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HomeMy WebLinkAbout0070 ANGELL ROAD Vo An� oa�d 'i ACTIVE ton Q1 +�f ( ' RISE Division of Thielsch Engineering,Inc. tjri'Y 10 (1' � 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02910 HIV 0 May 1, 2013 Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Re: Insulation permits Dear Mr. Perry, This affidavit is to certify that all insulation work completed for 70 Angell Road 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 401-784-3700 800-422-5365 •fax 401-784-3710 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- .y Parcel ` `7 Application # Z0 :dO`� Health Division Date Issued Conservation Division Application Fee ) u Planning Dept. Permit Fee ' S Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address r-hi Rd Village y G an/ s Owner L G. C{,mnYYI Address o�CQ a Cry S C2n�" 5� Telephone d �J� cJgL�_ S'�%�' _I�JOr dmptuy) D1OU0 Permit Request 1 I r Pa/ )�G, ► I nS1;t I o-i no-eri l', SVa ce ,o b aS-em to f- s) i I �fv_ bG s e.m e I- do ur a.h afho, h 0T_ky .s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation c) 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 v _ S Y Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: Q Ye&�U No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ UJ r 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 Mt _ —(BUILDER OR HOMEOWNER) tName C Telephone Number `3-7 ho Address 1341 EJ MIA-200d License # i n b W5 l LO hShnq D�)-9 l Q Home Improvement Contractor# Worker's Compensation # I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ` FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED r MAP/PARCEL NO. } ADDRESS VILLAGE 5 OWNER i DATE OF INSPECTION: TOUNDATION:J' _ j FRAME -` INSULATION' �1 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 4 GAS:_ ROUGH FINAL 'FINAL BUILDING-4':, "f ,e k" - 'DATE CLOSED OUT j s _ ASSOCIATION PLAN NO. ' r t 1 RISE ENGINEERING Federal ID 9 06-0405629 RI Contractor Registration No 8186 A division of Thielseh Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,R102910 (401)784-3700 FAX(401)784-3710 V®TR/+,y ,Page 1. . - THIS CONTRACT IS ENTERED INTO BETWEEN RISE - - ENGINEERING AND THE CUSTOMER FOR WORK AS E NG IN EE RIND DESCRIBED BELOW CUSTOMER PHONE - .DATE Cilent rI Chris Laflamme (413)584-8'19,,2 09/12/2010 112839 SERVICE STREET d ' BILLING STREET... - 70 Angell Road 262 Crescent St SERVICE CITY,STATE,ZIP BILLING,CITY,STATE,LP (` Hyannis,MA 02601 Northampton, 0 0,1�t .t . �. 4. ,VI JOB DESCRIPTION ' •_. jr. ! 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 b 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 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. 12.5 man hours. $825.00 RISE Engineering will provide labor and materials to install a I V layer of R-38 Class 1 Cellulose added to 944 square feet of open attic space. " $1,132.80 RISE Engineering will provide labor and materials.to-insulate the back of the basement door with 1"rigid fiberglass board and seal the door edge with weatherstripping to restrict air leakage. $100.00 RISE Engineering will provide labor and materials to install insulation and weatherstripping to 2 attic access hatch(es). $50.00 RISE Engineering will provide labor and materials to install 100 squarefeet'of R-19`faced fiberglass insulation to the.perimeter.of the basement ceiling at the house sill: $110.00 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 100%incentive for air sealing. $825.00 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. -$1,044.60 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN'ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Three Hundred Forty-Eight&20/100 Dollars $348.20 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO ROM AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED.MONTHLY ON ANY _ UNPAID BALANCE J TER D Y6.BEE. E FOR IMPORTANT'INFO RMATON ON OUARANTEEH,RIONTi10F RECWKKI,SCHEDULING;IWD�CONTRACTOn REOIBTRATK)N. DO-NOT SIGN THIS CONTRACT IF.7HERE'ARE Y. NK-$PACES ` r - "TAIRACCEPTANdEr-' AUTHORIZE i810NATURE-RISEENGINEERINO � � �' - NOTE: NTRACT MAY BE WITHDRAWN BY US IF NOT.EXECUTED WITHIN 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 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 Thielsch 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. ❑ I am a general contractor and 1 6. 0 New construction " employees(full and/or part time).* have hired the sub-contractors 7 -❑TRemodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑;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 myself [No workers' comp. *right of exemption perm MGL 11. 0.Plumbing repairs or additions: insurance required] t c. 152,§ 1(4),and we have no 12. ❑Roof repairs employees. [no workers' 13 Other. Insulation 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. tcontactors 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 is providing workers'compensation insurance for my employees.Below is the policy and job.site information. Insurance Company Name: The.Preston Agency Policy#or Self-ins.Lic.#: 3730961-00 Expiration Date. Job Site Address: 17() 0 I G),f - City/State/Zip:_ ; ,- A/ " Attach a copy of the workers' compensation policy declaration page(showing the poll number and expiration (date). Failure to secure coverage as required under Section 25a of MGLW152 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 the Office of Investigations of the DIA for coverage.verific400n. I do herby certify and the pains a enalties of perjury that the information provided above is true and correct. Signature: Date: l Print Name: Steve 'Hines Phone#:(401)784-3700 or 1-800-422-5365-extll7 Official use only Do not write in this:area to be completed by city or town official City or Town: Permit/license#: MIssuing Authority(circle one): LBoard of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: i �1cORD CERTIFICATE OF LIABILITY- INSURANCE OPID 47 F OATE(M1A/DDnY(Y) PRODUCER THIEL-1 04/13/10 The Preston Agency, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 140 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;401-885-1700 INSURERS AFFORDING COVERAGE INSURED NAIL g NsuRER.A Zurich-American Ins Co. Thielseh Engineering, Inc. INSURER B:Thielsch Group Inc, Le.clean tUsrant.a F yi.yllY,ty Hi Tech Realty Inc. INSURERC: North American capacity Ira Frances Avenue INSURERD: Hartford Insurance Company Cranston RZ; 0291.0 � - INSURER E' " COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING _ ANY RERTAM,iTHE I TERM INSURANCE AFFOTIONRDED OF ANY CONTRACT OR OTHER DOCUMENT WITH.RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR H41Y PERTAIN•THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT'TO ALL THE TERMS EXC r I LUS it 'F-,LICES.AGGREGATELIMITS LONSANC CONDITIONS •SHOWN SUCH H WN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - ' ILTTRR IINOSR TYPE OF INSURANCE POLICY NUMBER GATE(MM/D'D/Yl') GATE( "per + LIMITS - __ GENERAL LIABILITY EACH OCCURRENCE s 1,0 0 0,0 0 0- A I X COMMERCIAL GENERAL LIABILITY 3730962-00 04/.01/10 01/01/11 CLAIMS MADE o OCCUR'. PREMISES(Ea omurence) T300,000 MEDEXP(Any,one person) S 101000 • PERSONAL&ADVIN.:URY Y1,000,000. GENERAL AGGREGATE _ S 2,.0 0 0,O O D GENT AGGREGATE LIMIT APPLIES PER: - POLICY X "JET LOC ( PRODUCTS-COMP/OP AGG" "$2,0 0 0,0 0 0 Emp Ben. AUTOMOBILE LIABILITY - 1,000,000 i X ANY AUTO 37309*63-00 # 04/61/10 COMBINEq'SINGLELIMIT O1/Ol/11 s2,000,000(Ea accident) ALL OWNED AUTOS - i r - BODILY INJURY •-°SCHEDULED AUTOS - IPer person) $ ' HIREDAUTOS ._ WON•OWNED AUTOS , BODILY INJURY - e r (Per accide.N)- - r I PROPERTY DAMAGE ?Per accident)- « GARAGE LIABIU7Y ' ` ( -AUTO ONLY-EA ACC106T g MY AUTO + O*ER TH,4J EA ACC; $ ° A.UTO.ONLY' AGG ; EXCESS/UMBREL LA L IABILRY B X OCCUR CLAIMS MADE UMB 9 2 6 3 6 3 7—0 0 EACH OCCURRENCE ; 10,000,000 ❑ 04/O1 1 I 0 OT/O1/11 AGGREGATE T10;000;000 RDEDUCTIBLE X RETENTION S 10 0 0 0 WORKERS COMPENSATION AND - EMPLOYERS•LLABILITY - X TORY 1_!1,,1 ISEF. MY PROPRIETOR/PARTNERIEY•ECUTIVE 3730961-00 04/01/10 01./O1/11., E.L EACH ACCIDENT $ 1000,000 OFFICER/MEMBER EXCLUDED? ,__ It yes,describe under - E.L.DISEASE•EAEMPLOYEE 31,000,000 SPECIAL PROVISIONS bolo-++ - E.L.DI SEA.SE-POLICY LIMIT ,1 1,0 0 0,0 0 0 ' OTHER - C i Professional Liao- DVL00002 6800 04/01/10 '04/01/11 Prof Liao- 2`,000,000 D � Leased/Ren-ted Eqp: 02WNTD5678 04/01/10 04/01/11 Equipment 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES F EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION -DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAPS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESE V ACORD 25(2001/08) @ACORD CORPORATION 1988 4 i 44 F r gineering, a division .of Thielsch Engineering,. Inc. Associates; a division of Thielach Engineering, Inc. BAL Laboratory; .a -division of Thielsch Engineering, Inc. ESS Laboratory, a division of Thielech Engineering, Inc. ALCO Engineering, a division of Thielsch Engineering; Inc. Water Management Services, a division of Thielech Engineering, 'Inc. I r NAT-24531 - 1 3. :.3 Office of Consumer Affairs and usiness,Regulation o _ a. 10 Park Plaza - Suite 5170 Boston, Mass usetts 0211.6' Home Improvement` ctor Registration Registration, 120979 Type: . Private Corporation . -- Expiration: 3/25/2012 Tr#.,292329 THIELSCH ENGINEERING .+ + STEPHEN HINES M �' 1341 ELMWOOD AVE. �" Y r. CRANSTON, RI 02910 - 4 y rq" �/yf"� Update Address and return card.Mark reason for change. 4 —�'- Address Renewal' Employment Lost Card DPS-CA1 Cr 50M-04/04-G101216 - - • ✓�ie �a7�rr�onaealCfi o�../�,aaaacl c�aelta , -- k . License or registration.valid for in`dividul use only: Office of Consumer Affairs&Business Regulation w HOME IMPR EMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Reg istrati ow&,�� O97g 10 Park Plaza-Suite 5170 Expirati srk W-2012 Tr# 292329 3 "= .-?� Boston,MA 02116 . Typ���IF-P Nff ation THIELSCH ENC7l - STEPHEN HIN !�': aF� ..,? 1341 ELMWOOD AICV 74- CRANSTON, RI 029fd-t"-�1`- Undersecretary N valid without-signature a " t Page 1 of 1 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# 102935 ' Restriction 00 Name Stephen Hines City,State,Zip, Jamestown,R1,02835 Expiration Date 6/23/2013 Status Current i No complaints found for this Licensee: Back To Search • ��_��:&C't$il:y�jt4 - � ti: Si i�'3"t$3$ .is .��t$htJti �:iil,3 • €)is(fi ()f G'D Fl(tld$g R 'idai'I()r?� xt$( �Eiitlt3il'ij _icense: cs 102.935 Restr;cted to: /� STEPHEN HINES 222 NARRAGANSETT AVENUE t JAMESTOWN: RI 02835 'r•P-a =to;: 6/23/2013 102935 r s http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=CSL102935 4/2/2010 r OFIKEr Town of]Barnstable *Permit# ,y� 0 Expires 6 months from issue date Regulatory Services Fee • RARNSTABLE, •' v "'AS& Thomas P. Geiler, Director 16g9 ♦0 AIfD MA't A J� Building Division � v Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-7.90-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint Map/parcel Number ( Q Cpy Property Address 70 / //)ad / ,J 1(,x�/J/•S� 11),,7, 0,7—&0 residential Value of Work -01)10 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /-/,S aaa till a CCKK1(,,0; f Sf NOAAa-&4fi, /) 6i0c0 o . Contractor's Name �/ e �C(. jo&,, alg l Telephone Number LJ_;�05-9y5-��l Home Improvement Contractor License#(if applicable) d Construction Supervisor's License#(if applicable) p `l eworkman's Compensation Insurance Che k one: am a sole proprietor V❑ I h vin e Worker's Compensation Insurance -PRESS PERMIT Insurance Company Name h�Y�.S h, SEP .2Ui0 Workman's Comp. Policy# 6 ��' no a Co'7J TOWN OF BARNSTABLE Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Ey 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 #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. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: t Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 s "` T.is�arhusett� - Dejmrtotent()t`P:tt#i;li�: <<tfe:t _ B011 d Of Building Red=tt:i.tti�2nt anal Cx;t�ttl arils License: CS 23984 Rgstricted;to 00 I i Y GARY S HANSEN 3 z ti 27 HORIZON GlR CHATHAM MA 02633 ~ Expiration: 10/3L3011 ryiT1R7 i�C1+Ii f'C... 6555 ;.+',, Office��LoB(s9?YF@t:T '4SftBF�ih�s�fii( . HOME IMPROVEMENT CONTRACTOR Registration 101872 .Type Expiration: 6129/2012 DBA 6M.-J 3UILDERS Gary Hansen j 1 27 HORIZON CIR Chatham,MA 02633 Undersecretary +j License or re gist befote the gistration valid for - _... Office of Cons., date. Iffound►vtdul use only t er Affairs and d return to: B0°n MA 02ISuite 5170 Busine .16 ss Regulation of valid'. w t signature J .__t i They Cornirioirwealllr ofillassachuselts DeparfinerdloflndustrialAccidefits ---1N Office of1m estigaliohs ` 600 Washington,Slreel i '�'� tb'fi71'.IidldSS.gOV��r�da , Workers' Compensation Insurance A-ffida-vit: Built:lers/Conti-actorsJElectricians/Pl:umbers Applicant Information J Please Print Lefiblti Nar e. (Bionesv'Orgm zation°qndividnai): Address: /2 / PMul) C#;f (.Q. city/state/zip: u td/ a 3 Phone Are you an employer? Check the appropriate boa.: T}pe ofproject(rrquitvcl): _ LW I am a employer t°irith `l• 0 I am a general contractor and I ertlployees:(felt and/or part-time,). have hired the sub-contractors b :�New oonstrnrc.tion: 2..❑ I am a sole proprietor orpartxner-' listed oil the attached sheet. 7+_ Remodeling These sub-contractors have skip.and have no employees 8- �.Detuolition working :for me in any capacity. . employees and have tv'orker.s' [No workers' comp,insurance comp.:insurance. I 9. .Building addition, required] 5. lVe are.a corporation d its 10.[}Elecytrical repairs or additions tIt>trd] an offces have exercised their 3.❑ :1.am a.lnotrreotiti�er doing-all work 1 l.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per 1'1GL 12.%Roof repairs ins.urance:required.] T c. 1.52, §1(4),and.rave have no einp.loyees.i[No workers', 13..❑ other comli.insurance required.]° *Any aippticavt thstc-ecks box#Lnuist alm fill out the section beto-va'shoring iheirworkers'conveusationpolicy inforn atian_, I Hanreovruers who submit this affidavit indicating:they are doing all work and then hire outsidecontraceors must submit.a uew efidavit indicating such_ ICautractors that check this:bmc must attacbed sn additional:she.et showing the:mmn of(he sub-ccntracton and state whether or not those entits2:s have employees. Ifthe sub-contr:actors1a`'e employees,they:nxust provide their workers'comp.policy"number. pill ldld efllp.loy`er t>rtcrt'iSpr01'rdTlr�p 11wpr�r$rS Cai7fpei:IStTtItllr Ji!SF1rdr.11CB for iffy'eF1'rplt7�Jetls. Below is the t7'l1Cy 1717dj0i7 site infol^NraliOlt Insurance Company Name: Char J Policy#or Self--iris.Iac.#: y�'.Sd ,/.t!/� Expirationbnte: Job Site tiddress: r7V l)o��I dd. City/State/zip. /�( (� U Attach a copy of the warkers'compensation policy declaration page(slwiiing the policy.num r and expiration date). Failure to secure coverage as required under Section 2.5A of MGL c. 152 can lead to the invosition of criniival penalties of a fine up to$1,500.00 andfor one-year imprisonment, as well.is 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.cop)'of this sttt.tenment may:be forwarded to the Office of Investigations of the D.IA for insurance coverage verification. I do hereby certify under the pains.and penalties of pe�►"ty that the information prflt4did abovw is truo alid correct Date: Phone Official use only. Donot.ti'riteill this area,to.be coniplded by';ciih ortoivn official City-or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3: Cty/Toiith Cleric 4,Electrical Inspector S.Plumbing Inspector' 6. Other Contact Person:' .Phone#; Of THE?pk TownofBarnstable 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 r Fax: 508-790-6230 Property Owner Must Gotnplete and SYgn This Section ` f. Usi z A Builder." ' z- - ,/ - _ . ........... T er of the,subject property ' ; Y hereby authorize ��� 2. to act on m behalf, _ y . in all matters relative to'work authorizedf by'this building permit�apphcation for: (A/dress of job) Signature of ne-r Date Print Name Tf property Owner is applying for permit, please complete the Homeowners License Exemption Form'on the reverse side. QAWPFILESIFORMSIbuilding permit formsTXPRESS.doc Revised 072110 ~0IHEr, Town of Barnstable Regulatory Services ggFtSTABLE, ' Thomas F. Geiler, Director y (ass. ,619. Aim Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www,town,ba rnsta bl e.ma.us Office- 5)8-862-4038 Fax: 508-790-6230 — ----------------- HOMEOWNER LICENSE EXEMPTION Please Print DATE: 10B LOCATION: number street village "HOMEOWNER" narne home phone# work phone# CURRENT MAILNG 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 minimum inspection 4pruresements a h t he will comply with said procedures and requirements. 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." 1 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 personas it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware ofhis/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 " Revised 0721 10 • • RANI-TE STATE INSURANCE COMPANY 0070643-00 WC 002-50-2675 1310 2 -------=------------------------------------- 013-66-0310-00 .-•. GARY S HANSEN C H A RT ! 5 27 HORIZON CIRCLE } CHATHAM, MA 02633-0000 A Chartis company EXECUTIVE OFFICES: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 175 Water Street New York, NY 10038 MARK T VOKEY INSURANCE AGENCY WORKERS COMPENSATION AND EMPLOYERS PO BOX 1247 LIABILITY POLICY INFORMATION'PAGE WEST CHATHAM, MA 02669-.1247 INSURED IS hAEVIOUS POLICY NUMBER INDIVIDUAL RENEWAL 00742 777 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF:ITEM I.-OF THE INFORMATION PAGE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address FROM 03/22./10 TO 03/22/1 1 ITEM 3 A. Workers Compensation,Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here MA . , S. Employers Liability Insurance: Part Two of the policy applies to ti a work in each state.listed in item 3.A. The limits of our liability'under Part Two are: Bodily Injury by Accident$ 500,000 each accident Bodily dnjury by Disease $ S00.000 policy limit Bodily Injury by Disease $ r)00.000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here- SEE ENDORSEMENT. - WC200306A D. This policy includes these SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC990612 ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and Change by audit. Estimated Total Rate Per Estimated Remuneration Classifications Code Number $100 OF Re- Premium Annual ❑3 Year muneration Q Annual 3 Year I SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE WC7754 TAXES/ASSESSMENTS/SURCHARGES $256 EXPENSE CONSTANT(EXCEPT WHERE APPI(CABLE BY.STATE) 8 MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $3,969 If indicated below, Interim adjustments of premium shall be made: Semi-Annually Quarterly Monthly DEPOSIT PREMIUM 03/25/10 ASSIGNED RISK 66 issue bate Issuing Office Authorized Representative WC 00 00 01 39967(Rev'd 04/08) M 1 SEA S.�gave 0� 5NI owu of Barnstable � '`O _ Ifx+rb,tn Q rnonthtJlvn Lrsue fam awxxarwaes. i �4.!gU,;�,IIQj.%' �;Cndce:` i tee i ©�- - MASS, Thomas Ni. vrt:ilcr,Director BuilUiug Division Tom Perry, BuDding Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 - Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDEIVT1f.&: , ONINY Not Valid without Red X-Press Imprint Map/parcel Number Proporty Address -7n jCTe_( I n is -— Rcsidcntial value of Work Owner's Name 8t Address AN n r, _X1 A ,,J �J —_ Contractor's Name. Home improvement Contractor License#(if epplicablc) �q.17-I _ Construction Supervisor's License#(if applicable) P�3 filWorkman's Compensation Insurance Chock one; ❑ I am a sole propriotor ❑ I am the Homeowner I have Worker's Compensation Inm-ance Insurance Cwoapany Narno I1 G-�f CJ.,�' 1 `j �_:j 1C`t.. CA cv, _.l Worksnan's Comp.Policy# Permit Rcquost(chock box) Re-roof(stripping old.ahinglen) All construction debris will be taken to gay-M-DLA4 LQ hd A � ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Fj Replacement Windows. U-Value (maximum.44) ❑ Other(specify) •Whore raq„ired: Issuance of thin purmt don not cAcrnpt cmnpliancc anth othcr-town department regu 001,s,I.C.itstonc,Conscrvadu[L cis.. Signature Q:Fonrs:oxytncrg Ravised 121901 PROPERTY OWNER DUST COMPLETE AND SIGN THIS SECTION IF USING A BUILDER Rcx)FEi2 I, s Rat D 2 A �' ff A k f m a ly y, as Owner of the subject property Hereby authorize Paul J. Cazeault & Sons Roofing To act on my behalf, in all matters retative to work authorized by dais bn'1din9 Permit application for (address of Job) IS 12o ARoo3 Signature of Owner Late Print Name i 0&4e e return This form to Cazeault Roofers with your signed proposal/contract) r � - ` ✓ 6 Boara of BL111d'inc, RgUIIa -inns and Stan&trds One Ashh'i1>ton Place - Room 1301 Boston. Massachusetts 02108 Home Improwment Col tractor Registral io11 Registration: 103714 Tyl:;c: Private Corporation Expiration: 7/9/2004 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault P.O. Box 2781 Orleans, MA 02653 + Update Address':tnd return card. Mark reason for change. / /�� J, ; Address 1 j Renew:�l I�;tuplu�•mcnl Lost (':u-d 6,01"LlI"W( 1foe6zewl, 0 ' Board of Building Regulations and Standards License or rel;istraliou valid fir intlivi,ldl rise only HOME IMPROVEMENT CONTRACTOR hetorc the expiration date. If found return to: Registration: 103714 Board of Building Regulations and St.rtulards Expiration: 7/9/2004 Onc Ashburton Place Rm 1301 ' Type: Private Corporation' Boston, IINla.02105 • PAUL J.CAZEAULT&SONS, INC. Paul Cazeault 22 Giddiah Rd. 61 , [�Gn- h 7---•- p. �j�i" . /IGIN(�i iN.i%A %..�n iJNi:Ii;JCI(J Orleans, MA 02653 Administrator I'io EIOAIZD OF BUILDING REGULATIONS License: ,ONSTRUCTION SUPERVISOR Number CS 026325 C� Birthdate: 10/20/1959 vy r. Expires: 10120i-1003 Tr.no: 7310 Restricte< : 00 PAUL J CAZEAULT 1585 MAIN ST OSTERVILLE, MA 026',5 Administrator f r , o/IV// !/�y�) /� //�/j1/y/f/f/y/� �/ �{�-,Jf,.� li'' l�/V t�l fi�/✓1�1�1i/VC"'ilr/r A Board of wilding Regulations One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CONSTRU TION SUPERVISOR LIC Birthdatc: 10120/1959. Number: CS ' 26325 Expires: 10/20/2003 Restricted To: 00 p PAULJ CAZEAULT 1585 MAIN ST _ OSTERVILLE, MA 02655 Tr. no: 7310 Keep top for receipt and change of address notification. 1 DATE(MWDD/YY) AC - CERTIFICATE OF LIABILITY INSURANCE 811512 PRODUCER i THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McShea Insurance Agency, Inc• j HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main street, Suite#H f ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oaterville, M&_ 02655 INSURERS AFFORDING COVERAGE — -508��.9011 (INSURED paul J Cazoault & Sona Roofing Inc. II�NSUHER^ WAatern f$AZ _lna CO., IINSuncRe: TS.eVAlera jndQMMjty_ Ca of111in" 1031 Drain Street NSUPERC I OBterville, Ma 02655 INSUHERD IBQQ 698 5564 IHERE 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 T'HE 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 TYPE OF INSURANCE POLICY NUMBER P071E YMEFECTIVE POLI EY MMPOwAYT10N LIMIT B I GENERAL LIABILITY I EACH OCCURRENCE i E '0001000 t-x COMMERCIAL UENFRAL LIABILITY I FIRE DAMAGE(Any ono lira) $ 1 (CLAIMS MADE I OCCUR( MFD EXP(My one perron) 5 A _ SCRO467325 04/30/03 04/30/04 PEHSONAL6AOVINJURY S 000,000 I GENERAL AGGREGATE +52.000.,00 GEN'L AGGREUAIE LIMIT APPLIES PER'. PRODUCTS,-COMP/OP A I8"1.000.OOO I POLICY PHO LOC JECT iAUTOMOBILE LIABILITY COMBINED 31NOLE LIMIT S ', i (Ea accldar,!) ANY AUTO ALL OWNED AUTOS BODILY IN.)URY $ SCHCOULED ADIOS j (Per person) _ HIRED AUTOS I DODILY iINJURY S NON-OLVNEO AUT09 (Par acc dom)I PHOPERTv DAMAGC "- (Per aWdrM) $ GARAGE LIABILITY AUTO ONLY-CA ACCIDENT S ANY AUTO I OTHER THAN EA ACC I$ AUTO ONLY. AGG S EXCESS LIABILITY EACH OCCURRENCE S OCCUR I CLAIMS MADE AGGREGATE DEDUCTIBLE HIJFNT10N S 5 WORKERS COMPENSATION AND $ ?v Rv LIMITS ER EMPLOYERS"LIABILIYY 7PJIM-922X653-502 _ l08/10/03 108/10/04 .. t.L,EACH ACCIDENT $ 8 I E.L.DISEASE•EAEMPLOYEE S .00 E L DISEASE•POI ICY LIMIT S OTHER DESCRIPTION OF OPE RAT IONSILOCAT(ONS(VEHICLEFdEXCLUSIONS ADDED BY ENDOR6EMENTIBPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED:INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ti DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 DAYS WRITTEN I NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO 50 SHALL I I ! IMPOSE NO OBLIGATION OR LIABILITY,OF ANY KIND ON THE INSURER,ITS AGENT?OII REPRESENTA 1 9. � �AUT NORIZED R RE Tin 1 JI ACORD 25-S(7/87) ©ACORD CORPORATION 1988 �t r Town of Barnstable -Regulatory Services Thomas F.Geiler,Director ass. 9� .i639 �0 1659 Building Division Peter F.DiMatteo,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 G°f PERMIT# 577 FEE: $ SHED REGISTRATION 120 square feet or less Location of shed address) Villag Property owner's name Telephone number s{ x 8i 300 - 0gq Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) 0 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN 0-forms-shedreg REV:083001 r �. s. .e } 40� v it F.:ti �S I : 71 CD o ° +1mu p � ,n ' l 1 0 bD' 00 p to `0 0 0 ip 0 o rdoe r o s � � •off 0 `' fit. `� '�► M_ ,£� - L}���s.. ;�'�o yp �; +� •1 `� 1 � o•o o ► _�;- i �A acr C , CD f" u1 9 0•0 0 to J Id J Y � LO 4 J