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Home My WebLink About0458 BISHOPS TERRACE yc5�' ��shoIP5 TT1?We, -- -- Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 12/30/17 13UILDING DEP T Town of Barnstable Thomas Perry CBO MAR 0 8 2018 Building Commissioner 200 Main St. Hyannis,MA 02601 TOWN OF BARNS FA BL" RE: Building Permit a �� TO: Building Inspector(s), This affidavit is to certify that all work completed fof,458 Bishops Terrace,Hyannis has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Town of Barnstable REC�EI�PT DA 200 Main Street, Hyannis MA 02601 508-862-4038 a Application for Building Permit Application No: TB-17-4058 Date Recieved: 11/21/2017 Job Location: 458 BISHOPS TERRACE,HYANNIS Permit For: Building-Insulation-Residential Contractor's Name: WILLIAM J MCCLUSKEY State Lic. No: CSSL-102776 Address: West Yarmouth, MA 02673 Applicant Phone: (508)398-0398 (Home)Owner's Name: BARNSTABLE HOUSING AUTHORITY. Phone: (508)771-7222 (Home)Owner's Address: 146 SOUTH STREET, HYANNIS,MA 02601 " Work Description: Add R-19 fiberglass, 1" rigid insulation,and 2" rigid insulation to the basement. Air seal the attic plane and basement with expanding foam.General weatherization. Total Value Of Work To Be Performed: $1,400.00 �°''� 4 Structure Size: 0.00 0.00 0.00 r 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). 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. Signed: William McCluskey 11/21/2017 (508)398-0398 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $1,400.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 m I1/21/2017 $35.00 XXXX-X)M-XXXX Credit Card 0299 Total Permit Fee Paid: $85.00 11/21/2017 $50.00 xxxx-xxxx-xxxx Credit Card i 0299 y> THIShIS,NOT A PE } IT I1 _ -e....-,b e+,..... .:e.,, ..,...,x ...., A_..•+,.-2 n ,.,u,_ .$ ..w. .. .. .+, 6�- e YOU WISH TO OPEN A BUSINESS? For Your Information: Bus!ness`certificates (cost$40.00 for 4 years).,A business certificate ONLY REGISTERS YOUR NAME in town [which you must do by M.G.L.-it does not give you permission to operate.) You'must first obtain the necessary signatures on this form at,200 Main St, Flyannis. Take the completed form to the Town Clerk's Office, 1st F1., 367 Main St. Hyannis, MA 02601 (Town Hall) and get the BusinessCertific�ate that is required by law. st DATE: o�V / Fill.in please: ' APPLICANT'S YOUR NAME/S: �',� j Q U"ad) ,' al .l a . x`'' BUSINESS YOUR HOME ADDRESS: 6grTV ' i; s': � �,I II-kn'>'k�f.ias �'lle� ; J - b ! r— _S TIE LEPHONE # Home Te ephone Number NAME OF CORPORATION: Altr NAME OF NEW BUSINESS I_ "a- ' Y i r^Cd aLv TYPE OF BUSINESS 't t>i r7:i�r�rc (�'l�ee IS THIS A HOME OCCUPATION? YE NO .� li�`f ADDRES5'OF BUSINESS r 5 a S MAP/PARC L NUMBER ?42f) (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. = (corner of Yarmouth Rd.& Main Street) to matte sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO MISSIO ER'S OFFICE This indivi al h s e no d fhapf�rrmit requirements that pertain to this type of business: MUST COMPLY WITH HOMEO.CUFATION 9u_.t o ' e ign e** RULES AND REGULATIONS: FAILURE TO COMMENTS ~ 'COMPLY 6 / r 2. BOARD OF EALTH A This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: , Gig 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. �4 Authorized Signature** COMMENTS: I Regulatory Services Thomas F. Geiler,Director • s,�axsrA=, Building Division MASS Tom Perry,Building Commissioner 9$ i6yq A Mpt a 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma as Office: 508-862-4038 Fax: 508-790-6230 APProved@ ]fee: Jf-3,�7, �-O Permit#: HOME OCCUPATION REGISTRATION Date: Name: J 5 r-S r a/I� Phone# Address: 0 453' A i,5�oP,5 le r,na r-,- village:. Gt `7121 s Name of Busuess: G(-CL rl ,S • (7 M 917P PC ("IV,� a-) &,*7 t/7 Type of Business: Map/Lot: �� INTENT: It is the intent of this section to allow the residents of the To`vu of Barnstable to operate a home occupation vizthhin single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,proiaded that the acti-,aty shall not be discernible from outside the dwelling. there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or gromidwater pollution. After registration ii2th the Building Inspector,a customary home occupation_shall be permitted as of right subject to the following conditions: • The actitaty is carved on by tlhe permanent resident of a single family residential dwelling unit,located-i`ithin that dwelling unit. ` • _ Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary nh residential buildings,aid there is no outside evidence of such use. • No tr ffic.,AU be generated in excess of normal residential volumes. •. .The use does not involve the production of offensive noise,iabr lion,smoke,dust or other particular matter, odors,electrical:disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary•.Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. o There are no-commercial'vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to.exceed 20 feet in length and not to exceed 4 tires,parked on the same lot contauung the Customary Home Occupation: • No sign shall be displayed indicating the Customary Home Occupation. • If the Custonhary Home Occupation is listed or advertised as a business,die street address shall not be included. • No person shall be employed in the Customary Home Occupation i`dio is not a permanent resident of the . dwelling unit. I,the undersigned,have read and agreei ith the above restrictions for my home occupation I am registering. Applicant �� c..1 (� Date 02 6 odd Honieoc.doc Rev.01/3/08 CAPECOD INSULATION tIBtR O\AS.I SPRAYFOAM SDSPtn DED BATTS gum En, INSDiATIOH CEILINGS 1-800-0696-6611 'Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation'did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal& State Requirements, Propert Owner Y Property Address Village Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted. Ceilings ( ) (X) ( ( ) (X) Slopes (X) Floors ( ) ( ( ) ( ) 4_ `. o Walls lC�,.�sc SincerelyoJ� S� (�� po3 iv a coo. w M N He y E Ca sidy r, President Ca e Cod sulation, Inc. _. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ll Map Parcel �bppp � licatior� i Health Division Date Issued.- Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Acr'�' Village f�,✓ r/,�/<S Owner�Y�l /� b �I�1�� ,� Address Telephone &2,;,2�_9� Permit Request ��?a 1�TG Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation// d Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Zr"' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ia'I�o On Old King's Highway: ❑Yes ZMo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other C7 1 ; Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) ;, Number of Baths: Full: existing new Half: existing `` j new — n 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 _ I APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /',/.off �o d �d��/�1�06/ Telephone Number Z /4- Address /� I >;a License #I/DD :e cJ �L Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 72Z>` &Z 7 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION l FIREPLACE f { ELECTRICAL: ROUGH FINAL ti PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f DATE CLOSED OUT ASSOCIATION PLAN NO. , f _ w ✓ d i��l�Gl 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration . Registration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. —- - - -- - - - _ HYANNIS, MA 02601 Update Address and return card. Mark reason for change. L-I Address El Renewal' L,._I EmploymentL_I Lost Card )PS-CA1 ri 50M-0d/04-GI01:16 Utficc.i o�f�s,un,cr Affairs Ltus nc: Re ul,tiou Licoise or registration valid for i:::1i�'idt! us,n!" HOME PR tSV`�iflfffw"1Afw)iX,:, `<"�� Uc'i`ore the expiration date. If found return to: Registration: 153567 Type: Office of Consumer Affairs and Business Regulation / 10 Park Plaza-Suite 5170 r� I Expiration: 12/15/2012 Private Corporation Boston,MA 02116 SyOD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD: G _-may _^ HYANNIS,MA 02601 Undersecretary t alid ith t si tune ' \l:i,.,:,cliusctts- cl►artmcnt of PUI►lit.' Safeth Board of Builtling Rculatiuns and tit�ntl:u ds' Construction Supervisor License Licensd: CS 100988 HENRY CASSIDY 8 SHED ROW . WEST YARMOUTH, MA 02673 Expiration: 11/11/2013 Tr#: 7620 4 v I Z j : ilrwl No, 1605 P. • Gllent#:4597 CONSUL R ACORD,,, CERTIFICATE OF LABILITY INSURANCE DAT in-)MA`12 /) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONS rn LITE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the cerllflcate holder is an ADDITIONAL INSURED.the policy(ies)must be endorsed.If SUBROGATION 13 WAIVED,subject to the terms and conditions of the policy,certain policies may rugDlyd an andoreamenl.A statement on this certificate does not confer rights to the Celtlficate holder in lieu of such endorsemen((s). PRODUCER Rogers&GrayIns.-So.Dennis NAME: . Mar aret Youn PHONE 50 F 434 Route 134 -M No,Exl: 8-760-4602 (A/C.No- 877-816-2156 E-MAIL South Dennis, MA 02660-1601 508 398-7980 _INOURFR(0)AFFORDING COVERAGE NAIL N INsURSRA;Peerless Insurance 18333 INSURED^ -_"`- Gape Cod Insulation Inc INSURERB:EVanston Insurance Company 455 Yarmouth Road INSURERC:Atlantic Charter Insurance Hyannis,MA 02601 IN3URERD;Commerce Insurance Company 34754 INSURER E: _ INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT I-HE POLICIES OF INSURANCE LISTED 16-OW 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �R R Fi TYPE OF INSURANCE AODL SUI POLICY NUp�o[ry MMIODPECY/YEYW MM/ODY/YY1Y EIM!'rs A GENIRALUABIUTY COP8263063 4101/2012 04/01/201 EACHOCCURRENCE 11,000,000 X COMMERCIAL GENERAL LIABILITY ENTED CLAIMS-MADE a OCCUR pAW10E ,'ocurre ne $100 000 .MEO EXP(Any one person) s5,000 PERaoNAI,a ADV INJURY $1 000 000 OENERALAOOKOATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIE8 PER: PRODUCTS-COMPIOP AGG s2,000,000 POLICY JrCTPRO- LOC $ Q AUTOMo51LE uA91LlTy 12MMBCKVMK 4/01/2012 04/01/201 Paac drn SINGLE LIMIT 1 00p 000 ANY AUTO BODILY INJURY(Per per-.on) $ ALL OWNED x SCHEDULED _ AUTOS AUTOS BODILY INJURY(Par auddenl) $ X HIRED AUTOS X AUTOSWNED PROPERTY(Par ficrIff pMA `-` $ S B X UMeRk6LA LIAR OCCUR XONJ453512 4/01/2012 04/01/201 EACH OCCURRENCE 31,000,000 L CESS uqe CLAIMS-MADEAGGREGATE $1 000 000 D X RETENTIor7 10000 _ WORKERS COMPENSATION $ C WCAOp529902 6/30/2012 06/30/201 X WCSTATU• OTIi. AND EMPLOYE7RSq'�L�I4AB1'INLITY E ANY PROPRirE YIN OFFIC RIMEM80ER 6XCl UO i�ECUTIV&❑ NIA E.L.EACH ACCIDENT 1 000 000 N (Mandatary in NH) E.L.DISEASE-EA E10PLOYEE $1 000 000 If yea,daeCdbe nndar .. , DESCRIPTION OF OPERATIONS bel m _ E.L.DISEASE-POLICY LIMIT 10,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORb 101,Addldonal R—wkz ScheaulR,It more SpRc6la regU119W "Workers Comp Information Included Officers or Proprietors Certificate Holder is included as an additional insured uncler General Liability when required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION Cape Cod InSulation,Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 0E CANCELLED I?EFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROV1510N3. AUTHORIZED REPRFSPNTATIVF 0180 -2010 ACORD CORPORATION,All right,'mioryvd, ACORD 25(2010/05) 1 of 1 The ACORD name and 1000 aru registered marks of ACORD #S83849/M83848 MEY '\ The Corr more i l°, . I th of Massachusetts Department ,�,1 ij'ulustrial Accidents T w _ Office , i /n vestigations 600 bl t .;! rilgton Street boss, ;11A 02111 W'orkcu's cotitlycus4jtion Insurance Aftili.:. t: Builders/Contiactors/Llectrici�u�t:/.l'tu►�.tl�ct \pplicaut Lnformation Ple�ise. Print Legibly Naulr tliusitres /Orgauiz. uiurithidividual): r QT Ic \Jtirr,s. . �cCD.2V? L; 11017Z#l:a a OD `1!_ t L A I c ruu an elitplvycr? Check the approprialte.box: r Type of project Ire(tuired): I. I, n el c wpluye r with_ l ❑ I am,1;',,I r:.:.I ontractor and 1 httvi 6. Nr w constrLu iron --- --- rutployrrs (Gull will/or 1)u'c-trine)."' hired the ,iik ,owraccors listed on 7• RCruocteling the aaakh,.i Ianl a cull- proprietor or partnership These sue,.,.� im'ictors have 8. Derriol.ition i,uLl have ilk)culployees working;for entployc:c:,: i,l have workers' comp. 9. ❑ Building adt itiou nic in any capacity. [No workers' itisurau(c.' 10, ❑ .I✓1Cctrical repitirs Ur tI iIIIIIUIIs Ctnnl) nlSUILUICC regLlirCCl.j 5. We arc:i r,-,!Iioiucion and its officer,h:r,: .c.rcised their right of IL ❑ Plurrtbing repalrs ur ddclitunts hullwowuer doing all work exernp ion I" i MGL e. 152 5(4),and 1.2. Roof repaiis nt;s ll [Nu workcr:ti' COI71p. we havr nl-mployees. [No workers' 13. 0 t I �, 1 ntsur:u!rc reduu ed.) 'r COnrp, require(!.) c c r�l t'111 zct� , w al,l,l!rant that i ircks box 41 roust also fill OUt the section below slick,. •ill,it workers'compensation policy inforlrlation. iL uiru•.vu,;i who submit this affidavit irldicuting they are doing tilt wuil.. ,i d.,ittr hire outside conactors must submit a rtcw affiddvit indiCatiug Such. II',uu;i;tvu that chcck this box must attach an additional sheet showing ill, ro,n,-nf the sub-contractors and state whether or not those entities have enittlirl'rr.5.It lh >ub..muui:Wra ha1Ve employees, they ikILLSt pt'ovldc their wgrkeAS COlul: uulnbor. 1 am an employer that is'provielitig workers'compensation ix r,,uce for my employees. Below is the,policy and job site Polly r1 ill .Nall-ills. Lic.-It: tWCA (30A . / 1 .. Expiration Date: _ City/Scate/Lip: AAV,, l� �o Uuu h a copy of llte workers' cornpensatiou policy declaration pag,'i.l t wing the policy number and expit ation date).' i'AUK w scene rovw'ttgc its VC(luired under Section 25A of MOL c, t i.';,,,I IC!Id to Elio imposition of criminal penalties of a fiur up to$1,500.00 uuiUvt !Ilr-vC;u [till)'s)""Wut, as well as civil penalties in the firm of a STOP W1,I<K ORDER and a fine of up to$250.00 a day against tilt viulatur. Be,ntvlsetl !h:u a c„py Uf this stutcment nm C furwarcled to the Office of Investi',m- ,,:;vt the DIA for insurance coverage verification, I do litre c if urtcter the?) ins and penalties of'pl:,1cuy that the information provided above is true and correct. Dace: �_.�^�_.12— — lthtmr Il: 0 0.94:411 Ilse unl)'. L>u ('tot write irz this area, to be completelt o rr;ii,or lawn official City or I'ermitlLicense# Issuing; Authority (circle title): 1, Board of Health 2. .ttuiltling Department 3.Cit}lr'i r,;r i Clerk 4.Electrical luspector S. fltut►bing Inspector o.(.)they Contact Person: - Phone#: I 460 West Main Street - Hyannis,MA 02601-3698 T (508) 771-5400 F (508)775-7434) Hi n =on all lines ous Assistance `� �v�vsvlaaconc ecad Corporation Cape Cod Free W-teathe- rizatiuid Your tenant has requested and is eligible for weatherization of.your rental home through government funding. This will he provided at no . cost to you. Program regulations permit us to spend around $4,000- $10,000 in materials and labor per dwelling unit. Program regulations require us to weather-strip and caulk doors and windows; insulate attics, sidewalls and floors. All work is professionally done by established.private contractors. We will conduct a final inspection to make sure that all work is completed to specifications. If you request, you will be informed of the estimated measures before they are done and provided with a list of the actual measures and costs following the completion of the work. We also need proof that you own the property. A copy of a CURRENT TAX BILL OR DEED listing you as the owner will satisfy this requirement. , Please fill in all blank areas of the enclosed agreement and return with the proof of ownership as soon as possible. If we do not receive the enclosed form within two weeks, we will do a basic energy audit of the home, but no weatherization work can be recommended or done. If you have any questions please call Cathy Finn at 508-771-5400, ext. 105. LANDLORD �h fVA A4')'JC TENANT ,l/�Ld� vf�tC�ILI� °f � 1-7 PHONE PHONE. r r TENANT/PROPERTY OWNER/AGENCY WEATHERIZATION AGREEMENT : 1. The Parties to this Agreement are the following: (hereafter known as Tenant), (print your tenant's name) (hereafter known as Property Owner) (pent your name) and Housing Assistance Corporation (hereafter known as Agency). In consideration of the mutual promises hereafter stated,the Parties agree as follows: 2. The date of Agency's signature will be the effective date of this Agreement 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at(street, town) unit# and currently leased or rented to the Tenant: a) Enter the premises for the purpose of performing a Weatherization inspection. b) Enter the premises to perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection of the property and in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the. appropriate common areas of the building for the purpose of accomplishing the Weatherization work. The Agency and representatives of the Commonwealth of Massachusetts, Department of Housing &Community Development(DHCD) may. further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The Weatherization work will be performed in accordance with the Property Owner's consent as further specified below: INITIAL ONLY ONE OF THE FOLLOWING" I consent to performance by the Agency and its contractors of any Weatherization work determined necessary and appropriate by,the.Agency as a. result of its inspection of the property. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of work. I will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's inspection report and a statement of the estimated work and associated value. This additional consent will be sent under separate cover as Attachment A. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of the work. - 4. The Property Owner understands and agrees that any and all work, including related repairs for which the Property may also be eligible,will be performed at the Agency's discretion. The Agency estimated completion of the Weatherization work by the end of 2012- 5. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency, the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where ' the Property Owner receives a written extension from the Agency, time is of the essence in the performance of repairs by the Property Owner. 11. For breach of this Agreement by the Property Owner,the Property Owner shall reimburse the Agency in an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed on the premises, as well as attorney's fee and court costs. The Property Owner may also be liable for damages to the Tenant in accordance with applicable law; in such instance, the Property Owner shall reimburse the Tenant for attorneys fees and court costs. Without limiting the foregoing, the Agency may at its option terminate this Agreement, by providing written notice to the Property Owner and Tenant, in the event of breach by the Property Owner or Tenant 12. Performance of the Weatherization work hereunder by the Agency is contingent upon the availability of funds to the Agency from the commonwealth of Massachusetts and the. federal government, as well as the eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written notice to the Property Owner and Tenant, if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. 13. The Parties acknowledge that this Agreement is under seal. It is intended by the.Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement Property Owner' Signature: Date Phone: T Address: LEHOUSINGAURIOMf MINIS, ON { Tenant Signature Date Agency Approved Weatherization Company•� All Cape Energy Caliber Building &Remodefin Cape Cod Insulation Cape Save Frontier Energy Solutions Lohr&Sons Resolution Energy Agency Signature re Date 3 - /Z :•.. -� -r''t,,k^'e'^- � .._..'=e�, y r„.o"',:; ....�4 �y..�.�,. .:'s+rt�ar., vw,�9ti*-,*a+ ..n;,,a�.f'y�=.,..""`^c,%n�^'.."`v..�.�d•t,�'!'�=�^. t TOWN OF BARNSTABLE Permit No. . 321.83...... BUILDING DEPARTMENT { ;: I TOWN OFFICE BUILDING Cash ♦ +h9• �tcmr� HYANNIS,MASS.02601 Bond .....x......... CERTIFICATE OF USE AND OCCUPANCY Issued to Bayside Affordable Home Division Address Lot #7, LC 120, 458 Bishops Terrace Hyannis, Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD , _ , THIS PERMIT WILL NOT BE VALID, AND THE BUILDING�SHALL NOT BE OCCUPIED UNTIL SIGNED BY-THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. December 7, 88 .......................... 19................. ...............G�••� .......... `................. Building Inspector •'f��•: TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING rya HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: /�f 4 An Occupancy Permit has bbee�in' issued for the building authorized by BuildingPermit ................................... ........ 1 ..... .......... ......._........... . issued to ... c ;. . ��-1, ..(;t!. /� / ..�1..�;L; / /tffl Lr!XiM Please release the performance bond. c DATE, / a — ? ^8" � CONT I NUAT I Ora OF ROAD BONO BUILDING PERMIT I The undersigned owner/contractor 'hereby ag7--e 'to rrz i P al` ='e"r road bond in force until the fol l cwi ng work i-tms are c 1 yo thli satisfaction of the Engineering- Sect-ion .4orks. loam and seedse5ou darn as soon as , weather permits. other (explain) LW:rz4N ; SI r/Contract r EYGINEERIVAUTHORIZAT ON ` TOWN OF BARNSTABLE, MASSACHUSETTS DUILI DATE LU93., f= 19 PERMIT NO,"iQ 2 R F "APPLICANT -Ile i*r'005645 IN..I • ��E TP (CONTR'S LICENSE) PERMIT TO 1,211 1 h C )w f- 11 S74 ill C, Favriily Dwe 11.i ng.NUMBER OF • l 1 (11 ) STORY L' f!'Z! DWELLING UNITS (TYPE OF IMPROVEMENT F NO. (PROPOSED USE) AT (LOCATION) T 41--);� Bi-ihoos amkax dyamnis ZONING t D ISTR CT(NO.) •(STREET) Terrace BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY -FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION • TO TYPE USE GROUP -BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: 3%.nvdr 72321 AREA OR $ 81, 950.00 VOLUME PERMIT �_lli ESTIMATED COST FEE S61.50 (C SQUARE FEET) OWNER i;-j- side j3ujjdii-vj Co Aifordabl(-�' howe Div. BUILDING DEPT. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). 3. FINAL IN BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. • POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS ve r rl;",v All 2 2 2 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT OTHER BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE INSPEC_ PERMIT BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIOIJUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT ;S ISSUED AS NOTED ABOVE. NOTIFICATION, N OF BARNSTABLE, MASSACHUSETTS BUILDING PERM'�' • •.- DATE ..,,:...,.. 19 PERMIT NO!'N fir, Q A21 83 APPLICANT 1'.....i. ._ .1 •.1.�:, .. L� .�_ AD9�ElSisi-, (No.l r dr',•.• i'00i,O4 (STREET) (CONTR'S LICENSE) PERMIT 70 f`.iT ! f" t il.dx !.i i 9"I C" .( �T i)�rl1.':}.�. ilC; NUMBER OF (1 ) STORY_5-'--=•r6iL<: j��S4i.1•...; .7 DWELLING UNITS (TYPE OF IMPROVEMENTF NO. (PROPOSED USE) AT (LOCATION) _ t ..i'~r5 ti `<t'`' �SFI� -' - ZONING / r �1a ''' CjY'citlU�a._i DISTRICT (NO.) ZSTREET) _ 'I BETWEEN AND (CROSS STREET) (CROSS STREET) - SUBDIVISION LOT LOT BLOCK SIZE' BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTI TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE). REMARKS: '3't1G7;? J:-:Lbrt�-r- 2 j ' 1 .. AREA OR Bond VOLUME i rii'' - ''• (j1 950� oci PERMIT t ESTIMATED COST 7 „ (CUBIC/50 UARE FEET) FEE $Gl 50 OWNER +i i j i i'r` l:iLi' till a!' Lr'I ��. ..r',.•(.I S.c' ii IWE' 0 V. , ADDRESS T> f -�_ ,a.. BUILDING DEPT. • -- •s d'/I BY G` THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY ® PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE A PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINS FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIO OF ANY APPLICABLE SUBDIVISION RESTRICTIONS, MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL I NSTALLATIONS.O 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL _MINAL IN IRE INSPECTION TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. t POST THIS CARD SO IT IS VISIBLE FROM STREET ° BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS D'.Ji s�d ( , ,P_B.,,veaC �g✓1-d � �Gapi--�D15 T 0 2 2 Y7) HEATING INSPECTION APPRO ALS ENGINEERING DEPARTMENT 7 OTHER BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE INSPEC- P E RM I T W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE.OR WRITT CONSTRUCTION. lI PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. BrSHoPS �Q,o P��-'*'`� Lii•�oc..l�J L.t GCS, c...r G�it7 .�o.�t E G �. �tt.P�4 L.�- � At, `i"-OL4JAJ e0.4 -1~at-AA : CoMN1Li x-4 i-r( � o ti �p co��t4 .`y` tX� CE-eT/F/�-D_ GL oT �L AiV PJe E PAR E D Fo P- L 0C Q77o.v: .e 5 06- '&U tom. to- Zoce f' 2 ,c�EeEBY CEGT/FY ' 7'"oc7T T�-/E 49VI .n' 49P 5� pow o.v TNis .oLoCtiw IS LOCATED O.V THE II Yla�ur��'�-►fit t S�of� Tow..l�W r�6�.1 fn��c ��`,� Of o ARNE ,f i c�o�.un cam cn9in�ecr-in9 � of0,1 A,rx crJcJTE GA--YR�.E,v10uTs.-i, .s-!L75�. y �aTr J •eG'G. L Sc..�Vt,�o� I $le, FFS I l tz i1 S S+.I�ot.cln.1 •�--► •fir✓M c� . Go M t�/1 U r•.t r T`C �' I PLANNING BOAI75 Sub�/59 H Add, Lo, <,,dJ-itj appr t o x o w ! r zyX3z 7(c g ALOW e7p CEe T/F/E-D AL 07 f='A.A/y PREPARED Fo R: L o cAT/o�v: 8'BPS •T��t.� �•1�1�4ne/.i r S Lo-r 1 Zz, 17.4 Z /-/EC�BY GEGT/FY TN/4T THE 6V/LD/.VF 77AS S /S LOGfiTEa OA/ 7'I•/E yBOt/.Va fiS 3NOWAJ HEGEO/V 6U t e X#.-J 6- 4&jWZ,JAJ Go v fr-oe.►-ll, •Tv Ta4 E i BGac,L � OF y�c�cs�eE�-rEitr5 oG ra•!� To�,�,t w�l6�l co�t-R�u�rt,7 /��? o� ARNE G ohwn came Cn9ir'recrin9 $ oat C/�//L E6/G/4/EEt3 LgA./a SC/lVEYOB3 � 4�� - . EOc�TE GA Y2�.r��Oc.JTs-I" Mq��: fair �6. L e fir- �K P u , IQ►� or's offioe (1st floor): �. �� _C, pfTNEto Assessor's map and lot number ....��0......... . of Health (3rd floor):Sew Sewage Permit number ................................... Z B9Sa9Tl►DLE, i MUST CONNECT TO TOWN SEW NAM Engineering Department (3rd floor):*** loor): L�� e House number `T J� 2639. :......... '° o eA,ra. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR eel APPLICATION FOR PERMIT TO ...... ! � ..... .. /.......` C ...... TYPE OF CONSTRUCTION Ba .............................................. . .................................................................................... ............ ......... TO THE INSPECTOR OF BUILDINGS: The undersiigg�ne�d� hereby appliesfor a permit according to the following information:A Location T��`f. L� / �CJISGs' /Vav ProposedUse ........ .=�lIl '...................................................................................................................................... Zoning District ............. .C.l................ Fire District ..... <.5............................ .......F.......... --e3109-YJ106 Name of Owner ./ 77P.W.��`...71;W, ..4(:Yt..Z4~..�.,Address !r:00 '. � �Z(l!!/C;,,,,,,,,,,,,,, .... . Name of Builder .............. ` ..............................Address .......................6-P J(s��........................................ Name of Architect ..___.................................Address 4:51 ... s%... .......... l�................. Number of Rooms ................ ..........................................Foundation .. ! ......�� ..................... Exterior .�<. QD .... S!//.�1 `4 .......................Roofing .......! ••• .................................................... Floors e ........E/....V/VY(f—I.............................Interior ...P././.✓< ...�...��U�................................ Heating .. C......................................................Plumbing ..... f�..... ..4 / ........... .. .�..� /J!/ Approximate Cost ?,�� Fireplace .................. ... ........................................ ..�... ".. ................................. . ... 3 Definitive Plan Approved by a� Board ----- — /' �%- lU 19 Area }P..C1......`r ............... Diagram of Lot and Building with Dimensions �� Fee ........ ...... ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. :/�) Na e .. .. ...... V Construction Supervisor's License ..................................... AYSIDE AFFORDABLE ME DIV. o ... Permit for ....1.!...S.to.ry............. T Siriqle Fa mil dwellin ............. M..................... .q....................... ........... Lot ! Location ... -race. ... .... •"';. ..................H ............................................ Owner ...B a.v.s i.de...Affordable Hom.e...Div. ...... .... .. .. .. ................................. .. .... .......Type of Construction Frame....... .................... ......................................................................... Plot ............................ Lot ................................ Aust 16', 88 Permit Granled ....... ....ug............... .........19 4 i Date of Inspection ......../..................J.........19 Date Completed ...... 19 0 0 f "r X k! 00 M 7 Assessors offipe (1st floor): �^. THE Assessor's.map and lot number .....® SO...-" �... a �>' Hof Toy♦ Boa'pd of Health (3rd floor): ��/' _ � /��F Sewage Permit number ......................................... .. d Z BAS39TABLE, Engineering Department (3rd floor): oo S 9• a� House number �..... APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR .PERMIT TO ...... ...... . ........................................ ......................... ........... .. .....:�....... {: _ rTYPE OF CONSTRUCTION ...... dU ....... ......... ..................................................................... ..............1/ ........ .........19.oq�— k. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location // � �Z C / . 11 L{J ... 3........... ". ..i5.. ........-5... /'................................................. 1 ProposedUse ........ 11l�.t'...................................................................................................................................... �C �� Zoning District ....................................... Fire District' ..... .. 'i1.lN(; ............................ Name of Owner . ......`.....E E3.......!j!.-..-��,Address ?RO•00X�..........C/7 14= .. . ... .................. Name of Builder ( ��..............................Address .'' ......................(............. ;.................. Name of Architect 'Y...................................Address 5�,91W... 7LLT Number of Rooms ................ ..........................................Foundation .. �.� �jperrt� ..... .... ................................ Exterior .�1.�: 6?Gl .... 5�(/.�1�(— .:.....................Roofing .......� ///9/ .................................................... Floors ' '�'�........s/.... � ✓•�..............................Interior ...P.;A04c 5....."7r fv ................................ �J Heating .. .............. ......... . .................` Plumbing ....: Yt. C: 1 � ............�... � *!.'/.. Fireplace !i!/ ..........Approximate Cos . / d Definitive Plan Approved by Planni g Board ------ - '----�U-----19- Area .......................................... Diagram of Lot and Building with Dimensions Fee. ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ... .............. ...../ ......... ................................. ' C2%�JG� Construction Supervisor's License BAYSIDE AFFORDABLE HOME DIV. A=250-067 L 3b —o-4C? 6 o,3 No 21.$�.. Permit for ...1.12...StOXY............ Location ..Lc;.t...#J........45.8...33d.51ao.P5...Te.rrace .................ay.almls............................................. Owner ..BaLyaide..Aff.or.d.ab.l.e...H.Q.mQ...Div. Type of Construction ..,,Frame ...................................... ............................................................................... Plot ............................ Lot ................................. T Permit Granted ..,,,.August...1.6.! 19 88 ..... .... .. .. Date of Inspection .....................................19 Date Completed ......................................19 f Town of Barnstable *Permit# Expires 6 months fim issue date pERp�i+�. Regulatory Services Fee SEP 2 rr/I I Thomas F.Geller,Director 8 2006 Building Division T01414 OF B,RAf4 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 F-- www.town.bamstable.ma.us Dffice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY of Valid without Red X-Press Imprint -7,/parcel Numbe �� erty Address Or' ® S t Qe C_Q � tesidential Value of Work Minimum fee of$25.00 for work under$6000.00 A ier's Name&Address A tj tractor's Name Telephone Number NA.)S 7 R9'/-7 ie Improvement Contractor License#(if applicable) t.2k 1 9k struction Supervisor's License#(if applicable) Jorkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance rance Company Name o'l 1Qnan's Comp.Policy# � x 260 1 dj y of Insurance Compliance Certificate must be on file. ut Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to\)4e%4AL6 c,"f1_, ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope t sign.Property Owner Letter of Permission. A f e Ho Improvement Contractors License is required. .4ATURE: ms:expmtrg D061306 1!/11/Ltlt74 CJ4:17 Dt7tl��tl7/tl/ M1KtM --_ t-,Aut U1 MIKE MONGEAU (508)778-9797 / PROPOSAL 77 Traders Lane Cell (508) 367-2646 W,Yarmouth, MA 02673 Home Improvement Llc• #12678 Date: Constr, Supervisor Lic, #006670 ProposySumatted To: Moiling Ad ress Work to be performed at: Name: Street: Street: RA r� City. City, State: Zip Code: State: Zip Code: Home,Phone: Work: NOTES/Suggestions; TO � 5 Y cIAd �- WA Hereby iropose o f rnish the male als and perform the labor necessary for the completion of. 1 c (b) Removing old roof;.install new roof.with a �. shingle- .estimLate.:( ) sq This price will inclu e a year v+prranty on workmanship, new alumi- = num dnp a 15#'felt underla�`rrtaent, roof vent collars �lnstall loe and:water barrier a77 round 1661mney, valleys, naN fioose boar s;< leangutters, and .total clean up_Qnd :reir�oval of aaa debris. Color of roof is to be 2. Venting - can. be critical on certain homes. (a) Install _ ft. of Cobra continuous ridge vent option $ (b) Install ff, of Hicks vented drip edge on soffit. option $ (c) Install _� ft, of water & ice barrier on eaves to prevent I e damming _ option $ (d) Other `� 1 All material in guaranteed to be as specified, and the above work to be performed in accordance with the specifications submitted. for above work and completed in a professional workmanlike manner for the sum of $ with payments to b mad follows: Deposit of $ Balance due upon comp 1 n. Respectfully submitted ACCEPTANCE of PROPOSAL ny rotted or broken roof or tri boards unforeseen,repaired, will be The above prices, specifications and conditions are an extra cost above the quoted roof price.The charge for this will be, satisfactory and are hereby accepted. You are if needed, S5o/nr. plus moteriois.All agreements contingent upon authorized to do the work as specified. Payment will weather delays beyond our control. outstanding boiance over 30 be made as outlined above days will incur 1.5%flnonce charge per month,Owner to remove oii valuables from wails;LtobAlty tnsuronce on all•above=to be taken out Dote: �'/ -Z , by: Mike Mongeou Signature: CERTIFICATE OF INSURANCE Issue Date 3/2/2006 Continental Casualty Company Producer BRYDEN&SULLIVAN INS 485 ROUTE 134 PO BOX 1497 SOUTH DENNIS MA 02660 Insured MONGEAU,MICHAEL 77 TRADERS LANE WEST YARMOUTH MA 02673 Coverages THIS IS TO CERTIFY THAT THE POLICITT&,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. Type of Insurance Policy Number Policy Eff.Date Policy Exp.Date WORKERS'COMPENSATION 48OX760906 03/04/06 03/04/07 Workers' Compensation and:Employers Liability Limits EACH ACCIDENT $ 100,000 DISEASE POLICY LIMIT $500,000 DISEASE EACH EMPLOYEE $ 100,000 THE PROPRIETOR/PARTNERS/EXECUTIVE OFFICERS/MEMBERS INCL Description of Operations/Locations/Vehicles/Exclusions Added by Endorsement/Special Provisions Certificate Holders ° REEF REALTY PO BOX 186. WEST DENNIS MA 02670 Cancellation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE .CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAY(S) WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED ABOVE, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION.OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Authorized Representative _ RONAY NELSON Account Manager Underwriter ti Inv %.Unlrnvnrvcussn vJ 1/luJJua Isa•JG�W �L Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ' M yV•�� www mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): (Address: L �Q 4e 5 ./� Phone City/State/Zip: #: O' �_� kre you an employer? Check the appropriate box:. Type of project(required): I am a employer with�_ 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.0 Electrical repairs or additions required.] ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.Moof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] my applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. zm an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. surance Company Name: g C, )]icy#or Self-ins.Lic. M qe - %0(0 (� _ E iration Date: t b Site Address: � Ita C - City/State/Zip: " ttach a copy of the workers' compensation bolicy declaration page(showing the policy number and expiration date). diure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 'up to$250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office of tvestigations of the DIA for insur coverage verification. do hereby certify e he in an penalties of perjury that the information provided abov is true nd correct ature• Dater Lone#: 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#: a, S e n atvd"S�n AG�pFR a S R NpM�1MP 126�15 istRM�12g12��a Reg1 v\dual Mp�t ��, M`GNP pN�c ry pePaty A `GNP M �Nu. �'�RPG UjN