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HomeMy WebLinkAbout0021 LOOKOUT LANE - Cyr-ifs... !, .:s, ems,•-�-i ������ .. . 'il I� I • ,�. �� I, i 'Poo— TOWN OF15ARROCAPE COD INSULATION ? !Jr► ': 9 PIfE0.0[p[$ [EAMIfS[ SP0.pT fOAM 9YSPENOEO BqR[ OYR[0.[ 1-800-696.-6611 DIM IT` Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 r' Date: 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 (BP•I) inspector. All work preformed meets or exceeds Federal & State Requirements, Property Owner Property Address Village Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) ( ) ( ) ( ) ( ) Floors � M r l b't.j ( ) ( ) ( ) ( ) ( ) Walls 06 C r uµt A �-eo Sincerely He _yE Cas y Jr,,President P.. C e Cod I ulation, Inc. . i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .r Map Parcel Application #.. o +� Health Division Date Issued O ' S 3 T IC Conservation Division Application Fee �L2 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address ?/ 1v o/_a U 1' I-Al Village ,�� ,t/i✓i�f Owner Address .� Telephone ts�7,g7 Permit Request �/lM )aial �, �9X /,tifv//V�do-,11 �►/G� cr E co w Square feet: 1 st floor: existing proposed 2nd floor: existing proposed TJQ nev�i�� Zoning District Flood Plain Groundwater Overlay Project Valuation D, O Construction Type VX/ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting d.�pumPtation. Dwelling Type: Single Family ar-� Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes Urgo On Old King's Highway: ❑Yes Jaf4-o 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 ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name t22 glj Telephone Number LJ25 ? Address �/ � �, /�'��,�6 .��� License# A0 a 41.1'e'e- iOG'i1 Home Improvement Contractor# Worker's Compensation #41zA ioj"?s�%Q/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 3 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ^` MAP/PARCEL NO. ti ADDRESS VILLAGE "t OWNER { DATE OF INSPECTION: ' ��;FOUNDATI.ON:�_=;�•,::k=v,� �;. �r���-�e.. r FRAME ^.<<, o--.,•,;r rrn.ar. INSULATION .. FIREPLACE ti ELECTRICAL: ROUGH FINAL — PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING: "} t _ DATE CLOSED OUT ` ASSOCIATION PLAN NO. e� 3 r a } l �Irrnstr Ituactts I)cl,;u'tnnul of Puhlii tiafcrt 9,' a ISu;rrd uh buildirr" kc�ulatiows and "t:uulards (;onstru,)ction Supervisor License Lice„ , 'C•S. 100988 HENRY CASSIDYd SHED ROW WESjF `&ARMOUTH, MA 02673 Expiration: 11%11/2013 ( „ uu5i,iiuucr Try: 7620 Office of C,onsuine.r Aflairs and Buslne.ssl�egulation �. 10 Park Plaza - Su1te 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: '153567 Type: Private Corporation Expiration: 12/15/2°t114 Trk 2J;183'1 (,APF COD INSULATION, INC -- - _ HENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH. MA 02664 Update Address and return card. Marls rcasou 1i)r change. L� Address L_I Renewal �..� 1!;urlrloymc.ul I I,nst Card "/„_ (i t�ucrrtr rrtrC:rt%/t t`C:d l(.rr.,.,rrr/ru.,el�� 011irc Sir r Sma'umer Affairs J Business Regulation License ur registration valid for individul use only ! ", tj1UMt_IMPROVEMENT CONTRACTOR befurc the expiration date. 1f found rcluru to; uyiStratiuw 153567 - Type: Oflice of Consumer Affairs and Business Re-gulatimi xpiranon: 12/15/2014 Private Corporation 10 Park Plaza-Suite 5170 �:. Boston,MA 02116 y+'r ,::r;�!tivtii!IAfION,�INC - ' i::l�;lt i t:A;�51I11 ,i h:L:1f�1:111N CIt;CLF: :. AftP1�i U I t I. MA 02664 1_luticr�,a'rctnr)' } of Val, lyitho t trat l'c d The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 F.. t. tt www.mass.gov/dta Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber's AvOicant Information Please Print Legibly NaIT1C (llusinrss/Organization/Individual): Address: 12 ce City/State/Lip: , i e S= _ )hone Arc you all employer? Checic the appropriate box: Type of project(required): 1.�I am a employer with 4. ❑ 1 am a general contractor and I employers(toll and/or dart=time). have hired the sub-contractors 6• ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling shipand have no employees These stlb-contractors have • S. ❑ Demolition working for me in any capacity. t >employees and have workers' [No workers' comp. insurance Zcomp. insurance.$ 9. ❑ Building addition required.] 5. ,:+7�Ne are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' com right of exemption per MGL p' 12.[ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13 Other�Glw�-� 6 � comp. insurance required.] fAny applicant that checks box µ t must also Fill out the section below showing their workers'compensation policy information. r 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 ub-contractors have employees,they must provide their workers'comp.policy number. 1 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site inf un►rntion. 1 ; Insurance Company Name: Policv fF or Self=ins. Lic. #:/4-14 9 Q lL�'�,TG'% Expiration Dater Job Site Address_ �C�1�,�1��/� ��/ ��/ L/.e�/�f City/State/Zip: )91 .Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). hailttre 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. do irerebp certify Eder the pairs and p nalties oj'perjury that the information provided above is true and correct. �i mature.: Date: LS phone 4: �64- r -0ffirrl use only. Do snot►vfile in this area,to be completed by city or town pfficial City ol•Town: Permit/License# Issuing Authority(circle one): I, Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. other Contact Person: Phone#: • CAPECOD-27 MYOUNG CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Yl'YY) -- 7/812013 ..S 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 AFFORED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT B D ETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. TIMPORTANT: 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 Rogers&Gray Insurance Agency,Inc. NAME: Margaret Young 434 Rte134 PHONE FAX South Dennis,MA 02660 A/C E-MAIL -- ADDRESS:m oung rogersgray.com INSURERS AFFORDING COVERAGE _ NAIC 0 - .INSURED- ------- M --'--- INSURER A:PEERLESS INSURANCE COMPANY INSURER 8:COMMERCE INSURANCE COMPANY _ Cape Cod Insulation,Inc. INSURER C:Evanston InSLlrance Company 18 Reardon Circle South Yarmouth,MA 02664 INSURER D:ATLANTIC CHARTER INSURANCE GROUP INSURER E: ' 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 LTR _ TYPE OF INSURANCE A S-OBR POLICY NUMBER MM/DDlYEEFF _R0_LICYEXP LIMITS GENERAL LIABILITY — EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CBP8263063 ETORENTED —" - 4/112013 4/1/2014 PREMISES Ea occurrence $ 105,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 5,000 — PERSONAL 3 ADV INJURY $ 1,000,000 _----' GENERAL AGGREGATE $ 2,000,000 GE_N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $ 2,000,000 POLIC-� PRO- JECT LOC $ AUTOMOBILE LIABILITY - C MBINE� D SINGLE LIMIT Ea aaident 1,000,000 ALL B ANY AUTO 13MMBCKVMK 4/1/2013 4/1/2014 BODILY INJURY(Perperson) $ _ AUTOS X SCHEDULED _ AUTOS BODILY INJURY(Peracddenl) $ X HIRED AUTOS X NON•OWNED PROPERTY DAMAGE — —'--!AUTOS ER ACCIDENT $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAR CLAIMS-MADE XONJ453512 - 4/1/2013 4/1/2014 AGGREGATE $ 1,000,000 DED_[XI RETENTION$_ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY O LIMITS ER OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) ---- Iryes,describe under E.L.DISEASE-EA EMPLOYE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L�DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Props ddress) (Property Address) Chereby authorize Q- Q (Subcontractor) an authorized subcontractor for RISE ngineering,to act on my behalf to obtain a building permit and to perform work on my property. s Signature D Date Assessor's Ofce(1st floor) Map a� Tot �6 Permit Conservation Office(4tor) Date Issued h floor) — . 9 Board of Health(3rd floor)(8:30-9:30/4:00-2:00) Fee Y5?__2-Coo Engineering Dept.(3rd floor) House#1 J J APPUCA' G TIM Planning Dept.(1st floor/School Admin. Bldg.) - E Tgg CQJ\ MA8&. TO Definitive Plan A ' by Planning Board - 19 039. TOWN OFSARNSTABLE /�j�{, Building Permit Application Project Stre Village NN � ,Owner I�r��e 1� 17 ���1� Address � f'� «) 1— �T' yip iL m i S Telephone Permit Request A<'e Kl,0_k Total 1 Story Area(include 1 story garages&decks) square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ �{q� Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial gei�dent Dwelling Type: Ingle�Fai Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House �JD nfinishe`� Old King's Highway z Number of Baths Z No.of Bedrooms 3 Total Room Count(not including baths) First Floor e Heat Type and Fuel 1rt J Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attache Barn None Sheds Other Builder Information Name (�j-, �?j��� r��. l`f� d� Telephone Number "7 7 Address _?o-7 NAmj 5.) License# �. q,:�-`7 I t'JtJJJ Home Improvement Contractor# Worker's Compensation# � `j 3j 2 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) -FOR OFFICIAL USE ONLY PERMIT NO. 9506 395 t ' DATE ISSUED 080 J 325 103 MAP/PARCEL NO. ADDRESS 21 lookout lane VILLAGE hyannis OWNER - milton 1. perm _ • . f ! ,i • DATE OF INSPECTION: FOUNDATION { FRAME INSULATION ' "9 r i -- i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING:- RRQUTH FINAL GAS: R�MAP,H FINAL FINAL BUILDINliaGo , t a DATE CLOSED Oi ASSOCIATION PL } f ' (fonunajuvaaa 0 600 Wa , s 96,�, M..L A ozf r .tames.l.Campbell .. Gamm&Amer Woricen' Compensation itts znoe Af dlivit elfaes:edpamimee! with a principal place of business a ' �' caens�zw do hereby certify under the pains and penalties of perla ,. that: (� I am an employer provid'mg worken' compensation coverage for my employees war this job. d-547er n Co-u---1 i(i Insurance Company Policy Humber o [ am a sole proprietor and have no one working for me in any capacity- 0 1 am a sole proprietor, general eomratxor or homeowner (drde one) and have hire; cca,Lz tors listed below who have the following workers' cc I ensadon policies. Contractor Insmuanoe Coji a-W/Pofccy N Contractor Insurance Companylpol iicy N Contractor lnsm=ce Company/Policy N () I am a.homeowner performing all the work myself. t undusund--hu a copy of Ltis srt=m WN be farwvded to dre office of invesdpdans of da CIA tow aover4e verta=ion and that 1r wmaje=ra=-ed under Section ZSA of MGL 1sZ can lead m the imposition of abobw penjidea camisftc da floe of up to S1,50t ye=, imp tc-.xnam as well as dvd penalties in the four:of a STOP WORK ORDER ad a fUe of S 100.00 a day.M m mr- Signed this �1�5 i— day of Al)� UJ� • 14 C1.=— r LicenseelPermi� a Building �epa�teZK I, Licensing Board Select Office Health DePm=ent {I •f p •� COMMONWEALTH I DEPARTMENT OF PUBLIC SAFETY ialhrNbpoasgaoomsat OF ONE ASHBORTON PLACE Ma>itaCbYssttsStaMBs/ld/11Q N MASSACHUSETTS BOSTON,MA 02108 QOdolsaass�tOrsasoOatlOs--- •LICENSE - ottAhll"asa. EXPIRATION DATE CONSTR. SSUPERVISOR CAUTION I 10/05/1995 FOR PROTECTION AGAINST RESTRICTIONS EFFECTIVE DATE LIC-NO. r � � THEFT, PUT RIGHT THUMB NtiiIVE �'^' � o0b/30/1993 001927 PRINT IN APPROPRIATE ° BOX ON LICENSE. DCHARLES J MARKARIAN Z P O 9 0 X 2 23 0 BLASTING OPERATORS 5S # 016-48-5733 m HYANNIS MA 02801 m MUST INCLUDE PHOTO. RHO''( (BLASTING OPR ONLY) F - '- 1 0.001.. NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY � �- HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: ^.; 10/05/1955 THIS DOCUMENT MUST BE ��"� ✓""�`""� CARRIED ON THE PERSON OF NATURE OF LICENSEE « SIGN NAME IN FULL ABOVE SIGNATURE LINE THE HOLDER WHEN EN- . OTHER„i-RIGHTTHUMB PRINT GAGED IN THIS OCCUPATION. SIONER i f o avym abmo cn c o ma aa rna o ZO s o A -CIO N 2 ' C m Z p V 20 y a a 5 The Town of Barnstable M �� Department of Health Safety and Environmental Services Building Division 367 Main Sheet,Hyatmis MA MMI Office: 508-790-62V CrossBnildisag Cos Fax 508--775 33" For office use only Permit no. Date AFFIDAVIT HOME IMPROVF LENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"mconstructian,alterations,renovation,repair,modernization,conversion improvement, rcamral, demolitim or construction of an addition to any VMNcdsdng Owner 0=10ec building containing at least one but not mote than four dwelling um or to Or a r I which are 2J= to such residence or building be done by registered contras,with ce::aia ecmcptions, along with oche tegtuireaeuts. Type of Work: ITCI ek) WM `-E MODEL ESL Cost Address of Work- i �,�l�K,DUT �lU ) /J(5 Owner.Name: � (�1 ' �� 0 f Date of Permit Appik ation: I hereb%.certify that: Registration is not required for the following reason(s): Work exduded try law- _ ob under SLOOD Building not offlff-ooc upiod Pulling own permit Notice is hereby grew that: IERED CONTRACTOR OWNERS PULLING THEIR OWN FOR DEAALOING W NOT HAVE CAS 'In FOR APPLICABLE HOME IMPRO IF- ARBITRATION PROGRAM OR GUARANTY FUND UNDER,MGL r. 142A SIGNED UNDER PENALTIES OF PERIURY I hereby apply for a permit as the agent of the ow .nw. ///4 Ah4z- Date C""..'O name R+ Na OR n owner's name