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Home My WebLink About0135 WEST MAIN STREET (16) cL'I n S� I r Efficient Buildings, LLC October 31, 2011 Town of Barnstable Attn: Thomas Perry, CBO 200 Main Street (� Hyannis, MA 02601 re: 135 West Main Street, Hyannis, MA 02601 Dear Mr. Perry: This affidavit is to certify that all work completed at 135 West Main Street, Hyannis, MA 02601, has been inspected by a certified Building Performance Institute (BPI) inspector. Work included air sealing, and installation of 394 sq. ft. of R-18-20 unrestricted cellulose in attic. All work performed meets or exceeds Federal and State requirements. Sincerely, teve C. White Owner/Managing Member " s Efficient Buildings, LLC ' ;a k'v? 8 Jan Sebastian Drive, Unit 10, Sandwich, MA 02563 Tel: 508-888-1110 Fax: 508-888-1109 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` Parcel b�' � Application ('� ` Health Division Date Issued C C7 Conservation Division Application Fee Planning Dept. Permit Fee 4y Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street:Address s 5-` V3 vi vZ� Village Owner Address Telephone 6? � Permit Request � ( (13654 (inns(CA11CC-1 4=1 0A L C_ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 5--DO 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 ❑ 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 0jexisting anew size= Attached garage: ❑ existing 0 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 Telephone Number SL Address J?iAu�eC4 U.¢- License#, F s Home Improvement Contractor# h5 of Worker's Compensation # QC 7� � O ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO MQ ru eu3 s4c-4 " SIGNATURE DATE /V/0 1` r� d FOR OFFICIAL USE ONLY ' APPLICATION# its DATE ISSUED ,MAP[PARCEL NO.. _ ADDRESS VILLAGE OWNER DATE OF INSPECTION: C. FOUNDATION! l FRAME INSULATION t i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL µ -GAS: r x ROUGH ROWl"' .' FINAL `i J FINAL BUIL'DING��f k DATE CLOSED OUT . '' ASSOCIATION PLAN NO. The Commonwealth of Massachusetts II , ► Department oflndustrialAccidents � ,t• � � Office of Investigations F 1 �• . t500 Washington Street ►,u11 Boston, MA 02111 r 1=4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AIplicant Information Please Print Leaffily Kane (Business/Organization/Individual): 00 1'( Sr CJ. Zfl�4 6:-1 2 Address: ` C i /State/Zip: j C Phone #: 5-0 F57'- Are u an employer?Check t appropriate box: Type of project(required): 1. 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction I mployees (full and/or; art-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have.no employees' These sub-contractors have 8. ❑ Demolition working for me in any capacity, workers' comp. insurance. 9. [] Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ lam a homeowner doing all work right of exemption per MGL 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4), and we have no 12.❑ R of repairs insurance required.] t employees. [No workers' 13. Other W.S�Jla comp, insurance required.] *Any applicant that checks box 1()-must also fill out the section below showing their workers'compensation policy information. t Homeowiers 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Crlr (� Policy #or Self-ins. Lic. #: J d7 � T� Expiration Date: �- / Job Site Address: City/State/Zip: 4 c"c-.,C-y e vc,-�&J, 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 hereby certify d the pains and penalties o perjury that the information provided above is true and correct. Si nature: — Date: 1.1 /z� V IV Phone 4: 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): j 1. Board of Health 2, Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Pierson: Phone#: Information and Instructions klassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership, association, corporation or other legal entity, or any two or more cf the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an.individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three,apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house oe on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 151 §25C(6) also states that"every state or local licensing'agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant,who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its.political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have.-been presented to the contracting authority." Applicants . Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In.addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license.or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia 460 W st T.al.n .9._reoet HOUSING Hyannis, YTA_ 02601-3698.��,4 ENERGY « E-C E REPAIR c...)�.SI S,I,pCE� i T (508) 7'11-5400 F (508) 7 90- ORPOIR TT_ON 2425 HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: _......._.__......PLEASE-FIL--L-OUT-AN..D...S-G.N_-T.H..I_S..FORM--FFYOU-A-RE ----------....--------_._.-_.._--------------------- .._........ THEAPPLICANT HOMEOWNER. NA° C—e s _'S'm%T-i-i 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 I ocated at: H A tjs- Theweatherization work donewill be based on programmatic prioritiesand availability of funding and it may includeall or someof thefollowing 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 theweatherization work to bedoneat my home I agreeto thefollowing 1. 1 givepermission to the"Agency" itsagentsand employeesto travel onto or acrosssaid property with such equipment and materials as ma be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reservesthe right to inspect thefuel or utility bill for the weatherized unit on an ongoing basisfor no morethan five(5) yearsafter theweatherization work iscompleted. I haveread theprovisionsof thisagreement aslisted and freely givemy consent. Home Owner: (,Signature) Date: I{i ..L- )S::3 i C; Agent: (signature) �---�- m:.. Date i Z_ HAC approved Weatherization Company : ......:.-. p`- - Caliber Building&Remodeling Cape Cod Insulation Cape Save Creswell Construction Frontier Energy Solutions Lohr& Sons Peter Smith Resolution Energy Rock Solid Construction Sprinkle Home Improvement I i?ts-4s0.>-=bi1`;r i`•-la_:]3ea_-fit I.F C1?Ivy S'•.trer=:rcrn:ii rc;casc ks_.1 c J Massachusetts- Department of Public SafetN Board of Buildim-, Regulations and Standards Construction Supervisor License License: CS 95038 Restricted to: 00 STEVEN WHITE 147 RIDGEWOOD AVENUE HYANNIS, MA 02601 Expiration: 2/28/2012 (' mmi.<i mcr Tr4: 19311 °T1. o ra l Board of Ba#diag Regulation§and Standards TjHOME IMPROVEMENT CONTRACTOR Reg .' 154359 , =8/2011 . Tra 280764 Typ L#d LiBbil' Corporation CALIBER BUILD M, &W UNG,LLC. STEVEN WHITE 147RIDGEW60D/� ..�Q�...` HYANNIS,MA 02601 Administrator License or registration valid for individul use only before the expiration date. R found return to: Board ofBm ding'Regajations and Standards One Ashburtio&Place Rm 1301 Boston,Ma.01108 y Not'valid wft"t signature AGORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 09/15/2010 PRODUCER S08.94S.0393 FAX 508.94S.4048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eldredge & Lumpki n Ins. Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 697 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chatham, MA 02633 INSURERS AFFORDING COVERAGE NAIC# INSURED Caliber Building and Remodeling LLC INSURERA: National Grange Mutual Ins Co 14788 INSURER B: Commerce Group CI0001 147 Ridgewood Ave g INSURER Granite State Ins. Co:-ARWC 13102 Hyannis, MA 02601 ---- - Y INSURER 0: INSURER E: COVERAGES i 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILT R DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY FJ(PIRATION LTR N8R 'DATE M.MWYYYY DATE MM/DDMlYY LIMITS GENERAL LIABILITY MP027360 09/1S/2010 09/1S/2011 .EACH OCCURRENCE $ 11000,000 t_x- C MMERCIAL GENERAL LIABILITY ,PREMISES(Ea occurrence) $ S001 OO r CLAIMS MADE I -- OCCUR MED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATED IT APPLIES PER: PRODUCTS•COMP/OP AGG $ 2,000,000 , POLICY JECT LOC -- AUTOMOBILE LIABILITY BBNVCS 02/16/2010 02/16/2011 1COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 11000,000 ALL OWNED AUTOS BODILY INJURY $ B X SCHEDULED AUTOS (Per person) h--- HIRED AUTOS ! I BODILY INJURY $ NON-OWNED AUTOS (Per accident) ' r PROPERTY DAMAGE !(Per accident) $ GARAGE LIABILITY _AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ f AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ -- J OCCUR El CLAIMS MADE AGGREGATE $ -_ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC74ZS40S 03/02/2010 03/02/2011 AND EMPLOYERS'UABILITY TORY LIMITS ER_ Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ C OFFICERIMEMBER EXCLUDED? SOD,OO (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ S00,0O If yes,desonbe under --... .... SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of Barnstable IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Attention: Building Department REPRESENTATIVES. 19 200 Main Street AUTHORIZED REPRESENTATIVE Hy nnis, MA 02601 Alan R. Long, Presider ACORD 25(2009101) 01988-2009 ACORD CORPO ION. All rights reserved. The ACORD name and logo are registered marks of ACORD �„o•""'. TOWN OF BARNSTABLE Permit No. -------- 22950 � e -------------- 1 s Building InspectorSTAU Cash ------ —_-- 7 MYL OCCUPANCY PERMIT Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued'to 'Jams J. Tayl(w Address Centerville Unit 28 135 West Main Street, lyalis wiring Inspector Inspection date Plumbing Easpecto�r�/ ,ti„ 5 � Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT _BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. /1` .41 19 � � BuildingInspeetor