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Home My WebLink About0157 BRISTOL AVENUE / 010, B.eiSreG fh/C J f r I sh h Town of Barnstable *Permit#b,0 t� Regulatory Services Fee 6monthsfrom issue dat a i 9 1Mnas. ,�, Richard V.Scali,Director XOPRas Building Division Paul Roma,Building Commissioner JUL 2 9 2016 200 Main Street,Hyannis,MA 0260 ®U!!I!I. 'nrn� www.town.barmtable.ma.us � A L Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 02 Property Address 15 1 Ael Q nrUS r/ OC2o ❑Residential Value of Work$ 40 Mi imum fee of$35.00 for work under$6000.00 Owner's Name&Address 1 ►�i� C, n lD oxo Contractor's Name _ l ,O' e- of LS n 2.r Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance a Insurance Company Name Workman's Comp.Policy# 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 ❑ -e-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.;U-Valued J (maximum.32)#of window_s /5 #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with real S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is aequired. ' [SIGNATURE: Q:\WPFILES\FO \b ' ermit forms\EXPRESS.doc 06/20/16 d ?lie Cowwompeah*off Maysadtusetts Sr N Deparh maut cr,rnd ush id Acc identr Q e-of�atians 600 F{1ashirvfon street Bastan,MA 02111 ' tp�vt�ntax�g��iiia Walters' Cumpensafiun ce Af ffifava CantradurslElectricianstP�bers #TIIf S II ' Ple ase P`rin a1IIe Add�essti 15� � c � - cityrsb ft- 914'r &LCI rws del C06ol - 50 — .,5 W9 ,3 Are you an employer?QW-ek the appropriate box: T of ect r ' � I am a general contractor and I I� 1�7 { �l�d}'- I.❑ I am a employes with ❑ � 6. ❑New oonstrocEian employees(fish andfor part time).* have]sired.the sub-contractors 2.❑ I am a sole proprietor orpartner- listed on the attached sheet. .?. ❑Remodelffig ship and have no employees These sub-contractors have g- ❑Demolition wodzing forme in any capacity. employees and have wod ors' 9. .❑B,uil ,acldiiioa. [No vvodmw comp-insurance comp-n,srance I r 5_ ❑ We are a-r-osporaiian and its ME]Electrical repairs or adcli 3. F am a hotneou t doing all v�aslt officers haveexercised their IL Plumbingrepairs or additions right of mo on per MGI. L❑ C.I52.§I{ d a have no . Roafrepairs inm ante rid i e=ployees_ ❑Otfier camsp_insurance mquired.] •,§ecpapg H�atchecUbaz l— aLsalMoutthesecd=bgawstrosda &&wo&edcompeasatianpoEcyinf msdm. - I aaaeoa�aers teho sub=Otis affidavit mdkztbg dwy axe:doing zU vrnak sod&m bite aatw&cunt wwm—st sahmit a aiew affidzeYt mdiea>inn smcb- ICatrtxaM=tfi$t eb,,Jr this boat asbast w tadsed as addilianal sineet shau�g the acme of the sub comuscm��d stare whether canatf6ase a ieshspe employees.Iftbezdb-cast hose empIcyee-%dLe}'amsrpmndde w0dEM5'c=P•PoImF aim lam an elligr fiiat isgrauiriirrg�vrrr7rers'calugerlsafiarl i}rsrirarrce fur m eurpfo}�ex $eFnev is f7[egDtiry ar�d)Ob site inforraadom Insurance Company Name: Policy,or Self-ins.Lic, F piratianDate: Job Sif�Addmm CityylS P, Attach a-wpy of the workers'com2pensation.poEcy declaration page(showing the policy,mrmber and expiration date). Failure to secure coverage as raegdred.under Section 25A of MQ.a 157—can lead to the imposition of criminal penalties of a fine up to$L,54D OQ andlor oni-yeir impzisoumenk as well as ciurl penalties in the fans of a STOP WORK ORDERand a f me of up-to 00 a dap aggainst the violator. Be whised that a copy of this statement maybe fxvmded to the Office of IIIve&#p ioms of the DIA,for ihs=wce coverage verificakaon- " I do heraby M dis pains andpmafties oflredkq thatthe informatiarsgr"i&d a v rs bars and correct Si, ►*�- :Date: Ojcfal=w anfY: Do nat wrke in this area,to be wznp eted by chy,artow o ffidnE City or Tan= Permifflkense g Issue AX&Srity(creIe Gni): L Sid of IfiNd i I BwUmg Department 3.6ty1Tm4n Clerk 4.Electrical Enspmtor S.Plumbic Lnspector C.tamer Contact Person: Phone#: IL laformation and Inst-nctions Mucrar IrncetLs CTcb=Bl Laws dixptcr 152 regm=all MlpIayeas to provide worlh&aampeosEan far ff<eg employees. Pi S=tto•his sfatvfq,an flay='is defined m_, .evezypersaain$ie service of anothcruaderaqycantract ofhirr, express or hmplied,oral or wriffe " An.MT&YM is d0fxned as"an individual,partnersbili,asso��;cmPOratim or other legal entity,or any two or more of fie foregoing eangageff is a Joint else,anal incladmg the legal represezxta a of a deceased employer,or fhe rerei4er or traatee of an individual,per,association or ofherIegal entity,employing employers. However ffie owner of a.dwelli og house having not morn than theme apartments and who resides ffierem,or the occupant of the - dweIImg house of anoflier who employs pmsons to do n ai�cc,r-f ns mcti o or repay us wmk on such dwelling hoe or on the gmunds or bui7ifmg appmtmartthereto shaRnotbecanse of sorh eazplaymentbe deemedto be an employer." IvltsL chapter ISZ,§25C(�also stains that¢every state or local licensing agency.shaII withhold tiie issuance or renewal of a licen e.or permit to operate a business or to constract bundiugs is the commonwealth for any a_pplicantw•ho has not produced acceptable evidence of cdmpR-mae with the insurance:covexage requite-" Additionally.M(H.chapter L52,§25C(7)states"Neithmtlie nor any ofits political subdivisions shall e�inr info any contact for the pew once ofpublio work unfit acceptable evidence of compliance with,the msoran0 . regret==tsoftmaVtes have been presentrdtotheco-3�arztholity." Applicants Please fill o� the wotia'as'compensation affidavit completely,by g ine boxes apply to your situation and,if nmessaly,supply sob�tor(s)name(s), a&=ses)anti phone noznber(s) along W1&ffi==rims) of insurance. Limited.Liability ConTpames(LLC)or LimitedLiabiIity'Pmto.ecships(LLP)wiHino eanployees oil=flan the members or partners,are not rbqun-ed to caay wori�ers' compensation insurance If an LLC or I LP does have empIoyers,apoHcyisregiffied. Be advised ffiat this a$dayhmaybesobmittedtoth,Depadmentoflndusirial Accidmfs for confirmation ofmsar= coveaaga: Also be sure to sign and dateiffie affidavit. The affidavit should be returned to ffie city or town that ffie application for the pe mdt or license is being requested,not the D ep arfineit of Fadastial A ccide-L-_ Mcaldyou have any fines cns regarding the law or if you ate recpied to obtain a wmio=' compensation policy,please call ffie Depadment at the armmber listed below. Self-ins rd campanies should enter their s elf-jusm-an=lic :use number an the agprffpa line. City or Town Officials Please be sere ffi,at the affidavit is complete and prime legibly. The Department has provided a space at the both of the affidavit for you fo fM out in the event the Office of7nvestigations has to c:ortic-'t you regarding ffi•e applicant Please:be sore to fill in the peamit cenm mnm er which will be:used as a m&r mce number. In-addition,an agplic�t fh at must submit multiple pemmitlliceus0 applications i a any gives year,need only submit ant affidavit indicating c=eat policy or information(if necessary)and undea"lob Site Address"the applicant should write"all locations i a (may town)_'A copy of the•affidavit that has been officially stamped or matiCed by the city or town may be provided In ffi.e applicant as#oo-fthat a valid affidavit is on file for fataipez #s or licenses_ A new affidavitmust be JMed Dirt earls year.Where a home owner or ciiiz is obtaining a license or permit not related is any business or commercial venfiac Cie.a dog licseen or permit to bum leaves eta.)said person.is NOT req�d to com Iete f affidavit The Of oflnym-igadnas wouldlilmt o ff=kyou in.advm=fur your mcperafian and shouldyou have any questions, please do not hesitate to give us a call M5Dep�r[mmfs address,telephone and fax=Enb= . Defiant of hides Agents �tce of��tio� B Irk 02111 Ta 4., 617-' -49W=t406 or 1-977-MASAF Fax#617 727 7M lZevised 424-07 WW V r - Town of Barnstable Regulatory Services r H WAMn>ns. ` Richard V.Scali,Director Nua Building Division. Pahl Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable-mans Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If UsWg A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature-of Owner Signature of Applicant J Print Name ; Print Name t Date Q:FORMS:OWNERPERMISSIONPWLS Town of Barnstable ' Regulatory Services Richard V.ScalL Director Building Division ��. t Paul Roma,Building Commissioner 039. �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us - Office: 508-862-4038 - Fax: 508-790-6230 / HOMEOWNER LICENSE EXEMPTION / Please Print 7 J.?o ' DATE: ��--// JOB LOCATION: 15 T 6 e �/ � Qn � number street village "HOMEOWNERS: Ld�/J�- C0 - name home phone# work phone# CURRENT MAILING ADDRESS: &ah nib ci wn 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 undersi ed"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proced requirements and that he/she will comply with said procedures and requirements. ign eowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing.Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 RISE ENGINI L_,NG -eras ID#06-0406629 ° RI Contractor Registration No 8186 A division of 1 hielseh)Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,R102910 ��aa ��aa (401)784-3700 FAX(401)784-3710 ' '� ONT CT Page 1 IS - - r THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE Client# Diana Hildrenth Q , 05/16/2010 109138 , SERVICE STREET BILLING STREET ' 157 Bristol Ave. ""157 Bristol Ave: SERVICE CITY,STATE,ZIP - BILLING CITY,STATE,ZIP Hyannis,MA 02661 Hyannis,MA 02601 JOB DESCRIPTION MAI` 2 2iD $0.00 RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air ' exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for 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. 14.5 man hours. $957.00 RISE Engineering will provide labor and materials to install a 4"layer of R-13 Class 1 Cellulose added to 128 square feet of attic kneewall floored space. $115.20 RISE Engineering will provide labor and materials to install a 8"layer,of R-30 Class 1 Cellulose added to 1191 square feet of open attic space. $1,310.10 RISE Engineering will provide labor and materials to install an easily moved,insulating cover for the attic access folding stair. The cover has integral weatherstripp ing to restrict air leakage. $160.00 RISE Engineering will provide labor and materials to install 80 square feet of R-19 faced fiberglass insulation to the perimeter of the basement ceiling at the house sill: - $88.00 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. - $957.00 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. $1,254.97 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred (Eighteen&331100 Dollars $418.33 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTE 90 DAYS.BEE REVE .'t FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY SPACES f S �CUSTOFR AUTHO (ZEDSIGNATURE•RISE ENGINEERING AHCE - -1 NOTE:,THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE — T�i� ACCEPTANCF.OF CONTRACT-THE ABOVE PRICES,SPECIFICATIOAsS AND CCtdDiTION3 ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO OD THE WORK -- - DAYS.: AS SPECIFIED.PAYMENT WILL SE'MADE AS OUTLINED ABOVE - Ton R I S E Division of Thielsch Engineering,Inc. 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02910 ®VsIi � � May 1, 2013 Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 F. Re: Insulation permits Dear Mr. Perry, This affidavit is to certify that all insulation work completed for 157 Bristol Avenue 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 tnat�R , Map Parcel.' Application # Cif/ v 3 Health Division Date Issued - 1 J Conservation Division Application Fee Planning Dept. Permit Fee. Date Definitive Plan Approved by Planning Board �— Historic OKH _ Preservation / Hyannis Project Street.Address 157 Rri ctnl Ave Village Hyannis Owner_ Diana Hi l drenth Address same Telephone Permit Request air -,Paling_ insulate attic and basement reiIing perimeter Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2630 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 uj APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RISE Engineering Telephone Number 401-784-3700 Address _1341 Elmwood Ave, Cranston, RI 02910 License # 100459 Home Improvement Contractor# 120979 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO OV SIGNATURE DATE Erik Nerstheimer for RISE Eng. r t FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: F` FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations U. 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 Thiel ch 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 I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors . t0 Remodeling 2. 0 1 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.t required] 5.0 We are a corporation and its 10. ❑Electrical repairs of additions 3. 0 1 am a homeowner doing all work officers have exercised their 11. ❑Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4),and we have no 12. 0 Roof repairs employees. [no workers' 13. T& Other Insulate comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees.Below is thepolicy and job site information. Insurance Company Name: The Preston Agency . Policy#or Self-ins.Lic.#: 3730961-00 Expiration Date: 1/;1/11 Job Site Address: City/State/Zip Y Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration (date). Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or.one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $250.00 a.day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certi and �fhe Pains ► enalties ofperjury that the information provided above is true and.correct. Si nature: Date: Print Name: Erik Nerstheimer Phone#:(401)784-3700 or_1. 800=422-5365 ext133 Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#,': e Issuing-Authority(circle one): 1.Board of Heath 2. Building Department 3.Cityl:fown Clerk �4.Electrical lns�pec:+n.' S.I'1v�;nbing Irsspector 6.Other Contact person: '1:o1;r.#: i' AC®RD CERTIFICATE OF LIABILITY INSURANCE OPID 47 DATE(MM/DD/YWY) Y� __._--- THIEL-1 ER 09/13/10 The .Preston THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The .Presto Agency, In'C. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303 t HOLDER'.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, East Greenwich RI 02818-0810 Phone: 401-886-8000 Fax;401-885-1700 INSURERS AFFORDING COVERAGE _ NAIC INSURED INSURERA: Zurich-American Ins Co. I Thielsch Engineering, Inc INSURERS- Amor.lcen CU)T'.et.. a r.1,bllYty Thielsch lty Inc. , INSURER North American Capacity --T Hi Tech R6A�a1ty Inca p _y 195 Frances Avenue e INsuRERD: Hartford Insurance Company --Cranston RI: 02910 INSURER E' ' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWI-11-iSTANDING ' ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH.RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR _ W'1Y PERTAIN,THE INSURANCE AFFORDED By-THE POLICIES DESCRIBED HEREIN IS SUBJECI TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH{ - POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, InSR71ODL LTR INSFIC TYPE OF INSURANCE POLICY NUMBER DATE(MMlD'D/Y1') DATEATE( M) LIMITS - - _ I GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 3730962-00 - 04/01/10 01/01/11 PRENIISES(Ezocc�weme) a3 00,000 CLAIMS MADE OCCUR .,. MEDEXP(Any.one person) S 10,000 PERSONAL&ADV INJURY Y 1,000,000 GENERAL AGGREGATES 2,0 0 0,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,0 0 0,0 0 O POLICY X JET D LOC _ - Em.p Ben. •1,000,000 AUTOMOBILE LIABILITY - - - A X ANYAUTD 37309'63-00 04/O1/10- O1/Oi/11 COMBINED'SINGLE LIMIT g 2,000,000 (Ea accident) ALL OWNED AUTOS ' BODILY IN,rURY $. . SCHEDULED AUTOS (Per person) HIRED AUTOSO.. — NON-OWNED AUTOS 0. , (BP f lacldQN) PROPERTY DAMAGE ; _ (Per occiuenq GARAGE LIABILfiY +- AUTO ONLY-EA ACCIDENT S ANY AUTO -- OTHER TI�ArJ` CA ACC $ ` P.UTO.ONLY: AGG y "— ---- EXCESSIUMBRELLALIABILRY - EACH OCCURRENCE $ 10,000,000 B X OCCUR CLAIMS MADE UMB 9 2 6 3 6 3 7-0 0 0 4/O 1/10 01/01/11 AGGREGATE $ 10,000,000 DEDUCTIBLE ,-- - X RETENTION $10,0 0 0 y WORKERS COMPENSATION AND X TORY LIMITS I ER EIAPl0YER5'1ABILITY - A :VJ}'PROPRIETOR/PARTNER/EXECUTIVE 3730961-00 04/01/10 O1./O1/11. E.L EACH ACCIDEIJT $ 1,000,.000 ' OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,00o,000 it Yes,describe under _ SPECIAL PROVISIONS bolow - - - '- E.L,.01 3EASE-POLICY LIMIT :{ 1,000,000 OTHER C Professional L'iab - DVLOOOO26800 04/01/10 04/O1/11 Prof Liab 2,000,000 D Leased/Rented Eqp 02VUNTD5678 1 09/O1/10 04,01/11 Equipment 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS r 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 • IMPOSE NO OBLIGATION OR LIABILITY OF ANY HINO UPON THE INSURER,ITS AGENTS OR - - - REPRESENTATIVES. - AUTHOR4D REPRESE ' V •— -�- - ACORD 25(2001/OB) )ACORD CORPORATION 1989 PAGE 2 i �®��® INSUREDIS 1�A �y � .iislurl.eg. :a.`;i'a,_�I,dr}E1s.x..,.N .11i�1��o P • „ -,1 ,.i�". .. Also for RISE Engineering, a division .of Thielech Engineering,. Inc. Gaskell 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. diyision of Thielech Engineering, Inc. a y ' w O ice o nsumer faind usiness e u anon o g 10 Park Plaza- Suite 5170 Boston, l4ssachusetts 02116 ` -Home Improve ontractor Registration Registration: 120979 ^" Type: Supplement Card z i w Expiration: 3/25/2012 THIELSCH ENGINEERING ' ERIK NERSTHEIMER 1341 ELMWOOD AVE. ° CRANSTON, RI 02910 �711 v� . Update Address and return card.Mark reason for change. . Address Renewal Employment Lost Card DPS-CA1 it 50M W04-GG110T01216pp - /lie -(oovr�rrcoouiiea.�i �✓aGaa6ac�auaelifa `. - Office of Consumer Affairs&Bu iness Regulation License or registration valid for individul use only . OME IMPROVEMENT CONTRACTOR before the expiration date.. If found return to: Office of Consumer Affairs and Business Regulation Registration 79 Type: 10 Park Plaza-Suite 5170 Expira _ F I-12 Supplement Card Boston,MA 02116 - THIELSCH.ENC'�,[ _ w, ERIK NERSTHEMM 1341 ELMWOO CRANSTON; RI 029 Undersecretary Not valid without signature r-age i 0I 1 r. The,Official Web-site of the Executive Office of Public Safety and Security (FOPS) Mms:Gov Home rublic Safety _.-_. _.. _... .....F._-................. Department of Public Safety Licensee Complaints License Type Construction Supervisor License # 100459 Restriction WS,IC Name Erik Nerstheimer City, State, Zip North Scituate, RI, 02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee.. Back To Search t ' ✓JGG.�O!T72;/2�}�2 �,J✓�'L¢OCGQ�.^.f2Cl._�-} r � I.. _ _. '-' - .. .. Board of Tiiiildine Regulations and Staiidar�t3 Li.ceose or registration valid for individol'use only HOME IMPROVEMENT CONTRACTOR i. . before,the expiration date. If found return to: Registrali,oii,:. 120979 Board of Building Regulations and Standards p-- 3�25/2010 Ez: :o:n:_s-'. One Ashburton Place Rm 1301 Type .SuPplemeni Card :; �c?str�jl Ala. 02108 E L S C H ENGINEERING K NERSTHEIMER == i \NSTON, RI 02910 Admin�sti.ator Not valid without signs#%re x , http://db.sta-te.ma.0 %c�;`!lic,det�� 1 • asp%x71 eaICbl- .' .,� ;)04,C). _ �� g��^rf �� Q ��i � �{.s�Y y';�ham' � �`"• .. €�' "t7-•e ' #, i momemb, AM a r 'M ® a .', r t NAT-24531 -,1 E, y v WILLIAM F• CARDARELLI CLAIMS SERVICE www.cardarellicialms.com 800-562-8484 632 Warwick Avenue 56 North Main Street,#404 Warwick,Rhode Island 02888-2632 Fall River,MA 02720-2128 Phone:401-941-0010 Phone:508-679-0006 Fax:401-941-2252 Fax:508-679-8458 July 21, 2004 Hyannis Building Inspector 364 Main Street Hyannis, MA, 02601 Re: Insured: Poliseno, Janice M. Loss Location: -1_57 Bristol Avenue, Hyannis, MA, 0260 F Insurance Company: Encompass Insurance Address: . PO Box 9184, Quincy, MA, 02269 ..Polk No/Claim No ,.002794297/03 5,42127JB:, .. ,T Kind&Date of Loss: Soot, 6/15%04 .-.,Our File No.: 59484 Gentlemen' Claim has been made involving loss, damage or destruction of the above referenced property, which may either exceed $1,000.00, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under MA General Laws, Chapter 139, Section 313 is appropriate, please direct it to the attention of the above referenced Insurance Company and include a reference to the captioned Insured, location, policy number, date of loss and claim or file number. Very truly yours, WILLIAM F. CARDARELLI CLAIMS SERVICE For: Encompass Insurance Michael E. Allard, Adjuster mike @ cardarelliclaims.com On this 21st day,of July,2004, I hereby certify that the above letter was mailed First Class Mail to the person(s) above address. ec' C— Michael E. Allard Adjuster cc: Encompass Insurance • MEMBER NATIONAL ASSOCIATION OF INDEPENDENT INSURANCE ADJUSTERS •