The URL can be used to link to this page

Home My WebLink About1141 PHINNEY'S LANE :Tk I Y\Y-1 pv Lay,e, hk ALT�•ERNATIVE WEATHERIZAY.ION Date: z to :�•. Town of Barnstable �+ 200 Main St Hyannis,MA 02601 114 P•..n 4e insulation weathe rk at a..•..' r.. °.been com lete -dance with.# l�d :,;,:'<, 1:fir•• '.,i!.i'4•::! - : - Timothy Cabral, President CSL-10545A 58 DICKINSON STREET . 1 FALL RIVER,MA 02721, •I (508)567-�4240 1 ALTERNATIVEWEATFIP-ZAPONGGMAILCOM Application number....... ..................................... Date Issued.. ....... �... Wp 10di Inspectors Initials .. _. MAR 14 zo19 Map/Parcel TOWN OF BA►RNSTABLEs w r EXPEDITED'PERlklIT APPLICATION: : r ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/wEATHERIZATION s PROPERTY rNFORMATION L Address of Project:. .. `_.. _ NUMBER "� S T' VII.IAGE �,._ Owner's Name: G Phone N umber '�,(,�� Email Address: Cell Phone Number 777777 Project cost$ ,, D Check one: Residential. Commercial OWNERS AUTHORIZATION `; , , . As owner of the above I hereb authorize / f property Y t pu• to make apphcahon for a building permit with 78 1 m accordan . , ... 1VIR Owner Signature: ire,Q Date: TEE of wolzx71 Windows��no hechange air Siding., a ader.chars e # ( Insulatio*,Weathenzation x � g ) Doors (no header change)# Commercial.Doors.requre an mspector'strevtew ❑ Roof.(not applying more than l layer of shingles) Construction.Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# / (attach copy) J Construction Supervisor's License# / y. (attach copy) A/ Email of Contractor a f7'y6U),0A j('I:,Ch_&71, :Phone.number: .st ALL PROPERTIESTHAT.HAVE:STR!/CTURES;:OVER;75 YEARS,OLD.OR lF THESUBJECT PROPERTY,IS,IN A HISTORIC-DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A'PERMIT CAN.BE ISSUED. APPLICATIONNUMBER............................................................ - *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No '' (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a"separate piece.of paper. f r' Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a'site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval e g � *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APP IC 'S SIGNATURE Signature (/ Date All permit applications are subject to a building official's approval prior to issuance. Y �pi y y,.npT.S';4yi., " 3 Y f N 460 West Main Street 'Housing Hyannis, MA 02601-3698 ry Tel: (508.)771-5400 Fax(508)790 2425 Corporation TTY on all lines Cape Cod Free-Weatherization ! Your tenant has requested aInd is eligible for weatherization of your rental home through the Weatherization program at Housing Assistance Corporation. An average weatherization job is worth $4,500 and these services are provided at no cost to you. The following weatherization measures are applied to the typical job: air-sealing in the attic and basement, insulation in the attic, basement and walls, weather-stripping doors. Bath fans may be installed if necessary. We will test the efficiency of the refrigerator. All work is professionally done by licensed and experienced contractors. HAC will conduct a final inspection to ` make sure that all work is completed in compliance with quality work standards. Prior to the work being done you will receive a letter from HAC showing the actual measures that will be installed and the total dollar—value to the work. To confirm your ownership of the property, we will pull the appropriate town assessor's report. If necessary, we may ask for a copy of your tax bill or deed to prove ownership. The work on .your rental property will begin when we receive the signed copy of the attached Agreement. If we do not receive the Agreement, HAC will conduct an energy audit but no weatherization work can be done without the signed Agreement. During the energy " audit we will install energy efficient light bulbs and will test the efficiency of the refrigerator. If you have any questions please contact Suzanne Smith at 508-771-5400, ext. 123 or ssmith@haconcapecod,org LANDLORD: ... TENANT: � 11t email. ywnw sY'V't y PHONE: (home) PHONE: (home}. 1 " (cell Q D Cl ��. (cell) -ie 'U. 14. The Parties acknowledge that this Agreement is under seal. It is intended by the Parties that the Tenant or any'''. successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement. Property Owner's Signature: Date 6'11 1 " Phone: Address: dit 4 l bD c,> Y1 f�1 Tenant Signature Date " Agency Approved Weatherization:Company Advanced Windows Inc / All Cape Energy / Alternative Weatherization Cape Cod Insulation / Cape Save / Cazeault Frontier Energy Solutions / Lohr Home Improvement / MDH Construction, Inc Agency Signature.,. Date___ Receiw 1? C 0 7 (1 � lA� The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. 3 TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/individual): ALTERNATIVE WEATHERIZATION, INC. a Address: 2 LARK STREET ' City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.�✓ I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction 2.F1 I am a sole proprietor or partnership'and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 1M I am a homeowner doing all work myself.[No workers'comp.insurance required.] 4.F�I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.-* 6.�We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other INSULATION 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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. 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-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 information. Insurance Company Name: LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic/.#: XWO(19)58867158 Expiration Date:6/8/19 / �,, d Job Site Address: �/ / City/State/Zip: fi4---u//�T Attach a copy of the workers' compensatio olicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d ain a p Iti s f perjury that the information provided aboveXisrue and correct. Si nature: Date: y L / Phone#:508-567-4240 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#: DATE(MM/DD/YYYY) AC R® CERTIFICATE OF LIABILITY INSURANCEF06/11/18 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 have ADDITIONAL INSURED provisions or 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 UUNIALA NAME: Anthony F.Cordeiro Insurance Agency C No Ext: 508-677-0407 a/c : 508-677-0409 ,No 171 Pleasant Street F-MAIL ADDRESS: HSouza@Cordeirolnsurance.com Fall River,MA 02721 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURERC: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721 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 TYPE OF INSURANCEUULr POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE17- CLAIMS-MADE �OCCUR PREMISES Ea occurrence S 300,000 MED EXP(Any one person) S 15,000 A Y Y BKS58867158 06/08/18 06/08/19 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE. $ 2,000,000 POLICY 7 PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B AUTOS ONLY AUTOS OWNED X SCHEDULED Y BAS58867158 06/08/18 06/08/19 BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/08/18 06/08/19_ AGGREGATE S 1,000,000 DED I I RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STAT Y I N UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT S 500,000 C OFFICER/MEMBER EXCLUDED? NIA XW058867158 06/08/18 06/08/19 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary&Noncontributory basis per the terms and conditions of form CG2001 (04/13),for Ongoing Operations per the terms and conditions of form CG2010(04/13),for Completed Operations per the terms and conditions of form CG2037(04/13)and Waiver of Subrogation applies per the terms and conditions of form MEGL0241-01 (04-11) Additional Insured for Automobile Liability applies per the terms and conditions of form SCA005(02/16) Excess Liabilitv is a following form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road AUTHORIZED REPRESENT Waltham,MA 02451 ©198'-2015 ACORD CORPORATION, All rights reserved.' ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ... e:- �. � .� .#x �,,T; 'x.+��✓p,,a�"�'„.,,sJ �`t> � rb '�a"7r.—��:a �� _ y .' �t _ ,. � •a .. ter,. y,.A,,", c�y'r"` #.:. , .. 4 Y u0: ';' ��?Aw 61)�m6wlweal'w 1jac w� Office of Consumer Affairs and Business Regulation -� 10 Park Plaza- Suite 5170 Boston, Ma*Akhusetts 02116 Horne Improvemej=mtractor Registration w Type: Corporation Registration: 175M ALTERNATIVE Y1JiWATHERiZATION,ING Expiration: 0512812019 LARK ST , 'lei FALL RIVER,NIA 02721 Update Address and return card. Mark reason for change, S.H 0 2T>T 05 -...,._.._-__.____..d,__,/,./w.. J._j__........._../,....._.._........_.__._..,-.._.....-....._..,,.w.._..,._..............Q.�ti�3ress-L18va�!rl ' Ofte of Consumer Affairs&Business Regulation T HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use Only TYPE:C0rD0ratt0n before the expiration date, if found return to, B� iL! 31E1 Office of Consumer Affairs arm Business Regulation 051281201 g 10 pant Plaza-Suite S170 �. ALTERNATIVE W + ii=R7i (t3N,iNC. n,MA 0211r3 TIMOTHY CABRAL 2 LARK ST {_) FALL RIVER,MA 02M Undemeare4my of V O` V BiLir#: