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0095 ABBEY GATE
_ Q� ����p ��� ���� a y ��� �, �� � � � . � 4.�. ,q.�.��^^.... .,... ... ,��.. .. ..... .. {..5. �FSME Town of Barnstable *Permit# P� Expires 6 months front issue date Regulatory Services Fee + BARNSTABLE, * (M 9�A MASS. ,0� Richard V.Scali,Director p°'" TFD MA'I A �� Building Division MAY 0 3 2016 Tom Perry,CBO,Building Comn7i S fly'}t C C 200 Main Street,Hyannis,MA 02 0/U 1! Or g���U��ggLC www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number OZI I 0 2 1 Property Address C�-"5 C-1--9 L= C O TU i I ❑Residential Value of Work$ 3�°-1 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address -T--t'A T_-) L y S t" As-L:)0 L-N Ll S A 3(;�- �"l Cs�-f 2or� � Lo TU l.r i Contractor's Name TelephorNumber S '�C"►7-�` Home Improvement Contractor License#(if applicable) 10 3- -19 Email Of ne( ce e C.G.Ze a.c cl } C oV1,1 Cons tru on Supervisor's License#(if applicable)_ CS — t 0 9 1 S orkmanIs Compensation Insurance Check one: rsole proprietor he Homeowner Worker's Compensation Insurance Insurance Company Name LM N S e o a P Workman's Comp.Policy# W GS^ 3 O �Z Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque t(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 } The Coninzonwealth ofMassachusett's Department of Industrial Accidents Office of Investigations 600 A'aslungton Street Boston, M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Ad-V Address: 10 30 A_f A11V S 1 City/State/Zip: 6S vl LJ -E MA Phone#: Are you a employer?Check the appropriate box: Type of project(required): 1. am a employer with/d r-P0k4%4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have•no employees - These sub-contractors have g. ❑ Demolition working for mein:an i employees and have workers' y capacity.p �' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.# • required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ !.am a homeowner doing all work officers have exercised their. I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 1.2.❑ Roof repairs insurance required.]t c. 152, §1(4),and.we have no 13..�'Other �� 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-contractgrs 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 thepolicy and job site information. Insurance Company Name: L f �-1 I/V S Cop— P Policy#or Self-ins.Lie.#: W&.6 —3/ .�— 3� L6�0-GZ S_ Expiration Date: Fr/l O�l Job Site Address: �S /a-13 r3��( � City/State/Zip: Co 1,v r r M^'o ZB 3� Attach a copy of the workers' compensation police 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 under the pains aandpenalties of perjury that the information provided above is true and correct. Signature �C� 9— � Date: 7/Z Phone#: �~ �� Official ctse only. Do not write in this area, to be completed by cio;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 i Contact Person: Phone#: i DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/11/2015 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 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 DOWLING &O'NEIL INSURANCE AGENCY INC NCONTACT AME: 973 IYANNOUGH RD PHONE FAX PO BOX 1-990 M o E (A/C No HYANNIS, MA 02601 E-MAIL ADDRESS: i INSURERS AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Corporation 33600 INSURED INSURER B PAUL J CAZEAULT& SONS INC 1031 MAIN ST INSURER C: OSTERVILLE MA 02655 , INSURERD: INSURER E: INSURER F: ' COVERAGES CERTIFICATE NUMBER: 25918664 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 INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO CLAIMS-MADE 1-1 OCCURPREMISES Ea occu D nce $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JERCOT- �LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea atcident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEED RETENTION$ $ A WORKERS COMPENSATION WC5-31 S-386670-025 8/10/2015 8/10/2016 '/ STATUTE I ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 161,Additional Remarks Schedule,may be attached If more space is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. I CERTIFICATE HOLDER CANCELLATION PAUL CAZEAULT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1031 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. OSTERVILLE MA 02655 AUTHORIZED REPRESENTATIVE LM Insurance Corporation - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 25918664 1 1-386670 1 15-16 WC shankar.gadale©libertymutual.com 1 8/11/2015 4:45:09 AM (PDT) I Page 1 of 1 QA/e Office of Consumer Affairs and Business Regulation 1 10 Park Plaza - ,quite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 103714 Type: Supplement Card Expiration: 7/9/2016 PAUL J. CAZEAULT & SONS, INC:,. _—_ RUSSELL CAZEAULT --- -- 1031 MAIN ST - OSTERVILLE, MA 02658 Update Address and return card.Mark reason.for change. SCA 1 Q% 2CM-05n1 EJ Address 0 Renewal Ej Employment Lost Card irA. C�c�na�>rnrarxuca�U c�C'���i:i:luc�rt•;c(.l'J ♦ Office•of Consumer Affairs&Business Regulation g License or registration valid for individul use only � nOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation � fix: Reg istration; 1.03714, TYPE: 10 Park Plaza-Suite 5170 '^ Expiratlon;:.7/9(20.16;/• Supplemenl'Card Poston,MA.02116 PAUL J.CAZEAULT&SONS;lNC RUSSELL CAZEAULT•„ -;`•-- 1031 MAIN ST OSTERVILLE,MA 02658 Undersecretary Not valid with nature V - . 1 Massachusetts -Department of Pubjic Safety Board of Building Regulations and Standards I Construction Supervisor License: CS-108157 RUSSELL CAZEAI7LT,;, j 2071 MAIN STREET' �. '� ` 4i i Brewster AfA 0231 - ` Commissioner 1 1/2312 0 1 8 SONS Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. (print) �� I v AO o L 1) V as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job pS A6665� (3-A7-9 n-0- ,�' aTO,7 rr !11V Of 3S r Signature of Owner Mailing Address of Owner (kC tI), 0l l �3 Telephone # Date ---4 gl,6- Please return this form to Paul J. Cazeault Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com o`� ERM�yDIs Town t„F own of Barnstable *Permit# Regulatory Services Expires mo hsfr m issue d, . Fee 00 LV srABM p15 � 9. p`, Richard V.Scali,Director TOWN MSTABLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY y�Map/parcel Number Not Valid without Red X-Press Imprint �2� "V Z.� Property Address 9 5 A g g Ev C omr, CON 1 T XResidential Value of Work$ 1 Z M , rr Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ` woq AJAyot y fV 06 A T 9 CDTt!/T A V2.635 Contractor's Name ST,&VF-IJ GvIt- .(��-rit rT _G- 041 a_s16 . (.G Telephone N umber (�O��Y-//(,6 Home Improvement Contractor License#(if applicable) l 96 5-76 Emai1:ST-SV8 e T&(�5 vt) Construction Supervisor's License#(if applicable) C 6 -09'� y6Z ❑Workman's Compensation Insurance Check one: . ❑ I am a sole•proprietor ❑ I am the Homeowner XI have Worker's Compensation Insurance Insurance Company Name 13s2Ksmtu5 hA-rjgAGJAV GuAVLD Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑-Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side'P,&etint_— ExTX9I0A_rR1 U RIsPLACS94Z01- Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows �= #of doors: -1-:66AIr Y), Uvk ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Own must sign O rope er Letter of Permission. A copy of ome Imp ov ent ntractors License&Construction Supervisors License'is required. SIGNATURE: C:\Users\Decollik\AppData\Local\Micros \Windows\Temporary Intemet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 I, The Contmonivealth of Massachusetts Department of Industrial Accidents Office of Investigations j 600 Washington Street Boston,MA 02111 unviv. nass.gov/dra Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians(Plumbers Applicant Information Please Print Legibly Name aninesVOrganization/individual):_C.6-rtA,,-t 9Ay Drsir.6 LLC Address: q S BiZ"S i92 Roao CitY/State/Zip: M MA Mr-49 Phone# ( d)Zay- 066 Are you an employer?Check the appropriate box: project(required): 1.❑ I am a employer with 4.J� I am a general contractor and I employees(full and/or part-time). s have hired the sub-contractors w striction 2.❑ I am a sole proprietor or partner- listed on the attached sheet [7t ,7. emeing ship and have no employees These sub-contractors have 8. ❑Demolition working for in any capacity. employees and have workers' g- ❑Building addition [No workers'comp.insurance comp-insurance-1 required-] 5. ❑ We are a corporation and its M❑Electrical repairs or additions 3.❑ I 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.❑Roof repairs insurance required.]T c. 152,§1(4),and we have no employees-[No workers' 13.❑Other comp.insurance required-] *Any applicant that checks box N mast also fill out die section below showing their workers'compensation policy information. t Hameoemers who submit this affuURnt indicating they are doing all work and then bue outside contractors nmst submit a new affidavit indicating such jCmtractors that rhe*this boa mint attached an additional sheet showing the name of the sub•coromrmts and state whether or not those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. lam an enepinyer that is providing workers'compensation insurance for my employees. Below is fite policy raid job site inforniddOIL Insurance Company Name:3€pxsmp rs 14Q-T-A4A(,)AV ( 1.ARD Policy 4 or Self ins.Lic-#: 9 2 kf C-5 Z 219`1 Expiration Date: Job Site Address: 5 A3prsy�dTy City/State/zip:C IL M A 02.635 Attach a copy of the workers'compensation policy declaration page(showing thee 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 insurance 4verage verification. I do hereby certify an 'ns a pea of perjury that the informafion provided abotre is Orate and correct Si tore: Date: '5 y l5 Phone#: 508 2 +1166 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/Ucense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/roRn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• CERTIFICATE OF LIABIL ITY 1TY INSURANCE DATE(MhUDDA1N1� =THISCER'nFICATE IS ISSUED AS A MATT03,17 03117 ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD/2015 ER. THIS DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED TIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the oli the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the p cy(ies)must be endorsed. If SUBROGATION IS WANED, subject to certificate holder in lieu of such endorsement{s). PRODUCER The Insurance Agency Of Cape Cod NAME: T Julie Franklin PHONE . (508)888-2766 FAX 480 Route 6A E-MAIL A/c No: (508)833-0909 PO Box 960 DDRE s: Mie@insuranceofcapecod.com East Sandwich MA 02537 INSURER S AFFORDING COVERAGE NAIC 9 INSURED INSURER A: Arch Speclal Insurance 000000 MATT YORK CONSTRUCTION INC INSURER B: Safe Insurance 000000 Po Box 826 INSURER C:Atlantic Charter 000000 INSURER D: East Sandwich INSURER E: COVERAGES MA 02537 INSURER F CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEOD ABOVE FOR THE POLICY PERIOD N NUMBER: INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH OV RESPECT TO WHICH THIS CERTIFICATE MAY O ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, IXCLU510N3 AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1N R A LTR TYPE OF INSURANCE M YEFF NOVLDICO M YEXP IOa/LIICO GENERAL LIABILITY N POLICY NUMBER LIMITS X COMMERCIAL GENERAL LUIBRITY EACH OCCURRENCE S 1,000,000 CLHIMSWADE a OCCUR PREMISES Ea g 100.000 A N N AGLOD4991-01 MED EXP(An one ) $ 10,000 10/6/2014 10/6/2015 PERSONAL&AOVINJURY $ 1.000,000 GENL AGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE s 2,00D,000 1 POLICY PRO. LOC PRODUCTS-COMPIOPAGG s 2,000,000 AUTOMOBILE LIABILITY S ! C eMBIN IA LE LIMIT S ANY AUTO • Y B x ALL OS SCHEDULED BODILY INJURY(Per person) s 100,000UTOS i HIRED NON-OWNED N N 6216083 12/30/2014 12/30/2015 BODILY INJURY(Per accident) $ 300,000 I X HIRED AUTOS AUTOS PRO � PROPERTY DAMAGE ! Pe acctdenl $ 100,000 UMBRELLA lUtB OCCUR UNUnderinsured s 1001CAll EXCESSLIAB CLAIMS-MADE EACH OCCURRENCE g ! DED RETENTIONS AGGREGATE s I WORKERS COMPENSATION s AND EMPLOYERS'LIABILITYANY PROPRJETOR/p IN X WC STATU- OTH ! C OFFICER/bfEMBERE XCLUDEARTNERIEXECUTIVE Y�N/A(tvlandalory In NH) N WCV00999802 2/22/2015 2/22/2016 E-L•EACH ACCIDENT $ 100,000 IIyyes escribe und JPTIONOFO E.L.DISEASE EMPLOYE 8 100,)00 DESCRIP710N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,)00 ' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,if more space is required) ( I i _....................._.....-._-._..__.._......._...._.._......_......_._.._.. ........................._.... - --- __._... ..... .......- 1 CERTIFICATE BOLDER CANCELLATION.... ............................................... ...... .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE � i�vStCviJiL.LO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN r ACCORDANCE WITH THE POLICY PROVISIONS.''r32fitJ>Fa AUTHORIZEOREPRESENTATIVE ACORD 25(2010/05). . . . :..... ...... ........ ....... ..._. .: ..... �-�-"--"— .. . l The ACORD name and logo are registered marks o&ACOR. 0 ,c�RenauTrn�r ��� ���i Iynls reservEY1. i eAaxsrABM Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, r�_ /t/ .00-A , as Owner of the subject property hereby authorize >r V£� / &Cto act on my behalf, in all matters relative to work authorized by this building permit application for: 3-5,4mg-v 64 T9 ddress of J ) _5/q 15 Signature of Owner �D-ate -Tg.D OAD0 Ltj Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 t Massachusetts -Department of Public Safety Board of Building.Regulations and Standards Construction Supervisor License: CS-099462 ` STEVENR COOS.` _ fi. 43 BREWSTER ROAD Mashpee MA 02649 Commissioner Expiration i 07/16/2015 Office of Consumer Affairs and Buslness Regulation 10 Park Plazd - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contra�c+or Registration Registration: 176576 Type: LLC rF Expiration: 9/3/2015 Tr# 244445 COTUIT BAY DESIGN, LLC. STEVEN COOK 1 a 43 BREWSTER ROAD = MASHPEE,.MA 02649 r gYe��OUpdate Address and return card.Mark reason for change. scat 0 26m-o5m Address Renewal Employment Lost Card �e �ia�rvc�eaatraerc�l�o�C�/filaa�rcc�ccan,/,la - - `- ---_Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: :egistration: 176576 Type: Office of Consumer Affairs and Business Regulation xpiration: _9L3%2015__; LLC 10 Park Plaza-Suite 5170 COTUIT BAY DESIGNt=L `� Boston,MA 02116 ri1 `^ 4y STEVEN COOK 43 BREWSTER ROAD' F=>";af MASHPEE,MA 02649 Undersecretary of valid without signature Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 DATE �f� Il� Jy Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for 95 Abbey Gate Road (#201402822) has been inspected by a third party Certified Building Performance Institute (BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey NOISIAIG S ti Z1 Nd Z f AU14 h►i," NN-01 Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/11/2014 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for 95 Abbey Gate(#201307007) has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey sy h,a rn I � 7 Soil Go U., E0 y//5,177 \ QLA c/c b sANay ov �4' 0" V O �. FLIED. �J\ �d0 d la HL o o Z ,J 60 &'t; 0 �V`HOF.Af s C'.Q Tom' Col EVERE Zo Q U n U HINCLLtT. y n A IrN 1P 13236 1 v • �O;(K". NAI o Ad CERTIFIED '•P L O T PLAN L O C A T I O N oTUiT� ��e�s.-,� ��E� .ass. SysT-� .�>vow�, S C A L E: / -30 D A T E �'p Z�./977 ,o2oaoS O �q vo /vo OAS/G 4.1 R E F E R E N C E /-vU G o 7- Xq S, S Al O zo . .qT ��2vSTAl3�E ,eE�/ST/Ly a.c d E�o,S S 2 AlD A T E '8 I HE R E B Y C E R T I F Y THAT THE B UIL DING R G. LAND SUR V OR ' SHOWN ON THIS PLAN IS LOCATED O I THE GROUND AS SHOWN HEREON AND TH AT IT OoE-S CONFORM TO THE ZONING SETBACK REQUIREMENTS OF ��ZHOFA9ASS'c THE TOWN OF B�.e�/5 T�9,�E y WHE N CONSTRUCT E D . JOSEPHM. G� c MONAHAN,JR. y 13660 C M S ASSOCIATES , INC . �F R E G ISTERED EN G`IN EE RS d L AN D 5V-RV EY-O-RS MID - CAPE OFFICE BUILDING - 1 26S ROUTE 28 % SURV 77_38 SOUTH YARMO UTH, MASS . 0266. 4 r i Assessor4s map and lot number �......�`'v/ 1 Q/� �C ;j—.2 7 7- S. EPTIC SYSTEM MUST BE tka 7Y-13rINSTALLED IN COMPLIANCE Sewage: Permit number 2 �•,•�•••.• WITH ARTICLE !I STATE SANITARY CODE ND TOWN[ OFTNET� y TOWN OF BARN LIAT L9 • �Qr c` 0 ri ,—� 33"NSTAI LE, • r7 , O�Y.. -BUILDING . INSPECTOR G1 �p 1639., ♦� S Fh-J f y 7J We Li s APPLICATICIN FOR PERMIT TO .....................L.r........ A.......................................:.............................. ?' TYPE OF CONSTRUCTION ....j'U��l�......... /P h'l .................................................................. ......... ..........l:...... . .y1�..........19... .� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: - Location L c'+� .. 7 ✓..1.�w�'S �r ,� ./ I /J............................................................. ProposedUse XVgr/.V�"q.....2.g.-*!'t—�.L.L Z............................................................................................................... Zoning District T.l L.:. G..........................................................Fire District .... T(i/ .: it �QL 6J 1�'�4A1 i3PaP/ Y G 2 T�oyL S��J.cJ s i.. �oS%oN, /�.4• Nameof Owner.�..V....(........................:.. .................... ......Address .................. ................................................................ Name of Builder s.�1 ??!?1!�.x!:.....C'q�JS� , ('U . a ..... ......................Address .................. .............................................................. :3 L/003 veep; Name of Architect C1j'yJNIC IJC: `I�.0 USA" J� O•.............I'1'!i4'......... .....................Address Q��............. .................... ..A- Number of Rooms S Foundation .0....N�R ;�-7-4'— Exterior liv/ .! .....C� �9�.......�e .//JG.Li�5......:.,Roofing .... ................................................... Floors //l/. .U�.................................................................Interior ............................................. c P �7S Heating �44—e .T�/.....................................................Plumbing ...................... ......................................................... Fireplace /� .....................!�. ..................Approximate Cost .....1.U........................................... Definitive Plan Approved by Planning Board -----------______-----------19-------- Area /................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. (� Name / .................... ....`... ... Granberryq Julia- Weld �~ mx� l9��l � one m � . ................. Permit for ..... ' � o^ lm �a���� �������m 4 - ~ ��~ »�Tn��r � ---- - ................. --------^-----' � Cwtmit ........... . . Julia Wmld �vvno, -----------����.������.............. � - | frama ' Type of Construction -------------- � . , -----.----------.---------- ' Plot ............................ Lot ------r---' � � ' May 27 � 77 Permit Granted — ---. ''lp � Date of Inspection . ..�-..�./-��.*..�-.l9 � � � Dote Completed ...... .................. . � ' ^ . � PERMIT REFUSED -----,--.------------- lA � -----------.--------------- - . ' -- -._----.-.-----------------.. �.~--.-------.-----.--.------.. � � '.-----------.------.-.-----. | Approved ---------------' lg | � '--------------------.----. . � . � � -------`-----------.------- | � Assessor's map and lot number �— ,2 7 7'7 ��. V- wage Permit number OF.TRETC TOWN OF BARNSTABLE i , 11AMSTADLE i 9 BUILDING INSPECTOR. _�f• �0 YPY a' .. APPLICATION FOR PERMIT-TO ...... � .. �. ...... A ........................................./J.............................. TYPEOF CONSTRUCTION ..................................................................................................................................... ...............'N/�........ .`...........19..: .7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location c' �� .��.......................................................1-' �P�iP.Lop/yiJ/�Ji ........................................ .............................................................................. ProposedUse /1�� .W;F. ,Li/J. '............................................................................................................... Zoning District .�� .............................................................Fire District .... GTC /. ................................................... Name of Owner I.(I /h..........�..` �.....�a..'�A!U f3f4P.'V...Address ��. -:..r�� L.s/D v.:.S i. /8®5%aN� I�' "- ......................................... Name of Builder$.uN../�!?�'q'�!......CV!J5.!.'.�.v.:.............Address � SH �(. .. Name of Architect ?, ,Uy�lNl 1/ C:.....................Address . 4;. T�Y.....jJUSr R p. /;IA- .................... Number of Rooms ...S ......................................Foundation ......1!!'(QrT� ......................... .................................................................. Exterior�t✓t /.�sT.. ......0 ........5 .//J<o.LS........Roofing .... ��./ .A.�a................................................... Floors .. ..................................................................Interior .. S. J��T- � 1�' Heating a~'.�r'/ Plumbing oL /3�7/�fi'Oo�7S ............................................... .................................................................................. Fireplace ..............................Approximate Cost .................. ............................................... Definitive Plan Approved by Planning Board ------- - 19. ---. Area ..... .................................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH G I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......................... .... ....................... Granberry, Julia Weld A=21-21 N PV7.U.......1.....9..2..5. �erm-it for ......one...story ............ ........ .......single family dwelling b-o Location ......... ............................ ...................C.0 t!4.i.t.............................. ............ Owner ............Julia Weld Granberry ...............;N' Type of Construction .......................................... ............................ ............................................. Plot ..................... ...... . Lot ...........#7 ................... May 7 77. Permit Granted.c' .................... ...................19 Date of Inspection ............. ...........:�...........19 Date Completed . ....................................19 PERMIT ROUSED .......................I......................................... 19 z ...................................... .. ..................................... ..........Z. .... .... .........................................................T...................... ............................................................................... Approved .............................................. 19 ............................................................................... ................................ .............................................. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4?w Map Parcel v [ Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation / Hyannis Project Street Address q cx •e Village I Owner (L V ax IYa, d o 1 Address S 0.wt C Telephone Sv / Permit,Requ st `/a, old'P , C-' Q C @ (l 4k 11fo Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatior�l). �� Construction Type Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) N QI w Age of Existing Structure Historic House: ❑Yes ❑ No On Old King'sHighway:-1fl Ye " ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other c 0 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft); -v Number of Baths: Full: existing new Half: existing neW Number of Bedrooms: existing _new 0- 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 v✓1 �l 'C�l�� � f' vAt/C ►'� Telephone Number S—oC/ G J ©0 Address C ' `u� � ��` License # La Home Improvement Contractor# G �I xv o Email Worker's Compensation #WWC 30 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Yav-Acja V f 1 s SIGNATURE DATE `� T FOR OFFICIAL USE ONLY &APPLICATION# DATE,ISSUED- MAP/PARCEL NO., z ADDRESS VILLAGE F OWNER r a F DATE OF INSPECTION: FOUNDATION s, FRAME INSULATION FIREPLACE c ELECTRICAL: ROUGH FINAL 1 , ti ` PLUMBING: ROUGH FINAL GAS: ROUGH- FINAL FINAL BUILDING DATE CLOSED OUT — ASYSOFtON PLAN NO. • Laura Nado.lny , as owner hereby give my permission to . Cape Save, Inc. _ 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 95 Abbey Gate Rd Cotuit, MA 02635 Signed 7 rJ Date i The Commonwealth of Massachusetts ,�. Department of Industrial Accidents Office of Investigations }a 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly, Name(Business/Organization/Individual): Cape Save Inc. Address: 7D Huntington Ave City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 4. 1 am a eneral contractor and 1 1.0 1 am a employer with � g. 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 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' Y9. ❑ 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 LF] Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑✓ Other Insulation comp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their-vorkers'compensation policy information. t Homeowners who submit this atlidavit indicating they arc 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 ant an emiployer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: Wesco Insurance Company Policy#or Self-ins.Lic.#: WWC3085633 Expiration*Date: 04/09/2015 ,p a Job Site Address: 4�40he a ` City/State/Zip: 6-tol t�� Attach a copy of the.workers'comIlensation 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$250.00 a day against the violator. Be advised that copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties ofper' that the information provided above k tru and correct. Sianature: late] Phone#: 56$-399-839$ 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#: A D® 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 REPRESENTA71VE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is 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 require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: Colleen Crowley Risk Strategies Company PHONE (7H1)gH6-44O0 FAX (7t)1)963-9420 IC No 15 Pacella Park Drive ecrowley@risk-strategies.com Suite 240 INSURE S AFFORDING COVERAGE NAIC t Randolph MA 02368 INsuRERA:Selective Ins. , oF, America INSURED INSUURB:Safety Insurance Company 3618 Cape Save, Inc INSURERC.Wesco Insurance Company 7 D Huntington Ave INSURERD: I NSURER E: South Yarmouth MA 02664 INSURERF: 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. ILTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF -MMIDOPOUCIYYM EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY - PREMISES IEa oaurrence $ 100,000 A CLAIMS-MADE a OCCUR S1994480 6/16/2013 0/16/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 riPOLIC'r X FRO X 'LOC $ AUTOMOBILE LIABILITY COMBINED Ea accident SINGLEI I 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED M SCHEDULED 208200 1/6/2013 1/6/2019 BODILY INJURY(Per $ AUTOS ALTOS ( ) NON-OWNED PROPERTY DAMAGE X HIREDAUTOS AUTOS Peracadent $ X UMBRELLA LIAR FX OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION sl 1994480 0/16/2013 0/16/2014 $ C WORKERS COMPENSATION - fficers Included E'ox X 1M1>rS7ATU- OTH- AND EMPLOYERS'LIABILITY Y/N TO Y R ANY PROPRIETORIPARTNEWEHECUTIVE overage OFFICER/MEMBER EXCLUDED? N 1A E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) 3085633 /9/2014- /9/)2015 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under " I. } _•� , 4 ' ✓ DESCRIPTION OF OPERATIONS below ' A E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is required) Issued as 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. 1 CERTIFICATE HOLDER CANCELLATION msong@capelightcompact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Margaret Song PO BOX 427/$CH AUTHORIZED REPRESENTATIVE 3195 Main Street Barnstable, MA 02630 chael Christian/CLC ACORD25(2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name andlogo are registered marks of ACORD i �"=__ � C7(,,, f'fl`J.7 ?;•:.�1_�� `ICJ.-r - '.-7 / j.M,,ff.dr r-.n,���,sL.:i/J; ��. :t g L f Office of Consumer Affairs and Business Regulation a 10 Park Plaza - Suite 170 Boston. Massachusetts 02116 Home Improvement .Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2016 Tr,- 249Sa° CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON.AVENUE ------- "-"-" SOUTH YARMOUTH, MA 02664 - Update Address and return card.Mark reason for change. i-i Address ; Renewal Ej E,mployment Lost Card - Office of Consumer,Aff irs&Du Regulation License or registration valid forindividul'use only -' ==-'- before the expiration date. If found return to: ":'Z -- iOME IMPROVEMENT CONTRACTOR p 1 e istration: e: Office of Consumer Affairs and Business Regulation � 9 171380 TYP- g 10 Park Plaza-Suite 5I70 =' .'Expiration: 311412016. Corporation Boston,?44A 02116 CAPE SAVE INC. WILLIAM n4cCLUSKEY � 7-D HUNTINGTW4 AVENUE \NXz SOU T H YARMOUTH,MA 02664 Undersecretary Not vali . rt t signature � CSSL-102776 _. WILLIAM 3 MC PLUSKEY 37 IVAUSET ROAD West Yarmouth Ak.02673 06/28/2015 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued 1 C) 1 1 Conservation Division Application Fee Planning Dept. Permit Fee 3� Date Definitive Plan Approved by Planning Board /01-7/1 3 Historic - OKH Preservation/ Hyannis Project Street Address q 4. Village 1— (k 6 Owner Law' IV&6()to Address � ���° aS 4 410 Telephone J v " Permit Request �✓� S e u ( Alti K67f`C� i S u c'-IT AC�/a W IS' aG� k�e- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay. Project Valuation vo Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach porting qdcuqe tatio'n. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) c� Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings"ighway: 0 Ye ❑ No w Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) .o 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 FI 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) Q Name V�/a / �' `C CI �e c • v( e - Telephone Number �U 03l(� U Address I u��d A- �Jl / License # of to Id-rm d41 7'�V 66 Home Improvement Contractor# / J 390 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO /!�(�,►t SIGNATUREX DATE Id ` • FOR OFFICIAL USE.ONLY ;�.• -�, `.APPLICATION# DATE ISSUED MAP/PARCEL NO. ! ADDRESS VILLAGE _ OWNER — y DATE OF INSPECTION: u-,FOUNDATION... FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 3 PLUMBING: ROUGH FINAL s GAS: ROUGH FINAL FINAL BUILDING .. . ►,,_ DATE CLOSED OUT, r ki ASSOCIATION PLAN NO. ' t 'r Building Permit Authorization Laura�:NadoI y as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at ' 95 Abbey Gate Rd Cotuit, MA 02635 Signed Date The Commonwealth of Massachusetts --Pnnf Form Department of Industrial Accidents in Office of Investigations _ I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Cape Save,Inc. Address: 7D Huntington Avenue City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 17 4. ❑ I am a general contractor and 1 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I 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.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no Insulation employees. [No workers' 13.❑✓ Other 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: Technology Insurance Company Policy#or Self-ins.Lic.#: TWC 3353968 Expiration Date: 04/09/2014 Job Site Address: S �� City/State/Zip: .// qd 00263Y_ Attach a copy of the workers' c mpensation 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 under the aims and penalties of perjury t. tat the information provided above is true and correct. -- Date - - — — - Phone#: 508-398-0398 Official use only. Do not write in this area,to be completed by city or town offz'ciaL 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#: CERTIFICATE OF LIABILITY INSURANCE 4DATE/9/2013 m 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 pollcy(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 NAWACT ME Colleen Crowley Risk Strategies Company PAHON Ert. (781)986-4400 A/C No:(7el)963-4920 15 Pacella Park Drive '""'L Suite 240 INSURER S AFFORDING COVERAGE NAIC# Randolph HA 02368 INSURER A:Selective Insurance INSURED wsuRma:Safetv Insurance Cozilpany 33618 Cape Save, Inc iNsuRERc:Technology Insurance Company 7 D Huntington Ave INSURERD: INSURERE: South Yarmouth MIL 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL134960509 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 ADDL S POLICY NUMBER ICY EFF POLICY—EXP(MMIMNyr LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES fEa occurrence $ 100,000 A CLAIMS-MADE aX OCCUR S199448001 0/16/2012 0/16/2013 MED EXP(Ally one person) $ 10,000 PERSONAL&AOV IN.URY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 XPOLICY PRO LOC $ AUTOMOBILE UABILrrY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO BODILY PJJURY(Per pemon) $ B ALL OWNED SCHEDULED 6208200 1/6/2012 1/6/2013 AUTOS AUTOS BODILY PJJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per aca 7 X Underinsured motonst BI split $ 100,00 A X UMBRELLA LIAB X OCCUR S199448001 O/1612012 O/16/2013 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS4iADE AGGREGATE $ 1,000,000 DED I I RETENTION S $ C WORKERS COMPENSATION Officers Excluded from X 1hCST.4TT OTR- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN overage E.L EACH ACCIDENT $ 500,000 OFFICEWMEMBER EXCLUDED? N NIA 3353968 /9/2013 /9/2014 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If as,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LPAIT $ 500,000 DESCRIPTI ON OF OPERATIONS r LOCATIONS r VEHICLES(A1lash ACORD 107,Addirienal Remarks Sehedule•if more apaee is required) Issued as evidence of insurance. Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a/ National Grid, Action Inc., Colonial Gas Company and NStar Electric are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 427/SCH 3195 Main Street AtlTFtORIZ®R6'REst7JrATIVE Barnstable, MA 02630 chael Christian/CLC �6 C- ACORD 25(2010105) ©1998-2010 ACORD CORPORATION. All rights reserved. INS025(201MS).01 The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Pegulations and Standards Construction Supervisor Specialty _icense: CSSL-102776 WI LLIAM J MC CLUSKEY 37 NAUSET ROAD West Yarmouth MA 02673 ;-ommissioner 06/28/2015 Qr✓4 Office of Consumer Affairs and eusness Regulation >> 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 - Type: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. _ - - WILLIAM McCLUSKEY - T D HUNTINGTON AVENUE _ _ - SOUTH YARMOUTH, MA 02664 -- - 7. -=-, = Update Address and return card.Mark reason for change. Address Renewal ❑ Employment 1 l Lost Card OPS-CA1�0a 5�M-04J04-Gto1216 Te•tDa�rv»:,^naule¢l�/ cl •jGatc mcfi Office of Consumer Affairs&Bdsiness Regulation License or registration valid for individul use only n ,t HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: tMol', Registration: .-171380 Type: Office of Consumer Affairs and Business Regulation _ , � 10 Park Plaza-Suite 5170 a ,_ Expiration: -3114/2014 Corporation =- Boston,MA 02116 CAPS SAVE INC :::==`,.-:-,___ WILLIAM McCLUSKEY.`;_' 7-D HUNTINGTON AVENUE_-` SOUTH YARMOUTH,-MA:.02664 Undersecretary Not valid witha'at signa i ilk TOWN OF BARNSTABLE BUILDING.PERMIT APPLICATION.. Map 0 Parcel 0:l Application#' ?.m-76 01 Health Division Date Issued z, b),—,. (0-1 Conservation Division dS 0A 020c11 Application Fee Tax Collector Permit Fee "6qI W Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �1 5 Q i?,1?, �[ �TF R11 Village COTU l-j Owner ` kK G0 LA bL 1QV Address 9-5 g9146 &-�' •A , , cg)T-/i'T r1l Telephone v'�U�C� 4 A -153-0 1 Permit Request ��J�j (l�'�/— lqx ) n}U,—Serarz / -aA.)�M A /)1�)7')�l�L� Square feet: 1 st floor:existing-1/910 proposed.2.5— 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 6-On Construction Type WooD F2,,v7-►.E Lot Size e1 1 ACE Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure /1//_r i9��7 Historic House: ❑Yes UNo 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 cI new 0 Total Room Count(not including baths):existing new f First Floor Room Count 6 Heat Type and Fuel: dGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes P(No Fireplaces: Existing 2 New 0 Existing wood/co I stove: $Ye&-r l7 No o 2" Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑ce�!isting C ew 117e. N Attached garage:Usexisting ❑new size iyX le Shed:❑existing ❑new size Other: u> "' .f Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# m Current Use Proposed Use ----BUILDER INFORMATION ' Name 44weT 74WI �4- Telephone Number iv Address /.� A i�_a,4,1/ �b License# �� �G Home Improvement Contractor o ZG I/ Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN T-e BY -rC CA �v4� sAr_r - SIGNATURE �M DATE /Z-L r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. n t ADDRESS VILLAGE ' OWNER �. DATE OF INSPECTION: FOUNDATION < .070L? .FRAME 3/1 Lo ptvnc- ® INSULATION ro� FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING'8)`i 9y i?l'X /lJ bK qwm1z#,czL - - DATE CLOSED OUT i ASSOCIATION PLAN NO. - Vt w . . ......._.._..........._..._ ... ....___ -7 _. arvrzo�.u..ea�C o�./�aaaaclivaet�a Board of Building Regulations and Standards Construction Supervisor License ' License- CS 56765 Bi.Gthlate'�4/24/1957 ;Expiati4/24"/2009 Tr# 11598 Restn'c� TG- IM JAMES P HEALY(� --- 15 ANNAWON RD ' ;•, ,!>�,-�_ �J MASHPEE,MA 02649 s 5 i__t�"" Commissioner 92, '4 � � ami�zoauuea� o����%uwa:c'�zliaeQa•: ' 0W .- - Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 15770 Expiration:`,4%10/2008 ..Type:_:Individual JAMES P.HEALY JR_.'' JAMES HEALY JR 15 ANNAWON RD .: MASHPEE,MA 02649 `` "'� Administrator ation.valid for.individul License or registr use only before the ex Board of Buildpiration date. If found return to: ing Regulations and Standards Place Rm 1301. One Ashburton Boston,Ma.02108 Not valid without signat e i 1 WL The Commonwealth of Massachusetts Department of Industrial Accidents Of ttee oflnvestigations 600 Washington Street Boston,MA 02111' wtvw.mass.gov%dia ' Workers}Compensation Igsurgnce Affiddvit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Le gib Name(Business/Organization/Individual): Address:_ /� W,,v.4W 4,Aj 2D City/State/Zip: /�Ati/ /PIl G2Gy%Pholie.#: � • Are y an employer?Check the appropriate bog: :Type of project(required):. 1 am a employer with Z 4. ❑ I am a general contractor and I 1,L�7 * , have hired the sub-contractors mp 6. ❑New construction . eloyees(full and/or part-time). 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet 7• ❑Remodelin g ship and have no employees These sub-contractors have g• ❑Demolition 'working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp. insurance. 5 10. Electrical repairs or additions . [.] We are a corporation and its required.] officers have exercised their 11.❑Plumbing repairs or additions '3.❑ I arri a homeowner doing ill-work . • myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance.re ed t c. 152, §1(4),and we have no ] employees. [No workers' 13.❑Other comp,insurance required.] "Any ipplicant 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 mutt submit a new affidavit indicating'such. tContiactors that check this box must attached ein additional sheet showing the name of the$ub-contractors and state whether ornot those entities have employees, If the sub-contractors have employees,they must providb their workers'comp.policy number. 1 an' an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site. information. /� n Insurance Company Name: (Sl/A�l�j �/�Sd/A�✓Cf �rolr Policy#or Self-ins.Lic. WnC go'f,6,10 G Expiration Date: 1 G a o ff lob Site Address: City/State/Zip: aniT /LEA a�3S 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 tip 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 IDIA for insurance covers a verification. ,416 hereby certify under the pains. hd penalties ofperjury that the information provided above is true and correct. Date: Si ature: — Phone##: Official use only. Do not wrlte in this area, tb be completed by city or town official City or Town: ' Permit/License# Is Authority(circle one J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Phone#: r� P�otIKEro Town of Barnstable Regulatory Services BARNSfABM Thomas F.Geiler,Director nsnss. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, -improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: dyn rd6 Nl W i)D/TIO.✓ Estimated Cost - Address of Work: Gy 4-'1XM Al-41• arV 1 T "54. aZG3T Owner's Name: U /2/Ad GL7ll Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. /Z•Z/-�7 OR . i /b0 5'c-5 . 7t, Date Owner's Nam oFIHET Town of Barnstable � a Regulatory Services HARNSTABMASS'Kass. Thomas F.Geiler,Director 1639. .� M � lFo,,,y�a Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, %D,06US ,AQ0Z-,/Uy , as Owner of the subject property hereby authorize ,z!)?iJC- c /-167/ L Y. to act on my behalf, in all matters relative to work authorized by this building permit application for: 9-5 � G� ,6 0 --v7Z - ;1 Address of Job) ignature of Owner gate 7,00, ,-uE IVA ZV -�� Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. �1 Town of Barnstable �pF THE r, Regulatory Services , BARN5rA8LE, % Thomas F.Geiler,Director y MASS. q, 039. ,e Building Division AIFD �A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.' DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. ' Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. IIOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions. of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors;Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by. several towns. You may care t amend and adopt such a form/certification for use in your community. Sai<- Go G 6LA C/C Lop o V `,��Utio'9rio, Q CGEAN I %' Eti/cav�rEO ' •p0 �O•cJO �`�HUFpASS EVERErf tiG - 5 K. .. WNCLL".. y 2 p 13230 . FSS�ONAI C E R T I F/ I E D ' PLOT PLAN L 0 CAT1 0N :I <27 �.T>��2�siAeLE 1��4ss �ysTE 5 � �D w,, ,y� e�0� �S / 30 ' h-i`2� Z�,/977 �2o,QOS �q vo �vo O�s/G S C A L E� D A T E� �� SA�4 Sy-STEM !s R C F E R E N C.E oT �7' ,q S _5 A/0zo <� Ae l4A,1T ''�E'ECo20co /'�/ �L�.�•/ /�oo.0 Z 7 i SAG E S�, D A T E I HEREBY C E RTI F Y THAT THE B U I L DIN R G. LAND S U R V 190f 0R SHOWN. ON TH 15 PLAN IS LOCATE D 0 T-HE G ROUN D AS SHOWN HEREON AND T H AT IT OOE-S CONFORM TO THE ZONING SETBACK REQUIREKAENTS OF .I80FM'�ss� T H E T O W N O F _ B-'q E' JOSEPH W HE N CON5TRUCT E D . MONAHAN, • c AH ,JR. N v 13660 C M S ASSOCIATES , INC . F 1S O REGISTERED EN GINEE:RS d LAND SURVEYORS �4� �y04 k0 SuRV M I D - C A P E O F F I C E B U I L D I N G - 1 2 6 S ROUTE 28 7738 SOUTH YARMO UTH, MASS . 0266. 4 Paychex, Inc. 12/18/2007 9:07:40 AM PAGE 3/003 Fax Server ACORD: : : E1I : .. � :I�t : DATE(MAA1DD/YY) n...... ...........�,:...... �..:�: ........................T�.........�r.►...�.F �= < < > .. : :::::::::::::::.::::: .:::::: :::.:: ::. :::::: :::::::::::::::::::::::::::::::::::::::::::....................................::::::::::::: 12/18/07 ........................................................................ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PAYCHEX AGENCY INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 1175 JOHN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WEST HENRIETTA,NY 14586 COMPANIES AFFORDING COVERAGE COMPANY A GUARDINSURANCE INSURED JAMES HEALY JR COMPANY 15 ANNAWON ROAD MASHPEE,MA 02649- COMPANY COMPANY D . . ........... 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. TYPE OF INSURANCE POLICY NUMBETi POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDDIVY) DATE(MWDD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL UAB4UTY =ElLAIMS MADE�CCUR PRODUCTS-COMP/OP AGG $ PERSONAL 8 ADV INJURY $ OWNER'S$t CONTRACTORS PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED EXP(Anyone person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILYINJURY $(Per accident) RPROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ Li ANY AUTO OTHER THAN auto ONLY: EACH ACCIDENT $ `—' AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'$COMPENSATION AND X WC TATU• OTH- A EMPLOYERS'LIABILITY TRY UNTS THE PRCPRIETCRI EL EACH ACCIDENT $ 100,000.00 PAWNERSIEXECUrIVE INCL JAWC805606 06/30/07 06/30/08 EL DISEASE-POLICY LIMIT $ 500,000-00 OFRCERSARE: ®EXCL EL DISEASE-EA EMPLOYEE is 100,000-00 OTHER DESCRIPTION OFOPERATIDNSILOCATIONSNEHICLESISPECIAL ITEMS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TED NADOLNY EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 95ABBEY GATE RD 30 DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT. COTUIT, MA 02635 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATMES. AUT130MED REPRESENTAyIVE FdL1:2r"rS: ?;;: DC13;3I�33 A'ItOH�:1r��:� :� I ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix J Q {� Applicant Name: �' '� �� Site Address: t`J A , Applicant Address: /f /�/NNAW O�/ �� City/Town: Cd-tu a A. /t'ln.rb�a�t Use Group: M� . aZGy9 Date of Application: Applicant Phone: SGd- S(o!o-OGSU Applicant Signature: Compliance Path(check one): ❑ Prescriptive Package(Limited to I-or 2-family wood frame buildings heated with fossil fuels only) Package(A through KK from Table J5.2.1b): Heating Degree Days(HDD65)from Table J5.2.1a: (For items d. through i., fill in all values that apply from Table J5.2.1b:) a. Gross Wall Area sq.ft f. Wall R-value R- b. Glazing Area' sq.ft. g. Floor R-value R- c. Glazing%(100 x b_a) % h. Basement wall R- d. Glazing U-value U- i. Slab Perimeter R- e. Ceiling R-value R- j. Heating AFUE . ❑ Component Performance: "Manual Trade-Off"(Limited to wood or metal framed buildings only) Climate Zone(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 i Attach Trade-Off Worksheet from Appendix J, [and HVAC Trade-Off Worksheet, if applicable] ❑ MAScheck Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate(HERS rating score must be 83 or higher) ❑ Systems Analysis OR ❑ Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a. Gross Wall+Ceiling Area 700 sq.ft. b.Glazing Area' M 3 sq.ft. c. Glazing%(100 x b_a)�4'• % ADDITION with Glazing % (c.)up to 40% may use 780 CMR Table J 1.1.2.3.1 below: MAXIMUM U-value MINIMUM R-Values Fenestration' Ceiling' Wall Floor I Basement Wall Slab Perimeter,Depth' 0.39' R-37 R-13 R-19 I R-10 R-10,4 ft I Glazing Area may be either Rough Opening or Unit dimensions. z Based on NFRC listing. Applies either to every unit,or to area-weighted average of all units. 3 R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area (i.e.-not compressed over exterior walls,and including any access openings.) ❑ "SUNROOM" addition (greater than 40% glazing-to-wall and ceiling gross area) Attach"Consumer Information Form" from 780 CMR Appendix B. Official's Name: Official's Signature: Application Approved ❑ Denied ❑ Date of ApprovaUDenial: Reason(s) for Denial: (provide additional details as needed on back side) w Z � rn Q Q N N . .12 MATCH NEW RAKE&TRIM BOARDS EXIST. E-r Cjj W N TO MATCH EXIST. 00 TOP OF PLATE O a U. NEW CORNER BOARDS } z TO MATCH EXIST. N NEW W.C.SHINGLE SIDING TO MATCH EXISTING— FIRST FLOOR SUBFLOOR REAR ELEVATION EXIST. EXIST. EXIST. I GARAGE LIVING KITCHEN 5,-Ir 4 O J 1�1 EXIST. EXIST. DIRECT VENT I AND. AND. AND. '•FREESTANDING I TW 21 1036 TW 21036OGAS STOVE 2' ° T-4" " I b -- 1 -- io O Z I--I r � .EXIST. - ►,.-1 Z ANDERSEN I VELUX NEW p i I VELUX 1 �RSEN Z PATIO O po 'A31 Vs 308I A OVE10068 N I SU SKYLIGNROOM I A OVEHT I ¢F I I L.-—J (VAULTED CEIL NG) L I ANDERSEN I NEW 42" WIDE r � A31 � � r------------- —STEP--- ---- ---------- ---A3 i i A3 i , w� I IL ------------ ------- ----- ---J I 1� ANDERSEN ANDERSEN ANDERSEN TW 21052 TW 21052.2 TW 21052 it ANDERSEN GIB/ ' AFFW 602 ' REMOVE EXISTING PATIOT/PLANTER AS 4'-10' I 4'-1(' 4•-2' REQUIRED FOR NEW CONSTRUCTION (ADDITION) FLOOR PLAN SCALE NEW SUNROOM 252 S.F. NOTES: 1/4" = 1'-0" = ' 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS LEGEND: &DIMENSIONS IN THE FIELD DATE: Q EXISTING WALLS 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, 1 1/20/2007 ---, DETAILS,&FINISHES IN THE FIELD WITH OWNER CONSTRUCTION TO BE REMOVED THE DESIGNER SHALL BE NOTIFIED IF ANY NEW CONSTRUCTION 3. ROUGH.OPENING HEAD HEIGHT OF WINDOWS AT ERRORS OR OMISSIONS ARE FOUND ON IIIIIINI THESE DRAWINGS PRIOR TO START OF DRAWING NO. FIRST FLOOR TO BE 6'-10"ABOVE SUBFLOOR CONSTRUCTION.THE BUILDING CONTRACTOR 4. ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS IN THESELL BE DRAWINGSRESPONSIBLE FOR CONSTRUCTION CONTENT ) IN THESE DRAWINGS IF CONSTRUCTION STATE BUILDING CODE,SIXTH EDITION COMMENCES WITHOUT NOTIFYING THE DESIGNER OF ANY ERRORS OR OMISSIONS. THESE DRAWINGS ARE SOLELY FOR THE USE OF THE OWNER NOTED.ANY OTHER USE OF Al THESE DRAWINGS REQUIRES THE WRITTEN ' - CONSENT OF THE DESIGNER. V/ Q Q N O N CONT.RIDGE VENT C'D� WW �M NEW ASPHALT SHINGLES W N 12 12 TO MATCH EXISTING .-. 3 O EXIST. r _^ EXIST. i W Lo O � NEW FASCIA&FRIEZE W Q x BOARDS TO MATCH EXIST. O M Z Q i TOP OF PLATE NEW a CORNER S Z U a TO MATCH EXIST.ST. ,y NEW W.C.SHINGLE SIDING = TO MATCH EXISTING p . as FIRST FLOOR 'SUBFLOOR NEW DUROCK CEMENT BOARD W/R'x 19'VENTS RIGHT SIDE ELEVATION moo 12 12 � EXIST. EXIST. O OP-PF PLATE Fm] {� N 0 FRST FLOOR SUB FOR Li Lo cn SCALE: 1/4" - 1,_0„ DATE: oe0000lo LEFT SIDE. ELEVATION 11/20/2007 DRAWING NO.: j z EXIST. P.T.2x 10 LEDGER BOARD LAG BOLTED TO EXIST. W o �• SOLID BLOCKING W/(2)LEDGERLOK BOLTS O GARAGE 16"o.c.W/JOISTSHANGERSATBOTHENDS •.CRAWLSPACE ¢ N N O CD CpD V" o EXIST.FOUND.WALLS& L (y] p Lf') b FOOTINGS TO REMAIN C� U)Ln k NEW P.T.2 x 12's @ 16'o.c. Q N 0 xQ " EXIST. z PATIO — MID-SPAN BLOCKING a Jyp� N IL_JI iV m N—� x x a b � -- -- -- -- -- r z ------¢ ---- ----- -- Aa -- -- -- -- o -- ------t'-- --- —A— A3 w i w I A3 z I z I 1 NEW 17 CONC.SONOTUBE / NEW 3-P.T.2x 17s ON 24"DIA CONC.BIGFOOT NEW 17 DIA CONC. ' FOOTINGS TO 47 BELOW SONOTUBES TO _ GRADE 9',0" 9'-0' 3'-6" 4'0"BELOW GRADE REMOVE EXISTING PATIOT/PLANTERAS REQUIRED FOR NEW CONSTRUCTION 5 I� FOOTING PLAN NEW ROOF CONST. O CONT.RIDGE VENT -2 x 12 ROOF RAFTERS @ 16"o.c. O 7 Q 1/7'CDX PLYWOOD ROOF SHEATHING 2-1.75"x 14"1.9 E LVL -ASPHALT ROOF SHINGLES r T RIDGBEAM -15LB.FELT PAPER �••1••1 O 12 (VERIFY SIZE W/SUPPLIER) -9"BATT INSULATION MATCH @ FLAT CEILINGS(RS30) BOTTOM OF EXIST. -SIMPSON H 2.5 HURRICANE CUPS CEILING JOISTS NEW 1 G ON 2 x 8's @ 16"o.c. AT ALL RAFTER ENDS - ' 1 x 3 STRAPPING @ 16"o.c. -ICE/WATER SHIELD AT BOTTOM 3'0"OF ROOF -PROP-A VENT BETWEEN RAFTERS NEW 2 x 8 BLOCKING FOR WIND WASHING ..... .TOP OF PLATE CONT.ALUMINUM .SOFFIT VENTS O l NEW WALL CONST. F � P.T.2 x 10 LEDGER BOARD LAG BOLTED TO FFE Lj -2 x 6 STUDS @ 16'o.c., w SOLID BLOCKING W/(2)LEDGERLOK BOLTS -1 rr PLYWOOD SHEATHING W 16'o.c.W/JOISTS HANGERS AT BOTH ENDS -6'BAIT INSULATION(R-19) _ w -1R"GYP. GL < - CORRECTDECK ON -W.C.SHINGLE SIDING � 2 x 8 P.T.JOISTS @ 16'o.c. NEW NEW 3/4"T&G PLYWOOD -TYVEK HOUSE WRAP FIRST FLOOR SUN ROOM SUBFLOOR-GLUED 8 NAILED FIRST FLOOR T 1 SUBFLOOR � SUBFLOOR h�+�l 3-P.T.2x 1Us NEW P.T.2.x 17s @ 16"o.c. APPLY SEALANT UNDER PLATE T NEW DUROROCK W/6'x 16'VENTS �J R=14 RIGID INSUL 3.P.T.2x 17s SCALE: 2 LAYERS(R-28) „ z 1/4" = 1'-0 NEW 28"DIA"BIGFOOT"FOOTING UNDER 12"DIA.SONOTUBES AT DATE NEW 17 DIA CONC. PORCH 4'0"DEEP 1 1/20/200 SONOTUBESTO 4'0"BELOW GRADE DRAWING NO.: A BUILDING SECTION 0 NEW SUNROOM -7 y 0 I � • I Qpo N NEW 2 X 8 RAFTERS TO F^ 1n BE BUILT OVER EXIST. ROOF STRUCTURE I "-' 3 a o / I � WZLOLn cn +? o I U co+tip 4 x 6 POST UP i ♦ TO RIDGE 1 Cl W L�J 0 �I J 0 �Q 'Q A A A3 A3 I - MULTI LVL HEADER 3 1/2"x 5 1/f 3 1/T x 5 1/4" r LVL POST POST UP TO LVL POST Yl�r RIDGEBEAM ►..y 101-0' 18'-0" 29'-(r l ROOF FRAMING PLAN OzQ NOTES: 1.) ALL ROOF RAFTERS TO BE 2 x 10's Q UNLESS OTHERWISE NOTED .Q Q 2.) USE SIMPSON H 2.5-HURRICANE CLIPS AT ALL RAFTERS ENDS POST UP TO RIDGEBEAM � - 3.)VERIFY GUTTER TYPE/LAYOUT MATCH 12 W/OWNERS EXIST. BOTTOM OF MULTI LVL HEADER F��^y Fri 3 1/T x 5 1!4"LVL POSTS r►S TOP OF PLATE ^ X ��/ FIRST FLOOR FIRST FLOOR OOR SUBFL SCALE: 1/4" = l,_0„ DATE: 11/20/2007 ' DRAWING NO;: A .BUILDING SECTION 0 NEW SUNROOM