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HomeMy WebLinkAbout0115 CHESTNUT STREETr !/S �� r � - - _ _ - -- _ _ � � - _ . . °: The Town of Barnstable Q. ARic 916 9. � Department of Health Safety and Environmental Services rFp,�,i► Building Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6227 w, Ralph Crossen Fax: 508-790-6230 , Building Commissioner For office use only 4. Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements, Type of Work: dnj4,er zz Est. Cost Address of Work: l 1 S C�eS4rya T S-r. Owner's `lame MKS G Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under 5I,000. Building not owner-occupied Owner pulling own permit Notice is hereb?v given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. �flP /ZZ� C �p OR Date Owners Name --= r Department of Industrial Accidents ?� '= . -� : Ol�ct oflanstf�atlovs - - 600 Washington Street Boston,Mass. 02111 Workers' Com,Pensation Insurance davit name: POPS• 6,n4, ,OGi V CffUZ4 Af location: ,I' Pia Citv ` nhone 43 '•� J`�� ❑ I am a homeowner erforn ng all work myself. ❑ I am a sole lororTietar and have no one working in a�capacity I am an employer providing workers' compensan n for my employees working on this lob cam any Tia*Me Awl ' > hone#:. aAr .F fnsarnace Ca. iiaiicv# .: : ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following war]=' compensation polices: ... _. CetnAsny ilsme. >> :.::;::: : address. :.:. .;.. ::;:::. .:. ......... ::.. ::;:..: ......::.:::. XX :. .: ;:.;.:. #v . .. one:#; � kilt : .... �....:i:iii:<' :i:: ii:;:;:jigi;iv({: :i i:L:Jii li::i::isisLT:::::::i::_::<::;�ii :: :. ... .:.; . camp n n address. Clt9 %. p Gene#= _....... ....... ::.. ::.+>.....:. s: asvrsnce ca... % _ ..... .. .....:. ,...... olicv#.:. :>::;::;:::>:: F. Famut to secure coverage as required under Section 25A of MGL 152 an lead to the imposiilan of a'iruftsal penalties of a Hate up to S1,SOO.00 and/or one years'imprisortaent as well as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I understand ihst a copy of this statemtmt may be forwarded to the Oalce of Investigations of the DIA for coverage verlIIadlon. I do hereby c�erri&under the pairs and penakies of perjury that the information provided above is tru'and correct Signature _ Date Print ngtrn,- tl R,-54H Phane g a/o&o- 951 A otIIdal use only do not write in this arts to be completed by city or town otIIdal city or towTu pernsit/licaue is ❑Buading Department ❑T.iceming Board chock if t,nxnraLxt&resperoe is rTgmred ❑selectmen's Offt" ❑H_ ealthDeparuneat contact person: phone 0; ❑Other Uri""gigs?JAI ,4. ' ✓76 U/O'I)7//YI.07Z1(1PpGd 6` & �iFe�om,.r�ho�eu�eal�.o�.i�.oaaa�/uaellt i ' HOME IMPROVEMENT CONTRACTOR DEPARTMENT OF PUBLIC SAFETY Registration 100740 CONSTRllf iION SUPERVISOR ----EN: S \V Type - PRIVATE CORPORATION Number cxpirF . ' Expiration 06/23/00 CS087Qfi4 02J24!2000 CAPIZZI HOME IMPROVEMENT, INC ( Restrie ed To 00 } � �� p as Capizzi, Sr. } �lruw� CAPi77I ��°��1645 Newton Rd. ADMINISTRATOR Cotuit MA 02635 164S NE„�TOWN RD ' COTUIT, MA 02635 i --------- 1 ✓!ie �omzr�zarur<rea a��f/fa ta�uaPC✓ti E DEPARTMENT OF PUBLIC SAFETY j j n CONSTRUCTI00-SUPERVISOR LICENSE - Numbet Expires: Res tTo;- 00 THOMAS_1a NPI71I JR « '280 PERCIVAC OR W BARNSTABLE, MA 02668 i( `� A ✓12CVdYI7/IYLdIt[!/ECLCU2 d�a. (/(Q�SClC/LCLJP.�J r DEPARTMENT OF PUBLIC SAFETY s f CONSTRUCTION SUPERVISOR LICENSE / Number Expires: Restricted'To: 00 _ FREOERIU_V RASCH III 4 'i �r"K� !1068 BOURNE.RO PLYMOUTH, MA 02360 required unless same color/same materials specified ou application Map/parcel number Sign-offs m: Tax Collector 6/ Treasurer . P#of squares of shingles or square footage of roof to be shingled psp ify stripping old shingles or going over old roof. If going over Ohow many roof layers existing now what size are rafters? What is span? 0 Complete dwelling information for the Assessor's Dept. -if known Workman's Comp. form ' Home Improvement Contractor Affidavit(RESIDENTIAL ONLY Home Improvement Contractor's License OR Homeowner's License Exemption(RESIDENTIAL ONLY Check expiration date on license COMMERCIAL WORK-No License is required. q-fo=49UAITSI Rev 6WS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .Map: 3G_ � Parcel. (3 a Permit# 11 beaAILD vision Date Issued r Consematiorr-9ntisien _ Fee y e Tax Collecto o Treasure a r t Planning Dept. S Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address acstmt+ S elf Village ► gnu 5 .Owner Yl`l C �D� Address 'J�39 U� !'�yi�! Cc�.O �r0 Telephone clj 0 3 T 9 zf�d.3 Permit Request 5TR t E_kaOF Square feet: 1 st floor:existing proposed 2nd floor:existing 'proposed Total new Estimated Project Cost, CIO Zoning District Flood Plain Groundwater Overlay _Construction Type to vv b 6 e Lot Size t Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ -Multi-Family(#units) Age of Existing Structure Historic.House:- ❑Yes 40 On.Old King's Highway: ❑Yes Basement Type: 0 Full 0 Crawl 0 Walkout, O 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: •0 Gas '0 Oil O Electric" 0 Otherr A `Central Air: 0 Yes ❑No Fireplaces: Existing.,- New Existing wood/coal stove: 0 Yes ❑No ,�o,petached garage:Cl existing 0 new size Pool:O existing ❑new size Barn:0 existing ❑new size Attached garage:0 existing ❑'new size Shed:0 existing ❑new size Other: • t Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial ❑Yes LWI(o If yes,Me'plan review# - Current Use Proposed Use BUILDER INFORMATION Name 0 1 Z°Z i 6/h.,r_ crMP1e6Ve E,Aj1'- Telephone Number Address /#gS— A)e w Td Akt l� b . License# `�9 067-0.1 ilh dd, 35** Home Improvement Contractor# 1,0 0 rf40 Worker's Compensation# GtJ(? 6'fa?66if l ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO . SIGNATURE DATE �3��� FOR R OFFICIAL USE ONLY t PERMIT NO. DATE ISSUED MAP/PARCEL-NO., ADDRESS ,a _ VILLAGE OWNERr DATE OF INSPECTION. LF FOUNDATION FRAME INSULATION FIREPLACE k ELECTRICAL: ROUGH FINAL ( r Y 1 PLUMBING: ROUGH FINAL ' GAS: t" ROUGH - FINAL > r t ,r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Cape Save Inc.` J 7-D Huntington Avenue South Yarmouth MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 6/3/12 Town of Barnstable Thomas Perry CB0 Building Commissioner ,. 200 Main St. Hyannis,MA 02601' l RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for l5-Chestnut.Street,-Hyannis has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-30 & R-38 cellulose Walls: R-11 fiberglass attic stairwell walls _ Basement: R-19 fiberglass box sill area Ventilation: 4 low profile roof vents All work performed meets or exceeds Federal and State Requirements. Sincerely,_ ,. "ell � '. Cam •� William McCluskeya TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 0 g Parcel -Application # Health Division Date Issued ce Conservation Division Application Fee " a Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 1 _: Historic - OKH _Preservation/ Hyannis Project Street Address 5 C1 ubm i Village CL,ok Owner C aw I Car rs0A Address 534 Ze%emn D�:q 4 Pilo No 94303 Telephone Permit Request N4 Gqa 1�` 3$ no-%Aase tb -tl,e cW t�• code w,14 roo�-PIr -�-_g. �ld R- �;1 I�ss ,I-d tie n a ne. �,acnn��li' w��-�► �n�� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �1 ► 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 Jr 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 40il ❑ Electric ❑ Other Central Air: ❑Yes XNo Fireplaces: Existing New Existing wood/coal stove: �❑Yews ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑wasting Lthew�ize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ _ €.t a Commercial ❑Yes f(No If yes, site plan review # A ;,q Current Use s - "T - _Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) �0_) 5n -m- 0318 Name i , nc-0 Telephone Number Address ' �J,Aiien +60 SA �Jer- _ License # r0\7 l� S0VA Ya,M+naV\A 11� Home Improvement Contractor# 1 1 3,rL, Worker's Compensation # �W�3a99�,,a. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO )("rrjywl-t� SIGNATURE DATE s FOR OFFICIAL USE ONLY a - APPLICATION# 3 DATE ISSUED r MAP/PARCEL NO. i `h ADDRESS VILLAGE OWNER , 4 t r x DATE OF INSPECTION: f _ _FOUNDATION' % * 4 ' FRAME i INSULATION' FIREPLACE z _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL p GAS: ROUGH _ FINAL 3 - (FINAL BUILDING w - DATE CLOSED OUT ASSOCIATION.PLAN NO. s a f A 2 3 4� Free We' a .0 Your tenant has requested and is eligible for weatherization fryour. rental home through government funding. This will be provdd6.0 at ►i►o cost to you. Program regulations permit us to spend around $4000- $'10,000 in materials and labor per dwelling unit_ - ~ Program regulations require us to,weather-strip and caulk doorsand 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: w. ~ 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; s the proof of ownership as soon as possible. , If we do not receive the enclosed form within two weeks, we will. S do a basic energy audit of the home, but no weatherization work can be recommended or done. = j If you have any questions pleasecal! Cathy.Finn at 508-771-5400, LANDLORD _ 'TENANT CAS` t • R PHONE c - 'PHONE ��• l' y i 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) (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. 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 worts and inspections. The Weatherization work will be performed in accordance with the Property Owner's consent as further specified below; Fit t I consent to performance by the Agency and its contractors of any Weatherization work determined necessary and appropriate by the Agency as a qs. 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 z the completion of work. i < I will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's ry inspection report and a statement of the estimated work and associated value.. � This additional consent will be sent under separate cover as Attachment A. 1 ,T understand that the Agency will provide a detailed statement of the actual worts 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 201112012. 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. d 6. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel supplier/utility supplier as to the quantity of fueVutilities 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 Weatherizabon work hereunder,the Property Owner further agrees that upon the effective date of this Agreement and during a period extending.through 2011/2012 is approximately one year from the time the work is completed. a ;- er onth 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 Mousing Subsidy program your tenant is on and through which Agency. 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). c) In the event the Property Owner decides to sell the premises, Property Owner shall comply with one of the two requirements below: , —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 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 in Tenant' 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 govem. 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. e , 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: Psi `irte� ` ,.. r 7 :`ate12h rAoRai , Address: DPL Tenant Signature Date Agency Approved Weatherization Company Prme v All Cape Energy Caliber Building & Remodeling Cape Cod Insulation = CC:a -a Creswell Construction Frontier Energy Solutions Lohr&Sons Peter Smith Resolution Energy Building Performance Contracting LLC Nial Hopkins Builders Inc. Michael T McMahone&Son Inc_ 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 y r t°SAVE . Weatherization 08 39 -039 J � . w August 22, 2Q10 To Whom It May Concern: William J. McCluskey is an employee of Cape Save. He`is authorized to negotiate contracts and building-permits for our.company. s Michael McCluskey - t Cape Sere—owner 919-593-5939 cell X Huntington Avenue,South Yarmouth,MA 026" The Commonwealth of Massachusetts j Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lel=ibly Name(Businesslorganization!individual): M 10 14 A E( Address: nit,OTb(3 A•e City/State/Zip: YAAMo AUR Ai 67.Ugone M - 3q9_.0 3 Are you an employer? Check the appropriate box: Type of project(required): 1.[K I am a employer with h 4- I am a general contractor and 1 G. ❑New construction employees(full and/or part4ime).T have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached.sheet. 7. Q Remodeling ne ship and have no employees These-sub-contractors:have S. Demolition working for me in any capacity. employees and have workers' 9. [] Building addition [No workers cotiip. insurance. comp.insurancc.- required.] 5: We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I ant a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per.MGL 12_0 Roof repairs insurance required]} c. 152,51(4),and we have no s .1 1 employees. [No workers' 13.®Oder n 4. M -comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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 the sub-contractors have employees,they must provide their workers'comp.policy nurnber. I aet+an employer that is providing workers'compensation.insurance for my employees. Below is the policy and job site information. '�` Insurance Company Name: P A n b�o a V •1-.�S t! r( Ce `--o m p Q,() )( Policy#or Self-ins.Lic.#: C 3 9 I Expiration Date: 1 C 16+r,w S-rr . Job Site Address: \ City/State/Zip: Attach a copy of the workers'compensation policy declaration.page(showing the policy a=4 and expiration date). Failure to secure coverage As:required under Section 25A of MGL c. 152 can lead to the.imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well.as,civil penalties in the form of a.STOP WORK ORDER and a fine- of up to$25.0.00 a day against.the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerd jy under the pains and penalties erjury that the information provided above is true and correct f Date: Si afore: - •�- — Phone# q FS Official use on&. Do not ttirite in this area,to be completed by city or town official.- City or Torn: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electricaf Inspector. 5.Plumbing Inspector 6.Other Contact Person: Phone#: .. . CERTIFICATE OF LIABILITY INSURANCE D0/20/2011) Icy ' l /20/ 0 1 SY,IS 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 NAMEACT Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 FAX No (781)963-4620 15 Patella Park Drive AMpIL .ssperrazza@risk-strategies.com DRESS Suite 240 - INSURERS AFFORDING COVERAGE NAIC# Randolph MA. 02368 INSURERA:Selective Insurance INSURED INSURERB:Safety Insurance Company 33618 Michael McCluskey, DBA: Cape Save INSURER C:Technology Insurance Company 7 C Huntington Ave INSURER D: INSURER E South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL11102041451 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 DDLSUTYPE OF INSURANCE A B POLICY NUMBER MM/DDYIYYY`( MMID LTR D,IIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 L AGE TO X COMMERCIAL GENERAL LIABILITY PRREM SES EaEoccurrence S 100,000 A CLAIMS-MADE aOCCUR CPPS1994480 0/16/2011 0/16/2012 MED EXP(Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,0001 X POLICY PlFrT RO LOC $ AUTOMOBILE LIABILITY Ee BINEDtSINGLE LIMIT $ 1 000,000 a B ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED 6208200 ` 1/6/2011 1/6/2012 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED - PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident X Underinsured motorist Blsplit $100000 300000 X UMBRELLA LIAB X OCCUR CPPS1994480 0/16/2011. 0/16/2012 EACH OCCURRENCE S 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S 1,000,000 DED RETENTION$ S TH- C WORKERS COMPENSATION Executive excluded X WC STATURY IMIT ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N rom coverage E.L.EACH ACCIDENT $ _ 500,000 OFFICERIMEMBER EXCLUDED? NIA 0/21/2011 10/21/2012 (Mandatory in NH) C3297.9�2• - 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/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc., and Housing Assistance Corporation are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Housing Assistance Corp 484 Main Street Hyannis, MA 02 601-3 6 98 AUTHORIZED REPRESENTATIVE Michael Christian/SMS ACORD 26(2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. INSm oninn.r,)n1 Tho annpn name anri Inn.aro ronieforori marine of Arno 1 6777 0 c onsumerAaie/��d sm usmess Regulation c 10 Park_Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improve mentContractor Registration Registration: 164432 . Type: Supplement Card CAPE SAVE = Expiration: 10/6/2013 WILLIAM McCLUSKEY 8201 S. HOURD CT - CHAPEL HILL, NC 27516 ' Update Address and return card.Mark reason for change. IPS-CA1 0 50M-04104-G101216 L Address F-1 Renewal '-I Employment Lost Card o ` Office of Consumer Affairs&Business Regulation License or registration valid for individul use only a r410ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:' C, Office of Consumer Affairs and Business Regulation Registration,::164432 Type: 10 Park Plaza-Suite 5170 � J j Expiration 10/6/2Q13 Supplement Card Boston,MA 02116 CAPE SAVE WILLIAM McCLUSKEY - 7C HUNTING AVE-: S.YARMOUTH,MA:02664 - Undersecretary Not valid without ' nature ''- el:assachusett. Department- of Public Safctc Board of Building Rc_�ulaticros and Standards ' Construction.Supervisor Specialty License License: CS SL 102776 Restricted to 1C WILLIAM MC CLUSKY 37 NAUSET ROAD t : WEST YARMOUTH, MA 02673 ; Expiration: 6128/2013- ' i net Tr#: 102776 S� cs = 0110 6 of rq Town of Barnstable *Permit# Expires 6 mat from issue date Regulatory Services Fee , BnxNsr�►ar.E 9 ��� Thomas F. Geiler,Director Building Division n ' Tom Perry, CEO, Building Commissioner 200 Main Street,Hyannis,MA 02601 ; www.town.bamstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 . EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Yalid without Red X-Press Imprint Map/parcel Number 9 ` Property Address ' esidential Value of Work � 7 Minimum fee of$35.00 for work under$6000.60 Owner's Name&Address Contractor's NameA C_t�. Telephone Number 157?e-aL(6 Home Improvement Contractor License#(if applicable)_ ! J LJ d Construction Supervisor's License#(if applicable) '75 91 2<0' rkrhan's Compensation Insurance Xd Check one: �" '' PERMIT ❑ I am a sole proprietor 31EC13 ❑ the Homeowner 2011 I have Worker's Compensation Insurance �0 e, �. Insurance Company Name ' - _v�: SLZ _. Workman's Comp. Policy# C( � Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) �e-roof(stripping old shingles) All construction debris will be taken to C L: ,se,l ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re=side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windoNys *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Note: Property tyOwner must sig n Property Owner Letter of Permission. A copy of t e Improve t Contractors License&Construction Supervisors License is re ired. SIGNATURE: J . i Q:IWPFILES\F0PMSIbuilding permit formsTMUSS.doc Revised 070110 r� The Commo'nweaUk Of Mossachmeft Depdrhnmt of ladushied Accidents O,,lue of Invesfigadons Bostorn,ilk d2111 www mrl spv1dilr Workers' Compensation Insurance Affidavi#: Biidders/+G ntractorsfEle:cti cians/Pl tubers Applicant InformataDn Pease Frmt.Le 'Ii Name deal) pOlOI�nz5F C- Address:AteIvuZ h Ci rfStatef p: kvwou Ph'one# $C3 Z,-C(6 1 LC ; Are an eaipla er. Check the appropriate bay: ct(impel.-ed'j: ' 0/ am a c mtractor and 1 - Type of pruie 1. I am a employer with � 4. I� 6- 0 New construction employees{W audibrparwime).* have bred the sub-cantrac I❑ I am a sole proprietor,orpartne- listed�the attached sheer` ?. ❑Remodeliaxgj These sob-•contca+rtom have ship and have no employees .. $_ ❑Demolition • wcdcing for mein any capacity_ employees and have wars" 9. Builtit addition To wod='S' camp.inma-mce comp-n=ur;nt:e_$ required.] 5. We are a corpar�tion noel its- 10.0 Electrical repairs or additions o�tcers have exercised their, 3_❑ I am a liomeotvnes doing all .� � 1 I.0 Plvuibing rt�aaiss or additions myself[No wor1m s'ocmp. of exemptian per NfM— 1 of repass insurance required_]T C.152,§1(4),and we have no employ [No,arosi,�, II EI Other'' camp,m=aoee required-] n , •Any appHc=that dmcks boot#1:amsi also i11 out the wuian below shnuingtiI&wmake&ccMP—istim pa&y inf�mnsdao f Hnaieowners who submit this affidavit Mdiczmg they aye d=9 Owed bud dumbua a�tn a conft=ars mnst mbmu anew sfdsvit indicating and !CMMUMrs that t•hort<this bunt mar znRcbed an fde wanes!3bEE'[5�LOW1 L�,,.�� Gg The Lie c#the sub-c=mcton Intl Mn whether or IIot2"hnSE cniiewc gip. .. eaplayeas. Iftbe sub`cmttatscas have employees,&eyaaisi;F vide&Err Waken- mp:paltry amaber. I errn m employer that is prim g wor*e.rs my is thepve71:dMa fab Ske in ormadvn. L 7n=ance Company Name: Policy#or$eft'-ins_Uc Fxpitetion Date: t( Job Site Address: `r ( ✓v,�* "c� CityfStater7sp Attach a copy of the workers' declaration page(showing the policy number and motion date). Failure to secnce'coverage as required under Secticu?JA.6f MGL c.152 cau lead to the imposition of criminal penalties of a, fine up to S150Q_{)0 asidfar one-year imprisonment,as well as civil penalties in tiye form of a STOP WORK ORDER and a fine of up to$250.00 a day against'&e violator_ Be sdvised.tlsat a copy of this statement may be farwarrled to&e'Office of Investigatimrs of the DIA for a cat+IM ge verification I do herek,.Ca ifiy sndir e paints wa byes of tihaf the infor-ttzafiva gravit£ad nlaaira is b lta jind cr►rrect SU. Date: Phone#: OjUkid rM only: Dv na swite in this araa,to be comphdad by cioi or towrri o iiaitit Chy tar Town:. PermitUcense# fssning Authority,(cffde fine}: 1.Board:of Head y.Building Departn.mtit 3.CityiTown Clem d.Electrical inspector 5.Plumbing Inspector 6.Other, 6nlact Person: 3almne#- , R r PROJECT MANAGERS LLC. BUDGET / DESIGN / PERMITTING / SITE SUPERVISOR WILLY PLANINSBEK — CELL 508-246-1476 FAX 5087744-7038 EMAIL — 15 LEXINGTON LN. YARMOUTHPORT, MA 02675 ROOF PROPOSAL To: Jeff& Catherine Carlson 12/10/2011 Re: 115 Chestnuts Project Managers LLC. tender the following bid for labor and materials for the project located at 115 Chestnut St Hyannis, MA • PM will remove existing roof system. • PM will evaluate.frame structure-for any rot, present or possible future problems. • PM will prep roof plain and apply a 3' border of Ice & Water and the balance of roof covered with 15 lb felt paper. • PM will cut back plywood to establish a 2"venting margin for the installation of 8" vented drip edge. This system is not presently installed on the house: Without venting the rafter bays will produce condensation (dampness) for mold & mildew to flourish. If the soffits are not vented the'ridge cap can not breath. • PM will re-boot all penetrations of the roof line. • PM will install Architectural CertainTeed 30 year singles with CertainTeed starters and cap. • All singles will be hurricane nailed for lift protection. • PM will install to all state and local industry standards and codes. • PM will obtain an Express Building Permit. • PM will remove all debris and keep area safe and clean at all times. Total Price: $ 7,800.00 Regards, `� Willy Planinshek r Nlassachusctts - Department of Public Safctv Board of Building Re.-ulations and Standards Construction Supervisor. License t License: CS 95981 WILLIAM PLANINSHEK :� + 15 LEXINGTON LANEr, YARMOUTH PORT, MA 02675 Expiration: 10/25/2012 ('ununissioncr Tr#: 6871 Office o10 mer a s&Biness egu4aon License or registration valid for individul use only! HOME IMPROVEMENT CONTRACTOR before the expiration date. ''ff'"'nd"'te i ij-to'.£�1 Registration: f155863 Type: Office of Consumer Affairs and`$usine§"s Regulation Expiration 5/15%2013 LLC 10 Park Plaza-Suite 5170 r^ ::-, . Boston,MA 02116 8 R "` S R J CT MANAGERS LLC £l, WILLIAM PLANINSHEK' t 1„ 15 L E X I N G T 0 N LN YARMOUTHPORT MA 02675 a Undersecretary Not valid wit on i nature:. - g. . t Nov-0871'1' 01:42pm From- T-004 P.002/003 F-705 1110812011 INSU HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED by THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN HE ISSUING INSURERS ,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, FI PORTANT: -If the Certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION WAIVED, subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement 0h this certificate does not confer rights to the certificate holder in lieu of such endorsement. PRODUCER Edward J McGrath Insurance Agency Inc . PO Box 1003 Dennis,MA 02638 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY I INSURED Project Managers LLC 15 Lexington Lane I Yarmouth Pork MA 02675 �{ COVERAM THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER .'DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. •eo TR I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE Policy EXPIRATION DATE WORKERS COMPENSATIDN AND E'M[PLOYER&LIABRJTY �I HEPROPRIETORI { , i LIMITS ARTNERSIEXECUTIVE I FFICERS ARE NCL❑EXCL D 9847$BD 10/20/2011 10/20/2012 STATUTORY uMITs i. THER wamgv A*ie to MA Or ngfie 5a Only. - CHEA ACCIDEN r $ 100,00 ]ISSEPOUCYLLMIT S 500,000 �SIS[ASE-EACH EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS/VEHICLES/SPECIAL ITERfIS +` RE NO PARTNERS ARE COVERED BY THE WORKERS COMPENSATION POLICY. - - CERTIFICATE HOLDER CANCELLATION TOWN OF YARMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1146 RT 28 EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED!N ACCORDANCE I YARMOUTH, MA02o5 WIHTE THE POUCYPROVISIONS. AUTHOR=D REPRESENTATIVE !I J I II _ .