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1945 MAIN ST./RTE 6A(W.BARN.)
••� gr D 1 '.1 RECYCGG+p UPC 12543 Now �'�ST•CONSJ� HASTINGS, MN 1 ,1 'i i:• 0 a e i Town of Barnstable _ _ Building eAxrsrAMZ Post This Card'So That it is Visible From the Street-Approved,Plans Must be Retained on Job and'this Card Must be Kept- WAS& Posted`Ugtil,Final Inspection Has Been Made. , ;• - 163¢ ,� Permit �• Where a Certificate of Occupancy is Required,•such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-18-521 Applicant Name: Thomas Wineman Approvals Date Issued: 03/15/2018 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 09/15/2018 Foundation: Location: 1945 MAIN ST./RTE 6A(W.BARN.),WEST Map/Lot: 216r041 _ —4 Zoning District: RF Sheathing: Owner on Record: CONROY,LOU-ANNE Contractor NamCLEAN ENERGY DESIGN LLC Framing: 1 Address: 1945 MAIN STREET Contractor License: 149094 2 WEST BARNSTABLE, MA 02668 _ T_ ^�, Est. Project Cost: $ 18,171.00 Chimney: Y Description: Roof Mounted 3.77 kW photovoltaic solar sys}em .. consisting of Permit Fee: $142.67 (13)SW290 panels and (13) Enphase IC16 micro inverters. f Insulation: Fee Paid:' $142.67 Project Review Req: Date 3/15/2018 Final: /3�dptew Plumbing/Gas Rough Plumbing: -- --- --- —. \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the;approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road d shall be maintained open for public inspection for the entire duration of the Final Gas: Ad work until the completion of the same. i-- - -- ?� Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:l Service: 1.Foundation or Footing `_e-�. Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). e.� Fire Department Building plans are to be available on site \�— Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �U Town of Barnstable RECEIPT eAR„,9 t 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-18-521 Date Recieved: 2/20/2018 Job Location: 1945 MAIN ST./RTE 6A(W.BARN.),WEST BARNSTABLE Permit For: Building-Solar Panel-Residential Contractor's Name: CLEAN ENERGY DESIGN LLC State Lic. No: 149094 Address: 11 OAK LANE, OSTERVILLE, MA 02655 Applicant Phone: (508) 563-6990 (Home)Owner's Name: CONROY, LOU-ANNE Phone: (603)236-9264 (Home)Owner's Address: 1945 MAIN STREET, WEST BARNSTABLE,MA 02668 Work Description: Roof Mounted 3.77 kW photovoltaic solar system.. consisting of(13)SW290 panels and(13)Enphase IQ6 micro inverters. Total Value Of Work To Be Performed: $18,171.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). 1 understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Thomas Wineman 2/20/2018 (508)563-6990 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $18,171.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $142.67 Total Permit Fee Paid: $0.00 F ; T"HIS IS NO { A PER T. iu.:n.car�...."r•1taY4.W.r.. Town of Barnstable RECEIPT `" , "B`& 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-18-521 Date Recieved: 2/20/2018 Job Location: 1945 MAIN ST./RTE 6A(W.BARN.),WEST BARNSTABLE Permit For: Building-Solar Panel-Residential, . Contractor's Name: State Lic. No: Address: . Applicant Phone: (508) 563-6990 (Home)Owner's Name: CONROY,LOU-ANNE Phone: (603)236-9264 (Home)Owner's Address: 1945 MAIN STREET, WEST BARNSTABLE,MA 02668 Work Description: Roof Mounted 3.77 kW photovoltaic solar system.. consisting of(13)SW290 panels and (13)Enphase IQ6 micro inverters. Y� � - Total Value Of Work To Be Performed: $18,171.00 ; Structure Size: 0.00 ' .0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in workon the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the-subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved.are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. i Signed: Thomas Wineman 2/20/2018 (508)563-6990 Applicant Date Telephone No. + r Estimated Construction Costs/Permit Fees a. '' Date Paid Amount Paid Check#or CC# Pa Type Total Project Cost : $18,171�..0. _ y yp Total Permit Fee: $142.67 __..._.__..._..............--.................._........_.._......_.__........_....................................................................................................._.............._._....._......._............. Total Permit Fee Paid: $0.00 l /L GSZ - Diu x Hit: �o y,�c�rr r ..A LTE.RNN aT i-v'f WEA�'HERIZATION o Date w Town of Bamstable 'A' rn Building Division 200 Main St. The insulation work atj. has been completed in accq t\_:�� � N d�,r�. �/ :5;�. ;JJi,`: _ .:.fir �::;?::i.•�:.-'..-':� I •k .,\z;;n�.. •..:F: �: .•a.-,gyp ':gin ....,:' '.•.>e.. •i£.•.�:/SL, ,_;,-1;.t;fi`o'2'"•:.�%.� ..%J'�-e /f �.\. 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Permit Fee Z_ Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 7� / I I�� C� I rQ Village OwnerLia) Address � �`1� I 1 I lM� 3tr �( I Telephone - ts 11/1 T Permit Request yV - rows� 2018 C4 NMI BgANSlAI�=� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District 1 Flood Plain Groundwater Overlay Project Valuatio 'q J 66) /Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � Number Telephone l 1 p be c���� Address License # Eiji I R J ArfiA: Home Improvement Contractor# / (Ut[nOvt wa+Nf I z�mWQ 90O ZS7 0 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN T ra Jfgr SIGNATU E DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED _ MAP/PARCEL N0. _ - ADDRESS `' VILLAGE E , OWNER DATE OF INSPECTION: t - FOUNDATION r, FRAME INSULATION FIREPLACE • ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT •+ ASSOCIATION PLAN NO. r - . f _ a Tug Town:.of Barnstable :Re,.g latory-Services • ,IARI�LtiT,183i;. . � � Rrtiarf'V:Scat,:}7irector, '�o��'erty,.Bu�dingGoinraissi:over 200:IvlaaY SfiteGt;T yauriis,'MA;62'601 -,v.w tb -u;ba-labte_mn:us< 0, cc. 508=862-4038- Fax .508-790.-623..0 Pirope t waeT Must Caz p ete and,S n_Tlds Se ior� f:LJsxr: �� Build'e - Lov A j,vi C0 as.QwbCIZI0 the sbbbcr'praperty hexeby zuchorie:l�1!�.L�"►- 1`�P . L apt au Vie ,: —in allma�te"zs relative'to work:authorized-byth s thug per it app carioa-fo:r.. 5 ma?.1 S4. Lves+ J.rr154;t�le 1 M 4, w E61 " rm � offi* hcant,Poa^Pool-f6ces antaam :.afe'd e;. ds� ls are'.>aot:tci be"=f�ed.�r tirili:cecl'lef�re fenc�'is �s�11�:d a�adall�iaaI . ins too e:p )Oimed_and accepted. d . S' r of.' er S*nat me.,of:Appkant Print Name Print Name Z Daze Q:FORMS:Oxy'NMRFMAIS.SIONPWIs i The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02-114-2017 www.mass.gov/dia , v N orkers'Compensation Insurance Affidavit:Builders/Contractors/Electridans/Plnmbers TO BE FILED WITH THE PER.MUMG AuTAORITy. ,Applicant Information Please Print Leeibly Name(Business/Organization/Individuai):ALTERNATIVE WEATHERIZATION, INC. Address:2 LARK ST City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: 7[:] ect(required): 1.❑✓ I am a employer with 6 employees(frill and/or part-time).* construction 2.Q I am a sole proprietor or partnership and have no employees working for me in deling any capacity.[No workers'comp.insurance required.] . olition 3711 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.[]Electrical repairs Or additions ensure'that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12.a Plumbing repairs•or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t INSULATION �. 14.[✓ Other. . 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out.the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must:attached an additional sheet showing the name of the subcontractors 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 is providing workers'compensation insurance for my employees. Below is the policy.and jab site information. Insurance Company Name:STAR INSURANCE COMPANY 0849257 00 Expiration Date:02/26/2017 Policy#or Self-ins. nL,icl.#: p Job Site Address:I"I-1 .��—��r`"'� City/State/Zip: r Attach a copy of the workers'compensation policy declaration page(showing the policy number and egpiratiou date). Failure to secure coverage as required under MGL c. 152;§25A is a criminal violation.punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA:for insurance coverage verification. 146 hereby eertify'u r ,..,pains a o 'erjury that the information provided above is true.and correct S Date: i e: Phone#:508-567 40 E6.'O' only. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector j son: Phone#: I ALTEWEA-01 CCOSTA 'ARD CERTIFICATE OF LIABILITYDATE(MIWOD/YYYY) INSURANCE Fs�sWO0fY 12016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Mason&Mason Insurance Agency,Inc. NAME: 458 South Ave. Nd E»,(781j 447-5531 I we :(781)447-7230 Whitman,MA 02382 ADDRESS:info@masonandmasoninsurance.com masonandmasoninsurance.com INSURERS AFFORDING COVERAGE ; NAIC d INSURER A:Evanston Insurance Co. 00008 INSURED INSURER 8:Safety Insurance Company 39454 I Alternative Weatherization,Inc. INSURER c:Star Insurance Company 00006 2 Lark Street INSURER 0: ' Fail River,MA 02721 -- _ INSURER E: INSURER F: �— COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT T)iE 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. ILTRR TYPE OF INSURANCE IN O POLICY NUMBER MI O LIMITS AEXP X 'COMMERCUiLGENEfRAvL,LIABILITY 1 1 EACH OCCURRENCE is 1,000,00 CLAIMS-MADE I1^,i OCCUR C41683 j 06/07/2016 06/07/2017 PREMISES Eat�erx� e s 100,00 — ( MED EXP(Arty one person) S 6,OO PERSONAL B ADV INJURY S T000100 I GEN'L AGGREGATE LIMIT APPLIES PFR;POLICY 11 PRO- GENERAL AGGREGATE $ 2,000,000 { ' "JECT I _j LOC I PRODUCTS•COMPIOP AGG (S 2,0OO,flOO I OTHER: I { S (AUTOMOBILE LIABILITY B — ( ((Ea acridenl I 1 s 1,000,000 ANY AUTO 1(3237702 T0410=016 04/0812017 BODILY INJURY(Per person S ALL OWNED j y,SCHEDULED i AUTOS i "' i AUTOS ( BODILY INJURY iPer accident) $ NON-OHIREDAUTOS i AUTOS O X(UMBRELLA LU2 IX CUR 1 A f—i EXCESS LIAS ��CLAIMS-MADE� ! TBD EACH OCCURRENCE �S 1,000,000 06/07/2016 06/07/2017 A—GGREGATE s DED RETENTIONS ( g 1,000,00 i V40RKERS COMPENSATION i AND EMPLOYERS,LIABILITY i C ANY PROPRIETORIPARTNERID(ECUTIVE y7 � (WC 0849257 00 Ij'0b104/2016 104104/2017 I i STATUTE OFFICER/MEMBER EXCLUDED? u NIA f E.L.EACH ACCIDENT _S SO0,000 (Mandatory In NH) ( ( I! j E.L.DISEASE-EA EMPLOYEE'S 50O,000 If yas,describe ur>dar f DESCRIPTION OF OPERATIONS below 1 ;E,L.DISEASE•POLICY LIMIT S 500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddMonal Remarks Schedule,may be attached If friars space to requlred) Nat'l Grid Corp.Services LLC,d/b/a National Grid,d/b/a MA Electric,d/b/a Boston Gas and Action Inc as additional insured with respect to the GL anc contracted with Certificate Holder.Kathy Tobin @1BCD,Tremont St,Boston;Nstar Gas&Electric-James Care @ New England Gas,45 North Main St,Fall RiverMA 02720•Al Mickee,GLCAC,305 Esses St,Lawrence,MA;Columbia Gas of MA are included insured with respects to GL.Only for the fallowing projcect,Weatherizaiton Installation for Low Income Housing are Additional Insured with respects to Auto Liability per terms and conditions of form SCA 005 (02 16).Form Available Upon RequesL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE National Grid THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 40 Washington St ACCORDANCE WITH THE POLICY PROVISIONS. Westborough,MA 01581 AUTHORIZED REPRESENTATIVE I , ` ©1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I _ Yel Office of Consumer Affairs and Business Regulation ` . _ 10 Park Plaza -Suite 5 170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 175683 Type: Corporation Expiration: 5/29/2017 Tr# 265489 ALTERNATIVE WEATHERIZATION, INC. TIMOTHY CABRAL - - -- -"-��- -- - 2 LARK ST FALL RIVER, MA 02721 ---- --- - --- - -.___-_ Update Address and return card.Mark reason for change. Address i•i Renewal F_ Employment 7;; Lost Card Office of Consumer Affairs&Business Regulation License or registration valid for individul use only SOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: 175683 Type: Office of Consumer Affairs and Business Regulation Expiration: 5/2972047 Corporation 10 Park Plaza-Suite 5170 = Boston,MA 02116 ALTERNATIVE WEATHER12AT4014;INC. TIMOTHY CABRAL 2 LARK ST ! ! FALL RIVER,MA 02721 Al Undersecretary ( o valid wit ut signatu i s Massacfliisetts=Deparfnient of Pubbc Safety Board of Building.Regulations and Star>cla`;ds License:CS-105454' .�OmwcABR�, _Y 58 DICKERINSON..Sj ,W 7x ?Fatt River MA 0021 .s • �,�.-,1l��tesc.ar'g� Expiration CoffNdssioner 05/08/2017 .} �o t 01 l� oFTr rqM, Town of Barnstable *Permit# Expires 6 mont ro issue�u e Regulatory Services Fee t� � ; g rY 1639. • Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number y_ vi as Property Address _ 1 49s 6� E<esesidential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name& Address r �hi a s T Contractor's Name / T77 �. A. C/-�lv-p V Telephone Number M$727 2r'ot Vj) v-- Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) orkman's Compensation Insurance X-PRESS PERMIT . Check pne: I- am a sole proprietor AUG ' 0, 101l ❑ lam the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name--A Ev Workman's Comp. Policy# �,�/� / Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check.box) e-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows 'Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A co f the Home Improvement Contractors License & Construction Supervisors License is uired. SIGNATURE: Q:IWPFILESTORMSIbuilding permit forms�EXPRESS.doc Revised 070110 The Commonwealth of Massachusetts Department of Industrial Accidents '4 Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Organization/Individual): /Lie Address:��Qy � � City/State/Zip: !Lv Phone #: Are you an employer?Check the appropriate box: 4. am a Type of project(required): 1.❑ I am a employer with general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' o comp. insurance.$ 9. ❑Building addition i [N workers comp.insurance P• required.] 5• ❑ We are a corporation.and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp: right of exemption per MGL 12 oof repairs insurance required.] t c. 152, §1(4),and we have no employees. [N6 workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must 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:_ Act�0 Policy#or Self-ins, Lic.#: W � n 7 /y1 Expiration Date: Job Site Address: l 9 Y.r,P/ w ST �T City/State/Zip: Vf 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 cerd under pains and pen erjury that the information provided ab ve is true and correct. Si ature: Date: Phone#: 1-2 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M .'ACORQ CERTIFICATE.OF LIABILITY INSURANCE oii2�1 PRODUCER (508)997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAI Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND O 439 State Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELO P.O. Bob 79398 N. Dartmouth, MA 02747' INSURERS AFFORDING COVERAGE NAIC# INSURED All Cape Exterior Remodeling LLC INSURERA• Arbella Mutual Ins Co 17000 640 Main Street - INSURERB: AEIC Insurance Suite 3 INSURER C: Hyannis, MA 02601 INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 1 POLICY EFFECTIVE POLICY EXPIRATION LTR NS TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE MM/DDNYM LIMITS GENERAL LIABILITY 8500041933 01/14/2011 01/14/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 100,000 CLAIMS MADE a OCCUR MED EXP(Arty one person) $ 5,OO A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCT'S-COMP/OP AGG $ 2,000,OO POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea acciderd) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS / (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ j ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ EMPL COMPENSATION AND WCC5007896012011 01/14/2011 Ol 14 2012 X AND EMPLOYERS LU►BILRY YIN / / TORY OMITS ER ANY PROPRIETOR/PARTNER/EXEC-1 EL EACH ACCIDENT $ 1,000,000 B OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 H yes describe under SPECIAL PROVISIONS below OWNER INCLUDED EL DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS fel: 508-815-3099 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL Corey 81 Corey The Roofers IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 1694 Falmouth Road, Ste.115 REPRESENTATIVES. Centerville, MA 02632 AUTHORIZED REPRESENTAME Joanne Bretton ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I i CHARLE 'S . COREY . " The Roofer's Roofer" Roofing Cape Cod Since 1970 169.4 FALMOUTH RD #115, CENTERVILLE, MA 02632 PHONE 1 -508 -775-8240 CERTAINTEED LANDMARK LIFETIME - ALGAE RESISTANT . ARCHITECTURAL STYLE August 9, 2011 RE - ROOFING PROPOSAL JACK MARTIN INSTALLATION ADDRESS: 5 SPRUCE LANE 1945 MAIN STREET RT 6-A SUDBURY,MA 01776 BARNSTABLE,MA Phone: 978-443-2666 Office EM:jdmartin99@verizon.net CHARLES COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles&Gutters from the Entire House. Cut Miscellaneous Branches on the Tree at the Front Living Room Corner of the House. Supply and Install CERTAINTEED LANDMARK AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION, CLASS A FIRE RATED, COPPER/CERAAIIC STONES for a FULL 15YEAR WARRANTY AGAINST ALGAE CONTAMINENT,250 POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY, CATEGORY III HURRICANE, STORM/HURICANE NAILED (6 NAILS PER SHINGLE). MULTI-LAYERED,LAMINATED ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT SHINGLES. COLOR:' ®LAek. Supply and Install HICK'S VENTILATED DRIP EDGE on All of the Eaves. Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Entire Ridge. Supply and Install CERTAINTEED WINTER-GUARD('Ice& Water Shield)WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves&Under the Step Flashing on the Chimneys. Supply and Install #15 BLACK SATURATED FELT ROOFING PAPER Supply and Install ALUMINUM&NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. TOTAL INVESTMENT ------=------ $ 6450.00 Q CHARLES COREY " The Roofer's Roofer" POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing,Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra:Materials Plus Labor at the Rate of S 60.00 per Hour PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 30 Days of Acceptance and Receipt of Deposit providing the Materials are Available. Please Make Checks Payable to: CHARLES COREY CHARL,ES COREY Warranties the Shingles and Labor for 10 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and the Shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the Shingles up to a CATEGORY III HURRICANE-130 MPH WIND WARRANTY . CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. This Proposal May Be Withdrawn By Us If Not Accepted & Deposited Received Within Thirty Days Or Before The Next Price Increase In Materials. CHARLES COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: Ake,I-s 'r ACCEPTED BY: SUBMIT BY- JACK MARTIN CHARL CORE HOMEOWNER ROOFING ON CTOR Depal-tinelit of PuI)jiC S.111'etv Board of Buildin.- Regulations jjjj(j stalldar(*Js Construction Supervisor License' n�l Office of Consumer Affairs&Business Regulation. License: Cs 2881 HOME IMPROVEMENT CONTRACTOR -136066 Type:. Restricted to: 00 Registration: Expiration: 6/6/2012 Individual CHARLES E COREY a 'y -Q.VEMENTS CO &COREY�HON�-.'-IMP'R.—,- CENTRERVILLE, MA 02632 CHARLE 1694 FALMOUTH RD#115 OF;--, S CORE�A- - 2,F3�E-- Q 1694 FALMOUTH RID. #-14"5!-Q-�;3� 2 CENTERVILLE, MA 02632-j,-�-P—`y Expiration: 2/14/2012 Undersecretary Tr#: 14793 . i i �� ' I I r1 I Town of Barnstable *Permit d D ��D 4� Expires 6 m tths usuc d Regulatory Services Fee 5 `• 4 i * •ARIVSTAffi$ 16 9. Thomas F.Geiler,Director EO MP'� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not valid without Red X-.Press Imprint Map/parcel Number. D /®y Property Address 1945 M A B 13 ST&EO 1 , RA). %A k9S-fak NLE i H 4 Residential Value of Work 1A YeO r Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address TO R►el t. H A P7160 dada .5q AkD tJ L. .S 0 N OOV1S .5 SPQ_Ue.E LA &i , Sube)VRS, M4 01?74 Contractor's Name U Qi fr kl tO UL"U P Telephone Number Home Improvement Contractor License#(if applicable) I a 7 D 0(p "-"onstruction Supervisor's License#(if applicable) d 7.2SZA ❑Workman's Compensation Insurance Check one: D —I am a sole proprietor ❑ I am the Homeowner X,DR IESS PERMIT ❑ I have Worker's Compensation Insurance Insurance Company Name S E P .i. 3 2 o l l Workman's Comp.Policy# TOWN OF BARBS T ABLE 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 h #of doors Ed Replacement Windows/doors/sliders.U-Value e 3 V (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. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decolliklAppData\I.ocalMicrosoft\Windows\Te orary Internet Files\Content.OutlooklDDV87AAZ\EXPPESS.doc Revised 072110 r4 z�srnst�, • Town of Barnstable 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: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder .9®lyore ®• tlt,r dig ,as Owner of the subject property hereby authorize f e ave Q� to act on my behalf, in all matters relative to work authorized by this building permit application for: le (Address of Job) ram- b 9 �.� ®B eigl(ature of Owner Elate �k V% IN, r�l 4,1 a Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\ContentOudooklDDV87AAZ\EXPRESS.doc Revised 072110 The Conlniotnyvealth of Massachusens- Department of Industrial Accidents Office of Investigations ip 600 Washington Street Boston,RSA 02111 tii yvht:nrass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Conk actors/Elee.tiicians/Plumbers Applicant Information Please Print Lemb Name(Busmessl`Orgmization/im ividual)- e Address: �� �rv ►Le L� CirylStatefZip: 4 &12 VI'3,,� Phone#: ' yid O Are y I am a employer udth 4. ❑ I am a you an employer?Check the appropriate box: g 1.Eleneral contractor and I Type of project(required): employees(full andlor part-time).* have hired the sub-contractors 6. ❑New construction 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. ❑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 I LE]Phunibing repair or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]F c. 152.31(4),and we have no 13.K1 Other employees_[No wrorker' comp.insurance required.] Any appli:ant that checks box'l tnnst also fill arm the section below showing their warkers'compensation policy information_ i Homeowners who submit this affidavit indi:atmg they are doing all work and then hire outside contractor must sabms a new affidavit mdicatmg such. =Contractors that check this boa mw-t attached an additional sheet showing the name of the sub-contractors and state whether or not those entitties hare employees. If the subcontractors have employees,they must provide their workers'comp.policy number. lain an employer Heat is prmidbig workers'cotrrpettsation insurance for ntv employees. Below is thepoliet•and job site UIfOYttratiOlL Insurance Company Name: Policy#or Self-ins.Lie.4: 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 andlor one-year imprisonment,as well as civil penalties in the form of a STOP RTORK 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)terebv cetttfi under the pains and penalties of perjury that the inforination presided abou}e is taste and correct Si sure: Date: — Phone a: I Qfflcial rtse only. Do not write in this area,to be conWleted by city or town o eial City or Town: Permit/License# Issuing Authority(circle one): 1'Board of Health 2.Building Department 3.City frown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Office` &fofWW4l�'t`�`i°W'Bir i ee011M' ffdWfj License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: UWhM '-- Registration: ..,,,127006 Type: Office of Consumer Affairs and Business Regulation Expiration: 8 10 Park Plaza-Suite 5170 /19/2012 DBA Boston,MA 02116 N PROPERTY A_l_NTENANCE BRIAN COUGHLIS-1 82 PRUDENCE LAKE::---- COTUIT,MA 02635"„ . Undersecretary Not valid with si ure iVlassachusetts- Department of Public S:tfctY Board of Buildin;F Regulations and Shu►d4rds WConstruction Supervisor License License: CS 72354 Restricted to: 00 ; BRIAN P COUGHLIN 82 PRUDENCE LN COTUIT, MA 02635 Expiration: 6/14/2012 ('innmissiu„ci Tr>#: 27017 I M 06/04/2002 12:04 915087906230 PAGE 02 P: n Town of Barnstable *Permit# (O 3 Fsplres 6 monthtfrom lame date e�urer�w� $ Regulatory Services Fee �S ra6ee 1639-. Tboma8 F.Geller,Director `0 BuRding Division ` Tom Perry, Building Commissioner / 7 �� Z 200 Main Street, Hyannis,MA.02601 Office: 508-8624038 - Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY rr Not Valid without Red X-Press Imprint Map/parcel Number l� Property Address /9'ys /Ti4W SMEEr. W• IUVAMA M Residential . Value of Work �7 Owner's Name&Address J/O 14/ I 6&,er/d Contractor's Name A A Telephone Number 7� 780 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) I ❑Workman's Compensation insurance + 1 ut_r, Check one: YJ ❑ I am a sole proprietor ® I am the Homeowner ❑ I have Worker's Compensation Insurance v Insurance Company Name Workman's Comp.Policy# Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to M404 CIArMPAC . Re-roof(not stripping, Going over_�L existing layers of roof) 14 SA•,(04 1s IN 6**A ❑ Re-side - AoWt o*( eAtAt% 46%k•,. it IT ❑ Replacement Windows. U-Value IS �s usi1 ON? AA S�11NWvj- (ma .44) All u� same odor +' #YAe a� ❑ Other(specify) k4a ©s Ex/kl".. T66. Welk •Where requited: Issuance of this permit does not cxergpt corVhAhee with other town departrrmt regulations,ix,Mstoric,Conservation,etc. half 6f4% Signature rW is hod' %mm W 4bm :Forma: � Zevised12I901 06/04/2002 W20 FAX 15084800781 LNERPART INC 1a 001 *** TX REPORT *** TRANSMISSION OK TX/RX NO 0301 DESTINATION TEL # 15087906230 DESTINATION ID ST. TIME 06/04 11 : 19 TIME USE 01 ,01 PAGES SENT 2 RESULT OK I 06/04/2002 12:04 91501817906230 PAGE 01 Town of Barnstable a 9 Regulatory Services ,";y°`. Thomas F. Geiler,Director Building Division Tom Perry Building Co ;issloner 200 Main Street, Hyannis, M,A 02601 Office: 508-862-4038 Fax; 508-790.6230 PLEASE FORWARD THE ATTACHED PAGE(S) TO: d Tj0ro Jack t4 4 r+w% ATTN-. FAX NO: $08 480 0781 �O IPR"OQ{'l. Building DATE: 614/02 PAGE(S): _2— (INCLUDING COVER SHEET)