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Home My WebLink About0240 HIGH STREET aid ��- f� � _ .____�_.__. ._ � _ _ _ t2(r�'gf6 v%h i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 t\ Parcels 3 I Application # • 03 Zm Health Division Date Issued f�� Conservation Division Application Fee Q Planning Dept. Permit Fee b Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis ' Project Street Address o? G 14 S' I Village (A) . 134\►1� Owner , A S\-�l Aa,A L I-I fAl Address d c1 4 Gf k J Telephone S b E1.3 I Z --3 cl Permit Request .3 0 S �,� S u ti i�M. I�. IZ 98 6 F ci•J J 4� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new `t Z y Zoning District Flood Plain Groundwater Overlay Project Valuation `Y `/ Construction Type luo0 0 l Lot Size [ 1-/ $ P 4P Grandfathered:. ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 211'� Two Family ❑ Multi-Family (# units) Age of Existing Structure 3 Y' Historic House: ❑Yes OlNo On Old King's Highway: O�Yes ❑ No Basement Type: mull ❑ 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: 3 existing,_new Total Room Count (not including baths): existing _�new First Floor Room Count Heat Type and Fuel: VzrG-as ❑ Oil ❑ Electric ❑ Other Q7 Central Air: ❑Yes Flo Fireplaces: Existing New Existing wood/coal;stove: ❑.Yes ❑_No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new. size _ Barn: ❑ existing ❑ new size.- Attached garage: 21e&�isting ❑ new size Lo'S"hed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ l Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION --A BUILDER OR HOMEOWNER) Name /tit t f k,�A-2 I '11 e, i Telephone Number _ S6 60 - w Z Address 3 n (ate License # 2 G 6 C Q..v a PYt vt II -t Home Improvement Contractor# l I i S9 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE \aM DATE s FOR OFFICIAL USE ONLY ` ► APPLICATION# 1 , DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ` FOUNDATION a�f INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH 'FINAL 9 FINAL BUILDIN DATE-CLOSED OUT ASSOCIATION PLAN NO. " i � r �'WE Ta Town of Barnstable Regulatory Services BARNSTABr LF, • Richard V.Scali,Director 161 9.,.c& 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 1, � ,.,, I ()0,V , as Owner of the subject property hereby authorize /tt t k-e 11 C o ,o JT to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before.fence is installed and all final inspectio are performed and accepted. L L Signature o Owne Signature of App c Print Name Print Name Date Q:FORM&O WNTERPERMISSIONPOOLS Town of Barnstable , Regulatory Services P�oFme roiryy Richard V.Scali,Director Building Division Tom Perry,Building Commissioner 9Q� =MASS. 59. �� 200 Main Street, Hyannis,MA 02601 '°rEOt a www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 a HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"„shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimums inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the Stare Building Code Section 127.0 Construction ConfroL' HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,RuIes&Regulations for Licensing Construction Supervisors,Section 2.'I5) This lack of awareness often .results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,.our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor_ The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require;as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFfLES\FORMS\building permit fbn s\EXPRES$•dOC Revised 061313 i MORTGAGE INSPECTION PLAN (THIS PLAN WAS NOT CREATED FROM AN INSTRUMENT SURVEY AND IS FOR MORTGAGE PURPOSES ONLY, MACDOUGALL SURVEY WILL NOT ASSUME LIABILITY FOR ANY OTHER USE). i PARCEL ID: 111/003 i PARCEL ID: 111/032 /ASPHALA p' / DRIVEWAY �" SSG D 100�t /// P1 RCELOID: PARCEL ID: 111/031 yip000, HS ET I CERTIFY THAT THIS MORTGAGE mommoN PLAN WAS PREPARED IN ACCORDANCE W1H 250 CUR SECTION 6.05 OF THE MASSACHUSETTS RULES&REGULATIONS FOR THE PRACTICE OF LAND SURYEYM THE OLMDMG SHOYM IS IM AFFECTED BY A SPECWL FLOOD HAZARD AREA AND DOES_CONFORM 70 THE LOCAL ZONING BY-LAWS IN EFFECT AT THE TIME OF CONSTRUCTION WITH RESPECT TO SETBACK REWAREkSM OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASSACHUSETTS GENERAL LAWS GRAPIER 40A SECTION 7.R U04CM DEEP SUBJECT TO AND VMTH THE BENEFIT OF ALL RIGHTS, RIGHTS OF WAY, EAP RESFAWA71ONS AND RESTRICTIONS OF RECORD.IF ANY THEM BE AND INSOFAR AS THE SAME ARE OF LEGAL FORCE AND EFFECT`,/� �� TOWN: BARNSTABLE (WEST) DATE: 0$ 06 10 APPLICANT: MARY C. HAMILTON CERTIFY T0: SALEM nvE MORTGAGE CO., LLC SCALE: 1 =60 - - n+OF44S� TITLE REF: 3428/74 Mocpougall Surveying y� cy PLAN REF: 291/44 EDWARD �,� FLOOD ZONE: DC" & Associates A. ; COMMUNITY PANEL- P.O. BOX 2$28 STONE N 250001-0011—D Moshpee, Mo. 02649 No.28980 a• DATED: 07/02/92 90�4F CURRENT ZONING: "RF- ph. (508)419-1086 G1 7 fax. (508)419-1087 email: mocdougallsurvey L JOB# 10609 ®comcast.net Barnstable Old Kings Highway Historic District Committee 200 Main Street,Hyannis,MA 02601, TEL: 508 862-4787 Fax 508 862-4784 MAIM 9.1. . APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for. Check all categories that apply; 1. Building construction: ❑ New Addition ❑ Alteration 2. Type of Building: ❑ House ❑ Garage/barn ❑ Shed ❑ Commercial- ❑ Other 3. Exterior Painting, roof ® new roof ❑ color/material change, of trim, siding,window, door 4. Ste: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Other 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ Other Type or Print Legibly: Date NOTE AU applications must be signed by the cu Owner T44 ner : ;; k�— w` \(print):rmt) ��l Telephone#: \ Address of Proposed Work: U n t q1A .S Village �V. 3njkti Map Lot# /J Mailing Address(if ' erent) Owner's Signature Description of Proposed Work: 4ive particulars of work to be done: 1 `l' Y, 3 b T�t r%.{{ S f&I0,U Suty 4A w tM- [AAr<�n < <-O L- t()IA/fleWJ Agent or Contractor(print): M k e 1AA f2 -)—'k Telephone#: o 0- to to 1 z in Address: 7 f �i A/ �vZ Contractor/Agent'signature: 1 AQ, For co mittee use only. This Certificate is hereby APPROVED/DENIED REc� � Date Members signatures q GROWTH M-'%N ENT Q:IBoardr and Commissions101d Kings HighwaylOKHApplications10KH2O11 Cert Appropriateness.doc APPROVED 1 MAY 13 2015 Town of S-°h. vie Old Ki 'a 4 hMiy Co►rtmittee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 Copies i Foundation Type: (Max. 12"exposed)(material-brick/cement,other) ) 6.v e T L t t i Siding Type: Clapboard_ shingle_ other Material: red cedar white cedar _ other Color: Chimney Material: Color: Roof Material: (make&style) C n,t,,✓T c 3C V a le(.0 Color: Roof Pitch(s): (7/12 minimum) (sped on plans for new buildings, major additions) Window and door trim material: wood other material,.specify Q C. Size of cornerboards 1 y S/ t A size of casings(1 X 4 min.) color all -z Rakes Ist member i�i �_2d member t y Z- Depth of overhang Window: (make/model) material�i color 4/k�T (Provide window schedule on plan for new buildings, major additions) Window grills (please check all that apply_. true divided lights_ exterior glued grills_ grills between glass_removable interior None Door style and make: J i p ,,. ��},v opt K S e.✓ material Color: Cu I t-L Garage.Door,Style Size of opening Material Color Shutter Type/Style/Material: Color. Gutter Type/Material: 1 y AAl N v 1�tn- Color: Deck material: wood other material, specify Color: Skylight,type/make/model/: material Color: Size: Sign size: Type/Materials: Color:m Ya rr�Yi9 fia%�+ Fence Type(max 6') Style material: Color: Retaining wall: Material: H. AGE V 1 Lighting,freestanding on building illumminnattiing sign OTHER INFORMATION: THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBbIITTED Please provide samples of paint colors,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) Print Name Q.Ooards and Commissions101d Kings HighwaylOKHApplicationslOKH2O11 Cert Appropriateness.doc MAY 13 2015 2 Town of Barnstable Old King's Highway Committee Town of Barnstable Geographic Information System April 24,2015 111039 111026 ffi 68 ffi 169 111040 111026 042 vies 111034 ffi 61 111003 ffi 30 134023003 00 111033 ffi 36 134023001 ® 021 111027 ffi 304 111032 0 254 111014 Ja 111031 134023002 0260 ffi?� 039 i ® Olk 134001002 111072 ffi 210 ffi 295 yJGy Sr I ' ! 111018 .� ffi 27a 41 itiol7 134001001 111110116 247 �Q ffi18 ffi247 111019 0200 ffi 235 044 111016 134002 /( Q ffi 216 ffi 160 0 5 2 e 110002 e 19s DISCLAIMERS:This map[star planning purposes only. It 0 not adequate for 111 Pared:031 Selected Parcel r legal � N boundary determination or regulatory interpretation. Enlargements beyond a stele of Owner.OICRESCIO,JACQUELINE TR Total Assessed Value:$441000 _ V.100'may not meet established map accuracy standards.The parcel Mason this map ii11 E are only graphic representations of Assessor's tax panels.They ere not true property Co-owner.HAMILTON BARNSTABLE Acreage:1.19 acres Abutters • boundaries and do not represent accurate mlagonships to physical features on the map Loeabon:240 HIGH STREET Buffer T such as building locations. `f ,/r • � i i i f � i i i I i � � ; U. Q! U i� y YI 77F M L. -41, IS MAIIA I I - 1 fj7 ! i 0 rkj /O0000� 3 i , o ,or\ A IA Tv\ ��e :tv J! :t%-L.) �,7L 'o 7, i e �OV Aeo TV*,.w W, 6 ll L>;k 0 Qt^er) I-k .-3 T c IL CA A AP P ROV ED 2015 I t D 52 Uv I MAY 13 Town of BaHi9hway able Old co mittee ,ale .r .t . 1 s J Ine GOHMWnweaan gmassacnusetts Department of Indusfrigl.'Acciden& Office of Inveyfigations 600 WashhTton Street Boston,HA 02.111 www.muss gw/dia Workers' Compensation Insurance Affidavit:BuRders/Contractors!Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organirafion/fndividuaI): l ikY \ el-2 1. ( a.vj 1 Address: 72 2�7 City/State/Zip: M,6 Phone#: -S-Z) - )) / - 9 6 J_'� Are you an employer?Check the appropriate bow a of project 4. I am a eral contractor and I Type p i (��r� 1.❑ I am a employer with ❑ ! - employees(fall and/or part tone).# have hired the sub-contractors 6• [�'1�Tew construction 2.PrI am a sole proprietor or partner- listed on the attached sheet- 7. ❑Remodeling ship and have no employees' These ors have 8. ❑Demolition working for me in any capacity. employees'and have workers' [No workers'comp.insurance comp.insuranceJ 9. ❑Building addition required.] S. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their HE Plumbing repairs or additions myself- [No wodcers'comp. right of exemption per MGL 12.0 Roof repairs inc rance required�]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance rega red-] *Anyagplicant that ebreks box'#1 must also fill Out the section below showing their workers'compensation policy information. t Homcownera who submit this affidavit indicating they are doing all work and than hire outside contractors must submit a new affidavit indicating such. $Contractars that check this box must affichcd an addffional sheet showing the name of th a sub-contractors zndst d:whcthcr or not these entities have empIoyecc. If the snb-contoiclors have employers,they must provide their workers'comp.policy unbar. I am an employer that it provuUag workers'cornpensafon insurance for my employees. Below is the policy mad job site information. Ins=ce Compagy Name: Policy#or Self-ins.Lic.# Expiration Date: Job Site Address: A.1 O-in SR City/Stafx lop: (p Q S A Vt1M,.J7q(0/t 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DkA for insurance coverage verification. ++ Ido hereby certify under thhepains andpenaWu ofperjury that the informationprovidedabove is true and comer!. Signature:WA aA / n i• Date: Phone#: S-6 OjTwj l use only. Do not write in this area to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of$ealth 2.Balding Department 3. City/Town Clerk4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone a: Information. and Instructions Massachhsetfs General Laws chapter 152 rerlrmres aII employers to provide wodmrs'compensation for their employees. Pursuant to this statute,an.earployee is defined as"_.every person in the service of another under any contract of hire ' expr=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 m'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 mom than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repay 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 perfo mance of public work until acceptable evidence of compliance with the insufimce requirements of this chapter have been presented to the contracting authority." Applicants PIease fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)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 insuranc-e coverage. Also be sure to sign and date the afdavit 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.' i City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant - Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submif multiple permitdimnse applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in • ' (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture Cie. a dog license or permit to bran leaves etc.)said person is NOT requzimd to complete this affidavit The Office of Investigations wound like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a ca1L The Department's address,telephone and fax number. The Commonwealth of Massachusetts ' Department of Industrial Aocidents office,of Itave&tig-atiGm �Q4�ashiugtau�treel; Boston,MA 02111 Tel;#617-727-4900 Md 406 or 1-VTMA-,'��AM Fax#617-727-774-9. Revised 4-24-07. -MM-gavfdia C BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: IF the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Joanne Bretton Southeastern Insurance Agency, Inc. PHONE (508)997-6061 FAXAfc.Np (508)990-2731 439 State Rd. ��:jbretton@southeasternins.cam P.O. Box 79398 INSURMRAFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURER A Arbella Mutual Ins Co 17000 INSURED INSURER 8 Michael Renzi, DBA: Michael Renzi Construction INSURERC: 387 Phinney's Land 09SURM D: INSURER E Centerville MA 02632 INSURER F: COVERAGES CERTIFICATE NUMBER:2015 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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. LLTRTR TYPE OF INSURANCE ADD BR POLICY NUMBER POLICY MMIOnNyy POLICY EI(P LIMITS X COMMERCIAL GENERAL LIABLLITY 1,000,000 EACH OCCURRENCE $ TO RENTED A CUUMS-MADE Fx—I OCCUR PR6vI S fEa occunymm $ 100,000 8500061447 12/18/2024 12/18/2015 MEDptp(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 70THER- AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 OLICY❑� LOC PRODUCTS-COMP/OPAGG $ 2,000,000$ AUTOMOBILE LIABILITY CONIBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per aoddeno $ AUTOS AUTOS HIRED AUTOS �OSWNED PPRO�DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAO CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION PER OTtF ANDEIIPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNEWEXECUTIVE ]N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandalay in NN1 F1.DISEASE-FA E PLO $ If yes.desorbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHOR®REPRESENTATIVE Joanne Bretton/JB ©19W2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I101302-5 onumi Capacities for Pin Foundations Diamond Pier 6/4/15,8:08 AM Diamondivi' er. FOUNDATION Capacities Normal Soil Conditions Downloads Diamond Pier foundations sold through retail outlets are designed for projects that are founded b�Home in normal sound soils. Normal soils are typical in most residential neighborhoods throughout the •Load Chart United States and are defined in the International Residential Code(IRC)Table R401.4.1. •Cross Pin Grou ►Backyards Presumptive Load-Bearing Values of Foundation Materials. •Cross Pin Grou Boardwalks Supporting Soils � ►Buildings Some soils may not be appropriate for sup porting Diamond Pier foundations.Where unsound ►Videos soils exist,a registered design professional may be required to review the project. to,Capacities See the Installation Manual for a full description of Normal Soil Conditions ►Details Residential Diamond Pier Load Chart ►MSRP Pricing ►Contact Us Wnt Quote't Make Your Payment Here Bearing in 2000 psi SandslGravels' 3600# 3600# 3600# 51501$ 5850# Bearing in 1500 psf Sills/Clays' 2700# 2700# 2700# 3870# 44000 Equivalent Bearing Area 1.8 sf 1.8 sf 1.8 sf 2.58 sf 2.93 sf Base Area Comparison 18'cylinder 18'cylinder 18'cylinder 21'cylinder 23'cylinder Uplift 670# 920# 1175# ~1215# 1380# Lateral 575# 820# 1070# 1150# 1310# Frost Zone Rating 12'-24' 30'-42' 48' 48' NOTES: 1. Values applicable in properly drained,sound soils with a minimum 1500 psf bearing capacity.See IRC Table R401.4.1 for bearing soils listing and Table notes. 2. For simple structures only. No asymmetrical, rotational,overturning,or dynamic loads. For additional information,see the full Diamond Pier Installation Manual. 3. All capacities use four pins of the specified length per foundation.Length includes that portion embedded within the foundation head. 4. DP-50 uses defined in paragraph 2.0 of ESR-1895 and per blue-bordered box above are limited to residential decks,covered decks,stairways,and walkways. For DP-50 uses beyond these types of projects,and for DP-75 applications,refer to Cross Pin Group Test Report(EEI Report No.07-020-8). See Note 1 for applicable soils. 5. 50"Pins are recommended for use with the DP-50 where uplift and/or lateral loads may govern.The DP-50 comes with a 1/2"diameter embedded galvanized anchor bolt.The DP-75 comes with a 5/8" diameter embedded galvanized anchor bolt. 6. The Diamond Pier system is a shallow bearing technology that does not require"refusal" or"friction"resistance,or the professional installation monitoring or special inspection typically associated with conventional vertical or battered piling. 7. Larger Diamond Pier models are available-DP-100E and DP-200E. For these larger pier sizes,site-specific soils information and foundation loads must be determined by a registered design professional and provided to PFI for calculated foundation capacities. LPin Foundations, Inc. Northern Midwest:(612) 1 0• . Harbor,Gig . . General Phone:(253) :0• General Email: info@diamondpi'ers.com Copyright O 2013,Pin Foundations Inc.All images and information contained herein are the property of Pin Foundations,Inc., http://diamondpier.com/code-path.htm Page 1 of 2 a 'w l l I a . l • n � i I � _ I I 1 1 ; _ I ' , - , f I ' .. ............._ ... .. '1(�..Ir�l_ ... tJ a,(, _ _. _ ._ .... _lr._I� _..._!._.. v-± • ARs1 ' G laS13j I i L_ .. ,......._ _.... .. _ .... ! i G I I-. : I I I. •. i. I, t I i _ I I � II 11 i I I , I ! 1 � � I^ei. .L. .i •I i N ' i i ( I I i ! : : ! _ r AN 1-7 tA 0 .......... f o L... _ ... ..... I ; . � i i I I � f � P I i I � i 11 I .' I .f.. .......... AN A�l kill ......... 1-! �h NIA 4:u tt. Ir te Al 1-4.^ �T. LA) II I _.......i_.._.....i.__.•_ _I. _ ..{.. ...i.•...I .r. _L_..._.L.__``_ I (.._ i_ i._ ..i. �� .i.. ' ( i ^_ P ; (.. JO 6 TV"q C.g h c o Ul J*\ ji 60 0, 101 i Ail I i. i I � s I l I t I i i I I + .._. _�._ 'Pµ i I Al U Q 16 wp ( l d v L,c, I U y ------------- U 3 r o necki, a � W t ti t0 6 k. W t o l,-, r A k� S�n� S�--1i �� o� �a�i C,4Pf T 4vrl �ie�c ��Ik i�r�u�� 01,E NcraDP .vsto o �ee� '1'u ( 1 9k 6)oa C r jNJA�� GOO 'E r�tiQN (-Fli-e Y, 6� 2� , �oG1 on 9 ((:I/1, o,A-9 p��e� �x fir R"q w� �e��,Y. t'I Qou�^Qq w.(�z n sk �� glve ��60�` L+ C x 7. k i ,per T1 ,° .\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:,= q I185g Type: Office of Consumer Affairs and Business Regulation 1 *• 10 Park Plaza-Suite 5170 Expiration.: -2/4L2017 DBA Boston,MA 02116 MICHAEL RENZI CONSTRUCTt�O,NJ ,77 MICHAEL RENZI\�\, 387 PHINNEY'S LN- '= ==:_=:�,<j �� P ; r CENTERVILLE,MA 02632z;;r.:' Undersecretary I Not®rit out signature II '/ y Massachusetts -Department of Public Safety. Board of Building Regulations and Standards Construction Supervisor 1 &2 Family° License: CSFA-058266 MICHAEL J RENP 387 Phinneys Lan4 Centerville MA 02632 c Expiration 01130/2016 Commissioner a TOWN OF SAMSTABLE ' RISE Division of Thielsch Engineering,Inc. 2013 HAY 10 AM 11: 19 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02910 DIVISION May 1, 2013 Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Re: Insulation permits Dear Mr. Perry, t This affidavit.is to certify that all insulation work completed for 240 High Street has been / inspected by a Building Performance Institute (BPI) certified Professional. All work performed meets or exceeds Federal and State requirement.- Sincerely, Erik Nerstheimer Supervisor of Installations, BPI certified Building Analyst Professional and Envelope Professional, RISE Engineering, a division of Thielsch Engineering, Inc. 1341 Elmwood Avenue ' Cranston, RI 02910 t 401-784-3700 •800-422-5365 •Fax 401-784-3710 111460 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel, 03 Application # 6 off cP Health Division Date Issued �. Conservation Division " Application Fee Planning Dept. Q ermit Fee Date Definitive Plan Approved by Planning Board 'D . REC Historic - OKH Preservation/ Hyannis00i BY : Project Street Address 240 High Street Village West Barnstable Owner Jennifer Hamilton Address Telephone 508-362-3549 Permit Request air sealing, insulate attic (r-23 + R38) , insulate kneewall (R-10) insulate kneewall and attic access hatches. and the attie•.door.-; install 2 exhaust hoses and 12 soffit vents Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3388 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No ; Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current•Use �- - .W - w< Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER).- Name RISE Engineering Telephone Number 401-784-3700 Address 1341 Elmwood Ave, Cranston,. RI 02910 License.# 100459 Home Improvement Contractor# 120979 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 01 SIGNATURE DATE C)i l Erik Nerstheimer for.RISE i j FOR OFFICIAL USE ONLY i APPLICATION# I DATE ISSUED : �. MAP_/PARCEL NO, ^ ADDRESS VILLAGE OWNER DATE OF INSPECTION: V* FOUNDATION. 7 FRAME f INSULATION 11 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL s ROUGH FINAL >_:DATE CLOSED-OUT ASSOCIATION PLAN NO. : J t 4. _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): RISE Engineering a division of Thielach Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone#: (401)784-3700 or 1-800-422-5365 Are you an employer? Check the appropriate box: Type of project(required): 1. N I am an employer with 4. 0 I am a general contractor and I 6. 0 New construction employees(full and/or part time).* have hired the sub-contractors 7. 0 Remodeling 2. 0 I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance. # required] 5.0 We are a corporation and its 10. ❑Electrical repairs or additions 3. 0 I am a homeowner doing all work officers have exercised.their :t 1. ❑Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no 12. ❑Roof repairs employees. [no workers' 13. X Other Insulate comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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 thepolicy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins.Lic.#: 3730961—,0.'0 Expiration Date: 1/1/11 Job Site Address:_C-9—q e)ft,��ku; 1T I(,I City/State/Zip: ),)I Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration (date). Failure to secure coverage as required under Section 25a of MGL'152 can lead to the imposition of criminal penalties of a fine up to$1,500.00-and/or one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $250.00 a.day against violator.Be advised that a copy of this statement maybe forwarded to t'ne Office of.Investigations of the DIA for coverage verification. I do herby certi a/nd the _ins enalties of perjury tha.r the information provided above is true and.correct. Signature: f z„/—_ ��--��.�- Date: l -- Print Name: Erik Nerstheimer Phone#:(401)784--3700 or aztI3.3 Official use only Do not Ta,rite ilr this area to be complet d by city or town official City or Town:------_--- -- - —Permit/license#:-- -- —_--!--_ Issuing-Aufhority(circle one): I.Board of 1'leatb 2. Building Departmeut 3. Ciay/Totim Cle,rh 4.Electrical Inspector 5.F.'anibarig inspector f.Othe: Contact,per sort:— I'b.olze•#; r �4CORD CERTIFICATE OF LIABILITY- INSURANCE aPID 47 0 TE(MM'O0fyy(Y) THIEL-1 04/13/1)vaooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION .The Preston Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303' HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 8'10 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Greenwich RI 02818-0810 Phone: 401-886-8000 Fax:401-88571700 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Zurich—Alllerlcan Ins CO. Thielseh Engineering, Inc INSURER B: lrr.r.lc,n cuarant,% c Wabl.11.ty H iiTech Oroup Inc. INSURERC: North American Capacity Hi Tech Realty Inc. 195 Frances Avenue INSURERD: Hartford Insurance Company Cranston RI- 02910 INSURER E' ' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED To THE INSURED KA' ABOVE FOR THE POLICY PERIOD INDICATED.NOTMTHSTANDING ' ANY REOUIREMENT•TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH.RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR w%Y PERTAIIa,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. IOD INSR TAPE OF INSURANCE POLICY NUMBER NDATE(MMlDD/YY) DATE(MMlD � LIriIiS GENERAL LIABILITYEACH OCCURRENCE 11,000,0 0 0 zA X COMMERCIAL GENERAL LIABILITY 3730962-00 04/O1/10 01/01/11 PREMISES(EaRocc�vence) T300,00o CLAIMS MADE' X1 OCCUR MEO EXP(Any,one person) S 10,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE s 2,000,000 GEK AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG' $ 2,000 ,0 0 0 POLICY X JECT LOC Em,p Ben. 1,000,000 AUTOMOBILE LIABILTrY , A X ANY AUTO 3730963-00 04'/01./10 01/Oi/11 C(Ea accident) accident)D'SINGLELIMIT s2,000,000 ALL O"JEO AUTOS ' BODILY 11'TJURI' r SGkIECULED AUTOS (Per person) HIRED AUTOS BODILY INJURY 5 NO9lJ•OVA4E0 AUTOS (Per accident) . PROPERTY DAMAGE ; ?Per accident) MAGELLABIL" AUTO ONLY-EA ACCIDENT 3 ANY AUTO OTHER THAPr EA.ACC 5 AUTO.ONLY: AGG ; EXCESS IUMBRELLALIABILTIY EACH OCCURRENCE S 10,000,000 B X• OC!X1R F ]CLAIMS MADE UMB 9263637-00 04/01/10 01/01/11 AGGREGATE s 10,000,000 DEDUCTIBLE S X RETENTION S 10,0 0 0 S WORKERS COMPENSATION AND X TORY LItnITS EP. EMPLOYERS"LIABILITY A AN)'PROPRIETOR/PARTNEPJDIECUTIVE 31 3 0 9 61-0 0 0 4/O 1/10 O 1./01/11. .E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMSEREXCLUDED? E.L.DISEASE-EAEMPLOYEE 31,000,000 It yes.describe under — SPECIAL PROVISIONS below E.L.DISEASE-P<50C'Y LIMIT S 1,0 0 0,0 0 0 OTHER C . Professiopal Liab DV1,000026.800 04/01/10 '04/01/11 Prof Liab 2,000,000 DlLeased/Rented Eqp 02UUNTD5678 04/01/10 04/01/11 Equipment 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEAEOF,THE ISSUING INSURER'NI1.L ENDEAVOR TO MAIL 10 O_YS WRITTEN NOTICE TO TIic CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO 00 SO SHALL IIdPOSF NO OBLiGATION OR LIABILITY OF AN(KIND UPON THE INSURER.ITS AGENTS OR l REP RESENTAT!`%ES. A.U'THORIZED REPi+.ESE v i a ' ACORb 25(2001108) @ACORD CORPORATION 1988 ',r a: .Y r•ya .IkJv lfi: Ir CF i.),= r.,l -':'� r )P �><i=Cxr t rs> ! i.� .+tq.a rr. y va:•e,.,:-F-:;i a int l7 } [ l �::"J,t tyt=+r`•'' 4 3 t l is ,' .Yi:tis�.:.sr�rt��•;iteil'it'::,�:;i�i'vc�J�"c;,t:r s s:�)k.ti. �a,•�rFti�'.,r:q:•!<°;i'P, � ;�f;ls �'�^i- �f(�'�Y��,,,i��i;_ .l 11 rc-'1'HIEIi .� � rt,is. �.:1 I ,P:AC.�E I Z AA�� cC��,;� sc �5+ ��1:t��Ylra 4�l�c�tat�:�,Ik�+{f� �H ��:. ��7�iry��•��'{ `�a�Nl�k'n��J3 it�}YI�, ;to i ,��.�>,' Itl® s6.lik,a !�� NSU.��F�,D�SRiAMET24"igel�s Yfneeng+Jynly>til,�� OPID 27ft�r 14��+='r�„ DiIT;E Q4/12/r0 Also fox RISE Engineering, a division -of Thielsch Engineering,. Inc. Gaskell Associates.; a division of Thielsch Engineering, Inc. BAL Labora.tory. ; .a division of Thielsch Engineering, Inc. ESS Laboratory, a division of Thielsch Engineering, Inc. ALCO Engineering, a division of Thielsch Engineering; Inc. Water Management Services, a division of Thielsch Engineering, Inc. I - i nsumer fa n usmess . egu ation ,,.. g/wOffface M o b } 10 Park Plaza - Suite 5170 Boston, M ssachusetts 02116 PIome Improve ��ontractor Registration _ Registration: 120979 M Type: Supplement Card W Expiration: 3/2 512 0 1 2 THIELSCH ENGINEERING Cr ERIK NERSTHEIMER 1341 ELMWOOD AVE. _ CRANSTON, RI 02910 i Update Address and return card.Mark reason for change. ❑ Address ❑ Renewal ❑ ;Employment Lost Card PPS-CA/ 0 5OM-04/04-G101216 �/ae (Oo7rvazoouuea ./�aaaac�ivaet7a Office of Consumer Affairs&Bu iness Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation. Registrati6n 979 Type: 10 Park Plaza-Suite 5170 Expira` -H2 Supplement Card Boston,MA 02116 THIELSCH ENC [ 1,000, l ERIK NERSTH 1341 ELMWOOD _ � -- CRANSTON; RI 029 , �< '�-`-_�='� Undersecretary Not valid without signature ' rage_ I OI I The Official Website of the Executive Office of Public Safety and Security (EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 100459 Restriction WS,IC Name Erik Nerstheimer City, State, Zip North Scituate, RI, 02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Back To Search Board of 13itilding Regulations and Standar t 1" ' Li.Cense or registration var cd'for individlil use only HOME IMPROVEMENT CONTRACTOR .I. before the expiration date If found return to: 1 j Re9istr'-4 'n' 120979 Board of wilding Regulations and Standards Ezp.izati:o:n__3j25/2010 One Ashburton Place Rm 1301 - YP,e'= u'ppiemen!Card -o'st�n,l�1a. 02108 j. ELSCH ENGI[V K NERSTHEIMER= l 1 ELMWOOD AVF -�--- \NSTON, RI 029104 Admin.isti,lcor =' N 0t valid without signstz}re j -- _. i� S• lritp:;/cl�.st2i:e..ma.us/cps/licdetails.asp?txtSear CS chLN= :C,lOt „ s. m RIO' s. v/ r �i a•.�'„. rF.n�+w+.�v.��r'.��'wa�`.��i� .y,yM�' . �+�' ''�'-�'_ r ! }'$r.k+ ram.• ✓ .R r .�,',�r .py+s -;�'.T`tea,�,.�•�"ry"9 t P� ® � ^ . NAT-2453.1 - 1 a f RISE ENGINEERING a ral ID III OS4405629 FA E O�/�E Contractor Registration No 8166 V f' A division of Thielsch Engineering v Contractor Registration No 120979 Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,RI ONTRACT 7 P ge 1 RI, V CONTRACT IS ENTERED INTO BETWEEN RISE INEERINO AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE Client 0 Jennifer Hamilton (508)362-3549 07/30/2010 111460 SERVICE STREET BILLING STREET ' 240 High Street 240 High Street SERVICE CITY,STATE,LP BILLING CITY,STATE,LP West Barnstable,MA 02668 West Barnstable,MA 02668 JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for seating include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing. 20 man hours. this measure is for sealing the home and sealuing the kneewall transitions $1,320.00 RISE Engineering will provide labor and materials to install 2.25"R-10 semi-rigid fiberglass board insulation to 100 square feet of kneewall area. $270.00 RISE Engineering will provide labor and materials to install a 7"layer of R-23 Class 1 Cellulose added to 160 square feet of open attic space. $160.00 RISE Engineering will provide labor and materials to install a I V layer of R-38 Class I Cellulose added to 720 square feet of open attic space. $864:00 RISE Engineering will provide labor and materials to insulate the back of 1 existing kneewall access hatch(es)with 2.5"rigid fiberglass board insulation,and seal the edge of the hatch with weatherstripping. $170.00 RISE Engineering will provide labor and materials to insulate the back of the attic door with 1"rigid foam board and seal the door edge with weatherstripping to restrict air leakage. $100.00 RISE Engineering will provide labor and materials to install a new,finished plywood,attic space access hatch.The hatch will be insulated, weatherstripped and held closed by eye hooks. (Wood surfaces will be unfinished. Prime coat and/or paint is not included.) r RISE ENGINEERING Federal ID#06-W5628 [10 G IE R� �r E RI Contractor Registration No 8186 A division of T'hielsch Engineeringu v MA Contractor Registration No 120879 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,(401)784-3700 FAX(40AUG - 3 2010 CONTRACT \1 Page 2 R I S E THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE Client# Jennifer Hamilton (508)362-3549 07/30/2010 111460 SERVICE STREET BILLING STREET 240 High Street 240 High Street SERVICE CITY,STATE,LP BILLING CITY,STATE,LP West Barnstable,MA 02668 West Barnstable,MA 02668 JOB DESCRIPTION $100.00 RISE Engineering will provide labor and materials to install 2insulated exhaust hose wlroof mounted flapper vent to exhaust existing bathroom fan(s). $200.00 RISE Engineering will provide labor and materials to install 12 4" X 16"white rectangular aluminum soffit vents to increase ventilation in attic areas. $204.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$2,000 per calander year. -$2,871.00 i i WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred Seventeen&00/100 Dollars $617.00 UPON FINAL.INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 50 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHT8 O ION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ANY K SPACES 48, N-A RE-RISE ENGINEERING CUS / ACCEPTANCETE:T MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE ACCEPTANCE v ACCEPTANCE OF CONTRACT-TH ABOVE PRICES,SPECIFICATION AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO DO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE it FIKE r Town of Barnstable Expires 6 mo yths j in issue Regulatory Fee i i BARNSTABLE, ' MASS. a Thomas F. Geiler,Director iegq. DIED MAC A Building Division Tom Perry, CBO, Building Commissioner 200.Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY ( Not Valid without Red X-Press Imprint Map/parcel Number_ Property Addr ? L/7 0 �//Grp 57 �o?��g ©Residential Value of Work 5�(� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 7 41 Contractor's Name / 5 �p,�j/u/' Telephone Number T ��ys Home Improvement Contractor License#(if applicable) 1�' 5 917 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance ,APR 1 5 2010 Check one: ❑ I am a sole proprietor B�RNSTA�L� ❑ I arri the Homeowner. 'TOWN O I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# k l. y4 3 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is equired. SIGNATURE: QAWPFILESWORNObuilding permit forms\EXPRESS.doc The Commonwealth of MassaclTusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia lumbers Workers' Compensation Insurance Affidavit: Builders/Contractors/El please Print Lgpjbl Applicant Information Name (Business/Organization/Individual): Address: �� d�v ��4r✓ r / rA/3L� Phone#: �/ City/State/Zip: t!1/ES% �./t Are you an employer?Check the appropriate box: Type of project(required):' 4. I am a general contractor and I 1.[�}I am a employer with � 6. ❑New construction have hired the sub-contractors.. enipl6yed-(full and/o part-tim ). 7. Remodeling listed on the attached sheet. 2.❑ I am a sole have no emptor o eT- These sub-contractors have 8. [Demolition ship and to have no employees employees and have workers' 9 Building addition w00 k. r me in any capacity. comp.insurance-I No workers' comp. insurance 5 We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. p p 12.❑Roof repairs c. 152,§1(4),and we have no 13.❑Other insurance required.]t employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workcrs'compensation policy information. uts and then I Homeownerswho heck this box must attached indicating the one doing allshowingwork the name oare of the sub-contractors contractors and state whether or not ttde contractors must submit a new hose�entities havech. Contractors employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: t�E 5 Expiration Date: Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). lead to Failure to secure coverage as required under Sectinmen,as w of ss civil penalties in the forme imposition of criminal penalties of a STOP WORK ORDER and a fine fine up to$1,500.00 and/or one-year imprisonm t, of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certi der the ains and penalties of perjury that the information provided above is true and correct Date: hy 41V1106 R � Si ature: Phone#- < O 8l ELnDonly. Do not write in this area,to be completed by city or town officiaL n: Permit/Licensehority(circle one):Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Phone#: rson: �t ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 06/11/2009 ry R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCE INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SCHLE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 34 MAIN ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WEST. YARMOIITH, MA 02673 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Adilson Segolini D'.B.A. Segolini Construction INSURER& GRANITE STATE 117 Minton Lane INSURER C. INSURER D: West Barnstable, MA 02668 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING OR CONDITION F Y MAY OR PI MTHE INSURANCE AFFORDED BY THE OLNCIESCDESCRIBEDT OR EHEREIN USESUBJECT TONT WITH S ALL TTHE TERMS. EXCLUSIONS TO WHICH THIS FIAND CONDITIONS CATE MAY BE SOF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POUCY EFFECTWE POLICY EXPIRATION LIMITS LTR MSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDD/YY) EACH OCCURRENCE E GENERAL LIABILITY COMMERCULL GENERAL LIABILITY PREMISES(Eaocw'%rce) E CLAIMS MADE ❑OCCUR MED EXP,(Any one person) E PERSONAL&ADV INJURY S GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG S GENL AGGREGATE LIMIT APPLIES PER: PRO. LOC POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY S (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY S (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE E (Per accident) AUTO ONLY.EA ACCIDENT S GARAGE LIABILITY EA ACC $ ANY AUTO OTHER THAN AUTO ONLY: AGG S EACH OCCURRENCE S FXCESS/UMBRELLA LIABILITY AGGREGATE S OCCUR El CLAIMS MADE ` E E DEDUCTIBLE S RETENTION $ OTH- B WORKERS COMPENSATION AND WC 874,T48-33 05/23/2009 05/23/2010 X TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT E 100,000 ANY PROPRIETORIPARTNEWEXECUTIVE E.L.DISEASE-EA EMPLOYEE E 100,000 OFFICERIMEMBER EXCLUDED? It yes.describe under E.L.DISEASE•POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER r DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ADILSON SEGOLINI IS COVERED UNDER HIS WORKERS COMPENSATION POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ( DATE THEREOF. THE ISSUING'INSURER WILL ENDEAVOR TO MAIL 21 DAYS WRITTEN NONE ON FILE t NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO OQ SO SHALL `'? t IMPOS�NO OATON OR LIABILITY OF ANY KIND O E INSU AGENTS OR REPRES.AUTHORSENTATIVE D t Town of Barnstable RegulatorY Services • inRts'rnet�. ; Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us i Office: 508-862AO38 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, (Y) I L l ,as Owner of the subject property hereby authorize L to act on my behalf, in all matters relative to work authorized by this building permit application for. Addr�"Job) Signature Of er Date I Print Name If Proms ORmer is applying for permit please Complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION rtrtment of Public Safety ,:._. iVlussuchusctts= Br R��_ulutions M, Standat..' :. Bo u d of Bta►Idin .-alty Ljcense ervisor Spec, Construction Sup , t�•-.} 99�07 . it F e -,: r. r r is ram+ ,, ms � ° .. License:.:CS SL F,WS,DM Restricted to. R i s r ADILSON SEGOLINI ,�tIt, 117 MINTON `NE 02668 '. Y, WEST BAF2NSTABLE, MA " loll4120111. a � Expiration: • � (•u�nmissiune:. ---- - � istr�tion val►d for►ndi�►dul use anlY� . 1 L►censz or reg ��:-[f found rctur►�ao ?1 4 befo`i,' the expiration date . mld►i►g'`Z.e�°lat►ons and Standards, AI Y( Board of B CTOR 11 goarJ of Bu►1dt°g'RPgulationsya►i�Standards n s: �]30l HOME;IMOV,EMENT CONTRA, *y' One Ashburton Place 26822' Boston,M;a 02109,. Reg►stration\159597 Tr# 1 n :51151Q010 . • - '_1�T-hype h}` ' t nature i SEGOLINI CONSTF JCifION Mt lid iµlthOLt slg _ r �ADILSON SEGO N" _6 r * ' t LANE.M . y c� 11�MINTON: 0 668. Adnumstratoi , WEST BARNS ABLE, , _ =' TOWN OF BARNSTA3LE Permit No. ..... Building inspector Cash OCCUPANCY PERM11T Bond __._ 11311 Issued to Ni.r}ip]_P. KankaS Address Wiring Inspector Inspection date R - Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ................................................... . 19......._... ..........................................................:....... ..... ...........:........................._ Building Inspector f M,O M Zo `\ fAssdssur's map and lot number ..../41..-.!-4 Z............. ` f r i/ �jS� � THE 01` Sewage Permit number 6 - �6 a SEPTIC SYSTEM MUST g MU 83J INSTALL IN COMPLItAN BAUST&BLE. i House number .. .......Z`T.©......... Q�/�e I EN1/ WITH T1TLE 5 'ao i639 / IRt}IUM,ENTAL ,; � - CODE �;.D TOWN OF BARN; *mMONS BUILDING INSPECTOR / j �APPLICATION FOR PERMIT TO ....!• A:�+-Q!�C::....�............:s�:..................................................................... TYPE OF CONSTRUCTION ................... 1-4.�1 :. ............................................................... �.s. ......./�.�.................19L!-- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. .��.o. ..: ...k ....... �+....... ./.........j' '..f! � y ................................................. ProposedUse ..............4.9.U}! :`. ........................................................................................................................................ I ZoningDistrict ........................................................................Fire Districtt............................................................................... Name of Owner 7 Address � ......� . .......................... ..... .: .k��..�. ....G.Name of Builder' . ........................Address ls ^./ .......... K t..� . K l Name of Architect . . :?-r?... ... 4 a ?:..................Address (� . ''.... r ......... .... . ................................................................. Number of Rooms Foundation......... .7.. ......................... ..... . ......... ........................................... n Exterior .......Ut! rA ls...:'` , . .................................Roofing ........ �cir•�C� � (` :..... ..�............................ Floors .........Interior c�/L�, C(J^-�o Heating ...... - (: ...1.C.�:!...(.f '"'.."` "................Plumbing ...........`'2/ .....::Y.. "'-:.................................... Fireplace ...............................................................ApprOximate Cost .......................G O/.L.o...O....C.9.................... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area 1 .S".....:............ Diagram of Lot and Building with Dimensions Fee Z� SUBJECT TO APPROVAL OF BOARD OF HEALTH •U�N�� S��' ganoq v / OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..................... . . ' 4 ` KARDKAS, 0ICBOLAS 24308 1�2, Story , -----.. Permit for ---.—.-------. . ` . Single FamilyDwelling----.------. .---.---.. Lot #2 -- High Street Location Lot ' _ West Barnstable -- _^------.'�—~----.----------.. 0iobmlaa }{arukao Owner --_------------------.. ` }7�aoue ~ Typo of Construction -- ----------_—. ^ ' -------.------------------. ^� ' � Plot ............................. Lot ----------' t 24 ' Permit Granted —..��---..�_— 82..l� ' ^ . . . Dote of Inspection ------------l9 ~�� ~ �� "�� ~ ' ~ - . . . - ^ ` � . . ' . - . ' - . . ^ � ' . ? � •..; - ... -o<< . .ate �/a y%�L • �. Assessor's map and lot number .... .. . ...... ..u.. o*TNE'to r aSewage Permit number ...C�....-.y..............................:....:. i 33ARISTABLE House number .. .......:... ..............................................:........, r°o M639 1 6� � .. TOWN OF BARNSTABLE BUILDIAG INSPECTOR APPLICATION FOR PERMIT TO .... •c C�r .............../,x;t of n c ............................................:.. t • TYPE OF CONSTRUCTION ................... :... ., ............................:.................................. ................ T......44...............19 I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for as permit according to the following information: Location Location .. �.A.. ....�.. ....... .•1..{:. L.,......C�:. ...� '.. t;• spa. Ct�Y,R� ................................................. Pro o ed Use ...... � a .�-� / .... .... ................................................... ZoningDistrict . ........................................................................Fire Districtt.............¢.................................................................... Name of Owner :,1.!?:QX leml& ...... .......Address .(•;r z! �(c�e:..�-�!? .......� `'1. ^^�� ':.� a . ::Cry+'' Name of Builder' ..�•,•,,, .••�7•.•...'*,J . ►ti �.� ........................Address !i./�..�` L9G�?� /C�7.•.`.... .�!�-�.... .. . Name of Architect J A.WGVz. Address ............. Number of Rooms ............................................Foundation ........:. . 0 Exterior .......U JGt?e:5��...............r....`.. �e..................................Roofing ........l ...... � f.......................... Floors ............. .'r'� Interior:......................................................... '..1r'.1. .... :.. ............... Heating ��.. lt.X3r;/...:� ./•S.J .........................`E'"JPlumb'ing ...........:�:�:r/.............................................................. Fireplace Approximate Cost j O �, n O Definitive Plan Approved by Planning Board ---------------_—---------__19______. Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH �725 ��7-� f�• - r q tom. IT l j Ito ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. .� Name ..... ..................... .. ................r....................... • f lh' KARUKAS, Ni" �, OLAS- A=111-3;1 No 2 4 3 0 8.... ` j�""i Permit for .................................... Y y Single Family .Dwelling ........................................................................... ' Lot #2, High Street Location7 ................................................................ West Barnstable ............................................................................... Owner .......Nicholas. . . ...Kar. . u.kas .................. .. .... .. .. .. .... ....... Type of Construction .....I K'.4MQ........................ ................................................................................ Plot ....................... Lot. ......... .................. Permit Granted .. August 2 4,- 19 82 Date ofr Inspection ....................................19 Date Completed ......................................19 sr 8° } r Pk Town of Barnstable *Permit Eacpires f,months from issue date Reglllatol-y SerV�ces .... __ Fee... . ,Thomas:F.Geller,Director DWii IN: n GS � a _. ._ _Tom Perry, Building Commissioner E F_, .200 MainStreet,.Hyannis,MA 02601. office- 508-862-4038 ` MAR � G '06 f Fax:'508-190 . ;... PUCXTr0N '_RESID' �fVSi!�Not Yalid without Red X-Press Imprint 4ap/pazcel Number 2/ (/ 6/ 'ropertY Address �/ 'v N S e7 ]Residential Value of Work �C�y v, v O Minimum fee of$25.00 for work under$6000.00 owner's Name&Address I, 11 c<< < rJ aS v� 0 t (.� '�•r Y1 �� D�� b o� �o �0 Contractor's Name i i'✓i tl Q's t)AJ 4-Z-D Telephone Number Home Improvement Contractor License#(if applicable) Construction Superior's License#(if applicable) S S O a ❑Workman's Compensation Insurance Check one: gj I am a sole proprietor ❑ I amthe Homeowner ❑ Ihave Worker's Compensation-Insurance Insurance Compauy Name Workmen's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to rL ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side �J Replacement Windows. U Value . 3 (maximum.44) **here required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature Q: -.expMtrg Revise063004 i The Commonwealth of Massachusetts FDepartment of Industrial Accidents Offlee otlnuesdgadons 600 Washington Street, aFloor Boston;Mass. 02111 Workers' Compensation Insurance Affidavit:Building/Plumbing/Electrical Contractors o - name' 0�— c address' 57 city QOL C'✓n o✓4L „ , / ' f state' zip' Da G7_Pphone# �0 �-6p Zt'.F'Cva 75e work site location(frill address)' PIam a homeowner performing all work myself. Project Type; ❑New Construction❑Remodel am a sole proprietor-and have no one working in any capacity. ❑Building Addition ❑ I am an employer providing workers'compensation for my employees working on this job. v�. ra.. 2 - A' eom arn:+name � '- - - vr•tro >y,-•' at>:!�•wz•tt y� - T h�u ,�. 3-` a .�q' xu, 'r r4 - ..... <•„�,.� 11•• :r?'�•i .�.:.: ,.:uf..r<• G to-. :3�•j.,, \ w �".S: ] ;.1;:, :oir"'•: r. a r- .ter A°• wy'` -„ ,A( •'. 'a 4't'75� t X V j� 'r s ` % - F f i .� - b ♦. �f. t '� ,2 !. t d�Y � • R.•�� k 9 +F'7-YKNs•�, f r + ,r�Y a Nr •K ty3 t'y t v l'ILY r 13.1YY 2 '�5'a' K vax-+.E`i` LTn' > d K 'tdi ,+1^"• .� L��.1O�lle �✓eru.3 4 illFJ. ^E y >r• ,sx-T S f a h as,� :� ^F,$s v'i"r�yo "t,cT < .2 t F c. ✓ K a.w.•�� :LF5,2-ke'': "iw 7 ansLranceica._.,,. EHNEN ❑.-I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers compensation sattonpolices: !._ �.,i��:y.,,L?.��»�, Wr•�#"'€.i:.i3,r,ty s.aE,�3`�a i'a'$'�{Ts d¢X"t..i g s��s. '}�y'- . .. ..,.,l --•.... ..;.. ...::.:'..:::..:.:: ...fit;" >�"'F': `::�.,-:,a:.'ec'; cam an..hame a .. .—: _.< ... ... .... 1..,.,..x'...•-. ...<.... _, .... .-„!?.,,.,.. ems,. ...... �"i l.. ^Ht�.die§S• -•,�..� '•� x rrr:t..a,Laa�:.'�'ys;;y.:.. , �.w-,��...,<��3. ..::Y-..� , ,Mty t �- _ :cam <.,r'•.:.z - r` - u •f,'.'. 'ice.' .::.c ..,._:v,,.a,>•<..:.....n ....,.t_• .,,,.,-_.!_:-...,r.r„-..:.ia,-..<f,:.3.�.._:.,...1�:,....:,. ,.,d4::...4.:...,,.:.:::''•;:L:is �'. Li D one :`- t•a>�. �. * ;'r.°r sr rT,.� Y44 I.:, 4L � .' F2 , b f T urstira'n'�8°'fi$s,%._::,-e_.. .. •` ohc ,.#. .: ... ..... ' • Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP FVORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ce under the pains and penalties o perjury that the information provided above is true and correct Signature Date _ , Q 0� Print name Ulm 64 � � �d/!i A—�/ (� Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office []Health Department contact person: phone#; []Other — (revised Sept 2003) - Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or implied,oral or written. An employer is defined as an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a . .dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,7`h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 Town of Barnstable oQ �� , Regulatory Services ,$ T)Iomas F.Geller,Director Building DlvislOn Tom Perrh Building Commissioner 200 Main Street, $yaanis,MA 02601 yy vy.iown barustable;ma.us Fax: 509-790-6230 Office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using ABuilder �� /cam as Owner of the subject property I, z// C__ 6 hereby authorize .7—Fd' Z) sl- /.� .�.��. . to-act on mybehalf; in on ratters relative to work authorized by this building permit application for. ` (address of Job) a of Owner Da e S�gnatur 2rint I*iame � ✓/ze't�omvpzovzuiea.�/ o�,.%�.aaaac/auael�a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 055029 Birthdate.-t-5/14'/1964 Expiies:Q61t4/2006 Tr.no: 2903.0 Restricted:-'0.0 TODD R MACDONALD' PO BOX 544 G- YARMOUTHPORT,'MA—02675 Commissioner ✓fie T>oo�r��zo�zto� o�✓�aaaac�iuveka Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 111795 Expiration: 10/7/2005 Type: Individual TODD R.MacDONALD TODD MacDONALD 17 WAGON RD. YARMOUTH,MA 02675 Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 Not valid without signature Application:to: +PPS Old King ls Highway Regiona � ic District Committee in the Town of Barnstable for a CERTIFICATION.OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, Acts and Resolves o1 Massachusetts, 1973, as amended for proposed work as described below and on plans,drawings,or photo- graphs accompanying this application. / TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK `�1 S / ,A'Si ASSESSORS MAP NO. OWNER l,� I vV -�^ V `� � ASSESSORS LOT NO, o� l HOME ADDRESS h S f �-`� r 6g6�^S v/'�' TEL. NO.im:2— 2)�g gza �D— AGENT OR CONTRACTOR Ty'� - 4ZyL" .- ADDRESS P.O . g-yx S44 ��20,mydf �j OAS TEL.NO. 50 7!Z This application is for exemption of proposed exterior construction on the ground that: ( (1) It will not be visible from any way or public place. ❑ (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work,showing location on lot,and, if an addition Is involved, show" ing location of existing building. A t\J- rS 0F\ Ccc S,e nn e-A— u 11-ec,0 V �nyl JOLL vn ('4s p-� �im-e— me� s�I�en�, eW vrl'+ S (,.) t 1\••' . W aV t b��'�l�' m o le1 aG Sins w I�� Svb s �s0 Q- )i ODIC 0X aC---(y ` `-:P- Scgn - - Q a S SIGNED Space below line for Committee use. . Owner-G ractor-Agent Received by H.D.C. The Cart` is eby Date Time By Date Approved ❑' The categories of work entitled to exemption are listed on r' I Assessor' Parcel &#ermit Gomm, OR Date Issued Fee a� Engineering Dept.(3rd floor) House# BARNSTABLE. 15.yMAS& d 19 '• * FO Mpt� TOWN OF BARNSTABLE Building JPermit Application ; Project•,Street Address-l216 Village` 6e,C57t- Owner Address _TelephoneG� Permit Request r� [/ �'j First Floor square feet Second Floor square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name 1DPWkj Telephone Number Address �J 7/ / t.1Z4 vY► Cr2 License# Os4741oR Home Improvement Contractor# Worker's Compensation#ZZK /3/a y9a 3 O/y NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 7vJ FOR OFFICIAL USE ONLY r t � I PEAMiT N©. DATE SSU D r � • MAP/, AR EL NO. 1DR S VILLAGE OWNS - DATE F INSPECTION: - FOUN ATION ' FRAME - INSULATION r FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL ' FINAL BUILDING i't-I I'7Ice�e y DATE CLOSED OUT _C a ASSOCIATION PLAN NO. r The Commonwealth of Alassachusetty Department of Industrial Accidents Afteof12=119a1/ons 600 ►f•ashington Street Boston, Mass. 02111 Workers' Compensation insurance Affidavit Y'"^• - Pleace PR1NT�1,ibly �� Y name: Annls—n nformation• • � cc 5-sL1Z location 21 / L/Z ds citv C6 phone# 1 am a homeowner performing all work myself. 0 1 am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. contpnm nnmc' y—✓1 •Fi12 (-�`� r atldress• / 4Rit� an �� p •••� 9� cit3.. 06 �tc,�/� phone#• �°e�'l� O� insurnn e co. L J li •# a . I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: cominav narn nddress• city: #: insurance co nolicy# � ^�� .�. - - - Men:t 'C'•'Tl`C�'="�'r�'�7"+R'e.fT.c�l�,.s�• -- •�7T.�H�T7�'�'=R3'.�a�f.7�t�7F•a�.*;�•"_��'*R!RT"'�":�"� rim any name- address- citv- Phone#: insurnnee co nolicy# __ 'Atiach additionafshtiet if tiei �� :•is7:= •y._ +ss;:f+K:Jl Cap±� .-• :ea.�,.�. : .::vr:,?c n• M.--_-'�--- -_ Js•� %.tiai: Failure to secure coverage as required under Section 25A of D1GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or unc years'imprisonment as well as civil penalties in the form 0172 STOP NVORK ORDER and a fine of SI00.00 a day against me. I understand that a cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certifj •r tlrc pains mrd pe„aloes of perjun•that the information provided above is true and ct Signature 2.w-'� Date 'S Print name C jocv �` Phone# •0MCi21 use only do not write in this area to be completed by city or town official city or town: permit/license# nBuilding Department Licensing Board check if immediate response is required 135electmen's Office [311calth Department contact person: phone#; nUther r Immed 3,4)5 P1A) . : The Town of Barnstable AZMg Department of Health Safety and Environmental Sernces °1 `° Building Division Ma 367 Main Street,Hyannis MA 02601 Ralph Crosses Office: 508 790-6227 Building Commissions Fa)c 508775-3344 For office use only Permit no. Date d ' 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-e'asting owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements Type of Work: Est Cost O 0 Address of Work: g y o ! ORner.Name: Date of Permit Application: I hereb%-certifv that: Registration is not required for the following rzason(s): _Work excluded by law Job under S1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING wrm DO NOT HAGI MP S' ACCESS CESS TO THE FOR APPLICABLE HOME IROVEMENT ARBITRATION PROGRAM OR GUARANTY FUND UNDER MCI-c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. 5 o Registration No. ate Contractor name OR ' Ownei s name . :: :... 1��Application to i �NSt.�P�9ttP yPOt - ' `� `` 19 6 0 01 Old .Kings Highway gional Historic District.Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work, aszdescribed below and on plans, drawings or photographs accompanying this application for: ! CHECK CATEGORIES T"T APPLY: 1. Exterior Building Construction: •fl:New Building ❑ Addition M Alteration Indicate type of building: '® House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ _ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign _ 4. Structure: ❑•Fence ® Wall ❑ Flagpole ❑ Other_5'--'i r 415!44EJ' 0�'e'Q �?`�'Q (Please read other side for explanation and.requirements). TYPE OR PRINT,LEGIBLY DATE ADDRESS OF PROPOSED WORK 7 � l J 019114S:21 W ASSESSORS MAP NO. OWNER /Vic Ai'G 14S ASSESSORS LOT NO. HOME ADDRESS f � tY .fT' �' C3� Q A/sT'g b L� TEL. NO. -3 G S/ FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). G _ V .L •y s �� R tis �.s— [ens l / M t' �i¢ / /yR '` /vIR s L �o .y T;0 I.r z•Z Sz 4' x — /LIi -r. A q e- /9 ; 7r,9 N ! e.^-f AGENT OR CONTRACTOR �`R'�`fie42 �o .� r Ad NO. �a P ADDRESS 7/ T4 R Q 7 4 Al i R C C DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done)(see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs,give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). to Lc- m ✓e,'A- • o D D D Signed. ., o Owner-Contra or-Agent Space below tine for Committee us . Received by H.D.C. Date'' l �`� ?6' !The C rtificate is her I AC 6) VL: Date BY _{yamIle Approved ❑ IM"Tfficate is approved, approval is subject to the 10 day appeal period provided in the Act. j Town of Barnstatle .� �p Old King's Highway Historic District Committee . SPEC SHEET FOUNDATION SfJ iH A =9J' 'l CD�J•. � SIDING TYPE ,5'fJ ,�y G e .r COLOR 31 CHIMNEY TYPE COLOR OF MATERIAL j K COLOR PITCH WINDOW SIZE TRIM COLOR DOORS COLOR SHUTTERS GUTTERS DECK GARAGE DOORS COLOR NOTES: Fill out completely, including measurements and materials/colors to- be used. Three copies of this form are required for submittal of an application, along with three copies each of ' the plot plan, landscape plan and elevation plans, when © D applicable. Plot plan need not be "Certified" but . should ' show all structures . on the lot to scale. .1 oil •, �,: 11 34. .7 - >{ 104.7 2.3 lo / 11 :3 �t 116. ' ' I } X 114.2 \/ 114. /\ 114. �\ 32 I 14-' -. _ �/ 11212 ! J ,_• / 0-b r\ 21. s i{ 11 IfAa / 117.2 . — � \/ 1188 8.3 r i !ti 8.1 ,' r; 11 .0 i� ' \/ 115.E -72 16 4 111.1 A116.9' (` o X 114.7 I 114.5 r j{j 1 . .3 / 15 1*4 � p DES ARE ONLY GRAPHIC REPRESENTATIONS OF SCALE 0 too S.-THEY ARE NOT TRUE LOCATIONS cm h 8-3-94 IN FEET 100