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0081 CONSTANT LANE
i Assessor's office(1 st Floor): ,Q Y-'4'SE.PMC'SYSTEM &1UST®E i T Assessor's map and lot number 3 (o o�. INSTALLED IN COMPLIANCE -THE �o Board of Health(3rd floor): VM TITLE 5 Sewage Permit number < - ENVIRONMENTAL CODE AM j B�Bd9TSBLL Engineering Department(3rd floor): r4ea House number TG�IN REGULATIONSco �6}p. Definitive Plan Approved by Planning Board •19 ���Al APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF , BAR.NSTABLE BUILDING 114PECTOR APPLICATION FOR PERMIT TO 3 U V\ Y- TYPE OF CONSTRUCTION O C h-s v C t O /M /v 1sgo TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following in/formation: Location cc) $' Gl L C Proposed Use��- lrq L Zoning District , Fire District Name of Owner M R . W Address O Name of Builder >>d /� 4 Addressg8 Jo Name of Architect h o 1A Address Number of Rooms Foundation :.�11 C Exterior �ng .S l7 �'L C. .S 1`� Dig �� Floors LV � In 0 h c) �9�'.b� ®� � PL i!! terior �C � ,, e e— Heating 0 e Plumbing Fireplace O Approximate Cost 0 0 . ©C3 t Area Diagram of Lot and Building with Dimensions Fee 'D i5t. 50 Do lzt. g / C Iry OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name C/ Construction Supervisor's License I✓�'D C) ` KADELSKI, MR. V. No 33731 Permit For Build Sun Room ` Single F.am,1_y Dwel 1 i-nq Location 81 Constant Lane Cotuit t Mr. V. Kadelski Owner, . Type of Construction Frame " Plot Lot , Permit Granted May 8 , 19 .90 , � ���� Date of Inspection 19 el"e Cd pleted 19 It1 � . C V-��'° . f;A �� l lit ; r Assessor's office(1st Floor): q Assessor's map and lot number ' Board of Health(3rd floor) Sewage Permit number ��` „�1 • Z DAHd9'fODLL i Engineering Department(3rd floor): r+ua House number 0° i6}9. Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION �! v 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location y - i Proposed Use .-y-- Zoning District �« Fire District Name of Owner Address Name of Builder�,� � < `' �' Address y „ Name of Architect Address v Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace V - Approximate Cost � Area Diagram of Lot and Building with Dimensions Fees e �� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License y V KADELSY,.I , -MP.. V. =039--062 No 33731 Permit For Build Sun Room Single Family Dwelling G .Location 81 Constant Lane Cotuit Owner M_ V. Kadelski r Type of Construction Frame Plot Lot 'Permit Grdnled May' 8 ► 19 90 Date of Inspection 19 Date Completed 19 ; PERMIT COMPLETED 1/1/ Yt I PREPARED BY PAGE I % DATE 1 2 4 7 g S 12 13 / eye cK 14 " -C P 15 16 171 - 191 c C DY 20 w 211 22 29 I l Sl l TI -Ir'c3 ff o�� o 26 11 P con c r (:!. i 27 3Xrc'G�3�1!>3 29 I 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 PREPARED BY PAGE ' N0. DATE , 2 3 4.. 5� 7 8 12 13 r 15 16 e 17 ` . 18 19 20, r 21 - � t 22 k f 23 24 ` 11! 25 26 2728 x 4 EX@Cl6[48 ;� 29 30 31 32 , 34 .1 36 ~' 37 38 39 40 41 42 43 i44 s. 45 46 +I 'ice 13.47 ae 49 50 • w 51 ' 52 53 54 j 55 56 • _ '%isesisor'�,,map and lot numb pr.................... A0 THE Sewage Permit number . ........................................................ SEPTIC SYSTEM ' House number .............. ...rl...................... INSULLED IN CO ........... WITH TITLE 63 TOWN OF BA R N S rPAvr.10KNTALcowAw BUILDING JNSPECTOR APPLICATION FOR PERMIT TO .............................................................................................. TYPEOF CONSTRUCTION ........ .................................................................................. ................................................19.... TO THE INSPECTOR OF BUILDINGS: a. - The undersigned hereby-applies for a permit according to the following information: Location ............ 7 ....... ...........co.. t /).... ........L?o// I7...... ....7v/7. ProposedUse ...... .R ..................................................................................................................................... T Zoning District ......../�. Je. . -AA1 ....I(j C ..46....Ce.....Fire . .... . ...... Name of Owner .......... ..... .... ......... ..... .... c1dress ... ...................... ,�;T,f elll-l-I F Nameof Builder ......... ........... .....Address .................................................................................... Name of Architect ..........1.6&......................................Address .................................................................................... .. ................ Numberof Rooms ......... ..................................................Foundation ...... ...... .......................................... Exterior ....C'.).A ...... ..........Roofing ......... 4 ................................................................. Floors ............. ......................................................Interior ..........5#,4"C- / Rej- e 4--, ......................................................................... Heating ........ 4J ..........................................:.......................Plumbing ................................. ............................................ Fireplace .......... ...................................................Approximate Cost ........3Y. .................. .7 .. .... ..Definitive Plan Approved by Planning Board ------------------------------19--------- Area ......... C�Diagram of Lot and Building with Dimensions Fee .................................. .... SUBJECT TO APPROVAL OF BOARD OF HEALTH )4,41 ej e) X Al I hereby agree to conform to all the Rules and Regulations of the T wn of Barnstable regarding the above construction. .Name ...... 4. . ........ .. .......... ,Wetherbee, Dana o Permit for ....011.. story } „ single family dwelling Location ..............$.1 Constant Lane f .............................Y.Y.}:`!. ..................................... I k 5 Owner ............... ... ..:......................."�l !V ..K✓�'T1fF8��. - Type of Construction ................fraane. „. Plot Lot38.......... A9 Permit Granted ................. .....................19 Date of Inspection ........... ....... ...............19 �. Date Completed ......... ...... .rl...:... ........19 PERMIT REFUSED .................................:.............................. 19 rfs x. ............. y < ... r' 'a .........,.............................. ............. ..0...;..?•. ....................................... Approved j.=..:... .......................... 19 ............... .... ................................................................... •� !V) N i 44 ;----- m - t3o , 00 u Y,.j f o v� � ral4 rr I . -T�Wk.\ oT o wed OF: B-P ee j STPc6cE co ? v17 PAMA • d��° IS DLIZ Lti3. ErVT P_Aj Vi�c..E- �V Assessor's map and lot number--....... ......... ..... ...s........1..�� ��, /�JG �h- S / SINE T �f 7q i Quo o� Sp-) age Permit number .................. ....................................... �p Z ]DAW S''M E, i House number A NAea 9p0 1639 Q YAY a` TOWN 'OF BARNSTABLE BUILDING INSPECTOR 4 F APPLICATION FOR PERMIT TO ......../3 K.I. .............................................................................................. TYPE OF CONSTRUCTION .........+ l! S / l�^�:��t:a/�U. ....................................... ' ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............ .f? r............ .. '......................e'..: .'.:!.....t�.`. # !'�i."r•*'i�. ........Q�? T!9N7- �f}{t/ d7V/7 ProposedUse ............................................................................................................................................................................. Zoning District .......... �.�� 1 }i!. Fire District .,.`�t •+f �1 jc r */` ,�r ` "•5r-7 i•,? ��'` Address ram" 'r#.!,...� ..�.��s' r. f,�. Name of Owner :. ...................................................... .. ......... :. r.� ' 4�' // F ter . ts� J r �- e e�'- �-,- f' b Name of Builder ...::............................ Address .................................................................................... Nameof Architect ........~ .r ....................................Address............ .................................................................................... Number of Rooms <..................................................Foundation ......Q IF...................................... Exterior ( �/ /ice: _. ` , 't >. " 1,. 1. .�." .!............................................... r.. .........................:a...............................Roofing .... Floors ............................................................Interior .................. ..................... ............................................ , ;Heating. ...................................................:................... g .................................................................................. r Fireplace ..:...........:.. :'.:1.:�...................................................Approximate Cost ............?.:r., ..................... Definitive Plan Approved by Planning Board -----------_-_____-----------19--------, Area "? ..--....°" '. -^ � r... .................. Diagram of Lot and Building with Dimensions Fee .......... SUBJECT TO APPROVAL OF BOARD OF HEALTHjV Q . A - � 1 t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. C/.1r: ... ! ..... .✓`✓ .: :' ' ....:........ r Wetherbee, Dana' � 4-A=39-62` . ........ Permit for .,,one Story single family..dwellin$ Location .......... 1..Constanti.Lane - ............. ............................ Cotuit ............................................................................... Owner Michael . . Eco ............. .......................... Type of Construction ..........frame Plot ...:................ r . Lot .............03 ............ •Permit Granted ..................... ..................19 7� Date of Inspection ....................................19 Date Completed ........... 1 PERMIT REFUSED .................................................... 19 ............. i�.vj`1.,. .....�. .�. . s v I " ................ ... ....................... .. ............... ......... ......................... ..................................................... ` Approved .........................................:...... 19 ............................................................................... ............................................................................... �•'"`' TOWN OF BARNSTABLE 213 67 ' Permit No. Building Inspector Cash OCCUPANCY PERMIT Bond _ xx "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." I Issued to Dana Wetherbee a Address I Al Constant Lana Cotuit Wiring Inspector c� Ll,f-` f', _����. [ Inspection date Plumbing Inspector /sue, j� ^ �, Inspection date Gas Inspector '�1 •✓� �� n -cis �ir Inspection date LL:. r .., �� - 4E gineering Department � `�l� �ti Inspection date—5 d 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. O a'Building Inspector Y,. �r7lgby f Town of Barn �� S yd stable *Permit# O Expires 6 months from issue date - Regulatory Services Fee a Re RWQI'ARiR s t639. mnss.', $ Richard V.Scali Director Building Division PERMIT Tom Perry,CBO,Building Commissioner JUN 3 0 2015 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us TOWN OF BAR�116 1�gR�� Office: 508862-4038 Fax: 5 8-7 6 3 ---EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ' ` Not Valid without Red X-Press Imprint Map/parcel Number- 6 Property Address- q a& f- � esidential -Value of Work$2�1 6VZ - S1 Minimum fee of$35.00 for work under$6000.00 Owner's Name 4,.Address ell Contractor's N4�ie (;- Telephone Number�� Z� Home Improvement Contractor License#(if applicable) 104 7 Email: l'I 1!I (ill Construction'Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Che . I art asole proprietor ❑ I<arn,Ae Homeowner ❑ I-have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Reques (check box) n 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 r wired. SIGNATURE: C:\Users\Decollik\-AppDataUoca4hcrosoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 .---�a---—.._..-'--------'------'------ c <c d A to O r- ' i N M a N . ai [ PG 0 m y V X CD uJ O v" u (n p s o I d Z7 10 W �'Nl�lli�i lili��`is.��I'isiili:.�::� � CU _ (�S 9 jil �l�lii�iil�4i;: "ii'i�j'' a lA �% o�'en N y _ C J o _ d W H � O i .�. v N E w � ami 'x z '� o i m 0 -J G9 U ° " p LL C9 u.i I License or registration valid for individul use only ^� before the expiration date. 1 Office of Consumer If found return to: sda/nog sseyy mmm :l!s!n uo!�ew�o�u!8u!suaa!�sda Joj I Affairs and Business Regulation I Bo Park Plaza-Suite 5170 -asua3ij s14110 u01le30AaJ J01 asm si apo�8uipjina alelS i MA 02116 j suasnyaesseyy a4l10 uojllpa luaj]m a ssassod of aml!ej • f of valid without nature ao�ds pasoloua 30(JU166)laaj otgno 0001S£Uelp ssol utUjuoo ganlnn dnoig asn bus JO sgutpltng-palouisajun j: 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: �0, 8-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I , as Owner of the subject property hereby authorizF�' rf� C���c%A. -� to act on my behalf, in all matters rQI�tive to work authorized by this building permit application for: (Address of Job) A Signature of Owner Date Print Name If Property �er is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\2PIOI DHR\EXPRESS.doc Revised 040215 the Commonwealth of Massachusetts Department of Industrial Accidents Office of Irivestigatons ' 600 Washington Street Boston,MA 02111 ivrvty.ntass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Cone actors/Electricians/Plumbers Applicant Information /J Please Print Leidbly Name(Business/organization/In dual): ( �� Address: / City/Statc/2Fp: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I egr¢tloyees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.04 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.I 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 LF Plumbing repairs or additions sel€ o workers' right of exemption per MGL my (N �mP- 12.❑Roof repairs insurance required.]T c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] 'Any applicam that checks box#1 must also fill our the section betow showing their workers'compensation policy information- 1 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 bat 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 providee their workers'comp.policy number. I ana are employer that is proWi frig workers'contpetisatio►a ittstrraitce for my eniplo?ee& Below is the policy,acid Job site inforruation. Insurance Company 1\rame: Policy#or Self-ins.Lic.#: Expiration Date: zjo Job Site Address: & 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. I do hereby cerrift under the pains grad per allies of perjury that the inforatatiote prmRded abov is trt a and correct Sienature.: ! �� Date: #-Phone �:61/ lS /� >d Qfrcial use only. Do not write in this area,to be completed by city or town o.TiciaL I 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#: _5c i i M Insuiate sa"VW11 W e a t h e r i z a t i o n & Insulation ?C;q S ' -� > i �b 410 Grove SL Fall River,lvla 02723 Insulatessave net -September 2, 2014 ;Thomas perry, CBO 200 Main Street Hyannis, MA 02601 RE: 81 Constant Ln. Cat l�- °Dear Mr.Perry, This Affidavit is to certify.that all work completed at 81 Constant Ln. has been inspected by a certified BPI :Inspector.All Work Performed Meets or exceeds Federal and State Requirements. Sincerely!, 'Roland Langevin :Insulate 2 Save, Inc President :CSL 103861 FUC 166311 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 039 Parcel M Applicatio Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address $ Cof) ttan'r Lane, Cot t, /1IA Qa63E Village C otw'A OwnerIdons 1' Murray Address 2 l aoos�ant LOAP �GtcAi�;Ato Telephone ?�-7 y' aC I-A Permit Request '� T ► /' W -o rl Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 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 Baps: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor-oom Cou,Fi5 Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal sto e: ❑ryes ❑ No Detached garage: ❑ existing ❑ new 'size—Pool: ❑ existing ❑ new size _ Barn: 0 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 Telephone Number t]O L 6 7 6)Q6 Address �IID Grove � Ea P'dPr , Ah License # Home Improvement Contractor# J663 Email Worker's Compensation # /V wG `! . ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO A 11 Ir ed (1)0*,Au(�10fef q16 600-p- ;3t oAkf M SIGNATURE IL DATE7 / FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER r DATE OF INSPECTION: st FOUNDATION FRAME _ INSULATION s FIREPLACE ELECTRICAL: ROUGH FINAL C PLUMBING: ROUGH FINAL t; GAS: ROUGH FINAL ! FI,NAL BUILDING !� DATE CLOSED OUT N ` ASSOCIATION-PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 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 Le ibl. Name (Business/OrganizatiorAnd ividual): Insulate 2 Save, Inc Address:410 Grove St City/State/Zip:Fall River, MA 02720 Phone #:508-567-6706 ^ Are you an employer?Check the appropriate box: 1.PON I am a employer with 18 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have working for me in any capacity, employees and have workers' 8' ❑ Demolition [No workers' comp. insurance comp. insurance.-* 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.[J Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their myself. No workers' comp. right of exemption per MGL 11.❑ Plumbing repairs or additiot:s insurance required.] t c. 152, §1(4),and we have no 12•❑ Roof repairs employees. [No workers' 13.9 Other Insulation/weatherization comp. insurance required.) • *Any applicant that checks box#I 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:Guard Insurance Group Policy#or Self-ins. Lic. #:INWC311431 12/10/2014 Expiration Date: Job Site Address: ���` r'r �� City/State/Zip:CO}u;+, M 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 under thus an en ties of perjury that the'information provided above is true and correct Si nature: Date: / Phone#: 5085676706 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/12/14. THIS,CEf2TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CEkt0JC'ATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOM' THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPkESE WOVE 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 certifcate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Anthony F. Cordeiro Insurance PHONE- FAX (508) 677-0409 ltuc� (508) 677-0407 No: 171,Pleasant Street EMAIL Fall River, MA 02721 ADDRESS: lbrizido@cordeiroinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Atlantic Casualty Ins. Co. INSURED INSURER B:Torus,_SPecialty Ins. Co. Insulate 2 Save, Inc. INSURERC:Great American Ins. 410 Grove St. INSURERD;Guard-Insurance Groff Pall River, MA 02720 INSURER E: 'INSURER F: COVE)AGE§ CERTIFICATE NUMBER: REVISION NUMBER: THIS_IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. ,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLU6ibNS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADOL;SUBR i POLICY EFF POLICY YY IN RI D POLICY NUMBER MMIODlY _ MMIDDIYYYY LIMITS A GENERAL LIABILITY Y i Y M081000174-2 6/12/14 6/12/15 EACHOCCURRENCE $ 1,000,000 C�( OMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PR-MI ES,(E9.DxUfL_=el $ 100.000 CLAIMS-MADE X 1 OCCUR M�ED—EXP(Aryone prim) S 5,OOO PERSONAI RADVIWURY $ 1 000,000 �— __.-........ GENERAL AGGREGATE $ _ _ 2 000,000 _ , GEN'LAGGREGATE LIMIT APPLIES PER i PRODUCTS-CAMP/OPAGG $ 2,000�000 ._ }( .POLICY PRO- i lOC I AUTOMOBILE LIABILITY I COMBINED SINGLE LIM I_(Ea accident S _ A�7YAUTo, j BODILY INJURY(Per person) $ ALL O WNE D SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ! ( ) NON-OWNED I I PROPERTY DAMAGE $ --- klREDAUTOS _, AUTOS LPereccident B I X(UMBRELLA LIAR X OCCUR Y Y 178264D142ALI I 6/12/14 6/12/15 EACH OCCURRENCE $ 1,OOO,OOO EXCESS LI'AB CLAIMS-MADE i i AGGREGATE $ 10,000p 0,000 DED. RETENTION$ I $ NXJRK`eIQOMPENSATION ! INWC414038 X WCSTATU- I OTH- D i 12/10/13 12/10/14 AND&iI)LOYERS'LIABILITY Y!N I _._..I_TORY_LIMIIS_ E� "P"kOPRIETOit/PARTNERIEXECUTNE E.L. ACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? N!A _ __..._._ I!-" atd'ry In NH) �i I Ityy. describe under i E.L DISEASE-EA EMPLOYEE $_ �SOO,000� DESORIPTIONOFOPERATIONSbelow E.L.DIS EASE-POLICY LIMIT,$ 500,000 C Equipment Floater IMP375-99-76-02 j 6/12/14 6/12/15 Shop Storage 75,350 Veh Storage 76,250 l DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Proof of Ins. Residential Insulation contractor. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN -u ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 AC RD CORPORATION. All rights reserved. ACCAti 2-k(2010fq5) The ACORD name and logo are registered marks of ACORD Ph-no: Fax: E-Mail: i RISE Engineering Federal ID#OS O4o5629 RI Contractor Registration No 8186 MA Contractor Registration No 120979 A division of Thielsch Engineering CT Contractor Registration No 62012'0 25 Mid-Tech Drive,West Yarmouth,MA(12673 CONTRACT ' ,W%8-1926 Y-6613 FAX 508-568-1933 R I S E Page 1 PRUCiRAi14 THIS CONTRACT IS ENTERED INTO BETWEEN RISE CI`_RC.S ENGINEERING AND THE CUSTOMER FOR WORK A$ E N'G I N E E R I N G DESCRIBED BELOW CUSTOMER PHONE DATE CLIENTa - WORK ORDER Thomas F Murray (774)228-2171 04/10/2014 157856 00002 SERVICE STREET ... .. ' a1LUNC STREET 81 Constant Lane 81 Constant Lane . ..._....._..._.............._._._...__ .. _ ........ SERVICE CITY,STATE.ZIP BILLING CITY.STATE.ZIP . Cotuit; MA 02635 Cotuit. titA 02635 • JOB DESCRIPTION Provide labor and materials to seal areas ofyour home against wasteful,excess air leakage. This work will he perfornted in concert with the use of special tools and diagnostic tests to assure that your home will be left with it healthful level of air exchan,e and indoor air quality.Materials to be used to seal your home can include caulks,founts,weatherstripping,and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (11)working hours. v At the completion of the weatheriration work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will he conducted by the sub-contractor to ensure the safety of the indoor air quality. $847.00 Provide labor and materials to install ventilation chutes in(55)rafter bays to maintain air now. $19!- 5 Provide labor and materials to install(122)linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $267.10 RISE Engineering will apply all applicable,eligible incentives to this contract. You will he billed only the Net amount. Currently. for eligible measures,the Cape Light Compact offers 75%incentive•not to exceed$4,000 per calendar year.and an incentive of 100%for the Air Sealing measures. (E l 1 J U L 1 r 2014 "t # t. Total; $1,300.11 Program Incentive: $11191.35 Customer Total} $114178 ' WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WrrH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Hundred Fourteen 8r 781100 Dollars $114.70 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. ................. . .................,..._.. .. ...... .... .. .........._................ .. _ .. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AVTHORQED TORE•RISE ENO IN E IR NG CUSTOMER ACCEPTANCE. k - ��NOTE:THIS CONTRACT MAYBE WITHDRAWN BY US IF NOT EXECUTED WITRW DATE OF ACCEPTANCE GACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHOOMED TO DO THE WORK .. ..... DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE OWNER AUTHORIZATION FORM —11� (Owner's Name) owner of the property located at G!h � (Property Address) (Property Address) i 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. i Owner's Signature 1 1 V Date �G/, � �2f� G W . Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite S 170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 166311 Type: DBA Expiration: 5/11/2016 Trdt 251248 INSULATE 2 SAVE ROLAND LANGEVIN 410 GROVE STREET -- - - - FALL RIVER, MA 02720 Update Address and return card.Mark reason for change. -; Address j Renewal (� Employment Lost Card SCA 1 0 20M-05/1 '- ;c�/.; a� Office of Consumer Affairs& Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: f egistration: 166311 Type: Office of Consumer Affairs and Business Regulation Expiration: 5/1'1l2016 DBA 10 Park Plaza-Suite 5170 5F Boston,NJA 02116 INSULATE 2 SAVE ROLAND LANGEVIN 536 EASTERN AVE. FALL RIVER,MA 02723 Undersecretary Not valid without signature 1 Drtassachusetis -De.partn"•et t �J,�bitc S.ie3y Board of Bioiding Regulatcons a, ,io Standards Cntrtructinn Supen'icor �-�cense'. CS-103861low 6. o` ROLAND LANGEVIN,- 536 EASTERN AUE. ' Fall River MA 0'?723 _xptration `J54 " 0812412015 . "'g6sTi rl^.5 S6OR'�'r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map D` Parcel �v V Application # D `1 b4 It Health Division JUL 22 Z i-'° Date Issued J Conservation Division Application Fee S� Planning Dept. Permit Fee MiON Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address v 4 jZ Village 4 w� Owner�a&WjO yA �'��,i2�2�1 Address Telephone_ 2- 7- 7 / Permit Request ,22 le /T 4";ii/2P lei S i G Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new .Zoning District Flood Plain Groundwater Overlay Project Valuation 2 /0 a, "Construction Type AaJi 11W 7_10:0'� .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 A No On Old King's Highway: ❑Yes gNo Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement.Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# _ Current Use - Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name A�ee �'.� j�.fir� a e/ Telephone Number S Address License# ,mil' 11A�/2>Dl� Home Improvement Contractor# Email Worker's Compensation #4JC�jo_ A::9o1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP,/PARCEL NO. a ADDRESS, VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION C' FRAME INSULATION FIREPLACE- ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE-,CLOSED.OUT ASSOEIATION PLAN NO. Housing Assistance Corporation Cape Cod HOME.OWNER/RESIDENT WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM 1F YOU ARE !� THE/APPLICANT HOME OWNER. I PI 4�o Vl / t,�+-� 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 located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following 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 the weatherization work to be,done at my home I agree to the following: 1. I give permission to the "Agency'its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said .property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for.the weatherized unit on an ongoing basis for no 7re than five(5)years after the weatherization work is completed. I have read the provisions oF/ is-7agreem=entassted a}d fr ive my consent. Home Owner: (Signature) °�... _/ Date: Agent: (signature) Date: -7-- HAC approved Weatherization Company : -Aze ra2(' Live v(�Ti v� Adam T Incorporated All Cape Energy Alternative Weatherization Building Performance Contracting LLC (:::Cap�e_Co' d Insulation Cape Save Frontier Energy Solutions Lohr Home Improvement Resolution Energy Massachusetts -Depaftr4nt of Ppblic Safety Board of Building Regulations end Standards Construction Supervisor - r • �K { License: CS-100988 ``` c., HENRY E CASSIDY 8 SHED ROW s WEST YARMOUTH Expiration Commissioner 11/11/2015 'r. Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cgri>traptor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2014 Tr# 233831 CAPE COD INSULATION, INC — ---- r HENRY CASSIDY 18 R EAR DO N CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. f sCa t i; 2UPA-OS/i I Address Renewal n Employment ❑ Lost Card r� ryT c; v+aiie•r�eaircaeccll�u�C/G�c;wac�ivaat�� �u\ Office of Consumer Affairs&c Business Regulation License or registration valid for individul use only r OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: .f53567 Type: Office of Consumer Affairs and Business Regulation xpiration: 12/175/20.14 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATlbN'iIoJ HENRY CASSIDY 18 REARDON CIRCLE SO.YARMOUTH,MA 02664 Undersecretary Ab ( witho t Wsifnatkre i I d f I i ' I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations R d 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly Name (Business/Organization/Individua)): Address: City/State/Zip: —D6UA G(lf'IM,OU '� Phone #: 6A " 715' (`21 _ Are ou an employer? Check the appropriate box: Type of project(required): I. l ant a employer with 2'�'72 4. [] 1 am a general contractor and I employees (full'and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ 1 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' [No workers' comp. insurance comp. insurance.t ❑ Building addition i 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 1 I.❑ 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 I'j(f comp. insurance required.] // 'Any applicant that checks box#I 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. tContractors 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. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /I' 141/OUV(V�L Insurance Company Name: WVyh(/ 4& od Policy#or Self-ins. Lie. 0: Expiration Date: w 1 Job Site Address: ���,��� l�"7 /!i' / Cv Yu 1 Y' 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 tine 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 cer tfy r the pains and penalties of perjury that the information provided above is trite and correct. S�ture: Date' �212- /A/�- Phone#: J! fS 7� i Z,/`t' 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): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector ( 6. Other Contact Person: Phone M l CAPECOD-27 KLIGETT .QiCORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `�.� 6/13/2014 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 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 CONTANAME: Barbara DeLawrence Rogers 8 Gray Insurance Agency,Inc. PHONE FAXA/C 434 Rte 134 A/C No Ext: N.: (877)816-2156 South Dennis,MA 02660 A DRESS:bdelawrence@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company INSURED IN SURER 8:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER c:Evanston Insurance"Com an 18 Reardon Circle INSURERD:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,MA 02664 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL B POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 EN CLAIMS-MADE a OCCUR CBP8263063 04/01/2014 04/01/2015 PREMIDAMA ESESS R Ea occc Durrence $ 100�00 PREMI MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY❑ PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,00 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1,000,00 B ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 C EXCESS LIAB CLAIMS-MADE XONJ463514 04/01/2014 04/0112015 AGGREGATE $ DEC) I X I RETENTION$ 10,000 Aggregate $ 1,000,00 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCA00525904 06/30/2014 06/30/2015 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 If es,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EVIDENCE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I f ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD P �oFtHE,o,,, Town of Barnstable *Permit# /� T hP Expires 6 months from issue date ,,%RNST"LE, Regulatory Services Fee Q Thomas F. Geiler,Director /�4t/t i p'EDN1P`A Building Division Tom Perry, Building Commissioner X®PRESS ®E 200 Main Street, Hyannis,MA 02601 �"" .G Office: 508-862-4038 - OCT 2 2 2002 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENOM OMEMNSTABLE Not Valid without Red X Press Imprint Map/parcel Number 0 (o Z Property Address (21 ^ /-.-,^-� / el1 I— Residential Value of Work Owner's Name&Address Contractor's Name 12 an Telephone Number Home Improvement Contractor License#(if applicable) .�- Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ` ® I am the Homeowner ❑ I have Worker's Compensation Insurancev Insurance Company Name Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) i *Where uired: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revised121901