Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0063 SEVENTH AVENUE (HYANNIS)
.�::: i ,. i . Town of Barnstable i W g . Post Thisi`.Card So:That�it,is.Visible;From'the!tr<eet °ApproyedPlan's"Mus#�beRetamed`on Job and.;this Card Mus"t be,Kept�,, * SAIUMABLE. ' Permit. Posted Un#il=Final Inspection Has Been Made y „ � ► ° Where a,C,ertificate`of Occu anc',#isgRe, u�red uch,B,w�ldm ,hall Nofibe=0ccu ied un#il,.Final Ins ection,hasrbeen made a. s�s _p :.�t ,� gns,.a. p -p �';, - Permit No. B-18-1531 Applicant Name: Renoviso, Inc. Approvals Date Issued: 05/17/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/17/2018 Foundation: Location: . 63 SEVENTH AVENUE(HYANNIS), HYANNIS Map/Lot 246-152 Zoning District: RB Sheathing: Owner on Record: MERCIER JACQUELINE&GOONEY, RICHARD Contractor Name Renoviso,Inc. Framing: 1 Address: 314 MAIN ST UNIT 3 � � s �'` _ Contractor License 180151 2 MELROSE, MA 02176Protect Cost: $28,967.00 Chimney: Description: Siding i Permit Fee: $ 147.73 r r Insulation: Project Review Req: Fee Paid $147.73 _ � Date 5/17/2018 Final: Plumbing/Gas Rough Plumbing: - Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within si'x months after'i5suance. Rough Gas: All work authorized by this permit shall conform to the approved appl at n a'nd5 th approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structure shall be in with the local zoning by laws arid codes. Final Gas: This permit shall be displayed in a location clearly visible from access streeo' road and shall be maintained open for publmspection for the entire duration of the work until the completion of the same. , ,`. °' Electrical The Certificate of Occupancy will not be issued until all applicable signaawu es by the Builtl�ng`and Fire Officials are provided on this permit., Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing r „ Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health 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. Final: "Pe-csons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT I f Application numbe Kan II Date Issued................... ...... ``- exsrasLB, = MAY 15 2018 Building Inspectors Initials.. ' TOWN O� BARNSTABLE Map/Parcel....Z y�1`S-2--�............................. TOWN OF BARNSTABLE ` 1-7 EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 63 S 5Vuirn e— ETR STREET VILLAGE D Owner's Name: 1 N iv Phone Number Email Address: Cell Phone Number Project cost$ 9-1 Q67 Check one Residential ✓ Commercial OWNER'S AUTHORIZATION' As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Sao � t Date: TYPE OF WORK Siding © Windows (no header change)# 0 Insulation/Weatherization ED Doors (no header change)# Commercial Doors require an inspector's review ED Roof(not applying more than 1 layer of shingles) Construction Debris will be going to was an eAei--l- 8osMLu, Of CONTRACTOR'S INFORMATION Contractor's name wr7 OtO SO I-Fo(4.4 jJ61ttLro Home Improvement Contractors Registration(if applicable) # ��` � (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Sam tad rernoo(S© . Lom Phone number g gg$b7`16�C� ALL PROPERTIES THAT 11AVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN ?���� A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan-with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: 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 Date APPLICANT'S SIGNATURE a Sign re Date /> All permit applicati ns are subject to a building official's approval prior to issuance. i Docu!f n Envelope ID:Al EACFFE-1 B60-4606-8204-A15114D37BA7 RENOVIS® Rich Cooney 2 South Market Street 63 Seventh Ave Boston,MA 02109 Barnstable,MA 02648 617-848-9610 support@renoviso.com Project #1753418 Created on 5/3/2018 Your final quote Your final quote is below. The price includes the installation, manufacturer product warranty, removal/disposal of old materials,and our satisfaction guarantee. To move forward, simply make a 25%down payment and we'll schedule the installation date soon thereafter. Attractive financing options are also available. This quote is good for 30 days from date above. Description Unit Price QTY Subtotal Siding -Custom Order- 17 squares $23,962 1 $23,962 Strip existing cedar shakes and install new,raw white cedar shakes(17 square)and PVC trim or raw white cedar trim. ----------------------------------------------------------------------------------------- Existingsiding Cedarshakes Lead safe Yes lead Gutters Gutters without protection Shutters Choose later Additional Labor $5,005 Additional labor/materials- Change order resulting from sheetrock found upon stripping the home.Please reference separate note for full details.. ,,.$5,005 Total additional labor/materials=$5,005 Installation details • Complete tear-off of existing siding and underlaymentin order to expose and confirmthe integrity oftheunderlying sheathing(Strip and replace installation only) • Installation of new house wrap on all sheathing surfaces with staples,All seams will be taped down toform a sealed, breathable moisture barrier that keeps walls dry and prevents mold and water damage(Strip and replace installation on ly) • Installation of your choice of siding panels in selected color according to the manufacturer's specifications with corrosion- resistant nails • For vinyl siding projects: o Installation ofj-channel around all windows and doors,finish trim along all edges and sills,and corner posts on all corners to receive siding panels and create a finished look o Installation of aluminum coil wrapping on windows,doors,rakes and fascia,and installation of vinyl soffit. (Additional charges may apply for trim installation in excess of 1 window per square of siding installed,3 doors Project Total $28,96 Total Paid $5,991 Balance ; $22,977 r DocuSi-nvelope ID:Al EACFFE-1 1360-41306-8204-A15114D37BA7 Project #1753418 REN®VIS0 Terms I have reviewed my entire order for accuracy and agree to the terms listed below and at httpsl/renoviso.com/terms.1 also acknowledge that no refunds or credits will be provided unless I cancel my order within 3 days of making an initial payment by emailing support@renoyiso.com. DocuSigned-by: - (hb" 5/3/2018 Le ";AA7Ain Customer signature Date 5/3/2018 Renoviso signature Date Cancellation/Refund Policy You may cancel the project,without penalty or obligation,within 3 days of the date of initial payment by emai ling support@renoviso.com.If so, any payments made by you will be returned within 10 business days following receipt of your cancellation notice and the transaction will be canceled. After this 3 day period,no refunds or credits will be provided.Additionally,after multiple attempts via phone and email,if we are unable to - contact you to schedule the installation after 120 days,we reserve the right to cancel your order and withhold the initial deposit as a cancellation fee. Payments We accept payments via credit card,check,ACH and financing.For all non-financed projects,we collect 25%of the total project price as an initial deposit.Prior to the project start date,we will contact you to establish your preferred payment method for the remaining balance.If no preference is provided,we will assume the original payment method will be used and/or reserve the right to delay the project pending your response.At the midpoint of the installation,at our discretion,we may automatically process 50%of the total project price.The remaining 25% will not be charged until the sign-off process described below is completed. After your installation is complete,we will provide an electronic sign-off form to confirm that the project has been completed to your satisfaction.If there are outstanding items that need to be addressed at this time,please contact us via phone or email and we will work with you to resolve those items.Once we receivethe signed electronic form,we will process your final payment for the outstanding balance via the updated payment method indicated.If you do not complete the approval form,and have not indicated that there are outstanding items within 2 business days,we reserve the right to process your final payment at our discretion.If you are payingvia check,you agree to mail a check for the outstanding balance to our office address within 2 business days after the project completion date. For financed projects,you must successfully complete the financing application process,be approved for financing by our third party provider, and accept the financing terms in order for us to proceed with your project.For any project approved for financing at less than 100%of the total project price,we also collect the non-financed amount,up to 25%of the total project price,as an initial deposit and the remaining portion of the non-financing amount upon project completion.Once the sign-off process described above is completed,we will settle your authorized financing with our third party provider. Project Total $28,967 Total Paid $5,991 Balance $22,977 r m iz i da, 5 .� '�t6kaa ✓1��` A ow, vz. r `'u4 e 6 :`. ^5 ° sun "Win kt�z" " Sd I."k $+.+fi+.i � ,�•`4 �a7 o-x+,-;°ffn� ) y?? � .�R•t , � a*�b �' sG.. _r_ � R . t t r �t #a^r `�t ' r r AS-r NET A ybi�v' �� M�1' -y zr LY pilot, gi .Y c x a , � � T� '4Wd TEES — k ,71 gyp, t1` xr- �p� y.�& # i �.£ t'm aw No .A- a - 3 k � , Sly r its `.�. .. �.. oil011 fraNAP VON .,v _ � e �wa �i 4Ffrcr ��a.a. xk ° Raq lig,� j 4 ylow f he 5:J}�� ". Office of Consumer Affair's & Business Regulation IM PROVEM ENT CO. NTRACTOR ptTYPE:, Suoolement Card x irate 10/14/2Q 1 EN Vi SO J INC. TODD PAS UALIN FANEU I.L HALL MARKETPLACE 2 S. MARKET BUILDING, 4TH FLOOR BOSTON A 02109Ljndersecretar , 71 a Comnwnwealth of Massachusetts = Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly, Name(Business/Organization/Individual): Renoviso Address: 2 south Market St Boston,Floor 4 City/State/Zip: Boston, MA 02109 Phone#: Are you an employer?Check the appropriate box: F7. pe of project(required): I am a employer with g' 4. ❑ I am a general contractor and I ❑New construction employees(full and/or part-time).* have hired the sub-contractors Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ship and have no employees These sub-contractors have , ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers comp.insurance comp:insurance.- 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 1 I.[]Phimbing repairs or additions myself.[No workers' comp. t right of exemption per MGL 12.F1 Roof repairs. , insurance re- u ed. c. 152;§1(4),and we have no 13.g/Other d q� ] employees.[No«porkers' comp. insurance required.] *Any applicant that checks box i#I must also fill out the section below showing their xeorkeW compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then him 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name: Hartford Underwriters Insurance Company 10 WEC AQ3165 Expiration Date: Policy#or Self-ins.Lie.#: ' Job Site Address: (p3Ve Cit}?/State/Zip: C34ffl� j 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 imprisonment,as well as civil penalties m of a STOP WORK ORDER and a fine in the for of up to$250.00 a day against the violator. Bead ised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cov b verification. I do hereby certify udder the pains of enald of p rjury that the information provided above i trec and correct. Signature: Todd Pasqualino Date: 7 Phone#: 8 - -1 6 F only. Do not write in this area,to be completed by city or town off ciaL 77 n• Permit/License hority(circle one):Health 2.Building(Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: _ I -� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYVY) 10/04/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGA-61VELY 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(its)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 eadorseufeal.A statement on this certificate does not confer rights to the certificate holder in lieu of such eadorsement(s} PRODUCER CONTACT FoundNAME: 119 W rS b SI, rd F PHONE FAX '4e W 24t,S4 10 10 (A/C,No,Est)646-354-1059 Vew York,NY,J0010 (A/C No) E-MAIL ADDRESS:coiRfoundershield.com INSURED' INSURER AFFORDING COVERAGE -NA1C# INSURER A: MUMMERS AT LLOYD'S LONDON CFC- 15792 .South 2euth Inc.Market Street,4th Floor INSURERB: HARTFORD UNDERWRITERS INS CO HARTFORD 30104 Roston,Massachusetts,02169 INSURER C: INSURER D: INSURER E: INSURER F: OVERAGES CERTIFICATE NUMBER: REVISION NUMBER: (HIS 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 tEQU1REMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INStjRANCE AFFORDED BY THE 'OLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE:TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. `SR TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP rR NSD WVD POLICY NUMBER IIIM/DD/YYYY VDD/YYYY LIMITS COMMERCIAL GENERAL LIABEU Y EACH OCCURRENCE CLAIMS•MADE EI OCCUR DAMAGE TO RENTED PREMISES Fa occurteno MED EXP(Any oneperson) GENT.AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY POLICY I. (PROJECT 1 Q,OC GENERAL AGGREGATE tt �� LJ PRODUCTS-COMP/OP AGG THER: AUTOMOBILE LIABILITY _ ANY AUTO COMBINED SINGLE LIMIT _Fa accident OWNED CHEDUL$D BODILY INJURY(Per erson AUTOSIAUTOS BODILY INJURY Per accident HIRED :q ON-OWNED PROPERTY DAMAGE AUTOS UTOS Per accident Hired&Non Owned Auto UMBRELLA LIAB OCCUR EACH OCCURRENCE _ EXCESS LIAR CLAIMS-MADE AGGREGATE DID - RETENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N PER ANY PROPRIETOR/PARTNER/EXECUTIVE C STATUTE OTHER B FFICERIMEMBER.EXCLUDED? N/A 10WECAQ3165 10/07/2017 10/07/L018 E.L.EACH ACCIDENT $1,000,000.00 Mandatory In NH) If yes,describe under E.L..DISEASE-FA EMPLOYEE $1,000,000.00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000.00 4 Directors&Officers DOF00220453 10/22/2016 10/22/2017 $1,000,000.00 per oec $1,000,000.00 in agg SCRH'TION OF OPERATIONS/LOCATIONS/VEHICLE S(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ,vidence only -ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVI�DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Adence only AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION.All rights reserved. .CORD 25(2016/03) The ACORD name and logo are registered marks of ACORD At& CERTIFICATE OF LIABILITY INSURANCE DATE(MM/)DIYYYY) • I4. . " 1/16/2018 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 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 endorsement(s). PRODUCER CONTACT NAME: HUB INTERNATIONAL NEW ENGLAND LLC PHONE 978-657-5100 FAX No: PO BOX 696 EMAIL ADDRESS: WILMINGTON MA 01887 INSURERS AFFORDING COVERAGE NAIC ti INSURER A: SELECTIVE INS CO OF THE SOUTHEAST 39926 INSURED INSURER 8: RENOVISO INC INSURER C: 2 S MARKET ST 4TH FLOOR INSURER D: BOSTON MA 02109 INSURERE: 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 LTR TYPE OF INSURANCE d POLICY NUMBER POLICY DDYIYYW POLICY LIMITS X COMMERCIAL GENERAL LIABILITY X S 2139958 1/12/2018 1/12/2019 EACH OCCURRENCE S 1,000,000 CLAIMS-MADE a OCCUR DAMAGE O RENTE PREMISES Ea occurrence S 500.000 A — MED EXP(Any one person) S 15,o00 PERSONAL a ADV INJURY S 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY a PET Q LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED Y PROPERTRTDAMAGE ONLY AUTOS ONLY P r accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLg,MS MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNER/EXECUTWE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? El N I A (Mandatory In If E.L.DISEASE-EA EMPLOYE S DE•es,describe under nd SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) This Certificate of Liability Insurance was created by Selective on behalf of the agent. Todd Pasqualino is included as additional insured with respect to general Liability as required by written contractor agreement. CERTIFICATE HOLDER CANCELLATION Todd Pasqualfno 2 South Market St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS- Boston MA 02109 - AUTHORIZED REPRESENTATIVE r•�e6s C ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) -The ACORD name and logo are registered marks of ACORD I s1thS of tN Town of Barnstable` *Permit# �,. Building Departnt gees 6 months from issue date BAMSTABM : Brian Florence,CB %N ^I �q v� ,0� Building Commissioner 200 Main Street,Hyannis,MA 02601 APR 2 ..www.town.barnstable. /flfl J 20,� Office: 508-862-4038 Fax: 508-790-6230 H,u8I- EXPRESS PERMIT APPLICATION - RESIDENTIAL Oak' Z�ll [� Not Valid without Red X-Press Imprint � Map/parcel Number J A i Property Address(P3 � Auez V m s ezJ fe Residential Value of Work-$LID ��7 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �l U` CODW—Y 63 SQ-1 94Nfh Ave-, b4r/ISU LV 1z NIA c>z by v od j�,, Contractor's Name /�/10 U 9 b Telephone Number G 17— Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) Workman's Compensation Insurance �\\ "Check one: ❑ I am a sole proprietor ❑ I am the Homeowner KI have Worker's Compensation Insurance A7440)td Insurance Company Name `Workman's Comp.Policy# i W�CQc3 l Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 1; ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows 7 #of doors:� *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: P Owner must sign Property Owner Letter of Permission. co y o f e Home Improvement Contractors License&Construction Supervisors License is req r SIGNATU C:\Users\decollik\AppData\Local\Microsoft\W indows\INetCache\Content.Outlook\9NNOKXYW\RESIDENTILONLYEXPRES S.doc 09/26/17 DocuSign Envelope ID:C404EC48-F662-4DDB-9B9F-E36D94FOF77B RENOVIS® Rich Cooney 2 South Market Street 63 Seventh Ave Boston,MA 02109 Barnstable,MA 02648 617-848-9610 support@renoviso.com Project #1699657 Created on 3/13/2018 Your final quote Your final quote is below. The price includes the installation, manufacturer product warranty, removal/disposal of old materials,and our satisfaction guarantee. To move forward,simply make a 25%down payment and we'll schedule the installation date soon thereafter. Attractive financing options are also available. This quote is good for 30 days from date above. Description Unit Price QTY Subtotal Andersen Perma-Shield Gliding Patio Door $4,419 1 $4,419 Interior frame color White Glass type Lowe smartsun heatlock Grids 15 15 Grid style Simulated divided lite Hardware color Oil rubbed bronze Hardware style Newbury Exterior keyed lock No keyed lock Foot lock No'foot lock Lead Safe Install Yes --------------------------------------------------------------------------------=--------- U factor .28 Thermal performance 4 Visible transmittance .54 Solar heat gain coefficient .32 Harvey Classic Vinyl Double Hung Window-27.5x44.375 $569 1 $569 Glass type Double pane energy star Grids 6 6 Interior frame color White Exterior frame color White Hardware color White Lead Safe Install Yes Grid type Grids between the glass Construction type Replacement Screen type Standard half screen Location Basement Product note ------------------------------------------------------------------------------------------- U factor 0.25 Thermal performance 3 Visible transmittance 0.54 Solar heat gain coefficient 0.3 Harvey Classic Vinyl Double Hung Window-27.5x44.375 $569 1 $569 Glass type Double pane energy star Grids 6 6 Interior frame color White Exterior frame color White Hardware color White Lead Safe Install Yes Grid type Grids between the glass Construction type Replacement s � � p Project Total $10,057 ' Total Paid $2,514 E a. Balance $7,543 DocuSig Envelope ID:C404EC48-F662-4DDB-9B9F-E36D94FOF77B IN Project #1699657 FRENOVISO Terms I have reviewed my entire order for accuracy and agree to the terms listed below and at httpsJ/renoviso.com/terms.I also acknowledge that no refunds or credits will be provided unless I cancel my order within 3 days of making an initial payment by emailing support@renoviso.com. D"ocuSigned by, XtUl, (hb" 3/13/2018 A747A7GFSA4743D Customer signature Date 3/13/2018 Renoviso signature Date Cancellation/Refund Policy You may cancel the project,without penalty or obligation,within 3 days of the date of initial payment byemailingsupport@renoviso.com.If so, any payments made by you will be returned within 10 business days following receipt of your cancellation notice and the transaction will be canceled. After this 3 day period,no refunds or credits will be provided.Additionally,after multiple attempts via phone and email,if we are unable to contact you to schedule the installation after 120 days,we reserve the right to cancel your order and withhold the initial deposit as a cancellation fee. Payments We accept payments via credit card,check,ACH and financing.For all non-financed projects,we collect 25%of the total project price as an initial deposit.Prior to the project start date,we will contact you to establish your preferred payment method for the remaining balance.If no preference is provided,we will assume the original payment method will be used and/or reserve the right to delay the project pending your response.Upon completion of the project,at our discretion,we may automatically process 50%of the total project price.The remaining 25% will not be charged until the sign-off process described below is completed. After your installation is complete,we will provide an electronic sign-off form via email to confirm that the project has been completed to your satisfaction.If there are outstanding items that need to be addressed at this time,please contact us via phone or email and we will work with you to resolve those items.Once we receive the signed electronic form,we will process your final payment for the outstanding balance via the updated payment method indicated.If you do not return a completed approval form,and have not indicated that there are outstanding items within 2 business days,we reserve the right to process yourfinal payment at our discretion.If you are paying via check,you agree to mail a check for the outstanding balance to our office address within 2 business days after the project completion date. For financed projects,you must successfully complete the financing application process,be approved for financing by our third party provider, and accept the financing terms in order for us to proceed with your project.For any project approved for financing at less than 100%of the total project price,we also collect the non-financed amount,up to 25%of the total project price,as an initial deposit and the remaining portion of the non-financing amount upon project completion.Once the sign-off process described above is completed,we will settle your authorized financingwith ourthird party provider. Project Total $10,057 Total Paid $2,514 Balance $7,543 { i I I ,t • , �� 'ctxasear ' ; 3ee Pt�, fi � Alm M osk v � r { "" lr #mG � s. 0851 Tod } a�rr#can 076 :_ AIM AfAw- ,- -XpJ , MOEM Rner y ✓ S, 9 ���+,: 0 RS [ �e� .At�:°ed�$k?���N��'1 ���,'3 M 4.- `� P � �. � ��w° •e � t � '�,-�-��"�� •� ,fie�s t � i Vm �. e �� GAS — � `�"""" L�,v�� . E y a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street y r Boston,MA 02111 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Renoviso Address: 2 south Market St Boston, Floor 4 , City/State/Zip: Boston, MA 02109 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[� I am a employer with T ' 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).*, have hired the sub-contractors listed on the attached sheet. 7. Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have g. ❑ Demolition ship and have no employees working forme in any capacity. employees and have workers' 9 ❑ Building addition comp. insurance.} [No workers comp.insurance 10.❑ Electrical repairs or additions required.) 5. ❑ We are a corporation and its 3.❑ I a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs _ � and we have no ppt - insurance re,a ed. c. 15�,§1(4), 13. 0the I S �� ) employees.[No workers' �n ow 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. d state whether or not those entities have xContractors that check this box must attached an additional sheet showing the name of the sub-contractors an employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is'proyiding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Hartford Underwriters Insurance Company 10 WEC AQ3165 Expiration Date: — Policy#or Self-ins.Liicc.#: Job Site Address: V Cit}/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 ad ised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance.covcrverification. I do hereby certify under the pains ai enalti of p rjury that the information provided above i true nrrecL Si ature: Todd Pasqualino Date: - Phone#: 888-867-1660 7FOfficialonly. Do not write in this area,to be completed by city or town officialn• Permit/License#ghority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: �,Phone#: CERTIFICATE OF LIABILITY INS 4'kINCE DATE(nmvDD/YYYY) 10/04/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER- IMPORTANT:H 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 orsuch endomement(s). PRODUCER - CONTACT NAME: FounderShield,LLC PHONE FAX 119 W 24th St,3rd Floor (A/C,No,Est)646-854-1059 (A/C,No) New York,NY,10010 E-MAIL ADDRESS:coi@foundershield.com INSURED' INSURERS AFFORDING COVERAGE -NA1C# INSURERA: UNDERWRITERS AT LLOYD'S LONDON CFC 15792 Renoviso,lnc. INSURER B: HARTFORD UNDERWRITERS INS CO ARTFORD 30104 2 South Market Street,4th Floor INSURER C: Boston,Massachusetts,02109 INSURER D: 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:THEr POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- , NSR TYPE OF INSURANCE DDL 1UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS .TR INSD WVD AID1lDD D - COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE a OCCUR DAMAGE TO RENTED PREMISES occurrence MED EXP(Any oneperson) GENL AGGREGATE LIMIT APPLIES PER: •• PERSONAL&ADV INJURY =71 RPOLICYAGGREGATE ROJECTOC PRODGE UCTS COMP/OP GG THER: uu AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ANY AUTO Ea accident 't OWNED SCHEDULED - - BODILY INJURY(Perperson) UTOS UTOS BODILY INJURY Per accident). ICED ON-OWNED - PROPERTY DAMAGE AUTOS AUTOS Per accident i Hired&Non Owned Auto UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESSLIAB - CLAIMS-MADE -- -- AGGREGATE - DED RETENTION ` WORKERS COMPENSATION AND P� MPLOYERS'LIABILITY Y/N ` STATUTE E..`. OTHER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $I,OOQ000.00 B FFICER/MEMBEREXCLUDED? C` N/A IOWECAQ3165 10/07/2017 10/07/2018 (Mandatory in NH) E.L.DISEASE-:FA EMPLOYEE $1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L-DISEASE-POLICY LIMIT. $1,000,000.00 A Directors&Officers " DOF00220453 10/22/2016 10/22/2017 $1,000,000.00 per are $1,000,0.00.00 in egg )ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) ' Evidence only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION- DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY a PROVISIONS. Evidence only AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACC CERTIFICATE OF LIABILITY INSURANCE °ATE`MM,°°"r"' . .. 1/16/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR-ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.. IMPORTANT: If the certificate holder is an ADDITIONAL.INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to .the terms<and'conditions of the.policy, certain policies may.require an endorsement. A statement on this.certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT - - NAME: HOB INTERNATIONAL NEW ENGLAND LLC PHONE 976-657-,.5300 FA No: PO BOX�6.96 .E-MAIL - ADDRESS: WILMINGTONMA 01887' INSURER S AFFORDING COVERAGE. NAIC:$ INSURERA`: .SELECTIVE INS -CO OF THB SOUTHEAST 39926 INSURED INSURER.B: RENOVISO.INC - - - INSURER C I S .MARKET ST - 4TH FLOOR INSURERD: 805TON 02109- INSURER'E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBM, 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 WITWRESPECT 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 LTR: TYPE OF INSURANCE _ POLICY NUMBER POLICY D� MM/DDY� LIMITS X COMMERCIAL GENERAL LIABILITY. x S 2139858 1/12/2018 1/12/2019 EACHOCCURR 11 ENCE :S: 1,000,000� TEU- `CLAIMS-MADE .00CUR DAMAGE. (Ea occurrence) PREMISES Ea ccurrrr ence) S, 500;000 A MEDEXP(Any one person) S 15i0o0 PERSONAL&ADV INJURY S 1-,000,.000. GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY ID JPO- ET Fx I LOC PRODUCTS-COMP/OP AGG- S: ?,000,000 OTHER: S AUTOMOBILE LIABILITY - -- COMBINED SINGLE LIMIT S Ea accitlent ANY AUTO BODILY'INJURY(Per person) S OWNED SCHEDULED: AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED PROPERTY DAMAGE - S ONLY .AUTOSONLY- - Per ccid UM13RELLA LIAR. _ OCCUR. EACH OCCURRENCE `S EXCESS LIAB CLAIMS-MADE AGGREGATE S DEO RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY` Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE` E.L.EACH ACCIDENT IS OFFICER/MEMBEREXCLUDED?� ❑ N/A Under If yes;describe ntlei , (Mandatory In E.L.DISEASE-EA EMPLOY 5 :DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS!LOCATIONS:[VEHICLES (ACORD,101;Additiohal,Remarks.Schedule;may be-attached If more space Is requlred) - This Certificate of Liability Insurance was created-by.Selective on behalf of the agent Todd-Paequalino is included'.;ae:additi-onal insured withreapect,toOeneral'Liabili.tyae,required:by written.contractlor `agreement. , CERTIFICATE HOLDER CANCELLATION Todd Pas"Alino 2-South Market-.St. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. .Boston �24A 02Y09 AUTHORIZED REPRESENTATIVE' 61988-20,15 AC ORD CORPORATION. All rights reserved. ACORD 25(2016103) The,AC.ORD.name and;logo are registered marks ofACORD I. Mice of Consumer Affairs & Business Regina#ion HOME IMPROVEMENT CONTRACTOR a���1ri1 TYPE, Supplement Card Registration Expca__ 180151 10/14/2018 .. RTENOVISO,. INC - ! TODD PASQUALINO ,�.,� { FANEUIL HALL MARKETPLACE 2 .S. MARKET BUILDING, 4TH FLOOR N MA 02109 Undersecretary BO STO , 1 i t a. w 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #6 1Z_U Health Division Date Issued Conservation Division Application Fee Planning Dept Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Scyc.-�}� yc_ Village r. - Owner Lk eacw%( Address ;Serb Telephone d—ySS. OS1 f Permit Request \Jrb., 31, u aCl���,� kc t;..It, 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 gY/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No Qn Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other LNG OFp,. Basement Finished Area (sq.ft.) Basement UnnfiniANR. ��g-) Number of Baths: Full: existing new Hal�4r3Vrg� new Number of Bedrooms: existing _new NSTgBCF 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 ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name McCarthyMike Gonstriletinn Telephone Number P® Box 52 Address West Dennis, AI,. 02-670 License# Cell (508) 280-6964 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS P OJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY j APPLICATION # DATE ISSUED MAP/PARCEL NO. y ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. -`0 r--0 2f _ �,,•'�t, .4- Town of Barnstable °•: Regulatory Services NAM ' Richard V.Scau,DIrector s67y. � ► Building Division Tom Perry,Building Commissioner 200 Main Streit,Iiywmis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section _ r 'If Using.A,Buildc;r . I, Aft I) l-O_o _ _ as 0,wner of the subjecr propxtly berchy aurhorize /� Ca0 C1=!- L to act on my behalf, in all matters relative to work autho -this building permit application for: (Address of Job) "":'.Pool fence and alarms are the respozisibility of the applicant. Pools are not to be filled or utilized before fence is installed and all fin.-d inspections are performed and accepted. S* azure of Owner T� Signature of Applicant kICKAM Coo&e y Print Name Print Name. Date Q:FORMS:OW.3FRPF.R1d1SSIONPUOLS c97,v fowww,,� A Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY - MICHAEL MCCARTHY P.O. BOX 52 --- WEST DENNIS, MA 02670 — Update Address and return card.Mark reason for change. �1 4} Address Renewal _J Employment -� Lost Card SCA 1 20M-OS/11 L n�rle ((•'C1q/'./9Zp.TC[CCfR�III C/n��ClJrCIC'lLCI.:iBCIJ . . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only @HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: l Registration < 169393 Type: Office of Consumer Affairs and Business Regulation NNW Expiration -6/1"6/201.7 Individual 10 Park Plaza-Suite 5176 Boston,MA 02116 MICHAEL MCCARTHY.---.-.',..: ` MICHAEL MCCARTHY 6 RANGLEY LN. _ A. x_ SOUTH DENNIS,MA 02660` Undersecretary ` Not id withdAt signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633" MICHAEL J MCC,[R _ PO BOX 52 W DENNIS MA 0267 F Expiration Commissioner 04/10/2016 The Commonwealth oflllassachitsetts Department oflntlustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITHTTHE PE RlY1TTTING'AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Mike McCarthy Construction Po Box 52 Address: West Dennis, MA 02670 City/State/Zip: Cell 08)#280-6964 Are you an employer?Check the appropriate box: F7. f project(required): Lam a employer with employees(full and/orparl-time):+ New construction 2.01 am a sole proprietor or partnership and have no employees working for me in Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t • Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my pmperty. I will I0❑Building addition. ensure that all contractors either have workers.'compensation insurance or are sole ILL]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp,insurance) 13•� ]Roof repairs 6.❑We arc a corporation and its officers have exercised their right of exemption per MCL c. 14•L7Other b✓C.tl«,«h, 152,§1(4),and we have no employees.[No workers'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 stale whetheror not those entities have employees. If the sub-contraclors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. . Insurance Company Name: /_11A,1 Policy#or Self-ins.Lic.#: ( G 170(, Expiration Date: Job Site Address: 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 MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify tinder t a' s enalties of perjury that the information provided above is true and correct Signature: Date: Phone#: (s('k: �—C f C LLOt se only. Do not write in this area,to be completed by city or town of:ia own: Permit/License# thorny(circle one): f Health 2.Building Department 3.City/Town Clerk 4.Electrictor.5.Plumbin:gInsp ector erson: Phone#: DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/07/2016 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(ie§)`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). p�7p PRODUCER 01962-001 NAME:C7 Bryden&Sullivan Ins Agcy of Dennis Inc (508)398-6060 W.No,: _(508)394-2267 PO Box 1497 �. So Dennis,MA 02660 INSURER AFFORDING COVERAGE NAIC 0 INSURER A• A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: Michael McCarthy Construction Inc ER P 0 Box 52 INSURER D West Dennis, MA 02670 rINSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED WAMED 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. IL fR TYPE OF INSURANCE I yP W POLICY NUMBER MM/D I989t LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Me occurr CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY f ECOT OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ c irsn ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWMED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident g UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS MADE AGGREGATE $ DED RETENTION$ $ YIN E.L.EACH ACCIDENT $ 1,000,000.00 A ANYICROPRIETOW►ARTN�fj/��(ECUTNE� NIA VyyC-100-6017656-2015A 12H5/2015 12/15/2016 (Mandatory In NH) EXCLU to E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 DWIP'f ft OF 9PERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,U more space is required) CERTIFICATE HOLDER CANCELLATION Cape Light Compact PO Box 427 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Barnstable,MA 02630 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _ Parcel /5 ,-,--;� Application Health Division Date Issued W/ l S 1PPR_ Conservation Division Application Fee f2 ltlp) Planning Dept. Permit Fee 05 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner �1,.,�4 (�.�.,,� Address Sir. c Telephone 7k1'f17)=692( Permit Request 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 . 2/ 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 ❑ No If yes, site plan review # Current Use Proposed Use _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mike McCarthy Construction Telephone Number PO Box 52 Address West Dennis, MA 02670 License # Cell (508) 280-6964 CSt,-SB633 HIC-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��� L .•, in SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION t, FIREPLACE t -� ELECTRICAL: ROUGH FINAL w u PLUMBING: ROUGH FINAL GAS: ROUGH FINAL F FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1, Town of Barnstable Regulatory Services " Richard V.Scali,Director Ma Building Division Tom Perry,Building Commissioner 200 Main Stieet,Hyannis,MA 02601 %ww.town.barnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Usina A Builder 1, e_t- A 21a . ...__;as 0%-ner of the subject propon:y ]hereby authorize to act on my behalf, in all matters relative to work autho -this building permit application for (Address of fob) ""Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utIzed Ix-fore fence is installed and all final inspectioru are performed and accepted. S' ature of Owner Signature of Applicant ktc-KAM CodAe ..__ Print Name / Print,Name_ d� /S— Date Q:FORMS'OWA'F.RPFPJAISSIONPUOLi i JIM Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCCAR . - PO BOX 52 s W DENNIS MA 8267t Expiration Commissioner )' 111 04/10/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Goxtractor Registration G, Registration: 169393 Type: Individual Expiration: 6/16/2017 - Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY ` P.O. BOX 52 AE - WEST DENNIS, MA 02670F ' Update Address and return card.Mark reason for change. Address Renewal j Employment Lost Card 20M-05/11 S t \ The Commonwealth of Massachusetts Department of lnrinstrialAcci►lents. 1 Congress Street,Suite 100 Boston,MA 021I4-2017 Jy www.mass.gov/(lia Workers'Compensation Insurance Affidavit:Ilnilders/Contractors/Electricians/Phimbers. TO BE FILED WITiI TiIE PERMITTING AUTHORITY. Applicant information Please Print Le ibl Mike McCarthy Constrqctivu Nagle(Business/Organization/individual): PC) 13„:X 5 Address: Vest Dennis, MA 02670 e . - 6964 City/State/Zip:_ CSL-5e#:H1C-169393 Are you an employer?Check the appropriate box: Type of project(required): l.7m a employer with 4� employees(full and/or part-time).* 7. El New construction 2.E]1 am a sole proprietor or partnership and have no employees working for me in $. El Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 9.rl I am a homeowner doing all work myself[No workers'comp.insurance required.]► 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 Q Building.addition ensure that all contractors either have workers'compensation insurance or are sole I i.Q Electrical repairs or additions .proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.irsurance.► 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.dOther 152.§1(4),and we have no employees.[No workers'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 lin 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. lain an employer that is providing lvorkers'compensation ins►►rance for niy employees. Below Is the policy and Job site Information.Insurance Company Name: ATM rp� M.Ai'( Tn). r;..�p.„y Policy#or Self-ins.Lie.#: VW(,-h+a-(001 7 CS-6-.-).di`( Expiration Date:_ )a Ilf �►� Job Site Address:- (1 7 -7 4JL- - 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 MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,asmell as civil penalties in the form of STOP WORK ORDER•and a fine of up to$256.00 a day against the violator.A copy of this statemeni'may be forwarded to the Office of investigations of the DiA for insurance . coverage verification. I do hereby certify un el al sand Mies ,rjury drat the-information provided above is erne and correct. Si nature: Date: 6 I Phone#: 17 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ".7 t a S WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMAfiTIIIQ'PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 26158 POLICY NO. VWC-100-6017656-201413 PRIOR NO. VWC-1 00-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P 0 Box 52 FEIN:"'"'3862 West Dennis,MA 02670 Legal Entity Type: Corporation r Other workplaces not shown above: See Lo cation. 2. The policy period is from 12/1.5/2014 to 12/15/2015 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA` B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease. $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information.required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 0712979 INTER SEE CLASS CODE SCHEDU E { Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV GOV Deposit Premium $7,748 STATE CLASS MA 5479 State Assessments/Surcharges $28,601.00 x 5.8000% $1,659 This policy, includin all endorsements is hereby countersigned P Y� 9 � y by 12/15/2014 Authorized Signature Date Service Office: x Bryden &Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 Burlington MA 01803 So Dennis, MA 02660 WC000001 A(7-11) Includes copyrighted material of the National Gouncif on Compensation Insurance, used with its nermission. v 1 � c�?TIC S'';_.TEPIA MUST BE Assessor's map and lot number ....... .�............. ... .. .... ry s ~ Sewage Per It number �,�...... ...... �'6%l.`:�-' \, 1 ye� ` ter,. ,i l' " ' D Q �7 `� ...... :, n* EAND7p1 /J,dR�yG�gG� �LrJ / I`..aail AJ]O,NSe yoF?HEr��♦ TOWN OF BARNSTABLE i BBHBSTeDLS, i 9� O�Y•a`e� BUILDING INSPECTOR r APPLICATION FOR PERMIT TO .... °O•!P!l�L�� .... .. 5� 11! ....................................................................... 1 TYPE OF CONSTRUCTION ...../... FA4?PA.r......4- .4 /0...........R.A.?�.�. ...................................................... y' ��'.......!./...........I TO THE INSPECTOR OF BUILDINGS: - The undersigned hereby applies for a permit according to the following information: Location ....7...4VdF, .....w..�f!is !!ts/' .r°&?/ ...y. ! ,x ............................................................................................... ProposedUse .............................................................................................................................................................................. Zoning District ........................................................................Fire District ... t.� 411e4e........................................... Name of Owner ......;VX. off`` ... 7;.../ t'5�.� C ...........Address .................................................................................... Name of Builder `/- ........Address Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..../..........:................................................Foundation .4,ee.'2eiL ..................................................... Exterior ......Woa 4.........................I......................................Roofing ..1?.S.iOM 7 ........................................................... Floors .......4v 4.................................................................Interior .5HMT 10P Heating ..eV. O ......00V..........................................................Plumbing .................................................................................. Fireplace ... !!O.s? .................................................................Approximate Cost ...4100.?,..4PQ.......................... . ........ Definitive Plan Approved by Planning Board ________________________________19________ Area .... f. ..... : ..:......... FS 0 Diagram of Lot and Building with Dimensions p Fee ` �� ........ v..................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH X U. 2 L ------------ 7 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name , :.................................................... Palley, Mr. & Mrs. J. - ` add to single No J ...... P6rmit for ---.--- ' dz«e � -------..�, �--..�.~`---.---~. ...... Location' _? Avenue . ............................................. 1 ^ ......................... =-----' � � Mr. & Mrs J. . Owner .......................... ^ ° -���~* } Y��-----------' � | � / Type of Construction .................frame _ ' ' � ' -------..------.----..------.. | Plot ............................. Lot ................................ � . ` Xar6h 18 �4 Permit Granted ........................................lA ^ ' ` Dote of Inspection Dote Completed ../��A ...�—.�—. � � ' ' � ` ���0��� ~ PERMIT_ — ' ____—_------_-------.. 19 ' ' '—'-------~^---------------- � .._~.---.~...----...----------.. '—'----^-----^^^^—^---^^'------ ' � � � --------.—..--.~----~..—.—.--., ' � � Approved ................................................. lV � ' ----------------------^^--- , -------`---'-----------^--^'' � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map J ` Parcel Application# 026a *70J � Health Division Conservation Division Permit# _ � r,S le �6�Z hdt e-c 6t /�;��en� �j Tax Collector ���.��" / Date Issued ou Treasurer Application Fee60 S Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 63 Scvan th Aoc, Village W6,ST anvc is 1?T V6 Owner AV14) 14 -f .1 kl VJ 11enA60CY Address 10"4 LBW t/ ljm4 to Telephone kv° o r me p 10 s�- Ce-11 CC7 W' G d Fl 7 ®/•��'3 Permit Request Xe�/CuC e, �V 1 ftdow 5 �` s'lxl�� ; o,oen Goa.`Yi >4 S 4 l/ vl ovz/ l 00 - See Q . ada-d' %I Or4' -- G�`I�� /Ro-Dlice 3c) F"-ki deoe� zu • Square feet: 1 st floor:existing proposed/fie nd floor:existing proposed Total new/vo Zoning District Flood Plain A Groundwater Overlay Project Valuatio r ®Uv Construction Type Lot Size - 02 / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 2' Two Family ❑ Multi-Family(#units) Age of Existing Structure v Historic House: ❑Yes Ilo On Old King's Highway: ❑Yes U410 Basement Type: ®'Full ❑Crawl 11 alkout ❑Other Basement Finished Area(sq.ft.) ' `rL 10 Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new AQ Q-A Half:existing new AID ' Number of Bedrooms: existing_ new /VO e Total Room Count(not including baths):existing newX7 First Floor Room Count Heat Type and Fuel: 9'Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes Elo Fireplaces: Existing _� New Existing wood/coal s°ove: D'Y'Ps &110 �9 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exis4 ng ❑rr size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:-=f "r Zoning Board of Appeals Authorization ❑ Appeal# RecordLL1 Commercial ❑Yes ❑No If yes, site plan review# `•`? Current Use A��ao / lQ t 1 Proposed Use ° -m BUILDER INFORMATION 36 Name l LJG�/�l �'Iu �+I Telephone Number C�J/ SS/ Address License# `— 04 H4 Home Improvement Contractor# 0/S&3" 01 f a Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO flit-kip SIGNATURE DATE *40 ' i FOR OFFICIAL USE ONLY PERMIT-NO. `• DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE E _ OWNER DATE OF INSPECTION: $ FOUNDATION % FRAME Z r - INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i j Town of Barnstable pp THE Tp Regulatory Services BARNSTABLE, = Thomas F. Geiler.Director. 9 MASS, i639• �,� Buildin-a Division Tom Perry,Building Commissioner 200 Alain Street, Hyannis,Nik 02601 www.town.barnst2ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ��] j Q JOBLOCATI N: 3 S-eK1 1z ,C e-YI C,tm if �I h,/ j�number 'sleet �ip �r/villlaage "HOMEOV,NER": lk U I � fi �CGt PCs, tj 64 z4 n-3�9' 6 17 ��1-6 J d / S-6n, .36,?�—O I US name home phone 4 work phone#? CUTRRENT MAILrNTG ADDRESS: 16d ��a city/town state zip code The current exemption for"homeovvners"`vas 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 Off cial 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"homeo-vner" 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 minimu inspection procedur and equirements and that he/she v,U comply with said procedures and requir ents. ture of um 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. )HOMEOAINER'S EXEIMPTION 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-SupeMsors,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 Huth 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 Supem'sor. 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,rertifi cation for use in your community. Q:forms:homeexempt °FTMEr�� 'Town of Barnstable Regulatory Services s * - " BMWST"M " Thomas F.Geller,Director y Mass. �A1 639 •� BulidIIIQ D1V1s1011, ` rFD MA'S b Tom Perry,Building"Commissioner 200 Main Street,..Hyannis;MA 02601 . Office: 508-862-4038 . . Fax: 508-790-6230 " Permit no. " Date " AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT.APPLICATION, , MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, -improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. —a'."e( S fid ex 'G4tfe Fecal TypeofWork: CritJ�Gb� f /l�� ��n aa/Y{ GIM Il/�G�,—Es`timatedCost- Qd� _ Address of Work-k 6 �C/1't A, eQP 2�d1"!S j � / T � � . A OOwner's N !.J r Dam of.Apphcation: Registration is not required for the following reason(s): QWork excluded by law ❑Job Under$1,000 QB�ilding not owner-occupied' [rer pulling own permit Notice is hereby given that: _ OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY -I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No'. OR *I',-- Owner's e Q:f=:homeaffidav ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - All 600 Washington Street Boston,l{TA 02111' www.mass.gov/dia UW „•. Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Informationiss Please Print Le 1 Name(BuSine�ss/orgmdmtion&dividu "Attv l l i, y/State/Z p:= � ft,4-1 Phone.#: Cit g�„ Are you an employer?.Checkthe appropriate box: :Type of pioject(required)-. 1;❑ I am a employer with 4. ❑ I am a general contractor and I * • have hired the sub-contractors 6. ❑New construction . employees (full and/or part-time). 7. deling 2.❑ I am a'sole proprietor or partner- listed on lhe'attached sheet. ❑ ship and have no employees These sub-contractors have $.�[]Demolition ivorking for me in any capacity. ' employees and Have workers 9 ❑Building addition o workers' comp,insurance comp.insurance.$' quued.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 31 I am a homeowner doing all work . officers have exercised their l l,[]Plumbing repairs or additions ' myself.[No workers' comp. right 6f exemption per MGL 12,(]Roof repairs insurance.required.]t c. 152, §1(4),and we have no 13.❑ Other ' employees. [No workers' comp,insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Flomeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors mutt submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-cont=ton and state whether ornot those entities have . employees. If the sub-contractors have employees,they must provide their workers'camp.policy number. I ani an employer that is providing workers'compensation insurance far my employees. Below is.the policy and job site. information. Insurance Company Name: Policy#or Self-ins.Lic.M. Expiration Date• - Jab Site Address: 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 trader 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 maybe forwarded to the Office of Investigations of the WA.for insi rance coverage erification, I do hereby certify under a pains•and a es of perjury that the information provided above is true and correct Si „_-� Date: Phone#: Official use only. Do not write to this area, to.be completed by city or town official. 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 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 hiie, 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 ehapter.152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall 'enter into any contract for.the performance of public-work untii acceptable evidenee•af•complia*v{ithtlie 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-contiactor(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. Bp advised that this affidavit may be submitted to the Department of Industrial Accidents for confumation 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 requirea to obtain a workers.' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-inner-m$e 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 maybe 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 fo 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 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 De' aximent's address,telephone-and fax number;. The commonwealth of mmaausetts Depart mient of ladustfial Accidents QHIO of 111--Yea gations ' . • f�Q.�i�ashin��.�ree�_. Basta ILIA 021 2 1 TO.#617-727-4,6 0 ext 40;6 or 1- -MASSAFE Revised 11-22-06 Fax#617-727-7749 www.m=.gov/dia I Description of work at 63 Seventh Avenue, West Hyannisport, MA by owner, David Hennessy: Front of house (east wall-facing,street):, 1. Remove and Replace four 35"x48" Bedroom double hung windows (facing east) with identical double hung windows. (See #1 on Plan.) 2. Remove and Replace two Living room double hung windows 35"x48", (facing east) with 35"x56" windows. These windows would be approx. 26 inches above ; floor. (See #2 on Plan.) 3. Remove two Den double hung windows (facing east); install one 35"x56" double hung window on the center of the Den east wall. This window would be approx. 26" inches above floor. (See #3 on Plan.) 3,o South Wall: '4. Remove existing exterior door from Den. Frame and sheath existing opening. (See #4 on Plan.) 5. Install two 14 x 15 inch fixed windows on south wall. (See #5'on Plan.) West Wall (facing marsh): 6. Remove two double hung windows (facing west). (see #6 on Plan.) 7. Install three double hung 21"x56" windows on west wall. (See #7 on ,Plan. and Framing Detail #7) Kitchen: 8. Remove and Replace existing patio sliding glass doors. (See #8 on Plan) 9. Install new French EN. doors at existing sliding glass doors,(See #8). (See #9 r on Plan) , Living Room Entry to Den: 10. Remove existing wall between Lv/Rm and Den. (See #10 on Plan) 11. Construct new Beamed Entry between Lv/Rm and Den. (See #11 on Plan and Framing Detail #11) 12. Remove carpeting. Install engineered floor. Page 1 of " .� } Fireplac Den 9 LV/RM Kitchen/ Dining Rm i0 OO O Origional PI'an PropoSea Demo E r N . Amr"Sy f ® C2 Fireplac Den ® F i0 LV/RM 1 dchen/ Dining Rm ' . q0 I ►O O O Propo5ea New work E W 4X6 Beam TyP Wid Wdw Wdw 56.5" opeon9 operin9 oPe'm9 2x4`s TyP. v v 136" . #7 Three DOC Windows Framing Qetail1. . 4X6 5BAM TyP 58.5° O ng g • -2x4'i TyP. 136" #3 Three 21'06" Windows Framing Detail a 138 p 46" a —T6" d6 4x6 Deam T Ix4 Trim Typ. yp. 93" 87" 40 Post Typ, t, #11 Deamed Entry