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HomeMy WebLinkAbout0014 BROOKSHIRE ROAD l�{ Oroolfklr, le f�� Town of Barnstable BUl C111T1 :, x s�. Y .s .,.. ;,. ..,. .. 4 5,,,:. a a.,.. - ,�,. , -:..F is „ > r y,i�:.: v d..PFans:Musvbe R t �r1ed..dn..lvb-and this Ca d Must;be Ke t y is==itis ble fro the Stre .,A roe a_. P Post;This r SoTJta# n1 .. _ e. q. . r ,. ." „ Cad : . pp atxsa � '.. B n Made. , hfi,a ;lns ecton:Has, ee >s. .>. .Posted.Untli ra I .. ., .� � 3 _<._,.� .�` ,T. � ,.::. Y .,. :,,�'�^, �✓',.4 , '.b., .,x ,,y ,.. -Xf,.� 'r,.,,a_.. '--.gyp , ' action has:been,rnade {,., P. Illt = $er^t�fieat'e� f Occu ,anc.�s=#ie u�rcd.:,suFh-Build n ,shall�Not.,beyOccu [ed.un#�l,ea�F�nal Insp _, • '� '-_' ,a'Y>..��'>., +_s_�'��.ab,.�fitZ. Q. .,x.��,p.aff.,�� .,.��Asr�x ,<a,....a�.."��.; ��«g - Permit No. $-17-2875 Applicant Name: CAPE`COD INSULATION;INC Approvals Date Issued: 09/07/2017 Current Use: : Structure Permit Type: Building Insulation;Residential Expiration Date: 03/07/2018 '_ Foundation. Location: 14 BROOKSHIRE ROAD, HYANNIS Map/Lot 328-041 y Y. Zoning District: SF Sheathing: Owner on Record: AY_OUB,GEORGE T g� Contractor•Name: CAPE COD INSULATION, INC Framing: 1 Address: 818 MONTGOMERY ST3 'Contractor License' .153567 2 FALL RIVER, MA 02720 a Est Project Cost: $2,100.00 Chimney: Description: weatherization' Permit Fee: $85.00 ; F Insulation: Project Review Req: weatherization '- s Fee Paid $85.00 9/7/2017 Final: Date i Plumbing/Gas Rough Plumbing: 4 Building Official Final Plumbing: This permit shall be deemed abandoned and,invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and�the,,approved construction documents for which this permit has been granted. � " All construction,alterations and changes of use of any building and structurestshall be in compliance with the local zoning by laws nd codes. Final Gas: This permit shall be displayed in a location clearly visible from access streetor'road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. I F Electrical s The Certificate of Occupancy will not be issued until all applicable signatu es by the 13uiildi g{and Fire Officials are provided on thispermit. Service: Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or FootingRough: 2.Sheathing Inspection 3.All fireplaces must be inspected at the throat level before firest flue lining is installed Final:4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final:Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall-not proceed until the Inspector has approved the various stages of construction Persons-co.ntractln g"Wlth'unre g Istered.contras_tors;do.:not haue'.access to.-the: uarant fund (asset forth In IVIGL.c142A): . . g Y. _ Fire Department Building plans are to.be available on site Firal. All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 32..8 Parcel D"// Application #� Health Division Date Issued 9 /2 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village ,J/4 Owner , y6 4., 73 Address Telephone /';14 y- i fci f 2, Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 27 Construction Type_/&✓ _J/,-_ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Q' Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes 2-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 ( 9 baths)including : 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: at//, - Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ q(/� Commercial ❑Yes ❑ No If yes, site plan review# A001AJ0 Current Use Proposed Use =:a 'mac. APPLICANT INFORMATION ` (BUILDER OR HOMEOWNER) 4,4D Name W�t, _ i.v rLj !T!:�ekZ Telephone Number S _0 l77_5�IzL`f' Address f� ��Q�2��� C/� License#�/�Tp� 4;� "f u Home Improvement Contractor# Emai1,&Vh AB/® e-A&e'o Aaf t) 4w Worker's Compensation # 4>C l .3` �Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �,/ ;z 2 h 7 i FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. T,. The Commonwealth of Massachusetts Department of XndustrlalAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www,mass,gov/dla Workers' Compensation Insurance Affldavit: Builders/Contractors/Electrlclans/Plumbers, TO BE FILED WITH THE PERMITTING AUTHORITY, Aan_.1�cant-Inh motion Please Print Le Name (Buslness/Organizaeor4ndivid4al); Cape Cod Insulation Address; 18 Reardon Circle City/State/Zip; South Yermouth,MA 02664 phone #; 508-775-1214 Are you an employer?Check the appropriate boxt i,©l am s em to er with 48 Type of project(required); D Y employees(full and/or part•tlma),e 2,111 am a sole proprietor or partnership and have no employees working for me In 7' New construction any oapaoity,[No workers'comp,insurnnoe required,j 8, ❑ Remodeling 3,C]1 am a homeowner doing all work myself,,[No workers'comp,Insurance required,)t 9, ❑Demolition 4,C3 I am ensure a homeowner and will be hiring oontraotora to conduct all work on my property, 1 w111 10 ❑ Building addition ensure that UI oontraotora etcher have workers'compensation lnsuranoe or are sole proprietors with no employees. 11,[]131ectrical repairs or additions 5,(]1 am a general contractor and I have hired the sub•oontreetors listed on the attached sheet, 12,❑plumbing repairs or additions These sub-contraoton have employees and have workers'comp,insure totj 13,[]Roof repairs 6,[]We are a corporation and its officers have exercised their right of exemption per MOL o, 14,2.1 Other W eatherization 152,11(4),and we have no employees,rNo workers'comp,Inswun required,) tlAny applicant that checks bpx#1 must also fill out the section below showing their workers'compensation policy Information t Homeowners who submit tl ,Affidavit indicating they are doing all work and then hire outside eontraotors must submit a now affidavit Indicating such tContmotors that cheek this box must attached an additional sheet showing the nazme of the sub•oontmotots and state whether or not those endue,have employees. If the sub-contractors Kaye employees,they must Provide their workers'comp,P011oy number, I am an employer'that Is providing workers'compensation Insurance for my employees, Below is the policy andJob site iformation, Insurance Company Name, Atlantic Charter 00431902 ' Policy#or Self-ins,Llo,#, WCE Expiration Date' 06/30/2018 Job Site Addresi:4L_9" a ,/ City/State/Zip; - ft&e), Attach a copy ofthe workers' compensation policy declaration page(showing the policy 1au berandexpira on Failure to secure coverage as required under MOL e, 1521,§25A Is a criminal violation punishable by a fine up to$1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against-the violator,A copy of this statement may be forwarded to the Office of Invest(gations of the DIA for insurance coverage vedfloatlon, I do hereby certVy under the pains and penalties of perjury that the iVormation provided above is true and correci: SigHenry Cassidy �", :w`"t. ,M..,�.w,, .�.„ Bhonej, 508.775-1214 Official use only, Do not write in this area, to be completed by city or town olylclai City or Town PermltlLicense# Issuing Authority(circle one)i 1,Board of Health 2, Building Department 3, City/Town Clerk 4, Electrical Inspector;5� Plumbing inspector 6,Other Contact Persons Phone#t CAPECOD-27 KD DATE(MMID Y)LE ACORO" CERTIFICATE OF LIABILITY INSURANCE 06/30/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER C ACT RogRte 134 A/C,No Exters&Gray Insurance Agency,Inc. PHONE 434 n/c,No:(877)816-2156 South Dennis,MA 02660 - AIL .mail rogersgra .com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peer less Insurance Company 24198 INSURED INSURER B:Safely Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ CLAIMS-MADE [X]OCCUR CBP8263063 04/01/2017 04/01/2018 DAMAGE TOE ES RENTED 100,000 MED EXP(Any one erson 5,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,00- X POLICY❑jpeT LOC . PRODUCTS•COMP/OP AGG 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ciden ANY AUTO 6232707 COM 02 04/01/2017 04/01/2018 OWNED SCHEDULED BODILY INJURY Per person) $ AUTOS ONLY X AUUTNOOSy��Ep BODILY INJURY Per accident X AU S ONLY X AUTOS ONLY ROPERTY AMAGE sr.ccident $ C UMBRELLA LIAB X OCCUR EACH OCCURRENCE 2,000,000 X Exclessuna CLAIMS-MADE EXC10006635002 04/01/2017 04/01/2018 AGGREGATE 2,000,000 DED RETENTION$ D WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N RIO WCE00431902 06/30/2017 06/30/2018 E.L.EACH ACCIDENT 1,000,000 RQFFICER M9 NER EXCLUDED? �N N/A e I H) 1,000,000 It yes,describe under E.L.DISEASE-EA EMPLOYEE DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Thlelsch Engineering Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 Frances Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Cranston,RI 02910 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION: All rights reserved, The ACORD name and logo are registered marks of ACORD board of Sullding Regu atlons�and8 andarcyl ndards l,loensei 09.100888 ' . Oanetruotlon 9uperv�sor lr HENRY V OAWIDY; 8$HBO ROW W30T YARMOUJ'H `1 fs AINlII' , I1 � �:. 9xpiratloni ' Co missloner fir 1112017 Office of Consumer Affairs and Business Re 1.0 Park Pima - Sulte.6170 Regulation, Boston, Mai�`,e'h� setts 02116 Home Improveme..I.. �t r rrucTrutv;uln'rrnrfr)r+yotor Registration e Co r � T pe' `Oorp n Ca ;Its,«. , �,,,,,,,;', ,�� �ion� oratlo p � Insulatlon, Inc �� ,;,,' ' .'r':'►�:r' t�'.1f Reglstra 163 18 ;.fltlrt'.,v„LPL! i, r 6$7 Reard��i Cirole ;rll'VII'c W �xplratlonl 12/1a/2018 SoYarmouth � .` .. M:.?r v l. , MA 026 � .,�; ''`-�,,, ri'�.,{.� . M 64 ' � yy �',tl trd��.{" �rlll'fltt�till� '`�4`A�,I' ay 40M�04111 �.,,�. Update Addreea and return card Mark reason Io p� r ohanga, ��V��c4J(60IGGWBG`tJ r) rtt-near;n!_►v4,Tn:ploy/m'attrl.�.l.o,9t. ' r�#... OHIO$of OOn1UMIrAlllira&BvIlMs n1guiallon KOMI IMPROVEMENT OONTRAOTOR T'-ft..l Oorporallon R/glltratlon valid for(ndlvlduai use only before the explratlon date, If aI P 1 112q Moe of Oonsumer Affairs and sl esnRegulatlon 10 Park Plaza a 5170 I' t, UP0 Ood lihs4l t ' �1 Boston,M 11 Henry Oassldyy'+;'.� 18 Reardon Olrol 8a Yarmouth,M '�; Vnderseoretary t al hout sl atu ,, i Pa es.a p'tti_......ck..oviledg`e ahat.this reement Is under teal. i 9 e ea t is intended b the Partie s s that the Tenant or an ' — y successor Tenant,is the:intended;trerieficiaiy.of the Agreement and-shall have a right-of enforcement r a rtyQ. rtera=.Sr`nai`:e`. // $.. r Date 1 I l 7 ....�rta Ame WC ,s= x J k :_ ,.. =x fi. v�R S. 1,.k •Sb: a• fit• :� na :t at s -,. �.pFit,_... .,, ..x,..,,...., ,..:..:::..... ....... ..:..r, _k - (o;���� t k ae^ ., -y,.. 1-v[.a,-tx :':_:,^^`-.l%:.:r.:t....::.. ....:.::...::Vnt1..`_v.'�T:�,':•:::;.,� - ! r' ..^j , , _:.-*=^tea.., ...,,.,,. .. ....._:.�...............:..:.... .. .. - e tion W. Cazeau. .., ,fie,..._[.. .. ....:, . . It.... �► OItS-_. z .. ...,.:.. MM.- �.. <'T �ns#ni 4r �Qtl a �t X .Y, T q,n r _ e c+. u n� 'Lx, ��'+F. -,a:,a 1..4-~:!••s:t' .-.,.,...:..v-..-::,....r.:�,..1:::'.._::,.:i.r::..:..:.:.:.....::,: nr t rt, , .u f Z _ - L�u-an-•6,1 3 c y ti- n ir J.t� a- K yn. i.•, ny - Et �yy ti tic ,y" _ "`max::.3•.,: t� �.Y ".t::4•a va. at "hn.V.�iV?};:�;`.;!?i�c,•S,io;r,'[::;-y:;�;':y:.::;i:�����;`F:;tiS'�.'�;��1:': >a w } QnO r`j'4 r CAPE CO ,{ r9. INSULATION FIBER GLASS SEAMLESS SPRAT FOAM SUSFENGED �; .,}3•♦,a l BATTS GUTTERS INSULATION CEILINGS 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 � . Date: Dear Building Inspector ' f Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed& E 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. f Property Owner Property Address Village F Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes Floors i Walls 1 1 a ' Sincerely H y Ca dy Jr, resident 4 Cape Cod I sulation, Inc. �► _ - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel �' Application #,�0l J Health Division Date Issued Conservation Division Application Fee 'UV Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village t�(O9nu a5 Owner (_2�r tA, 6-- oda Address TI$ ►'►1oPA,Q o.•er--i S}-• PA�� 9:, , j- Telephone 7?N, G`1 y^ q 23 MR- 601-7;Lb Permit Request t�-c4' ej✓�►z►9�-�ov✓ �l►�� �, R"� C e����o��c re�}�C �o�s �� y Sip 3' V,ewb r,)&A—, p�4� L,*s k,w► CrAl"low, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain - Groundwater Overlay Project Valuation 5_0 v 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 N� 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 I Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stov®:-.❑Yai ❑ No N M 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 UsEL Proposed"Use T - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) hev ry Cis �- Name C fte Co co .Q6LJ44 F'oiu Telephone Number 5ag-77 S—( --I � Address 44s-S �ygt✓�o� . n License # 10 0 9�� �,/,q�-�v i� M i4• Q�0 Home Improvement Contractor# 5-L7 Worker's Compensation # Gu d C_00 S oL /C ' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE -7 —/7't r FOR OFFICIAL USE ONLY .APPLICATION# DATE ISSUED ' MAP/PARCEL NO. r f - ADDRESS VILLAGE, r , OWNER 4 DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL: PLUMBING: ROUGH FINAL}' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 7 Tie Commonwealth of Massachusetts ' Y---- Department of Industrial Accidents 1 Office of Investigations 600 Washington Street Boston, MA 02111 .�yy www.rnass.gov/aria , Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Print P,eLyibly Name (Business/Organization/Indivi dual):---CA Address: ✓� - City/State/Zip: Phone #: SOS 7 7 r, Q Are you an employer?Check th appropriate box: Type of project(required): 1.X I am a employer with 4. I am a general contractor and I 6. ❑New construction * have hired the sub-contractors . . ei>:iployees(frill and/or'part-time). ... - 2.❑ I am a sole proprietor.or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working forme in any capacity. employees and have workers' 9 Building addition No workers' comp. insurance comp. insurance.$ required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner.doing all work officers have exercised their l LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12.0 Roof repairs insurance required.] t c. 152, e s, [ and or have no 13.❑ Other(4tX"rn _ employees. [No workers' ;. � Q�'�� comp. insurance requued.] *Any applicant that checks box#) must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work end then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If fhc sub-contractors have employees,they must provide their workers'comp.policy number. f am an employer that is providing workers'compensation insurance for my employees. .Below is the policy and job site inforrnatiom 1 - Insurance Company Name: ! L'611-'('I t co Policy#or Self-Ins, Lic.#; CA,)CA 00CZY9 0� Expiration Date; b 3� Job Site Address: �y wk-5A W—) City/State/Zip: �TT��//ff��tiA,°5 /I��• C�L I lie declaration page (showing the policy rkmber and expiration date). Attach a cop} of the workers. compensation policy p f; ( g p Y Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of.criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250,00 a day against the violator. Be advised that a copy of,this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ldo hereby certify cu e pa' and penalties ofperjury that the information provided above is trice and correct. Si nature: Date; ✓�$ �! _ _ Phone#; Yo 715 ' 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 Flealth 2. Building Department 3, City/Town Cleric 4. Electrical Inspector 5. Plumbing Inspector _ 6. Other Contact Person: ` ' Phone#: /2011 Time: 11:28 AM To: 9,15087785735 Rogers & Uray ins. rage: uue Client#:4597 CCINSUL CERTIFICATE OF LIABILITY INSURANCE D7/0112011FACORU. NWDDYM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Margaret Young Rogers&Gray Ins.-So.Dennis PHONE o F 0 434 Route 134 N Ext: - - AIC No58-258-2102 oun ma ro ers ra ADDRESS: Y 9 � 9 9 Y•com P.0.Box 1601 CUSTOMER ID#: South Dennis,MA 02660-1601 INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A:Peerless Insurance 18333 Cape Cod Insulation Inc INSURERS,Ohio Casualty Insurance Company 455 Yarmouth Road INSURER CAtlantic Charter Insurance Hyannis,MA 02601 Commerce Insurance Company 34754 INSURER D: P Y INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR NSR POLICY NUMBER MMIDD MMIDDIYYYY LIMBS A GENERAL LIABILITY CBP8263063 04/01/2011 04101/2012 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrencel $100,000 CLAIMS-MADE Fx�OCCUR MED EXP(Any one person) $5,000 PERSONAL&ACV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 : POLICY F7 PR0 LOC $ D AUTOMOBILE LIABILITY 11MMBCKVMK 04101/2011 04/01/2012 COMBINED SINGLE LIMIT $ . (Ea accident) 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $_ $ B UMBRELLA LIAB X OCCUR 0001254514645 04/01/2011 04101/2012 EACH OCCURRENCE $1 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1 000,000 DEDUCTIBLE $ X RETENTION 10000 $ C WORKERS COMPENSATION WCA00525902 06/30/2011 06130I201 X WC STATU- OTH• FR AND EMPLOYERS'LIABILITY RYLIMIT ER ANY PROPRIETORIPARTNER/EXECUTIVEYIN E.L EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? ❑N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors (See Attached Descriptions) r CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE , 01988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109) 1 of 2 The ACORD name and logo are registered marks of ACORD #S68575/M68179 MEY y ` 10 Park Plaza- Suite 5170 Boston,Massachusetts 0211.E •,, Home Improvement Caatractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 -------. CAPE COD INSULATION, INC HENRY CASSIDY ------- - 455 YARMOUTH RD. HYANNIS, MA 02601 A; ...... .,Update Address and return card.Mark reason for change. Address (J Renewal Employment C-) Lost Car � d �_ cat sons owoa oioti2ts License or registration valid for individcl use only Office o mer=AffairSus ne Kegul tion before the expiration date. If'found return to: HOME Type: _ Office of Consumer Affairs and Business Regulation .•w. Registration: 153567 10 Park Plaza-Suite 5170 Expiration: 1:2/15/2012 Private Corporation Boston,MA 02116 OD INSULATIQ ., HENRY CASSIDY.',.: 455 YARMOUTH t g HYANNiS,MA 026ta:a .-.fir.,:;; : ..:: Undersecretary Atalid ith t si tune Massachutic(ts- Dc`Itartmt'nt of Puhlll' S,tl'ctN Board (.FrBuilding Regulations and Standards Construction Supervisor License License' CS 100988 Restricted to. 00 HENRY CASSIDY 8.:SHED ROW - ' WE$T YARMOUTH, MA 02673 '� '5'A'4 Expiration: Ii/11/2011 c uiui..i,rocr Tr#: 100988 F ......................... 46-0 W---t Main Street HOUSING Hyannis, MA 02601-3698 HOME REPAIR ENERGY & ASSISTANCE T (508) 771-5400 7 F (508)790-2425 . ...... CORPORATION TTY on all lines wunv.haconcapecod.org LANDLORD AZZ-?-A, TENANT -- I PHONE- 771-1-6 qY-5t;A-3 PHONE t c( Dear Landlord, Your tenant is eligible for services through the Weatherization Program. Program regulations permit us to spend an average of$5,000.00 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. Prior to making the inspection and doing the work we must have your permission. If you want your tenant to participate in this program,please sign the agreement and return the form to me. This agreement states that: 1. You will not raise the rent because of the Weatherization work or for one year from the time the work is completed. I You will not evict your tenant for one year following work completion date except for good cause related to the tenant's failure to pay rent or serious or repeated violation of the terms of tenancy. 3. If you sell the property during the specified period,either the new owner must assume the obligations under the agreement prior to sale,or you must refund to us the entire amount of materials and labor we spent in weatherizing the unit. 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. Failure to fill out the entire form will result in a delay in processing the application. If you have any questions please call Michael Sartori at 508-771-5400,x. 105. • Sincerely, 28 29aa t 01 ry Ruth Bechtold' Assistant Director Energy and Home Repair Department ... _. ........ ....... . . _...... ... ..-. .._ ........... _...._...... _. TENANT/PROPERTY OWNER/AGENCY WEATHERIZATION AGREEMENT 1. The Parties to this-Agreement are the following: C e2 A� EA CH E CO (hereafter known as Tenant), (print your tenant's name) 2 C=OdZ GE 1-- AY f n 08 (hereafter known as Property Owner), (print 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. The Agency will sign and return a copy of the Agreement upon completion of the proposed Pdeatherization work. 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at(street,town) MA 096101 1 T S H (0� 10OAQ , ,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 Weatherizatiou 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, Executive Office of Communities and Development(Office of Energy Conservation)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 Veatherization work will be performed in'accordance with the Property Owner's consent as further specified below:. ***RUML ONLY ONE OF THE FOLLO` UV (G** V1i� •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. f - 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. 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. 6. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel supplier/utility supplier as to the quantity of fuel/utilities used at the above address in each of the past three years and the future three years. The information is to be used only to determine the cost effectiveness of the Weatherization improvements. 7. The Property Owner agrees that the rent for the dwelling unit will not be raised because of any increase in the value thereof due solely to the Weatherization work performed. 8. *In consideration of the Weatherization work hereunder,the Property Owner further agrees that upon the effective date of this Agreement and during a period extending one full year from the time the work is completed: a) The present rent$ per month will not be raised for any reason. (The rent amount must be filled in). **However,this Paragraph(8a)will be waived by the Agency in writing if,and only if,the premises are leased under a state or federal rent subsidy"program,in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. Please state which Housing Subsidy program your tenant is on and through which Agency:_ S fj N D LJ I C U�2 j_S rA) rA Tu fe,k T b) The Property Owner will not institute any summary process action for possession except in the case of non-payment of rent or other good cause related to the Tenant(or any successor Tenant). In the event the Property Owner decides to sell the premises,Property Owner shall comply with one v o f the two requirements below: LO --The Property Owner shall not sell the premises unless the buyer agrees(with a copy forwarded to the Agency)in writing prior to sale to assume all obligations of the Property Owner set out in this �C' Agreement:or The Property Owner shall pay the Agency an amount equal to the cost, as certified by the Agency,of the Weatherization materials installed and labor performed in the premises as of the date of sale. Said'amount shall be paid to the Agency immediately upon sale 9. (*Applicable only if Tenant's heat is included in rental payment and blanks are filled in.) At the end of the period set forth in Paragraph 8 above,the rent shall not be raised more than %per for an additional period of one year,and the provisions of 8b and 8c above shall continue in effect for such period. However,the rent provisions of this Paragraph 9 may be waived by the Agency in writing if,and only if,the premises are leased under a state or federal rent subsidy program,in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. 10. The Parties agree that the terms of this Agreement are incorporated into any other lease or agreement between the Property Owner and the Tenant,and between the Property Owner and any successor Tenant,and if there is any conflict between the provisions of this Agreement and the provisions of such other lease or agreement,the provisions of this Agreement shall govern. However,if such other lease or agreement, including without limitation a lease or agreement under state or federal rent subsidy program,contains stronger protections for the Tenant, such stronger protections shall apply. 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 Iimiting 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's Signature: Date-.. Phone: 7 7((- 6 n7 3 Address: _ 5I E M O,ijT&a M ay S j R eET l�LL l2�VFJ-L T �( 0�7�0 Tenant Signatur �Q >>.2-� �, �4-6�`:� 4, ,- Date Agency Approved Weatherization Company: Cta{L¢_ All Cape Energy Caliber Building&Remodeling Cape Cod Insu— lat o Cape Save Creswell Construction Frontier Energy Solutions Lohr&Sons Peter Smith Resolution Energy Rock Solid Construction Sprinkle Home Improvement This Agreement becomes Effective as of the Date of the Agency's Signature. The Agency will sign,and return copies of the Agreement to all parties,upon completion of the proposed Weatherization work. The Agreement shall remain in Effect for one full year from the Effective Date. Agency Signature Date