Loading...
HomeMy WebLinkAbout0037 MURPHY ROAD 37 /�Ivephy �a.�_ _ _- _ . - -� YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$4D.00 years). A business certificate ONLY-REGISTERS YOUR NAME in town (which you must do by M.G.L:-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis., MA 02601. (Town Hall) and get the Business Certificate that is required by law. DATE: ^ 31 - Fill in please: ''';?,i l<,rarirf;�icp;:y�;•t-.c;r4r:i>::i�t 4'tAu'>j ~I.3�z+.t,, :r';';�,. APPLICANT'S YOUR NAMES:�� .� BUSINESS YOUR HOME ADDRESS: L-ajI!'s'a2!;zf TELEPHONE # Home Telephone Number l T f� ,Y� �r.a4 ,iu'kl ,ysii�ryyd E—MAIL \�J � (. dsn, NAME OF CORPORATION: ��� h TYPE OF BUSINESS NAME OF-NEW BUSINESS of ✓� IS THIS A HOME OCCUPATION? YES NO M ADDRESS OF BUSINESS- AP/PARCEL NUMBER " I (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to-assist you in obtaining the information you may need. You MUST GO TO ZOO Main St. — (corner of Yarmouth ' Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your us in this town. . 1. BUILDING COM ISSIO ER'S OFF E This individu I h s e i-Tor ed o n per it re uiremerits that pertain to this type of busiST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE.TQ Aot on igrm ** COMPLY MAY RESULT IN FINES. pM ENT ' CIZ nTi 2. BOAR OF USALT4 This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has.been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: r Town of Barnstable FVE Regulatory Services '►c Richard V. Scali,Director Building Division M`S• Paul Roma,Building Commissioner 'OrFpCl A 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: - o- HOME OCCUPATION REGISTRATION Date: Name: Qr- a Phone#: 7 5�(, I Iv ? 1 Address: 31 Avg Pk � yww�JS Village: s - Name of Business: _ r C'` y v CJ O►���'�t,�-�Y►/.� Type of Business: Ca '��r Map/Lot: V 9 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,'and there is no outside evidence of such use. • No traffic will-be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular -matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. •. There are no commercial vehicles related to the Customary Home Occupation,other than one van or one. pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked.on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwe ' it. I,the undersi ed,have ad and agree th the above r tric ons for my home occupation I am registering. Applican Date: A, 3 i a IV/6 , Homeoc.doc Rev.06/20/16 49 Herring Pond Road Buzzards Bay,MA 02S32 P.5o8-888-iy4o P.508-833-3377 Resolution . E N E R G Y March 25, 2013 Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Q o Re: Insulation permits co Dear Mr: Perry: --a Thisffidavit is certify that all work compered for insula ion walk rn at 37 Murphy'Road, Hyannis has been,inspected by a certified Building Performance Institute (BPI) Inspector,:' All work performed meets or exceeds Federal and State requirement. Sincerely, Lisa M. Haglof, Executive Off ice Coordinator Y ..} <�:r.S„ ,n "° s..l,$£W -zm_ ..,.fir.. ,•a. .� '�x,.. i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3bS Parcel Application Q/d 19 t�3 Health Division Date Issued 1 Gl l D Conservation Division Application Fee i Planning Dept,. Permit Fee ��✓ Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis fy Project Street Address 3 a'4 Village H .S Owner K �N �l�a Tca.}`d Z Address 3� Telephone ermit Request w E a:•�6,� .Z �` o % /�Q✓ ''7`�?�i(�S G b 2 �D✓� r Square feet: 1 st floor- existing proposed 2nd floor: existing - proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation G�fi� 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 tis Historic House: ❑Yes 21No On Old King's Highway: ❑Yes ❑ No Basement Type: C"Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Z new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing ce new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes A 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: CD Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ " 01 r - Commercial ❑Yes ❑ No If yes, site plan review# ' Current Use Proposed Use P APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address ­-q License # &31 oz m., ozS 3 Z Home Improvement Contractor# ks X Worker's Compensation # we Z-i ts 3j es z3 - o3S ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �o w1. 1Z es � v L C w—�► � SIGNATURE DATE -4 - ; FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED t MAP/PARCEL NO. ADDRESS VILLAGE OWNER y DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE w ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r - ,.� DATE CLOSED OUT ASSOCIATION PLAN NO. I� c H The Commonwealth of Massachusetts Department of Industrial Accidents � F Office of Investigations I' I 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print L,elZibly Name (Business/Organization/Individual): �k,t_ �,,3 Address: %-\g �����.��.� co �o ►.3� �� City/State/Zip: a sum, w- Phone #: s c)1L- `s 8 1, - %,:;,A O Are you an employer? Check the appropriate% box: Type of project(required): 1.I ZI I am a employer with .5 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g_ ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required,] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.[410-ther �, v ���la.�•0 1� 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 number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 4-` 4a o ,,% s =L S Policy#or Self-ins. Lie.#: Expiration Date: c,--L y Job Site Address: l.Q City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL 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 DI nsurance coverage verification. 1 do he y ce a der he pains d penalties of perjury that the information provided above is true and correct Signature: Date: ' - N L• t Phone#• 10% AV4 - �1 `kQ jOfficial use only. Do not write in this area, to be completed by city or town official 3 City or Town: Permit/License# 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#: Information and Instructions w 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 that"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. iShould 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 givedyear,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)."lA 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like 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 Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 .Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia r , ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: `e Site Address: print Town: ��..a..�►.►.s Applicant Phone: _ a Applicant Signature: Date of Application: j _ .L Z - to . NEW CONSTRUCTION: choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE-AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab Option 1: Basement P Fenestration exposed Wall Floor Perimeter U-factor floors R-Value R-Value Wall R-Value AFUE HSPF SEER R-Value R-Value and Depth National Appliance Energy R-10, Conservation Act(NAECA)of .35 R-3 8 R-19 R-19 R-10 4 ft. 1987 as amended,minimums or rester as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: REScheck Version 4.1.2 or later variant software analysis must be completed (780 CMR 6107.3.2) REScheck—Web which can be accessed at http://wwv✓.energ cy odes•gov/rescheck/ ADDITIONS'OR-ALTERATIONS;TO EXISTING BUILDINGS.OVER:5 YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b_ a) SF 100 x — _ %.of glazing (b) Glazing area equals SF b a If glazing is:<'40% use the chart below. If glazing is > 40 % proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM ❑ Ceiling and Slab Perimeter Fenestration. Wall Floor Basement Wall U-factor Exposed floors R-Value R-value R-Value R-Value R-Value and Depth .39 R-3 7 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling j area(i.e.not compressed over exterior walls;and including any access openings). SUNROOM—An addition or alteration to an existing building/dwelling unit where the total - El glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120T) Town of Barnstable Regulatory Services ' RM Thomas F. Geiler,Director acs.MAS& Fo;9;. A�O� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I to, as Owner of the subject property herebyauthorize Z�Sc� .o�, z�u �,.,� to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) l t Signature of Owner V, Date Print Name If Property.Owne.r is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION of r Town of Barnstable IME o Regulatory Services t3nartsr"r E Thomas F. Geiler,Director 9q,A 1MAS9 amp Building Division TED l'a� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 10B LOCATION: number street village "HOMEOWNER": name home phone# work phone#t CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a:license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109;1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and.requirements and that he/she will comply with said procedures and requirements. Sig nature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page 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. Q:\WPFILES\FOR.MS\bomeexempt.DOC Barnstable Assessing Search Results Page 1 of 2 m Home:Departments:Assessors Division:Property Assessment Search Results New Search New Interactive Maps>> Owner: 2010 Assessed Values: TAYLOR,KENNETH M 37 MURPHY ROAD 2010 Appraised Value 2010 Assessed Value Past Comparisons Map/Parcel/Parcel Extension Building Value: $126,400 $126,400 Year Total Assessed Value 309 /169/ Extra Features: $3,000 $3,000 2009-$261,800 Outbuildings: $700 $700 2008-$287,400 Mailing Address — Land Value: $102,400 $102,400 2007-$286,500 TAYLOR,KENNETH M 2006-$272,800 2010 Totals $232,600 $232,500 37 MURPHY RD Residential Exemption Received=$92,000 HYANNIS,MA.02601 2010 REAL ESTATE Tax Information: Tax Rates:(per$1,000 of valuation) Community Preservation Act Tax $32.75 -Fire District Rates Town Residential Barnstable FD-All Classes $2.43 $7.77 C.O.M.M.-All Classes $1.26 Town Commercial Hyannis FD Tax(Residential) $423.15 Cotuit FD-All Classes $1.56 $6.87 Hyannis-Residential $1.82 Town Tax(Residential) $1,091.69 Hyannis-Commercial $2.88 W Barnstable-All Classes $2.28 Community Preservation Act 3%of Town Tax Total: $1,647.59 Construction Details Building Property Sketch &ASBUILT Cards Building value $126,400 Interior Floors Carpet Property Sketch Legend Style Ranch Interior Walls Drywall Model Residential Heat Fuel Oil Grade Average Minus Heat Type Hot Water / Stories 1 Story AC Type None ,"N a �0o6j_ Exterior Walls Wood Shingle Bedrooms 3 Bedrooms O � Roof Structure Gable/Hip Bathrooms 2 Full Roof Cover Asph/F Gls/Cmp Living Area sq/ft 1,532 Replacement Cost $154,149 Year Built 1954 Depreciation 18 Total Rooms 6 Rooms Land Gross Area sq/ft 3,244 Ce CODE 1010 / � AsBuilt Card N/A Lot Size(Acres) 0.26 Appraised Value $102,400 C W y L� http://www.town.bamstable.ma.us/assessing/2010/displaypareell0map.asp?mappar=309169 7/1 10 .,. ,p� ✓fie �anvnzaruuecr,��i o�✓�aaaac,civavlta �\ Board of Buildi.:g Regulations and Star.laa .'s HOME IMPROVEMENT CO RACTOR Registration':,162158 Ex iration 1126/2011, Tr# 280039 Type Individual JEFFREY R.TONELLO:_ = ` JEFFREY TONELLO 60 STATE RD. ^�' SAGAMORE BEACH, MA 02562 Administrator Massachusetts- Department of Public SafetN Board of Building Re!-ulationsand Standards Construction Supervisor License ` License: CS 53202 i Restricted to 00n JEFFREY?R,TONEL1L`O PO BOX itib 26 SAGAMORE BE i, MAC 02562 - —� Expiration: 7/14/2011 ' Commissioner Tr#: 19157 I DATE(MMIDDlYYI'Y) ACORD0 .. CERTIFICATE OF LIABILITY INSURANCE 10/28/2009 PRODUCER' (781) 344-8578 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE C.L.• Hollis Insurance J Y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR L7 Glen Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Stoughton MA 02072- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:LIBERTY MUTUAL RESOLUTION ENERGY INC. INSURER B: 43 Fieldwood Drive INSURERC: PO Box 1490 INSURER D: Sa amore Saach MA 02562— INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY (MM DD/YYE POLICY (MM/D/YY)N _ LIMITS LTR INSRD ( ) GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS MADE DOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY' JECOT- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNEOAUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIREDAUTOS BODILY INJURY (Per accident) $ NON-OWNED AUTOS iPROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY I _ I OCCURRENCE $ OCCUR CLAIMS MADE AGGREG E $ $ DEDUCTIBLE RETENTION $ $ A WORKERS COMPENSATION AND WC2-31S-370523-039 09/02/ 009 09/02/2010 T�OYLIMITS OER EMPLOYERS'LIABILITY , ANY PROPRIETOR/PARTNER/EXECUTIVE .EACH ACCIDENT $ 500,000 OFFIGER/MEM.BER EXCLUDED? / /�\ / E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes;describe under 500,000 SPECIAL;PROVISIONS below - E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ,ERTIEiCA •Ea.H.6 CANCELL?ATION SHOULD ANY OF THE'.ABOVE DES,CRIBE.D POLICIES`.BE CANCELLED.BEFORE THE s n J. EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ` _DAYS'1NRITTEN`NOTICE TO THE.CERTIFICATE`HOLDER NAMED TO THE LEFT,BUT t i t, FAILURE TO DO SO SHALL IMPOSE:NO OBLIGATION OR'LIABILITY OPANY KIND UPON THE t H`:z'c"'4�rq'°t��nr-bKl4" s:,*,"Rye•„#r Ti+,c%z''� '"�a'',^'rn- ..:: -_ .- s- .INSURER.ITSJIGENTS OR REPRESENTATIVES: " -'.-; AUTMORIZED�REPRESENTATNE r ; ��Q�mwflz (20 ©ACORD CORPORATION 1988 ill,ry J$0 40 K j r ELECTRONIC LASER FORMS,INC-(800)327-0545: Page 1 of 2 t I tit i.' - i 7 The Commonwealth of Massachusetts Department of Public Safety A p ication for Grandfathered Insulation Construction Supervisor License if r ' n D �e F,�r�e ---- 19 0 f3y �d o __ (� ) ' ka) o(t, A eAt k azL City I State ZIP Code 1 JC f�dd CO Cam n6- -- Home P ione Email Address 9,e.50) L41�L 10 JFil erci V Name of C r nt Employ --Yyo k Phone 604/ U1Of� Street Address City State - ZIP Code C0 P0, � i 6 n1 /6�l�d GS L -- 5'3 0 Current Occuj2ation HIC Registration Number Indicate an building or trades lic nse(s)currentlyheld . License under the Grandfather Pl s ievieWthe required minimum qualifications found on t e Lea<-er o ttestation page, I, being the person referred to in the application for a license as outlined in Special , Regulation R5 of tfie Sta e Building Code,do solemnly swear that the statements herein made are true and correct;that the application is made in good faith; th it I Have complied with all the requirements of law to the best of my kno �� f;;that I am familiar with and have available o m A.Regulationse a copy of the latest Massachusetts State Building Code and all ofu"f and, that I meet all qualifications to be licensed by the Board of Examiners without being tested.Also,I hereby attest to.the,fact that I have READ and UNDERSTAND the i i:mum qualifications for the category of license sought and attest tha'JI meet or exceed these qualifications by virtue of my experielcE. i Under the penalties of perjury, I declare that the information contained in herein is true, correct and complete. I further and(ist nd that a false statement made in this affidavit and application is stURiOt cause�o'4i jection or revocation of a license issued:Purs n t:7 the Massachusetts general'laws,Chapter 62C,Section 49A,I certify under the penalties of perjury that to my best knowledge and Del ef,I hafil d all state tax returns an aid all toe taxes required under law. , Signature of applicant _ _ Date: 416,512�� Please check here if o (th applicant) au orize the Department of Public Safety(DPS) to el ,IL onically access your photograph from the 114 ssachusetts Registry of Motor Vehicles (RMV) database solely for use on this construction supervisor license. f P cannot acquire a,photo from the RMV please supply one as indicated below. Notary Public. Date: . ` Expiration'of Commission: / 3 _ Signature OFFICIAL SEAL ROBERTA A. GRIMES Applications mus t be Postmarke,d on or before May 2-, 2009. Applicati LI this date will be returned. My Comm.Expires Dec.s,2oto u Please return completed application along with a check for 150.00 made. License Number: __ Affix 1"x 1i/a" payable to "Commonwealth of Massachusetts"and retail to: face photo here Date of Issue: _ Department of Public Safety,Attention: Insulation CSL or provide One Ashburton Place-Room 1301 r Expiration Date: authorization Boston,MA 02108 —----- to use RMV photo. Date Received: Check Number: Transaction Number: Y �I I� 07/19/2010 11:49 5088333377 HAGLOF INC PAGE 02 49 Bening Pond Road I Buzzards Bay,MA oz532 e.50-888-1940 r.508-833-3377 Resolution E N E R G Y Town of Barnstable July. 19, 2010 200 Main Street Hyannis, MA 02601 Re: Jeff Tonello/Resolution.Ent r k To Whom It May Concern: Jeffrey R Tonello is.one of the principles of Resolution Energy Inc,as well as the holder of Construction Supervisor License cs#53202 019157 Exp.7-14-1.1 Horne Improvement Contractor Registration: 162158 tr#280039 Exp 1-26-11. Should you have any questions regarding this matter please fell free.to give us a call. Office# 1=508-888-1740 „ 4 Jeffrey R. Tonello Principle Phil Haglof ` Principle r 4