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0063 SPRING STREET
G�3 CS�,�� CSfre-�-f-� - . Town of BarnstableBuilding "Car s tplo S 'tecl Uner tdz �S"o,aT•+!haz t,.ita:i�s� �1./�i's�bsl e F�rom5.:„t'he St,reet'zA PY-s'p m r"o';:�v�.e.a asd: P.Ia,.ns.�:Mik uyst<,.b,3ea Retainn,;•`ed o.s,n:zJob and this Caw rd Mteust b+ce m';Ke:.,pr,�t • Permt Werhe - Permit No. B-18-1434 Applicant Name: C& F REMODELING INC Approvals Date Issued: 05/14/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/14/2018 Foundation: Location:, 63 SPRING STREET, HYANNIS Map/Lot 328-018 Zoning District: SF Sheathing: Owner on Record: ROUGHNEEN, MARY CATHERINE ; �,Contr�gctor'Name C& F REMODELING INC Framing: 1 Address:. 63 SPRING STREET Contractor Lc nse 153792 2 HYANNIS, MA 02601 E'stProfect Cost: $3,200.00 Chimney: Description: Roof Peft, iTee: $35.00 Insulation: Project Review Req' :, E Fee Paid:` $35.00 Date 5/14/2018 Final I _ Plumbing/Gas s Rough Plumbing: _ w Building Official __,_ r �, Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after`issuance.This Gas: All work authorized by this permit shall conform to the approved application and tlgapproved construction documentsfor which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. Final Gas: � �a; This permit shall be displayed in a location clearly visible from access .reet�o�'road and shall be maintained open for public inspection 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 signaturesby the Building and fire Officials are provided�onthis permit. Service: Minimum of Five Call Inspections Required for All Construction Work:fi: 1.foundation or Footing Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining g is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) g g 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: 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: "Persons 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 . .� Town of Barnstable Building Post This'Card SoThatrtis Uis�ble From the Street-Approved.Plans;Must,.be Retained on Job andthis Card Must be:Ke t mwr�weis Poste163 d Uritl Final?Insf�f"ection HasBeen INlade.. a � F �� P ,a «�+e Where�a�Certificate of Occupancy is Re''quired,such Bu�ld�ng shall Not4be Occupied until a Final Inspection has been made fl Permit . .� � �, .��.��.e: .....__.« 3e�'a:.,.r-...-d...A.,,,a,.a. ".>t.,t� .,w,,,.,.s....,., I�.�•e�=: ', k s""...n.aa�` >�.za..... ,..", .., r u..�^.>..,.>, sz .,.� Q,a.,.�a.,".w:� ..:�..�:. ....,�,..w ry"l. ...... Permit No. 13-18=1434 Applicant Name: C&F REMODELING INC Approvals Date Issued:' 05/14/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/14/2018 Foundation: Location: 63 SPRING STREET, HYANNIS Map/Lot. 328-018 Zoning District: SF Sheathing: f " Contractor Name°;�C&F REMODELING INC Framing: 1 Owner on Record: ROUGHNEEN, MARY CATHERINE g: �p s Address: 63 SPRING STREET Contractor License •153792 2 HYANNIS, MA 02601 ' Y Est Project Cost: $3,200.00 Chimney: Description: Roof Permit Fete: $35.00 Insulation:. " Project Review Req: Fee Paid $35.00 i Final: T,eDate 5/14/2018 3"A,"NS Plumbing/Gas Rough Plumbing: x ..., Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authored by-this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the'approved construction documents'zfor whiehthis permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoningfby la sand codes. Final Gas: This permit shall be displayed in a location clearly visible from access streetor road and shall be maintained open for p bl�ic m pection for the entire duration of the . work until the completion of the same. Electrical e Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: g 1.Foundation or Footing Rou h: 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: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: 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: "Persons 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: w All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT � a a Application number. ... 6...... ....A Date Issued....... .. ..(`�C<�" .................. ........................ ! Building Inspectors Initials..... MAY 0 2019 � 9 Map/Parcel......... ....................................... .................. TOWN OF RNRN,STABLE TOWN OF BARNS TABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY NFORMATION Address of Project: 63 5 NUMBER STREET VILLAGE Owner's Name: Phone Number Email Address: ZC Cell Phone Number, . r Project cost$ ?j ,2m0 alb Check one Residential_�� 'Commercial OWNER'S AUTHORIZATION As owner of the ab ve property I hereby authorize to make application or a buildinj permit in accordance with 780 CMR Owner Signature: Date: o S o q g pi TYPE OF WORK ❑ Siding - ❑ Windows(no header change)# ❑ Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review C�TRoof(not applying more than 1 layer of shingles) Construction Debris will be going to r CONTRACTOR'S INFORMATION Contractor's name .►,, Home Improvement Contractors Registration(if applicable)# l #3 �� _ I (attach copy) Construction Supervisors License# l (attach copy) Email of Contractora+E'� U � �Zocj 2 Phone number �Q in, A ALL PROPERTIES THAT HAVE RUCTURES OVER 75 VEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................... ........... *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. s . •tip . 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 o 8:00am--9:30 am or 3:30 m-4:30 m. Commercial events may require Fire Department approval. .f P P y q P *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 CAM 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 Signature Date i0r ` All permit ap 'catio s are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Y Department of Industrial Accidents Office of Investigations 600 Washington-Street Boston,MA 02111, www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgm ization/lndividual): CvP Address: C c City/State/Zip: Phone#: Are.you an employer?Check theaf propriate box: Type of project(required): 1.❑ I am.a employer with 4. 0 I am a general contractor and 1, employees(full and/or part-time).* have hired the sub-contractors 6. D New construction 2.9�j 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. El Building addition [No workers'comp.insurance comp.manrance,$ required.] 5. We are a corporation and its :10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or'additions right of exemption per MGL myself [No workers comp. : 12.❑Roof repairs insurance requirr :]t c.152,§1(4),and we have no employees.[No workers' 13.[]Other COMP.insurance required.] I - *Any applicant that checks box#1 must also fitl 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. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or notthose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy n®ber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. nn Insurance Company Name: 7't pow Policy#or Self-ins.Lic,#: IAJ C-C, ,moo so V86 q d Expiration Date:. 0. ' 0 —Za q Job Site Address: ' �+T City/State/Zip: �. Attach.a copy of the workers'compensation policy declaration page(showing the policy number and 1xpiration 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 DIA for insurance coverage verification. I do hereby certify under a pains and penalties of perjury that the information provided above is true and corn Signature: _ _ Da#e: Phone#: 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#: 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 o' en in a joint enterprise,and including the legal representatives of a deceased employer,or the d 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 brat"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 requir 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 requirem eats 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance: Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-hisurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided,to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i,e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. ` The Office of Investigations would 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 massachuse is Department of Industdal Accidents Office ofInvestiggoo s 600-Wasbington Street Bow,MA 02111 Tel.#617-_727-4900 ext 406 or 1477 NWSAM Fax#617 727-7749 Revised 4-24-07 www.maw.gov/dia �� yrnaonc�eal�a�Q��cwod�Izu�a �,, Commonwealth of Massachusetts Gtfice ot'Cuns�imer Affairs&Business Neg sr ti '�' Division of Professional Licensure k / HOME iA7PR0IQ=MEMT CONTFiACl OR U Board of Building Regulations and Standards TYPE:'Corporation I3� IStY�410n Exgir�tian Const�NJ6l tl•`{S� rVisor v, ff - �9 - 01/07/2019 CS-104107 } . empires 08/25/2019. C FREMODEIStIN i�f �'��'{{Cyyy ,• �•arloS F'igdeiroa CARLOS H FIGUEIROA r l z .Q CGC/x �_... LI 2�J Captain Noyes�Pel. � f 20 CAPTAIN NYES R S.-Yarmouth,MA J?B�4 _ SOUTH YARMO,U�TH :r4 i y Undersecrc;a 1o� Commissioner ti Ftegiatration valid.for individuhl use only before the expiration date. li f:4und return to. fice of Consumer Aflairs and Business Regulation , 11J Park Plaza pauite S'17Q Boston,MA 0'�116 } r Ot uaHd xg1thou'l.Sig re Irk t _ • •,�� zinraazusea�d�C��aaaaclZ�w s= QLice®4 Cn m csuerAfiairs& R Business o 4; Commonwealth of Massachusetts > '�' Division of Professional Licensure HOMEJUIPRWEM ENT CONTRACTOR Tyi'. Corporation Board of Building Regulations and Standards Constgg6titSr�I b rvisor tZ wtraLon Exairatian ��, j 01/07/2Q19 4 ' CS-104107 ires: 08/25/2019. C F REMOD,El51�LG�f t",I % ;� f V it � ,4; -� Carlos higtieiroa, CARLOS H FIGUEIROA . ' 20 Captain�Noyes�Ret, ;y' �� { 20 CAPTAIN N6.YES'R S.•Yarmouth,P11A�'09$04 - Undersecr�;� ,`,,; SOUTH YARMOl1�T(, ss " a.;r �.r.• Commissioner `f Re stration vafigfor indivirio61 use only g before the ex iration.riate. If found return to: Office of Consumer Affairs and,Business Regulation ' 10 Park Plaza i,ttijite 5170 :,oaton.MA 6211a. r Ot valid Wi'thoQ5.!t.irq.naltdl'�e ? Providing Insurance and Financial services Home Office, Bloomington,!L _ A State Farw March 5, 2018 Barnstable Building Commissioner '' State Farm Claims4`�_ 200 Main St PO Box 106169 " Barnstable ME 02601 r Atlanta GA 30346-6169 ZEE CERTIFIED MAIL RETURN'RECEIPT REQUESTED RE: • Claim Number } 'N21=3184-L15 :; fi } a ,w �z , Our Insured Mary Kay Roughneen w» 3 �' }` ,;° ,�F R Date of Loss. t March 3 2018 Loss Location '' 63 Spring St, MA 02601-3034 { t' x► }. Tax Block: 328 , rw rn r— Tax Lot 018 To Whom It May Concern: State Farm Fire& Casualty.Insurance Companywrites,to provide notice as required by Massachusetts law in connection with the matter referenced above. Stafe'Farms received notice of loss or damage in excess of$1,000 at 63 Spring St., Hyannis,MA 02601-3034 We hereby notify your office pursuant to General Laws c. 134,§31B that State Farm intends to make a payment of$1,000 or more in connection with the above referenced insurance claim. t1 Further, the applicable amendatory Policy Endorsement informs the insured of the Massachusetts requirement by stating the following T f r 'We are required by Massachusetts law that we must notify local inspector of •, _ _ buildings, or Board'of Health at least 10 days~before we make a payment of;$1,000 or A'; more for'loss to a building or structure: •F ; ;_ -, �F ay: We must also give,notice if there is damage which makes a building a health or safety hazard Or dangerous or unsafe for-occupancy.regardless of the amount of our payment. - If, prior to payment,''we receive official notice of a.pending or existinghlien against.your ; premises, we must`delay payment until the matter is settled. If we are required to pay all,,- or part ofthe amount of the lien,'we will not be obligated to pay that amount to you. ` fi If you have any questions or need further assistance, please call us at (844) 458-4300 Ext. 9726571844. z' ,4 21-3184-1-15 Page 2 March 5, 2018 Sincerely, Winston J Adams External Claim Resource - Eberl (844)458-4300 Ext. 9726571844 Fax: (844) 236-3646 State Farm Fire and Casualty Company TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION s Map .3Q X Parcel 019 Application # d o,5(p(Qe, Health Division Date Issued I • l Qj l Conservation Division Application Fee Planning Dept. ?Permit Fee U Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address Cp 3 S P>71 N G- S'�. , L4 Y A nJ N 1 5 Village fV N I S Owner MA kAy 1?=0yc- -(A/EEN Address 4'3 SPAING-ST4PMNNf5F^4 DaCo�! Telephone 66 0 - Permit Request 1033 50-W 7 P-3' CEcLut-osC ft��c ^�0 11bnF3 y rsTs z f2ooFy&`NT5 : 1 1033 SaDY-T' 91q t•G d�A-rt� v�N7� g,�� f �T�Pr�' �%Svt�r►o,a�2S Frta c ,�e l�n P, toI& S, IJALL—NSoi� Square feet: 1st floor: existing . proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay J Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn:Qbxisting::-: neR size_ < .� Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other,:_, CD I Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ s Commercial ❑Yes ❑ No If yes, site plan review # F; a � '• €ate Current Use Proposed Use ' APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name CAL-1 f3g:F 2 63(-0 C�- -I- OfMo Off-/d,N Cs Telephone Number 56ff- cfe� / / l D I Address License # S41VD 01�H M49 oc .5&3 Home Improvement Contractor# �5�f 3 5 I Worker's Compensation # q q4 7? 9 L19 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO )V1AgSTnNS SIGNATURE DATE /67S'�/ p it t i. S - • FOR OFFICIAL USE ONLY f � r APPLICATION# DATE ISSUED _ MAP/PARCEL NO.... y R} ADDRESS VILLAGE j 4 OWNER t� ! t - { { DATE OF INSPECTION: z _ FOUNDATION,- FRAME s INSULATION?! FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS-. r :-.lS' ROUGH *'H „ FINAL t '.UF.INAL BUILDING , r - f - - DATE CLOSED OUT ASSOCIATION PLAN NO. - ' t s s_ -, ' `'Is 7. t'1,IlJ HOME OWNER WEATHERIZATION WORK PERMITS, FUEL RELEASE: t -- TIU APPLICANT HOME OWNER. hereby consent to and agree that weatherization.wok may be' done by the Weatherization Program of Housing Assistance Corporation ( herein after referred as "Agency") on.the property located at: The-weatheri/--atiou work done will be based on p:rogrammati.c priorities and availability of funding and it may include all or some of the following measures: Weather-stripping &caulking of windows and doors, insulation of attics, sidewalk &basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows.In coasidera.tiurr,of:the ,eathtriZation work to be done at my home I agree to the following: l_ 1 -1ve permission to the "Agency" its agents and employees to travel onto or across said property with such equipment aad materials as may be necessary to perform cveatherization Work oa said property. I -e Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the �vtathcrized unit on an ongoing basis for no more than five (5)years after the weatherization z ork is completed. x have read the provisions of this agreement as listed and freely give my consent. A Tome. Owner: (Signature Lace: f r� dent: {signature} Date: ._ HL,1C approved Weatherizatioa Company : C aliber BuBding&1 I'Mot^e � Cape Cod Insulation. Cape Save Creswell Construction Frontier Energy-. r�s Low�- & Sons Peter Smith Resolution Energy Rock Solid G�r�s,;=en Al Cape Insulation Aco CERTIFICATE OF LIABILITY IN DATE(MM/011 Y) �..� INSURANCE 9/14/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT David Crawford Eldredge & Lumpkin Insurance Agency, Inc.,; PHONE FAX . (508)945-0393 AIC No:(508)945-4048 697 Main Street AIL ADDRESS:david@elinsurance.com. INSURER(S)AFFORDING COVERAGE NAIC# Chatham MA 02633 INSURERANational Grange Mutual Ins Co 14788 INSURED INSURERB:Commerce Group IG001 Caliber Building and Remodeling .LLC, wsURERCAce American Ins. Co. - ARWC 22667 Efficient Buildings, LLC. INSURER D: 8 Jan Sebastian Drive #10 INSURERE: Sandwich MA 02563 INSURERF: COVERAGES CERTIFICATE NUMBER Housing Assistance Corp 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY) (MMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY - DAMA E TO RENTED PREMISES Ea occurrence $ - 500,000 A CLAIMS-MADE a OCCUR 027360 9/15/2011 9/15/2012 MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 5 2,000,000 X POLICY 17 PRO- LOC S i AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1 000 000 �t•�"AUTO BODILY INJURY(Per person) S B -.UTOS OWNED X AUTOSULED - BNVCS - /16/2011 /16/2012 BODILY INJURY(Per accident). S NON-OWNED PROPERTY DAMAGE j r+!RED AUTOS AUTOS _ Peraccident $ $ X UMBRELLA LIAB OCCUR - EACH OCCURRENCE '' S 1,000,000 EXCESS LIAB CLAIMS-MADE A i I - AGGREGATE S 1,000,000 DED RETENTIONS E iCU027360 9/15/2011 9/15/2012 S C WORKERS COMPENSATION ( WC STATU- OTH- AND EMPLOYERS'LIABILITY t N _ Y IT ANY PROPRIETORiPARTKER { r__w.. ;N A - E.L.EACH ACCIDENT - $ OFFICERWEMBER EXC; ' - 500,000 (Mandatory in NH) j, i 494P844 /2/2011 /2/2012 E1.DISEASE-EA EMPLOYEE S 5O0 000 11 yes P b L'_ n7 - _ _ - Sr�l C' E E.L.DISEASE-POLICY LIMIT S 500,000 I j I Z'w Z)—_RAT t:'S :OC_A?i-QvS•VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) with the Weatherization Assistance Program, the following entities are named as for Liability coverage under Pol #MP027360:National Grid Corporate Services LLC DBA aa kC Tnc. , Colonial Gas Co. & NSTAR Electric. 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 PROVISIONS. Housing Assistance Corporation ` Att: Ruth .Bechtold 460 West Main St. AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 ( David Crawford/ELDDCI ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INRn25 r9mnns m Tho Ar. 1Qr)n¢mn nrvi 1r ^oro ronicforuri mnrlec of Ar.r)pr) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investia ations 600 Washington Street Boston, AIA 02111 wwlU.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization;Individual): CA118E9 J301L0/N + ��fy1oDELING LLC Address: K ,TAN SEF3AST1A0 D PIVE City/State/Zip: SAn1bWicH NIA Da5(o 3 Phone#: 5 0 8�- S g— ('�� p Are you an employer? Check the appropriate box: 4. I am a general contractor and I Type of project(required): . 1. I am a employer with�_ ❑ g • employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 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' [No workers'comp. insurance comp.insurance.: 9• ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I-❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12.❑Roof repairs employees. [No workers' 13YOther_ rg9V LATt b1-) 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. -Contractor 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'compen information. sation insurance for my employees. Below is t/:epolicy and job site nn n Insurance Company Name: /`I C Policy 9 or Self-ins.Lic.#: q� `�gtjl Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration pace(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 S 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of InvestiE,ations of the DIA for insurance coverage verification. I do hereby eertifJ) der the pains and,n nalties of perjury that the it formation provided above is true and correct. - - Date: H 50g_ Fro, - 1 0 �77 j Offc•ial use onh Do not write i✓r thic area, to be completed by city or toxin official City or Town: Permit/Licena-e.= Issuing Authority(circle one): it1.'Board of Health 2. Building Department.3. CityiTown Clerk 4. Electrical Inspector S. Plumbin- Inspector 6. Other Contact Person: Phone-: Massachusetts - DCIMI-tntCM of Puhiic Safcl% 1 Board.;nt' Building Re,-miatiuns and Mandards I Construction Supervisor License I. License: CS 95038 Restricted to: 00 - i STEVEN WHITE x 147 RIDGEWOOD AVENUE HYANNIS, MA 02601 Expiration: 2/28/2012 s ( imui i ncr Tr#: 19311 �✓uQaaar/�aek`a f \ Office of Consumer Affairs& siness Regulation ti HOME IMPROVEMENT CONTRACTOR ` Registration:. Type: Yim Expiration 2/28f2013 Ltd Liability Corpo( CA�BER BUILDING'A, t�t@ litkOfl LING,LLC. STEVEN WHITE 8 JAN SEBASTIAN pRtV t11T 1'0 � � SANDWICH,MA 02563 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation ati 10 Park Plaza-Suite 5170 ; Boston,MA 02116 r r Not valid without signature a, h ## Town of Barnstable Assessors Division Page 1 of 3 ru Your Location : Home : Town Departments : Administrative Services : Assessors Division : More About «Back-Forward>> > Tuesday, January Search Website V Assessors Division- More About Town Departments *All Departments Data is based on Fiscal Year 2002 Assessor's database and is provided for inf< *Town Council purposes only. *Town Manager *Administrative Services 39 BEARSES WAY •Regulatory Services Map/ Parcel/ Parcel Extension: Mailing Address: *Community Services 292/020/ NISSLEY, HELEN M •Public Works Owner of Record: •Police Department NISSLEY, HELEN M 63 SPRING ST Property Location: - HYANNIS, MA 02601 Town Information 349 BEARSESWAY Parcel ID:292020 *All Information *Agendas *Annual Report *Committees •Employment Fiscal Year 2002 Assessed Values •FAQ's Appraised Value Assessed Value •Forms and Applications Building Value: $69,300 .$69,300 •Hearing Schedules •News/Press Links Extra Features: $0 $0 *Operating Budget Outbuildings: $0 $0 *Ordinances Properly Assessments Land Value: $23,700 $23,700 *Regulations Totals: $93,000 $ 93,000 *Town Charter *Town Calendar *Town Maps Town Newsletter Receive Town Updates gales History By E-mail Click Here To Join Owner: Sale Date: Book/Page: Sale P NISSLEY, HELEN M 5/15/1995 9650/268 $ 1 Contact Town Hall NISSLEY, MARCUS K& HELEN 7/15/1984 4185/200 $0 Town Hall ROSENBAUM, AUGUST 7/15/1984 4185/ 199 $0 367 Main Street Hyannis,.MA 02601 Phone 508-862-4000 E-mail Land and Building Description Contact Town Hall Land Building Lot Size(Acres): Year Built: 0.32 1959 Appraised Value: Living Area: http://www.town.bamstable.ma.us/comeonin/departments/administrative services/FinanceI... 1/29/2002 Town of Barnstable Assessors Division Page 2 of 3 $23,700 1144 Assessed Value: Replacement Cost: $23,700 $ 86,676 Depreciation: 20 Building Value: $69,300 Construction Details Style: Interior Walls: Ranch Drywall Model: Residential Interior Floors: Grade: Carpet Average Grade Stories: Heat Fuel: 1 Story Gas Exterior Walls Heat Type: Vinyl Siding Hot Water Roof Structure: AC Type: Gable/Hip None Roof Cover: Bedrooms: Asph/F GIs/Cmp 3 Bedrooms Bathrooms: 1 Bathroom Total Rooms: 6 Rooms Outbuildings& Extra Features Code Description Units/SQ FT Appraised Value Assessed Va No records returned. Building Sketch http://www.town.bamstable.ma.us/comeonin/departments/administrative_services/FinanceI... 1/29/2002 I Town of Barnstable Assessors Division Page 3 of 3 1 p. Back - Home Departments Town Information Contact Town Hall Website Developed and Maintained internally by the Town of Barnstable Information Systems Department Town Hall-367 Main Street- Hyannis,MA-02601 -508-862-4000 DISCLAIMER: Although we strive to provide accurate information,we are only human. Please consult directly with the appropriate department if there is a question of accuracy. Copyright 20010 Town of Barnstable. All Rights Reserved. http://www.town.bamstable.ma.us/comeonin/departments/administrative_services/FinanceI... 1/29/2002 f Town of Barnstable WebMap Page 1 of 1 o a � ,�Fuil ScreeMap i � Magnified ,Zoo�n�lrt , Z�ar�n ,�ut� ��� tMap'�� http://www.town.bamstable.ma.us/webmap/assessors/TOB WebMapmedres.asp?mappar=2�... 1/29/2002