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HomeMy WebLinkAbout0157 POINT HILL ROAD I Sr7 4 o �lll ��cYcxF,� llll ® 2 Z UPC 12543 �o NO °ot,rah WASTINGS. MN .r Consarvwon 11/14/14 Thomas Perry, CBO Town of Barnstable Building Division 200 Main St Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for insulation work at 157 Point Hill Rd (application#201401252) has been inspected by a certified Building Performance Institute.(BPI) Inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Conor McInerney y' o. ConserVision Energy cP-4 ' .-. . . o C:) -� co oa _ . 376 ROUTE 130,SUITE C SANDWICH,MA 02563 508-833-8384 WWW.CONSERVTODAY.COM OF THE Tp� Town.of Barnstable �Permit# p� Expires 6 months from'sue e Regulatory Services Fee anxtvsrnslA 9� MASS. � Richard V.Scali,Director , ArEo N1A�s 1�_ . Building Division . �� � . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us JUN 17 2014 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENT ,ONLY_ 1 c Not Valid without Red X-Press Imprint Ri p'VSTABLC Map/parcel Number ( L (1 Property Address �. �n:ti� :�\ \�c , r W Oc�`I1rAS`��"�' 94 +v( Residential , Value of Work$ %yp . Minimum fee of$35.00 for work under$6000.00 QS �¢Owner's Name&Address 5 �a;�� tt Sr ��n r �b�Q . L4 PC Contractor's Name V r.^o Telephone Number (Cbn).;L .-—04-63 Home Improvement Contractor License#(if applicable) (p d 7,�(' Email: )d Q MAct'yty\(A4 Mk C.CyM Construction Supervisor's License#(if applicable) [IWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [W I have Worker's Compensation Insurance Insurance Company Name J rc.vti` I-C, S tn�a K L Workman's Comp.Policy# (h IS Q V (P -7 Q b 3��a Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows 3 #of doors: _ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: Q:\WPFILES\FORMS\building pe4formsE)TRESS.doc Revised 061313 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-091884 "`Yx VINCENT J MARE190 H 58 LIBERTY LANE � MARSTONS ND17 MAI 02`'48 ,I lit Expiration ~' +; Commissioner 01/2412015 ,per tC 0097/lJZ09LlU L ai\ 9 Office of Consumer Affairs&Business Re ulation ' 1 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 Regis tration1.60991 Type L 10 Park Plaza-Suite 5170 Expirafi�on=g/17/2014 Supplement Gard Boston MA 02116 MARINE LUMBERIOPERATORI;I1C = � ` t==• ,I VIN MARINO 134 LOWER ORANG,E��`IIST NANTUCKET,MA 02554=' ~ Undersecretary f(, {, Not v lid without signature �a 4l ; r. MARVIN DESIGN GALLERY a complete window and door showroom 6y MHC Permit Authorization as Owner of the subject property understand that Marvin Design Gallery by MHC is a department of Marine Lumber Operator located at 134 Orange St., Nantucket, MA and hereby authorize V--, 04 �o �� 2r���et-ee'S to act on my behalf, in all matters relative to work authorized by this building permit application for: s 7 (Address of Job) Signature Owner Date Print Name 73 Falmouth Road Hyannis,MA 026011(508)771-6278 1(508)771-6279(Fax) wwwmarvindesigngallerybymhc.com MARVIN I DESIGN GALLERY Page 1 of 2 a cq w)we window and doorthowroom by MHC Date of Agreement: 4/30/2014 Client: Dana Mitchell Installation Address: Dana Mitchell 157 Point Hill Road 157 Point Hill Road West Barnstable, MA 02668 West Barnstable, MA 02668 (.SAS) 744-7598 (508) 744-7598 Marvin Design Gallery by MHC Representative: VM HIC Registration Number 160991 Expiration-Date 09/17/14 greeµen,_ Customer Acceptance t'7b o� $8,116..93 (Date) (Customer Signature) Total Amount of Agreement $8,116.93 �� Commitment $2,400.00 (Date) 006 by MHC Representative Signature) Second Payment $2,379.43 Balance Due on Completion $3,337.50 By signing above, you hereby authorize Marvin Design Gallery by.MHC to furnish and install 3 Integrity Wood-ULtrex Casement Windows and 2 swing doors (see detail''listed on Project Specification Form - attached) Cash/Check/CC/Payment Options Accepted Estimated Project Start Date: C,��Q I� I Total Includes The Following Services: Installation Following Marvin's installation instructions ,L Estimated Project Completion Date: I��I�`h Removal and disposal of existing windows & doors Removal and disposal of all construction materials and debris The buyer agrees to pay Marvin Design Gallery by MHC the total of: $8,116.93 Protection of customer's property with drops and covers (Amount should match Total Amt. of Agreement to right) Vacuum of affected area Washing of newly installed windows & doors All permits (if applicable) Exclusions: Interior and Exterior Painting You, the buyer, understand that you may cancel this transaction at any time prior to midnight on the third business day after the date of this Filling of nail holes transaction. You have received a Notice of Cancellation from the Marvin Design Gallery by MHC and understand your rights as explained on the Removal or installation of window treatments Notice of Cancellation. Moving of furniture Buyer Initials: J Last Date for Cancellation: e ; I Upon installation,any unforseen circumstances discovered such as;wood rot.inse t infestation;etc will be assessed and discuss ew feasibi will o e rate proposal for additional work to repair an /or rectify to do u mer Signature) MARVIN DESIGN GALLERY Project Specification Sheet Page 2 of 2 a complete window and door showroom byMMC Date: 4/30/2014 Dana Mitchell Installation Dana Mitchell Client: 157 Point Hill Road Address: 157 Point Hill Road West Barnstable, MA 02668 West Barnstable, MA 02668 (508) 744-7598 (508) 744-7598 Marvin Design Gallery by MHC Representative: VM HIC Registration Number 160991 Expiration Date 09/17/14 Qty Location Type Grille Type Screens Hardware Color Exterior / Interior I Kitchen Sink Integrity Wood-Ultrex Casement 3/4"Removable Interior White Stone white/Prefinished white i The Commonwealth of Massachusetts Department oflndustrial Accidents Office of limestigations 600 Washington Street _ Boston,MA 02111 rvtytt.utass.gor/tlia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information �A ( Please Print Legilbly Name(Business/Organization&dividoal): R",,r-:,4, rJ'2 ®�V 0,,r.�a t Address:__ City/State/Zip: 1,.1'1+-,c.LA-, PtA 6015S--q Phone# Are.you an employer?Check the appropriate box: Type of project(required):1.[X I am a employer with 3 0 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.V Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance. I 9. ❑Building addition required.] 5.❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.[]Plumbing repairs or additions myself o workers'co right of exemption per MGL �' (No mP• 12.❑Roof repairs insurance required.]7 c.152,§1(4).and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant ton checks box"I must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affldmit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. IContractors ta.t check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those emities have employees.If the sub-contractors have employees,they,must provide their workers'comp.policy number. I air►air en►plgfer that is providing workers'compensation insurance-for uty employees. Below is tyre.policy alld fob.site information. ___--7 ` Insurance Company Name: \C&,Ar—, \e i-< 7 ^r--A CE Policy#or Self-ins.Lie.TM:r��,Q-k t, o O��5­1 c, Expiration Date: ` � viA Job Site Address: [ci Y0 6c T14t f l el City/State/Zip: (J JoaPl V"4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failuree 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the.form of a STOP'WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifutl ly penalties ofpejrry'tlratthe inforu►adorn protrided nbvte is true and convect c Sienalure: Date: & Phone#: (5-11 f o7c101 ' 0�1�� Official use only. Do not n rite in this area,to be completed by city or town o fffl City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityllown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 I i ACCOR0 CERTIFICATE OF LIABILITY INSURANCE i/7/20 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREiR(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy{Ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and Conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the Certificate holder In lieu of such endomemen s. PRODUCER Judi March Risk Strategies Company 1W N . 781-961-0325 116116 FAx 781-396-4420 15 Pacella Park Drive E L .jmarch@rink-etrategiea.wm Suite 240 INSU AFFORDING COVERAGE NAIC0 Randolph MA 02368 INSURERA:Travelers Indemnity Co 25658 INSURED INBURER B Marine Lumber Operator, Inc. dba INSURERC: Marine Home Center INSURERD: 134 Orange St. INSURERE. Nantucket MA 02554 1 INRURIFRF; COVERAGES CERTIFICATE NUM$ER:a141771302 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP �� LTR TYPE OF INSURANCE Y NUMBER GENERAL LULBIUTY EACH OCCURRENCEDAMAGE TO RENTEN_ i COMMERCIAL GENERAL LIABILITY 7 S CLAIMS-MADE El OCCUR LIED EXP one S PERSONAL a AOV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S POLICY PRO- LOC $ WMINNED SINGLE 3Mr-- AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY(Per Penton) $ ALL OWNED SCHEDULED BODILY INJURY(Ps=l4e A) S HIRED AUTOS AUTAUTON-0NMED PROPERTY E S S OS UMBRELLA LU1e HOCCUR EACH OCCURRENCE S EXCESS LIAR CLAMS-MADE AGGREGATE S OED I I RETENnoN sS A IWOR XERB CDYPEI I vVC ST T DTI+ AND EIIVLorERs,LILA61uT4muTrYIN ANY PROPRIETORMARTNER/EXECUTIVE N/A E.L EACH ACCIDENT $ 500.000 OFFICERIMEMBER EXCLUDED? 513 267HO3 2/18/2019 2/28/2014 (Wndabry In NH) E.L DISEASE-EA EMPLOYEE S 500 000 If yyeeaa�deaa4re under DESCRIPTION GF OPERATIONS below E.L.DISEASE-POLICY LIMB a 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ABtdl ACORD 101,A44XIenal Re w Sehedum.IF more apace Is r*wWI4 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Marvin Design Center ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORAZO REPRE89RATAIE Bernie Gitlin/JUM ACORD 25(2010106) 9)1988-2010 ACORD CORPORATION. All rights reserved. INS026(401oonoi The ACORD name and hW are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map.: y%C , Parcel �z> pplicatio Health Division ' " Date Issued o'2 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board \ Historic - OKH Preservation/ Hyannis Project Street Address c7z -A Village �.5: �a.�� :,`F. 4 Owner e, a v� c_-d, �_ Address - Telephone_ \_C_ , Permit Request co.Z���. t •d*-- Z _ v.�� .._a. . �,`, k N �E — �,�a.�� Z- Z 'L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup rting dopument4tion. . Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) -� Age of Existing Structure k 5%0 Historic House: ElYes ❑ No On Old King'sHighway 4 'es ! No Basement Type: ZFull ❑ Crawl ❑Walkout ❑ Other .may Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) -+ Number of Baths: Full: existing 1-. new Half: existing Lnewc? ey Number of Bedrooms: 3. existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 Gas Oil ❑ Electric ❑Other Central Air: 0 Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing . ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 0 No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name c. o�o_ C_ . 3 1 "'n Telephone Number -4- $3 3 - 8 3 g 4 Address License# Home Improvement Contractor# \A L Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ��1N�'�`J " " I DATE FOR OFFICIAL USE ONLY ' 9 APPLICATION# DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER DATE OF INSPECTION: = FOUNDATION f FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO, r - RISE ENGINEERING RI RI Contractor Registration No 8186 A division of Thielsch Engineering MA Contractor Registration No 120979 y CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,11102910 (401)784-3700 FAX(401)784-3710 CONTRACT Page 1 R I S E PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CLC-RCS ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE Client M Dana Mitchell (508)744-7598 1 1/20/2013 151210 SERVICE STREET BILLING STREET 157 Point Hill Road 157 Point Hill Road SERVICE CITY,STATE,LP BILLING CITY,STATE,ZIP West Barnstable, MA 02668 West Barnstable, MA 02668 JOB DESCRIPTION Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (18)workin.o hours. At the completion of the weatheri-r-ation work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $1.386.00 Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(308)square feet of kneewall area. $1.019.48 Provide labor and materials to install a 10"layer of R-35 Class 1 Cellulose added to(968)square feet of open attic space. $1,297.12 Provide labor and materials to install a 6"layer of dense packed R-22 Class I Cellulose added to(352)square feet of kneewall Floor. $696.96 Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. The cover has integral weather-stripping to restrict air leakage. $230.19 Provide labor and materials to install(3)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). $348.30 Provide labor and materials to;nstall ventilation,chutes n(66)rafter bayS,to,mainla .air S230.3a Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2"rigid board that meets the sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and seams with FSK tape. S72.22 LE G 9— i�OV 2 7 2013 ,`L� i L I RISE ENGINEERING Federal ID#05-0405629 RI Contractor Registration No 8186 A division of Thicisch Engineering MA Contractor Registration No 120979 f CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,R102910 (401)784-3700 FAX(401)784-3710 CONTRACT R Page 2 I S E PROGRAM THIS CONTRACT Is ENTERED INTO BETWEEN RISE CLC-RCS ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE Client Dana Mitchell (508)744-7598 1,1/20/20.1 3 15 T210 SERVICE STREET BILLING STREET 157 Point Hill Road 157 Point Hill Road SERVICE CITY,STATE,ZIP BILLING CITY,STATE.ZIP West Barnstable,MA 02668 West Barnstable,MA 02668 JOB DESCRIPTION Total: $5,280.61 Program Incentive: $4,306.96 Customer Total: $973.65 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "**Nine Hundred Seventy-Three&65/100 Dollars $973.65 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY*ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES J AUTHORIZED SIGNATURE•.RISE ENGINEERING CUSTOMER CCEPTYU7CE�G=_�/� NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTEDWITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS., AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at l5 7 (Property Address) (Property Address) ' I hereby authorize 0-cl a S 1 (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a bui ing permit and to perform work on my property. Owner's Signature l l�/o f 1,3 Date :. CSSL-1027* CONOR D 11%ICINERNEV 39 SIASCONSET.DRWE SAGAMO1tE BEACH MA 02562 `%L.:: :. OW19/2014. Office of 1 oosumei•'Affairs'&Busincis'Rcgulalion' HOME IMPROVEMENT CONTRACTOR Registration, 121251 type Expiration: 3/1/2014 Partnership. CON-$ERV.E ENERGY' CONOR MCINERNEY 376 ROUTE•136'90IT:E C- -SANDWICH.,'MA 02563• Undersifretar:• License orregis`tration vand'for individul use.only before.the expiration date: If found return to: Office of CoosumerAffairs_and.Business Regulation, td:Park Plaza-Suite.5l70. Boston,-MA,61116 Not valid,without signature. J �1 CONSENE-01 MVAUGHAN ACURU' OU"DDNYM �..� CERTIFICATE OF LIABILITY INSURANCE DATe31ze/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain Policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement e PRODUCER NAOUE• Strategic_Business.Unit Rogers 134 Ina.-Dennis Branch . PRONe 608 398-7980 877 818.2156 South Dennis,MA 02660 ao s INSU AFFORDING COVERAGE NAIL B.. INSURSRA:Selective Ins.Co.of theSoutheast INSURED _ -INSURER B: Co"erve Energy,Inc. INSURERC:. - dba ConserVRalon Energy 507 Main St. INSURER D: Hyannis,MA 02601 INSURERE: INSURER F; COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED,ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRISED HEREIN IS SUBJECT TO ALL THE TERMS,. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF Ui9tRRANCE wVD POLMYRUMBER 011MIDWYM _ _.LIMITS GENERAL LIABILITY - EACH OCCURRENCE. S ..1,000,0 A X COMMERCIILobsimUA94TY 2011299 3114f2013 3h412014 PREMISES(Es acma S 100,0001 CLAIMS-MADE 000CUR MEDEXP ar S 10,00 PERSONAL a ADY INJURY s_ _ 1,00010 GENERALaGGREtRATE $ 3.000,00 OENL AGGRIXIATE LOnr APPLIES Phi: PRODUCTS-COMP IOPAW S 3,000.00 X1 POLY [71LOC. S AUfGY06BE LRABILIrY Es sadden) n. S. .. . - ..... I ANYAUTO ..BODILY INJURY{W -p-" S ALLHEDULED AUK O AU AUTOS BODILY INJURY(Per added) S WREDAUTOS NON AUTOSO•ANEO P R IOE S S UMBRELLA LL10 OC�" EACH OCCURRENCE- S EIOCE8.I LJAB CLAJMS4AAOE AGGREGATE - $ JOED1 IRETINrDN S INORICEtSCOYPELSATION A AµNrD�mE=umEy" C7956639 3/1412013 3/14/2014 E.L EACH P�ENT s 60Q0 i OFFI ERAI�000LUDED7 II � OP O N R A I, 0PE.L. ELLFLOYE DISEASE-Fa S. 600100 EF/1DONSOebw _.. ...._. E.L DISEASE-POLICYUMR $ 500.000 I DESCRIPTIONOPOPFRATIONaILACa7DNSrVEHM=I111Wb ACORD 1*1,Adfift l Rma.0 Sdwdul%r mats sp+ brwWed1 EXCLUDED OFFICERS UNDER WORKERS COMPENSATION:CONOR&COURTNEY MCWERNEY"NOTE THAT BLANKET ADDITIONAL INSURED OVERAGE APPLIES TO THE COMMERCIAL GENERAL LIABILITY(IF A WRITTEN CONTRACT IS IN PLACE)., CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVEREO IN Rise Engineering ACCORDANCE WITH THE POLICY PROVISIONS. 1341 Elmwood Ave. Cranston,R102910 - AUTHORIZED REPRESENTATME AIA 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Print Form.:,- Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Auulicant Information Please Print Leeibly Name(Business/Organization/individual):Con-Serve Energy,Inc dba ConserVision Energy Address:376 Route 130 City/State/Zip:Sandwich, Ma 02563 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.21 1 am a employer with 8 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. Q Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers'comp. insurance comp. insurance.*- required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.Q Roof repairs insurance required.]t c. 1.52,§1(4),and we have no employees.[No workers' 13.❑✓ Other Weatherization 2013 comp.insurance required.] 'Any applicant that checks box#[must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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. tf the subcontractors 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:Selective Insurance Co..of the SouthEast Policy#or Self-ins.Lic.#:WC7956539 Expiration Date:3/14/2014 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the ans and enalties ofperjuty that the information provided above is true and correct. Si nature: , Date 3 2 2013 Phone#:508-833-8384 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health L Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: e �Por�vnaoaacueaCG�a1Q&aa1acXa4eZ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: �;'71251 Type: Office of Consumer Affairs and Business Regulation xpiration:�'3//201.6�. Partnership 10 Park Plaza-Suite 5170 !YAK fi �,t�r Boston,MA 02116 CON-SERVE ENER( _ . i CONOR MCINERNEYJ,4-,_ r " 376 ROUTE 130 SUITE'C...`�=-T; SANDWICH, MA 02563 Undersecretary Not valid without signature a r �+ Town of Barnstable *Permit`©/,qc,) R�9 Expires 6 m•eths rom issued e Regulatory Services Fee • BAMSTABLE. 0ss. 039. Thomas F.Geiler,Director �0 / p�EO MAC� 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 ae4mo Property Address 15�7 & 1't i'I rt� Q � C� 1' e% \ WO(D23 Residential Value of Work �� 7(�J� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name T �r) Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) JD)OG ❑Workman's Compensation Insurance X-PRes k one: ®Arl`CCh I am a sole proprietor ��11'!/[ T ❑ I am the Homeowner DEC ❑ I have Worker's Compensation Insurance Z 12012 Insurance Company Name TOWN 0,F ._ Workman's Comp.Policy# r� � Aa Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ee-side Li SJ^ 1 ❑Fence over 6' #of doors , ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Al copy of the Home Improvement Contractors License&Construction Supervisors License is /'r quired. SIGNATURE: f A Af Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 051811 r . 4 The Co>nimonwealth of Massachusetts Departmerit of Indusftial Accidents Offwe of Investigations 600 Washirigion Street Boston,MA 02111 wmr.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Naive(Business/Organizafionfludividuaq. J ytn Address: e, N. Q►cl City/State/Zip: me Phone#: 'M 03 b 'Q O J Are you an employer? eck the appropriate box: T of project 4. I am a general contractor and I Type P I (���= 1.VI am a employer with ❑ g 6. ❑New construction mployees(full and/or part-time).* have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet. y- ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demolition wo dng for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insumnce cam-insurance-, required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself_ [No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance required.]T c. 152, §1(4),and we have no p employees-[No workers' 13.L�ether o f t comp.insurance required-] ;Any apphcaut diet checks box C mast also fill out the section below showing their wozkers'compensation policy information. Homeowners who submit this af6dat7t mtcating they are doing all work and then Lire outside contractors mast submit a new affidavit indicating such T-Caatractors that check this boot must attached am additiocA sheet showing the name of the sub-camdractm sad state whether or not those entities have employees. If the sub-contactors have employee%they must provide their workers'comp.policy number. lain art ertipL:'y�r that is prodding iiwrkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(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,�zolator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hemby c epains and penalfies ofpedury that the informatianprovided above LES and correct Si tune: Date: O` J Phone#: <-73� Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone it: 6 I r r + + BAMSCAB14 r Town of Barnstable prED MA'S� Regulatory Services Thomas F. Geiler,Director Building:Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as 01Wner of the subject property hereby authorize �Y b01►'1 to act on ray behalf, in all matters relative to work authorized by this building permit application for: (Address of job) p kf) ' of Signature of Owner date 1 - R Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWHILESTORMS\building permit forms\EXPRESS.doc Revised 051811 i __ IKE Town of Barnstable Regulatory Services ` MnssnacE Thomas F.Geiler,Director 03.t►`e� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person wbo constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval'of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code - Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as"supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application,that the homeowner certify that 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc [devised 051811 1 ��- ���.__�,-.-._..-�-.-;: // (y�.��-j'-•�+•^wry..r-^-'�..�..o_s,+/c/:--.�..��y-.;. .' Office df Gossamer.AtYairs business IPegulation LitF.ensg ar P .4 yet d for indtviilui use only OME IMPROVEMENT CONTRACTOR R . Warp the a'Kpira0on date. if fquod return to: egistration `,09982 Type: Office of Cgnsumer Affairs and Ilpsiness.Regulation xp�ration -61-62014 bBA 10 Palk Plaza-Sdi 5190 i`RQi?�=�••t --- TIMOTHY P JOHNSONz`CO�1STRUC,ON - : .ate :!_• .: .. TIMOTHY JOHNSON• ',,_, 180 MEGAN RD HYANNIS,MA 02601 Undersecretary. Not 1, without signature Massachusetts-Department of Public Safety Board of BuildingRe ! Regulations and Standards i Construction Supervisor License: CS-101696 TIMOTHY P JO 180 MEGAN RD; j�d' Hyannis MA 02601 P " ", \ Expirateon Commissioner 08/23/2014 13 `-,2 3 MCA As;,,4so�' map and lot"number. ........................... .. . .::.... o SEPTIC SYST M MUST BE �22 INSTALLED IN COMPuANCE Sewage'Perm.+,nu ber ° - WITH TITLE b 'i Ofy0F / THE ODE AND TIONS BAEBSTeFILE; oY��• - .BUILDING . INSPECTOR APPLICATION FOR PERMIT TO .. fd.. ...1� .... ? ......................................................... d TYPE•OF CONSTRUCTION ........06O1V :.............................. 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: , �y Location ` ..8....Q�i9:r.. `I�j. �P/..(.. /J.. f7�..1111�� � i � j.,f/..tCbe................................ ProposedUse W e1.,.tn. .................................................................................................................................................. Zoning District ........................ ....t..........................................Fire District `...... L ............................................ Name of Owner �.h,�...1��.. ca. � .�--..........................Address ...o�- ..IVA .4144580#lIVA02&6 ., i. .4. .00 Name of Builder . ........Address /r /. .. .. a...........'I Ia /a id /e 4 . /! Name o t ...�............f.. ..................................Address ............... .................................................................... Number of Rooms ........ ?......................................................Foundation'POVN..S.I.Jevoe .............................................. Exterior ..a(cpAw,14......................................................Roofing .I .�IJfT .�I�IV�° ................................ Floors Avap k. "'Oa./...............................................Interior ,C lr� �'� ��Jl& .............. no Heating'�`e�?'' h!rif:...4�!��............................:..................Plumbing.......................... ....... Fireplace ......./.......................................................................Approximate Cost ................. „C?/..&..... ........1. i+ Definitive Plan Approved by Planning Board -----------_______-----------19 . Area ...... 1... I........a.`... ohs Diagram of Lot and Building with Dimensions Fee �ialp�...:"' ............ ........... //XS UBJECT TO APPROVAL OF BOARD OF HEALTH ��0• 0_0 ga a� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... . . . .. _........................ FULLER, JOHN A. 1 .224 4 9... Permit for .,Two........ . ........... Single-Fam lv- Dwellinc ,_ Location 'Lot__#8�-1"57 -Point Hill Road »._.. ........................ West Barnstable........................ Owner ... .....:.................... Type of,Construction .....Frame........................ Plot ............................ Lot ................................ E " Permit Granted .......A gUst...22......::19 '80 ,Date of Inspection ............./'�q/ 19 00;6 Date Completed ...........?....7.°.�....19?1/ , Lz A7e r PERMIT REFUSED .................... ...... ......... 19JJ r W. �. . .......... .................................... . . .....................................:..: ................................................... y -� i1' C) fir- . Appr? ...`�., ................................ 19 " ..................... ........................................ ... Assessor's map and lot number ............................... _ Sew Permit number .......................................................... THEp���i� F BAR e�Q o� TOWN O NSTABLE 33AWSTLBLE, i s639• BUILDING INSPECTOR \00 'E0 M of. APPLICATION FOR PERMIT TO + ... --r 4 TYPE OF CONSTRUCTION ............. .. ......19... ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:: Location �,�f R.....2!� {' ,t.tltall � w 7'�l �1�13c I' /�lF?. � CSC':................................ .�• �• . Proposed Use ..T X,rf�. ....i� rm.................................................................................................................................................. .. . r.......................................Fire District !.a'... . �L&, Zoning District ................................ Name of Owner `.`? �ta1 ?:�'.r"..........................Address ... ! ?l tlL Y �RLtI �Cltl�T�l/.�M .1�nvf /. ..k(2 7r" Name of Builder 76111)...)ITI.,$Jb ........Address .................................................................................... n Nameof Architect ...I...............................................................Address .... .............................................................................. Number of Rooms ...........Foundation� Exterior ..t..`''c.!r/)/h,? Roofing .!�/LIIT .( ..F�L-r. .................................................. Floors ..................i.3, P may..... •........................Interior 2...1IJ,rt......,.PS(9/1•.. ......?.............. / ! Y r t Heating �_..."• ..j r ...........................................Plumbing l.� �. ..........................:.............. ...................... ....!... . ... .. Fireplace ........f.......................................................................Approximate Cost s/GC�, Definitive Plan Approved by Planning Board -----------______-----------19_______. Area �./,/ _ S.' ..:..... ....................... Diagram of Lot and Building with Dimensions Feed /....... ..... ".............. SUBJECT TO APPROVAL OF BOARD OF HEALTH 410 )­0 i r) ,t r Y�� ' � 1 r t� / r I hereby agree to conform to all the Rules and Regulations-of the Town of Barnstable regarding the above construction. Name ............ ...' ....:... ....a/f.....fl.......................... i FULLER, JOHN• A. a t = 36-23 No ..22449.. Permit for . Twa.,,Stofy ............... Sin'le FamilX ......................Dwe Location ..LQ.. ... ...8.:...157 Point Hill Road t. . ......... t West Barnstable ................................... . .................. Owner .........John A. Fuller { ........................................................ Type of Construction Frame ................................................................................ E tPlot ............................ Lot ................................ j j Permit Granted ............i � gus:t..22.,...19 8 0 .i - Date of In pection .,............................ ......19 Date Completed- � i } -PERMIT REFUSED ....................................... ................ 19 z ..................f. ............ a .,!....6.!fl?�l. ..... ..! / ........... �.I . .... ..i.�.. 1 ©.0 .......................... .. ................. .t. rApproved ....:........................................... 19 j ............................................................................... 1 I I /F Ail,c- i�1-ar©0 O wFLL- L o T-- g T I N, 41 � , ! r 38r .lb I q' t N 3 to f 1 N 5 ,`Y^iE i P O W T" E-1 I L L R O A c • � Gee r,�-r T'iif/T' ?f/� r=-r;vs�t�a<s rrr�i� I-.00A-r-CP G/J T' G�Guh�D y��J4 ra 7-OW k) off' AAND Qlir-l4,0. &S. LOT 1-A, l-.,! P'oP-,, TOHm A , BLit-L L--k. t ALIA.4 ' cy� S CALE / 4o! AuC, ZZ,/HBO O' a I<I/U G 5 $VAe ySuR_v!?'PIA.,6,a X•VG K1#261 I y t o !-o w 6 Ee-A,<oA�N tv.4 s� ,Q �2b2Q1 . `'ot Ir S 4, � o w I r- , �M A 53. TOWN OF BARNSTABLE permit No. 2 2 4 4 9 , e l »n� Building Inspector cash _ $64 0 • 0 0) r •�•r;;Y w� i OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to John A. Fuller Address North Attleboro, Ma. Lot #8 1 7 Point Hill Road West Barnstable oe Wiring Inspector Inspection date Plumbing Dispe V Inspection date Gas Inspector Inspection date V'Ehgineering Department Inspection date THIS PERMIT WILL NOT BE VAL AND THE BUILDING SH LL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. 41-- :4 _ _._, 19l __.. Building spector