HomeMy WebLinkAbout3512 MAIN ST./RTE 6A(BARN.) (9) 3s I
��►*4 d
m
o
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 061 00 Application #
Health Division Date Issued
16
Conservation Division Application Fee'
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _Preservation/ Hyannis
Project Street Address r-DIV t� ;]- �� f
Villages
Owner 1/U,f�, ill Address
Telephone ` 26 v
Permit Request �, �� ��tt ( �(, . ��� (V.
rc )"i_vw t d- 5 cc�
w1k 2: 3s ckoy-1 I Co k(,14� bo T ")Pat
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation ���J�1�= !fir Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
—a
Dwelling Type: Single Family U Two Family ❑ Multi-Family (# units) .�
Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kingl ighway" .0 Yeses ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other VCo
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)�
j w
Number of Baths: Full: existing new Half: existing I neW. 2?
ewe,
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 I"No If yes, site plan review #
Current Use Proposed Use
APPLICANT INFORMATION
/ (BUILDER OR HOMEOWNER)
Name, �� Cad /,J/,fl�� �.� Telephone Number c
Addres,546� _y��> 4&6 72� License #��
Home Improvement Contractor#
Worker's Compensation
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
4
SIGNATURE DATE hxlt
F FOR OFFICIAL USE ONLY
APPLICATION#
s DATE ISSUED
y MAP/PARCEL NO.
ADDRESS VILLAGE
{
OWNER
DATE OF INSPECTION:
FOUNDATION .
FRAME
INSULATION
t
} FIREPLACE
S
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED-OUT
ASSOCIATION PLAN NO.
rm I
The Commonwealth of Massachusetts PrinLFo .....
h Department of'Industrial Accidents
�M, Office of Investigations
1 Congress Street Suite 100
Boston MA 02114-2017
i '• ,r
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
Name (Business/Organization/Individual): Q
Address: i� &kAm, (1-db
City/State/Zip: V!ltti MA' Phone #: -r200-
Are you an employer? Check t e appropriate box: Type of project(required):
1. 1 am a employer with M 4. ❑ I am a general contractor and I ❑
employees (full and/or Part-time).* have hired the sub-contractors 6. New construction
listed on the attached sheet. 7. ❑ Remodeling
2.❑ l am a sole proprietor or partner-
ship and have no employees These sttb-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition
req u i red.1 5. corporation and its 10.0 Electrical repairs or additions
❑ We are a cor
3.❑ 1 am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions
m self. No workers' com right of exemption per MGL
y P 12.❑ Roof re a rs
insurance required.] t c. 152, §1(4), and we have no �/ ���� I� /D
employees. [No workers' 13.� Other, W Kw
comp.comp. insurance required.]
*Any applicant that checks box H I must also till out the 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.
1Contractors 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. I I'the sub-contractors have employees,they must provide their workers'comp.policy number.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
iriforrriation. p y f, , rl�.C�' IM%Vao
InsuranceCom an Name: ,6vlf l( �(nJ��`�� C-&
Policy #or Self-ins. Lic. #: W6A OD~l 1 '/Di Expiration Date: w o-
Job Site Address:��(Z. � City/State/Zip:- �
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.
1 do hereby cer f(`,nller the pains_uted penalties o er'ury that the in ormation provided above is true and correct.
Si'nature: Date.
ILI
Phone#: �4,
llfficial 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#:
IN'lassachusetts- Department of Public tiaret%
Board of Buil-ding Regulations and Standards'.
Construction Supervisor License
Licen-'GCS 100988 _
HENRY CASSIDY
8 SHED ROW
WE°i,T IJARMOUTH, MA 02673
Expiration: 11/11/2013
('uumis�iune.r Tr#: 7620
((JfYy�2�1�/2
Office of Consumer Affairs and Business Regulation
- % 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 153567
Type: Private Corporation
Expiration: 12/15/?_t14 Tr# 233831
CAPE COD INSULATION, INC
HENRY CASSIDY
18 REARDON CIRCLE ----------___---_- ----_.-__.. .
SO. YARMOUTH, MA 02664
Update Address and return card. Mark reason foi change.
-.
❑ Address ❑ Renewal 0 Employment Lost Card
SCA 1 Co 20M-05/11
C''%�ir. ((+�>.ri�rreoraccK;�cl/�.[���E'lxdJcrot2cc9c�J
�. .Office of Consumer Affairs& Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
registration: 153567 Type: Office of Consumer Affairs and Business Regulation
�' xpiration 12/1`5/2014 Private Corporatieii. 10 Park Plaza-Suite 5170
�- � Boston,MA 02116
CAPE COD INSULATION;;INC,,
F1
HENRY CASSIDY
18 REARDON CIRCLE
SO.YARMOUTH, MA 02664 -------
Undersecretary of val with t nat re
�•' Gilent#F:4597
t~GINSLIL
ACORD," CERTIFICATE OF UABILITY INSURANCE UAl't(Mh11(IIIIYYYV(--_-
THIS CERTIFICATE IS 15SUED AS A MATTER OF INFORMA-IIUN ONLY AND CONFER 2
_NO RIGHTS UPON TIiG CERTIFICATE HOL07/020,1
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ANII NO,EXTEND OR ALTER TFIE COVERAGI,',AFFORDED by THE POLICIES
fltEL.OVV/ THIS CERTIFICATE OF INSURANCE DOES NOT CONS 111 u rF-A CONTRACT BETWEEN THE t;;yulNG I1\1;iU1il R(S),AUTHQR14LO
REPRESENTA rI VE OR PRODUCER,AND THE CERTIFICATE IIOLOtIt.
IMPQRTANT:If tho certlfleatr,i7uldar ib an AbDITIO_NA L INSURt n nr 1)u1icy(ies5,ust i L endarsed.II`SUBRGGATION IQ WAIVED,sublucl Ial
tr1C Willl;l and coll(HHoli3 of the pollcy,colla rl 1Jollclati May ondortamitnit.A titalolliell,on this LL+I IIIICUIc(1(14:1 IIUI GDIIICf fIRI1lS(U(11c
el"0 "tv hglLlur 6-1 IiLU I;1I'SU411 tlI1C1Ur90nitlll((9�.
Roger; & Gr:Jy Iris. -So. Uciruits
NAME: Mar diet YUun(t
434 Kau ca'I 34 PHDN@
NC No Bill:506-760-4002 ....._._—
E-MAIL 1.....I...... J
;xnith Dulwln, MA U2UU0.9U0'I
5044 304900 - INdUftft(U)AFFORIAN(rCOVEtiA(tt
NAIL N
----------- _—__ -- NsunEI:A:Peerless lnsurancu 10333—
Ir:gllitt_lJ ..._.
Cape Cod Insulation (no wsURERD,EVaillit0li IIISUI'anCo Colklipany
xiss Yal inclutfl RuaU wsul eRc:Atlantic Charter Insurance
�- IN9uRERD.Commerce(nIsUrance Com "tn--T-------.'_.___._L.r .._....
Flyannia, MA O..uO'I .-w— _.� N•_Y 3l7�4
IN9URER E
--'-- ---------- - _ ......
Jvt:Iwril_E; __ CLRTIFICATL:NUMBER:
__ RUVISION NUIVICIC=.R:h; I "rO ('FiR1lF1' THAT YI ll= I�OLICIrS Or wSURNNI".E LIS'I'Fr? 0�u.W'IIAVE BEEN ISSUED TO*1HE INSURED IJAMED ABOVE I-OR TFIL POLICY PERIOL)
INDICAIk). NO)WIll-191-ANDING ANY RtZRENIENT, TERM OR (ONDITIONOF ANY CONTRACTOR OTHER DOCUMENT WfIFI RL=SPECT TO wl-IIUId luls
1';CR'IlF1i;AIE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE ;Wri)ROED BY Tlil_ POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL. TIIi 1'tiliMS,
-M U1SIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN IW.5' NAVE B@E
N REDUCED BY PAID CLAIMS.
_ ADOL WGR ---ITR _ 1'YYr OF IN9UNANGE _ POLICYEFF POLICY e1(P
raLlcv r�u_NY MMIDOIYYYY (MMJDD/YyYYI LIMJ'rt:
A utti�ka�uawiury GBP82630133 -
4I0112U12 U4/01(2U1' cAcrtoccul•�rt1_NcE $1 (100000
X ia)MMt'NCLALGLNtfrtALLIABILITY A t_ ErlRlT)
I�k11s'r tt„
L r:'!uB 1)ul)
CIAIMti-MADE [-Xl OCCUR ��� -
MED EXF(Any one poroon) S 5,DU1)
- ..._..-__.__. ---------- PERBG10.aAUVINJUHY �'I000O1)0
_, ..._..._...._._— ---•.._ .--- 0ENLRALH(IOREOAl*h $2,UUp,000
i.�rn Atii:;nt:UATk LIMIT APPLIGtt PER --'-----
PRODUCTS-COMPIOP AUG 4 Y UUU 00L)
D AIJTOMUNIL,L LIAt31LI'I'Y — -----' ---'
12MMBCKv(v7ft 41U1/2012 p4/p1/toil Ep°, ���°sINGLcl.ifrllT- .i UUU UUU
N1t i+U ID
AL.1.UWNFD 'X- BODILY INJURY(Pm
sera nuL�D -
AUTOS _ AUTU$ BODILY INJURY(Pd :wciunnl) $
NON-OWNED -- .........._._..._.
PiIkLU AUTOS _ X AUTOS PROPERTY LIAMACI
— --._.
tl X UMdRkI LA LIAR
__ O cur XONJ453h1<' 41U'I12U12 U4/01I2U'1' G4C1I qCC UNRk-CICT 11DUD,QI)U _eXCE�G LIALI _ CLA1MS-MAQE AGCRECAI'E
ucu
WunKpnti C:Uhlf'ENt/Al'ION
AND EMPLOYERTLIABILITY WCAOp525JU' 613U12012 U6190/2p1' X .WGSI'A1U._
ANVPRONRIL1'O}1�(?,4 C / kCUTIVK YIN
UFrICER/M£MBE{t NIA C-.L.CA(;1I ACC-10KNI [11�UU1000_(hlun11-01y iu NtO !.=1
it YUu.Uuncnga Intloi C.L.DISEASE..GA CMPLOVE6 ") UUU ptll)
[it.'Si)NIPTtON OF OPLiftA I'10�QNS tloluw C.L.DISEASE-PgUCY LI611T y'I UUD 1)U�
I
I
I
1
O[0II:NII'(ION UN r)PLYlAIIONS J LOCATIONS/VCNICLES(AUaah ACORn 101,Addlllun,I,i.,inwkc tl�hpauly,11 PIPIU 9PB�d Ib rtl(INIIdGI
Workej-6 Co(np ITforrnatiun ^'
Ina=AJOU(1 officere ar Proprletor5
C�rtlrlcatc Iluldmr is 111Cluded as do additional insura(i unclur i;unuia!Liability wholl roquirod by written
contract or a&ecment,
,FI;rIrICArE HOLDER -----
CANCELLATION
------- -
Cape God Irl;ul�ition,lnc SHOULOANYOF THEABOVE OESCRIBEO POLICIkS WE CANGkhlhp UGI GFiL
THE EXPIRATION DATE THEREOF, No'rlct WILL BE IJE.LIVEkED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUMORIZLO REPR@SENTA'IIVE
(�980 2010 AGORD CORPORAriON,All dyliN re imj.
�CuHu z (aUTU/Uy) 1 of•I The ACORI)name and logo i1R)roylsLBrud(narks of r#sa�a��/ma3t����► mrY
OWNER AUTHORIZATION FORM
(Owner's Name) '
owner of the property located at K b-!5-.CJQJ �- - r f JaM S
(Property Address) '
►�+ sic.-& COI k -- 0 o
(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.
Owner's Signature �Zu?Tz:� L)16-3 f
4 1N W A71Z Y, �7-7,
Date
�/•� 1 IDS (1�I�1'1" �}�-j2��1 . ` � �(SSA G1i4�7o J�
tot.
T t
CAPE COD TOWIN OF BARNS TABLE
INSULATION
2913 MAR -5 Ail : 24
IIYIYgIA>i G.....YIl3Y
\A S ! 3pYAY IOA31 SYSp[NP(q
If! f IN\YLAl10N C{ILINgf
1-890-696-6611 aIV1SIt
.Down ol:Barnstable
Ilelulatory Services
Building Division
200 Main St
1-tyamiis, NIA 02601
Date:
Dear Building Inspector
Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. perfor►-ned
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 Vil_ lgj e
Z et, (0P
Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted
Ceilings ( ) O ( 3 ( ) O
Slopes
Floors ( ) ( ) ( ) ) ( )
Walls
Sincerely
I-le y E C� sidy J , President
Cape Cod nsulation, Inc.