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0049 STATICE LANE
i �z -76 oqzZr w Art k �Q. �e,4.40�- X-150 -cam- -PRo(3(e a ).Q.ecQ 1 -r .e- �,s Le I i i i CAPE INSULATION Cal ®® 111&ATIS' 3 OUTTEAM IRS SPRAY ULATI N SUSNINDID 9�T1! DDTT19! INSULATION CIIlIN07 1-800-696-6611 4 Town of Barnstable Regulatory Services V3 Building Division ._.s 200 Main St }.;j X" Hyannis, MA 02601 IT Date: Z-//� Dear Building`Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village �1114 S y 9 s7-,0-;,C4- 4" Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) ( ) ( ) ( ) ) Floors ( ) ( ) ( ) ( ) ( ) Walls Kw -a1��ca•,A, ( ) ( ) (/c� ) ( ) �iv e red y (vor k1 /der)ror,01to/ Sincerely 2Hry E ssrationpInc. sident Ins TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. Parcel C K(a 9 A Application # I `� Health Division Date Issued _Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Str et Address e Village A Owner—:61k I t ,• ���� Address s � Telephone r7 -1 I� ) Permit Reque t Z" v 4�14&,WU v4V4t,�" Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain_ Groundwater Overlay Project Valuation Construction Type 0 c�n Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting doc&nentation. Dwelling Type: Single Family ;7Two Family ❑ Multi-Family (# units) ". Age of Existing Structure Historic House: ❑Yes ❑ No On Old King4 Highway: 0�s ❑'No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other 1 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 Au 'orization ❑ Appeal # Recorded ❑ ❑Commercial Ye s o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name Telephone Number Address License# V V Home Improvement Contractor# Email Worker's Compensation # VJ6 '-ZA . ALL CONSTRUCTION DEBRIS RESULTING F O,frM THIS PR JECT WILL BETAKEN TO SIGNATURE DATE �� r - FOR OFFICIAL USE ONLY APPLICATION# DATE.ISSUED MAP%PARCEL NO. F ADDRESS VILLAGE - OWNER DATE OF INSPECTION: i FOUNDATION f ' FRAME �� •L INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL T GAS: ROUGH FINAL FINAL BUILDING t - DATE CLOSED OUT s - ASSOCIATION PLAN NO. ` h ' ���tneroY fa o PaxnciranNs 9 ` COMMON L mass save iii-nus thfauoh encrey off d my I PERMIT AUTHORIZATION FORM I, LNL owner of the property located at: (Owner's Name, printed) Ti9/'1G1� T IIIVAJAIIX (Property Street Address) (City/Town) � r I I hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. A � 1 ( . 1 Owner's Signature - �A �( J s Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: r _.., CA PE co QIS u c,+r 3 !� Participating Contractor 6ate Rev.12132011 I k Mass ic;husetts - Debpartment.of Public Safety :•Board of Building Regulations and Standards Construction Super r License: CS-100988 t 1` HENRY E CASSPV 8 SHED ROW > WEST YARMOUfiH . r � ✓,�..� " j11 Expiration Commissioner 11/11/2015 a `b Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Co ltra'ctor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY ------ - 18 REARDON CIRCLE ---- -- ---. SO, YARMOUTH, MA 02664 Update Address and return card, Mark reason for change. ;CA1 {5 20M•05/11 Address Renewal Employment Lost Card (93ze ai�rnnoauue���C/c�C%�/l�rwJrcc%r.udeGi \ Office of Consumer Affelrs& Business Regulntlon License or-registration valid for, individul use only OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: eglstratlon: 1.53567 Type: Office of Consumer Affairs and Business Regulation xplratlon:,.,;.1;2/15/20:1,6 Private Corporation 10 Park Plaza -Suite 5170 1.0 1365'ton,MA 02116 .;APE COD INSULATI;Q..N;'INC'. -IENRY CASSIDY 18 REARDON CIRCLE":.`.--'-` 7 __ 30,YARMOUTH,MA 02664 Undersecretary N valid wi , tit sign e ' r The Commonwealth of Massachusetts Department of IndustrialAccidenls u W Office of Investigations J a d 1 Congress Street, Suite 100 Boston, MA 02114-2017 www,mass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ff,1 Please Print Legibly Name (Business/Or 'zation/Individual); 4 VV Address; �0 VbVL City/State/Zip; tk\V1 MOA Phone #; t-76l�'11 W Are you an employer? Check he appropriate box: 1,�'I am a employer with 4. ❑ I am a general contractor and I Type of project (required); employees (full and/or part-time),* have hired the subcontractors 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,t 9, ❑ Building addition required,] 5, ❑ We are a corporation and its 10.0 Electrical repau•s or additions 3,❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repau•s or additions myself, [No workers' comp, right of exemption per MGL 12,❑ Roof repairs insurance required,] t c, 152, §1(4), and we have no employees, [No workers' 13,[ Other �( comp, insurance required,] *Any applicant that checks box#hmust also fill out the section below showing their workers' compensation policy information. t Homeowners who submit thisuffi8avit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors 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 dnfbrmation' Insurance Company Name; 1' G '�(� -. ��,�(,V�K(✓U Policy# or Self-ins. Lic, #: Expb•ation Date: 1�jf Job Site Address; Lei City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy numbr a d expiration date). Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition rimbial 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 cert� n r pains and penallles of perjury that the Info rmatlon provided ab ve Is tr e ren correct, Si nature: Date: Phone#: 1_49 Offlclal 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 b, Other Contact Person: Phone#: r I I CAPECOD-27 KLIGETT CERTIFICATE OF L DATE(MMIDDIYYYY) LIABILITY INSURANCE 611312014 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 ON Rogers .Gray Insurance Agency,Inc. NAME: Barbara DeLawrence 434 Rte 134 PHONE iAAc Ne) 816-2156 _ (A/C No Extl South Dennis,MA 02660 ADDRESS: bdelawrence@rogersgray.com — r INSURERS AFFORDING COVERAGE _ NAIC_tl_ INSURED INSURER A:Peerless Insurance Company INSURER B:COMMERCE INSURANCE COMPANY _ _ Cape Cod Insulation Inc INSURER C:Evanston Insurance Company 18 Reardon Circle South Yarmouth, MA 02664 INSURERD:ATLANTIC CHARTER INSURANCE GROUP _ INSURER E: INSURER F: CO ERAGES CERTIFICATE NUMBER: REVISION NUMBER: T IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN ICATED. 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 A D BR POLICY NUMBER MM/DD�YY MMILDDYYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY I CLAIMS-MADE X EACH OCCURRENCE $ _ 1,000,000 OCCUR CBP8263063 04/01/2014 04/01/2015 PREMISES(Ea occurence) 100,000 ME EXP(Any one person) $ GENT AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ 1,000,000 X a POLICY PR GENERAL AGGREGATE $ 2,000,000 _ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: -----. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B Ea accident $_ 1,000,000 ANY AUTO 14MMBCKVMK ALL OWN 04101I2014 04/01/2015 BODILY INJURY'(Per person) $ ED X SCHEDULED _ AUTOS AUTOS BODILY INJURY(Per accident) $ AUTOS X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE $ Per accident r4DED UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1 000,000 CEXCESS LIAR CLAIMS-MADE XONJ453514 04/0112014 04/01/2015 AGGREGATE X RETENTION 10,000 Aggregate $ 1,000,000 ORKERS COMPENSATION ND EMPLOYERS'LIABILITY PER OTH- -- D NY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCAOO525904 STATUTE ER — FFICER/MEMBER EXCLUDED? ❑ NIA 06/3O/2014 06I30/2015 E.L.EACH ACCIDENT $ 1,000,OUO Mandatory In NH) — _ I es,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 ESCRIPTION OF OPERATIONS below --- — E.L.DISEASE-POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CER IIFICATE HOLDER CAN_ CELLATION .t. �, r ���,b � � ■ •. ' „' � ,�� � �� t �� !� ,� ,` �� Y .a ..a.� �s 1 i - - - I _.._._ _ _._. - ____.. _ _-_. ___.. - f i Kam[ ST0.t'LC£� � '��4�,.-•- 5(De, � �_ -_ _ , �� t. _ -. I �: � I 1prj,s��€x�� �o2c�.��� l /.e�-.r S c`�2�- i � r _ J ` . 4_ ___ ' __. __. _.- ___ _. -___�_ -_. _ - k f { TOWN OF, BARNSTA E ;. CERTIFICATE OF OCCUPANCY P- PARCEL ID 273 086 001' GEOBASE ID 41206 ADDRESS 49 STATICE :LANE PHONE HYANNIS ZIP -- LOT 3 BLOCK ' LOT• SIZE DBA DEVELOPMENT ' DISTRICT HY PERMIT 38554 DESCRIPTION PERMIT TYPE B000 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department•of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: WE BOND $.00 CONSTRUCTION COSTS $.00 1 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE P. ,111 EsARNSTABLE, MASS. 1639. ED MI`►� BUIL W �IVISI N BY _ DATE ISSUED 05/19/1999 EXPIRATION DATE TOWN OF BARNSTABLE PARCEL ID 2`M 083 001 ^ GEOBASE- ID 41,206 ADDRESS 49 STATIC E LAuNE PHONE 14YAI;4NIs ZIP LOT ,3 s nock LOT SIZE .D&A, DEVELOPMENT DIS`RIC.r H s! PERMIT . 35425 DESCR-1PTION NEW 3BDR.M SING r�k"I TOWti SHIMEP PERMIT TYPE BUILD TITLE NEW RESIDENTIAL BLDG PMT rmd� �� Department of Health, Safety ARCHITEC` and Environmental Services ND FEES: $387.50 Ox t1lE GOVSTRU T IV COSTS $1.6 5 y 000,00 �► 101 SINGLE FAM DETACHED I _, PRIVATE, P + BARNSTABLE, + iMA83. `®�► r' BUILDING DDI�V*ISIO�N'' BY '� DATE ISSUED 1,2/17/3,998 EXPIRATION DATE t, °» THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND y�HERE. APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. � 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY - ® ® i ® � BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 �(✓V�✓�-� 7 1 Q.0 `� 1 2 ` I I 3 1 HEATING INSPECTION APPROVALS ENGINEERIW DEPARTMENT 2 a BOARD OF HEALTH c OTHER: / SITE PLAN REVIEW APPROVAL s,9 qy 3-6 WORK SHALL N , PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. i I I`I V I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7 3 ' Parcel �, Permit#=-+ 3��a-s Health Division 7��n �iew Pic+ y Date Issued l `Conservation Division ° r Fee 3�'7 Tax Collector ' -t Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board ' Historic-OKH Preservation/Hyannis ' Project Street Address F i �o� `3 !-1� ,5 �'ct�l c�� �,�c��c��e. �$�o�.-��j-e-z-�ti �1�`��v Q: :Village �2 'LI Owner orb �•- '�j cke Address •0•" e 2��� ,� �oc� t CJ + -Telephone _S b g- 479 S'S Ito Permit Request Aa�X 6 A co "`rG eR$ c m M IL ) 4 IR i` e-0 S V'Q Q In G1�C�A1°2 e_ O CC�r' Qr Square.feet: 1st floor: existing proposed 1gCD 2nd floor: existing proposed 00 Total new Estimated Project Cost 1 a.G;�D0 Zoning District Flood Plain Groundwater Overlay Construction Type ' Lot Size Grandfathered: U Yes ❑No If yes, attach supporting documentation. r Dwelling Type: Single Family W 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 iN, 'Half: existing new 1 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 l(new size INS Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# 'Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# ' Current Use Proposed Use -�-'l BUILDER INFORMATION Name 4V�V\ ��C��`iOn, Telephone Number 5 09 - °��'a.- Q Jed Address�L-�G, �c�y{'_ �� Ct�.�2 License# 0t-� Home Improvement Contractor# Worker's Compensation# \ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TO SIGNATURE DATE - FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO.; 3 a .. i _ d '4 tt * .. � y t� "' ♦ - i ' i _ '_ s t. , t ° •ADDRESS � . r � VILI4AGE OWNER = •; i DATE'OF INSPECTION: FOUNDATION FRAME INSULATION- FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ,ROUGH ' FINAL �" ..� ' ,• _ c- _ �• '�� � , FINAL BUILDING DATE CLOSED OUT ASSOCIATION•PLAN NO. G „ t'Y'�-.-., y. .._.-.'7..P y -. .r - , - ✓ Y .e _ .. - ��.y.-.. P • -w.. ; •^'r+y ...v .•`r•. 4 ,HE r The Town of Barnstable BARNSTABU. ` Department bf Health Safety and Environmental Services MASS Building Division 367 Main Street,Hyannis,MA 02601 g Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice i Type of Inspection Location q q 5�" C. E'_ � Permit Number Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: r, tZeWe 61) Q k 0 6,61140e �)M R- (e 'Z- G A1��Iq {• `Td 40I e i tct /` t RG Ta /cC k- c t i t Pe <-r/ pw- vJ/ .Il z-e -V/,oC C- S-r2 A 0 RC AFL WA (� -D oq-i , (A)�.e R-C_ 1-f 7- ;t rZ-. U�_=\\ 6 � /� �.�1(( � f5 ..T.'lT oLrUf Q�G.s" rj1 C A,t- ,, A f t't C: ;�C �•Vt )Q N-�A u �!� Aj i Please call: 508-790-6227 for re-inspection. Inspected bye ` Date P i OO, VJ LOT 3 31.5' 14,845f SF 32.5' i 6' cn N � New Concrete Foundation Z O�O. s, 17.9 39.6' REFERENCES: ryry N Assessors Map: 273 Parcel: 86-1 "V ZONE: Rc-1 Setbacks: \ L1-36a°o CC�, Front: 30' Side: 15' Rear: 15' FEMA Zone C Panel # 250001 0005 C , - _ Revised: 19/AUG/85 I certify that the foundation 9CHARD y�s� shown hereon conforms to the R. a LHEUREUX setback requirements of the No Zoning Bylaws of the town PLOT PLAN No 343 � :� of Barnstable. IN / �Si� /yr ✓y (Hyannis) Professional Land Surveyor'- Date Ul%LlG l�J�o NOTES: DATE: 13/JAN/99 SCALE: 1"=40' 1.) The structures shown were located on the ground 0 10 20 30 40 60 80 FEET by conventional survey methods on January 13, 1999. PREPARED FOR: 2.) The property information shown hereon was The Community Bank compiled from available record information and 1090 Main Street does not represent an actual on the ground survey. Brockton MA 02301 3.) This plan is not for recording and is not PREPARED BY: to be used for construction layout or deed (VaPOSUJ N description purposes. PO Box 718 Hyannis MA 02601-0718 DWG #. C356PP1 FIELD BY. RRL/RJM (508) 790-7902 / 790-7905fox "" `�_-�_� The Commonwealth of Massachusetts- __v_ .° . � .. Department of Industrial Accidents ; =;—. . -= Ofl/ce of/nsestigatioos _ T 600 Washington Street r,. - . Boston,Mass. 02111 ) Workers' Compensation Insurance Affidavit name: -J 6 � ��`�—�r�C,r70 V1 V �'C C f e( - ©G0.�C o 11 11 \\ \ , 1 i �—� , w location• ',5 - k ti e>w�atie� V e-ce `1'k 0,��C C,e ,a Vk V(.l=Lk. // city':2�;eL", 1U Re-,,,- 02-2 r! 1 vhone# LE 4.Wkg5oo ❑ I am a homeowner performing all work myself. ty . , ///❑////%%%%%%% % %%%%%%%%%%%/%%%%%%%%%���ve n one w %%%%% %%%%%I//%%%%%%%%��/%%%%%%%%%%%%%%%%%%%%%%%%%%%%/%%�%/%%%%%/�%/%�%%///, ❑ I am an employer providing workers'.compensation for my employees working.on this job. ::.:::.:::::::::::: :: Vontnanv name ......::.:, :dM ..::..:..:....:..;;. a on6# ::..::.:::.::::......:...:::.. ...: ". insurance cu:.: .. oh # ::.;>;:':.;;;;;;;>;>::<:... _.. ... ... %/ ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors•listed below who have the following workers'compensation polices: cam sn,;name, . .;... . 11 > > ::.:.. :'j::: ii tL... .)....0 r. ......."..'iii:v :::::::::. iiii '. .:...... :..<::6......t..,. �y 4:;i.,..;.;. ,1:111 on ::::::::::.:.... ..................... :.::.�:::::::::::v4:::v:::::::.::�:::::•: .....::::.:::.......ii::i:.. ...........::::is ii:...I. .....::::::::::::.. : .....::::: ................::::::::':::: ... .. .:::.:ii'i:iii::::. ::::: ............. .. A., .. .....:........ .. .. :: .:ii::.. ..::i: -: ... ................ .. ........................... ............. ... ......................... ::::.: ........:..:.:.........................:::::::.. ........ i::t iiiiiii'r::::::::±::.:::...i'':'!`:is ii::-:`: i:::iii:::::-*$:.X-::::iiii:'-``::::ii]:j::is*;i::`Si;isS;':i;:::j:j:;.::_::�ii:%`::::i::::i:?;:<;:;:S ii::is ii::i+:ii::is is ii::3 i:'^i:;i}:':'i'}i:ii'ji:: u. v:....................................... :::::._::::•::::::•::::::::.�:::::.�::::. ......................................... ....::••:::::::::::::.:::::.:::::.:::::...........................:................................ i ... .........................................................................:::.:.:.:......:::................:.................... ..................................:.�.�::.::.�:.::n..<.. .. nsn:rance:ca:.............::::;:;:>::<:.>::<:.:>:<:::>:<:: olr :/►.::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.:�::::::vn::::�::::::..::..:.. :.::•::::.:::::.:::::::::.:::...::.::.:.::..:::•....................::.::::::::::::::::::.::::::::::::::::::::::...........................::•.::::::::::::: :.::::.:::::.::::::::::::::::::::::.::::::.:::::::::.:::::::::::::::.:::::.:::::::. .c as:.name:::::.:.::.::::::.:.:::::::.::.::::.:....:.:.:,::.:............................... ...... ... �;:`>: ;: a idelrEss ::i:ii' �':;:;:;?:: i;:'}}:i1<4:+i iiiiiJiiii%!�i::i' i:<%iiiii:::::::::::::iiiii::� ^`::ii?iiiiii`::^i:::is iiii: ::isis iJiiiiiSiSiiii:`.::!:i$ii:]:�:::':':`�::::iii:::::: :::::::':_`';:.:;:iii:ii::iiii:::: :::`:::%:::i:ii::G?ii:+iiij::::ii:}ijii:>�j i:Li:iiii�ii:?i:i :::.:.;:::::.:;::::-.;;;:;:.::::•::::::.::::::::..:..:...:...:. aeif. ---:;............................ o ...............................................:...:::.:::..........:...::.:._..:......::.::..:.__...... ..... :::: . ............ .............:�..::.:. ::.:::::::::::::::::.::::::::::::::::::::::.::::::.:::..::::::.::::::::::::::::::::::::................................::::::::.::.s.......... :.;: ;:.;;:.;;;:.;:.;;:.;:.;:.;:.:::::::::::::::.:::::::::::::::::.:::::::::::::.:::.:::::::::::::::::.:..::..............::.:::::::::::..:::::::::::::::.:::::::::::::::.::::::::.:::::.:::::::. : >€'a `:» ::::::::::::::::::::::.:::::.:::.::.._:::::::::.:::::::::._:::::::::. .. . . .::.::::::::::::.:::::::.::::::.: *11 ::::::.::.::::::::..:::::.:...::::::.:::.:::::::.::::::::.::::::::::::::::::::::.. ...`- oli ..#.:...::::.:::::::::..:, ::.::::::::::.::.:.::.::,::::.:::::::::::::::::::..:...... n3nrance.ea<.,. ::. _ _.. ....... _ __ Fafim a to aecmre coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand abet a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do here by c the pains and peT es of perjury that the information provided above is true and correct v� Signature tate I 'T( hT - - . r Print na4J me Phone# ,!a,ra-ter 7-5,o � 11111111111111 official use only do not write in this area to be completed by city or town official . city or town: - permit/license# • ❑Building Deparhnent OLicensing Board ❑checkif immediate.response is requited ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other Oevind 9l95 PJI) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any con=--z- 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 raore of ax—foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rec.--ver . :*ustee of an individual , partnership, association or other legal entity, employing employees. However the owner of s dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of —4.n a. v%intrc TPTSn"c to fin maintenance , construction or repair work on such dwelling house or on the grounds c: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commomveaith nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the coatraC-"= authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your 'situation anti supplving company names, address and phone numbers along with a certificate of insurance as all affidavits may be r,F, submitted to the Department of Industrial Accidents for confirmation of inanranre coverage. Also be sure to sign t date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is „ a, being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you compensation Policy, lease call the D Y are required to obtain a workers comp � P �arm=at the number listed below. 2111 City or Towns 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. Place be sure to fill in the permit/licease number which will be used as a reference number. The affidavits may be returned io the Department by marl or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please is not hesitate to give us a call. The Depmr-micat's address,telephone and fax munber. The Commonwealth Of Massachusetts Department of Industrial Accidents Otflce of Investlpatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 7274900 eat. 406, 409 or 375 ..._. .... .._ .. ... !, j DATE(MM/DD/YY)... ACORD� � t�T1 � A 0 .NI ► 3�LM'�1'"Y �111$l� M� cSR MP ' k&MRE 1: 12/11/98 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The' Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE of Cape Cod, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 480 Route 6A, P O Box 838 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. E. Sandwich MA 02537 COMPANIES AFFORDING COVERAGE The Insurance Agency COMPANY PnoneNo. 508-888-2766 Fax No. A Legion Insurance Company INSURED COMPANY - - B R & M Realty Trust COMPANY Roger S Goode Trustee C P 0 BOX 742 COMPANY Forestdale MA 02644 p COVERAGES ... .. ... . 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. CO TYPE OF INSURANCE - POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE IMM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY - - GENERAL AGGREGATE - $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ CLAIMS MADE OCCUR PERSONAL&ADV INJURY $ OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE S FIRE DAMAGE(Any one fire) $ MED EXP(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO ALL OWNED AUTOS BODILY INJURY _ 8 SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE. $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN TO ONLY EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM -- _ _ $ WORKERS COMPENSATION AND WC STATU- TORY LIMITS I I ER EMPLOYERS'LIABILITY _ EL EACH ACCIDENT $ 100000 A THE PROPRIETOR/ INCL TBI 12/09/98 12/09/99 EL DISEASE-POLICY LIMIT $500000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 100000 OTHER - - DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS - - Carpentry CERTIFICATE{iQlspfR.. CANCELLAT-O:N BA MT01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, . Town of Barnstable 367 Main Street BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR ABILITY Hyannis MA 02 601 OF ANY KIND UPON THE COM AN ITS AGE S OR REP AUTHORIZED REPRESENTATIVE The Insurance Agency AGORD 25S i1/951. .:»:.. ©RCQ{#D COHPORAYION..1988.. AYCER CERTIFICATE OF LIABILITY INSURANCE "', DATE(MMIODII Y) PRODUCER (508)888-2244 FAX12/11/98 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bryden Insurance Agency Inc. — ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 125 Route 6A HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Sandwich, MA 02563 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW - COMPANIES AFFORDING COVERAGE Ate: COMMERCIAL LINES COMPANY Commerce Insurance Company „ Ext: A INSURED Catherine Little d/b/a Little Concrete COMPANY Eastern Casualty Ins Co P 0 Box 1832 e b �_ Sandwich, MA 02563 COMPANY y i C. COMPANY p , ; COVERAGES 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.LIMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER ' DATE(MMIDOIYY) DATE(MMIDOIYY) LIMITS . GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY a GENERAL AGGREGATE f 600,000 ;F PRODUCTS COMPICInAGG S 300,000 A CLaMSMAOE X OCCUR OWNER'S aCONTRACTCR'SPROT K24387 08/18/1997 08/18/1998 PERSONAL dAOVINJURY f 300,000 EACH OCCURRENCE S 300,000 FIRE DAMAGE(Any ene Ine),' S 50,000 AUTOMOBILE LIABILITY MED EXP(Any one person)= f 5,000 ANY AUTO COMBINED SINGLE LIMIT f ALL OWNED AUTOS `' . - � X SCHEDULED AUTOS " BODILY INJURY t f A 97MM194963 0711711997. 07/17/1998 (Pei person) 100,000 HIRED AUTOS NON-OWNED AUTOS BODILY INJURY SI (Per seadent) 300,000 PROPERTY DAMAGE f a ,GARAGE LIABILITY 50 000, _ • � ANY AUTO AUTO ONLY.EA ACCIDENT S OTHER THAN AUTO ONLY. - c EACH ACCIDENT f AGGREGATE f EXCESS LIABILITY r p . EACH OCCURRENCE UMBRELLA FORM S AGGREGATE f OTHER THAN UMBRELLA FORM ` _t S WORKERS COMPENSATION AND o X WC STATU• OTH• EMPLOYERS'lIAB1UTY TORY LIMITS ER B THEPROPRIETORI WCG1003602A 06/1.2/1998 06/12/1999 ~EL EACH ACCIDENT' s 500.,000 PARTNERS/FXECUTIVE INCL OFFICERS ARE EL DISEASE.POLICY LIMIT S 500,000 EXCL " .� orHER " -EL DISEASE•EA EMPLOYEE S SOD,O00 OESCRIPTI t7N OF OPERATICNSILOCATIONSNE►1iC1E51 SPECIAL ITEMS r r p & k _ LOT #3 Statice Lane 'Hyannis, Ma.` CERTIFICATE HOLDER CANCELLATION R.P.G. Construction, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE P.O. BOX 211 _EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL TO MAIL Sagamore Beach; Ma. 02562 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SIIALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTII()nt2T:n RFPRFSFNTATIVF ...::.:....:..::.. ...........,..:..........:.............:.............�...: T.E.;i AB *. .. .... ..... :: GATE(MMlOO/Yv .::.:.:::•.::::..::::. ::...:. �.. Y:.1. . Ns F N.: :::::::::::.::.:::.:.:.::.:::: PRODUCER ...........:.:::::::.:�::::: .............,:::::..: :::::.:.:::.>:.>:;:;.>::.»:.:;<.::.:;:i:::::::;::::::::::::':::;:::::;:;;;: ;: U6�24�199(508)238-0056 FAX (508)230-8367 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION d'rse Insurance Agency Inc. _ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 285 Washington St. - HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Easton Village Shopper COMPANIES AFFORDING COVERAGE North Easton, MA 02356 -- - Attn: Daniel Morse COMPANY Assurance Company of America Ext: 213 INSURED ... ..... P & W Construction, Inc. COMPANY 50 Elm Street e North Easton, MA 02356 COMPANY C COMPANY D t CAME: GES.»>:::»<:::::>:s::>s>:<:::>::::»>;.;>;;:.:.>::.:<.;::;:.:.>:;::::::.::.::.:.:;:.>:•;:::::::::... .:::................... R A :::.: :: . ...:.:.:::: ::::...:::.:::::.:::::.:::.....::•::. ::....:.::::::::::::::::::..:..:::::.:::.............:..........:.::::.:::::::::::::::::::::. :';: i ::;r,::;:::3:2::i::::>:'i>:: :':::: ;.3;::':'.........s :. :;' '':"::: :?::;: :::>':;::%::::; :::::::::: ::::;<a;:2:;::.:::;:::;; 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. ................................................. . T TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION: LTR' POLICY NUMBER DATE(MMR)O/YY) DATE(MM/DO/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE S X COMMERCIAL GENERAL LIABILITY 2,000 C CLAIMS MADE X :OCCUR PRODUCTS-COMP/OP AGG :S 2,000,C q >::......: "•"•'• $CP 32752702 PERSONAL&ADV INJURY S OWNER'S&CONTRACTOR'SPROT; 03/12/1998 03/12/1999 :............................................................]... ..... EACH OCCURRENCE S 11000,C ...._. ................. i .. FIRE DAMAGE(Anyone tire) S .........................................:.... ..................50,C MED EXP(Any one person) S 5+ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) _ S HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) S L PROPERTY DAMAGE S GARAGE LIABILITY i ANY AUTO AUTO ONLY EA ACCIDENT S OTHER THAN AUTO .. .. ......................................... Y' ONL EACH ACCIDENT.S ..................................... AGGREGATES EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM S OTHER THAN UMBRELLA FORM AGGREGATE s WORKERS COMPENSATION AND s_ EMPLOYERS'LIABILITY X TORY LIMITS ER i2 A TC9 95834108 L EACH AcaDENr THE PROPRIETOR/ 03/12/1998 : 03 12 1999 E.........................................:.. X : INCL : / OO+ PARTNERS/EXECUTIVE ..; EL 5 DISEASE-POLICY LIMIT :S OFFICERS ARE: _... OO,C EXCL. OTHER EL DISEASE-EA EMPLOYEE i$ 100,Cr DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESlSPECIAL ITEMS "Do b4Z-115, a�rt.� Ch�p > �SLr�i 0`1 ;CEitTIf=ICAn`;Ftvl�� :. :::: . . .. . : ::. .::.:::::::::::: :.X. :::.:.:::;.::::::.: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE R.P.G. Construction, Inc. EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL P.O. BOX 211 Sag amore Beach, Ma. 02562 10 OAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIN PON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED R ESENT/!\T u.....: n t:CORD 1 r4 CORD )'::: ?:;::::::;: BATE(MM/ :.....:RT1.F.l. :::::::: ::::::::::: ,T ...Cy :.::.:: :::::::;: : :: :: :::: : ::::: ::::::: F.. .IAE3.iL.iTY.:iN:SIJRANE:: . :::::::::::::::::........ :::. :. ODU CER ... ,: 0 4 / 2 3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM ONLY AND CONFERS NO RIGHTS UPON THE CERTIF RIDER RISK SPECIALISTS HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEN ALTER THE COVERAGE AFFORDED BY THE POLICIES B INSURANCE AGENCY, INC. _ JAMES W.RIDER INSURANCE COMPANY COMPANIES AFFORDING COVERAGE 2 SHORE ROAD BOURNE, MA 02532 A WESTERN HERITAGE INSURANCE CO. suRED - -- COMPANY RPG CONSTRUCTION, INC. e PO BOX 211 COMPANY SAGAMORE BEACH, MA 02562 C COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T14E POLICY PEI INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TE� EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE(MMMDNY) DATE(MM/DD/YY) LIMITA GENERAL UABIUTY GENERAL AGGREGATE 'S 1 1000 X COMMERCIAL GENERAL UABILITY PRODUCTS-COMPIOP AGO E 11 0 0 0 Fir CLAIMS MADE OCCUR PERSONAL R ADV INJURY S A X OWNER'S 6 CONTRACTOR'S PROT BINDER ##R PGC-0 9 0 4/2 3/9 8 0 4/2 3/9 9 EACH OCCURRENCE E 1, O O O FIRE DAMAGE(Any one fire) $ MED EXP(Any one person) S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT E ALL OWNED AUTOS -- SCHEDULED AUTOS BODILY INJURY S (Per person) HIRED AUTOS — NON-OWNED AUTOS BODILY INJURY S (Per accident) PROPERTY DAMAGE E GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT E — AGGREGATE E EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM AGGREGATE E OTHER THAN UMBRELLA FORM S WORKERS COMPENSATION AND TORY LIMITS_ OT EMPLOYERS'LIABILITY _ ER EL EACH ACCIDENT S T}1E PROPRIETOR/ INCL PARTNERS/D(ECUTNE EL DISEASE-POLICY LIMIT_ S___ OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE S OTHER s f 1 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS c c awo c - S elf ern to C RC' :. :.:<:.::::.::......;:;.::.;;;:.:;::.;.: .IC11T .N�LUH :.::.. AN0.5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR CATAPILLAR FINANCIAL SERVICES EXPIRATION DATE THEREOF.'THE ISSUING COMPANY WILL ENDEAVOR TC 10440 LITTLE ' PAWTUXENT PKWY #12 0 0 DAYS WRITTEN'OTICE To THE CERTIFICATE LDER NAMED TO THE COLUMBIA, MD 21044 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOS O OBLIGATION OR LIP OF ANY KIND—UPON TYE COMPANY, ITS, ENft OR RFPnFeFNTA 08/14/1998 09: 31 5087461668 ALMEIDA & CARLSON q PAGE 01 )R'dQ: QRD~ �1«x° :��.:.:.,.��yr;:+!io1`�:I Q:He'<.x t:<.:x•,x:�r:«:R:R:R:Asa,kx R:RSt :yo :p %s:ee:�R.:�ae?:�°X' :�:..::�..' 'e:kf:::,e. .l.Y:p:%so:e:Xxa p::f.(.,,:;4.\:: .:9:0.0:4.4�<vR 0!«:a:d,c:« X°ef<� :Xt"m.°°e6' ...^.D�.A..'...n•..(..Y.•Y...I.D.,D...IY...Y)HIM,ei ,g w_.... ,... ?"F'?.✓.7?.?:C?V?.:�!.C..?(�'TR�?�9!9).C?':?'M..C!.�x��:L�..l.�..i•'�l wr:.w.. w:%e>'ta:x. � 08/14/98 PRODUCER THIS CERTIFICATE I$^ISSUED^AS A MATTER OF INFORMATION ALMEIDA & CARLSON INS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEIL THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 345 COURT ST BOX 3255 COMPANIES AFFORDING COVERAGE PLYMOUTH MA 02361 COMPANY A GRANITE STATE INS CO MSURFD COMPANY MARK SHANAHAN DBA 9 MARK $HANAHAN DRYWALL COMPANY BOX 1126 C PLYMOUTH MA 02362 COMPANY ••JL.RA:Q.. x:::R•Rx`•s%� - ::oiafeQ oaox,iaX•x«o:oX ««oxbiei<e.,:iexb:e:e.<a:ev:Q-:e:6!<%S:�:weia� Sir S> �:l 4:F%�:k: :isiR;i:p:eie:%ie.ie%�%i:%3:e:ty:ei�»x:R%,FAk>�A� �9 � 'd•' � 4e�o�:.as� eX•:aX.Aa.S«e:e�.:<:X: ::e:e,:.X eeXa: X•�••X,X: :eAe:: >:s:r.A6: X.p«A.A.s::.A.A.s: :xXA:A:A:A:en:X:xx;p« « ,:«•A .,a . z: u 'uM A....Ah.....ff.....9�`.....;a..,...........^w,..,.&'„r........1.°�,14..'�.�1"lp.�.«,..Ea THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCW6046 ANP COMPITIOMIS OF 6UCM FOUCIEG. LIMITS. !SHOWN MAY HAVE SEE N REpl10E0'Bv PgLp Ctl►!M, CO TYPE OF IIGUIRANCE POLICY NUMBER POLICY eFFECTWE POLICY MWIRATMM UNM LTR DATE(MMMWY) DATE(IIMADD/YY) QFNEAAL LIABIL11" GENERAL AGGREGATE E COMMERCIAL GENERAL LIABILITY PRODUCTS•COMPAP AGG E CLAIMS MADE a OCCUR PERSONAL A ADV INJURY E OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE 6 FIRE DAMAGE(AM or&five) E MED EXP(Any any prrson) E AUTOMOBILE LIABYJTY COMBINED SINGLE LIMB E ANY AUTO ALL OWNED AUTOS BODILY INJURY 6 SCHEDULED AUTOS (Plat paeon) HIRM AUTO$ BODILY INJURY NON•OWNED AUTOS (Pfar ffooldufry E PROPERTY DAMAGE 8 OARAQE LIAStftY v AUTO ONLY•EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: ^EACH ACCIDENT i AGGREGATE E EXCESS LWBAITY EACH OCCURRENCE S UMBRLSLA FORM AGGREGATE i OTHER THAN UMBRELLA FORM $ WORwIS COMPENSATION AND WC 3548519 . 7/0 8/9 8 7/0 8/9 9 X TORY uM,T8 ER EMPLOYERS'UABaJTY EL EACH ACCIDENT 10 0. .0 0 0 THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT is 500,000 PAPITNERE/EXeCUTIVE OFFICER! ARE: EXCL EL DISEAS&EA EMPLOYEE E 100, 000 OTN6R DI&SCRUMON OF OPERATIONWLOCAnONBNEHICLESISPEGAL IMUS, DRYWALL INSTALLATION A.A.A:k:e:a p:a ae:n:e;?<;;h 9 p:R a iReil�9xA9A•f°,i<:Re:rt:°e:axe;i 9 R °:RMe�i'p ;R:feb:'�Q'?i R%Q'RSx°N4 7s•.A:eM»:Qxux'�y<&n°«Xi&.kne&,nf.ix�<-b :owwAM �,e .._....::..•.<...:�..:.':...:.....m.,wr,.,•..:3:°:w°.ogaffirt:e:gw�:�:�:�acRR;R:R;�;Aaek;k�•,Sap,:K4aei0.gaa9:ahRR•p��'�,.A•<,.Z;�.p;..¢..e;ck�x.>:<.x.o..<xe»>:x«ex.A.Le,�:�p...oQ.p.�a.f.0,...t»:>:�e.pep.a.°.,uS�N..p,:S.vaeea�p.�.?H!... ..•.....:4A�... SHOULD ANY OF THE ABOVE DEBCRWV POLICES BE CANCELLED BEFORE TIE R.P.G.CONSTRUCTION, INC. E1XPIIRATIM DATE THEREOF. TK ISSUING COMPANtt WILL FJWFAVOR TOMAL P.O. BOX .211 .1.Q—DAYS 1VRRTEN NOTICE TO THE CEATLFlCATE HOLEJEA NAMED TO THE LEFT, SAGAMORE BEACH, MA. 02562 WN FALLRK TO MALL SUCH NOTICR SHALL IMPOSE NO(IOU"71011 OR LIABRM OF ANY MM UPON TI4 . PAW. TTS AGWM REDRESE14TATMED. AUTHOlUllD WRESIMATTYE u y ° Diane IhH• rQ.X.a.xXS.S.Rk;S.Ak;o.Aty;SR�.%AQ.:�-.RAk.'^Rhr.AL'.'.A:.:1wRS�.i«fv:A..n�.•fAe:¢Yni Q.iv:�R%:AQ.aA^';<:xs�.:RF::RnQS A:nAa4'siAo'4gi:AeAwA:4e7RA:QA:Aa:fAnx:xf:e1:�:e!':Ae:s.x.i:eseisX«q-:A.•3R:i:.;6,:•Awz.:R�.k4<;nx ox'.:p.g..,ak:;.Xef:p,:.p:ag.eAa:A<:.f f.:!e.;xR..:A<e..A!C1,i:1:: A . es;c�r o:f\e r��„�I.Q^�bh�4•.a:e.:^:ee:«.e 4 \4!Y+r' Dia e M Pratt )v [!L� DP ? ,§ « � ! �C// . ,o>fe�kAa � acC-Rv CERTIFICATE OF LIABILITY INSURANC PIo TP DATE(MM/DDNY) IN-1 11/20/98 j PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Drake,Swan & Crocker Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc.g y, HOLDER.THIS CERTIFICATE DOE S NOT AMEND,EXTEND OR j 14 Lot's Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. f Orleans MA 02653-0429 Phone• 508-255-3212 INSURERS AFFORDING COVERAGE INSURED INSURER A: American Economy, Ins. Co. INSURER B: Massachusetts Bay Insurance M.A.P. Insulation Co. , Inc. INSURERC: New Hampshire Insurance Co. P 0 BOX 1309 INSURER0: Sagamore Beach MA 02562 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER DATE MID DATE MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 02CC32643570 01/03/98 01/03/99 FIRE DAMAGE(Any one fire) $ 5 0,0 0 0 CLAIMS MADE D OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ ,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,00 0 POLICY I I JECT ELOC AUTOMOBILE LIABILITY' COMBINED SINGLE LIMIT $ 1000000 B ANY AUTO ADN534489601 05/01/98 05/01/99 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) _ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) I AGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ ' OTHER THAN AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS*LIABILITY C WC5886162 11/01/98 11/01/99 E.L.EACH ACCIDENT $ 100000 E.L.DISEASE-EAF_MPLOYE $ 100000 E.L.DISEASE-POLICY LIMIT $ j00000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Insulation and gutter installation. CERTIFICATE HOLDER N ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION R.P.G. CONSTRUCTION, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN a P.O. BOX 2'11 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Sagamore Beach, Ma. 02562 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED SEWATIVE , �V ACORD 25-S(7/97) ACORD CORPORATION 1991 L i1lwK ._ Gl.nw.(al [HA2 Cf_OV.{TIQN.� t', C I � •' i, � .. _- "API - �WDMIWML77 Pan io 1-77 LJ ' sG:•:�: - J��• / I III Y uewttr•:r�•#_`"�' ,72`�•� -� cs�clerw.cr' �/ �.: .. •. �.� I -4a 1 r, V. u 1� we�C � - 1. —_ _�_... coca "3'�•'� , I r. 1 J' • „"^"fry_ t I r ` C... !. ' l4�I.wtnw). MMt ♦ aCD.we to.ttK vte a ttr Doty:M/AM•r H ttri<II�• a St-. I S 6CD000M I I 0' 1 \ _ - -------- -- '_.' — _ MDeooM i � � L ♦� 1 , — il I I v , .+�� IDC1 ao.-rouwo SECOND FLOOR RAN (.. I 1• Im- 47 r I Ni i iI I � i•I i.o �•e r.o'. z.o .N S 1 �40=M�AKjAb.. ��9�cc aoa avi - vr'�Lo'. io Ls hOI Ornit:_wriae.a.��Cr i .waZ11a-eowc,-�.cw• ci Custom J u esigns O WMi rff9 All q t � �971•.�}�YP2ft- �..t.•. 7 ' - .•- .'- 10:0- '.a:'� f':IZJ-{ T:Y 10'OROV t'..]' w m 3 A' nroA„nur I.—•tea —1r Aoy o - ur p,un,o,I. C I areAwec Pea2GG SOwC ra spS lNa.lorworm '�C-1�RPQOOFi NCI I O • -- — FAMILY 2gOn I---j- I c.Tw.uq.: � SECTION A-A I co 1 LIVINC tOOM O I cATr:CVS - t 1)1 NINLIROOM I' i.:22 ..� •� ._..MASTER SUITE .. _ _ �.. _ �_ _ _ _ oi /.- 4 acAu`^I}0 .a arRwbolNK fGARAGEn'swceTQ<'T K.CQN(.O S. oIi•.STVOS wIt-I308.426.6191 KITCHEN •ro.t�sra-- I cowetrc�� I oevlin O G @/a O 1.)aTWPIN I .y UStOM —�-- :• ` n j- J, v.-ewQ�rtxlL signs `•_. i A 1 � �.V 2•♦GTVea wle-I)IN)V. ctgy.tnl a'.998 Ta • 1 _ eawnl. 1r< BREAKFAST 0 i.lo a0 aTa � I • n: R-It IN6Ul. �J,.�., Ta'RPROOFINS - aiy;�-'-• aJ -a0' a0 TO' •.O 4D p! I to t-0 )O' )•_' M I fir., .. Ir:o• I t:O'• I lo:e- I (f:o- 16 .. '----------------- FIQST R.qf ;.PLA►1. - SECTION B-16 _ C v ~{• HNun•nary WI and 1.1P 1 Ry OC O.a•10.I of I my Any P ....Fi 5• 0 aN 1 _ 1I j uw4. 07 xCAOMOGC ._„vm=ca ICI fi0.5i FLOOR F nw4 I ',FCQI.ln Et ME Guw{uT_ - - - . iVO iAS7[IIjIt -- y •. t f Imo(, 1 .. II I - - a_�_ � � •. � I� 01, a:c1.oT BSI/! SO$J�1•Hfl .ri _ ...... @Wfonl Af Ignf '. � ': / •. � — �[�LaMb�._...: — coayr�gnr C t9Se i - -- w HII ---- Z _..1_.. -__ 1• p L—% _11� 1 I.el•.rn�ry r•You..Oy OC O.�re ror rnnr to finer my Any o , ........ ... o•r• L • �I UAMPEIL UNIT 2+4 TOP QAIL C. 3.5•ts/e"sn, a TtL CC, ;..( s 1 l"YT FIRE pR1CK t +I 6TC21LL NSHIELD I'SEALER: O FIRE 60'. .NI 3/2.IO CII2DER FINrSH CZADH I'4 _ — is FELT _ J `64LUSTE2` 3. ASH DUMP •`;�/: "C 4' SEAT(PHN.1 I ! ul - a ear. 2AIL.. C ONT. FLASH-CI I s 4 FIR DECX'C,I 1 SEWER LINE - B o LAC,. BOLTS Itp O.C• F-7 .j p,r 701ST5 G 1 WALL SLLEVE GROUT ~r kA�ISERS . I 1 _ R"THK FOUND WALL I FOUNDATION WALL SECTION 4•4 POST N FIRE PLACE DETAIL NATERPROOFINCI ASHPIT ` 'k-PRE MOLDEC E.P. 701t,4T • 1 I_—. h C01.1C.SLAB DE ----- - DECK PLAN;rri •, o; FILL I•PTc,.Pr-OS.CI♦TMK•)ALL Ici E'I q428-6191 StDrc F.P. FOVmu 508.R.C. CLAPBOARDS OWo ev ... .. . .... ! i f rvvE::02 EQUAL . i ! @ustbm I 'ILP_Y��OOD o esigns i All R.O tit® 1997 � F-- All(tights Ir Reserved SNIn1CtLE STAZTSIL as � C�A44P i' Ni LEAD GL AS H'CT(PAINT) b(451 CUT) • ..:O ^ n n 4 S i , CUT; ' 1P _( "! 1,l PT SILL N1SEALCR r OTC 4. �I I WATERTABLE � FIREPLACE DETAIL U; Preliminary plans and layouts by DC are'Or Ine use of I me,r customers only Any other use �s strictly pfontbfte r s I y06. ..WtNftLlti �. I 1w•'�R �� '�L.�wINS►ea—.. aw.a•,wrw..y,aM.ai .. .- •--• ' [GAR Gt.QVA?IQN � - - -1'R_c'r_-_p�'tS/Att�.►_. ^_... ` ____ • � - ' �. -. .ice' .. - EHII.• r e;;Y, .11�1►'W� nJiA1<t'C, .f_+.� _ •,, I IL LL rRow h�ltilwwt. MMs� t e� OCO.wo IM IM vn a 1 r.tt omr.M waM•tI M.t.rtuC rt . "DaooM - aeDeoon i a Al .,DC!P.WOd.. PTMRI s � l: • y 1 $ ! I L. � s.e �44 secoNo Ft ooa PLAN 1 _. 1 sue- r 1 .I I 1 i i a q I �t�.x��coiac. roR t•h• ' �I :�� �I Ocwt:•Rue.a.�'r�. - ..... vr�l.o1 io st M, —f •� soaras•eivt i ' ^ u eviln @ustom Cesigns -CMIN�CT A..l ML - a+�ar• is ..`. ._ - 1 - AZ 3 I•e,rnnn.q Oun.m1 i.•o.,n eY-pG o.•ro.,n•,•.•el ina(•u .,t wq o ..u,� prow o•.• • � /� •O QAFTE: P[OPY[ V[VT 7 2,11 y 1•- 1•f f.TGAPPINC• - _ - 'h-YrCRCOCK A L a o r • __«-._._ ._•.-.__..___..._....._._.. _•.______ t'o` • o aAa-rQ Pa•r`.foon. r r —--• — —. L•r0 N WS: i -. � - J r ' �'• VATG[R[OORIIaS r FAMILY 2QOM SECTION A-A - 1 LIVINCtOOM CA—"S. �ININLIR[bH - ' • i z.10 tAltftl - ._.... L.e cLC.laTS. _ O tw eeu+K rraf- r • N[ST(SR E SUIT _ _ _ _ _ _ _ 1 .—.._.._—_— '�, ra-0.rWOD0 ...._ L.a eaAcwS •�•• N GARAGE• V - t•TMK.C-C SLAyK-1 N - -- v.a•.o q.A .r. ^I � 1 " . - � -- L_tn o! cr �� - L..s)VDS wr[•rawwL:-� °j v:��l.o• rolLsl! �• La r� t SOS-428.6191 KITLHlN z•o�Ifx- la yI-'40.1.Ofr[RIrIXZ� eviin acL� -�j _. O _ I.p,Tw.w`` � YStO1T1 a u 0519175 1• ._�'1[' .2 __ •' _•i•w a_L., a.o N 'q-�.r-� 1•a' o i.a cTuof wlQ•13 rHa.�L '� - ,oq•.enr.'�nfa w r - &geAKFAST �/a'ra.c xYWawD 0 z.lo saax ol ✓,�•• AJ \C' aO 10' ♦.O 4 D' 70 f-0 ! 10' i•p' w'.L. t r t[ N ?ny Q • IM1 0• 1!:D•' 1 10,:0• 1 It:O- .. `, 1 FItST FIOOR� .SECTION B-Bul ' . ' _ A3 U ��� «I w•^r•na i•rw.•f ey oeo••ler r '.1 r Any o ittrr pr or.r are I Lr 14 M IT— tr A i y M� I ._ —.... �•.. y p 1 L—=o y pp III; _ •I 000 Z.TCG�Q7[L I 1 1 .. Dti JfTL DY01=la_I'.�1TQStR � � �' Y t- _ --- I i LY.XT.Mn�clll+S:. �Cr•,Y•ttYl •SlsdrevnC�•.�t.-� II j I 1 PUT FLOOR FQ^Awlu I FFii13tL �: ' ,.La ffifsr� I� of Krli- A —_� :tw�urieY:uiuu_:. .I� '=� SOi-�l�•Mtt . I� i •etrltn'Uitom j Of�f�Ilf cognynr C nis �_��. 1SiIDOa�n1 .. nu fpnn "SELTtIIN-L:L_ F�- IIP I — 5 jl ,-` _ O •ry •n0 r•your+oy OC D•r rr.t+r+ r my wny o r r� y prom o•r• f ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION Applicant Name: Site Address: # c2-t..y� Applicant Address: 10 . N k City/Town: w _ Use Group: t'Zz>M*-cM P.- (IF QQ e Date of Application: t Applicant Phone:.50'. $9h? SIV16 QWL4, Applicant Signature: Compliance Path (check one): prescriptive Package (Limited to 1-or 2-family wood frame buildings heated with fossil fuels only) Package (A through KK): _ _ Heating Degree Days Base 65 (HDD65)from Table J5.2.1a: 4a 1�3`7 (For items d. through i., fill in all values that apply from Table J5.2.1 b:) a. Gross Wall Area 2�4"9 2 sq.ft f. Wall R-value R- 1 3 b. Glazing R.O. Area 2.18.8 q.ft. g. Floor R-value R- 1 c. Glazing% (100 x b_a) 11.9 % h. Basement wall R- 10 d. Glazing U-value U- . 40 i. Slab Perimeter R- Co e. Ceiling R-value R- 38 j. Heating AFUE 0 Component Performance: "Manual Trade-Off' (Limited to wood or metal framed buildings only) Climate Zone (from Figure J6.2.2) Zone 12 0 Zone 13 0 Zone 14 Attach Trade-Off Worksheet from Appendix J, [and HVAC Trade-Off Worksheet, if applicable] ❑ MAScheck.Software Attach Compliance Report and Inspection Checklist printouts. Systems Analysis OR Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis Official's Name: Official's Signature: Application Approved Date of Approval: Application Denied ❑ Date of Denial: Reason(s) for Denial: (provide more details, if needed, on opposite side) ssRs 01r.2198 I OEPHTMNT OF PUBLIC SWT.1. INC:T MMISH LICENSE T oires: Birthdate: t � � 1/Z000 G1121/19d3 D~s License . I - _ as wiouc am Q Rsna JAMM. i0m J A 45 JM NOWLAM PL SEECOM MA 02"1 pq . -., QO O 00� Rim=72.0' S nv=66.6' Lot 27 57 s 0 Elec TEL / ,.ot 26 Lot 2 l c O Lot 3 14,845±SF p s co Mca dam- \�� EO e\ 31. ,. \ oQowe \ 2.5' i Rim=70.8� Rim=71.3 ov�a��io� Inv=66.1' / of F S. \\ \�, / 10P . 0o 00 Invert 67.6 00 / \ Proposed 6 Dwelling / N - 4 Cb F I / Q c� \ \ / 39.5' / 22.5'\ Pv o fs o / ry/ a I y CIV General Notes a r� tkhp Assessor's Map 273 Parcel 86RICHAR -1 Lot 4 / p Zoning Classification: RC-1, Setbacks: 30 / 15 / 15 Legend. , � � , D ,..EU � Lot 3 as shown on Subdivision No. 701 Bayberry Place; Plan Book 459 Pg 83 Q Sewer Manhole s ® Catch Basin 70 Lot 3 Area: 13,226 SF+ -& Hydrant s he Site is located within an ground water protection district. O CB/DH O��X � 6. 0 No wetlands or water bodies within 100' of lot perimeter. Sign �� DO Lot 11 Light Post The Site is not located within a historic district, FEMA flood zone or an ACEC. � . _ _... — � —' �"R�� ® Water Gate (round) -�N of M The proposed dwelling to be connected to Town sewer and © Gas Gate (round) y ��' PETEa� A SEWER CONNECTION PERMIT is required. Sewer pipe to be 4" diameter Gas Gate SULLIVAI� O Water Gate Lot 10 No.29T33 STR 35 or.approved equal. Maximum pipe bend to be 45' with minimum 3 foot cover CIVIL and a 4 x 6 reducer at the existing stub. Minimum slope of pipe to be 2%. All questions regarding sewer connection direct to David Anderson, Town of y - Barnstable @ 862-4080. Title: PREPARED BY PREPARED FOR: Note$ 1)The topographic information shown Proposed Site Plan Mark Lebeaux hereon was obtained by conventional � P Sullivan Engineering, Inc. ��peSury survey methods. PO Box 659 PO Box 718 °/ M & R Real Trust 2)The property information shown hereon Lot 3 Statice & Myrica Lane 0ster0le, MA 02655 Hyannis MA 02601-0718 ° was complied from available record • (508)428-3344 (508)428-3115 fox (508)790-7902 (508)790-7905 lax Fore$tdale MA �264 information and does not represent an Hyannis MASS Psti�►PE� a^, �a,.� °o'^O^° ^°t -- actual on the ground survey. � 3)The datum used is approximate mean 20 0 10 20 40 so Field: Q 12 R 4 IZM Daft: R LH P5 sea level. Dote: Scale: as noted camp.: t2. L' Wr Review: 'ti='�• December 9 ,1998 Pro] # 1 9 Drawing #