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0410 WIANNO AVENUE
s C -• NMI - i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -y OK Map Parcel Application# r - Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fe4 '`'e� �S Date Definitive Plan Approved by Planning Board ��07 S Historic-OKH Preservation/Hyannis Project Street Address Villager Owner y� 7'.+1�2 .a � ,;_,'�; 4g�e� Address Iq 1l6&Ar 1577 M 0w Telephone _y2� Permit Request 7 ai:�a orlb' aagf,gy f, ��2�/T .# 9,i o7O�( Square feet: 1 st floor:existing proposed 2nd floor:existing 1 VO proposed Total new-Y— Zoning District PC j Flood Plain Groundwater Overlay Project Valuation a? odD: W Construction Type iAtooD f T0,4mc Lot Size Ve-3Z / Grandfathered: l-f�❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#unniits)/ Age of Existing Structure Historic House: ❑Yes l W-b On Old King's Highway: Liras Basement Type: 2full ❑Crawl ❑Walkout ❑Other = Basement Finished Area(sq.ft.) ( � Basement Unfinished Area(sq.ft) /1Number of Baths: Full:existing _ Y new Half:existing ne , I Number of Bedrooms: existing_ newco r Total Room Count(not including baths):existing new 1) First Floor Room Co int. rQJ m Heat Type and Fuel: Q61as ❑Oil ❑Electric ❑Other Central Air: es ❑ No Fireplaces: Existing �_ New / Existing wood/coal stove: ❑Yes No Detached garage:❑existing ❑new size Po -O existing ❑new size B existing ❑new size Attached garage:U4xisting ❑new size Shed-fl existing ❑new size Comer: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ---Commercial ❑Yes O,No If yes, site plan review# Current Use h Proposed Use -- BUILDER INFORMATION Name��Pc.il Lc�f=f r_„�/ Telephone Number Address 20- ly !ylD License# O Y�e1 Home Improvement Contractor# 1� 20 Worker's Compensation# a F/SS 3 7V 72 0/6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7�s��7 _ FOR OFFICIAL USE ONLY c PERMI4O. DATE ISSUED i MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' Y FOUNDATION FRAME a oi; INSULATION e FIREPLACE Co- I1 I ELECTRICAL: ROUGH FINAL i I PLUMBING: ROUGH FINAL GAS: ROUGH FINAL _ FINAL BUILDING DATE CLOSED OUT, ASSOCIATION PLAN NO. r °FTHE Tp� Town-of Barnstable Regulatory Services BAIrIsnAffi.E, i Thomas F.Geiler,Director 9 MAS9. g ie39 •� B1111t incr Division N1P'�a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax; 508-750-6230 Permit no. Date AFFIDAVIT. HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, -improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adj acent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements- Type of Work g;r'I -l�iwe t�/-�G45C stimated Cost J75 on . address of Work: V!D IN4441A/n ✓�� /�STE.O�j LLB' Owner's Name: /1 Ti5Fv2 1AA C r'.4/�T TSB Date of Application: 7 I hereby certify that: Registration is not required for the following reason(s): MWork excluded by law []Job Under$1,000 OBuildmg not owner-occupied 70wner.pulling own pennit Notice is hereby given that: OWNERS FULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICADLE HOME IMPROVEMENT WORD DO NOT HAVE ACCESS TO THE ARBnTATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES.OF PERTURY I hereby apply for a peffiit as the agent of the owner: Da Contractor Name Registration N o. OR Date Owner's Name Q�oms:home�dav . r �UFT►iE rokti Town of Barnstable Regulatory Services 9s"?'v Thomas F.Geller,Director `bArf16.19.cA10 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 I, /-///E v'LZ we ind�i9'Y , as Owner of the subject property hereby authorize GLw- Lv��r.� �. i-A to act on my behalf, in all matters relative to work authorized by this buuilding permit application for: (Address of Job) SigrTature of Owner ate Print Name Q:FOP MS:O WNERPERMISSION tine tisnnurion riace - xoom i su i Boston. Massachusetts 02108 Home.Improvement Contractor Registration Registration: 128405 Type: Partnership Expiration: 4/5/2009 Tr# 129989 KENDALL & WELCH CONSTRUCTION. DAMON KENDALL 54 KOMPASS DR. FALMOUTH, MA 02536 Update Address and return card.Mark reason for change. :-CAI 0 50M•05i06-PC8490 ❑ Address Renewal ❑ Employment E] Lost Card fie Toomvmoozurec�,l/ o�./�aeaac�urael� - -- Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 128405 Board of Building Regulations and Standards J19 Expiration: 4/5/2009 Tr# 129989 One Ashburton Place Rm 1301 Type: Partnership Boston,Ma.02108 KENDALL&WELCH`CONSTRUCTION DAMON KENDALL 54 KOMPASS DR. � �o,,` �i FALMOUTH,MA 02536 Administrator Not vali without signature BOARD OF BUILDING REGULATIONS• License: CONSTRUCTION SUPERVISOR Nurn erjpS 083484 r Buthdate 07/?1/1,963 .Expires.+07/1-1%2008 Tr:no:.2353.0. .e`; jI&E ;1 Re6tFicted.A00� " „i a e. RONALD W WEECHi 85 BRIGANTINE .,;':`' HATCHVILLE, MA 02536'' /J Commissioner 910 I7b: 3r 5084205553 YANKEE SURVEY PAGE 01/02 I _ U.S. WENT OF OMr=LAND SECURITY ELEVATION CERTIFICATE OMB No. i6emocia Federal Emergency Mariagemerif Agency Expires March 31,2012 National Flood Insurance Program important Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION Wit" Al t Building Owner's Name ARTHUR MCCAR I HT A2.-•Building Street Address ftluding Apt..Unit Suite,and/or Bldg, No.)or P,O, Route and Box No. 410 WIANNO AVENUE/ City OSTERVILLE State MA ZIP Coda 02655 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) BARNSTABI E ASSESSORS MAP 163 PARCEL 23 L.C.PLAN 7684C 9LOT 4) A4. Building Use(e.g.,Residential,Non.-Residential,Addition,Accessory,etc.)_RJMQ9N_T1AL A5. Latitude/Longitude,Lat 4i&Z?A_0S Long.m7O.OL71225 Horizontal Datum- EJ NAD 1927 0 NAD19M AS. Attach at least 2 Photographs of the building if the Certificate is being used to obtain flood Insurance. 7) A7_ Building Diagram Number g ::0 C3 —n AS. For a building with a crawrspace or enclosure(s); A9. Fora building with anattach NJ to N) P3 a) Square footage of crawlspace or endosum(s) 2200 sq ft a) Square footage of attached garage 12661 sq R b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood opi4nings in the!vttFs�',garage endosure(s)within 1.0 foot above adjacent grade J-1 within 1.0 foot above adjacent-grade 0 cn C) Total net area of flood openings in AS.b sq in c) Total net area of flood opon'Ing;In AQ-b) A 7-3 sq In d) Engineered flood openings? M Yes 0 NO d) Engineered flood openings?- 0 Yes 19 No SECTION 8-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1- NFIP Community Name&Community Number B2.County Name B3.State BARNSTABLE 2500DI TBARNSTABLE MA 64.Map/Panel Number 95.Suffix I 86.FIRM Index B7.FIRM Panel B8.Flood S9,Base Flood Elevation(s)(Zone 2600DI 0016 D Date L Effective/Revised Date Zone(s) AO,use base flood depth)R�A� LY 2,im REV.JULY 2, 1992 A13 12 BIO. Indicate the source of the Base Flood Elevation(OFE)data or base flood depth entered In Rom B9. [I FIS Profile to FIRM 0 Community Determined [I Other(Describe)_ BI 1. Indicate elevation datum used for BFIE In Item B9: J2 NGVD 1929 Ll NAVD 1988 El Other(Describe) B12, Is the building located Ina Coastal BanierResoumes System(CBRS)area crOthemise Protected Area(OPA)? [:1 Yes No Designation Date EJ CORS [3 OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawinge 0 Building Under Construction* Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2, Elevations-Zones AI-A30,AE,AH,A(with BFE),VE,VI-V30,V(with 113FE).AR,ARIA,APJAE,AR/A1-A30,ARIAH,AR/AO. Complete[terns C2.a-h below according to the building diagram specified In Item A7. Use the same datum as the SFE. Benchmark Utilized aWlVertleal Datum NOV01929 Conversion/Comments Check the measurement used. 8) Top of bottom floor(including basement,crawlspece,or enclosure floor)§.70 0 feet L3 meters(Puerto Rico only) b) Top of the next higher floor 14,02 0 feet El meters(Puerto Rico only) 0 Bottom of the lowest horizontal structural member(V Zones only) ❑feet [I meters(Puerto Rico only) d) Attached garage(top of slab) feet 0 meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building feet 0 meters(Puerto Rico only) (Describe type of equipment and location In Comments) f) Lowest adjacent(finished)grade next to building(LAG) 9,2 feet [3 meters(Puerto Rico only) q) Highest adjacent(finished)grade next to building(HAG) aLo.z 0 feel 0 meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,Including g.1 0 feet 0 meters(Puerto Rico only) structural support SECTION D-SURVEYOR, ENGINEER OR ARCHITECT CERTIFICATION This certification Is to be signed and seated by a land surveyor,engineer,or architect authorized by law to certify elevation information. /corW that the fiftm?ation,on this Cerffflaste represents my best efforts to Interpret the data avaflablal 'kAA undaFstand that comments statement may be punishable by fine or ft6sonment underCode,Section 1001.0 OF 414,4 Check here if comments am provided an back of form. Were latitude and longitude in Section A provided by a M, licensed land surveyor? 0 Yes L3 No if Z Certifiers Name STEPHEN DOYLE License Number 37559 .4 c3 Title LAND SURVEYOR Company Name STEPMEN DOYLE AND ASSOCIATES Address 42 CANTEReVRY LANE City EASTFALMOUTH State MA ZIP Code 02536 D SU Signature Date 04-08-10 Telephone 508 540-2534 FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions ti 141 ri'l/Z ri I ri rid; I I t)UdQ2U555J YANKEE SURVEY PAGE 02/02 IMPORTANT: I I :— - --these Spaces,COPY the cOrreSPIWiding information from Section A.Building Street Alid—resg'linr-ludlng Apt,,Unit,Suds,and/or Bldg.No.)or P.O.Route B 410 WIANNO AVENUE Bo No. Oily OSTERVILLESthte MA ,ZIP L,13Ce UL655 ...............: SECTION D-SURVEYOR, El ARC.HITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)Insurance agent/company,and(3)building owner, Comments 11JAPLATF®RWMELEVATION FOR ENCLOSURE VENTING. UNITS,INTERIOR vLJJ6W1N%4:o UTILITIES PLIMS LOCATED ENGINEERED SMART VENTS USED FOR ENC'��"-MRE VENTING. ABOVE THE FLOOD ZONE Signature Date l?4-Ofi-10 Check here If attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT SFE) For Zones AO and A(without SFE),complete Items EII-ES. If the Certificate is Intended to support a LOMA or LOMR-F request,complete Sections A,8, n a and C, For items EI-E4,use natural grade,if available. Check the measurement used, I .O Only,enter meters. Ell. Provide elevation information for the following and check the appropriate boxes to show the elevation Is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawispace,or enclosure)is C3 feet 13 meters Ll above or©below the HAG, E2- b)Top of bottom floor(including basement,cMWISPace, ❑or enclosure)Is For Building Diagrams 6-9 with permanent flood Openings provided in Section A Ham a an E3 feet 13 meters El above or EJ below the LAG. (elevation C2.b In the diagrams)of the building is _. Band/or 9(88G pages 8-9 of Instructions),the next higher floor E3. Attached garage(top of slob)is _._ _ 0 fbet C3 meters Ll above or 11 below the HAG. E4. 11 feet tj meters 0 above or E]below the HAG. Top of platform of machinery and/or equipment ❑ servicing the building is �_ [3 to E3 bo below th G ES. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevatedC]feet ❑me rs ❑a ve or e a HA -1 No [3 Unknown. The local official must certify this Information in Section G. ordinance? 11 yes I in accordance with fire community's floodplain management SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or Owners authorized representative who completes Sections A,B.and E for Zone A(without a FEMA-Issued or community-foued BFE) Or Zone AO must sign here. The stgfemenft In SectionsSectionsA,8,and E am correct to the best of my knowledge. Property er's or Owner's Authorized Representative's Name STEPJqEN DOYLE d resS 42 C BURYLANE City EAST FALMORA State MA ZIP Code 02536 Signature Date 04-08-10 Telephone 508-540-2534 Comments ❑Check here if magh"Bla SECTION G COMMUNITY INFORMATION(OPTIONAL) Te local Official who Is authorized by low or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,F(or�E), id G of this Elevation Certificate. Complete the applicable items)and sign below. Check the measurement used in Items GO and G9. 1. 0 The Information in Section C was taken from Other documentation that has been signed and Sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data In the Comments area below.) 2- El A community official completed Section E for a building located In Zone A(without a FEMA-Issued or community-issued BFE)or Zone AO. 3-0 The following information(items G4-G9)is provided for community floodplain management purposes. Address 42 C711UIIY LANIt-- Si 're gnat 34.Permit Number G5. Date Permit Issued GS. Date Certificate Of Compliance/Occupancy Issued 7, This permit has been Issued for El New Construction 11 Substantial improvement 3. Elevation of as-built lowest floor(including basement)of the building: 0 feet meters(PR)Datum ). SIZE or(In Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum 10.Community's design flood elevation ❑feet ❑meters(PR)Datum .00al Officlal's Name Title ;ommunity Name Telephone ;tgnab.Im Date 'ornments Qbedchere 1 attachments :MA Form 81-31, Mar 09 Replaces all previous editions •1:." %'.'..al�hf'.".,�MCI.y4'+�iMra.y'�f•..�•1"n'.'-�•'iN�� :.{^'ry�1= •�}`:Vi•y^t�`•r"°.'v.fiw1YViy��' �'; }�� ;r��.I'�w,^+i Y`.'.�i 1�"i,t1 �lR;,. � 3� B•E- ,,i n. Town of B arnstable Regulatory Services BARNSTABLE. • . . MASS. g. - t63 Building Division prf0 MP't s. 200 MainStreet,Hyannis, MA 02601 Office: 508-8624038 Fax: 568-790-6230 Inspection.Correction Notice Type of Inspection I—ra wt e- Location ��l o W,u„„o AV?— Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need (� :correcting f lJ t�w4e-s heeded -i 'r P �ac����iw�a S u oor I CZ) Tn �o- -Aa n gists n ee-d W-erg su nna r4- y y/1 't i t� �l cal 5� l,J YAP rP QAL9P �0 S f1V" Please call: 508=862-4038 for re-inspection. Inspected by v' Date TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map —Parcel Z).� Application# Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application F _J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 4//D /�a �/� Village. ST�Pyl-1,—,C' Owner d/2lAno2 VA 4- 6*21W Address Telephone Permit Request �L>�a�ov� ��[�S'T,:y� 2,aG.� 1��.�L ,�fzy Q ADD VE-It, 4``za3 ems" �'�� wt / ��.P�o�►�( •:r cYa Square feet:-1st floor existing!�� proposed /aD 2nd floor:existing /Da 4C proposed /G Total new Zoning District k Flood Plain Groundwater Overlay Project Valuation �- W Construction Type 14,., TFv?,f ft t ;z, I Lot Size .5s yf Grandfathered: es ❑ No If yes, attach supporting documentation. r Dwelling Type: Single Family pK' Two Family ❑ Multi-Family(#units) Age of Existing Structure YF_cge,C,- Historic House: ❑Yes XNo On Old King's Highway: ❑Yes No Basement Type: PPOIf ❑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 W-y Heat Type and Fuel: as ❑Oil ❑Electric ❑Other Central Air: UAIs*' ❑No Fireplaces: Existing �_ New_D Existing wood/coal stove: ❑Yes , No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:Aexisting ❑new size Y3 n 9 Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review-# ; CD ZE Current Use Proposed Use t, BUILDER INFORMATION Name 20.daf- 6-ize;," Telephone Number _ Cg— :2 — q Rve Address License# D S3 Y-Sy �� w14 o�26 Home Improvement Contractor# a Ef Worker's Compensation# lriG Q 4 /5 33'4 7-7 Yoi 6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �Zo FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ! MAP/PARCEL NO. ADDRESS' VILLAGE + • OWNER + + Y DATE OF INSPECTION: ' FOUNDATION l 0'1 a FRAME INSULATION U 6 i 4 FIREPLACE ! F ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH . FINAL FINAL BUILDING O 7/34 I DATE CLOSED OUT 9 ASSOCIATION PLAN NO. ' I Y. ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA. 02111' www.mass.gov/dia ' Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization Tndividual):. L�*V Ubz 44f ILL•. q .X�(l_- -Address: 2 0.0,n, A40q tl'?,r) City/State/Zip: 0,',^-,e Y11GG._ wh 'a�Phone.#: 0 — Are you an employer? Check the appropriate bo :Type of pioject(required):, 1;❑ I am a employer with 4. !am a general contractor and'I employees(full and/or part-time).* • have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole.proprietor or partner- listed on the-attached sheet. 7. PRemodeling ship and have no employees These sub-contractors have. g• ❑Demolition' R'orldng for mein any capacity. employees and have workers' insurance.$' 9• ❑Building addition co [No workers' comp.insurance �' 10.❑•Electrical repairs or additions required.] 5. ❑ We area corporation and its officers have exercised their 3.❑ I am a homeowner doing ill�work . l 1.❑Plumbing repairs or additions myself,[No workers'comp. right 6f 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 anew affidavit indicating such. tcontractors thaf check this box must attached an additional sheet showing the name of the$ub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide theiF workers'comp.policy number. I am an employer.that is providing workers'compensation insurance for my employees. Below is.thepolicy and job site' information. Insurance Company Name: Z_ `bi fy,!G 1-'ry/�' l;,• Policy#or Self-ins.Lic.#: Itre- 31 S g eq 77 C_/ Expiration Date: rPZ15: �7 Job Site Address: y/D' 7 wv i1,L e City/State/Zip: D;XG•,5 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 maybe forwarded to the-Office of' Investigations of the DIA for insurance coverage verification. I do hereb under the pains•and penalties of perjury that the information provided above is true an'd correct Si attiite �. Date o 7. Phone Official use only. Do not write in this area,tb be completed by,city or town officiab City or.Town: • Permit/License# Issuing Authority(circle one): `1.Board of Health 2.Building Department 3,City/Town Clerk 4;Electrical Inspector 5,Plumbing Inspector 6.Other Contact Person: Phone#; 1D.1Qr1U;1L1U11 UJIU ill��,l ��;l.1�➢it� 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." 1vMGL chapter 152, §25C(6)also states that"every state or local 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." . AdditionaIly,MGL chapter-152,§25C(7)states"Nelthir the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public-work until acceptable evidene6•oftomplimiee Qyithtlie 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-conti•actor(s)name(s),address(es)and phone number(s)along with their certificate(s) 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 sdre to'stgn 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 permit/license applications'many 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.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 of 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 C0z=0nWW1h of MaMchus4tts Dgpal ent of lad-Ustual Accidents Of ace of Tuvesftaltow 600 Washington St-�:a Boston,MA 02111 - . Too.#617-7274%0 ext 406 or 1' -MASSAFE Faye##617-727-7749 Revised I1-22-06 W .mams6v/dia ►E Town'of Barnstable ti Regulatory Services XAM.9s $ Thomas F:Geiler,Director `�pfo ,►`� Building Division Tom Perry, -Building Commissioner 200 Main Street, Hyannis,MA 02601 ffice:. 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property .01 hereby authorize �F�(��LC�— /,v 6- CCW Gp. to act on my behalf, in all matters relative to work authorized by this building permit application for: ylp AxIP-4/41VO 5Ii5?!l/1,LA- (Address of Job) Signature of Owner Date Print Name Q:FORMS:OVINERPERMISSION ' RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $ 50.00 Alterations/Renovations $ 50.00 Building Permit Amendment $ 25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS.OF EXISTING SPACE square feet x$64/.sq.foot— x.0041= plus from below(if applicable) GARAGES(attached&detached) l�G _square feet x$32/sq,ft.= G x.0041 ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 ' >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00 (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Projcost Permit Fee o. 7 Rev:063004 1 item 2005-02511/18/04 Substitute Demo/Rebuild Zoning Ordinance Amendment Upon a motion duly made and seconded it was ORDEOD: That Chapter III,Article M of the Town of Barnstable General Ordinances, the Zoning Ordinance,is hereby amended by inserting paragraph 7 to Section 4-4.2 Nonconforming , Lots,to rea -follows: 7) Developed Lot Protection—Demolition &-Rebuilding on Non-conforming Lots: * I _ Pre-existing leg non-conforming o s. - h have been unproved-bythe-construction --...—... of a single or two-family residence which conformed to all provisions of the zoning ordinance or bylaw at the time of construction shall be entitled to completely demolish the old residence and construct thereon a new residence in accordance with ' the following. , A) As of Right: The.proposed demolition and rebuilding shall be permitted as-of-right on a•pre- existing legal non-conforming lot that containg a minimum of 10,000 sq.ft.of. contiguous upland provided that the Building Commissioner determines that all of the following criteria-are met: 1) The proposed new structure conforms to all current use and setback requirements of the zoning district it is located in; 2) The proposed construction conforms to the following requirements of lot coverage, floor area ratio and building height: ' a., Lot Coverage by all buildings and all structures shall not exceed tw,tnty percent(20%)or the existing lot coverage,whiclever is greater; b. The Floor Area Ratio shall not exceed 0.30*or the existing Floor Area Ratio of the structure being demolished and rebuilt,whichever is greater; and c. The building height in feet shall not exceed'thirty(30) feet to the highest plate and shall contain no more than 2 % stones. The building height in feet shall be defined as the vertical distance from the average grade plane to plate. ' 3) Further expansion of the rebuilt structure must conform to Section 4.4.2 7)A)2) ' above. B)By Special Permit: if the proposed demolition and rebuilding cannot satisfy the criteria established in Section 4.4.2 7)A) above,then the Zoning Board of Appeals may allow the demolition and rebuilding by special permit provided that the Board finds that; 1) The proposed yard setbacks are equal to or greater than the yard setbacl s of the existing building; and 2) All the criteria in 4.4.2 7) A)2) a;b & c, above is n1et. ' 3) The proposed new dwelling would not-be substantially more detrimental to the A TRUE COPY ATTEST �` ` `. e ✓l e '6aavnza,L� -1-Arxa-du,,ae& BOARD O.,F BUILDING%REGULATIONS License: CONSTRUCTION SUPERVISOR i Number.. .CS 083484 `' � � Birthdatec;O7i11/1963 r '`rf I ;Expires: 07/11/2008 Tr.no:.2353.0 dm Restricted:r:00 i RONALD W WELCH;" 85 BRIGANTINE DR, HATCHVILLE, MA 02536 Commissioner Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registr tion Registra�n: 128405 T)pe: Partnership Expiration: 4/5/2007 ——` KENDALL & WELCH CONSTRUCTION DAMON KENDALL 54 KOMPASS DR. FALMOUTH, MA 02536 Update Address an return card.Mark reason for change. u 5GM•04105-PPC�8698, Address n Renewal [] Employment ❑ Lost Card \ ✓�C .�6'!!L')JL(J-!l((1el6l.�ll• OL a.lLQ4JlLCI(L ._• ' Board of Building Regulations and Standards License or registration valid for Ind Idd`'u-'l use only P)2- HOME IMPROVEMENT CONTRACTOR BBooaordd re of Building expiratIoRegulations and Standards date. U found Registration: 128405 One Ashburton Mace Rm 1301 Expiration: 4/5/2007 Boston,Mo.02108 Type. Partnership cNDALL 8 WELCH CONSTRUCTION kMON KENDALL KOMPASS DR. 1LMOUTH.MA 02536 Administrator Njt valid without signature ' m o PROJECT NAME: kO 11) ADDRESS: (J,i PERMIT# PERMIT DATE: '/ V0 M/P• SP 3 m i LARGE ROLLED PLANS ARE IN: BOX SLOTP�- DATE COMPLETED: BY: q/wpfiles/archive Inspections Schedulingfir= �o ILxJ My File Edit Tools Help ^� Field Sheet) Type Requested Scheduled Time Inspector Performed Results Balance Due App Profile CHIM 2 JLAU 02/28/2008 PASS EFINAL#1 WAMA 07/23/2009 PASS ',,EROUGH 1 ! WAMA 10/10/2008 PASS 'ESRVCINSP WAMA 11/18/2008 PASS !FOUND 1 , JLAU 09/14/2007 PAS S (FRAME 1 JLAU 10/15/2008 REINSPECTI !FRAME 2 JLAU 10/30/2008 PASS iGAS FIN 1 i RBUR 07/21/2009 PASS GAS ROU 1 RBUR 08/07/2008 PASS j iGAS ROU 2 RBUR 11/18/2008 PASS I :INS INSP 1 1LAU 10/30/2008 PASS RBUR ; j � 07/21/2009 PASS 1 i PLUM i RBUR j 08/07/2008 PASS j View Schedule i. 11 <-/ QA CL PROJECT NAME: , ADDRESS: wo PERMIT# 20070I 1 (O DATE: M/P: LARGE ROLLED PLANS ARE IN: BOX. SLOT J DATE: a rl �IME Tqw T01iVN O F BAR ti NSTABLE BuildingApplication Ref: 2007 „ 01660 IIAItNSTASLE, ' Issue Date: 03/26/07 MASS Permit y �A i639- ��� Applicant: WHELCH RONALD Proposed Use: SINGLE FAMILY HOME Permit Number: B 20070565 Expiration Date: 09/23/07 [Location. 410 WIANNO AVENUE Zoning District RF-1 Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 163023 Permit Fee$ 870.77 Contractor WHELCH RONALD Village OSTERVILLE App Fee$ 50.00 License Num. 083484 Est Construction Cost$ 212,384 Remarks ------ --- --- — —---- ------ , I TO REMOVE EXISTING GARAGE WING AND ADD NEW GARAGE I APPROVED PLANS MUST BE RETAINED ON JOB AND AND MUDROOM I THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A Owner on Record: MCCARTHY,ARTHUR S&PATRICIA I CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Address: 19 HOWE ST BUILDING SHALL NOT BE OCCUPIED UNTIL:A FINAL MEDWAY, MA 02053 INSPECTION HAS BEEN MADE. Application Entered by: JL ate_Building Permit Issued By: Jr�� ��_/�� THIS'PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET;ALLY OR SIDEWALK OR AN.' P RT.T HERS F THER TEMPORA�OR PEP IANENTLYi ENCROACHEMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BliILDMG CODE MUST BE APPROVED BY THE JURISDICI ION. STREET OR ALLY GRADES AS WELL AS DEPTH AND LOCATION OF:PUBLIC SEWERS MAY.BE'.OBTAINED,FR0M'THE DEPARTMENT OF PUBLIC WORKS.. THE ISSUANCEOF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE IM CONDITIONS OF ANY APPLICABLE SUBDIVISION.RBSTRICTIONS: MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK:1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1s%29/cAlf &I � 2 2 Z ( S �-- 77— 3 1 Heating Inspection AP eroyalsP Engineering pt Fire Dept . r 2 'dvy0 B of It t-:Iit; 41 1%a-t t CO Viz, t� j TNE TOWN OF BARNSTABLE . Building ti Application Ref: 200704156 • • Permit BARNSTABLE, + Issue Date: 08/07/07 9 MASS. 1639• Applicant: WHELCH RONALD Permit Number: B 20071884 ArFO MA'I A Proposed Use: SINGLE FAMILY HOME Expiration Date: 02/04/08 Location 410 WIANNO AVENUE Zoning District RF-1 Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 163023 Permit Fee$ 1,127.50 Contractor WHELCH RONALD Village OSTERVILLE App Fee$ 50.00 License Num. 083484 Est Construction Cost$ 275,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND .REMOVE EXISTING HOUSE AND RE-CONSTRUCT NEW DWELLING THIS CARD MUST BE KEPT POSTED UNTIL FINAL PHASE II INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: MCCARTHY,ARTHUR S 8r PATRICIA I BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 19 HOWE ST INSPECTION HAS BEEN MADE. MEDWAY, MA 02053 Application Entered by: JL Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLY OR SIDEWALK OR A PART THE H EMPORARILY OR PERMANENTLY. ENCROACHEMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, UST BE APPROVED BY THE JURISDICTION. STREET OR ALLY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.' MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. '4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5:INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). `� 0 :gyp 5"� o Q [v�P1't;�1�j 9� � � ® 4�i"i`aY-1i► BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1s�e 1 d`C 2 ? 'd �roi 3 1 Heating Inspection Approvals Engineering Dept �wU Of Fire Dept 2 Board of Health Town of Barnstable Building Department - 200 Main Street EARNST"LE. # Hyannis, MA 02601 MAC. (508) 862-4038 9� ieg9. ArFO MA't A Certif icate of Occupancy Application Number: 200704156 CO Number: 20080419 Parcel ID: 163023 CO Issue Date: 09114/09 Location: 410 WIANNO AVENUE Zoning Classification: RESIDENCE F-1 DISTRICT Proposed Use: SINGLE FAMILY HOME Village: OSTERVILLE Gen Contractor: WELCH RONALD Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: 9 /Y to Builvinwpartm/ent'Signature Date Signed i F i r Telephone: 508/563-6049 COLONY INSULATION, INC. 28 Jonathan Bourne Drive, Pocasset, MA 02559 CLOSED ELL FOAM 4IN4ATION SPEC SHEET i CONTRACTOR: JOB SITE ADDRESS: DATE: AREA THICKNESS R-VALUE Ceiling Cathedral Ceiling Garage Ceiling Basement Ceiling Slopes 3 aoo Exterior W all Garage Hse. W all Walkout Wall Cathedral W all Blockers 'Cl© Overhang ! - Stair/Risers All R-values and thickness measurements are deemed to be accurate by the following installers: y4titlaoo.,r TECHNICAL DATA FOR MATERIALS IS ATTACHED TO THIS FORM 7hermoSeaC 2000—Product Specification -. Air Permeance/Air Barrier ThermoSeal 2000 fills an shape cavity y p Burn Characteristics v including all voids,cracks,and crevices ThermoSeal 2000 will be consumed by Spt ate rs: adhering to multiple substrates such as flame but will not sustain flame upon wood,metal,and concrete creating a removal of the flame source.ThermoSeal `rhermoSeaC2OOO system with very little air permeance.With 2000 will not melt or drip.ThennoSeal Product Specification ThermoSeal 2000 no additional interior or 2000 must be installed in accordance with exterior air infiltration protection is all applicable building codes and a building Product Name required. inspectors approval should be requested ThermoSeal 2000 is the registered ASTM E283 Air Leakage prior to installation. trademark of SprayFoamPolymers.com for Zero(0) ft3/S.ft2 @ 75Pa(25mph wind) ASTM E84 Surface Burning Properties its 2.Olb high density,closed cell foam Sustained Wind Load Flame Spread @5" <=25 insulation. Smoke Developed @ 5" <=450 60 minutes@1000 Pa(90mph wind) Class 1 rating Product Description TBD Fuel Contribution none ThermoSeal 2000 is a semi-rigid,partially ASTM 2863 Oxygen Index TBD% water blown,2.Olb high density Gust Wind Load Test d i wind)polyurethane foam insulation system blown @3000 Pa(160 mphVOC TESTING by Enovate®blowing agent and water TBD CAN/ULC-S774 Pass which simultaneously insulates and air- SASKATCHEWAN RESEARCH seals your building structure. ThermoSeal ThermoSeal�2.0 qualifies as an air barrier COUNCIL 2000 is designed to make homes more as defined by ICC. energy efficient,stronger,healthier,quieter ThermoSeal 2000 must be covered by an and more comfortable.ThermoSeal 2000 is Water Vapor Permeance approved 15 minute thermal barrier or applied as a liquid spray which expands ThermoSeal 2000 is water vapor permeable ignition barrier, approximately 15 times its initial mass and and will allow structural moisture to escape. cures within seconds into a semi-rigid mass. For situations requiring a vapor barrier the A These flame-spread ratings are not ThermoSeal 2000 fills all building cavities use of low vapor permeable paint on the intended to reflect hazards presented by this completely sealing all cracks,crevices,and interior of drywall is an option. or any other material under actual fire voids where air loss and infiltration are conditions. most common. Water Vapor Transmission Properties: ASTM E96 data Compressive and Tensile Strength Technical Data 1.11@ 1" ThermoSeal 2000 has favorable compressive and Tensile strength properties Thermal Performance Water Absorption for high density foam. Thermal resistance(aged 180 days)R/in. ThermoSeal 2000 is water repellent,will ASTM C518: R6.62hr.ft2 OF/BTU not wick,and does not exhibit capillary ASTM D1623 Tensile Strength 80 psi properties.Water cannot be forced into the ASTM D1621 Compressive Strength 35 psi Average insulation contribution in stud foam under pressure because of its high wall: degree of closed cell structure Physical Characteristics 2"x4"=R23 2"x6"=R36 DIMENSIONAL STABILITY Acoustical Pro erties ThermoSeal 2000 provides greater R value Performance in a 2"x 6"wood stud wall. ASTM D—2126 performance than other equivalent R value 1580 F 100% Relative Humidity,7 days insulation materials which are air ASTM E413 STC Sound Transmission permeable such as fiberglass.ThermoSeal TBD Volume Change <8% 2000 does not lose R value due to wind, ageing,convection,air infiltration or ASTM E 90 Class 33 Closed Cell Content moisture.An R value fact sheet is available ThermoSeal 2000 is considered closed cell upon request. Fungi Resistance foam insulation: ASTM G—21 ZERO RATING DISCLAIMER:Information contained herein is,true and accurate,but all recommendations or suggestions are made without guarantee.Spray Foam Polymers,LLC(SFP)products are intended for sale to industrial and commercial customers.Since SFP exercises no control over its customers appreciation or use of the product manufactured by SFP and since materials used with the products may vary,it is understood that SFP can warrant only that our products will meei our written specifications.Nothing herein shall constitute any warranty of merchantability or fitness,nor is protection from any law or patent to be inferred.nermoSeal must be installed in accordance with all applicable building codes and a building inspector's approval should be requested prior to installation.All patent rights are reserved.SFP requests that customers inspect and test our products before use,and satisfy themselves as to contents and suitability.The exclusive remedy for all proven claims is replacement of our materials and in no event shall SFP be liable for any consequential,incidental,indirect,or special damages resulting in any manner from the furnishing of the material. I t 6� ThermoSeal 2000-Product Specification ASTM D2856 >=90% Viscosity&Weights ASTM D2196 Viscosity A Side ISO @ 700 F 215±35 B Side Resin @ 700 F 700f100 ASTM D1475 Weight/Gallon A Side ISO @ 77°F 10.2lbs B Side Resin @ 770F 9.81bs PO Box 1182 New Canaan, CT. 06840 Mixing Ratio By Volume Phone&Fax: 800.853.1577 ThermoSeal 2000 is a standard 1:1 mix http:///www.SprayFoamPolymers.com product.Slightly off ratio can produce slightly heavier odors and foam characteristics.Typically a heavier A ratio will produce a crunchier foam result,and a heavier B Side ratio will produce a spongier result. Electrical Wiring ThermoSeal 2000 is chemically compatible Suggested Preparation &Use with all 14/3, 12/2 and other similarly ThermoSeal 2000 will perform best when coated electrical wirings.For knob and tube gradually climate controlled to 77°F the wiring please seek the approval of your night before application.While local building inspector. recirculation of ThermoSeal 2000' without Product Storage heat prior to each days spraying is Component A-550 lbs of Isocynate stored suggested,recirculation of ThermoSeal in a a 55 gallon container outlined above. Bacterial and Fungal Evaluation 2000 in order to rapidly heat the product is Component`A'must be protected from ThermoSeal 2000 is not a source of food not is not suggested and may result in a freezing or deemed useless. for mold,insects or rodents.It has no decrease in catalyst count and product nutritional value.ThermoSeal 2000 reduces yield.We suggest starting with a Component B-500 lbs of ThermoSdal 2000 the introduction of moisture,food,and temperature of 125T and a working proprietary formulated resin Component mold spores into the building envelope pressure of 1000 psi. `B' must be stored between 55°F and 80T significantly more than traditional never exceeding either extreme. insulation such as fiberglass,cellulose and other non-sealants which do not provide an Both components temperatures should be at air barrier. Product Availability 75°F prior to mixing and use. Contact Spray Foam Polymers at WARRANTY Environment/Health/Safety 1.800.853.1577 for sales and availability When installed properly be a Spray Foam ThermoSeal 2000 contains no CFC's options. Polymers authorized representative who has HCFC's,formaldehyde,or volatile organic completed all training offered by SFP,SFP compounds.Following installation there Packaging warrants that the product will meet all will be a 24-48 hour occupancy window Products are shipped in 55 gallon open top product specifications outlined in this before the odors,emissions and gasses have steel drums.At the customers request the specification document. dissipated to a habitable level for products may be shipped in 55 gallons open. individuals highly sensitive to the materials top semi-clear plastic resin drums. installed. ThermoSeal 2000 is is not to be installed within 2"of heat emitting surfaces where heat dissipated exceeds 185T. DISCLAIMER:Information contained herein is,true and accurate,but all recommendations or suggestions are made without guarantee.Spray Foam Polymers,LLC(SFP)products are intended for sale to industrial and commercial customers.Since SFP exercises no control over its customers appreciation or use of the product manufactured by SFP and since materials used with the products may vary,it is understood that SFP can wan-ant only that our products will meet our written specifications.Nothing herein shall constitute any warranty of merchantability or fitness,nor is protection from any law or patent to be inferred.ThermoSeal must be installed in accordance with all applicable building codes and a building inspector's approval should be requested prior to installation.All patent rights are reserved.SFP requests that customers inspect and test our products before use,and satisfy themselves as to contents and suitability.The exclusive remedy for all proven claims is replacement ofour materials and in no event shall SFP be liable for any consequential,incidental,indirect,or special damages resulting in any manner from the furnishing of the material. I r ACORDM, CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD/YYYY) 7/25/06 PRODUCER THIS C13M FICATE IS ISSUED AS A MATTER OF INFORMATION Dolan & Maloney Ins. Agcy. LLC ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE 141 Turnpike Road HOLDER THIS CERTIFICATEDOES NOT AMEND,EXTEND OR Westborough, MA 01581 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I INSURED INSURERS AFFORDING COVERAGE I NAIC# I. .. . ....CO... ...... INSURER..A: MMERCE INS CO JOSEPHT VILLAGE DR ELECTRIC INC ; - -'--'--' - _.-.._..._ . __ . __ . i 40 VILLAGE DR ! INSURERS: ASSOC IND OF MA MUTUAL INS E SANDWICH, MA 02537 IINSURERC: INSURER D: INSURER E: COVERAGES 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. INSRADD'L .._ ..._..._.__...__...__.._.._ -__---_'--- _ POUCYEFFECTIVE POUCYEXPIRATlONI... -.---. --IMS C POLICY NUMBER LIMITS GENERAL LIABILITY I I EACH OCCURRENCE $ 1_ 000_ 000 i A COMMERCIAL GENERAL LIABILITY i HQQ443 i 9/25/05! 9/25/06)D-AMAG'TOREENTE0nce) i � 50� : $ 000 CLAMS MADE }{ OCCUR i l (Anyoneperson) $ 5000 i 1 MED EXP I ' PERSONA LBADVINJURY i $ A_. - ! GENERALAGGREGATE $ 2,OOO,.00O._ GEN'L AGGREGATE LIMIT APPLIES PER: - ' PRO- : PRODUCTS..COMPIOPAGG $ 2,000,00Q- x .POLICY , JECT LOC ' i AUTOMOBILE LIABILITY I I ; COMBINED SINGLE LIMIT p ;ANY AUTO YV2598 ' 8/29/051 8/29/06: (Eaaccident) ! $ ALL OWNED AUTOS ! i I � •-- - X .SCHEDULED AUTOS l : BODILY INJURY (Per person) ! $ 100,000 }{ :HIRED AUTOS }{ i NON-OWNED AUTOS ! I BODILY $ 300 000 r PROPERTY DAMAGE i (Per accidem) $ 100,000 GARAGE LIABILITY :ANY AUTO AUTOONLY-EAACCIDENT $ I OTHER THAN ACC ; $ i AUTO ONLY: ' AGG $ EXCESSJUM�SRELLALIABILITY I i EACH OCCURRENCE $ :OCCUR CLAIMS MADE I ; LAGGREGATE - j $ DFJ)UCTIBI i I $ RETENTION $ i $. i ' $ WORK MS COMPENSATION AND WC T 1TQRYUMITS_1-X_ ERB EMFLOYERS'LIABILITY IVWC 6008130012006 3/28/061 3/28/07 --- ANYPROFRIETOR/PARTNER/D(ECUTIVE : _ E.L EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDECO I � h-'--.-- -- _ ...... tt>es.descdbeunder i E.L.DISEASE-EAEMPLOYEE $ 500,000 SPECIAL PROVI9CNSbelow E OTHER .LDISEASE-POLICY LIMB $ 500,000 i i I i ! ESC RIPTIO N OF OPERATIONS/LOCATIONS I VEH ICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ELECTRICAL CONTRACTOR CERTIFICATE FAXED TO 508-888-5003 :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS W RITTEN KENDALL & WELCH ONSTRUCTION NOTIC ETO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO OOSO SHALL PO BOX 1478 IMPOSENO OBLIGATION OR UAB I ILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR N FALMOUTH, MA 02556 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Lk7C-02001/OS) ©ACORD CORPORATION 1988 Ju 1 21 06-0a! 341, -1,701 DATt(MMIWyYVYY) ACO ' CERTIFICATE OF LIABILITY INSURANCE 6 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION KcShea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 39terville, Ma. 02655 508-420-9Oil INSURERS AFFORDING COVERAGE NAACO _ INSURED A & E ConcreteFo rms, Inc. INSURER A: National Grar4e mutual Ina Co. INSURER B: ATIMer1C41A Home insurance Company 32 General Holoway Rd. INSURERC: South Yarmouth, Ma 02664 INSURER D: 508-394-9046 INSURER t: COVERAGES THE POLICIES OF INSURANCE LISTFu BELOW HAVE BEEN ISSUED YO THE INSURED NAMED ABOVE FOR THE POUCY 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 1 HE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.AGGREGATE UMITS SHOWN MAY I LAVE BEEN REDUCED BY PAID CLAIMS. LTR ao TYPE POLICY NUMBER PDOA ICY or C �L ... LIMITS -.._ GFNF.RAL LIABILITY FACH OCCURRENCE S 11000,000 X COMMERCIAL GENERAL LIABILITY 70"PERITIT —" M&PREMISS Meocalmncr s 500 0-00 CIAIMsbiADE FAIOCCUR MED FXP(Anyone pown) i 10,000 A MPI34700 4/4/06 4/04/07 PERSONALaADVINJURY _ s 1,000.000 _ GENERAL AGGREGATC s 2,000,000 GCN'L AGGREGATE PIMIT APPLIES PFR: PRODUCTS-COMPIOPAGG s 2,0QO OOO i POLICY T LOC AUTOMOOLCUABIUTY COMBINEDSINGI E 1 IMIT - ANYAUTO tEaec4tlent) i 500,000 ALL OWNED AUTOS - X SCHEDULED AUTOS BOD11.Y INJURY i trarpersorl) A HIREDAUTOS U8134700 4/4/06 4/4/07 Y NON-OWNEOAUTOS BODILYIN,IURv i . (rereraaenq --"' PROPLKIY DAMAGE i M. (Peracuaent) GARAGE LIABILITY AUTOONI Y.FA ACCIDENT i _ ANYAUTO OTHERTHAN LA ACC S AUTOONLY: Acc S EXCESW IMBRELLA LIABILITY EACH OCCIIRRCNCC i 1,000,000 X OCCUR 7I CLAIMSMADE AGGKEGAYE _ s 1,D00,000 A DI_aucrlaLE TSI 4/4/06 4/4/07 s ---- s RETENTION S SO 000 i WORKERS COMPENSATIONAND CMPLOYCRS'LIABILITY I TO LIMITS I I ER ANY VK0VNIt10(4pAA1NtWEXKV11Vi WC6704106 4/4/06 4/4/07 G.L.EACH ACCIDENT s 500,000 g a►lcewye"eeN t xeLwl ur t.L DISLASL-to t:WLOYt s -500,000 Ityy�e6,AnTiCI49VI t E.L DISEASE-POLICY LIMIT s 500,000 SPECl11L PROVISIONS bebw OTHER DES(:RIFT ION Oh OPtRA I IONS/LOCAL IONS I VEHICL ES I EXCLUSIONS AODFO BY ENOORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 1 SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Kendall & Welch Construction DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO NWL30 DAYS wwrrEN NOTICE TO THE CCRTncATC HOLDER NAMED TO WE LEFT,BUT FAILURE TO DO SO SHAt l 5 0 8-4 2 8-4 9 0 7 W POSF.NO ORI tGATION OK LIAWLI I Y OF ANY KIND UPC) INSURER,ITS AGENTS OR N01ftS1:NTATfVEqK- ALIT)tORIZED RF ACORD25(2001/08) O ACORD CORPORATION IM r Aug-07-06 09:56am From-MURRAY & MACDONALD 15064573101 T-074 P.02/02 F-663 DATE(MYYYV) /7/loos6 ��o�. CERTIFICATE OF LIABILITY INSURANCE 8M(OD/ 9/7/ PA WER (508)540-2400 FAx (508)289-4111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Murray & MacDonald Insurance Services HOLDER. THIS Y AND CONFERS ERTIFICATE DOES NOT OAMEND, CERTIFICATE OR 406 Jones Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Falmouth MA 02540 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURERArWQ&teXn World Kendall & Welch Construction Inc &NSUReR8;Saf0tY Insurance® 39454 P.O. Sox 1478 INSUfAERC-.X'ibCrW Mutual Ins COrP INSURER D: North Falmouth 1& 02556 INSURERE: COVERAGES 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 SY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE LLIILY PIRA ON IkjL NSR TYPE OF INSURANCE POLICY NUMBER OATS(MM/D DATEI M LIMITS GENERAL LIABILITY EACH C R $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMIS EINQ runco 5 300,000 A CLAIMS MADE EXKOCCUR NPP989749-2 6/15/2006 6/1S/2007 MEOW(Any one arson) i 10,000 PERSONAL IL ADV INJURY S 1,000,000 GENERAL AGGREGATe S 2,000,000 GEN'L AGGREGATE ppLIMIT APPLIESPER, PRODUCTS-COMPIOPACC i 2,000,000 X POLICY JE LOC AUTOMOBILE LABILITY COMBINED SINGLE LIMIT i ANY AUTO (Ea acd0eni) 1r1 ALLOWNEDAUTOS 2152655 11/17/2005 11/17/2006 BOOILYINJuRY X SCHEDULmAuTOs (Pa Pam-) 8 250,000 X MIRED AUTOS BODILY INjURY X NON-01NNE0 AUTOS (PeeacejdenA 8 500,000 PROPERTY DAMAGE i 100,000 (ParaCgOwu GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 5 ANY AUTO OTHER THAN F-A ACC S AUTO ONLY: AGG S EXCESSAIMBRELI A LIABILITY FACH OCCURRENCE S OCCUR CLAIMS MADE A80REGA7E S S DEDUCTIBLE i RETENTION S i C WORKELS COMPENSATION AND I TwOrAMMIA I 10EV, EMPLOYERS,LABILITY ANY PROPMETOR)PARTNERIMECUTNE E.L.EACH ACCIDENT S 100,000 OFFiCER/MEMBEREXCLUDE09 WC23183S4774016 6/15/2006 6/15/2007 E.L.DISEASE-EA EMP40YEN 8 100,000 If Yes,dcamw under SPECIAL PROVISIONSodow E.L.DISEASE-POLICY LIMIT Is 5001000 OTHER DESCIUPMON OF OPERATIONS/LOCATIONSNERICLES=CLUSIONS A015pO BY ENDORSEMENTISPE&AL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCCU.W BEFORE THE Town Of SaWnetablO EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDFAVOR TO MAIL Suild:Lng Inspector 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 200 Main Street FArLURE TO 00 SO SMALL IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE Hymmis, MA 02601 INSURER ITS AGENTS OR REPRESENTATIVES. AUYHORIYED REPRESENTATNE Claudine wrighter/KCD �� LACRDO 25(2001/00) ®ACORD CORPORATION 1988 S025(0108).06 AMS VMP Mwmge Sd4Uuna.Ina(800),927.05a5 Pw 1 of 2 f wv—c. r ! -'V111 lr lvr c.vv r lc. .zz ..io rrr rewL:. vv.�r vv:a raR owl vc1 DACE MM�D Y' A ( Di 1. I!• u� i:. , PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION— ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ROBERT E BOUCHIE JR INS HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR P O BOX 400 ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. CATAUMET MA 02534 COMPANY COMPANIES AFFORDING COVERAGE A HARTFORD UNDERWRITERS INSURED COMPANY COSTA, THOMAS L DBA B TOM COSTA BUILDING & FRAMING COMPANY 29 LADY SLIPPER LANE C MASHPEE MA 02649 COMPANY D HIS+IS TO CERTIFY :THAT THE POLICIES OF INSURA NCE+LISTED y BELOW `HAVE•BEEN,I SUED TO THE INSURED NSURED 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. j TO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MMWMYY) DATE(MM\DD%YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE=OCCUR. PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one tire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ HIRED AUTOS BODILY INJURY 71 NON•OWNED AUTOS (Per Accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND STATUTORY LIMITS EMPLOYER'S uABILITY (UB-8118A40-9-06) 09-21-06 09-21-0� EACH ACCIDENT $ THE PROPRIETOR? INCL PARTNERS/EXECUTIVEf�] DISEASE—POLICY LIMIT $ OFFICERS ARE: x EXCL DISEASE—EACH EMPLOYEE $ OTHER —ErCRIPTION OF OP15RATIONSILOCATIONSIVEHIC LESIRESTRICTION&SPECIALIT EMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. taf MT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL KENDALL AND WELCH CONSTRUCTION 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE INC LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 846C MAIN STREET LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. OSTERVILLE MA 02655 AUTHORIZED REPRESENTATIVE ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 16125*MI2006DDIYYYY) 6/25 PRODUCER (508)540-2400 FAX (508)289-4111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Murray 6 MacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR. 406 Jones Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Falmouth MA 02540 INSURERS AFFORDING COVERAGE NAIC S INSURED INSURERA:Arbella Protection Colony Insulation Inc. INSURERB:AIG 28 Jonathan Bourne Road INSURERC: INSUR POCasset MA 02559 INSURER E: COVERAGES 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. rA ADD'L POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE WDDNV ID DATE MMOMI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 pCom MERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 CLAIMS MADE [EOCCUR 8500026928 8/18/2005 8/18/2006 MEDEXP one n $ 5,000 PERSONAL 6 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY F1 ipm LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea acddont) $ 11000,000 A ALL OWNED AUTOS 49692400002 8/18/2005 8/18/2006 BODILY INJURY X SCHEDULED AUTOS (Per perm) $ X HIRED AUTOS BODILYINJURY X NON-OWNED AUTOS (Per acddent) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-CA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSltIMBRELLAL'ABILITY _FACH OCCURRENCE $ X OCCUR 7 CLAIMS MADE AGGREGATE $ $ A DEDUCTIBLE 4600028929 8/18/2005 8/18/2006 $ Rx RETENTION $ $ B WORKERS COMPENSATION AND WOC S�IMT 7S OE7 EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER(MEMBEREXCLUDED? NC8942449 6/15/2006 6/15/2007 E.L.DISEASE-EAEMPLOYE $ 500,000 If yes,deserlbe under SPEC$AL PROVISIONS below E.L.DISEASE-POLICY LIMIT IS 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVENICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (508)563-1062 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Kendall 6 Welch Construction EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Ronald Welch 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT BOX 1478 FAILURE TO DO SO SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE N Falmouth, MA 02556 INSUR ITS AOHiTB OR REPRESENTATNES. AUTHORIZED REPRESENTATIVE Gloria Smith/GMS �'"f ACORD 25(2001108) a ACORD CORPORATION 1988 reroone aeeo TOO 'A Wegb:T.T CIO 017.11 CA /T.T.R bRq RRq •RNT •ANI nnn fL josr l A- ainks La TAYLOR DESIGN ASSOC., INC. SHEET NO. OF • P.O. 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Box 1313 FORESTDALE, MA 02644 CALCULATED BY— TEL./FAX: Gil T DATE (508) 790-4686 AA CHECKED BY DATE SCALE —._....._._.._..... .__...._.__—_.:__.._...... ..... ... ..... _..... -- — — — ... ... ....>. € € s J _ __ - - _._......_.;. - ---- - .. ..... ...._ ...... _.. .._ ....._ ..... - - ..... -- -.. _..... _ _...._ ..... _....- S ._. ...... _...__ ..... - - --........... _..... - - - - ....................... .... _..... _.._. ...-- -_.._ ..... -.. _ .. ... ....:.... _O S c� _.... ..... ............ ...... - - - _. ...... _... __....._..._.....-- -.. -.................. ...-......_.._....___......... ...... _ _......... ........ _. ..._. _ _._.-..._........._._.... ---- - ._. ............... �l - Y..... .._ ..t..._...S_._.__..._ .._.. _... - - : t _......_.. .__ ._---- ----_ _. ... - - _ ..- -..... .. --- -.....- - .... - - - - -- -. _ .... - - - ....... -..... --- _...._ _.... ............-- -- - -... -- - - - -- - - :-- =- ... _..._.._. .__._...._.._._..__......_.. ............_... ..,._.._....._ ..... _ ._.. -- --- ..... .................. ..... _.. _..... .......................... - -.. �r __..._. ._...._._._..... _ ..... _ _ .............. ................. _. ................ .... .......................... - t ..._......------ -ry- - _ _...... _.....__.... .............._ ...-- ....... ........ Permit# i Permit Date i - 4e REScheck Software Version 3.7.3 Compliance Certificate Project Title: McCarthy Phase 1 Addition Report Date:02/13/07 Data filename:C:\Program Files\Check\REScheck\client reports\MCCARTHY PHASEI.rck Energy Code: Massachusetts Energy Code Location: Osterville,Massachusetts Construction Type: 1 or 2 Family,Detached Heating Type: Other(Non-Electric Resistance) Glazing Area Percentage: 14% Heating Degree Days: 6137 Construction Site: Owner/Agent: Designer/Contractor: 410 Wianno Avenue Northside Design Associates Osterville,MA 141 Main Street Yarmouthport,MA 02675 Compliance: Your .. Ceiling 1:Flat Ceiling or Scissor Truss: 1568 30.0 0.0 55 Wall 1:Wood Frame,16"o.c.: 1432 19.0 0.0 74 Window 1:Wood Frame:Double Pane with Low-E: 206 0.330 68 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space: 1568 30.0 0.0 52 Compliance Statement:The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the Massachusetts Energy Code requirements in REScheck Version 3.7.3 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.The heath'�load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions,found in the Code.The HVAC equipment selected to heat or cool the building shall be no greater than 125%of 11 the design load' cifie in Sections 780CMRR 1310 and J4.4. 'Builder/Designer Company Name Date r McCarthy Phase 1 Addition Page 1 of 4 4 i REScheck Software Version 3.7.3 Inspection Checklist Date:02/13/07 Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame,16"o.c.,R-19.0 cavity insulation Comments: Windows: ❑ Window 1:Wood Frame:Double Pane with Low-E,U-factor:0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: Floors: ❑ Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-30.0 cavity insulation Comments: Air Leakage: ❑ Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. ❑ When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944 Us)air movement from the the conditioned space to the ceiling cavity.The lighting fixture shall have been tested at 75 PA or 1.57 Ibs/ft2 pressure difference and shall be labeled. Vapor Retarder: ❑ Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: ❑ Materials and equipment must be identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. ❑ Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications. Duct Insulation: ❑ Ducts shall be insulated per Table J4.4.7.1. Duct Construction: f ❑ All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions.Mesh tape may be omitted where gaps are less than 1/8 inch.Duct tape is not permitted. ❑ The HVAC system must provide a means for balancing air and water systems. Temperature Controls: ❑ Thermostats are required for each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. McCarthy Phase 1 Addition Page 2 of 4 i Heating and Cooling Equipment Sizing: ❑ Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: ❑ Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: ❑ All heated swimming pools must have an on/off heater switch and require a cover unless over 20%of the heating energy is from non-depletable sources.Pool pumps require a time clock. Heating and Cooling Piping Insulation: ❑ HVAC piping conveying fluids above 120 degrees F or chilled fluids below 55 degrees F must be insulated to the levels in Table 2. McCarthy Phase 1 Addition Page 3 of 4 i Table 1:Minimum Insulation Thickness for Circulating Hot Water Pipes I , Insulation Thickness In Inches by Pipe Sizes Non-Circulating Runouts Circulating Mains and Runouts Heated Water Temperature("F) Up to 1" Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2:Minimum Insulation Thickness for HVAC Pipes Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range("F) 2"Runouts 1"and Less 1.25"to 2.0" 2.5"to 4" Heating Systems Low Pressurelremperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant and 40-55 0.5 0.5 0.75 1.0 Brine Below 40 1.0 1.0 1.5 1.5 i NOTES TO FIELD:(Building Department Use Only) i�. I w, McCarthy Phase 1 Addition Page 4 of 4 I r' 7- Permit# Permit Date REScheck Software Version 3.7.3 Compliance Certificate Project Title: McCarthy Phase 2 Addition Report Date:03/16/07 Data filename:C:\Program FileslChecklREScheck\client reports\MCCARTHY PHASE2.rck Energy Code: Massachusetts Energy Code Location: Osterville,Massachusetts Construction Type: 1 or 2 Family,Detached Heating Type: Other(Non-Electric Resistance) Glazing Area Percentage: 21% Heating Degree Days: 6137 Construction Site: Owner/Agent: Designer/Contractor: 410 Wianno Avenue Northside Design Associates Osterville,MA 141 Main Street Yarmouthport,MA 02675 Compliance: . ..- Ceiling 1:Flat Ceiling or Scissor Truss: 2516 30.0 0.0 88 Wall 1:Wood Frame,16"o.c.: 4769 19.0 0.0 224 Window 1:Wood Frame:Double Pane with Low-E: 708 0.330 234 Door 1:Glass: 301 0.330 99 Door 2:Solid: 20 0.140 3 Floor 1:All-Wood Joist(Truss:Over Unconditioned Space: 2516 30.0 0.0 83 Compliance Statement:The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the Massachusetts Energy Code requirements i EScheck Version 3.7.3 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.T eatin oad for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design�-onditions ound in the Code.The HVAC equipment selected to heat or cool the building shall be no greater than 125%of 7Buil >sign loa s spec' in Se 80CMR 1310 and J4.4. esigner mpany Name Date z 'L McCarthy Phase 2 Addition Page 1 of 4 t h r REScheck Software Version 3.7.3 Inspection Checklist Date:03/16/07 Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame,16"o.c.,R-19.0 cavity insulation Comments: Windows: ❑ Window 1:Wood Frame:Double Pane with low-E,U-factor:0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? 'Yes No Comments: Doors: ❑ Door 1:Glass,U-factor:0.330 Comments: ❑ Door 2:Solid,U-factor:0.140 Comments: Floors: ❑ Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-30.0 cavity insulation Comments: Air Leakage: ❑ Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. ❑ When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 1• Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944 Us)air movement from the the conditioned space to the ceiling cavity.The lighting.flxture shall have been tested at 75 PA or 1.57 Ibsht2 pressure difference and shall be labeled. Vapor Retarder. ❑ Required on the wane-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: ❑ Materials and equipment must be identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. ❑ Insulation R-values and glazing U-factors must be dearly marked on the building plans or specifications. Duct Insulation: ❑ Duda shall be insulated per Table J4.4.7.1. Duct Construction: i ❑ All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed using mastic and fibrous backing tape Installed according to the manufacturer's installation instructions.Mesh tape may be omitted where gaps are less than 1/8 inch.Duct tape is not McCarthy Phase 2 Addition Page 2 of 4 r permitted. 0 The HVAC system must provide a means for balancing air and water systems. Temperature Controls: ❑ Thermostats are required for each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Heating and Cooling Equipment Sizing: ❑ Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and AA Circulating Hot Water Systems: ❑ Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: ❑ All heated swimming pools must have an on/off heater switch and require a cover unless over 20%of the heating energy is from non-depletable sources.Pool pumps require a time Gods. Heating and Cooling Piping Insulation: ❑ HVAC piping conveying fluids above 120 degrees F or chilled fluids below 55 degrees F must be insulated to the levels in Table 2. McCarthy Phase 2 Addition Page 3 of 4 Table 1:Minimum Insulation Thickness for Circulating Hot Water Pipes insulation Thickness In Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature("F) Up to 1" Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2.,Minimum Insulation Thickness for HVAC Pipes Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range("F) 2"Runouts 1"and Less 1.25"to 2.0" 2.5"to 4" Heating Systems Low Pressurefremperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant and 40-55 0.5 0.5 0.75 1.0 Brine Below 40 1.0 1.0 .1.5 1.5 NOTES TO FIELD:(Building Department Use Only) 's McCarthy Phase 2 Addition Page 4 of 4 i 1 --TU CERTIFICATE OF LIABILITY INSURANCE DA7/25106 PRODUCER THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Dolan & Maloney Ins. Agcy. LLC ONLY AND CONFERS NO RIGHTS UPON THECERTFICATE 141 Turnpike Road HOLDER THIS CERTIFICATEDOES NOT AMEND,EXTEND OR Westborough, MA 01581 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I i INSURERS AFFORDING COVERAGE j NAIC# INSURE) [INSURER A: COMMERCE INS CO I JOSEPH E PELTIER ELECTRIC INC - -" — — —- — — —-- INSURER B: ASSOC IND OF MA MUTUAL INS 40 VILLAGE DR INSURER C: E SANDWICH, MA 02537 INSURER D: INSURER E: � COVERAGES 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. INSRADD'L POLJCYEFCTIVE PDUCYEX PIR ATDN -' -- LTR p C POLICY NUMBER D T FIDED D E D 1 LIMITS GENERAL LIABILITY I LEACH OCCURRENCE $ 1,000,000 ACOMMERCIAL GENERAL LIABILITY ! 443 H I DAMAGE-TO RENTED I $ 5� I 1 _ QQ i 9/25/05 9/25/06) PREMISES(Eaoaurerxz) _ ,.OQO CLAMS MADE X: OCCUR! I (-MED EXP(Any one person) $ 5,000 _ PERSONAL&ADV INJURY $ — i GENERAL AGGREGATE $ 2,000 000 GEN'LAGGREGATELIMITAPPLIESPER: ! i I PRODUCTS-COMPIOPAGG $ 2,000,000 X ,POLICY PRO- JECT r LOC -. ..- ! AUTOMOBILE LIABILITY 1 ANY AUTO � COMBINED SIN GLELIMIT A 1 YV2598 ( 8/29/05`I` 8/29/061 (Eaaccident) Is ALL OWNED AUTOS SCHEDULED AUTOS I ! BODILY INJURY (Per person) I $ 100,000 X HIRED AUTOS I BODILY INJURY 1 X ANON-OWNED AUTOS ( I (Per accident) $ 300,000 I t PROPERTY DAMAGE (Per accident) Is 100,000 i GARAGE LIABILITY 1 AUTO ONLY-EA ACCIDENT $ I ANY AUTO ._. .. - --� I OTHER THAN EA ACC $ AUTO ONLY: AGG 1 $ EXCESSJUMORELL_ALIABILITY I EACH OCCURRENCE $ OCCUR CLAIMS MADE I .AGGREGATE. _ $ $ DFOUCTIBLE 1 I $ ,RETENTION $ j I I $ WORKERS COMPENSATION AND I i I WCSTATU- ! TH- B EMPLOYERS'LMBILITY IVWC 6008130012006 3/28/06I 3/28/07 J1Q13YLIMITS_Ix-L ER_1 ANY PROFR IETORIPARTNER/S<ECUTIW II E.L.EACH ACCIDENT I! $ 500,000 OFFICER/MEMBER Abeund rEXCLUDED? I I l E.L.DISEASE_-EAEMPLOYEE I $ 500,000 If yes,d escri be under _ SPECIAL PROVISION S below I i I E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER I { I I I � ESC RIPTIO N OF OPERATIONS I LOCATIONS I VEH ICLES I EXCL USIONS ADDED BY END ORSEMENT I SPECIAL PROVISIO NS ELECTRICAL CONTRACTOR CERTIFICATE FAXED TO 508-888-5003 :ERTIFIC ATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIESBE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER W ILL ENDEAVOR TO MAIL 10 DAYS W RITTEN KENDALL & WELCH ONSTRUCTION NOTIC ETO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TOD OSO SHALL PO BOX 1478 IMPOSENO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR N FALMOUTH, MA 02556 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 4CORD 25(2001/08) ©ACORD CORPORATION 1988 ACORD,� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ODtYYYY) 6/25 2006 PRODUCER (508)540-2400 FAX (508)289-4111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MurrayMacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1' HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 406 Jones Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Falmouth MA 02540 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Arbella Protection Colony Insulation Inc. INSURERB:AIG 28 Jonathan Bourne Road INSURERC: INSURER D: Pocasset MA 02559 INSURER Et COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,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. 1NSR INSRO ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY IC EXPIRATION X OOZY VN LIMITS LTRDATE GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 MO, CMERCIAL GENERAL LIA81UTY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 A CLAIMS MADE �OCCUR 8500028928 8/18/2005 8/18/2006 MEDEXP An one n $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY J£CT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea acGdont) S 11000,000 A ALL OWNED AUTOS 49692400002 8/18/2005 8/18/2006 BODILY INJURY X SCHEDULEDAUTOS (Per Person) $ X HIREDAUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ X OCCUR CLAIMS MADE AGGREGATE $ S A DEDUCTIBLE 4600028929 8/18/2005 8/18/2006 $ RX RETENTION S $ B WORKERS COMPENSATION AND WC STATU• OT - EMPLOYERS'LIABILITY TORV LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT 1$ 500,000 OFFICER/MEMBER EXCLUDED? WC8942449 6/15/2006 6/15/2007 If yes,describe under E.L DISEASE-EA EMPLOYE $ 500,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (508)563-1062 SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE Kendall ♦L Welch Construction EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Ronald Welch 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT BOX 1478 FAILURE TO 00 SO SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE N Falmouth, MA 02556 INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Gloria Smith/GMS �/o-r�a-- _-do ,� 'tft_ ACORD 25(2001108) ®ACORD CORPORATION 1988 ulon�c........ •ue TOM 'A wegb!T.T. PO/017//O /T.T.R fsgq ROlq 'SNT *ANnW In W 1/ 1U/ Lvu 1 14 LILA :DZI erl 11AILZL UUJ/UUJ r dx ourvur _�jt:xa:'kx: k: x DATE IM �.VE'R` A001H .......................... ni—nq— .......... ........... ............ ...... ........ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ROBERT E BOUCHIE JR INS HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR P 0 BOX 400 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CATAUMET MA 02534 COMPANY COMPANIES AFFORDING COVERAGE 29GAM A HARTFORD UNDERWRITERS INSURANCE COMPANY INSURED COMPANY COSTA, THOMAS L DBA B TOM COSTA BUILDING & FRAMING COMPANY 29 LADY SLIPPER LANE C MASHPEE MA 02649 COMPANY D THIS IS TO FY BEL OW HAVE BEEN`I i SUED TO THE INSURED,NAMED CIVE FO THE I THAT THE ISTED 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. co TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LT R POLICY NUMBER DATE(MNI\DD\YY) DATE(MM\DDkYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ i CLAIMS MADE=OCCUR. PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per Accident) PROPERTY DAMAGE $ IGARAGE LIABILITY AUTO ONLY-EA I ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ P AGGREGATE $ 1EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND (UB-811BA40-9-06) 09-21-06 09-21-07 STATUTORY LIMITS A EMPLOYER'S LIABILITY EACH ACCIDENT $ THE PROPRIETOR/ INCL DISEASE—POLICY LIMIT $ -inn,nnn PARTNERS/EXECUTIVE OFFICERS ARE: EXCL DISEASE—EACH EMPLOYEE $ 100-.000 OTHER DESCRIPTION OF FPER—ATIONS/LOCA'nONSVEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CANOE CAN4CE V:NOE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL KENDALL AND WELCH CONSTRUCTION 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE INC LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 846C MAIN STREET LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. OSTERVILLE MA 02655 AUTHORIZED REPRESENTATIVE . ............ i 07/20/2006 14:36 FAa b08 790 1877 FAIR INS I�001 c:kRT�FICATE OF LIABILITY INSURANCE RAM 0°f W07,73-11,31 FAX (S08 790-15T7 07 S 006 Thda Cad. Saau,l4nea Ae,,my, 2nc T}�GC TIFIII M ISSNCO AS A MATYER OF>NM�ORW1T10N P.D. Bane Ii30 ONLY AND CON6E+>IGq NO RIQ NTs tJPOay THE CERWICATE NOLpER.TMIS CERTfFiCATE DOES NOT AYF QD.AND OR St4 MR-in St. :.etitarvi77c, Abl 02632 WSUREM AFFORMp COWRAOr. INdtilr� /1q 11D� ]A %., NAICB P.O. aoac 339 MURNIA; Nat ona Graw Marston Mills. K4 02648 MFMRW sa LtBurance CC. INBUIlJ!!lll!D; Rd6URp�C. TWE PbuC16E OF NfSuRANCE LIffnW BELOW FIAVE BEEN ANY PeQU1RL°NENT.TT�1 DR CONDITION OR ANY C �TO THE IN:yURE D NAMED 1111 FOR Tii!POLICY _ MAY PERTAIN,THE ONTIZACT dR OtHER DOC{MeIENT WITM 1$BPECT IAIi11CN RICO INOK,IITI;D�ASOTYW 171BTANDINti POtJCiEB.At3dREQATE t E pyyN� y HA�OEM W By A SUBJECT TO AL171i!7L°RNIS,exCLlll3lO�I'Is AND AAAy BE CONd 3 DCA WM OF WKWAKOE PcLwy MM� CLAUSL SUgi MIM. r MPI70531 LrlTg CwaSm a O=m Eacfl + 1 000■D sDD .ate to/oz/ZOps Zo�OZ/2oo6 wieeow%sAaW"gr We PRoaucrs LmaLrr„ i ODD 00 AWAUM 19D0608 12/D3,/aODs 12/03L/Z006 A%L0WW0 urp8 W.W.1dinl1"'WE Wfr = s X saMEDtaiDAurnp eoDltrnwl�lnr MMC AL fba fPp f 6 NOKOrM�AUTD$ ZDO (P���gwiJRY • 30D QA%*W L*jK rr o i ANT AUTO IONA+rroae4r-aAooMrrr : Asa s Go" 17]CLAW maM AAQn e , Alit i twmereLE F!'e11YrlpM i i vxxuum arLrrr71°N Ai1° A U01157go-1 re0fi 0i/i01 3 C AFANY PRO A�®fCta curl� /2006 0 1l2007 4L tACJ1ACC IMIII s OrM� Brew E.LDISEASE-EA ! 10. CL OfsABG-POLICrLMIt i Spa, > P7�OMOPOROU �LAGn1eNf;�yEM�s/9202JXDKWS ADM rjy MOpp�IBliriPEaAl,ppplR/laTi CAMC SHOW A AUV GP7W AMM Cokarg m FOt1C1�as W limpnw[TNt CIM&AT M MTN TflelfapF,IM IM111010 NMJM V&L Ia1WANK TO MqL KEWLL E IIELCM 15 a►rawRrrM+Ie. -M7 MCaRT I-14TRMWMwUAWDro7mLI•Ft PO 8M 1678 M"FALURX'G"4's1=Wa'O!aM4LL wP0W M0 4MJGAUM oR YI1Mlu v N FAt 90M. MA 02566 ofAMYatU UPON TMIN0 MP.nsAOenndeRBieF�leeA71Yi6 A{flilplt®�lMfAlalC DORD lI5 0=1l00} FAX. (50a)563-1062 lKathX Silvi AITUX 4t76,— MlD C00mMATU M is" I JUA 21 Ob-O:': 3�1• -1•:U1 DATL(MMA)UIYYYY) CREL CERTIFICATE OF LIABILITY INSURANCE I 712IL2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Da<cSriea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 744 Main street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3sterville, Ma. 02655 508-420-9011 _ INSURERS AFFORDING COVERAGE NAICN _ INSURED r A & E Concrete Forms, Inc. INSURCRA: National OastgMl Mutual IIIe Co. .. _ INSURER R: AmerLC*A M=e Insurance Company I 32 General Holoway Rd. INSURERC: _ South Yarmouth, Ma 02664 INSURER D: 94- INSURER t: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED YO 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 1 HE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.AGGREGATE LIMITS SHOWN MAY I1AVE BEEN REDUCED BY PAID CLAIMS. ILTR RD TYPE POLICY NUMBER pq MMIFFNV DA MAD TI LIMITS - - GFNERAL LIABILITY F.AC14 OCCURRENCE E 1 OOO 000 *-XCOM MEROAI GENERAL LIABILITY OAMAGC TD RE —' ^ PREMISES Fa oow. 5 500 000 CLAIMSMADE �'OCCUR MFOFXP(Anyone pason) s 10,000 A _- MP134700 4/4/06 4/04/07 PERSONAL&AUvINJURY s 1,000 000 GENERAL AGGREGATE S 2 OOO OOO GCN'LAGGREGATELIMI1APPLIESPFR: PRODUCTS-COMPlOPAGG 5 2,000•lO00 POLICY fJE lT .LOG . AUTOMOBILELIABILITY COMBINEDSINGI E I IMIT S 500,000 ANVAUTO (Ea acMent) ALLOWNEDAUTOS •_ _•-- X SCHEDULED AUTOS ROOMY INJURY 5 (Per person) A HIRED AUTOS M8134700 4/4/06 4/4/07 BODILY INJURY $ NON-OWNEDAUTOS (Perecdaent) --- FROPt:R I Y UAMAGE s (Perawdent) GARAGE LIAMLITY AUTOONf Y•FAACCIDENT I$ ANY AUTO _... _.......-.- OTHFRTHAN tA,nCC 5 AIJTOONLY: ACC S" EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S 1 000 000 X OCCUR F—I CLAIM.SMADE AGGREGATE -_ S 1,000,000 TBI 4/4/06 4/4/07 __ s A DEDUCTIRLE -- s RETENTION S 10,000 g WORKERS COMPENSATIONAND Y X TOR ATU ER IM EnMPLOYCR3'LUBILITY WC6704106 4/4/06 4/4/07 E.L.EACH ACCIDENT s_ _ 500 000_ •N'Y vKOvNltrOp,O,A1NEWEkeCU11Vr .. .. 8 Cwtrtwum"[K Exclwtur aunaer t.L DIStASt•FA t:WLOYI:l 5 500 .000 nyyee5s aescrto SFECIALPROVISIONSbelow E.L.DISEASE-POLICY LIMIT 6 500 000 OTHER DESCRIPT ION Uh OPtRA I IONS LOCA1IONS r VEHICLES r FXC1.USIONSAOnFO BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Kendall & welch Construction DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL30 DAYS WRITTEN NOTICE TO THE CCRTITICATC HOLDER NAMED TO TIIE LEFT,BUT FAILURE TO DO SO$HAl I 5 0 8-4 2 8-4 9 07 IMPOSE.NO ORl fGATION OR LIABILII Y OF ANY KIND UPO INSURER,ITS AGENTS OR KtWtEStNTATN AUTIIORl2ED RFP ACORD2$(2001l08) OACORD CORPORATION 1988 / / 'L1_j/ U0 1 2 : 00 : L3 F'Ivl 41J4 VJ ACORD - CERTIFICATE OF LIABILITY INSURANCE ,i20/2006 7DUCER FAX (508)289-4111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION —urray & MacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 406 Jones Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Falmouth, MA 02540 Douglas MacDonald INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A'Charter Oak Fire Cape Cod Mechanical Systems, Inc. INSURER BTravelers Indemnit 8 Fruean Way INSURER C:St. Paul Travelers INSURER D:AIG South Yarmouth MA 02664 1 INSURER COVERAGES 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. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDlYY) DATE(MMMDIYY) LIMITS A GENERAL LIABILITY I6806937B396 03/12/2006 03/12/2007 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ Cl AIMS MADE a OCCUR MED EXP Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JE T L�iC B AUTOMOBILE LIABILITY I8101333B747 03/19/2006 03/19/2007 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL()V64JEDAIJT05 BODILY INJURY X 3CHED'ULEDAIJTOS (Perperson) $ X HIREDAUTOS BODILY INJURY X NON-OVkJED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ C EXCESS/UMBRELLA LIABILITY CUP0657Y378IND05 03/12/2006 03/12/2007 EACH OCCURRENCE $ 1,000,000 OCCUR ❑CLAIMS MADE AGGREGATE $ l,000,000 $ DEDUCTIBLE $ RETENTION $ $ D WORKERS COMPENSATION AND 8957286 03/12/2006 03/12/2007 TORYLIMITS ELF EMPLOYERS'LIABILITY .=JJ'f PROPRIETOR/PARTNERIEXEC'UTIVE El EACH ACCIDENT $ 500,000 OFFICE scribe under a EXCLUDED? II yes,describe El DISEASE-EA EMPLOYEE$ 500,000 SPECIAL PROVISIONS oelow E.L.DISEASE-POLICY LIMIT Is 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Certificate holder is additional insured with respect to general liability form CG D2 520 01/03 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Kendall & Welch Construction Inc EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Katrina 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT PO Box 1478 North Falmouth, MA 02556 FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Gloria Smith/GMS - -��'-f ACORD 25(2001108) ©ACORD CORPORATION 1988 INS025(oiosw6 AMS VMP Mortgage Solutions.Inc.(800)527-0545 Page t oI2 5993 I �a:.o: rl cvl cvvv aivao. a:s.r cc: av: o a,s, auuoaa a noi�.0 .r�� •s�� :avr xav auo. e�y�.Y. cnyo: vv� Clibnt#:42270 NORTSEA ACORU. CERTIFICATE OF LIABILITY INSURANCE 07/20/06'""""' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.Agency,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED Northern INSURER A: Ohio Casualty Group 20 Candlewood Lane and Paving,Inc. INSURERS: American Home Assurance P.O. Box 995 Lane INSURER c: Arbella Protection Co Dennis Port, MA 02639 INSURER D: INSURER E: COVERAGES 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. LTR fi= TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION—DATE fMM/DO/YY1 DATE(MMIDDIYYI LIMITS A GENERAL LIABILITY BL00753312747 01/22/06 01/22/07 EACH OCCURRENCE $1 000 000 NCO, MERCIAL GENERAL LIABILITY DAMAGE TO RENTED O O PREMISES(Ea orcurrence) $SOO CLAIMS MADE �OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 00O ODO GENERAL AGGREGATE $'Z OOD OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000 POLICY PRO- JECT F LOC C AUTOMOBILE LIABILITY 59140400002 01/21/06 01/21/07 COMBINED SINGLE LIMIT ANYAUTO (Ea amdent) $1,000,000 ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY(Per (Par person) X HIRED AUTOS X NON-OWNED AUTOS BODILY INJURY(Per (Per accident) PROPERTY DAMAGE $ (Per accdent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WC8959278 04/01/06 04/01/07 X I WC STATU•I OTH. EMPLOYERS'LIABILITY TORY LIM ITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 OOO OFFCER/MEMBER EXCLUDED? If yess,describe under E.L.DISEASE-EA EMPLOYEE $500 000 SPECIAL PROVISIONS below E.L.DISEASE.POLICY LIMIT $500 OOO OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Kendall&Welsh Const.Co. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN East Falmouth,MA 02536 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #23306 WOB ©ACORD CORPORATION 1988 n JOB �v TAYLOR DESIGN ASSOC., INC. SHEET NO. ' OF P.O. 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Z __J . ............................. - _ _..._ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations �' sd 600 Washington Street Boston,MA 02111 w www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmizationadividual): &ENPA 1-G Address:_ Govt `+/9 0 F City/State/Zip: ©S�Z'"441 - MA V+ o `"Phone.#: ASS Are you an employer?Check the appropriate bog,i -Type of project(required):. L❑ I am a employer with 4. am a general contractor and I 6 New construction.. employees (full and/or part-time).* have hired the sub-contractors listed on the-attached sheet. 7. [0,Kemodeling 2.❑ I am a'sole proprietor or partner- These sub-contractors have ship and have no employees 8. ❑Demolition and have workers' working for me in•any capacity. employees9. ❑Building addition [No workers' comp.insurance comp.insurance.$, 5. ❑ 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 df exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.[] Other employees. [No workers comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside.contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: L/3 6 — Policy#or Self-ins.Lic.#: ly C- 13d Expiration Date: Job Site Address: y/D ymo .4,/G City/State/Zip: T�diI,CG.�tr1 D�GSS� 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 incur ce covera e verification. I do hereby certi under t ns nd penalties of perjury that the information provided above is true and correct Simafore: Date: .Sol Phone 011 FBa only. Do not write in this area, to be completed by city or town officiaL n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ` son: Phone#: Y i 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 recei�or tmstee: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 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 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-contiactor(s)name(s),address(es)and phone number(s)along with their certificate(s)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 -.tl at must submit multiple permit/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 aoven)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the pplicant 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 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�Tassaebuset�s Depar4nent of Industrial.Awidents Office of Investigations 600 Washington Street B.ostan,Mai 02111 Tel. # 617-727-4900 ext 406 Qr 1-977-MASSAFE Fax#617-727-7749- Revised 11-22-06 www.mass.gov/dia 00 The CommionweaTth ofMiusachusetts yf� Department oflndustrialAccidents 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 Legibly Name(Business/organizationrmdividual): Address: City/State/Zip: L�2T,el,a W A 0?6 P one.#: ?,�k— tjgao Are you an employer? Check the appropriate bo :Type of pioject(required):, 1;❑ I am a employer with 4. am a general contractor and 6. [-]New construction . •employees(full and/or part-time).* • have hired the sub-contractors � 2•❑ I am a sole.proprietor or' listed on the'attached sheet. 7. Remodeling ship.andhave no employees These sub-contractors have. g• 0 Demolition' working for me in any capacity. employees and have workers' [No workers' comp,insurance comp. insurance$ 9. El Bui7ding addition required.] 5. ❑ We are a corporation and its 10.0•Electrical repairs or additions '3.❑ I am a homeowner doingall-work . officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp, right of exemption per MGL insurance,required.]t c. 152, §1(4),and we have no 12.❑Roof repairs . . employees. [No workers' 13.❑ Other comp•insurance required.] *Any applicant that checks box#1 must also fill out the section below sbowing their workers'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. =Contractors thacheck this box must attached an additional sheet showing the name of the Sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. Iam an employer,that is providing workers'compensation insurance for my employees. Below is the policy and job site' information. Insurance Company Name:_ Z,/ a4,(, Policy#or Self-ins.Lic•#:_ L_5� S-LI 77 yj 1 (o Expiration Date: Job Site Address: City/State/Zip; DEG„ ' Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date),' Failure.to secure coverage m required tinder 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 WA for insurance cover-age verification. I do hereb under the pains-and penalties of perjury that the information provided above is true and correct: Date: d Phone#: — Official use only. Do not write in This area,tb be completed by,city or town official City or.Town: ' Permit/License# Issuing Authority(circle one): .1.Board of Health 2•Building Department 3, City/Town Clerk. 4;Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 01 U / Z : Ui : 00 rIVI 4106 W 03/03 ACORDr„ CERTIFICATE OF LIABILITY INSURANCE 6/222/200' PRODUCER (5108)540-2400 FAX: (508)289-4111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Murray & MacDonald Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 550 MacArthur Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Bourne MA 02532 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Western World Kendall & Welch Construction Inc INSURERB:Safety Insurance 39454 P.O. BOX 1478 INSURER C:Liberty Mutual Ins CO rp INSURER D: North Falmouth MA. 02556 INSURER E: COVERAGES 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. INSR DD'L POLICY EFFECTIVE POLICY EXPIRI 1 TYPE OF INSURANCE POLICY NUMBER DATE MM/ODN1f DATE MMA LIMITS GENERAL LIABILITY ACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED 300 000 REMISES Ea Occurrence $ , A CLAIMS MADE OCCUR NPP889748-2 6/15/2007 6/15/20EDEXP An one erson $ 10,000 ERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: COMMP $ 2,000,000 X POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) B ALL OWNED AUTOS 5055064 6/15/2007 6/15/2008 BODILY INJURY X SCHEDULED AUTOS (Per person) $ 250,000 X HIRED AUTOS BODILY INJURY $ 500,000 X NON-OVNED AUTOS (Peraccident) PROPERTY DAMAGE $ 100,000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY0 $ OCCUR CLAIMS MADE AGGREGATE $ 1 R DEDUCTIBLE $ RETENTION C WORKERS COMPENSATION AND VvRSTATY IMIT OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBEREXCLUDED? WC2315354774016 6/15/2007 6/15/2008 E.L.DISEASE-EA EMPLOYEE$ 100,000 If yes.describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES)EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Douglas MacDonald/TED ACORD 25(2001/08) ©ACORD CORPORATION 1988 INS025(0108).08a Page t of 2 5730 6.00000 Lot EAST BA Y A14 3 - A13 60' 50, 4 LOC �. 4 _ -40. Lo 1 5 1A11 kq 0 (c S a 10. A10 I / 1, , Silt Barrier Assessors Da ta: j 11 Hap 163 Parcel 23 41.5 3 Zoning District., J?F1 'A9 -0417 C0,9.Sta' 50' 60 Toy) o T Building Setbacks: Fron I -- 30' 01 9 fl�etland Flags by "L VS'J? Consulting'' 0j )un�,atjo A Side and Pear 461 6 TEzWA Zone., '�A]5"' La EFF = Elev I'a 0' -anel: 250001 0016 D Propos' ed 9 FIRM P \X /* Bork pn�itl- Silt Barrier Panel Revised- July Z 1992 A6 4 ting Slone 7�,o 5167 4-1`30'�E Foun a tjo Toy.) of Existing Foiindation El, 11.0' (NGTD) 10, 5 6 I'A5 5 Al 7 6 qc NO 7'41",30 W .......... p too 4 E57 4 t a 110 0 4:1 76 B4 6 A2 5 50, 0 0"`A4 6 0 B6 9 8 '5 V". 183 60' 1 V Lo 1 �0Oa Top qE E 1 6 98' Ill R 65' 50' Ell 411- 3 43,864_-�- sq.ft. B 3e 81.0 Cil j 6 B2 ire 4 4 5 L l 2it kl� ........ ... . R K 6 , . . . ...... ...... i N Hle Ilan d 6 1 B19 El 7 Septic Tank Relocation Plan For 2�410 Wianno Avenue Lot I GRAPHIC SCALEIn 20 0 10 20 40 so 0sterville, Massachusetts 1,92 L=7 .01 Scale.- 1" 20' Date November 29, eOO6 ..................... .......... .......... ............. ............. IN FEET Prepared Br. I lmh P-0 ft- OF 4�46S Stephen J Doyle and Associates ....................... 42 Canterbury Lane, E Falmouth, HA 02536 Lot 3 Telephone: 5081540-2534 STEPHEN J. DOYLEJ--sc- #'101 37559 1 -14-07 sham' septic tank NO. DATE DESCRIPTION Sao � �- ��� t . -, , 5.00 Lot 9 3 ;:: �tAt� 4��� �� ti Q EAST BAY A14 • 60' 3 50' 4 LOCU '4 40, Lo t 5 A I 171' O( C US 10 4L 5 Pork Limit, jA10 37' L_silt Barrier Assessors Da ta: HaP 163 Parcel 23 3 tric t: RT,I A9 6 Toj_-) of' To Coas Zoning Di- Building Setbacks: ?ont -- 30' Side and Rear 15' jo 0 Un "-A Sri Cons ull'111gr -t1and PIag_�z Z�y 6 V 4� tfng r IYS 1A Zone, A711 19 BPE =- Ele v 1,' 0' Propos F[Rilf Panel- -';'50001 0016 D _ 3 Abrk Limit silt Earrier td Panel feevised: Jul),- 1992 J�Sf�lt Barrier A6 4 VOL Ung (73 S8 7 041`30 T fi-o un a tion ------- �. $ � , f ,,' � 7b_p of Ex sting If'oundation 11.0' (NOVP) 115 05 /* 6 1A1 6 A5 7 P 2 6 ..... I IV 7 W�30 X 10(-1,5o P 3 4 4 0 B4 1 \' _, 51?. or IA2 V 06.66 50' -A 4 0r ...... TJ� N 0 6 B6 /* IIH3 V Lot 4 60' lei 4 65' 411- 3 �0 B7 - 7 3 BM.- To,p r,B El, 6.9 8 43,864_�- sq.ft. 6 PO \`6 orlia 81,0 6 85. 7 _58 4 4 5 ov� -4 191 6 71. . .f N fileeland 6 E9 V) BI la a Sep ti n c Tak Reloca tion Plan For L o Wianno Avenue t I RAPHIC SCALE In G1 20 40 80 0sterville, Massachusetts P"' �iPll,�'11 f7l',;77 WF`w WIPIT L=70 Scale.- 1 ?0' Date., November e9, 2006 ...... ...... ...... IN FEET Prepared Br. ............. t inch 20 M Stephen J. Doyle and Associates Lot 3 4,0 Canterbury Lane, E. Falmouth, MA 02536 Telephone: 5081540-,2534 STEP <=> X-2- <= 1_5= J. DOYLE #37559 1 03-14-07 shoi), septic tank NO. DATE M DESCRIPTION ——--------- ------ —------