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HomeMy WebLinkAbout0004 GROUSE LANE TOWN f. BARNSTABLE NLo . H � Q Ln N �4 D"Y'STONN � <L 00 N co- Q O N r _ N Q O 70 QO� 0 u 11, 2G.0' m � z LOT 14 rn G543.. 1 5.F., R 59.4G' l 13UILDING .,LOCATION PLAN FOR 4 GKOU5E. LN.,' WE5T NYANNI5POKT, MA' ,SH OF PREPARED FOR RUSSELL : GEKEMIA- GIL A. m 5CALE: c DATE: DRAWN U BY: 0 .1 '� 30' 1 0- 1 1 =201 G TMW JOB NUMBER: . REV1510N: 5HEET NUMBER: Tea�o I G-202 CPP- WELLER A550CIATE5 P.O. BOX 417 CENTERVILLE, MA 02G32 TELEPHONE: (508) 328-4692 EMAIL: trl5weller@gmall.com REGISTERED LAND SURVEYORS * ENVIRONMENTAL CONSULTANTS Traverse PC r MORTGAGE INSPECTION PLOT PLAN NORTHERN ''ASSOCIATES, INC. ` 630 TURNPIKE STREET N. ANDOVER M_A . 01845 TEL_ 508-975-7117 NOR MA60R.. RUSSELL S.G 6EREMIA L.BIL DEED REF 5455 / 348 L_OCA TIM 4 SROUSE LANE PLAN REF. 245196 'ITY, STATE. ' HYANVYTSPORT MA SCALE,* i— 30 ' DATE' i0 / J5 / 9.t JOB 0.' .9116004 1 68/2� to J \ y 4k t 54-1 Lli � O o a e V A r E'ft t ) pr. �- ' 44 4 CERTIFIED TO: NORTHEAST SA VINGS BANK NOTE: This i-mortgage inspection was prepared I FUR T I tC R STATE THAT IN MY PROFESSIONAL specifically for.mortgage purposes and is not to be relied OPINION the.principle structumrs.and accessory upon as a survoy,-Northern Associates, Inc. accepts no ,X.p/ Y „ ouibuild.ngs'responsibilityCONFORM lor'damages resulting from said reliance by � -- anyone other than the said mortgagee and its assigns"in t. with tliu sutback roqutromonts of rho local zoning connection with its proposed mortgage financing to,said F O S ordinances,and that!hero are no encroachments of major mortgagor. _ r irnprovemonts eithor way across proporty lines except as shown, Z5 C,001 V, MIi 0 A!SO This ,men a e ins ection was — fQ P� ! i PropC-rty is not in a Flood Hazard Area. 9 g p propared in accoroanco i'i0;,er,y with the Technical Standards for bMort^ace Lcan Tk ❑ ,s in a Flood Hazard Area. 1 V Inspections 'us—adopir�d by the Massaehusotts�Association �� ❑ 3 '"formation is insufficient to determine Flood Fiazorc 01 Lend Surveyors and Civil Enginuers, Inc. Flood 11:t=aid determined from latest Fedoral Flood In; :an;u'laic htiao Pannll TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel A lication #" � � NNA Health Division n Date Issued /o / d Vz— Conservation Division Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address e Lan Village Tl(,Iayi y 1 I S Owner t1 ,� GA I I Address �"� Goa La yiAei Telephone _� J e as I �qlU� Permit Request y0' Fames Porch Square feet: 1 st floor: existing 1040 proposed 2nd floor: existing proposed Total new Zoning District 96 Flood Plain Groundwater Overlay Project Valuation 160o•Od Construction Type Lot Size SE Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) &-1 VV Age of Existing Structure R1 i Historic House: ❑Yes )(No On Old King's Highway: ❑Yes ko Basement Type: VFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) 10L40. 66 Number of Baths: Full: existing a5 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: aexisting s0 new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:«4 1 r-� 03 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes to If yes, site plan review# co C" Current Use Proposed Use r- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address 93 S. O rl-ean S )U_ License # 1,S- V U 3 `)M)S I , MA A OZIP3 1 Home Improvement Contractor_# Email 6aer ( "fir QD Worker's Compensation # epwc t5n ALL CONSTRUCTION DEBRIS ESULTING FROM THIS PROJECT WILL BE TAKEN TO t-J exc D SIGNATURE DATE 1 119 l FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME flp IS INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING I 1. DATE CLOSED OUT ASSOCIATION PLAN NO. TNE Town. of Barnstable t Regulatory Services TA y MASS Richard V:Scali,Director F16.3 Building Division Tom Perry,Building Commissioner ' 200:NIain.Street,Hyannis,.NIA.02601 wwwtown:barnstable:ma:us Office: 5.08-862-4038 Fax: 50&790-6230. Property Owner Must Complete:and,Sign This Section If Using_A Builder as Owner of.-the ubleet propert} hereby authorize I Aye 4A. r to act on my behalf, in all matters relative:to work:authori7ed.by this,building pemut application for-. ��►e�- (Addtess of Job) i' **Pool fences and alarms are the responsibility of the'Applicant. Pools: j are:,not to be;filled or utilized before fence is installed and all,final inspections are performed and accepted. ature`ofowner ignature'ofllpplicant . Print Name Punt Naive f t Date. p Im ortant �%�Berkshir'e Hathaway Information �► � e GUARDCompanies�, Insurance Agency Baer Custom Carpentry LLC RISK STRATEGIES COMPANY 93 South Orleans Road 15 Pacella Park Drive Brewster, MA 02631 Suite 240 Randolph, MA 02368 Changes to Your Workers' Compensation Policy with AmGUARD Insurance Company Policy Number BRWC77794O Policy Period From January 12, 2016 to January 12, 2017, 12:01 AM, standard time at the insured's mailing address. Party Requesting the Change and Type of Endorsement The Agent- Changed Additional Names of the Insured effective 01/12/2016 Baer Custom Carpentry; Effective: 01/12/2016-05/10/2016 The Agent- Changed Insured's Legal Status effective 05/10/2016 New Business Type: Corporation New Federal Employer ID: 81-1675736 The Agent- Changed Insured's Name effective 05/10/2016 From: Brian N Baer To: Baer Custom Carpentry LLC Premium change: n/a This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective See Above Policy No. BRWC777940 Endorsement No. Insured Baer Custom Carpentry LLC Premium N/A Insurance Company Countersigned by AmGUARD Insurance Company Thank You Again for Choosing Berkshire Hathaway GUARD.Insurance Companies! s Call Customer Service at 800-673-2465 with any questions. Endorsement ._ 17M Cmuntornvea#h oaf_ Massachusetts ., Deparament afrird=-ftid Accideu& . - - -- t3,Tce of M-W1,09i7daars. 600 WasldiirxgiM meet -- Baston,M4 02111. WGrkers' Cumpensa ianln nce AMdavit"B.gilders/CantractursMectricians/Phumhers ' Applicant lnfwm3{IQn Please Brent BaerC-a!TMLL Address: '93 JOA Orleans U City/stag 021v31 pjcW-,`Nq lv3 57g2- Are TOU an employer?Ch-eckthe apprepriate bay T r Type of Project( ff1dMd3'= I. I am a employer�it11 4. ❑I am a general conttactor and I 5_ ❑New consirut#ion employees(fall andforpart-time).* bavehired.fhe sub-coabacto s 2.❑ I am a sale proprietor orpartaer- listed orlthe attached sheet, 7- ❑Remodeung slip and have no employees. These sub-confractom have 8- ❑DemolifiDn wadicng far me,is any capacity employees andhare wormers' 9_ ❑Building addition [NO Ti4-OdMM'CoMp_fiL%U Ca Cpnlp-me11=1:,--1 ' 5- ❑ We are a corporation and its l�i❑Eleciical repair,or adddious officers have eRRr-reed the:x 3_❑ I am a homeowner doing all work officers L❑Plumbing repairs or$dditicis n7sel€[No 'gip- ugbt of e$emp6on per M(M L_❑Rflofregairs i mmzmce required_]i t~152,§1(4h aadwe have no r employees.[No wu ebue 13�Other comp-iasarance Mquiv ] ',day appHa13t&2t cheers 6os rl west elsa ffiaaEthe sec�aabebw�xahiag�e¢wor�ces'�P„�fi�,,•policgi�acrosuo� t E.eaw ns s who sabngt df 2S afiidaeu indicating bey are dain--SH We c zMEL du a hie outside conuxct= mst submit a new afadxzit indieaN SmdL fCaatourtorsl'bsf cbe lc dds boa mast atfarhed m uddiliaasl d and sbamiag doname of the sat-cog mui state whedlu or nut tense enffiesha•e empluyees.Ifffiesub-cmtact sbavemnpIofee-%dfie3'mustpm-ddetba warkErs'tamp.paIicpaU-bez lam Beloiv is tTtc pttticy arrd joh site Fufvrrnfflian ' Iasarance Carapany Na=:'6erLsk1,q, '4AItIA0 Ell I A Pffficy�or�f i�11C.a � �V FSpS£dt[DIIDa�e: ( �• �0 I Job Site Addres�G ro Uss e, Law c yfstater : R, An At(2ch a copy of the warkers'cbmrpensationpolicg dedaration page(shaving the policy er and eipiration date). Failure to secure coverage as required.unckr 5ezion 25A o€MCrL m 15-7 tan lead to the imposition of rsim-mal penalfaesofa . 'fine up to$1,Saa OU andfar one--yearimpxisonmeut,as w¢ U as civ2 penalties n fire famt of a STQP WORK ORDERand a Time ' of up to MOO a clay abgainst fihe violator. Be adirised drat a copy.of this statement maybe fxwarded to the Office of ImresEgations af:'the DIA for insurance coverage ymrificatio= Ittv IteraTiy esrtFf r aardsr fits "is andPeruthyes of farrsrafiatt prmd abm�s ig bus and csvrrect Phone -��y- a�3 . 51 g�- aiRcicd wo turfy: Do`rat write in this`area,to be.=W&ed by C4 artOPPH Offrrcfat Cky or Town: Perm ffI,icense;9 I=ingAntlmxfty(ccaa&one): L Sward o#$eal& 1 Buffi"mg Department 3.fRylTown Clerk 4.Electrical h spector S.Phrmbing Enpecter 6.(ether C'on et Persons Phones#: :formation and Instructioas . ensajion far theU*=np,1:5 e - 7„s���se#ts G�nraal Laws ca I52 rer�es all euiglaye3s to�e l� a pazs..tto,ibis sue,an np�yee is defined ss¢.e�erypc�son is$�e sedvice of another Under airy CDlftC ct ofhU-r, eqx1__sS or implied,oral or Vrh=f An.Mayer is &,fined as SanmrTzvidmal,pa ,association,aasporaiion or aiiir legal entty,or any'tWo or more of the foregoing r< is a Joint PrtI F'Tp�se,and i ar-I ding the legal represen fafives of a dLceased employer,-V fir, or off=Iegal entity.employing=3p1Oyees. However the receiYer or trustee of as mdi4idr�P Q the o ofti�e - owne r of a.dwelTmg house having not mare tbaa three apazimeuts who residua therein, &,Ui.g house of mw is r who employs p=cus to do Wince,rCIUSEE r_f,an or repair wal on such dWellmg house or or1 the grounds or bmilimg apP?�a &=b sbaIlIIDt becanse of such m3ploym.ent be d=med to be au rmployrrf M_ GL chapter 152,g25C(S also states ffiA"every state or Local TiceUsiug agency shall wrdLlioId$ze isS¢aace or renewal of a licerzse or permit to operate a business or to construct buildings in the comQnwe2Ith for any aPplicanf who has not produced acceptable evidence of cdm.P anm with tine insurance'eoverage requirecL Additionally.MGL cbaptrr 152,§25C(7)sus fileifher the nm=_ nor any gfits political subdivisions shan eni�r tutu any contract for the pera—"ce ofpublia work-ua I acceptable evidence of compliance with the"'`m-a"cd.. rents of this chapter have Iieeu pzPse to the confiacfing anihozity_" APplicaufs ' b the boxes�apply to your siination aud,if Please fill 0-at the wozi�rs'compensafion aihdavlt compl�IY, Y g necessazL StIpPIY sob-contractar(s)name(s), addresses)and pb.one momber(s) along wish their=tncafe(s)of insutmlce Limier-d L��Y�P�es g-C)or LimitedLiability Par�b1ps,(LI P)with no maployees other fhm th e members or partners,are not��to catty WD.13 rs' =Mpensaf am msarance- If an LLC or LLP does have employees,apolicy is regnired. Be advisedtbattbis a$sdaYttmaybe sal milted to the;Depazimeut of m- Ishould on of ms�ce coverage: Alsa be sure to sign and dafehe affirdavit The affidavit 'demos fur con�rmafl . Aa�i not#heD, arimeutof be retnmed to$e city or townthat the application for the permit or license is being requesbA ep Teri„ r_ddenfs Sbouldyou have airy gnesda s_ t ao law or ifyou a=e requn ed to obtain a worms' Please call the D arment at the mmtber listed bedov7 Self insn¢ed companies should en nr their compemsation.poIicy,P � [ . s elf_fijs c e6 license nua bee on the appraptiaf--line_ Gity,or Town Officials_ Please be sure that the affidavit is complete and prlchtd legibly- The Department has provided a space st the bottom of the affidavit for you t4 fill out m the event the Office oflnves�igations has to cow You regarding the aFPg „t Please be sure to f llin the p=h1license member whichw:M be used as azcfe=ce number. In-addition,an applicant that mnst submt multiple permif/Hccease applications is any given year.need only submit ane affidavit indicaiiog cent p olicy infb=.ation(if necsszy)and Under"fob Site_A ff&ess"the applicart should vra -"all locations in (Gi'LY or_ town)-"A copy of the-affidavit that has beep.officially stamped ed ormakedbythe city or town may be provided to the - applicant as proof that a vaU-d affidavit is on fide fi3 .p for reetmil or licenses A new affidavit�st be 1Mcd out earl Year.-i here a home owner or cite is obtaining a license or petit not mIabed to any busmr_ss or commercial v&:Qfm.e (ie_a dog license or p=it to bum leaves a-)said pmsan is NOT req�Ed fn complete this affidavit um advance for our cooperaEiam and sb uldyouhave any questions. • 'I$e Off oflnveslig�nn.S wouIdl�efn thankyo Y please do not hesitate.to give trs a call. The Dt p t m anf.'s address,telephone and fax number: v _ CQ=01MVMj*of Massa h . D�rfm�of 1ud,�.1 A�id�n� IA Oil11 -4 mt 406 car Fax#617'2'-7M r . aCons na.eccll�a�p/frcae(rd -\ Office of COOSUmOrAffairs&Businessl�ar�ac Regulatle� i HOME IMPROVEMENT CONTRACTOR ,sType: LLC License or registration valid for Individual use only Beglstrati0. Exoiratlon before a expiration date. If found return to: Office of =18@6,14 Consumer Affairs and Business Regulation 07/18/2018 10 Park Plaza-Suite 5170 BAER CUSTOM Boston,MA 02116 4CARI?ENTRY, LLC. - <I BRIAN BAER { 93 S.ORLEANS?RD.== ' BREWSTER,MA`'02631 � - Undersecrere tary Not valid without Signature 6. V # ep 42 ��ay�Q" O Sol y L7 Q G P9 �• g v*^�. �. r,,> A f 4 ., `�' r�r� c�^s,�.,`p,�` � �•� 7 u .,.. v ra .R j. -� f� .,-�, �'� �'� � '<ffi'rt �f 1C:: - Y9' '' - 's S c;:a fow qQ • - , �' '��� =°�j..Gp .. q- ry ,y �,Fa U 4 a•Cj v� s' r� - s ,. ,.�* M' y , 4,. .. s xp rJ.' ,r• p P C2",z �J ! gr sS tfs. Depart y o Boar Public Safe atio �h t / 9© 633 c, ' .� . 8RlAIV N 13AER . a � B RLEANS ROAD REV1lS 7' ER MA 0263 i c a� .e ay ,, • - �„�. ' ;. Issi ,.� _ y. 7 r yir 12"M '�rats n: T 1 ' 03/10I2018 . �'�+t� 'off �`�`,. ,,� a' " ' �': �' •�, t4}e :q � r �Ws�+' � g�'' }'� .gyp ` ".^ ��,; 1► � ,� f1, ,4 Ln N� \JP N TOWN OF BARNSTABLE \�� g w cz LO N C9 00 N � � Q I O 0 n r <n O w Q 70 0 D N 26.0' m � Z 00 r � z LOT 14 rn 0 I G543 . 1 5. F. 1 59.4G' BUILDING LOCATION PLAN fop, 4 GROUSE LN., WEST HYANNI5POPT, MA PREPARED FOR RU55ELL GEREM IA GI L VEB m SCALE: DATE: DRAWN BY: 30' 1 0- 1 1 -201 6 TMW JOB NUMBER: PEV1510N: 5HEEi NUMBER: reRS.° 16-202 CPP- I Vk LAW WELLER * A550CIATE5 b�,L.� �, P.O. BOX 417 CENTERVILLE, MA 02632 TELEPHONE: (508) 328-4692 EMAIL: trlsweller@gmall.com REGISTERED LAND SURVEYORS * ENVIRONMENTAL CONSULTANTS Traverse PC Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 11/11/2014 Thomas Perry CBO Town of Barnstable - Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for 4 Grouse Lane (#201405888) has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William-McCloskey , I t , Cape Save Inc.. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 u ` 11/4/14 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permit TO: Building Inspector(s), This affidavit is to certify that all work completed for 4 Grouse Lane has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. Ceiling: R-38 cellulose Basement: R-19,fiberglass in box sill ` cn All work performed meets or exceeds Federal and State Requirements. Sincerely, - William McCluskey 7 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION •� T M1111'' 0°' Map Parcel k6 5 Application ji `Z� 6 Health Division 710" oLl '`�`° Date Issued 1-r^ Conservation Division Application Fee �G Planning Dept. Deb Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project.Street Address Gr g 11111,4P, LA n.e Village Rq n i s Owner Address cSa m C Telephone 3 a chi• a 7 ro Permit Request `4 ���u► �o s� - 't-�e, A�r, 1 t erc L ss -ty Ae -65CM(�O4 b pK Pry.- q -F � _ L ,.�,f 1r J L+ wt Irl CJr1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new. Zoning District Flood Plain Groundwater Overlay ' Project Valuation 3 0 QD 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 K"No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION '(BUILDER OR HOMEOWNER) Name Wt 11lam &CLS6[/ Telephone Number S®b 34g 0�5q a _ Address ` I vL' License# 7 In k 79-L So�'� ��rmp�-�L►, A (2a 6 6 Home Improvement Contractor# [9:13$b Worker's Compensation # Wyg3og .5633 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# _DAATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER c DATE OF INSPECTION: ti arFOUNDAIQNf ;� l�-x.v� u !,{. FRAME s` INSULATION:-. FIREPLACE ELECTRICAL: ROUGH FINAL i, t PLUMBING: ROUGH FINAL :y. GAS: ROUGH FINAL FINAL BUILDING' 3- DATE CLOSED OUT ASSOCIATION PLAN NO. Building Permit Authorization I, Russell Gil --,, as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 4 Grouse Lane W. Hyannis Port, MA 02601 Signed Date ��� ty a The Commonwealth ofMassaehusetts Department of Industrial Accidents k at Office of Investigations , r, 1 Congress Street, Snite 100` Boston,MA 02114-2017 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name.(Susiiiess/Organization/Indi'vidual): Cape Save Inc. Address: 7D Huntington Ave City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): i.�✓ 1 atn a employer with 4. Q 1 am a general contractor and,1 p I s 6. New construction employees(full andJar pairt-time): have.hired the sub.-contractors 2.C] Lama sole proprietor or partner- listed on the.attached sheet. 7. 'E]Remodeling ship and have no employees These.sub-contractois have 8. Demolition working. forme:n,an ca acit : employees and have..*orkers' o Y A Y 9. ❑'Buildinb addition [N.o:workers'comp.insurance comp_insurance required.] 5. We area corporation and tts 10F Electrical repairs or additions. 5,11 lam a homeowner doing all work. officers have.exercised their 1 L.ElTlumbi tg repairs or additions in [No workers'comp., right of exemption per MGl 1.2.[D.Rootsepairs insurance required] c. 152, §1(4) and we;have fib employees. [No��orkers' 13.Q'Other .lrisulatiort comp.insurance required;]. *Any applicant that checks box 41 must also fill out die section below showing their xvorkers'compensation policy infonin t Homeowners a?ho submit this affidavit indicating they are dbing ail work.and-then hire outside contractors must submi a new affidavit indicating such. Contractorsahat check this box must attached an additional sheet shoe?in-'the name orthe sub-coniraetors and`state whither or iiot those enftties have employees. If the sub contractors have emi loyees,they must provide their'W-orkeis'comp.-Policy number: I itin an e»iployer'that is providing workers'conepensgtron insurance for n:y e�riployees. Below is thepnlicy and jofisite information. + Insurance Company Name: Wesco Insurance Company Policy#.or Self-ins.Lic.# WW0085633. .._ . Expiration Date: 04/09/20..15 Job Site Address: &TVOC` L0.nr,___ City/state/Zip;, Attach a copy of the workers'compensation policy declaration page(show.ing the policy number and ea:piration,date);. Failure to secure coverage as required under Section 25A-of MGL c. 152 can lead to the imposition of criminaY;penaltfes of a fine up to s1,500:00 and%or one-year imprisonment,.as well as civil penalties in the form ofa STOP WORK(ORDER and a fine: of up:to$250.00 a day against the violator. Be advised data copy of this statement may be forwarded''to the Office of lnyestigations of the DIA for insurance.coverage verification: 1 do hereby certify under the arras and penalties ofpzi�61hai-&e:infLo.stowliniaI n provided above is true and.,corred. Serrature:' _. Date _.. _ 41 Rhone*': `':Official`ase.only Do not write in this areu,:,to be cvsrapleted by city or totvrr o�ciul. City oir'`Towm, - _ Permit/Licensg,# lssuiug Authority(cirele one;); 3.Board of Health 2.Building Department: 3.C tylTown Clerk. 44 M&tiical Inspector,5 Plumbing.Inspector 6.Other. M " _- Gontaet Person A�" CERTIFICATE OF LIABILITY INSURANCE 4i 4i2o14) 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 IleU of such endorsement s PR06UCER CONT T Colleen Crowley Risk Strategies Company PHONE . (781>986=4400 FAc No:t7e1r963-4429 15 Patella Park Drive Annocss. Suite 240 INSURER(S)AFFORDING COVERAGE Randolph. MA 0236.8 iNsuRER'A:SeleCtive. Ins, of America. INSUREo. - INSUPERB:Safety, .Tnsurance Ccmpany - 3618 Cape Save, Inc INSURER Weseo Insurance Company 7 D Huntington. Ave INSURER ... ._. INSURER E:: SOU Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1441475243 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.: ILTR TYPE OF:INSURANCE POLICY.NUMBER MM ICY EFF MPOOL�EXP LIMITS GENERAL.LIABILITY _. .. ._. _ EACH OCCURRENCE $ 1,000,006 -:X COMMERCIAL GENERAL LIABILITY CAPME70 RENTED PREMISES Ea occurtenae $ 100,000 A CLAIMS MADE a OCCUR S191944810 6/16/2013 0/15/2014 MEEU EXP(Any one person) $ 10,000 PERSONAL BADV INJURY• $. 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER:: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY X. JECT PRO X; GOC AUTOMOBILE LIABILITY (Ea-accident)mGL L IT 1,000,000 B ANYAUTO BODILY INJURY(Per person) $ ALL X AUTOD 208200 1/6/2013 1/6/2014 BODILY INJURY(Per accident) $ NON-(W4ED PROPERTY'DAMAGE Ix HIRED AUTOS X AUTOS Peracddent $ X UMBRELLA LIAR X.. ... . OCCUR EACH OCCURRENCE I$ 1,006,600 EXCESS UAB CLAIMS-MADE. A AGGREGATE $ 1,OOO,,OQO -NI 1994480 .�0/16/2013 0/16/2014-: AEp RETENTION . fi C WORKERS COMPENSATION fficers Included For V�CSTATU- OTH- AND EMPLOYERS'LIABILITY Y:/N - - X RY LIMITS -ANY PROPRIE(OR/PARTNER/EXECUTIVE - overage OPFICERIIIEMSEP.EXCLUDED? Q.NIA E.L.EACH ACCIDENT $ 500,000 jMandatoryinNH) 3085633 /9/2014 /9/2015 E.L.DISEASE-EA EMPLOYE -$ 500 .000 tfYycribounder E.LDISEASE-POLICYI MIT'`$ 500,000 DESS RIPCRIPTION OF ORERATIOIVS below DESCRIPTION OF OPERATIONS!LOCATIONS,IVEHICLES(Attach ACORD`101,Additional Remarks Schedule,If more space is required) Issued as evidence of .insurance:. Issued as: evdence of insurance. Thielsch ;E'ngineeririg, Inc., is listed as additional insured as respects General Liability as required. by written contract. CERTIFICATE HOLDER CANCELLATION msong@capelightconpact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Conpagt ACCORDANCE WITH THE POLICY.PROVISIONS. Attn: Margaret Song PO Box 427/SCH AumoRIZEDREPRESENTATIVE 3195 Main Street Barnstable, MA;. 02630 chaeil Christian/CLC ACORD 25(2010/05)`' 01988-2010 ACORD CORPORATION. All rights reserved. INS025 tzoloos.o? The ACORD:name.and logo are registered marks of ACORD Office of Consumer Affairs and I 1: ­usiness Regulation 10 Park Plaza =Suite 5170 Boston; Massachusetts 02116 Home Improvement Contractor Registration -" Registration: 171386 f 4„ i Type: C,,orporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. WILL-IAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664, E Update Address and`return card,Mark reason for change: scA i 0 zoM osn : Address 0 Renewal Employment Lost Card - �✓21G' CY/7UNZOyJZI(IBCGUCfL CtUIiLCIwCGCfZCWG'�rJ' Office of Consumer Affairs&Business Regulatiion License or registration valid for indwidul,use'only' L OME IMPROVEMENT.CONTRACTOR before the expiration date. If found return to: egistration: :'jj1380 Type:: Office of Consumer Affairs and Business Regulation i 10 Park Plaza-Suite 5110 Expiration 3/14/2016 Corporation i l Boston,MA 02116 t CAPE SAVE INC. " j44, WILLIAM McCLUSKEY� a� 3 7-D HUNTINGTON AVENUE r SOUTH YARMOUTH,MA.02664 a 4 Undersecretary Not vali rthout signature S x Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen�isor Specialty License: CSSL-102776 W ILLIAM J MC-dull E 37 NAUSET ROAD " West Yarmouth MA r JI"4ta\� \` f Commissioner. 06QS/2015 E I S • eA'P.Fa k d f kr v IN,- `. i� 1i" Icy tyo- �t wi ��:i k �.M Aid +�1 �5�+�� a�j. 5�;��re!.P �-.c¢+'t» �t'' "3'� a•e•���. ,erg `r' 3.�B�. � �tt)a �e__��e_. • • ._ EM NONEMEIVMMMM � ZMEMEME. 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AC6-Post to Beam II I# Ceiling Material TBD II I, • LU26- Ceiling Joist to Ledger 6x6"PT Post Wrapped W/.75"PVC III � 2x6"PT Ledger ap 4 'I w/"Ledger Locks" " Decking TBD Ii.I Staggered,l6'O.C. to - , • - - - Main House Box H2.5A Beam to Post pace 3-2x10"PT w/1/2" Spacers i 2 Sides 2x6"PT Joist @16"O.C. - - - - - - - - - - - - - - - - - - - - - - - - - 6x6"PT Post I AC6-Post to Beam ' LU26-Both Ends Of Porch Joist to Ledger and Bem Box End Joist to Have"Blind"Hangers R ��A.Sp,(,. i Cp Nf i ABA66-PC Pier to Post-- "BF20"w/8"Tube ! r I ~ and 4'Frost Protection I I ��vi,Masser - DATE — — 09/01/16 — — — — DRAWING NO. w 1 OF 3 Typical Fraining SGALE: 3/8 V-0" B. PROPOSED PORCH ,4 GROUSE LN SCALE AS NOTED - Deck Joist and•Post e. r r .r yA_ ° J L J l J l Jl - m ILI n t '1 -1 13/32 -1 13/32 1 -1 1/16 .. 6 -0 5 -11 b 5-11+ w41/4 s , a ;32 r _ • r. - A 9 T } �m 2 r y SGALE. .1/4" = V-0° m y N u « y p, r a. a t. a " a S . P •Piers r % • C F . 4 - . , - w „ Not -F BF20 w/.8.." e - Tube Tube and Post Spacing Dependent 4 Frost Protection Typical - on Front Door LocationR _ r . , as DATE 091 -O 5 -11 • ' {. 5 -11 'a oins 41/4 4�a DRAWING NO. r w + , ' a - - TOF3 401-011, f . y C ' Post. and Pier , , PROPOSED PORCH - A4 GRO USE -LN _ SCALE as NOTED t , ro