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0139 TIMBER LANE
�39 ?mb��' �ar,� 1 - -_ -- _. _ v i'. �O r � CeCQ.9 oFt rq� Town of Barnstable *Permit# Expires 6 mo, s rom issu ate Regulatory Services Fee r � * SARNSfABI.E, r Mass Thomas F.Geiler,Director �A 039. lED MA'S� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Map/parcel Number 141 Not Valid without Red X-Press Imprint t Property Address f 31 esidential Value of Work$ 7 ow Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 'L(e- Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: "T�a peew�at� uwa . c,a>n�. Construction Supervisor's License#(if applicable) cj r A- FIER ❑Workman's Compensation Insurance MI " Chec SEP 2 4 I am a sole proprietor 20�3 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name BARN STABLE Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Rp-r6of(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑'Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: r Q:\WPFILES\FORMS\building permit forms\EXPRES(—jdc Revised 060513 I ... . ... .... .... c. Rze Commonweal*of Massachusetts Deparhnent of Industrid Accidents - Office of Investigations s 600 Washington Street Boston,MA 02111 ",m mass.gov/dia Workers' Compensation Insurance Affidavit: Bugders/Contractors/EiectricianslPlumbers Applicant Information Please Print Legibly Name(Ba�OWniz;&onlindividnal)-. J. &4-4 Y 6&a-pa NY�ir Address: ;L `7 -- City/State/Zip: tP+��vS° S ��s �"" Phone#: Are you an employer?Check the appropriate box,: Type of project(required): - ❑ 1.El I am a employer with 4 ❑ I am a��contractor and i 6. New oans5nrction loyees(full and/or part4ime)* have hired the sub-contractors 2.LZ a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-oontractors have g_ ❑Demolition. working forme is any capacity. employees and have workers' 9. ❑Building addition [No workers' comp_insurance comp.insurance., required-] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all wont officers have exercised their I LE]Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]I c-152, §1(4),and we have no employees.[No workers' 13-❑Other comp.insurance required_], '"Any applicant that checks boat#1 must also fill out the:section below showing their woxters'compensation policy infflrsastian- 1 Homeowners who submit this affidavit indicating they ace doing all woak and then hire outside contractors most submit a new affidavit indicating such- lComtcactors that check this boot mast attached an additional sheet showing the name of fe sub-ors and state whether or not those entities have employees. If the sub-contndors have employees,they must provide their workers'comp.policy number. I am an employer that is prmdding workers'cottrpensatfon insurance for my employee& Below is Ste policy and job site inforwtation. ',,ice Company Name: Policy#or Self-ins-Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(shelving the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c. 152 can Lead to the imposition ofrriminal 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 ce - tinder the pal attdpenaldes ofpedury Statthe information provided above is hue and correct Si tore: Date: / Phone#: E;-Od— ;w d K. Qf icial use arty. Do not write in this area,to be completed by city or town officiat City or Town: PermitUcense It Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylI'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied., oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal.entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withb,old the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required_ Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple pennit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.V&ere a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-977-MA.SSAFE Revised 4-24-07 Fax# 617-727-7749 www.ma.ss_gov/dia °F'ME r Town of Barnstable ti Regulatory Services ` HMAMSTA"B E. Thomas F. Geiler,Director Mass Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis;MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work,authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date I Q:FORMS:OWNERPERMISSIONPOOLS 6/2012 A Town of Barnstable Regulatory Services 9BIRNrA .KABS.lEg Thomas F.Geiler,Director �i01F0 39. 16 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction SupervisoIrs);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section'2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,otir Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doe Revised 053012 Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supcn-isor 1 & 2 Famih License: CSFA-057540 DAVID J GAOL >-- �•r. 217 A TI 04t MARSTON ' 8 �� Expiration tom• ` Commissioner 12/28/2013 -_ V/G Qii7t�I6o9'ClIl6CG�lfl.O��G�L14C7,C�(t?8�' 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: ;egistration: 1 14561 Type: Office of Consumer Affairs and Business Regulation ___ Expiration:,: 10/4/2015 DBA 10 Park Plaza-Suite 5170 DAVID GADY CARPENTRY Boston,MA 02116 David Gady 217A Timber Ln g VL C Marstons Mills,MA 02648 Undersecretary Not valid wit ut signature TOWN~OF BARNSTABLE R I S E Division of Thielsch Engineering,Inc. 1Q63 NAY 10 AN 11: 10 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 139 Timber Lane has been inspected by a Building Performance Institute (BPI) certified Professional. All work performed meets or exceeds Federal and State requirement. Sincerel , 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 C 0IkET� ` own ®f Barnstable *Permit# Exp', S n+on s rom fh issue date 2e ul�to�- Services Fes mMSTABLE. g Y =' .`�•� �' � Thomas F. Geiler, Director � Building Division U Tom Perry, CBO, Building Commissioner �Q�/�/ G 7Q j� 200 Main Street, Hyannis, MA 02601 OFSARNST www.town.barnstable.ma.t.ts Office: 508-862-4038 '9SL� Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY (� Not Valid without Redd Y-Press Imprint Map/parcel Number I Lt r dt, Property Address 1 ,3 L7 �idential Value of Work Sew Minimum fee of S25.00 for work under S6000.00 Owner's Name& AddressQcr Contractor's Name -_T�,,Q-y e*J 60-a Y Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ?�{ ❑Workman's Compensation Insurance Chec one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. 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) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic.Conservation,etc. *"Note: Property-Ow er must sign Property Owner Letter of Permission. Home I p e e Contractors License& Construct Supervisors License is required. SIGNATURE: Q:\WPFIL:ES\FORMS\Express\EXPRESSPE MIT.DOC Rrvice0fn409 • iviassachusetts- Department of Public SafetN r Board of Building Regulations and Standards M1 1 Construction Supervisor License License: CS 575Q Restricted to: 1 G , DAVID J GADYt 217 A TIMBER LN MARSTONS MILLS, MA 02648 Expiration: 12/28/2011 . ('ummissiuncr Tr#: 14061 OffitE tVEMENT �u!s/HOME IM CONTRACTOR before tLicense or registration valid for indiv dul use only j before the expiration.date. If found return to: Registration• - i �. `114561 1 Office of Consumer Affairs and Business Regulation _ Expiration:�1.0/4/2011 Tr# 288716 I 10 Park Plaza-Suite 5170 Type: _pg I Boston,MA 02116 I —' i DAVID GADY CARP'E-N?''R�r I David Gady1 i 217A.Timber Ln Marstons Mills, MA'.i)264 _ L�� I Undersecretary s4 s.:y - - Not valid withou signature _ I •a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 :�•`� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print JLe ibl Name(Business/Organization/Individual): Au (9 OLD Address: l`( dot --rav_'b, UC119- ays�," S - Phone.#: City/State/Zip: . Axe you an employer? Check the appropriate box: Type of project(required): 1.❑�Plo employer with 4. 0 I am a general contractor and I � have hired the sub-contractors 6. ❑New construction yees (full and/or part-tim.e)..2. sole proprietor or parhier-' listed on the attached sheet. T. 0 Remodeling ship and have no employees These sub-contractors have g. '❑Demolition workingfor me in an capacity. employees and Have workers' Y P h'• � 9. ❑Building addition [No workers'.comp.-insurance comp. insurance. required.] 5. r] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their l l.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant.that checks box#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. XContractors 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure fo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification 1 do hereby certify under the pal and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: 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 information and I.nstrUcti®ns Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. . Pursuant to this statute, an employee is defined as "...every person in.the service of another under any contract of hire express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not.more than three apartments and who resides therein, or the occupant bf the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a.license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance«ith the insurance requirements of this chapter have been presented to the contracting authority.' Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contiactor(s)nanie(s),address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Compauies*(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirniation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple pennittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Sile Address" I.he applicant should write"all locations in__(city or town),".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as roof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each p year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Department of Indtlstri,al Accidents Office of Ynvestigati.ans 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov(dia � r Town of Barnstable e . Regulatory Services 9x' �B $ Thomas F. Geiler,Director i639- �Fo a Building Division 0 Tom Perry,Building Commissioner 200 Main Street, Hyanuis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: S08-790-62 Property Ovmer Must Complete and Sign This Section If Using A Builder 1 as Owner of the subject property hereby authorize I)AV 116 C 9 611�t 0 y to act on my behalf, in all matters relative to work authorized by this building permit application for. c39 r ti .l C. Hav,,47�,,5 VA,ccs (Address.of job). AW Signa e of Owner Da LOA Y. • Print ame If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. To of Barnstable -THE y y�� o Regulatory Services Thomas F. Geiler,Director BA RNS-r"LF— �P i6 Building Division rED '� Tom Perry,Building Commissioner 200 Maio=Street;—Hyatmis;MA 02t501 vrww.town.barnstable.rna.us Office: 509-962-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. •- DEF9,TMON Ol?130MEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homowner" shall submit to the Building Official on a form acceptable to the Building Official,that be/she shall be e responsible for all such work performed under the building permit. (Section 109.1.1) ibility for compliance with the State Building Code and other The undersigned"homeowner"assumes respons applicable codes, bylaws,rules and regulations. The undersigned."homeowner"certifies that-he/she understands the Tpwn of Bar.a.stable•Building Department minimum mspecti procedures and requirements and that he/she will comply with said proce.duies rand re r,4ri�nts Signatur of Home'ovmer t. VIV #a' • t Approval of Building Official j Note: Three-family dwellings contaLnin `3` 0 ie for 1a". will b � ed��to r tply with the State BuEding Code Section 127.0 Construch� 1 , ].0MEOWNER'S EXEMPTION The Code states that: "Any homeowner perforrning work for which a building permit is required shall be exempt from the provisions of this section(Section 1o9.1.1--bccnsing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall ad as supervisor." Many homeowners who use this exemption arc unaware that they are assuming the responsibtlitics of a supervisor(see Appendix Q, Rules&Rcgulations'for Licensing Construction Supervisors,Section 2.15) This lack of awareness often rrsu)Ls in serious problems,particularly when the homeowner hires unlicensed persons.' In this case,our Board cannot proceed against the unlicensed person'as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the bomeowner is fully aware of his/her responsibilities,many co require,as part of the permit application, that the homeowner certify that hc/she understands the rrsponsibilitics of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt sueb a f6umiccrtification.for use in your community. TOWN OF.,BARNSTABLE BUILDING PERMIT.APPLICATION V A166 , )(Map Parcel. ),Applicatidh #0"' Date Issued 5 41,- Health"Division u Conservation Division ''-Application Fee �._,Perli`it Fee Planning-Dept: Date Definitive,Plan Approved by Planning Board Historic OKH Preservation Hyannis Project Street Address I 35' Village Miut6-6ni 111,11-S. Owner 7;),6,v LOA F52�>PJ ks.Ir Address 139 -7-1 1�� LA-,-.e— Telephone -,s;z I - Permit Request PIf )C.1 IrX154,ti Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District -Flood Plain Groundwater Overlay Pr9ject Valuation 404* -Construction Type bJ 00 Z> L6t Size Grandfathered: U Yes U No If yes, attach supporting documentation. Dwelling Type: Single Family .�W, Two Family Q Multi-Family (# units) Age of Existing Structure I? Historic House: L11 Yes &<_ On Old King's Highway: Ll Yes &<o Basement Type: U1611, L1 Crawl Ll Walkout Q Other Basement Finished Area (sq.ft.),- 9400, Basement Unfinished Area (sq.ft) 3 4V Number of Baths: Full: existing- 72, new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing —_new First Floor Room Count Heat Type and Fuel: L3 Gas &1O'il L11 Electric LJ Other Central Air: Ll Yes 2<o Fireplaces: Existing New Existing wood/coal stove: LlYes Q1110, Detached garage: L11 existing Ll new size—Pool: Ll existing L1 new size Barn: LJ existing Ll new size Attached garage: L1 existing L).new size —Shed: ®'existing Ll new size 4fAther: Zoning Board of Appeals Authorization L1 Appeal # Recorded L] Commercial Ll Yes G14o If yes, site plan review# "q 41 Current Use Proposed Use r wC) ry 7M, APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 9P 00 rn Name Pv Oth - Telephone Number &C04 t> Address License # &V�bi_cws Home Improvement Contractor# < IL4 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO "&V llt4"_ SIGNATURE 44.41 6A DATE le.-'Zo i 0 k` FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE - OWNER 1 "-DATE OF INSPECTION: a-� f FOUNDATION FRAME D V,3 l0 yzx INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ,.FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO: � r Town of Barastab e Regulatory Services Thomas F. Geiler,Dixector 16y�)'l� Building Diisiori Thomas Perry, CBO,Building Commissioner 200 Main Strcee, Hy�s,MA. 02601 www.town.barnsta b1e.nla.us • r Fax:. 508-790-6230 'Office( 508-862-4038 PLAN REVIEW Owner: /AU L F Map/Parcel: 7 cI d �L�r .`�it-A Project Address /. 3 L� Builder: . itch The following items were noted on reviewing: 1064 S zZ Vo0 6s �x (e l v 'Gv)b� « S o y P610 149 �lrirriev6- PE E C_ ; Reviewed by: Date: The Commonwealth of Massachusetts "Deparftnent of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation insurance Affidavit: Builders/Con tractors/Electricians/Plumberg Applicant Information Please Print Leib1Y Name (Business/Organization/Individual): Address: XV7 `>—iw.le�. �..� . City/State/Zip: M&V446,5 (A Phone-#: '&d 4 a Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am -employer with 4. �] 1 am a general contractor and 1 6 New construction c ployees (full and/or partatn.e).* have hired the sub-contractors listed on the-attached sheet. T. E]Remodeling ..2. ' I am a soleproprietor or'pariber-' These sub-contractors have ' ship and have no employees 8. •�]Demolition . working for me in any capacity. employees and Have workers' 9 Building addition [No workers'-co insurance comp• u�surance.� comp. S. We are a corporation and its '10.[]•Electrical repairs or additions required. 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant.that checks box#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 prvvidb 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: _. Policy#or Self-ins.Lic.#: Expiration Date: 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 crimiri4l penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cent under th poi and penalties of perjury that the information provided aboveis tr�ead correct.Date: � — Phone : ���� ' _40 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 ,. Phone#: _ Information and Irn'tr'UctzOns Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "..:every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal enti ty, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or tiustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dweLlang house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house eto shall not because of such employment be deemed to be an employer. or on the grounds or building appurtenant ther " MGL chapter 152, §25C(6)also states that"every state or local Iicensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) slates"Neither the commonwealth nor any of its political subdivisions shall . ublic work until acceptable evidence of compliance Frith the insurance enter into any contract for.the performance of p requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if of necessary, supply sub-contiactor(s)name(s),address(es)and.phone number(s) along with their certificate(s)th insurance. Limited Liability Companies.(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permiWicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town),".A copy of the affidavit.that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations. 600 Washington Street Boston, MA 02111 Tel. #617-727-4.900 ext 406 or 1-877-MAS.SAFE Fax# 617-727-7749 Revised I1-22-06 www.mass.gov/dia �YHE, Town of Barnstable Regulatory Services '" MASS.� � Thomas F. Geiler,Dfrector 1 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder T ?0'U L-pt It-yt--t-m , as Owner of the subject property hereby authorize 'b iAv i4 Y to act on my behalf, in all matters relative to work authorized bythis building permit application for. (Address of rob) w r ture of Owner to �i4 Print Name If Pro er Owner is applying for permit please complete the . p PP Homeowners License Exemption Form on the reverse side. Q:PORM S:OWNERPERMIS SION Town of Barnstable ��z►+e ram, , Regulatory Services Thomas F. Geiler,Director i BA"STABLE, MASS.- Building Division ATfD 1iu'v a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: village number street "HOMEOWNER': work hone# name home phone# P CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such homeowner' shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and w, . requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,006 cubic feet_orlarger will berrequired to,corn with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that ht/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC Restricted to: 1 G N'lassachusetts- Department of Public Safety 00- Unrestricted Bohrd of Building Regulations and Standards 1G-1 2FamilyHomes Construction Supervisor License License: CS 57540 Restricted to: 1 G Failure to possess a current edition of the DAVID J GADY Massachusetts State Building Code 217 A TIMBER LN is cause for revocation of this license. MARSTONS MILLS, MA 02648 a Mass.Gov/DPS Refer to: WWW. o— J � 'f�`-` Expiration: 12/28/2011 ---- -- ('�rmmissinner Tr#: 14061 f" OmW HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only Registration:.;- before the expiration date. if found return to: 114561 Office of Consumer Affairs and Business Regulation Expiration::'A_ 0/4/2011 Tr# 288716 10 Park Plaza-Suite 5170 Type: DAVID LADY _ - -_ Boston,MA 02116 CARPENTRY`- .~ "` David Gady 217A.Timber Ln Marstons Mills,MA;,0264 Undersecretary Not valid withou signature I GUNv-C�- 6-K- `T® fin `L J 1 IN-LINK FENCE vy t V Q O 26 38' LP . �• I I :r ,� ��, cn rLl -ta V N 1 a 1a n, ; Ef i S F i NG THREE ti STOCKADE FENCE NCE C.f l/t Ri O BEDROOM DWELL I Nti i �y `r s 6 O A T i 116.69' t 43 1 - TI MBBR L ANE 108666 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I I Parcel Application # 0010 O�� 3 5 Health Division Date Issued 4 Conservation Division Application Fee y "� Planning Dept. Permit Fee �- Date Definitive Plan Approved by Planning Board 9 Historic - OKH Preservation/Hyannis Project Street Address 139 Timber Lane Village Marstons Mills Owner Paula Finkle Address 139 Timber Lane Telephone 774-521-3432 Permit Request air sealing, attic insulation, install 5 soffit vents, insulate 16sq ft of basement ceiling Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2712 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No • Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ 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 401-7842-3J00 Address License # 100459 01 n N Home Improvement Contractor# 12097An Worker's Compensation # c u o an ALL CONSTRUCTION DEBRIS RESULTING ROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 3/19/10 Erik Nerstheimer for RISE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/`PARCEL NO. ADDRESS VILLAGE OWNER V DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE •j' -_1 - ELECTRICAL: ROUGH FINAL `= = PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - DATE,CLO-SED OUT ASSOC IAT- ION-1PLAN'NO .. te,e r j• . The Commonwealth of Massachusetts Department of Industrial Accidents Off gee of Investigations 600 Washington Street Boston, MA 02111 UV >`www.mass.gov/diva Wo,rkelrs9 Co»ImpensatIlon ffnsulranee Affidavit. Dann➢dears/cContracto>rs/IE➢ectiricia s/Pllumnbelrs ➢meant Inform 2tion Please Print, Legibly Name (Business/Organization/Individual): RISE Engineering; A Division of Thielsch Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone #: 401-784-3700 or 1-800-422-5365 Are you an empl®yetr?Check the�pproprnate box: Type of project(required): 1.® I am a employer.with 4. ❑ I am a general contractor and I 6 ❑New construction employees (full and/or part-time).: have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ME] Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions .myself..[No workers' comp. c. 152, §1(4),and we have no I2.❑ Roof repairs insurance required.] t employees. [No workers' l3.❑x Other Insulati comp. insurance required.] on °Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. i 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 their workers'comp.pol icy infonnation. I am an employer that is providing workers'compensation insurance for may employees. Below is the policy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-.ins. L2ic. #: WC2-Z11-259874-019 Expiration Date: 04/01/ 10 _ Job Site Address: 1",� � � l City/State/Zip:�C 'h �� V Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certo undir�the `ins an -penalties of perjury that the information provided above is true and correct. Signature: ;,^;,�/' -�,° �. - Date: Nei 1 C ��-�- Erik Nerstheimer for RISE Engineering Phone#: 401-784-3700 or 1-800-422-5365 Ext. 133 Official use only. Do not write in this area, to be completed by city or town official .City or'Town: Per # Issuing Authority (circ)e one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ! ra8e t oI t i 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, R1, 02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Back To Search Board of Building Regulations and Standarlt Lkense or registration vaFid for individiil use only j HOME IMPROVEMENT CONTRACTOR I. before the expiration date. If found return to: Registration:. 120979 Board of Building Regulations and Standards E`zp.i_`ati:o:n_=3j25/2010 is One Ashburton Place Rm 1301 upplemeni Card i _ ' �1,1�42. 021,0.8 iIELSCH ENGINEER+I. ;_�.�_i tag=•-'::::' ii 21K NERSTHEIMER—;_ s.. _;_, i 41 ELMWOOD.AVE` ' ' 2ANSTON,RI 02910 '-- �i -- -- Administi: ibr ------ ?' o va wt ou .—I N t 1'd 'th t sign http-.Hdb.state.ma.us/dps/licdetalls.asp?txtSearchLN=CSL100459 a/1)A/1)nn� r A ORD CERTIFICATE OF LIABILITY INSURANCE OPID 27 DATE(MMIDDI� PRODUCER THIEL-1 I ;U 15 09 The Pr6ston Agency, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO 1350 Division Rd Suite 303 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Box 810 HOLDER-E CSO ERTI CAIE DOS NOT AMEND ICIES BELOW East Greenwich RI 02818-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE INSURED NAIC# INSURER A Bartford Underwriters inn Co Thielsch Engineering, Inc INSURERS: Bartford�1t, T„n„�,,,e Thielsch Group Inc. Co H1 Tech Realty Inc. INSURER C_ T-iberty Mutual lnstLranmGrotp 195 Frances Avenue INSURER Amerlc:an ci Cranston RI 02910 D: North E COVERAGES INSURER THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR LTR NS TYPE OF INSURANCE POLICY NUMBER D%E LJMftS GENERAL LIABILITY EACH OCCURRENCE b 1 000,000 A X COMMERCIAL GENERAL UABIUTY 02UUNTD5678 04/01/09 04/O1/10 PUPMA(��Tv HEN REMISES aooIED b300,000 CLAIMS MADE OCCUR MOD EXP(Arty one Person) b 10,000 PERSONAL BADV INJURY b 1,000,000 GENERAL AGGREGATE b 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY X Esc Loc PRODUCTS-COMPIOP AGG b 2,000,00 0 AUTOMOBILE LIABILITY Emp Ben. 1,000,000 B X ANY AUTO 02UEr1TD4850 COMBINED SINGLE LIMIT 04/01/09 04/01/10 (Eaacddent) b 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS (BODILY INJURY $ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY b (Per accident) PROPERTY DAMAGE (Per accident) - b GARAGE LIABILITY AUTO ONLY-EA ACCIDENT b ANY AUTO OTHER THAN EA ACC b AUTO ONLY: AGG $ EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE b 10,000 000 B X OCCUR ❑ CLAIMS MADE 02XHUUF6573 04/01/09 04/01/10 AGGREGATE b 10,000,000 0DEDUCTIBLE b X RETENTION b 10 000 b WORKERS COMPENSI►TK)N AND b EMPLOYERS'LIABILITY X TORY LIMITS ER C ANY PROPRIETORIPARTNERIEXECUTIVE WC2-Zll-259874-019 04/01/09 04/01/10 EL EACH ACCIDENT b 500�000 OFFICER/MEMBER EXCLUDED? If as,describe urWer E.L.DISEASE-EA EMPLOYE b 500,000 SPECIAL PROVISIONS below OTHER EL DISEASE-POUCYLIMIT b 500,000 D Professional Liab DVL000025902 04/13/09 04/01/10 Prof Liab 2,000,000 A Leased/Rented Eqp 02UUNTD5678 04/01/09 04/01/10 Equipmmnt 100 000 DESCRIPTION OF OPER/171NIS/LOCATIONS I VBfCLE$1 EXCLUSIONS ADDED BY ENDORSEMEN IT I SPECML PRMISIONS *Except 10 days for non payment of premium. Holder is included as an additional insured when required by a written contract with respect to the General Liability coverage. CERTIFICATE HOLDER CANCELLATION TWNOAKB SHOULD ANY OF THE ABOVE DESCRY POLICIES 13E CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE EMWIG YIIdL ENDEAVOR TO NAIL *30 DAyS wmrrFN NOTICE TO THE CERTIRCATE HOLDER MINED TO THE LEFT,BUT FAILURE TO DO SO SHALL ONPOSE NO OBLIGATgN OR LIABILITY OF ANY KIND UPON THE W$URM ITS AGENTS OR REP<UMBITATMS AUTIIO� I ACORD 25(2001/08) ©ACORD CORPORATION 1 r n % �.�- E`."""r!h1e18Ch yg t Also for RISE Engineering, a division of Thielsch Engineering, Inc. Gaskell Associates, a division of Thielsch Engineering, Inc. SAL Laboratory, a division of Thielsch Engineering, Inc. ESS Laboratory, a division of Thielsch Engineering, Inc. ALCO Engineering, a division of Thielsch Engineering, Inc. Water Management Services, a division of Thielsch Engineering, Inc. RISE ENGINEERING Federal ID#05-0405629 RI Contractor Registration No 8186 A division of Thielsch Engineering MA Contractor Registration No 120979 4 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,R102910 �l (401)784-3700 FAX(401)784-3710 CONTRACT R _^ �1i✓s/ Page 2 I S THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE Client p Paula Finkle (774)521-3432 02/ 108666 i SERVICE STREET BILLING STREET �,. J�-.C3 �!:'f• ` 139 Timber Lane 139 Timber Ln SERVICE CITY,STATE,ZIP BILLING CITY,STATE,LP Marstons Mills,MA 02648 Marstons Mills,MA 02648 /Y N J)� [ ;'Q JOB DESCRIPTION RISE Engineering will provide labor and materials to install 16 square feet of missing R-19 faced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $17.60 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. -$2,232.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Eighty&00/100 Dollars $480.00 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 A NK SPACES O / AUTHORIZED SIGNATURE- E ENGINEERING CUS OMER ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE RISE ENGINEERING Federal ID#05-0405629 e RI Contractor Registration No 8186 A division of Thielseh Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341.Elmwood Avenue,Cranston,1R102910 (401)784-3700 FAX(401)784-3710 CONTRACT Page 1 THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE Client# Paula Finkle (774)521-3432 02/23/2010 108666 SERVICE STREET BILLING STREET tz.% 139 Timber Lane 139 Timber Ln L ' � t SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Marstons Mills,MA 02648 Marstons Mills,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 home will be left with a healthful 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.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing. 12 man hours.This measure is available for 100% rebate from the Cape Light Compact. $792.00 RISE Engineering will provide labor and materials to install a—7"layer of R-23 Class I Cellulose added to 346 square feet of floored attic space. $380.60 RISE Engineering will provide labor and materials to install 3.5"R-13 faced fiberglass batt insulation to 171 square feet of kneewall area. $188.10 RISE Engineering will provide labor and materials to install 2.25"R-10 semi-rigid fiberglass board insulation to 207 square feet of kneewall ; area. / $558.90 RISE Engineering will provide labor and materials to install a 13"layer of R44 Class 1 Cellulose added to 446 square feet of open overhead / attic space. J/ $579.80 RISE Engineering will provide labor and materials to install insulation and weatherstripping to the overhead attic access hatch. j $25.00 �J RISE Engineering will provide labor and materials to insulate the back of 1 existing kneewall access hatch(es)with 2.5"rigid fiberglass board insulation,and seal the edge of the hatch with weatherstripping. $85.00 RISE Engineering will provide labor and materials to install 5/4" X 16"rectangular aluminum soffit vents to increase ventilation in attic areas. $85.00 J i Assessor's office(1st Floor): /// n Assessor's map and lot number �7 `7 V l/ os TN E too e Conservation Board of Health(3rd floor): Sewage Permit number { seal°raai 7 YY• Engineering Department(3rd floor): o° ie39• House number ,tp�r'r► Definitive Plan Approved by Planning Board t9 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:0o P.M.only TOWN OF , BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION _Jam ( C=Y20✓ tt- i2 � 31 i 19 5L TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1 y7 T;�%du t2 SI—OM✓/114 Proposed Use 5�!/ Zoning District Fire District d Name of Owner V& 1 H, S t4A/- Address � 3 / T�'�bey LN/ �/) L4P44Aw,*,%ls Name of Builder BG e2� f9 W�4I S Address 1A4 it r Name of Architect Address Number of Rooms 1Y/IA" Foundation �6 - Exterior e=V Roofing Floors �� Interior Heating Plumbing l� Fireplace Cost Area Diagram of Lot and Building with Dimensions Fee 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 SACHT, KEITH No 35592 Permit For Re—ROOF Single Family Dwelling Location 139 Timber Lane Marstons Mills Owner Keith Sacht Type of Construction Frame '•- Plot Lot Permit Granted December 31 ,� 19 92 Date of Inspection 191, Date Completed 19 r • x i , i i . t FEE (a ca TOWN OF BARNSTABLE, MASS. ow 19 � wgco O •� THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO cc U � �..� U ..._....................._..............................................»»................................................................................................ ..........._..v��................................................._................._..._ 0 �� (PROPERTY OWNER) (ADDRESS) `J r/1as EI^� rJ'd (BUILD) (ALTER) )REPAIR) w4 N OS ......................................................................................................................................_.._...__._.._.........._................. ................................................_............._............. ._._.__ C a N (TYPE OF BUILDING) (APPROXIMATE SIZE) O w o � LOCATION ................._.......� _..................................................................._.........._..... ..._............................................................................................................_... y V ( . ._ STREET AND NUMBER) (VILLAGE) � PD NAME OF BUILDER OR CONTRACTOR _._.... ._..._».»................................»........................................_......_...................._........._........ ............ r_...�� M � � APPROXIMATE COST 0 OeoOS I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN m OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. 0 M >.Q 0 a U= a � _....._....»............_._._......»_—...................................................................... _......_._..........._............................................................................................................................ h u0 g fop (OWNER) (CONTRACTOR) (�ONaq v O U _._...__.............__..............—....._.._......._....._._.._._.................................................................................. � a BUILDING INSPECTOR Subject to Approval of Board of Health. b � r -71 Assessor's map and lot number ... "..: �" ......... Sewage Permit number ........ ....r�. .................. ... v *THE' TOWN OF BARNSTABLE Z B9SBSTABLE, i "6 9 0 M BUILDING INSPECTOR � PY�`' U . . APPLICATION FOR PERMIT TO ..... ...... . ......... ....r.. .. ......��..�.:�-........,1...,�!1..1!l.�/.....................::.��., TYPE OF CONSTRUCTION . .�..... .'.......p } � ? ..:................................................ �. . ... .. .. .................19�4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby appliesapforda permit according to the following information: y� M Location !., .!....�.. .........` rl.� .Y �.-:P.N..E.......0....MARS f••����„ IFI � •���........ . . .. . . . .. ........ y ProposedUse ....... .................................. .........�........,....... ....................... ............................................................... Zoning District -........-......... (�......1>';•Z--....................................Fire District ....... ..... ........................................... ...;: Name o�f Owner` L- a � I%.. . . ....... ..�....t... ddress ....... ..-..�........ .... ............ . e. ... s` Name �of Builder ....................................................................Address .................................................................................... .NAR0 H I �!l`=14L =fit r= E��,?. ......... 1 �i Name �f Architect ....:�.............."....,e.,. ..............,......��:............Address .,..,.........:.. CSC......,..�_...,..... '� �<,>...... y r� . 4T�4 w rrt a i.!u.�....................: tt Number of Rooms '� >. t� Foundation .. C�............... c:.: Exterior`f�, ....... ............................................ Roofing ..............................................u .................... . u . ..,.... : / I 9'° �.• �,t� �..� Interior ..�. ►.c!, .. ...... _ Floors ................................... \. Heatin � .....................Plumbing ....... ka. ........ a Fireplace ....................................................................... Approximate. Cost ................... ..... r 9 ... :. a Pp Y g `_-------------- ..... .....: � I Definitive Plan Approved b Planning Board _____________ � 19________ . Area �. c� .¢mil Diagram of Lot and Building with Dimensions Fee r -_ SUBJECT TO APPROVAL OF BOARD OF HEALTH r a K� II �A I , II" 6 otdi A I 9 q R I 0til Gli� d II here y agree to._,conform to all the Rules and egulations of th__e Town-of_Baarrnstoble-,egarding the above -_._constr-uefi"on. j__III �N L � 1!�� `tName .�.. � Columbia Leather Co. , Inc. qTimber Lane � PERMIT REFUSED � -------,-------------.. lV � .------------------.------- .------.-----------.-------.. � � —'----'—^-----------^-------' --------------------''-----'' � Approved ................................................... lg -----`--------------------.. ' -------`--------'---------'' � ^ l+T'w'^•!"'-y.^.._�-.. ...,. : .- _.-:..-- ,, -�... .'-..X..,.-.,.. _ �....,��..�..� _'ry".'_._.., ro .�-..;a�YS;.A:......... ..iYir ��-,♦..,h-^...p. ry Rs�-,.�. .. ..•ta+_..-.. .� aa n � I , Assessor's map and lot number ..../ �...S4?............ UGV. IC SYST' ST�number - INSTALLED IN COMPLIAHM �� ,... �.,��..°... . WITH ARTI%j U STATE Sewage Permit number ........ ........ . SANITARY CODE AND TOM REGULATMS- y�F7NET��♦ TOWN N OF, BAyRNSTABLE i EARNSTeDLS, OY � BUILDING INSPECTOR APPLICATION}FOR PERMIT TO ..... . . ........�1 .. ...�../ .... .................................... TYPE OF CONSTRUCTION ...—....... ...8........ . ...... .:e.................................................... f..I....................,9 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies.�for a permit accordin to the following information: Location LOT�..as .........!..'.��.��....�.....Ll.. ............�d.J...����.�.�....�..�..f...,+�.�.............. c i 3 I� ProposedUse ..`�?.1..�1.r..���.......o ..t L�... .M..U�:...................... .................................................................... Zoning District ^^�� ............ <R.�41'.. ....................................Fire District .. !.......^............................... Name of Owner.W 1 d �r a"7 IT. ...CQ..(N&ddress ............... Nameof Builder ....................................................................Address ...................................... ............................................ . { . : �- "A .. ?. ... .ASS Name of Architect .... .......Address q,...�1.......�•r�(.'3C. � ! !��. ,.. 4 Number of Rooms ........ ...................Foundation .. r...1/ i.r .... ...:.. ...`./A.6........................... Exterior ............................................................Roofing ph.��. ........ .............................................. Floorsv .........................................Interior .............................................. Heating ��.I.........................................................................Plumbing .................. ....1�T0 ................................. c Fireplace ..................................................................................Approximate Cost ............................A........................... r Definitive Plan Approved by Planning Board -----------______-----------19______. Area 5t3.4 4 ',.... ........... ............. Diagram of Lot and Building with Dimensions Fee ..............Sp................ SUBJECT TO APPROVAL OF BOARD OF HEALTH Tai('it ec W '73 Llf �rz,�Ufl,` �4j I hereby agree to conform to all the Rules and a ulotions of.:]arding the above Name .. e.�... . ................... Columbia Leather Co. , Inc. 17203 1 1/2 story, No ................. Permit for .................................... single familydwelling ............................................................................... Timber Lane Location ................................................................. Marstotis Mills ................................................................................ Columbia Leather Co. , Inc. nr Owner .................................................................. Type of,,Construction ............frame.............................. . ................................................................................ Plot ............................. Lot ........A?5.................. Permit Granted .............July..11........:-.19 74 ' Date of Inspection ....................................19 Date Completed PERMIT REFUSED ........................ 19 ................................................................................ ................................................... ........................... . ........................................................... ................... .............................................................................. 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