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HomeMy WebLinkAbout0033 WARREN STREET 0;'le—" '. -.'_.. c6mmanwealth of.Mass.achasetts q Sheet Metal Permit Map 34 Parcel L I Date: Peamit Fated Job•Cost ©. NOV 1 6 2016 Plans Submitted: 'YES NO . TOWN U�.WII ge YES NO Business License# y S 7 Applicant Ilcense# ZI Jr—r 7 Business labnnati= Praperty Owner/Jvb.•Loczonlnformki= Name: Nl rme c�vL t r'S treEt ' •3 L �2:- / /�eG "� 54.4 e <. Crty/Towm � �- ..._. City/Tawn , / c.6c v o We N-v� Telephone: ® $ Z 5 l 70 Telephone: © 0 Y S�Z Photo LD.required/Copy of Photo.LD. attached: YES - NO sirieted.lirense J-2 N1-2 restricted to dwellin J-stories or less and commercial up-to 103'000 s4-fft /2-stories or less i Residenc(ial:-1-2 fmmily :Ivlulti-famfly Condo/Townhouses Other .I Commercial: Office Retail Industrial Educational Fire Dept Approval Institutional_ Outer Square Footage: under 10,ODO.•sq.ft. V aver 10,000 sq.ft. Number of Stories: Sheet metal Work•to be let:&ch blew"Work: Renovation: HYAC Metal Watershed Rnofing. Kitchen Exhaust System �. Metal-•Chmmey/Vents .Air'Balancing Provide detailed description of work to be done: i INSURANCE COVERAGE: I have a curmut liabriltv.Insurance poppy or Its.equivalent which meets the requirements of NLG:L CIL 112 Yes No ❑ If you have checked Ym indicebe the of coverage.by checking the appropriate box.below: A rrabi[ity, insurance pdocy Other type of indemnity ❑ Bond ❑ OWNSWS INSURANCE WAIVER:`I am;aware ttsat the riumme cioes.•nof have.the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and#-at my.signaf p on'this•permh apptk�ation• -this requirement Check One Only Owner. ❑ Agent ❑ - S'ighaturE of Owner or-Ow4er's Ageni By ehecidng this•bo O,I hereby cer61•y that all of the detans and infarmation•1 have submitted(or entered regarding this appfication are true.and } axurate to the best of my knowiedge and.tbatatl sheet metal work add insWistions performed under the permit issued•forthis,apprim idn will be in compliance with all pertinent provisibri•of the Mas�;achusefts'Runding Code and Chapter 112 of the General Laws. Duct inspection required prior tor•Insulatiori Installaflon:YES - . NO Proearess•.Insnectibng •• Date comments Final IngRection Date Comments Type of�Uasp 3Y 0J4asrer' or Me ❑Master-Restricted �Ryrrmm , ❑Jottmeypersoh'. Signature of Licensee 'e .❑ m Joueypetson-Restricted • Ucense.Nurriber: S-5� 7 . =ee chedc-at www mass.aovklol inspector signature of Permit Approval . 's r. °y'ME Town of Barnstable Regulatory Services KAS& .. Richard V.Scali,Director a63p. �e Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L 4J+ <f Lou c,c ; , as Owner of the subject property hereby authorize /Ile r K 5; V to act on my behalf in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools ate not to be filled or utilized before fence is installed and all final inspections are performed and accepted. /tom Signature of of Owner Signature of Applicant W r G�. , q,r„L C `A r -r- Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS MOMMONEi LTH OF:M i �ll'�W I ' - ., g,t a, 4. `SHEEThtVfET7aL1NQRkCE[25>:>:€:r.< r ,ISSUEStHEFOLLOWING<L[CENSL'<'' • �:f:��. �4., i�.' ..;.;:2?;3:'i ww,;: - •friiaa '+�?rw.eiCl�;,..... :`7;iq`, : �11111A5TER=UNRESTRI T.E ...°•ice.,.. '.: ...... ...: :f.,'•t.;S.Sly''�:,:::: .l ._ `;F ... PETER:J�:SAVARY%::;- " GREAT;K, .0 RD VVQ R tt M.EItiIA`02571=242 . - _ .•,.�;;sr.%; :tYY; .rig iq• _ -w 05T'? ''^ w t'`M9/28/201 •r b3:'n 1' CONTROL# J 7 ?0 7 3 2 IMPORTANT If your license is lost,damaged or destroyed;is inaccurate;or needs to be corrected,visit our web site at mass.gov/dpl for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations.Your license is a privilege,and cannot be lent or assigned to any person or entity under penalty of law.Keep this license on your person or posted as required by law and/or regulations. r r 6 ' �� asat€ s a��msr�e�c� Office 17 60 W &set fastav,MA 92M yvfvw t�rcrsgr��ia • Y'�'Q,�- � �]']CiiFa7ifP�-'fRI�"747�'�'�^*If��'$����T'Lr�i�l�CTL'T�Ti 4fL ifLL'Je� .��i�t IiTfe�saf Fcm. PtetaSe P`rnQ€E�� - a2S 71 oo L S'f Ci€y/S : rc���a a. /1�1/� Phom 9' S 4� 6 7� ARI e7aployer?C =kffie Mj rffpiiafabo= TAM-@f��( kam a employerwi& (I4. ❑I a have b ge car and f ❑Idea caas5 employees{full an�torpart4ima}.* � 4ffithe i s Z❑ I am a sole psogriefor orparfner- Iid-ed on the armed sbnet 7- ❑Rem deHng sing as�d have no employees _1h�snb-oou'Sradas have g- ❑ ni;fi,,, , emPlnyees and have wmS=,' firi ng fps ale i a-MYT g_ ❑$is�g additi( LNO caotlo 'M'np:in==d Camp- ��1 5_El We am a c aPm-z fimmdifs Ifk❑ ctacal=epaus or additions 3-❑ I ara a home awner doing all work afR=s have ecercised their IL❑Fbmmb�m.g 1epzim or ad& cns . i sght oanper 15+mGL salt€[No wotlor'comF- f em=pk I2.❑RDafrepaim ':' req°iseell g c-157, kI(4} andwe Bxve nb' 13❑O6�r emplagees_[Ncrwoffime conop-immmm r=Fimd-I fiLlt FCa�rs'�sf chevct�ns bmcm�sty at•��;fi••,•i s�eEt rhtrce�t3�n�eaf�e m3s�teEx�et�si<��ies�! �Iayees. fft3�snIr•coaiisd�hssa empIo�s,6ieg�st gcavide ibis'mot�d eomg P�S'�� lam ara sri�gL ffsatisprmddrag tsarLers'coh�t irrsurrcr�ce 'ar ra}�mesa Belau is Stz pac}*aad jnb�iLa �rt,fririr�srtiaes.. - Insmance CompmyyN=e: NEE 4 cr Sepias.Lio.ik Inb Site AA&=s= tL�glSfaf tLF: At tacT,a copy of the nmrkers'con penSa6m paid dei froa page(vhwwmg hepofiey der awd cTaab o-n dstfe). FaRum to secorc cav=p as mV ired-nuder Secfioca 25A o€MM c 152 can lead to the imposifi—ofcamir,.al PCMdf=of a free np to$1,,5DO ODD znd/oranL-yeariapds=m=t as vaetl as civA gcadfics io-the fb=of a STOP WOR'K ORDER-and a fine ofup ta',250-00 a day agafist file violafna Be wised ffiat a COp'F of tbfiis stafPme maybe f=warded to the Office of lkvcsfigad=o€the DIES fox iasara=coverageverffration- I4Td bsreby aerftfp under&spaiiis AapenaM=ssfpegscty IffiaMe Mt cars est F surF usg aMF}: Do,nat truly in dds area,t2 be causP&W by city at tai=oficiaL City or Town: , PmnrdtUc==ig h=ing authority(drde one L Board of IleaTth 2.Bwldh IIep-zrb=mt I Cifyffatm Qerk 4_Elec txieal Easgectur S.Phnmfi;mg E=Putar 6.Qther Contact Pacsoss: Phi is Information an.d lidstructions M ssachusetfs G-MMsl Laws chapter 152 requires ell employers to provide workers'compensation for their employees. Pmsaantto This sue, an mmpIayee is defined as`°—every person in the service of another under any contract ofhire, express or implied, oral orwrittea" i An errFIoyer is defined as"m individual,pmtimship,association,corporation or other legal entity,or any two or mars j of The foregoing engaged in a joint ent mprise,and including the legal represe tafves of a deceased employer,or The i receiver or trustee of an individual,partnambip,association or other legal entity,employing � owner of a dwe horse employees. However the Ilmg having not more&m, three apartment and who resides therein,or the occupant of the - dweIIing house of another who employs persons to do maiatmance,construction or repair Work on such dwelling house or on the grounds or building appmtenant thereto shall not because of such empIDyramt be deemed to be an employer.". MGL chapter 152, §25C(6)also staffs that'every state or local&causing agency shall withhold the issuance or renewal of a license or permittn 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 ofpublie work until acceptable evidence of compliance with the insurance requirements of this chaptra•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-contractors)name(s),add=s(es)andphaae r nmber(s)along wi$i their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)wiihno employees other than the members or partners,are not required to carry workers' compensation ins ct. If an LLC or LLP does have employees, a policy i 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 firths pezmit 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-fimred 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 primed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office ofInvestigations has to contact you regarding the applicant' Please be sure to fill in the permit/license number which well be used as a reference number. In addition,an applicant that must submit multiple permit/hcense applizxtinns in any given yen•,need only submit one affidavit indicating cunt policy i fonnation(ifnecessary)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 mimed by the city or town may be provided to the applicant as proof that.a valid affidavit is on fie for firiraepeamits or licenses A new affidavit must be filed out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture CZe.a dog license or permit t4 bum leaves eta.)said person is NOT required to complete this affidavit The Office•of Investigations would lilm to thank you in advance for your cooperation and should you have 2ny T.mLions, please do not hesitate to give us a caM The Department's address,telephone and fax mambo¢: 'the COMMOnwr-aIth of Massachusott-- Depajt m=t C&kidnstdal Aide ats =ce ofluvMagati s Em-Waakaba Stream Bogt MA G2111 T(-,L 4 617'27-49R{1 at• -06 or 1477 MASS.AFE Revised 4-24-07 Paz#617-727-7749 -Ma gav1dia r AC�® DATE(MMIDD/YYYY) , . . CERTIFICATE ®F LIABILITY INSURANCE 11/14/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Mar NAME: g aret Viera _ Morse Insurance Agency, Inc. PHONE (509)748-9577 FAX A/C yEx.0o (AIC'No):(508)748-9579 354 Front Street E-MAIL ADDRESS:magg ieviera@morseins.com Suite 4 INSURER(S)AFFORDING COVERAGE NAIC# Marion MA 02738 INSURERA-Main Street America Assurance 129939 INSURED INSURERB:NGM Insurance Company 114788 QUALITY MECHANICAL SYSTEMS LLC INSURER C: 143 GREAT NECK RD INSURER D INSURER E: WAREHAM MA 02571-2426 INSURER F: COVERAGES CERTIFICATE NUMBER:2017 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP LTR N WV POLICY NUMBER MM/DD MMIDD/W LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE X OCCUR DAMAGETO RENTED 500,000 PREMISES Ea occurrence $ MPM25432 11/7/2016 11/7/2017 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRCTO- JE LOC I I PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Individual Risk Mod Prem $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accidentl B ANY AUTO BODILY INJURY(Per person) $ 250,000 ALL OWNED X SCHEDULED M9M25432 11/7/2016 11/7/2017 BODILYINJURY(Peraccident) $ 500,000 AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE I$ 250,000 HIRED AUTOS AUTOS Per accident I Is UMBRELLA LIAB HOCCUR EACH OCCURRENCE is EXCESS LIAB CLAIMS-MADE AGGREGATE I$ DED RETENTION$ I$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE _ ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT i$ 500 000 B OFFICER/MEMBER EXCLUDED? ❑N NIA — (MandatoryinNH) W1M25432 11/7/2016 11/7/2017 E.L.DISEASE-EAEMPLOYEI$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Peter Savary is included for coverage on the workers compensation policy. CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Margaret Viera/MMV ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 onldn+t t VWE Town of Barnstable *Permit'T -45 U � ires 6 months from issue date �.� Regulatory ServYc'Fort ` P�dpft#mk.. Mass. g Richard V.Scali,Director 0 OCT o4 2016 U U ,19. �0 Building DivisoY'al" OFN Paul Roma,Building Commissioner ������I 200 Main Street,Hyannis,MA 02601 L www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number t 39 DIM Property Address 33 tQAR9,vr?J srRb' r:r 62s-17,ev?L4E /" ©z6515 Residential Value of Work ,,`` 060 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /P/4 a ��1UeT G'C A-r1$ ?.� Fi2DT�iNG-e�i9tif ST. /yllLTort/t /sJrq �Z /S� Contractor's Name WILLle4tA `K'. E1IEp— �-IC7`7 Telephone Number Home Improvement Contractor License#(if applicable) /74492. Email: Wl/10sq&--yae!T"re gTA'y ll- &'"I Construction Supervisor's License#(if applicable) %Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name AMT-- C ,A,. Workman's Comp.Policy# qqa00Sz 1(06 —©� 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-4t.Wf- h.Qbrlw /❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum .32)#of windows #of doors:�L ❑ 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 '11 required. SIGNATURE: UVu ,MA(,` D • CL��.�/VV Q:\WPFILES\FORMS\building permit forrns\E)PRESS.doc 06/20/16 f i I i t Massachusetts Department of Public Safety Board of Building Regulations and Stai dards License: CS-012955 Construction Supervisor WILLIAM T EVERITT PO BOX 1340 e, COTUIT MA 02635 CA_ Expiration: Commissioner 03/17/2018 1 l t i a i I !i! 1 t i 1 Lieensi or r stration valid for individual use only _ OIBce of ConsumerA6airs&BuNness Regulat�oo i y HOME IMPROVEMENT CONTRACTOR aefore the aspiration date. If found return•to:.., Registration:.: 179992 Type: Office.of Cobsumer-Affairsand'Basiges Regulaiion 10 Park li aza Suite 5170 ":::: :> :: ::.:• r r,.. Expiration:.,!9CL9/2018 Individual._. t,, •}•: ••' -=- Boston, WILLIAM T.EVERIff'.:I r ;WI4"--EVERITT.:`:, :. I 155RIVERRIDGE DR '.:` 1UWRST.OIVS MILLS;MA b26�8 ppdersecSetary Not valid without signature I i ii Z� 1 I ; I 1 i f j s i Town of Birnstab►le Regulatory Services, MAW s` Richard'V Scan,Director ' Building Division Pawl Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns� Office: 508-862-4038 Fax: 508.190-6230 ; I Property Owner Mu t Cotnplete and Sign This Section If Usir>-A Builder f ; I JWS-I eJP—TIS ,as Owner of the subject property hereby authorize 101"f W ?: Edovt rr I! to act on my beha14 Ii . in au maths relative to work authorized by this building permit application for (Address of Job) "Pool fences and alarms are the responsibility of Ithe applicant Pools are not to be filled or utilized before fence is installed and all final j inspections are performed and accepted j S' ' e of Owner Signature of Applicant x G1X12� �u RT`��S Print Name Print Name f Date j c r SOA Basw�MA 02HI '�Pt�ets' Campensad�Iasm mac$�7�,'friQ�l:• . . _, r�r.. _ ,,,, . Please Pxixd .Nam (A9 l t.,i.A iA�1 T E✓E2 t y - i ArO YGu an ea43103er?f keckthe agprapriate ba= L I am a saployer 1_ 4. ❑I am a general eomizsct�r I [7- Type°€ {re�¢,ed�: eavlayew Cfif anIbrpm e)* �hi�•Sie� 6- ❑New 2,❑ I am a sole pmp6tas orparfw faed oa�e s ®Bemndeimg sip and Nava as empl s �rese snb-cavxactms l 8 1 Da Waddng forme iFc any cagacag employewandhmwad3xe [NoWaffaw°UP-kmmma camp-t„MMZ=F-I 9_ E13mMqga&f6= 3.❑lama homtmvm2er doing all work afbceis hmm esemsed their 1L 0xep Baas ' ffigsei€[No�aorlaets'comp- - Ofper}siCzI. -M❑Roe i cerecgzifedji e-M¢1t4kondwehavenorvaim emplayem[Now` 13_0.O& r caret imp reguireq •����accF�asbor�1�els¢snamc,5e�brLvar�g lea � P�F � . a�vsa�3a�isstt�r� ��������o�r� aabmitsn�a -Cam eber3�9�bas nest gffi[l�¢aad�t��gfl�n�of 6se ss�-oo �d stems araotS�ase e�h¢� _ emplapees�ft b=B they a=p=m L-&W sask='�Panty MM&MI lam im� �isP rrorkets'mart irrsura�a�r�g S Berow isYlta paftcy mgd job sets b mate: 3—3/—17 Job Me A 33 cars Af#aeb ar copy Qf fhe workers'cbmpea=rtiQagulicy demon p2ge (sharvisg&e pnTicp amber and.eia-atinn date}. Fs&=tan s=m eoverage as rEgauedm&r Sect 25A o€MCE,c.1}-ice¢lead fo lEie� imPOsWm of criasumai pew of a fine up tm WOt}W aadlor one-3rearimpdS=MeI3k as wMH as cial penalties in fe farm of a STOP WORK i M)ERand a rme Ofu0DSMM3daYaZmEusMeIWa Be advised gid a copyoffiis be far�dedto fire flfice of . Isves�frcros of8re�� coverage ,fln_ . lFa*ii ftEraby erar n,; (�(seert�P^� F - flss u an�a€iaa �aQbovais true me/d correct; Pig Sos-Iz$ —7Qoy -3�5�--Z6S aid Ow ra<d y. Da not wry in dds area,ib be avatp&W by rite ar:bm Officid, T�orar T'ava: F cease �.`b (ChTle OWN LB*MaOf Ek2l& I Buffffmg Deparbnez& 3.Cdylrm.ct 4.DechicaI s-Pbm93bg bTed33r i 6 I Av v CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DD/rfM I 07/06/2016 RI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO GHTS 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 CONTRA�T 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) musf,�be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A dtatement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER coNTACT NAMEKaren McHu h Arthur D.Calfee Insurance Agency,Inc. PHONE 508 540-2609 F 508 457-1715 www.calfeeinsurance.com EaHaIL kareli calfeeinsurance.com Falmouth Gifford Street i NSURER AFFORDING COVERAGE NAIC# Falmouth MA 02540 INSURER A: Arbella Protection Ins Co i INSURED y INSURER B 1 William T.Everitt INSURER C P.O.Box 1340 INSURER D Cotuit MA 02635.1340 INSURER E: N INSURER F COVERAGES CERTIFICATE NUMBER: iI 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. ILTR NSR TYPE OF INSURANCE D UB POLICY EFF POLICY EXP POLICY NUMB LIMITS COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $1,000,000. A CLAIMS-MADE El OCCUR DAMAGE TO RENTED $100 000. 8500042614 03131/2016, 03/3112017 MED EXP one n 5,000. PERSONAL&ADV INJURY 1,000,000. GEWL AGGREGATE LIMIT APPLIES PER: X POLICY i GENERAL AGGREGATE 2.000.000. j� LOC PRODUCTS-COMP/OP AGG S 2,000,000. OTHER! i $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ i (Ea atxident) ANY AUTO j BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS i BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS NON-OWNED PROPERTY DAMAGE AUTOS g i 1 $ UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS L1AB CLAIMS-MADE AGGREGATE $ O ED I I R TIO $ WORKERS COMPENSATION AND EMPLOYERS,LIABILITY N I PER x OTIi A OOFFICEERIMEMBER EXCLUDED? EVE YL NIA 4220052168-01 03/31/2016 i 03/31/2017 E.L.EACH ACCIDENT $500 OOO. (Mandatory in NH) ( EL DISEASE-EA EMPLOYE 5OO 000. If yes,desdibe under DESCRIPTION OF RA NS below EL DISEASE-POLICY LIMIT S 500,000. f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached If ore space is requlmd) William Everitt is excluded from Workers Compensation coverage as a sole proprietor Job Location:33 Warren St,Osterville,MA I . t CERTIFICATE HOLDER CANCELLATIONI Town of Barnstable SHOULDANYOFITHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE <KMM> 11 �240q&--- ©1988 2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD f�i r ' � C License. registration valid for individual use onlyi ffice of Consumer Affairs&Business Regulation g O HOME IMPROVEMENT CONTRACTOR before the,ezpirafiou46te. If found return:to:. ;. Registration.~'Y-,,�79992 Type: Office of &C sumir:Affairs and Busi"4s,.Regulation I .Expiration_�29k2018 Individual. I lO Park �aza`-'Sirite'S77o- Bostou,.��� 0211'B! 11VILLIAM T:E�7 , EF211ryc ;WILLIAM•-EVERITT,- ;155RIVER-RIDGE DR,, :;~: :*�:: .z_..ti,�:= li(/��:Ccct�sr y • G�� �ryyV MARSTONS MILLS;MA'02648 jIndersecretary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-012955 >t?� Construction Supervisor . , WILLIAM T EVERITT PO BOX 1340 COTUIT MA 02635 Expiration: Commissioner 03/17/2018 Construction Supervisor Restricted to: Unres Restricted to: y.ildings;mf1-tiny us6jg?,al$i�GvYiic�Fi•' 8� .ain • less�g� cubi�'nneters+ op3a enclosed 0e aas pal afupp n�aug hn�'RC' Failure to possess a current etc Rion ofthe-Massachusetts State Buildi_hg_C`_0( �} gf�bdi n this license. DPS Licensing information visit: WWW.MASS.GOV/DPS t i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map /3 9 Parcel DS e Application Health Division_ a ` =�r�'T. Date Issued Conservation Division �' SEP 08 20 Application Fee Planning Dept, TOWN OF BA 6 Permit Fee a ► RNS Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address, 33 W kRREM S46zr-7' Village 05-t-EA0 LLC Owner!aut_A'� OVA-E75 Address A Sr Im.iaxl 40 OZlso Telephone (off? -51A3 - 6150 Permit Request REl DbEL EX%S-rXOtr t6,nWE-tJ Aib 6,477t OA.1 A S7- A2EbX . C'oa?5 T 8 X 1 q" aug"b Rwi-9&w mu v�oX* TyB --MMi-C P&A) V-tt� W4-%Qu0 Aug &Ay- Fie Oc- t1J k4l-CA� Square feet: 1 st floor: existing 1530 proposed a05- 2nd floor: existing &0 proposed 41446 Total new Avg Zoning District RF 1 Flood Plain "In Groundwater Overlay A�o Project Valuation,$7 coo Construction Type Wob FRAWR' Lot Size 24, S f y Grandfathered: ❑Yes ® No If yes, attach supporting documentation. Dwelling Type: Single Family Id Two Family ❑ Multi-Family (# units) Age of Existing Structure ( -70 Historic House: ❑Yes �1 No On Old King's Highway: ❑Yes A No, Basement Type: 0 Full Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 1040 Basement Unfinished Area (sq.ft) 4(ob Number of Baths: Full: existing ,2 new _� Half: existing / new Number of Bedrooms 3 existing new T� F(JLL ,8.47-H Total Room Count (not including baths): existing 7 new Alawf- First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: VYes ❑ No Fireplaces: Existing New 064LO- Existing wood/coal stove: IL Yes ❑ No � ems- �nrovE Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:)A existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name W LU-kykV k T. �.-1lErZ tr- Telephone Number -42?8-3&Lf-?SS2 Address OX Ivy License # Home Improvement Contractor# Email WILuAIcEySxiIT- Gy �y AIL . C&.NI Worker's Compensation # yz200S.Z1�$ D/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ��i �\U DATE tF FOR OFFICIAL USE ONLY - APPLICATION # ' DATE ISSUED ` MAP/ PARCEL NO. ' { ADDRESS VILLAGE OWNER ' J f. DATE OF INSPECTION: I FOUNDATION FRAME ' INSULATION `r. FIREPLACE '< ELECTRICAL: ROUGH FINAL j PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING , DATE CLOSED OUT ASSOCIATION PLAN NO. h.• � o N g o 1 { i m g8 + bc € 00 se = m s i i Y N 5 ' a o n 3 9 � 1 m W p e ' sbsaveY j 1 fE� a Qe om it �r "o o s o � 0 ' f 1 t7�1l'J-1y`J� !!Jc'�5.5r •I r�uri i HIYI�L't ,..Lu:�...i 7-1 f A VESUD 1�.95, 00, VA�R�N xHIRp Avg. 807to `�'06 t LOT B o cn b o 0 VERHANG x „ ,;;'GAR. „0 1' < 5 y �N 9 ,I. c 'z, � 5a 5 �c DECK o cis 1, N ,`0 O LOT A Q N �. r '08 Si 9• tiY 52 : FOND �VES E RoAD ---- ,SL' PAPF' v,S ZONE. "RF r" — This MORTGAGE INSPECTION Plan is For, - �'LOO.D ZONE' "B" Bank „Q lY FWN: _ __ ._____ PEG 7S'T'RY 0 WNER: Q8'RA_I.� E E D REF: _24_01,27__-------BUYER: p_A_vL JA)y�T L—CURTIS_..-------__ — ATE: — 1�94___ _—_-- PLAN REF: _WZI,3i?__ _ ______SCALE: I" 30'___1-T. I�%113Y CERTIFY Tb - 7=07 'Q-.O177792'12� __-- YANhEE SURVEY ?ANK-,���_________ __-THAT THE BUILDING T 4Jl% OF 4 TOWN ON THIS PLAN IS LOCATED ON THE GROUND AS �� CONSULTANTS TOWN AND THAT ITS POSITION DOES CONFORM a �'A. 40B (SUITE ]) > THE ZONING LAW SETBACK REQUIREMENTS OF THE it M INDUSTRY ROAD )WN OF -------------AND THAT No.320.� � MARSTONS MILLS, MA. 0264 it DOES_ NOT _ LIE WITHIN THE SPECIAL FLOOD IIAZARD � � o Ti~L 4�28-.0055 ZEA AS SHOIVN ON THE-H.U.D. MAP DATEI)_�F'/�z___ F. 't —Panel ,250001 00.16 D �anPf�t i�caq' = FAX: 420-5553 '111I1; PLAN NOT MAllG i JtoM—AN- UMENT 1:1160 iflll y -- LI. SURVEY, NOT TO FOR FENC `8; ETC. P '�1L A. ME ITH w PLS ' RE USFO Yi�...., � .�..��, Massachusetts Department of Public Safety lug Board of Building Regulations and Standards License: CS-012955 Construction Supervisor WILLIAM T EVERITT PO BOX 1340 COTUIT MA 02635 .- Expiration: Commissioner 03/17/2018 (92e cpaizzmzrnzcoea�l o�C-��a�czc/zczae Office of Consumer Affairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR 00 re the kpiration-date. If found return•to:....: Registration: 17ggg2 Type: Office of Consumer"Affairs and Busirtes,%ft9gulation A10 Park Il --Suite'5170;. :::: Expiration:_9l�9L2018 Individual._ $oston;lVIA 0211`8 osto.,:. WILLIAM T:EVERITT: ::WILLIAM-EVERITT '155RIVER.-RIDGE DR. �. :�i,.r:x_•�,,..____ �i(��,Q i.r... U. G � %�✓yV �...MARSTONS MILLS;IIAA'02648 �Inderseeretary Not valid without signature i �•++E Town of Barnstable Regulatory Services Richard V.Scab,Director. 1"9. *� Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder T TA,t1>�T Co ,as Owner of the subject property hereby authorize 101"f 4-t/ T: Ed&w/ r-f to act on my beh4 in all matters relative to work authorized by this building permit application for: 33 vJARP-W ST. os Rv��,.� ` mA yz ss (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. S' a of Owner Signature of Applicant U.,f'12 �r1��. �►� Print Name Print Name Date Q_FORMS:OWNERPERMISSIONPOOLS j Town of Barnstable Regulatory Services dF Richard V.Scan, Director Building Division iBARNSUMM Paul Roma,Building Commissioner �� `�� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXE3fIION 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 buildingpermit. (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 .,.. a �"• Approval of Building Official a 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 builOing permit is required'"' shall be exempt from the-provisions of this section(Section 109.1.1-Licensting�of co on provided that if the homeowner engages a person(s)for hire to do such)worWihatrsuch Homeowner shall.act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the'responsbilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15), This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. I I The Comm 0lmL'ah*of Ma" TO se aJ . DeparL7ffext&frndksftid Acd dm tt4 O ke Of brFeakudem 600 Wad*gtm Strea Baston,MA 02111 WV"LmaSM9M/ra Workers' CmapensaffimIuswanc$Affidavit:SaflderSIEUM ..,/���,ers AppHcamt Infarm2ti= Please Pry Env Name - W L LU w T. EJE2 t I' I Addre= YC l W�O Ciws Cerwir ©Z4,3-5 Pianos S-o8- 3404 - 7552- Are you an employer?(Meckthe apprapriate bay Type of project(required)_ L I am a=ployer witb / 4. El am a general contrsctor and I 6. ❑New eons employees C and/or per).* have hkedifte mgy-� 2.❑ I am a sole propfdetos orpartaes fisted cafhe aftgched shaeL 7- [ RpmodeHng ship and have no employees . These sub-co�s have S- ❑Demolition vradfing for me in any capacity. emplores and bane wodmrs' jNo cvodome comp.;ra.M.,M comp. I • . 9. ❑SaAcHng addition mod-] 5. ❑ We are a troaporafim and is 16-0 Elecffical repair&or ad&fions 3-❑ I ama homeawner doing all wmk offices have esemised thek 1L❑Plumbiagregairs or adffiiic= My5df[No woxk='gyp. of per 1t M. 13..❑Roofrepais ins requited.]Y c.M g1(4).andwebaveno `mplaya S END v0doe s• 13-❑'other comp-ia=wxz mqured.] •8•rip agp6�,t�ac cheaavoz�1 mast also ffioaEthe sectioaheimvsho�g�eswa�ecs'�ersaSonpaficpia�a� #l�evamga�lmsubmFtdris�dae n � acgd�<sIfW�and6a�hixeoa ecoatmc�mQstmffm tanewafdzVft saciL rC'a �sr cbecY ttas but n�wed as addffiaaal sheet shorting thence of the nab-card state vheths tonal Ybase e�ham emp3oyePs.Ifthesn5- dashare emglof �YF •P �h� lam ern euiplsr t7iertis prauidurg�tror&ers'caarperisrdiotc irrsurascsor empluy�eea. Selufv is 1liri prrHey and jafr sits hzfMMatfDzL a1;maase Compafrp Dame: IAQ1.3 rt�l.d.rQ. -V�7S=10 0 M . 'Po&cyl'torSelf-ias.I.ic-t- 42zOO5216O -0/ FBpindon.Date.- 3 -3/- 17 Job Site,Address= 33 Azwo A Rath a copy of the warkere compensafianpolicg deeinafion pne,(showing the policy number and EMPh7tioa date). Fad to secum coverage as required under Section 25A of MGL e.152 can lid to ffie imposition of criminal permltses of a fine up to S1,50a OU and/or ono-yearimprisonment.as vreill as civil penalties n the farm of a STOP WORK ORDERand a fime of up to$251000 a dap a the violalnn Be adcnsed tlxat a cxff of this sit maybe forwarded to the Office of InvestigaHom of$te DlA€ar- coverage vefiScafien. 1FtIa ker-aby cardffyn(a�rrdsr tits pats medpsnaItces thatt/fs u formapcPtidad abam ig true ad correct DktL- Pimne ikSOS- YzB -7Yo9 , -��4r�.ZSSZ t7,�i�use� Do oat erreis Fn�asery ter be cotugfetc�by ci#p artafcu a�rcial: Cuts or Tows: PermhM cease 9 LonmgAuBmnrritp(circle one): L Board of Healtk 1 Sdifidmg Dqmbnent 3.fOty/rown Clerk 4L IIedrical for S.Plambiag b Tector b.Other Contact Person Phi : 6 orm�ation. and lastcfions ' ` In w�=Mp�an fxc fbD=omployees. 7�F�ssa�In,ce�s Gebeasl Laws rJiap(ra ISZ regoaes aII enzglap�s lie . P=saatD ih= ,an�loyee is drdmed as¢.ovezy pcdssc�m ffie sEavicc of�otber x any fact ofhae, esprass oriropliA oral orwlitft� Aa Toyer is de�ncd as M ix�laag pEThIM sbxp,�C�"n,aM:poraiiom Or otheS legal e�y,or�Y�� of$�fregDsig�g��a Jornt eotecpnse,and �Iegal seprese�xves of a deceased emploYex, receiver or tivate--of an kdVidual,p associaban or otheslegal entity,eznglaping=p]DYel-- Aowever$ie owner of a.dweIImg house havmgnot more than three apmtmests and who rues ffieacni,or ffim o=gmmlt oftbe - dweslling horlse of anu8ier who employs p=sons to do mom,won or repair wDac.on.such dwelling house or on flo grounds or building eppurft=ax3tffierein shallnotbecame of scLch employment be deeme;dto be en e3plo7er." MGZ chapter 152,§25CC6)also states aeRery state or locaI Firms agency shall t Iiold ffie issuance or renewal of a ficense or permit to operate a baseness or to construct t bimilffimp i m tfie commonwealth for nap applicantw•ho has notproduced acmptable evidencz of cdmpIi=ce with ff=inc=2n`e,coveragie required-" onRTiy,Mc� ea chapt I52,§25C(7)slates-Neif wfbe nor any ofifspoFTical subdxv%sions shall � ester j0JD nay contract for tha p cc ofpabHr,wox$mail acceptable evidence of compliance vfth Ifie fi=rance.- rsg m-f.s of I:Lis chagfrz have Been prese�d to.ffie g Y" APPI?can-fs Please fslt o-C± ffia Wo&=' CZMpensatinn affidavit completay,by checking the bmo s ffiat apply to your sRnzdc n and,if n.D=ssa ry,amply s)name(s), addrcs-s(es)and phone nimmb=Cs) along with tiva cerbfrca(s other fig the mscaance. LlMit LlZb�y Companies('LC)orLMntedLbb-MtTPm-�rshtps.(!ZP)w161no CE byres me mbtx's or paci=s,ale not rtgmzed to cant'wox3cer9' campensafrnn If an LLC or LLP does have ra¢ployees,apolicy is reclined. Be advisrdtioattixis affidaykmaybe submitted to Eo Depadxnent of Iudo-s[rial enis for confi mzf=of�De�ve$age- Also be sire is sign and datafile afiidayit Tho affidavit shoul Acrid d be retained to the city or town that fbe application fin the permit or license is besng requested,not the Depar�enf of ; aaLsf=sI Ac riP ±R- Should you base any questions I%m-r mg ffie Iaw or¢you axe reqmred to obtam a wDxio:rs' coxupenmtionpoliey,please call ffiz Depa tncut atffic n=berlis�below: Self-insured should enter their s eIf-insurance license nM MMber as the 4 TMPMa f n Ime- Ci y or Town of6ccdals Please be sore ffiat the affidavit is campletz and priotedlegily. The Deparlmenihas provided a space at.fficbott= of the affidavit fr you to fill out in the eves the Of of JuTcsfigaffi=has to camftLct you regarding the applicant. Pimsebem=tofillint3iepen�iVlicease=nberwhi.chvffi used asar 5==cenombcr In-addidon,anapplicamt that must sabmit multiple permifficense applit:Hians in any given year.need Only sabm¢one affidavit mdicatmg eat Policy. mf min on Cif nay)and Wider-Job gte Address'the applicant shoL+ld wr>t,-"aR lacations in (may Or_ town):,A copy of the affidavit that has been_offic iaIIy steed or marked by the city or town may bo provided to ffie applicant as proof that a valid affidavit is on file for B:d= .pemri!3,or licenses A new affidavit Bust be fMcd out each year.W4err ahoxae owner or cai2m is obtaining alicense or pexmitnotrelatedfin anybusmcss or cow=cial vet - CLe. a dog license or permit to bnxn leaves etc-)said p==is MOT=Fdred to Clete taus affidavit The OfE-=ofIuvesdgH&m wDuldhZcetn fl ankyoumadvance foryour cooperation and sbopldyamhave nay gmeshons, please do not hcsRztc to give uS a call. The,Depart Mf 9 address,telephone and;bm n=bm-. 'h COMMOUwMalft of Massachuseft6 - , lent cif hiftstda A=Ueuta Bwbw=IA Ei].1F - TeL.#6I7727-49W eft 4€6 or 1-UMLA SAFE Fagg 617'27 7M WW Kevise ¢24-07 �r DATE (MWD A o• CERTIFICATE OF LIABILITY INSURANCE 0710612016 Dom, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). NTACT Karen McHugh PRODUCER CO Arthur D.Calfee Insurance Agency,Inc. PHONE 508 540-2609 FAx 508 457.1715 www.calfeeinsurance.com E-INAIL karen@calfeeinsurance.com 336 Gifford Street INSURERS AFFORDING COVERAGE NAIC# Falmouth MA 02540 INSURER A: Arbella Protection Ins Co INSURED INSURER B William T.Everitt ANSURER C P.0.BOX 1340 INSURER D Cotuit MA 02635.1340 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 TYPE OF INSURANCE DL SUB POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000. A CLAIMS-MADE F OCCUR DAMAGE_T`REeNTED $100000. 8500042614 0313112016 03131/2017 MED EXP(Any oneperson) 5 000. PERSONAL&ADV INJURY 1,000 000. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 42,000000, X POLICY ECOT LOC PRODUCTS-COMP/OP AGG 2,000,000. OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ F1EXCESS UAB CLAIMS-MADE AGGREGATE DE D I I RETENTION WORKERS COMPENSATION PER X OTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $50O 000. A OFFICERIMEMBER EXCLUDED? a N/A 4220052168.01 03/31/2016 03/31/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $50O OOO. De dIPcION ribe u F& RA IONS low E.L.DISEASE-POLICY LIMIT $50O 000. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) William Everitt is excluded from Workers Compensation coverage as a sole proprietor Job Location:33 Warren St,Osterville,MA CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE <KMM> ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD —oCo 33 L�) n � qj J + Ltk e lc 7c tJ v f l J�-La „ b,�.s .1 4- 0,� ' 1t 1 r �'. A. f r 47- � .>. ti ! - �` ,`\ � k�. r •r T O,h .i t'�ir� ' jr•K. - It PAW Wro - -W_ j • '_.� ��-�' �- ,•�.,� r•.f � •ram --� r4+�• .. - _,.;.- -, - _ - yh `` I` •�-a I -_ _ _ .�:e" _a...- -•"+-._ w.o.cooamnlE < _t 0 5 { % 15 25 1 a _IjA - COMMERCIAL . i �' a y - 7 AM FLORAL � <4ieT �o n a. A - _ , a _ mm fig -_r• - kr 1.F _%- ` `�• a. L "'"'y`, .Yy " P.T.2 x 10 LEDGER BOARD LAG BOLTED TO SOLID BLOCKING Wl(2)LEDGERLOK BOLTS 16"D.C.STAGGERED W/JOISTS HANGERS 2"MIN.WOOD EDGE DISTANCE OR(1) LEDGERLOK AT V o.c. 4 X 4 POST FROM RIDGE TO WALL RED CEDAR NQW 4 x 10 RIDGE BOARD pT z O COVERED ASTEN JOISTS TO BEAM +B PORCH W/SIMPSON H2.5A TIES s� q RED CEDAR c dx8RAFTERS _ AT 24"D.C. T 2 M,?8 q� q� 18'SQUARE SHINGLED NEW 1(r DIA.CONCRETE SONOTUBE N BASE W/RED CEDAR ON 24'DIA. T FOOTINGS TO FLOOR PLA 8 x 8 POST 8 2"THICK 4'0^BELOW GRADE.GRADE.USE SIMPSON CAP ZMAX ABU66 POST BASE. /3r q q� 8 x 8 B FASTEN TO POST II FRAMING PLAN W/S BPESONRLO CBTZ CONCEALED 8 TIMBERLOK FLATLOK SCREWS I INSTALL FLASHING UNDER 1 I HOUSEWRAP&DECKING j AZEK DECKING NOTES: ROOF FRAMING PLAN I 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS FLOOR JOISTS MI" &DIMENSIONS IN THE FIELD P.T.2x ITS@ 16•o.c. 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, DETAILS,&FINISHES IN THE FIELD WITH OWNER INSTALL PEEL B STICK 3.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS RUBBER MEMBRANE BETWEEN LEDGER STATE BUILDING CODE,8TH EDITION AMENDEMENT&IRC2009 TYP. ROOF CONST. SHEATHING 4.) 110 MPH EXPOSURE B WIND ZONE RED CEDAR 4 x 8 RAFTERS®24'O.a 'G BOLTED TO SIMPSON LSTA24 STRAP -3 x 6 T&G RED CEDAR PLANKS SOLID BLOCKING W�)LEDGERLOK BOLTS 5.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ATEACH RAFTEROVER -ASPHALT ROOF SHINGLES 16 o.c.STAGGERED W/JOISTS HANGERS ALL SIMPSON COMPONENTS THE RIDGE -ISLB.FELT PAPER DECK DETAIL 2'MIN.WOOD EDGE DISTANCE OR(1) RED CEDAR 4 x 10 RIDGE BOARD LEDGERLOK AT 8'o.c. 6.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS -SIMPSON H 2.5 HURRICANE CUPS AT ALL FTER ENDS TO BE 3000 PSI 12 ICE/WATER SHIELD AT BOTTOM -Vr UOF NM D 7.) VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS ON THE SITE T AU RIP EDGE DURING FRAMING CONSTRUCTION 8.) TIMBER FRAMING TO BE RED CEDAR NO.2 GRADE RED CEDAR 8 x 10 BFAM RED CEDAR 8 x 8 BEAM FASTEN TO POSTS W/ KIKE OARD SIMPSON CBTZ CONCEALED COVERED &TIMBERLOK FLATLOK SCREWS 4 x 6 --NEW ROOF SHINGLES 1 18"SQUARE SHINGLED PORCH RED CEDAR 8 x 8 POST BASE W!RED CEDAR 12 STS TO MATCH EXISTING-- 8 x 8 POST 8 2'THICK TCAP RED CEDAR FASCIA ED CEDAR 8 x 8 TO MATCH EXISTING ERIFY DECKING UPPORT BEAM FIRST FLOOR .-0 :q W/OWNERS SUBFLOOR RED CEDAR 4 x 8 ®i8'o.c. SUPPORT BEAM FASTEN POST BEAM W! 3-P.T.2 z 12 BEAM SIMPSON A34 ANGLE i MEN" NEW 10'DIA.CONCRETE TI N S TO a 9 4V BE 24'DIA.GRADE.BIGFOO FOOTINGS N UBE I 4'0'BELOW GRADE.USE SIMPSON SQUARE SHINGLED ZMAX ABU68 POST BASE. BASE W/P.T.8 x 8 POST INSIDE 9'SQUARE CASING &21'CAP r THICK SECTION a� COVERED PORCH I FRONT ELEVATION SIDE ELEVATION EREORSIORO S OMISSIONS ARE RE FOUNID ON ANY SCALE : DRAWING NO.: NEW ADDITION/REMODELING FOR- ERRORSORg1550NRTOSTAROF ®Q® COTUIT BAY DESIGN, LLC THESERUCTiD.THEB BUILDING RIDE 43 BREWSTER ROAD w"L9e�RESosaE�"«� „TTOR 1/4" = 1'-0" MASHPEE NA. 02649 CURTIS RESIDENCE LATHE D� ffQRS=,RU� COMME DRAWING ARE SOLELY THE Al PH. (508 274-1166 DESx FOR ER NOTED ASOTKFRSONS. I TRESE DRAWINGS ARE SOLELY EOR,RE USE DATE FAX (508) 539-9402 33 WARREN STREET OSTE ILLE .MA C ER"� ���USE� 9/1/2016 THESE ORAW WGS REQUIRES WE WRITTEN RV ORCHITE OF RE DESIGNER UNDER PROTECTION ' �TOOIQM COPYWWIT WtOTECTION 1 �