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HomeMy WebLinkAbout0072 STONEY POND CIRCLE 0 0 D _ yyA'w�+,.w�r-.. w.�W�+�....�►i� ....+y.�M'�.I�'� r �vw•^�'." '__' ��r�il�..�.w.. A'LT ER N-AT I•V E WEATHE•R1Z.ADON Date: Town of Barnstable , 200 Main St Hyannis,MA 02601 Re:Permit# , :>: V'illage. •,S•' F r� ' I. r.�Cw:Srivl•.' i a •e insulation weathei�a�t�Qu tnidrk t ! -.: :been co 1 ,... .,r.. .: as-:been eted i: .; aince with8.,,. ...�' y;tir:`• ,:6'.r)i�...' •ri,i•,.' r'.i,i`TU/i" Re aini ds .;y:, :,' °:s: :<:r %•:, :';;:.4 r :•t'�_?..'- � '.. .tom. �a.d:y-;, ( �'..:�� . ••.L=d;.'•i'<:::•.:;.:�.,:. :�,'y t,ki�'y', •q'�yf.:0 2:::r ::i �:''• ::1.:;';,."r':.."''.i�.�.�.�.n;t:�..�i"..�'PiI `��'�.; ;?;.r. ;tt;,r ,;�,q:: ,•.f::;Yr<':.;.:;.,,-,:...�Y4'{::,.�_•, tal;S:-�`i. .o. .O ': Timothy Cabral, Z' President CSL-105454 58 DICKINSON STREET FALL RtYER,MA 02721 (508)567-4240 ALTERtdATIVVv.EATHERQl�T1dN@GMA1LC0tvJ:. O� Application number................................................ Date Issued........... �.!:Z�.� ........... s j 0 - , Building inspectors Initials........ x . . ��� � ��� Map/P �� I ) ABL arcel V l� ............. TON" OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION s . Address of Project: 7o� NUMB `` T- VILLAGE Owner's Nam.4n/1" � `Q,r _ ` ° Phone Number - 291a -- '2 y Email Address:O-MChlakg-E(UW s-A Put- Cell Phone Number Project cost$. Check one Residential y Commercial OWNER'S AUTHORIZATION As owner of the above properly I hereby authorize to make application for a building permit in accordance with 78 MR "A azzaich Owner Signature: e Q,/,-�G�c -� Date: 3 1-90 TYPE OF WORK ❑ Siding ❑"Windows(no header change)#.° -: Insulation/Weatherization Doors (no header change)# Commercial Doors.require-a.h inspector'spreview ❑ Roof(not applying more than 1,layer of shingles) Construction Debris will be going to ' CONTRACTOR'S INFORMATION Contractor's name T�L Home Improvement Contractors Registration(if applicable)# (attach.copy) Construction Supervisor's License# (attach copy) Email of Contractor �' yG - ft 7k, Phone number OF-57i7W.V ALL PROPERTIES THAT.HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY 1S-IN. A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ f *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X , X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am--9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES * , Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APP IC T'S SIGNATURE Signature ./ Date f All permit applications are subject to a building official's approval prior to issuance. DocuSign Epv�eloApe ID:346743D6-149F-41DB-8F52-5F62014C1A80 �F Permit authorization mash, save Form Site I133715577 Customer:. Ann Blake Ann Blake owner of the property loca#ed at:; (Owner's Name;:printed)' 72 Stoney Pond Circle Marstons Mills, MA 02648 (Property street Address) (GityJ hereby authorize#tie Mass Save.Home Energy Services.Program assigp0d Partic patipg Contractor listed ._ .. WoW to action ftyb6hV and obtain'a building permit to perf6tiin insulatidh'a-6d/or Weattier'rzativn work;ommy,properw DocuSignedby: Owner 1s Signature- AD386008B6D748F... ; 3/5/2019 1 5:39 PM EST Date;` FOWOFFICE USE ONLY: We have assigned-theJollowing Mass:Save'.Home,Energy.Services Participating,Contractor to the Above;referenced project: aA�L--11 Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 FocIDff'rcg fJsL-DMW . it'ev:10205 , i The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AApnlicant Information Please Print Legibly Name (Business/Organization/Individual): ALTERNATIVE WEATHERIZATION, INC. Address: 2 LARK STREET City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.[] 9. El Demolition I am a homeowner doing all work myself.[No workers'comp.insurance required.)' 4.M I am a homeowner and will be hiring contractors to conduct all work on,my property. I will 10❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.r7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.' 6.F-1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other INSULATION 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic.#: XWO(19)58867158 Expiration Date:6/8/19 Job Site Address: r. City/State/Zip:_9I� 5G`S Attach a copy of the workers' compensa on policy declaration page(showing the policy number and expiration date)./ Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d ain a p lti s f perjury that the information provided above is rue and correct Signature: Date: Phone#:508-567-4240 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ' ® DATE(MMIDDIYYYY) ACORV CERTIFICATE OF LIABILITY INSURANCE ��. 06/11118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Anthony F.Cordeiro Insurance Agency (PHONE/ . o Et I: 508-677-0407 FAX No): 508-677-0409 171 Pleasant Street E-MAIL ADDRESS: HSouza@Cordeirolnsurance.com Fall River,MA 02721 . INSURERS)AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual INSURED INSURERS: Ohio Security Alternative Weatherization INSURER C: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY) (MMO DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX_1 OCCUR PREMISES Ea occurrence S 300,000 MED EXP(Any one person) S 15,000 A Y Y BKS58867158 06/08/18 06/08/19 PERSONAL a ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) S B OWNED X SCHEDULED Y BAS58867158 06/08/18 06/08/19 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/08/18 06/08/19 AGGREGATE $ 1,000,000 DED I I RETENTIONS S WORKERS COMPENSATION PER Y I N AND EMPLOYERS'LIABILITY STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT S 500,000 C OFFICER/MEMBER EXCLUDED? n NIA XWO58867158 06/08/18 06/08/19 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary 8:Noncontributory basis per the terms and conditions of form CG2001 (04/13),for Ongoing Operations per the terms and conditions of form CG2010(04/13),for Completed Operations per the terms and conditions of form CG2037(04/13)and Waiver of Subrogation applies per the terms and conditions of form MEGL0241-01 (04-11) Additional Insured for Automobile Liability applies per the terms and conditions of form SCA005(02/16) Excess Liability is a followinq form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENT 1 ©19#-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I�---Woowl Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Maca-chusetts 02116 Home Improvemera ntractor Registration Type: Corporation Registration: 175M ALTERNATIVE WEATHERIZATION,INC. Expiration: 05/2812019 2 LARK ST iEFREM` 3 = i FALL RIVER,MA 02721 'i•�' ' � Ire Update Address and return card. Mark reason for change. SCA t 0 2CM•05i!4 Address [i Ponawal n Frreln=ant n Leat.t�arrf .A 'w�t!,�[:ii,lif G'•ilftGltl�il G�r''l�/.CL`:ititT'lft;:t'�t Office of Consumer Affairs&Business Regulation i HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only E TYPE:Corporation before the expiration date. If found retum to: ion 9xMination Office of Consumer Affairs and Susiness Regulation �t756 3, 05/28/2019 10 Park Plaza-Suite 6170 ALTERNATIVE WEATjJER 'rlON,INC. n,MA 02118 4 TIMOTHY CABRAI: '"` '' `:' {\� — 2 LARK 5T FALL RIVER,MA 02721J Undersecretary Ot V O 8i BtiJrB LOT LOT 7 `Yn ��ti •6'' .tw cr_ , •w_ • s � No �6 0 w % 201 41' �o N79 03'58"E STONEY POND CIRCLE LOT 9 FLOOD ZONE "c"_ FO UNDA TION CERTIFICATION RES ZONE.. "RF"___ TO AN.MARSTONS MILLS SCALE I"=40' PL.REF. 432 32 ELEV.•N/A I CERTIFY THAT THE ABOVE YANKEE SURVEY CONSULTANTS FOUNDATION IS LOCATED ON ���� OF P. 0. BOX 265 THE GROUND AS SHOWN, AND PAUL 9�yG UNIT 5, 40B INDUSTRY ROAD IT'S POSITION��--_-- A. MARSTONS MILLS, MASS. 02648 .CONFORM TO THE ZONING LAW ` N11®.0. 3 MERITH EW -a eti' 2096 � SETBACK REQUIREMENTS OF �' o TEL: 428-0055 FAX 420-5553 BARNSTABLE ------------------- JOB PA UL A. MERITHE'W -' `' { DATE.211�94 Nur�Bx.50421fnd i TOWN 6F BARNSTABLE R I S E Division of Thielsch Engineering,Inc. 2013 MAY 10 AM 1(: 20 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02910 DIVISION May 1, 2013 Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Re: Insulation permits Dear Mr. Perry, This affidavit is to certify that all insulation work completed for 72 Stoney Pond Circle has been inspected by a Building Performance Institute (BPI) certified Professional. All work performed meets or exceeds Federal and State requirement. Sincerely, Erik Nerstheimer Supervisor of Installations, BPI certified Building Analyst Professional and Envelope Professional, RISE Engineering, a division of Thielsch Engineering, Inc. 1341 Elmwood Avenue Cranston, RI 02910 401-784-3700 •800-422.5365 •Fax 401-784.3710 4 C a)0 � Town of Barnstable *Permit# Regulatory Services �ce 6eronthsfrom issue dute ' tAxrrsnE, ' . Thomas F.Geiler,Director X.P R E S S P E R NI Building Division Tom Perry,CBO, Building Commissioner APR 1 O 2012 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 TOWN FOP#A f gLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 6 5/0 2 6/1 01 0 Property Address 72 Stoney PoldtCircle Marston Mills Residential Value of Work 9, 0 0 0 °0 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address. Harry J & Ann C Blake 72 Stoney Pond Circle Marstons Mills Contractor's Name Northern Colony Builders. LLC Telephone Number 508-744-33Q Home Improvement Contractor License#(if applicable) 167739 Construction Supervisor's License#(if applicable) CS 53638 ®Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Southeastern Insurance (central Ins) Workman's Comp.Policy#WC 7 9 9 7 4 9 014 Copy of Insurance Compliance Certificate must accompany each permit, Permit Request(check box) KRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to YarmouthLan ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows `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\decoM\AppData\Local\NEcrosoft\ rr3dews\Tempoiary Internet Files\ContenkOutlook\DDV87AAZ\EXPRESS.doc 'Revised 072110 snNvsTasuE, t 659. Town of Barnstable Regulatory Services Thomas F.Geiler,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, Harry Blake , as Owner of the subject property hereby authorize Northern Colony Builders LLC to act on my behalf, in all matters relative to work authorized by this building permit application for: 72 Stoney Pond Circle (Address of Job) 4/7/2012 Signature of Owner Date Harry J Blake 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\Mcrosoft\Windows\Temporary Intemet Files\ContentOutlook\DDV87AAZ\EXPRESS.doc Revised 0/2110 '" i 5 e�onrintoatPealth of- assachusetts Dgwr nrent of Indush iul Accidents Office of Investigations 600 Washui'gion Street Boston,MA 02111 nmi mass gmldia Workers' Compensation Insu muce.AffidaviN Buaders/Contractors/Electricians/Plumbers plicaut Information Please Print Leelbiy Name 93lumeWOrganization4ndividualJ: Northern Colony Builders LLc Address: 1694 Falmouth Rd Centerville MA 02632 C /Statejzi : Phone#- 508-744-3362 Are you an employer?Check the appropriate box: T of Project(required): 1. I am a employer 4- I am a en Type P j p yer with�_ ❑ general contractor and I employees(full and/or part-time)-* have hived the subcontractors 6 ❑New constrrxction. 2.❑ I am a sole proprietor or partner listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me to any capacity. employees and have woda!W[No worloers'comp.insurance comp-insurance 9.I ❑Budding addition 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 l l_❑Plumbing repairs or additions mywlE[No workm'cow right ofexemption per MGL 12.❑Roof repairs insurance required.]I C. 152,§1(4} and we have no employees-[No worker' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 also fill am the section below sbowing their workers'oompensation policy information_ 1 Home—us who submit this affidavit iadicatmg they ue doing all wait and then Lie antsfde coatzacmrs nmst submit a new affidavit indicamig mcb. tCoaaactors that cbect this box must attached sn additioaal sheet showing the nee of ate sub-counwims and state whether at those entities have employees- If the,sabtanumars hate emPlayee%that ist tzmvicle their workers'camp-policy number. I ant an employer that is providing workers'congwusadon insurance for my employee& Belot=is the policy anal job site information. Ins'ranceComPanyName=Southeastern Ins, Central Ins. Policy#or.Self-ins.Lic.#: W C 7 9 9 7 4 9 01 4 Expiration Date: 7/0 8/12 Job Site Address: 79 Stnna)4pc)nd Circle Coy/StaWZip: Marstons"Mills 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 fm. 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 FPCH "es of pediloy that the informalmn provided a ,, true and correct Phone#: tJ Official u w only. Do not write in this area,to be completed by city or tmvn official. City or Town: Permit/License# .Issuing Authority(circle one): 1.Board of Health .2.Building Department 3.C WFown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• I - 6 f Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massach.:setts 02116 `Home Improvement ;,tr'Ctor Registration Reqistration: 167739 Type: LLC r 0+ `"fir'— r Expiration: 10/25I2012 Trit 205252 NORTHERN COLONY BUILDERS DANIEL GALLAGHER 1694 FALMOUTH RD #135 CENTERVILLE, MA 02632 Update Address and return card. Mark reason for change. 71 Address i_1 Renewal i_JI Employment Lust Card PS-CAI C, 50M 0a/Oa-C-101M �iy f�/ ayp gg1 eA I Imo. iS us It �/ �artn�t License or registration valid for individul use only ti^� Oflice of nnsumer airs loess e u anon g IMPROVEMENT CONTRACTOR HOME IMPR before the expiratioli.date. If found return to: - n. Office of Consumer Affairs and Business Regulation t FT Registration: ,,,Al,57739 Type: _ I 10 Park Plaza-Suite 5170 Expiration: ,:11U25/,2012 LLC Boston,MA 02116 NOWERN COLO.t,l:Y'"BUtE.RS,L C. DANIEL GALLAGHER<.' 180 HIGH STW. BARN, MA 02068 Undersecretary of valid withou tg nature I I +=.rmUlLMassachusMts - Department of Puhli SSufet 9 Buurd of Building Regulations and Standar(Is.T! Construction Supervisor License License: cs 53638 t- +- . DANIEL J GALLAGHER PO BOX 471 W BA,RNSTABLE,.MA 02668 $. Expiration: 10/27/2013 ('iunmisxiuncr Tr#: 5259 L :;4f11 VCI G i4v r L1IDDIYYIY� ,4C;�rc>J ��RTIFICATE �F LIABILITY' INSURANCE ' 08/23/2011 PRODUCER 508.997.6001 FAX 508.590.2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 439 State Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. — P.O. Box 79398 North Dartmouth, MA 02747 I INSURERS AFFORDING COVERAGE I NAIL# insuRSD NortFlern Colony BuiTdiny Co LLC 111•r.,UAERA_Cent ral Insurance Companies -- -120_3.0 -- 1694 Falmouth Road #135 INUnEAe: Merchants Insurance Group i Centerville, NA 02632 �IN.uaeec— I ---. COVERAGES '- THE PC!ICIES 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,?HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLIC!ES.AGGREGATE LIMITS SHOWN M.AY HAVE BEEN REDUCED BY PAID CLAIMS. —'-- POLICYC�CTi\"E j POLTCYEXFTIR�T10tT LIMITS INS�'D+DD-L' r•pE OF INSURANCE — PO:ICY NUMBER I DATE M!vVDU11'll'Y DATE MMIDD _—_ -•� LTR 1Nsao _ I? 1,000,O00 1 GEN=Pa-LIABILIrr CLP7997489i 07!08/2011 107/08/2012 per!.r:I:7APrI EI -co �r?�J�F.NTE'r.---j'y-----300, GFM=R.AL L!Aeii;TY I ReM1SE tEa - ---' MED EX-1 iany_ma --1_,o_Uo,ooc j -'__I--------- I "F.NERA AI;!3RF.GATE— j Z 000,0- --- -00' Cc!wProP'AG' !; 2 000.000 r _::<•;.=_i1at:a'/IFr.o?IiE::PE2 I j i----•-----'-'------�.___ -----_.._ L';C --�- Ar—UTOM031Lc LIABILITY MCA7013965 01/05/2011 101/05, 2012 : -•�,!g!NEG i;hLE LIB ! i �• a-cio QO OClO a=L'=UT:J` I ;Per pB150nl I nr_'LI!Fr;?!J-U� I ' I L_.�nl.t_r�=UTis I I;Gtll Gi:,:1.Je1,11 'a ""i - I i ! 'RJru•.T'I:.Y'•LAvc - i ---•—_---T • _ - — I.;,L'TC 0'JL';•EA;.CCIDEiT 15 GARAGE LIABILITY ---•- -'--'---------..._ EXCESSrUMSRELLALIABILITY ------ I zCr'REGATE i --TWSRKERSCJN.PENSATION j NJC799749014� 07/08/2011 0/Z012 If TORiUL_�ry� y�R I AND EMPLOYERS'LIABILITY Y t 14 I I I =_I - CH ACCIDENT I 1 3 00,000 :Y PR(:c':Ir.T^?;%aR NEFYE%°CJTIVE ---I I I -I---' -=-----' A 'GFFICE %!EL!ca-.E:cCLLUE J^ D1 [.,— -_..A EMPL:))'FEI S 100,0 (IA>tndomry In NH) I I I -"----_ --~_.'-'----"-----...... I(ye;..; ry in ,") EA3c•PO.:c;LeF!T !t 500,00 j^—)=--- - --�-- I I ---- - OESCkIPTION OF CPE21710HS:LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS I CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL'.CO BEFORE THE EaPIRA710N DATE THEREOF,THE ISSUItIG INSURER WILL ENDEAVOR TO MAIL 10 DAYS'NFITTEIJ NOTICE TO THE CERTIFICATE HOLDER NAMED TO THC LEFT,BUT FA;LURE TO 00 So SI ALL V IPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPCN THE INSURER.ITS AGENTS OR FOR INFORMATION REPRESENTATIVES. __--_- ---•-- - PURPOSES ONLY AUTHORQEO REPRESENTATIVE Karen Bernier ACORO 25(2C09101) 01988-2009 ACORD CORPORATION. All rights resB�ved. The ACORD name and logo are registered marks of ACORD 11-4211 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # *� ,f:8�J s. Health Division Date Issued 2 l Conservation Division ";Application Fee Planning Dept. : . 'Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 72 Stoney Pond Cirlce Marstons Mills Village Owner Harry Blake Address same Telephone 508-420-1317 Permit Request Air Sealing R-19 insulation to oepn attic. 2 Attic hatches Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1847.60 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) a Number of Baths: Full: existing new Half: existing new = o Number of Bedrooms: existing _new 7W C> 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,=O No co m 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 RISE Engineering Telephone Number 4017784-3700 Address 1341 Elmwood Avenuce License # 100459 Cranston RI 02910 Home Improvement Contractor# 120979 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Erik Nerstheimer for RISE Engineering {yj 7 5 ' FOR OFFICIAL USE ONLY APPLICATION# S : . DATE ISSUE_ Y : MAP/PARCEL,NO�. r ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FRAME "INSULATION_ FIREPLACE ELECTRICAL: ROUGH FINAL j PLUMBING: ROUGH FINAL GAS:Hy` ROUGHS, > FINAL c 'FINAL.BUILDING:l .-AUdl9,; . r_ DATE CLOSED OUT .: `St ASSOCIATION PLAN NO: . t f , } RISE ENGINEERING led,ral ID a 05-0405629 ontractor Registration No 8186 �7A division of Thielsch Engineering �!JContractor Registration No 120979 ontractor Registration No 620120 1341 Elmwood Avenue,Cranston,RI (401)784-3700 FAX(401)7 DEC - 1ONTRACT e 1 RI S E CONTRACT IS ENTERED INTO BETWEEN RISE EERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE Client W Harry Blake (508)420-1317 11/15/2010 114211 SERVICE STREET BILLING STREET 72 Stoney-pond Circle 72 Stoney-pond Ci SERVICE CITY,STATE,ZIP BILLING CITY,STATE,LP Marstons Mills,MA 02648 Marstns Ml,MA 02648 JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your homb will be left with a healthf d level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) $1,056.00 RISE Engineering will provide labor and materials to install a 6"layer of R-19 Class 1 Cellulose added to 824 square feet of open attic space. $741.60 RISE Engineering will provide labor and materials to install insulation and weatherstripping to 2 attic access hatch(es). $50.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$2,000 per calander year. -$1,649.70 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Hundred Ninety-Seven&90/100 Dollars $197.90 UPON FINAL INSPECTION AND AP VAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 OA .S E REVERS1 FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. OT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES R SIGMA E EN IN CUSTOMER ACCEPTAN THIS C MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTAN �� ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHOR[M TO DO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE A _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations U. 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):_RISE Engineering a division of Thie1sch Eng9 neering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone#: (401)784-3700 or 1-800-422-5365 Are you an employer? Check the appropriate box: Type of project(required): 1. N I am an employer with 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 7, 0 Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. 0 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 11. 0 Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4),and we have no 12. ❑Roof repairs employees. [no workers' 13. N Other Insulate comp.insurance required.] *Any applicant that checks box#1 must also rdl out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach as 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: The Preston Aeency Policy#or Self-ins.Lie.#: 3730961-01 Expiration Date: 1/1/12. 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 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 $250.00 a.day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certi and the ins enalties ofperjury that the information provided above is true and-correct. S nature: .- Date: Print Name: Erik Nerstheimer Phone#:(401)784-3700 or 1-800-422- 365 Pxtill 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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: a OP ID: 31 CERTIFICATE OF LIABILITY INSURANCE DAT12/30H 10 12/3 0 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 endorsements. PRODUCER 401-886-8000 CONTACT The Preston Agency,Inc. 401-886-1700 PHONE FAX 1350 Division Rd Suite 303 A/C No Ext: A!C No): PO Box 810 -ADDRESS: East Greenwich,RI 02818-0810 cuosTOMERIDr:THIEL-1 INSURERS AFFORDING COVERAGE NAIC# INSURED Thielsch Engineering,Inc INSURER A:Zurich-American Ins Co. Thielsch Group Inc. INSURERB:American Guarantee&Liability Tech Realty Inc. 1 INSURER C:North American Capacity • 95 Frances Avenue Cranston,RI 02910 INSURER D:Hartford Insurance Company INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR Y EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDYIYWV M EFF MIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 3730962-01 01/01/11 01/01/12 PREMISES Eaocarrence $ 300,00 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X ,CTPRO Loc Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,00 A X ANY AUTO 3730963-01 01/01/11 01/01/12 (Eaacddenl) BODILY INJURY(Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NOWOWNED AUTOS $ $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,00 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 10,000,00 B... AUC-4857188-00 01/01/11 01/01/12 DEDUCTIBLE a RETENTION $ $ WORKERS COMPENSATION X VvC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N r JER -A ANY PROPRIETOR/PARTNER/EXECUTIVE 3730961-01 01/01111 01/01/12 OFFICEWMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 1,000,00 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 C Professional Liab DVL000026800 04/01/10 04/01/11 Prof Liab 2,000,000 p Leased/Rented Eqp 02UUNTD5678 01/01111 01/01/12 Equipment 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) +CERTIFICATE HOLDER CANCELLATION TOWN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVEAUTHORIZED I' ©1988-2009 ACORD CORPORATION. All rights reserved. i ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD NOTEPAD TWIEL-1 PAGE 2 QQ Q INSUREDS NAME Thielsch Engineering,Inc OP ID:31 - DATE 12/30/10 RM E r ngineerjn a division of Thielsch En ineerin9 Inc. �a kell Associat9es a divisio f Thiel h� ineeri}gi' ,Inc. A Laboratory,a c�jvlslon o lesch n lnderjn ,Inc. �t orptor�r,a drvi iqn o h n ineermg,Inc. ngmee nq ddivision �if�tc tglsch inee i ,Inc. ater a ageme ervices,a division of Welsch Rgineering,Inc. 91te n umer a�an usmess e u ation O icM o s g 10 Park Plaza- Suite 5170 , Boston,= ushetts 02116 Home Improventractor Registration _ Registration: 120979 m Type: Supplement Card z w Expiration: 3/25/2012 THIELSCH ENGINEERING ERIK NERSTHEIMER b '1341 ELMWOOD AVE. ° CRANSTON, RI 02910 A ti� Gy y s� Update Address and return card.Mark reason for change. ❑ Address Renewal R Employment Lost Card . DPS-CA1 a'9 50M-0004-G101216 ,per ✓die �\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration g79 Type: 10 Park Plaza-Suite 5170 Expira 12 Supplement Card Boston,MA 02116 THIELSCH EN 14,000, ERIK NERSTH _ 1341 ELMWOOD — CRANSTON;RI 029 _�:% Undersecretary Not valid without signature Licensee Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 100459 Restriction WS,IC Name Erik Nerstheimer City,State,Zip North Scituate,RI,02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Back To Search http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=CSL 100459 1/7/2011 NAT-24531 - 1 J Control No: 34244 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF LABOR DIVISION OF OCCUPATIONAL SAFETY J' 19.STANIFORD STREET, BOSTON,MASSACHUSETTS 02114 LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER RISE Engineering A Division of Thielsch Engineering, Inc. 1341 Elmwood Avenue Cranston, RI 02910 WAIVER: LW000672 EXPIRES: April 15,2015 IN ACCORDANCE WITH M.G.L. C. 111, § 197(B)(b)AND 454 CMR 22.03(3)(b), THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER IS ISSUED BY THE DIV. OF OCCUPATIONAL SAFETY TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF PERFORMING LEAD-SAFE RENOVATION WORK. THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER MUST BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L. C. 111, § 19713(b)AND 454 CMR 22.04 WHEN PERFORMING LEAD-SAFE RENOVATION WORK. HEATHER E. ROWE,ACTING COMaffSSIONER <J , Printed on Recycled Paper LOT `�- ti°`• g LOT 7 CD � 3e3 s � 0 36•� •o_ w , 93 201.41 r? CDC)- N79"0 3'58,E STONEY POND CIRCLE LOT 9 FLOOD ZONE "C"_ FO UNDA TION CERTIFICATION RES ZONE. "RF" TO WN.MARSTONS MILLS SCALE•1 "=40' PL.REF. 432 32 ELEV N/A I CERTIFY THAT THE ABOVE YANKEE SURVEY CONSULTANTS FOUNDATION IS LOCATED ON �`�N OF ��ss R 0. BOX 265 THE GROUND AS SHOWN, AND PAUL 9�yG UNIT 5, 40B INDUSTRY ROAD ITS POSITION DOFs ____— A. CONFORM TO THE ZONING LAW MER THEW V MARSTONS MILLS, MASS. 02648 9 No. 32098 0� TEL: 428—0055 SETBACK REQUIREMENTS OF9FG1$TER�O Qa�a FAX 420-5553 ARNSTABLE ------------------- JOB PA UL A. MERITHF,W � ' ^J DATE. ZI1•194 NU l?50421 fn d cSSPK /VU-U Assessor's office(1st Floor):" c Assessor's map and lot number d �- `� d <� � �� �� "� � �� i TMt T Conservation(4th Floor): �- ` 3 ` WITH TITLE 5 Board of Health(3rd floor): ENV1R0aMME��'i�L CODE AND • Sewage Permit number - 1< seas�r�nt a , Engineering Department(3rd floor):' �J' Y®VV1q`'RI EGULATI®NS � ■Y s639. . House number Ito 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 BAR ABLE BUILDING INSPEC 08 APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ✓ 19� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use Zoning District Fire District Name of Owner(I4 cJ yS4ti ✓T �_ Address• 1/>�,L Lc A 4�lbk Name of Builder 6&L44on Address O` O �( �2�1 (✓�Q Name of Architect Q Address Number of Rooms C> Foundation �itrLe Exterior rJJ Roofing A 19 - Floors �U -7L Interior Heating � S Plumbing V—CI" Fireplace ����G� Approximate Cost �S o o J Area 2� Diagram of Lot and Building with Dimensions Fee ✓©� 7r� ye� 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 k Construction Supervisor's License _Da�061 i HUGHES, CHET & SUSAN t No 36506 Permit For 112 Story <, Single Family Dwelling ^ Location Lot #8 , 72 Stoney Pond Circlel-�Marstons Mills ' Owner Chet & Susan Hughes f.. Type of Construction Frame - YP F Plot Lot i 1 Permit Granted February 2 4 ; 19 94 Date of Inspection:.. -Frame 19 Insulation '��' 19, Fireplace 19 Date Completed "� '19 f ` y tj i TOWN OF BARNSTABLE 36506 Permit No. ................ BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash � ,Yl ego• X HYANNIS.MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to CHET & SUSAN HUGHES Address lot #8 72 Stoney Point Circle, Marstons Mills USE GROUP FIRE GRADING OCCUPANCY LOAD 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. June 2 19......94....... `� ... ... .... ... .. .. ..... .. ... . ... �................. Building Inspector OF BARNSTABLE, MASSACHUSETTS BUILDING .P -#_' _ MIT DATE rCi'I Lia +' 't , 19 ' s PERM _,,-; IT NO. .49 365ns �1 PLICANT Jon I ittc,ii ADDRESS' 1-�. (.y: Y.i Ci;, _ / i`:Ci r'SS V. (NO.) (STREET) _(CONT R'S LICENSE) '�' i t �'' i •i ' - WUMBER OF PERMIT TO iitl;li... i�it•'CC-i_.L�.�lt, 1 j .iZt. '�'�:;: _.,,. ' t.,;�•ii.`_..�_11C (_) STORY - SWELLING UNITS (TYPE OF IMPROVEMENT) N0. (PROPOSED USE) / .U't: #8F 72 St i1.e V 011C: C1 ' arc;$ont} 4411E ZONING llr` AT (LOCATION) DISTRICT (NO.) (STREET) - BETWEEN V AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT, WIDE BY FT, LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT-WALLS OR FOUNDATION (TYPE) Se-wane IT34-1 REMARKS: 1so d I AREA OR 1270 sq. it. 125�000. 0C PERMIT 101. 75 VOLUME ESTIMATED COST FEE (CUBIC/SOUARE FEET) OWNER Citi u & Susan Hughey + ADDRESS iirIaIc. P dc. +iZ marStons 1"Ill BY BUILDING DEPT. ' 1� THIS PERNJT•:ONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. '2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN MADE, 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION AFVROVALS /'�� PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2i G a o 2 /� 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT s _ �O 2 9�40ARD OF HEALTH / llr�S OTHER SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'N!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. l t > - 0`r+/N bF,BARNSTABLE, MASSACHUSETTS BUILDING 'R ' ■ DATE 19 PERMIT NO. i•40 6506 v C•,:1 !�Y)_1.C._i.I , t'. iJ: ..7 L,:. ` .. / ..,._. .._.1:- :1_L.. :t U U J l/ Cl APPLICANT ADDRESS ' -- (NO.) (STREET) ICONTR'S LICENSEI PERMIT TO c3Ull:3 ��'V;l:.i.Ll�lt) j 1 S'I'--;j.L�1 •]•�,;,- �i / L)C'i'`i.j- i'jCNUMBER OF (_) STORY "bWELI_ING UNITS (TYPE OF IMPROVEMENT) N0. '1PROPOSEO USE) ,moo 'D /i :i,.:iil-li:yl G,lU �'i:.i;�..'� ,.�..__;f.:�..1:J ,_�l i:.. ZONING AT (LOCATION) DISTRICT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) I LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION f TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR nn PERMIT 0 VOLUME 1''` 70 'Ll• L:t 1c5 vti . l�l� ESTIMATED COST $ FEE (CUBIC/SOUARE FEET) l ac:i S �iU:, c1 1'=U�i1L OWNER ' Li 1CilC :c�L :i, to Yu%V11y ,':111. BUILDING DEPT. ADDRESS BY .t/? •�' ! l// c 1 THIS PERMIT ::ONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANEN'.*LY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. '2. PRIOR TO COVERING STRUCTURAL QUIREO,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI 70 BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE $, OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION AP ROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS K 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 1 BOARD OF HEALTH OTHER SITE PLAN REVIEW APPROVAL &44,1 WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'N!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION BUILDING P EKiIT NO. 3��p DAT- 0 f 9 9 Via; ASSESSORS PARCEL NO. p CONTINUATION OF ROAD BOND The undersigned* oumer/c3ntractor hereby agree to maincain their road bond in force. until the following work it.e_s ara cc=letzd to the satisfaction of the En gineeri:.g 'Sec::-on of the Depar=ent cf Public wor'_cs: ,1 lcan and seed shoulders as saon as weZther pe-- ts: 72 ,l S7 ;LD (G;ti►;c.:.!CC:; C:CR) —(print --name ) --- - ------ - • 7: r•` �r COMMO k.c c= ID T:-r/J1;")`02\TT O r P.NTD U STTr4Q%ACCI D ENMS �amcs: Ga-s��e� OSTON. J\,LASS.ACI-JUS-TSS 02111 -W0R}C£RS'COM7'F-NSA310N INSURANCE AFFIDAVIT 1, (iccnscc/permiacc) with 2 princip21 plxc of business/residence 2c do hereby ccr 66—, undcr the pains Znd pcnzhics ofperjur);� char. j] l am 2'n employer providing ncc following workers'compensation covcr2gc for mycmployccs-orking on xhi< job. lnsuranee Company Policy Number l 2m 2 sole proprietor and have no onc working for me j] 1 2m 2 sole proprietor,gcncr.J eoraraor or homeowner (arcic one)z nd havc hired the eontr2aors Iisted below• -who hzvc the following works^compc=don inn=ncc politics: 1,7=mc ofConrmcror Inscusncc Comp=y1policr Nummbcr -2mc ofContractor Insurance Company/Policy Numba 1amc ofContmaor Inn=ncc Comp=yfPoliq Number Q 1 Zm 2 homeo k-ncr performing ell the work mysdL ItiOT� 1'k=sc be aM_.rc t!•_tv.?-s7<l:eo<o•mcrs�o erployper�oe:to 20 ra:;ctcasotc„eoortnset;oo otrcpait�ork on_ 1�c1lins of no:raor<tl:�tSrcc t:civ is�+:i�L<bocaco,-=cc 2.1so r<j;des or oe the soouels appunCC=t tSacto uc rot EeuC-vY «nr;dcrc J to be employers vLcr tSc for:<ri Corapccs.t;oc AR(GL C.152.sect.1(5)).applicat;oo by:borxo«acr fora lieeas< or p<rrn;t r.._y<.•idccc< t_c 1cfJ:tars c!:=cr_-loycr cacr tic Workcrs'Ciomp<o:atioc Act i uaccrstanc tract c copy of tr, sc_t<rn<r.,.ica ic.-•ulce to ti,c Dcp_:-r..cnt of lndu:triJ/.ccdcnu'Or,«ofl-isc::nu ��crifie=tion sd th_t f:.;l ue to sceur<eor<rz�c::r<Su;rcd undcr Section 25/t of MGL 152 a:n lcrd to tsx impos;uon o%jr ina3 p<nJc;cs consisting of a fine of vp to S1500.00:r.1Jcr i�rri onnest cf vp to onc yt2r and c;Q pcnaltici in the form bf:Stop clock Order acid a I fsn<of S 100.00 a day against nv- Signc this CtZi day of _. 19 ccn. 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Ti. :. s>.y . � +� `'a ,.�;r• —__—fir__ _. _� .. .... .._. ._ �\f�c� �Ix15 FA C a A. �LU/N ourT6a t-: LtA I'>G24—.._: ' � - Y� :'II:F`•to�t�b'•+' '� jl___. � i{X8 LOFFIT.WIT71: q. - - ve- 75 , • - :'J:rf.�.••:;. � _, sl -h' _y.____Yo'FIrb2EOl.py. _ ; ..--t.1"COX SN GATMIN •t �. ;�.,•;.N .,)1• LAP •i}.'::,d,r �' -_._ J i ' V.0 514ING1 r-S REAIL , .. � .fir..•.�'•3.. f � N �_ANry 517CS . ' •... ... _: •.,.:. .o.;...� Wit•_.@.-------- ��-�•O-F` •I11'�, ! ' '?'t;,• sT. •-AyLSt4=.r COo .:r,'•t•' -./g^:ps.Y..sur,>FLooR __ 1 .-t� 1x`,11.L ON 51t1•F1lL a• '' t w. 1914 ` (c 014 1 1 yulL-nIWG - GENr 2�/11_1_q SE:C T 1 n IJ - 69 `It 4 or -i :I I I - I• a 1. ��� COMMONWEALTH 0 PARTMENT OF PUBLIC SAFETY A ' OF ''!'t•910 COMMONWEALTH AVE. , nisi BOSTON,MASS.0221S 3 a MASSACHUSETTS 's r3 ENCLOSE CHECK OR MONEY ORDER LICENSE EXPIRATION DATE Ig.CONSTR. SUP ER V I SOR ' FOR REQUIRED FEE, 06/30/1993 j ,`. RESTRICTIONSr.-.EFFECTIVE DATE LIC NO. :j' bi' ,. . MADE PAYABLE TO NONE s U6/30/1991 009909 ,,,-J "COMMISSIONER OF PUBLIC SAFETY" a'W_BARNSTABLE MA 02668"' 'jRSE •'N FE INC�'_•EAc ~� " PHOTO(BLASTING OPR ONLYI FEE: yjLE;; a 100.00 4 •i. ' CTIVE F 1 ,� 1989 HEIGHT: I,` hOT•VAIID UNTIL SIGNED BY LICENSEE AN o OFFICIALLY"' 1 STAMPED'''OR-SIGNATURE OP THE,COMMISSIONER .L �r-� ////// y`I`F- ' f'.iv� p�0 T D E T A u � � p ' r THIS DOCUMENT MUST BE : F'•.A.rl _ t.i y,a t i .•47� L .��! N S E 7��1�. C7 ' CARRIED ON THE PERSON OF '-Lx T,SIGNAT iE'OF (ICES ;'I SIGN NAME IN FULL•ABOVE SIGNATURE LINE„ OTHERS RIGHT4HUMB PRINT THE HOLDER WHEN ENGAG I r EO IN THIS OCCUPAom TION. .k• 1 - x ( 200 M'2•B7 Q]9zg_. _ / `"mot^^.k y • j I I � � i i i —...=~ ate.. ��rw�......��........— - ,�......�•..-�•�_,_.,._•_.------- r COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY OF ONE ASHBORTON PLACE MASSACHUSETTS BOSTON,MA 02108 5 Fallaro to pasae*s a oarrsat RdseeccA.rr�dt%b�.rPt!w�BePl�Irf� L I CEN'_;E r®en:.T?!ua .,� �• EXPIRATIONDATE FADNSTR. :_;IIPERVI•=1IR CAUTION '� ��r•"��(' EFFECTIVE DATE UC-NO. FOR PROTECTION AGAINST RESTRICTIONS. .)v•_ J THEFT, PUT RIGHT THUMB NONE o i 6/_:0/199 0( CV-5) C) o PRINT IN APPROPRIATE 6 6 BOX ON LICENSE. _ION P BR I TTON g,..:;"'—"8CA5�NT"pPERATORS # m P i BOX 492 m MUST INCLUDE PHOTO. PHOTO(BLASTING OPR ONLY) FEE: I BARN':TABLE MA c i26._-:1 •+ `-� ��' ' 100. 00 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: STAMPED-OR.SIGNATURE OF THE COMMISSIONER -% 11 AV 4 1 - � ; ' .,,•-- ,.z _—� . THIS DOCUMENT MUST BE M SIGN NAME IN-F�.LP�VE$IGNAfI�iE LINE CARRIED ON THE PERSON OF SIGNATURE OF LICENSEE THE HOLDER WHEN EN- OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. ,