.TY DAMAGE Psracradent PANO UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AEXCESS LIAB GLAIMSWADE AGGREGATE $ 1,000,000 DED. RETENTION. NIL1994480 0/16/20i3 0/16/2014 WORKERS COMPENSATION C Officers Included For X ORY LIMITS OTH- EMPLOYERS'LIABILITY Y1 N. CRY I' ER PROFRIETORPARTNERIEXECUTIVE overage FlCERIMEMEER EXCLUDED? a: N f A E.L.EACH ACCIDENT $ 500. OOO (Mandatory describe under In NH) 30.85633 /9/2019 /9/2015 Ifye s E.L DISEASE-EAEMPLGY $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESGRIPTION:OF OPERATIONS t LOCATIONS I VEHICLES(Aftch ACORD 101,Additional Remarksschadute,if more space isrequired) .Issued 3s evidence of insurance'. Issued. as evidence of insurance. Thielsch Engineering, Inc. is listed as additional insured .as respects General Liability as required by written contract... CERTIFICATE HOLDER CANCELLATION msong@cdpelighteonpact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES:BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POL►CY.PROVISIONS. Cape Light Compact Attn: Margaret Song PO BOX 427-/SCH AUTHORIZEDREPRESENTATIVE 3195 Main Street Barnstable, Mk.,. 02630 k"chael Christian/CLC ACO.RD 25(2010/05). 01988-2010 ACORD CORPORATION: AIC:rights reserved. IN5025120)o05)_09 The ACORD>name and logo are registered marks of ACORD Office of Consumer Affairs and-Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration �• Registration: 171380 Type: corpora tion {� Expiration: 3/14/2016 Tr# 249649 " CAPE SAVE INC. _ WILLIAM MCCLUSKEY � . 7-D HUNTINGTON=AVENUE , + SOUTH YARMOUTH, MA 02664 .� �AUpdate Address and return card.Mark reason for change D Address - Renewal Employment D Lost Card SCA 1 0 20M-05/11 - �lLB ((s007Ui710.72(IIQCGGLfL O��OGCIJJG:CiLIC'J�S t ry . : Office of Consumer Affairs&Business Regulation License or registration valid for individul use"only OME IMPROVEMENT CONTRACTOR t before,the.expiration date. If found return to: j i Office of Consumer Affairs and Business Re ulation : 171380`` Ty pe: egistration g Expiration 3)1%2016 Corporatwn. 4 10 Park Plaza-Suite 5170 s� BOston,TlA 02116 CAPE'SAVE INC. WILLIAM MCCLUSKEY r 7-D HUNTINGTON AVENUE SOUTH YARMOUTH,MA 02664 Undersecretary. Not vali rthout signature r „n.,..: Massachusetts -"Department of Public Safety- Board of Building Regulations and Standards Construction Supers isor Specialty - License: CSSL-102776 - WILLIAM)MC G' US,KE 37 NAUSET ROAD West Yarmouth NA 02 Expiration Commissioner 06/28/2015