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0197 MARSTON AVENUE
4A eby-) A&0 W-, . Town of Barnstable Building ,Post This`laird So k "'' " "' "h r`et=A ``°roved'Plans Must be:Reta ed�on Job�and this Card:Must b'e Ke t snRxsrArst� That its Ulsible.From t e St e, ,r PP p o tPOsted�Until F�nallnspection Has Been Made ` P m 1b3A p her � : �.,a � � � � � ,. v. � .-; � � Permit Where a Certificate ofOccupancy is Required,such Building sFiall Not be Occupied until a Final Inspection has been matle Permit NO. B-18-3967 Applicant Name: Whalen Restoration Services Inc. Approvals Date Issued: 12/26/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 06/26/2019 Foundation: Residential Map/Lot 288-116 Zoning District: RF-1 Sheathing: Location: 197 MARSTON AVENUE, HYANNIS ContractorName Whalen Restoration Services Inc. Framing: ®yob Owner on Record: FARLEY,MARSHALL&MARY ANNE F Contractor License 129244 2 Address: P O BOX 537Est Project Cost: $115,000.00 Chimney: HYANNIS PORT, MA 02647 a Y� Permit Fee: $636.50 Insulation Description: water damage repairs-heat pipes, large living roomy reQve h FeePaidr' $636.50 6� replace ceiling&wail drywall,insulate., remove andreplace Final: windows on 1st floor. install new kitchen cabinets flooring,. 1st Date 12/26/2018 a� !6 tzh 9x� floor laundry-bath&den remove wood walls and insulate& � <fr a drywall �_ Plumbing/Gas z Rough Plumbing: Project Review Req: � ,,` Building Official p Final Plumbing: Rough Gas: Final Gas: _ Y Electrical This permit shall be deemed abandoned and invalid unless the work authorized by tins permit iscommenced within siz months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents=for which this permit has been granted. Service: All construction,alterations and changes of use of any building and structures,shall be incompliance with the local Zc ning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or;road and shall be maintained ope Rough: �, � , � „ n.for'public inspection for the entire duration of the work until the completion of the same. Final: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Low Voltage Rough: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Low Voltage Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue linin ' lied Health 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspecti n tr 5.Prior to Covering Structural Members(Frame Inspection) yr Final: 6.Insulation 7.Final Inspection before Occupancy Fire Department Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. i John M. Baylis Project Manager MA CSL#106294 Restoration Services Inc. Fire,Smoke,Soot,Water&Mold Remediation Cleaning•Deodorization•Reconstruction www.whalenrestorations.com 22 American Way Phone:508-760-1911 -2598 00-244 8 South Dennis,MA 02660 Fax: 08-244-2598 �jbaylis@whalenrestorations.com 0 Cell:77444887-00437 i i O Application Number......... ............ MASEL BUILDING DEPT Permit Fee.......................................Other Fee........................ 16,1 DEC04 2018 Total Fee Paid..... ............................. ...... TOWN OF WPIN'TABLEpemit Approval by....... .......on..TOWN OF BARNSTABL BUILDING PERMIT Map........................................Parcel............................................. APPLICATION Section 1 - Owner's Information and Project Location Project Address 'Village N�,6 P ®P-7— OwnersName Owners Legal Address cl-7- M 0,-2 S 7D tJ ail City A PO P-. State zip Owners Cell# C/ 'C' 9 E-mail F— Section 2 -Use of Structure Use Group_ 0 C ommercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 -Type of Permit ❑F New Construction ❑ Move/Relocate [:] Accessory Structure E] Change of use El Demo/(entire structure) El Finish Basement El Family/Amnesty El Fire Alarm Rebuild El Deck Apartment Sprinkler System ❑ Addition ❑ Retaining wall F] Solar Renovation ❑ Pool ❑ Insulation Other-Specify. Q- P 1E4- 6&f- L�A14S -Ile.*r Section 4 - Work Description ost—f'r 00,4_- mgeniak-e— 'y"00-0 LA, Last update4- 11115/2018 n Y Application Number.................................................... Section 5—Detail Cost of Proposed Construction`k a7D q Square Footage of Project 6b - Age of Structure ��Cc Z Dig Safe Number # Of Bedrooms Existing L4 Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics f'Wiring y ❑ Oil Tank Storage [Smoke Detectors Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom i Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone 1 Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No .❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. s Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes No i Last updated:11/15/2018 The COMOWNWaffitJ8 efmdsaechrseus Dgarirtteitt gfludushQAectde►ats I Co ess stmete Sune in De9teu,MA 02D4®2039 www.meM-90VIdde Warskorso CompORsaBton Insurance Affidatvito�uQders/den rectal a/E�ec8r8cie�ts/I'ltt�beas. TO BE FM WM THE PERNnMG AUl'hIIOIlfl Y, -AM aut�fott�ation Pasati®Prlat iLeae6ty Nam®(i oss/Oeganimtiaa&divldual)e Whalen Restoration Services Address 22 American Way QtP/GWt@/Zfp: - South Dennis, MA 02660 Phoage#; 508 760 1911 Are you oa ampioyar?Check theepprapdate 6oxr 'lope of project(required)¢ 1.GIem8employcrvich_15__ m y�s(fullsndloPps tirrm),� 7. 13 Now construction 20I eta a sale praprietoror parmembip and have no employees working for me in &. �Rotrtadeltng 'HWcWhY.IlOworhe camp,insum cerequiired] 3.®I ame hosieowaordoing ell work mysellf.(AIO worket�°comp.ittsuranr;ee required.]4 9. ®Demolition 4.®I am ahoaownarad wM be bsn conr m to conduct ell work oa� lE will 10 Building addition eUrethuall eonOmelther1ma warke&eampeaseton instmap ot. e ape 11.0 Elsctrleal repairs or additions prhpristarstaith aoemployees. 12.f 1plumbing repairs or addidons I am a geuam cenirantarandl have hited the sub-commmm listed on to atteeheisheet. Thssesub'eoutraotomhave employees and havowc*OWcamp.insurance$ 13>[JRaofrepairs 613W68meeGJPf8t[ffRNd its a. ATF/C.-D *OA` 152,§1(4),sndwahavenoemplayees,(Aloworkers°camp.insurancerequired., *Any appiirsrttthstohWks tsx91 roust also fm outthe sudeft below showing theieworkew cotepensation policy iatbrratlflan. t>iYomeowaerswhomonkidsailldavltin oadagthuamdoiggallworkandtheahireOuismecpntraororsmustsubmitaaewof8davieindiaedngsuch, tContmslotsth�cbeak tisboxmustattaehedanadaltianalsheetshowingthe=0Ofthesttb•eontPaotorsandstatewhetherernatthoseen6deshave ! loya L Ifthesub cornea n1mv9=ployees,tlr®ymustp=16tbair work Wcamp.polieynuarber. �a W 601 10yffl?M09IS,P®ueei eagWOMM'0eWeeetNafa 1089pwsee, OPRW Oplayees. Below Is the Palley andjob Me 6�orao� 1asi=c@CounpWWWWfie. Ace American Insurance Company Politer#or self-in.Lie.t#: 2 B 5 B8 9 45 4 217 Exp�atioB Date. 4/1/i 9 Job Site Addeesse 1/� — - CitylStete/zip: ,�a% 3Py��Xf,4— °2-6-f- Afteh•a eopyof the Workere compensation policy declaration page(showing the polity glum a ieatioa date). � ) F011M to NOUN coverage as required under MOL a.152,625A is a crh*al yi®latton PUdsitable by a fine up to 81,500.00 And/of Mt Alf imprisonment,as well as civil penal#es in the hum of a STOP WORK ORDER acrid a fine of up to$250.00 a day against the Violator.A copy of this statement may be fomurded to the Ofiiee of Investigations of the DIA for Insmance eav®rag0 verifindOn. _ _ I�hereby cesI,fy��dep flee peraePft ®fpres�Juey that the a� esaatinrt,ppovlded above isstr/ue cad collect al obvee ®ata Z�/�0��� P 12, o #: ®feiat use ashy De not wMesra this arse,to 6e coWieted by eftr ortowre ta, MRL City or Tot . Permit/License Ustung Authority(alrcle one): L Board ofHealth 2.Building Department I tl;ity/Ttawp ClOrk 4.ZROUrical lbspede r S.Plumbing Inspector 6.Mer ��P9one, l�lAOEiaS DEBRIS DISPOSAL FORM ` In accordance with the provisions of MGL 'c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: LOCATION OF FACILITY ' Signature of Applicant Date AFFIDAVIT As a result of the provisions of MGL c 40, S 54, I acknowledge that as a condition of Building Permit Number _ _ all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. I certify that I will notify the Building Official by (two months maximum)of the location of the solid waste disposal facility where the debris resulting from the said construction activity shall be disposed of,and I shall submit the appropriate form for attachment to the Building Permit. " Date Signature of Permit Applicant (PRINT OR TYPE THE FOLLOWING INFORMATION) Name of Permit Applicant Firm Name, if any Restoration Services Inc. Fire, Smoke, Soot,Water Damage&Mold Remediation Services Cleaning • Deodorization • .Reconstruction Specializing in Fire Restoration e All Work Guaranteed Access, Authorization and Direct Payment Request Form I (we) authorize WHALEN RESTORATION SERVICES to perform work at property located at to repair damage caused by w 1�e-`2— 'P�kACfk jP5a-V1-tJ on As owner(s) of this property, I (we) understand that I (we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work and accept responsibility for payment upon completion. I (we) authorize and direct my Insurance-Company Policy No. , to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim Specialists, for doing this work and to that extent I (we) assign.the benefits applicable to this loss to WHALEN RESTORATION SERVICES. I (we) acknowledge receipt of a copy hereof:. OWNER DATED SIGNE7'D ,ar OWNER WHALEN RESTORATION REP. SIGNED 22 American Way, South Dennis,MA 02660 Phone: (508)760-1911 Fax: (508)760-9995 • 1-800-244-2598 •E-Mail:restore@whalenregtorations.com Web Page:http://www.whalenrestorations.com OFFICE COPY=WHITE CUSTOMER COPY=YELLOW Andersen.; Andersen Windows -Abbreviated Quote ReportWA Andersen: ,h Project Name: 197 Mafstons Ave Hyannisport REV 11.19.18 ` .00.. ooaa _ Quote#: 17697 Print Dater 11/19/2018 Quote Date: 11/19/2018 iQ Version: 18.1 Dealer: Shepley AW Showcase Customer: WHALEN RESTORATION 75 Ben Franklin Way Hyannis 02601 Billing Cell- 774-836-3068 Email cfischer@shepleywood.com Address: Fax- 508-471-3225 Phone: Fax: Sales Rep: CRAIG FISCHER Contact: Created By. Trade ID: 111111 Promotion Code: Item Qty Item Size(Operation) Location Unit Price Ext.Price 0001 1 CR25(LR) Kitchen-dbl casement J. RO Size=2'10 1/4"W x 5'0 3/8" H Unit Size=2'9 3/4"W x 4' 11 7/8" H 400 Series -Unit, White/White- Factory Painted, LR Handing, (All Sash) High Performance Low-E4 Glass, Divided Light with Spacer, Specified Equal Lite, 2w4h, 3/4", Ext Grille-White, Int Grille- Prefinished White Insect Screen, White Viewed from Exterior Hardware Pack, PSC, Traditional Folding- Distressed Bronze U-Factor:0.29, SHGC:0.29 0002 4 FWHID29611 (AR) NEW Single FWH inswing door. $ ROSize=2'9"Wx6:11" H Unit Size=2'81/8"Wx6'103/8 H A Series Unit,.Inswing,4 9/16"Frame Depth, Bronze Sill,AR Handing, White/Pine, White- Factory Painted, High Performance Low-E4 Tempered, Divided Light with Spacer, Colonial, 3W5H, 7/8", Ext Grille-White, Int Species- Pine, Int Grille-White- Factory Painted, Factory Applied White Hinges Viewed from Exterior Hardware Trim Set, FWH/FWO, RH, Encino- Distressed Bronze COMMENT: NO Hinged screen U-Factor:0.31, SHGC:0.21 Quote#: 17697 Print Date: 11/19/2018 Page 1 Of 8 iQ Version: 18.1 Item Qty Item Size(Operation) Location Unit Price Ext Price s 0003 1 C14(L) C14L $ RO Size= 2'0 5/8"Wx4'0 1/2" H Unit Size=2'01/8"Wx4'0" H 400 Series Unit, White/White- Factory Painted, L Handing, High Performance Low-E4 Tempered Glass, Divided Light with Spacer, Colonial, 2W41-1,3/4", Ext Grille- White, Int Grille- Prefinished White Insect Screen, White y Viewed from Exterior Hardware Pack, PSC, Traditional Folding- Distressed Bronze U-Factor:0.29, SHGC:0.29 y - 0004 1 C14(R) C14R $ RO Size=2' 0 5/8"W x 4'0 1/2"H Unit Size=2'0 1/8"W x 4'0" H 400 Series Unit, White/White- Factory Painted, R Handing, High Performance Low-E4 Tempered Glass, Divided Light with Spacer, Colonial, 2W4H, 3/4", Ext Grille ' - -White, Int Grille- Prefinished White Insect Screen, White Viewed from Exterior Hardware Pack, PSC, Traditional Folding- Distressed Bronze U-Factor:0.29, SHGC:0.29 Quote#: 17697 Print Date: 11/19/2018 Page 20f 8 iQ Version: 18.1 Item Qty Item Size (Operation) Location Unit Price Ext. Price 0006 1 C34(LSR) Triple-LSR $ RO Size=6'0 3/8"W x 4'0 1/2" H Unit Size= 5' 11 7/8"W x 4'0" H 400 Series Unit,White/White-Factory Painted, LSR Handing, (All Sash) High Performance Low-E4 Glass, Divided Light with Spacer, Colonial, 2W4H, 3/4", Ext Grille-White, Int Grille- Prefinished White Insect Screen, White Hardware Pack, PSC, Traditional Folding-Distressed Bronze Viewed from Exterior COMMENT: YES confirmed LSR handing_ U-Factor:0.29, SHGC:0.29 0006 1 WDH V 9 5/8"x 3'3"(AA) Bath YES`-`DOUBLE HUNG $ ROSize= 1' 101/8"Wx3'3" H Unit Size= 1'95/8"Wx3'3"H 400 Series Unit, Woodwright Basic, White/Pre-finished White, White/White Liner, AA Handing, High Performance Low-E4, Divided Light with Spacer, Specified Equal Lite, 2w2h, 3/4", White/Prefinished White, Permanently Applied, Chamfer/Chamfer.(Each Sash), 1 Sash Lock,Traditional, Black Full Insect Screen, White - Viewed from Exterior COMMENT:YES'Double hung. U-Factor:0.30, SHGC:0.28 Quote#: 17697 Print Date: 11/19/2018 Page 3Of 8 iQ Version: 18.1 Item Qty. Item Size(Operation) Location Unit Price Ext. Price • 0007 1 WDH 1'8"x 3' 3" (AA) STORAGE YES DOUBLE HUNG $ RO Size= V8 1/2"Wx3'3"H Unit Size=1'8"Wx3'3" H 400 Series Unit, Woodwright Basic,White/Pre-finished White, White/White Liner, AA Handing, High Performance Low-E4, Divided Light with Spacer, Specified Equal Lite, 2w2h, 3/4 , White/Prefinished White, Permanently Applied, Chamfer/Chamfer(Each Sash), 1 Sash Lock,Traditional, Black Viewed from Exterior Full Insect Screen, White COMMENT: YES Double hung. Width Reduce due to brick. U-Factor:0.30, SHGC:0.28 0008 1 PSA 2'10"x 3' 7"(V) Kitchen $ RO Size=2' 10 1/2"Wx3'7 1/2"H Unit Size=2' 10"Wx3'7" H 400 Series Unit,Awning Basic,White/White- Factory Painted, V Handing; High Performance Low-E4, Divided Light with Spacer, Specified Equal Lite, 3w4h, 3/4", White/Prefinished White, Permanently Applied, Chamfer/Chamfer Full Insect Screen, White Hardware Pack, PSA, Traditional Folding-Distressed Bronze Viewed from Exterior COMMENT: r "`RO to be modified. YES 4w3h grille layout.. U-Factor:0.29, SHGC:0.29 Quote#: 17697 Print Date: 11/19/2018 Page 4Of 8 iQ Version: 18.1 Item Qty Item Size(Operation) Location Unit Price Ext. Price 0009 2 CR245(LR) Great Room back wall YES- $ dbI Casement RO Size 2' 10114"W x 4'5 3/8" H . Unit Size=2'9 3/4"W x 4'4 13/16"H 400 Series Unit,White/White-Factory Painted,LR Handing, (All Sash) High Performance Low-E4 Glass, Divided Light with Spacer, Colonial, 2W4H, 3/4", Ext Grille - White, Int Grille-Prefinished White Viewed from Exterior Insect Screen, White Hardware Pack, PSC, Traditional Folding- Distressed Bronze COMMENT: **RO HEIGHT TO be modified. U-Factor:0.29, SHGC:0.29 0010 1 CR236(LR) Closet-dbl'.casement $ RO Size'=2'10 1/4"W x 3'S 3/8"H Unit Size=2'9 3/4"W x 3'4 13/16" H 400 Series Unit, White/White-Factory Painted, LR Handing, (All Sash) High Performance Low-E4 Glass, Divided Light with Spacer, Colonial, 2W3H, 3/4", Ext Grille -White, Int Grille-Prefinished White Insect Screen, White Hardware Pack, PSC, Traditional Folding- Distressed Bronze Viewed from Exterior COMMENT: RO to be modified. U-Factor:0.29, SHGC:0.29 Quote#: 17697 Print Date: 11/19/2018 Page 50f 8 iQVersion: 18.1 t Item Qty Item Size(Operation) Location Unit Price Ext. Price 0011 1 CR25(LR) Great Room - FRONT-dbl $ casement RO Size=2' 10 1/4"W x 5'0 3/8" H Unit Size=2'9 3/4"W x 4' 11 7/8" H Lj 400 Series Unit, White/White- Factory Painted, LR Handing, (All Sash) High Performance Low-E4 Glass, Divided Light with Spacer, Specified Equal Lite, 2w4h, 3/4", Ext Grille-White, Int Grille- Prefinished White Viewed from Exterior Insect Screen, White Hardware Pack, PSC, Traditional Folding- Distressed Bronze U-Factor:0.29, SHGC:0.29 0012 1 Front-Entrance 3/4 Lite 1 panel $ door. RO Size=N/A Unit Size=N/A Not Applicable Simpson Water Barrier 2868 RHIS, 3/4 Lite- 1 panel, 2w4h, Applied grilles 7/8", Double bore, Distressed bronze hinges, 0012a 1 Baldwin Front door hardware. $ RO Size=N/A Unit Size= NIA Not Applicable Baldwin Reserve Rustic Arched Deadbolt dark bronze, Baldwin Reserve Pasage set, Arch lever, Dark bronze. Key alike. Quote#: 17697 Print Date: 11/19/2018 Page 60f 8 iQ Version: 18.1 Item Qty Item Size(Operation) Location Unit Price Ext. Price 0013 1 8RS 32"x 80" (Left Hand) Front StormdoorWITH Retractable $ Screen.. RO Size=31-7/8"to 32-3/8"W x 80"to 80-7/8" H Unit Size=32"W x 80" H Storm Door,Andersen, Fullview Retractable Insect Screen, Black, Left Hand, Single-Pane Clear, Tempered, Retractable Insect Screen, Pro Install,8 Series Andersen, Traditional Storm Door Hardware Trim Set, Oil Rubbed Bronze viewed from Exterior Total Load Factor — Customer Signature -2.411 Dealer Signature **All graphics viewed from the exterior ** Rough opening dimensions are minimums and may need to be increased to allow for use of building wraps or flashings or sill panning or brackets or fasteners or other items. Ask to see if all of the products you purchase can be upgraded to be ENERGY STAR®certified. This image indicates that the product selected is certified in the US ENERGY STAR®climate zone that you have selected. ® Data is current as of April 2018.This data may change over time due to ongoing product changes or updated test results or requirements. Ratings for all sizes are specified by NFRC for testing and certification.Ratings may vary depending on the use of tempered glass or different grille options or glass for high altitudes etc. Nexia is a registered trademark of Ingersoll Rand Inc. Project Comments: Quote#: 17697 Print Date: 11/19/2018 Page 70f 8 iQ Version: 18.1 L4 rF., P. Alkv�/ C I'DSE T Fl o I �Li+purr� o I�IG. ��c( l�rt�b,✓s" o�" 15�Gloo2 O Q (� SPE e- SUCET le/- I,l O i �' ® FIiM1iN IZ.Ot)� I (.(�u � DR'��i✓'All 'Gfzi('iNG - ►�A-III K4LNEW o �(b Rr;��i�o6+r/�D 2 D e' D E Q C7 n i tii�La �„�•_ kIv t l4aVi oVedb`J• �� . Eb ?c) R L LA Qe� WHALRES-01 JPOWERS ACORD' DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/14/2018 THIS .CERTIF*ATE 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 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 License#1780862 CONE AACT John Powers HUB International New England HCo,No,Exc:(508j 945-7866 FAX No 265 Orleans Road (At North Chatham,MA 02650 ADME. AIL John.Powers@hubinternatibnal.com INSURERISI AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B: Whalen Restoration Services Inc. INSURERC: Whalen Services Inc. 22 American Way INSURER D: South Dennis,MA 02660 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE p WVD POLICY NUMBER IRp pYYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR POK1799951 04/01/2018 04/0112019 DAMAGE PREMISETO D � $ 100,000 IVIED EXP*y oneperson) 5,000 PERSONAL'&ADVINJURY $ 1,000,000 } GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 i X POLICY iwoT LOC PRODUCTS-COMPIOP'AGG $ 2,000,000. OTHER: $ , A AUTOMOBILE LIABILITY CO MINED LIMIT $ 1,000,000 ? ANY AUTO PHPK1799939 04/01/2018 04101/2019 BODILY INJURY Per Parson $ 1 OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HARED NON�ppyW/�N� pp ROP.idenDAMAGE $ 1 X AUTOS ONLY X AUTOS ONLY f 0010,000 I A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1, ..� EXCESS LIAB CLAIMS-MADE PUB623768 04/0112018 0410112019 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE a E.L.EACH ACCIDENT $ (f PMa dalory In 8 EXCLUDED? N I A E.L.DISEASE-EA EMPLOYE $ If yes,describe under { DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $ f r DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES`(ACORD 10i,Additional Remarks Schedule,may be attached If more space Is'required) i i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Marshall Farley THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y I ACCORDANCE WITH THE POLICY PROVISIONS. 191 Marston Avenue Hyannis Port,.MA 02647 AUTHORIZED REPRESENTATIVE i I Z ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The-ACORD name and logo are registered marks of ACORD j Acc® CERTIFICATE OF LIABILITY INSURANCE °ATE`MMI°°"YYY' 11/14/2018 THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICAT-�-DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELCk 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 CONTACT NAME: John.Powers HUB INTERNATIONAL NEW ENGLAND LLC. (A/C, (508 945-0446 aIc No): E-MAIL ohn. owers ADDRESS: I P ers@hubinternational.com 600 LONGWATER DRIVE INSURERS AFFORDING COVERAGE NAIC fI NORWELL MA 02061 INSURERA: ACE AMERICAN INSURANCE CO .22667 INSURED INSURER B WHALEN RESTORATION SERVICES INC INSURERC: INSURER D: 22 AMERICAN WAY INSURER E: SOUTH DENNIS MA .02660 INSURERF COVERAGES CERTIFICATE NUMBER: 337939 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 t 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. 1�TR TYPE OF INSURANCE JN=S D POLICY NUMBER. MMIDD800 POLICY FOP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE O RENTED_ PREMISES Ea occurrence $ MED EXP(Any one person) $ !` N/A PERSONAL&ADV INJURY` $. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECTPRO ❑LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLALIAS OCCUR EACH OCCURRENCE" $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION /� STA UTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE YINF--1 E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? I NIAI NIA NIA '6S62UB5B89454218 04/01/2018: 04/01/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS beloiv E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD.101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits Will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. i This certificate of insurance shows the poiicyin force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date.-of this certificate.of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensationMvestigations/. i CERTIFICATE HOLDER` CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION .DATE THEREOF, NOTICE WILL BE DELIVERED IN Marshall Farley ACCORDANCE WITH THE POLICY PROVISIONS. 197 Marston Ave AUTHORIZED REPRESENTATIVE ` �Hyannis Port MA 02647 ` _p Daniel M.Cr, ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD. _�.-- =------"-- - Commonwealth of Massachusetts /rcnr�cnrn,rcu�a/!/r c.�c l��r��*rr�r�Jelt ' Division of Professional Licensure Office of Consumer Affairs&Business Regulation Board of Building Regulations and Standards - r2 HOME IMPROVEMENT CONTRACTOR Constrj.,6fl rf iSu rvisor TYPE:Coroorationsl - IBM# Registration Expiration CS-074928 _ Lxpires:08190/2020 y T29244_ 07/29/2019 E - f WHALEN RESTORATIONSERVICES INC. ^ ' WILLIAM WHALEN %j �r 122 POND STIYEET" a BREWSTER MA1Q2631" WILLIAM WHALEN 22 AMERICAN WAY, J a SOUTH DENNIS,MA 02660 UnderseCretai D �L Commissioner /l/ 4-1 Registration valid for individual use only before the.expiration date. If found return to: Construction Supervisor Office of Consumer Affairs and Business Regulation Unrestricted-Buildings of any use group which contain 10 Park Plaza-Suite 5170 Boston,MA 02116 less than 35,000 cubic feet(991 cubic meters)of enclosed space. d Not valid without signature Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpi rr - Application Number............................................. Section 9- Construction Supervisor Name �`( � �J� l�21�-' Telephone Number 7-7 7 cO 16; 7 Address C ZZ� �b��j �j City t3 R-16�S've2- .State W N Zip License Number CS����{9 Z� License Type G� Expiration Date y r Zy ,Caw( Contractors Email ,��y s �,.� � � R�5`�1t�'� S Cell # 7 -7 tv YT 7 "P-Y3 7 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license.Signature 1 Date 3 �/6 �"LL" l� Section 10—Home Improvement Contractor Name �A,Alel✓ S-6611- Telephone Number 77 y 'lr7 0�'3 7 Address 7�� Nt�it/!� ty D���'S= State A-'14'— Zip 42--4 6 a Registration Number 12— Expiration Date 7 Z I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 C d the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: k XS kA l( -- ik A-Ci A4-fV6 Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature kog� Date _. APPLICANT SIGNATURE Signature Date 3af10/1r' Print Name IoIG` Telephone Number- O3 E-mail permit to: Last updated: 11/152018 Section 12 —Department Sign-Offs , 4 Health Department ❑ Zoning Board(if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13—Owner's Authorization I, gA. ,Ypg f_- , as Owner of the subject property hereby authorize W kA-te-t,.e -eS to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Si a of Owner d4e, AVUte," FOA l Print e } Last updated: 11/15/2018 l 4 TQ'>P OF ¢RNTAME HEATLOK. T_111188 A' it - 1,0, CAPE COD INSULATION ' tt —1=°800-696-6611 Company Name. Phone Number� . ,�t , Whalen Restoration 04-10-2019 Keith Dacey 22 American Way Installation Date 197 Marstons Avenue GE018379 Jobsite Address Hyannisport A-Side Lot Ws Permit Number B-Side Lot #'s P3570431218 amwr ON 3.2 R-21 360 Square Feet Walls 3.2 R-21 150 Square Feet Rim — • • • • • ti . www.Demilec.com % DEMILEC H EAT LO K@ oQ x . 77J yap Company Name Cape Cod Insulation Phone Number 508 775 1214 Applicator Name Keith Dacey Installation Date 4/10 Jobsite Address 197 Marstons Ave A-Side Lot #'s GE018379 t Permit Number B-Side Lot #'s P3570431218 .0 ® O O u Walls 311 R-20 360 Attie Joist 311 R-20, 150 DC315 Joist 15 mil wet TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application �� � Health Division Date Issued Z/ S Conservation Division Ma Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address ` -7 Ave- Village ttU 0,y 1V,1 S To(A- U Owner 1 + �Wi A -nYip— Address R7 Telephone i r Permit Request 1 &, OWn ZO` wp 4 AI'rf� P� MkWye, �- O ty\Odih Q 17 le d i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 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 ❑ 0� Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use -- --- - - _APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name S Telephone Number 7l D / �/ Address 'n 7 fpn- ^� 7Y1f License #Q.cn v�i s a 7-10 �7 ' -Home Improvement Contractor 7 # 3 } Email U.'oy�x�Z{o�_ . OWI� �2J� Worker's Compensation # WPA 031[,76715 ALL CONSTRUCT ON DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOT1 t2 0 SIGNATURE DATE s • FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: LYl FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111. ' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly "'NaMe(Business/Organization/Individual): •P_i Address: C Nan rr�-� A- e, C /State/Zi � i tY P�..' Phone#: 774 _ ¢'57n—(J 7) �• - Are you an employe heck the appropriate b 4" I am a ene ah'contractor=and-I Type of project(required): 1.❑ I am a employer with -, _ „gam. _ n 6. New construction employees(full and/or part-time).* have hired the:sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached'sheet: 7. ❑Remodeling shipand have no employees These sub-=contractors have 8. Demolition ,;a..n working for me in any capacity. employees and have workers'? 9 uilding addition [No workers' comp.insurance comp.1msuranc--a. required.] 5. We are a corporation and its 10.❑EIectrcal repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other 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,snb'mit-ti_davit=indicating they aze doing all work and then hire outside contractors must submit a-new affidayi£indicating.such. $Contractors that-check this box must attached an additional sheet showing the_name-ofthe=sub-contractors-and state whether or not those entities have dmplo s.IfIf th_�r nhactors_have=employees;they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information_ Insurance Company Name: (iol��"\h e jj �J�B �X `(klsWr_CM ' J e Policy#or Self-ins.Lic.#: VJ PA o 3 162 -7(47 1 j Expiration Date: Job Site Address: • `_Q I"1G � _&�i City/State/Zip: _T►115 ` 0�(� � 02.�4`7 Attach-a`cophe workersycompensation_policy declaration page(showing the policy number and expiration date). GFailure-to-secur voce�erage 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$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 mcnrance coverage verification. I do h certifyMunderpains d pe 'es of perjury that the information provided above is true and correct Si atur' Date:._ _ Phone Official use only. Do not write in this area,to be completed by city or town officiaL Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other, , Contact Person: Phone#:- r Information and Instructions Massachusetts General Laws chapter 152 requires all'employers to provide workers'compensation for their employees. . Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because`of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states thaf"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. ' City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of I 4assacliusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 4-24-07 wwv��mass.govfdia rM DUN July 8, 2015 To Whom It May Concern, This letter is to inform you that the metal shed behind the house at 197 Marston's Ave, Barnstable, does not have any electric or. water connections. It appears to be a storage shed. Thank You, Darren Johnson Robert B. Our Co., Inc. 24 Great Western Road,P.O. Box 1539, Harwich, MA 02645 Tel: 508-432-0530 Fax: 508-432-7057 Web: robertbour.com ROBERT B. OUR CO., INC. Proposal 24 Great Western Road, P.0. Box 1539 North Harwich, MA 02645 Specifications and Estimate (508)432-0530 FAX(508)432-7057 Proposal submitted to: Maryann Farley Phone: 774-487-0719 Date:6-30-15 street: 197 Marstons Avenue lob Name:Garage Demo City,State,Zip Code: Hyannisport,MA 02647 Job Location:b6okl6veri25@conic5st.net Architect/Engineer: Date of Plans: Supervisor. Darren Johnson Job Phone: We hereby propose to furnish materials and labor necessary for the completion of: Demo Garage/Shed Behind House 1) Dig Safe property 2) 'Wait for permit II I 3) Remove garage/shed and dispose of A9ltr�s -4-0 t� w 4) Loam and seed disturbed areas. PLEASE NOTE: • Information needed to proceed will be given when contract.is signed and returned. t WE PROPOSE hereby to furnish material and labor—complete in accordance with the.above specifications,for the sum of. Three thousand and 001100....................... l)ollars(5 3.000.00' ) Payment to be made as follows.: S1,000 deposit with signed proposal. Balance due upon completion. All material is guaranteed to be as specified.All work to be completed in a substantial Authorized <. ernes FL/rsc� Workmanlike manner according to specifications submitted,per standard practices.Any Signature, 1 1"r 'f( I/) alteration or deviation from above specifications Involving extra costs will be executed only ., upon written orders,and will become an extra charge over and above the estimate.All Note:This proposal may be withdrawn by us if not . agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry : fire,tornado and other necessary insurance.Our workers are fully covered by Workman's accepted within 30 days. Compensation Insurance. y , ACCEPTANCE OF PROPOSALThe above prices,specifications and conditions are satisfactory . and are hereby accepted.You are authorized to do the work as specified.Payment will be made Signature &�� as outlined above. DATE OF ACCEPTANCE: Signature J _ An interest charge of 1 Y.per month(18%per annum)will be charged on all invoices over 30 days.If any invoice remains unpaid for more than sixty(60)days and is referred to Legal Counsel for collection;then,in addition to the unpaid billing and accrued service charges,the above signed further agrees to be responsible for all costs of collection,including all legal fees incurred by the Robert B.Our Co.,Inc. Town of Barnstable Regulatory Services - oF Richard V.Scali,Interim Director Building.Division 13MINSMA3311 - - Tom Perry,Building Commissioner 9cb 1 MASS. ,�� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6250 HOMEOWNER LICENSE EXEMPTION _ Please Print DATE: ` :e2 O p JOB.LOCATIQN: v r r number II street h Wlage "HOMEOWNER": 1� I �" nam c7� R home phone# ,` work phone# CURRENT MAILING ADDRESS: 1 l I✓C�X N �12tnni-, �yr� (Vl� Do2(7t7. -4tty/town y � zip code The current exemption for"homeowners"was extended to include owner-occulied dwellings of six units or Iess and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a hvo-ye-r period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work-performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. , d y The undersigned` mecwner` es that he/she understands the Town of Barnstable Building Department minimum inspection pro es and ements d at he/she will comply with said procedures and requirements. pro es and r Signature: meowner / Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 10911-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a super Asor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness_often results in serious problems,.particWarly when the homeowner hires unlicensed persons. In this case; n our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that be(she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. ? E rokti Town of Barnstable 0 Regulatory Services t RAANCTARj,F, t .. _ afass �, -)Richard V.Scab,Interim Director 39- �,m Building Division Tom Perry,Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.barnstable-mains Office: 508-862-4038 Fax 508-790-5230 roperty,Owner.Must Comp te. and Sign This. Section Us' A Bi ilder ' as Owner of the subject property, hetebp autlhoriae to act on Iny behalf, in all matters relative to work authotized by building p emit � r-� M o z7 (Address of job) Of Pool fences and alamms ate the�tesponsib' the applicant. Pools .n. are not to be filled'ot utilized befo�te fence is ins ed and all final inspections are petformed acid accepted. S e of Owner Signature of Applicant R,av n� Print acne Print Name ..Date AGURD, CERTIFICATE. OF LIABILIT Y INSURANCE � 1k,r i THIS.CERTtFICATE is ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.T'rOS � ( CERTIFICATE HOES,NOT AFFIRMATIVELY OR NEGATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 1 I OW.T14IS GERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S).AUTHORIZED I RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. i IMPORTANT.'Ifthe certificate holder is an ADDITIONAL,INSURED,the poll; (ies)must be endorsed.If SUBROGATION IS WAIVED,subject to 1 -the terms and conditions of the policy,certain policies maV require an endorsement A-statement on this certiticate does not.confer riahts to the certificate holder in lieu of such endorsement(sl. PRODUCER AIAME: Cathi Lawrence HUB International New England PHONE.- tArc.Nc Ezt_508-235-2207 E A/c No: 866-569-4091 222 Milliken 8h►d ADDRIES$: catherine.lawrence@hubinternational.com Fall River,MA 02722 $ 508 235-2200 INSURERS)AFFORDING COVERAGE I NAIL# I INSURER A:Acadia insurance Company 131325 1 INSURED INSURER a:St Paul Fire and Marine 124767 I Robert B.Our Co., Inc. {-I--- - I INsuRER e.Fire10en S Ins Cts Washington IBC 217$4 24 Great Western Road t -I P.O.Box 1539 INSUP.ER D.Chartis Speciality I Harwich.MA 02645 t INSURERE: �J I r INSURER F: t i 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 I i INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS l CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. I ,.� EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 INSR ADDL SUBR POLICY EFF { POLICY EXP n-I LTR TYPE OF INSURANCE INSR N VD I — POLICY NUMBER I LIMITS JMMIDDIYYYY I MM/DD/YYYY) C " GENERAL LIABILITY 1 CPA130142823 12/0112014 12/01/201 d_EACH OCCURRENCE 1$1,000,000 X COMMERCIAL GENERAL LIABILITY I !DAMAGE-1 RENTED � i [PR MISES Ea oaxiir . s250 000 CLAIMS-MADE U OCCUR ! I MED EXP(Any one person) l$5,000 I PERSONAL&ADV INJURY $1,000,000 ( 1 E GENERAL AGGREGATE $2,000,000- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS=COMP/OP AGG 1$2,000,000_ POLICY 1 PE Q LOC $� �C. AUTOMOBILE LIABILITY MAA130144023 2/01/2014 12/01/201 COMBINEDxident) $SINGLE LIMIT 1e 000�000 Ea a XXJI'ANY AUTO. BODILY INJURY(Per person)' $ !ALL OWNED SCHEDULED BODILY INJURY(Per accident) '$ AUTOS AUTOS {{{ X HIRED AUTOS N NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident I I !$ B UMBRELLA LIAR X OCCUR ZUP15R5073214NF 12/01/2014 12/01/201 EACH OCCURRENCE ($10000000 EXCESS LAB CLAIMS-MADE, I I s AGGREGATE $10 00O 000 DEO RETENTION$ ({ $' WORKERS COMPENSATION 1 I WC STATU OTH- - C WPA031676715 1/01l2015 01/011201 X ITORYLIMITS AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $SOO OOO j OFFICERIMEMBER EXCLUDED? NO NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE).s500 000 If yes,describe under DESCRIPTION OF OPERATIONS below I - E.L.DISEASE-POLICY LIMIT $500,000 D Pollution Li CP08087906 12/01/2013 12/01/201 1,000,00012,000,000 A Equipment CIM5182149 12/01/2014 12/01/201 _500,000)eased r DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) RE:Trenching Permit Town of Barnstable is listed as additional insured with respect to general liability as required by written contract. 4 is CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE.. Town of Barnstable THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 367 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601-0000 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION.All riahts reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1258948/M1257702' +, ': ,+ ' ` SP002 y ! ` v f ) �'►. ,.; �. t� r' ' Ids./ ✓ i "`J t,• � � f r �!1..1, �� a� ,�� i♦`•..,+y T- ,fir � '1 y.,Y �'' ) - �"• + .r•,r • `y" `i+. ?r j Yc. , Al e �• MA' Y `(y ow - f. IL + rr y t� AV s ,r :. Opt ` ` � 1..S ..r � ♦ � � � I pPA,.. 1' .. . �- ♦ • , � •r-k'� r'�/�T�j�•r•- �ir.D.. r ~.aN� �3'?t' 1�� �l. ��' 4�. < ���.- r' t� �:�jr. '�.� I fir.• .� t r ;, �� f t; �K �• \ c 'Y`,`; / '�ri '�,. �� '-.+►try i, •,yf. ♦ , � r p.�! �fn'� •1w- .�/'y` • - - L .►tip.' -. 1.j', �,�'"� * �� ` � �"j a �.� •�'•��� e_�,..♦ .. '�` J . - Y r Y 1 r �' .♦ -i..b�i. �:, :4 � .. �`r-sew -,s �'�,. Vill, Lo WM .10 ;' hc 00 r i. / . Town of Barns *.PermitI ?THE table # r O„ Expires 6 march a s Regulatory Services Fee � XtMrAWX, MASSThomas F. Geiler,Director Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www-town.barnstable.ma us Office: 50 8-8 62-403 8 Fax: 508-790-623 0 EXPRESS PERMIT APPLICATION - RESIDENTIAL; ONLY Not Valid without Red X-Press Imprint ,Map/parcel Number Property Address -/S �71• /L����Y` ��C!�f � � ���%�f s � ❑ Residential Value of Work U r L) O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address- Telephone s`►/��� ��Qj�C' Contractor's Name t C�Y Number,162? dome Improvement Contractor License#(if applicable)_ Z—;7,�__ _<4- .onstruction Supervisor's License#(if applicable) X,-j 6 0 ]Workman's Compensation Insurance Check one: MSS PERMIT ❑ lam a s proprietor ❑ I aprffie Homeowner C 2011 have Worker's Compensation Insurance /r ; sal f ' isurahce Company Name:_ �� �j�,�c • CQ .. 'orkman's Comp. Policy# { spy of Insurance Compliance Certificate must accompany each permit emit Request(check?sb C;—te�_roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going-over existing layers of roof) . Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows, *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Canservatinn,etc, ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the a Impro ent Contractors License& Constructian Supervisors License is wire !MATURE: � 'FIl-EST0RM5lbuildine hermit formslEXPRESS_dnr. 4(� The Commonwealth of mussa husetts . i)wrfinenf of 1ndusfrial Aeci.,d O,Q'ice of Invesfigadons 600 Waashingihm S`bvef .Boston,MA 0211 wrc*w.nrrrss.gryvv/dria Workers' Cumpeensatiun Insurance Affidavit: BuMer t/Contractors/Elechi ns/Phimbers Applicant Information Please Print Lezibh Name 1� Address: 1✓ifS : Phone# Arg an eruplafe0,Check the appropriate box: Type of project(required): 1_01 am.a employer with 4. ❑ I am a general contractcr and I to full andr`ar s have hired the sub-contractors 6. New conshucfiac .0 p ?- 2-❑ I am a sole proprietor orpartner- listed on the attached sheet Z. ❑Remodeling ship and have no employees These sub-cofactors have S- ❑Demlitica wodang .for me many capacity- employees and have wodters' [No wodmm' comp.insurance Comp.ies�varsrp.Z 9. �Buddingaddition required-] 5. ❑ We are a corporation.and its 10.❑Electrical repairs or additions officers have exercised their 1❑ I am a htsmeoiRner doing all work 1 T_❑Plumbing repairs or additions o warl=s' right of exemption per NIGL myself � comp- 12.❑Rflof repairs insurance required.]r c-152, §1(4),and we have no employees.[No workers' 1�,❑O#fier comp.insurance required.] ;Any apphcznt that checks hour*1:mnst also fill ow the section below showing then vorlteW compensation policy inivrmuian. Homeowners wbe submit this affidavit indicating they ate doing all Breit and thm hire outside cant wwrs mast submit anew affidavit indicating sack iCoanactors thzt check this btat must al zttached as additionsbeet showing the name of the sub�znd state whether or not those emkies have employees. If the mb-cenwiams hm esaplasees,theynntst:provide their tiworkaV comp.policy munber. I am an employer tl e&providing workers'coarpensrrtiorr insstrance for.my eurplojvm Below is thepv&—y and job site informaden. �j Insurance.Compariy Name: 61!/ Policy i m Set ins-Lic.# Fagairaticn.Date: Job Site Adder: ��T ,S5 , T l/ cityfstate/4: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of NIGL c- 152 can lead to the imposition of criminal penalties of a fine up to$1,500-00,arndfor one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 luvmstigations of the DIA for msur me cmmrage verif=ticr I do herek,cc the and per efpedwy that the information prmpided above is bite and correct Si Date: Phone#: Officitrl am only. Des not write in obis area,to be couipleW by cio or t etwwr offida! City o:IDC'I own: PermitUcense# Issuing Authority(circle one): 1.Board:of Hralth 3.Building Department 3.CitFlTown Cleric 4.Electrical Inspector 5.Plumbing Inspector . 6.Other Contact Person: Phone#: 6 i HIS CERTIFICATE 18188UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED Y THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN HE ISSUING INSURERS AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. MPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION 8 WAIVED,subject to the terms and conditions of the policy,certain policies may require and endoreement A statement n this certificate does not confer ri hts to the certificate holder in lieu of such endorsement PRODUCER Olds Cape Cod Ins Agcy Inc 296 Winter Street Hyannis,MA 2601 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Vlilanl Construction Inc Po Box 692 Hyannlsport,MA 02672-0000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-11MIT8 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 00 LTR Tel or wWRANOB POLICYNUMBER FOUCYEFFECrrVC DA1E FOLr ZVRAT10N DAZE A oETdP�OY0ER8�LY9iLm LIMITS E PROPRETORI ARTNERSM(ECUTNE FFICERS ARE NCL o EXCL 0 1 16W670 1 1/08/2011 1 1/08/2012 LIMITS OTHER CwwapaAWIwtoMAOpwapma0*. CH ACCIDENTJATMRY MAN POLICY LIMB S 800,00EASE-EACH EMPLOYEE S 100,00C DESCRIPTION OF OPERATIONSNEHIOLMS/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE 230 SOUTH ST WNTETHE POLICY PROVISIONS. HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE s/he -0owvnaan&,ea1& o/ laoaachuaeCCa Office of Consumer Affairs&Busi✓!ness Regulation License,or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration F 128560 Type: Office., ffice.,f Consumer Affairs and Business Regulation Expiration.___4'/21/2013 Individual 10 Parn Plaza-Suite 5170 Bost on;iMA 02116 RICHARD VILLANI't ,r. I / RICHARD VILLANI r y ,; 109 WAGON LANE y Awl, � HYANNIS, MA Undersecretary Not valid without signature —......... ._ rutmcnt of Public Safct} Massachusetts- DC ��ulatiotts and Shutdards Re. Board of Building ervisor License _ Construction Sup license: CS 74360 J y RICHARD VILLANI p0 BOX 692 W HYANNISPORT, MA 02672 Expiration: 6123/2012 ` Trit: 1239 VILLANI CONSTRUCTION INC. Roofing&Siding Specialists PO Box 692 West Hyannis Port,MA 02672 508-778-2495 1-888-766-3043 Member of the Better Business Bureau—Insured—Licensed—Free Estimate Marshall Farley October b,2011 19 Marston Av. 508-398-9532 Hyannis Port. DESCRIPTION Furnish and install the following, labor and materials to re-roof building at 194 Marston Av. Hyannis Port Ma.as follows: 1. Remove existing roof shingles. 2. Install 30Yr. Architectural Roof singles. Remove debris from job site. Note: -Dump fees for removal are included in this quote. -Villani Construction,Inc.guarantees-labor for I0 years. We propose hereby to furnish labor&materials complete in accordance with above specification for the sum of: SIX THOUSAND EIGHT[.'HUNDRED DOLLARS.$6,800.00- Payments to be made as follows: DUE ON COMPLETION J All materials are guaranteed by manufacturer. All work to be completed in a substantial workmanlike manner according to specifications submitted,per standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon verbal request and will become an extra charge over and above the estimate. All agreements contingent upon weather, accidents, or delays beyond our control. Owners to carry fire, tornado, and other necessary insurance. This proposal maybe withdrawn if not accepted within 30 days. ACCEPTANCE OF PROPOSAL— The above prices, specifications and conditions are satisfactory and are hereby-- accepted. You are authorized a wo specified. Payments will be made as o me a e. Signature Signatures Date��� ^�/ CB FND BENCH MARK - ^� CONC PAD AT METAL GARAGE EXIS PORCH ELEV. T 2.s. POOR COND 3 �9 FfN�F 230•21' 26 �' 88 COMPOST go, AREA 2) cy a EXIST. DWELL. <- MARE3LE BND' FND / a• I, 119 32 01 a 33 �c 34 _ MARBLE BN' Gf, ,I l i i I i ' � I CB FND 2� o NED DRIVE i 28 N 29 � 1 i x CB FND \W \ W I,y O \ cV 1S1 28' JD 22 1SS pq QED � CB FND a N Ii