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Town of Barnstable Final Inspection Affidavit
Date:
., ,
Thomas Perry, CBO Ln
Building Division
200 Main Street
Hyannis, MA 02601
RE: Insulation Permits
Dear Mr. Perry,
This of iid vit is to certify that all work completed at:
Street:- ( a W O__
Village:
has been ins ected by a certified"Building Performance Institute (BPI) Inspector. All work
performed meets or exceeds federal and state requirements.
Permit applicati n mber:20 C.rO®�
Issue date: S
Sincerely,
Francis Sheehan
President
Frontier Energy Solutions, Inc.
502 Harwich Road
Brewster, MA 02631
Office: 774-237-0410
Email: fssfrontierenergy@gmail.com
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
CA
Map Parcel U 3X'pplication #
Health Division Date Issued —�'—�S7 0
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address -Tey ak
Village ki.iA y�y i 5
Owner i «- r it.n Address CU,-4,('ry S+(%eZA-
Telephone ' 7 S 3 3 ✓- NA 0 �
PP t
Permit Request �C^ �d
�"D ��� �(-2 �� C�:-h�� �(.v'��' �_c�z �c?�ilcJ��� 'IfS �,`12 ��-�•� C.`E''f1�C ct't.Cl��
-i3 ab^5z
Square feet:.1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay 3
:>
Project Valuation (0U Construction Type «"=
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach u"pporting- ocurr�ntation.
Dwelling Type: Single Family U/ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes LirNo On Old King's Highway❑Y ❑ No
Basement Type: ®'Full 0 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 2(No If yes, site plan review#
Current Use s iAe^l�a Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name �f-OA- &r �P - � S�1�;�-►'e �; Telephone Number -7 3Lf " `'d 0
Address S z 40-tr � �L Ad, License #
peer'i+qr c M./`1 o Home Improvement Contractor# L
Worker's Compensation #VVV 6
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILLBE TAKEN TO
1 l &sA^ A lit As- d( Uo1 t�`r �I���i L y mil" A 0 Z Lt S
SIGNATURE DATE 2l S
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
5
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MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
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k:
i
i DATE OF INSPECTION:
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4xFOUNDATION _ + �z= _ �__v <mz
_ FRAME
INSULATION. —;
. FIREPLACE
ELECTRICAL: ROUGH FINAL
Y,
1 PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDINGS —
C DATE CLOSED OUT
s: ASSOCIATION PLAN NO. : �`
The Commonwealth of Mmachaseft
Department of Industrial Industriial Aeddents
O, rce o f invesPigations
-
x 00 Wasltiraglraaaa t eet
Boon,M 01111
xintas&gov/diaa
Wormers'Compensation Insurance AM&val 'Bh iderslCvntracta#m/Ele ciia€s/Plu ers
.�PIease
Name Msmess orpnizativn/iuclkvi4tualj:
aaz t
Ci!X1StahJ-Zp-.[jrz W t Ph�ne >
Are you an empMyer?Check_the apprspriate:box.-. Type of project(reqalrWj.
L I ant a employerFrith 4 0 I am a general contractor arid..I 6. 0 1kTew oot ztictiot3
employees(falt.antilor part ttnte).� have-6ireci.tlZe s ntractoas
2_O'l am.a sole proprietor or p tot= diaced oii the attached sheet 7 Re nQdetit�g
ship and have eta employees T 4sese was have.. ._ . $ .:�Dertiolition
working for me a any capacity. employees and have workers' 9. 0 Building addition
(No workers'comp.insurancecomp...€nstvance
I 5. �:We are a corporation aadi lQ,�pleetricat Fepairsor aaiditiotis
requireoffices have exeretsed dtezr
Plumbinght
3. I san a hotrteovaer datag.all work11.
. mhir :repairs or additions
, . nht of em
0mysetf [ lo� okcomp- gexpoltper.. Roorepairs...
insurance regwresi.}# C 152,§1(4),andtNS llas�@€lo t
3a.0 I amp a homeowner acting as a sznpttiyees;.[No worlserss l3 [tt2ier r cl
ggnc al corttzctor-(refer to 4) comp-Insurance!eq' -
*,Any aW icant that checks bos.#l_wast dw fill out the section below.-showing their wotkc&co eY aeon:
t Hatnownets who wbnstt the au wit indicaing toy are doing Z sa o&and d=hire outside connectors oust subaant aaiew affidavit indicating such. .
tconvacun thst chacic t§rs box iausi atiached au.additiml sheet showing the nsmo of the s and mat®whCam.or not those cations have i
enqiQys Irhebufetssha-� .they
i Y unist
F+o4icm:their-dr*exe.camp
:go#Irrynun�s�
4..
1.�us: er tl�rf�s mvrtCers'ev anon.insrerarnce rat. can Below is the � h sle ,
iarfornt�iun. �-
Immnce Compamyidaaate: . - �I t� 3 l` _(mac n.. .
Policy#or Self-ins:Lic.#:,V 9 1�7 1 57�� �� i� E�zrrttton Date: . _ ;3
ff
Job Site Address 1 : V ti9 City/ tatela�ap. �1 ✓�:h.; 1 CAL�?LS
.77
Attach a cow of&vverkenleorapeasatiottpouicy dec3 ratuin psge(shoeving thepolley.numher said ezplrstlon elate .
Failure to Secure ccverage as required under Section 25A of vfCL c.152 can lead to tho.imposition of criminal penalties of a
foie up-to g 1,500.00 an&or one-year imprisoz3=4 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:tie:forwarded to the€3f iice:cif
Investigations of the DIA for insttaauce coverage verification.
d doe hereby cer*Lander, a urfdFenakks vl�perjur a ithm.the inforn adw provided above h arnl
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afflciai we only.. Ito not wi*e in ft area,to be ro mptett'd by city or.town ofc aid
Ck or Town: P'ermitlL,icense# . .
Issuing Authority(eirde one}:
1.I e&M of Health-2.Building Department 3.Cityfl`owa Clerk. +4.Electrical Inspector 5.Plumbing Inspector
5.Either
Contact Persom Phone#r
3/18/2014 1 : 10 : 10 PM " 8740 z:a 03/06
u CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIWTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVISLY OR NEGATIVELY AMEND,EXTEND,OR ALTER THE COVERA43E AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTTtITE A CONTRACT BETWEEN THE ISSUING IMSURER[S}.AUTHORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER.
IMPORTANT:tithe certificate holder Is an ADDITIONAL INSIIR€D,the pefty(ies)must be endarsed. #SUBROGAMN IS WANW,suhqed to
the terms and condiliuns ofthe policy.certain policies may require an endorsement. A statement on this certiftate does not confer.rijhts to the
catficale holder in fieu of such endomernerrt{sj�
PRODUCER 00509_001 - ��CI_ JaMey Ford -
��po��rs&trap Insurance Agencyrc _ fsa4}6saaet , r�. [Baft}39s tt24s
43 Route ia4 ,
Sou%Dennis.MA OM
ROURIMMAfFORMCOVERAGE
A.i M Mutual Insurance Car"" 33758
INSURED -
Fnm ter Energy Solutions Inc z
602"Harwich Road
$reY r.MA 02031
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CGVE#AGES CERTIFfCATE NUIMER: REVISION UUMWR-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE:INSURED XWED ABOVE FOR THE POLICY PERIOD.
INDICATED. NOTMTHSTANDING ANY ReQUIREMENT,TERM OR CONINTION OF ANY CONTRACT OR OTHER DOCLUEPLT WTH RESPECT TO WHICH THIS
O CERTIFICATE MAY BE ISSUED R MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SMECT TO ALL THE TERMS,
EXCLLISIONS AND COMONS OF SUCH POLICIES_LPXM SHOWN KAY HAVE BEEN F=UC£D BY PAID CLAIMS.
IN j TYPE OF IPNSWM4CE POUECY KUMBm 'S POL I:QIiTS
c$7ERFL..uABILtrY EACHCCCURF&MCEDAMAGE TO REW-5[)
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0OWffl3:C1ALG8CERA%LIARILrrY - S ocan cet S
GLkjmsA9Ax a OCCAiR' M®D(P(Aw oryo Pemn) S
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PERSONALSAUV WARY S
- + GE193M AGGREGATE 8 .
M AGGREGATE LM 1TAa Lib1 p F'ROOUCF&-CWILPCFAGG .$
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AUTOMOBILE LIABILITY 8
t ANYAUTO . BODILYI my(PetPuma) S
I AUTOS OV SCHHII IID —_
LILYII+ RY(Par JUactt� S
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AUTOS
LURH3AU1ZS3- AUTOS 'Peracci
UTASRELLA LIAB OCCUR EACH 3CCUMUNCE $
MWEWL" HCLAAW U40E AGGREGATE $
DED . t
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A v>rl .I N L A 1MIC-180 50 I'a3i3-Z898A 311412914 3114*015 a�cir n $ i,000;000 8l?
ttVmdetoryinti14 wm [.L GWAM-CAM4PLOY - $ 1,040,000.00.
. DESGftkFfSOH F`CP1rRAfiONSbe�avI iE.LOfSEA.W-P0VCYUNT $ ,oaoa9aao
L7FSCRFPfiDH t�6PF3iAFfONS f tDGL1L0LiStYE1{{KXZs��chAEO8Ui0t./[d Res�arl�8ct�&e.$tttotespace is re�ni�ea}
CERTIFICATE HOLDER CANCELLATION
Town ofSandwittt
130 main Stmeet SHOULD ANYOF INE ABOVE DESCRiBBD POLICIES BE CANCELLED BEFORE
Sandwich,MA0260 THE E(PIRATIM DATE InflDEOF, NOTICE VVILL BE DELIVERED IN
ACCORDANCE VM THE POLICY PROVISIONS..
AUTMI rZUI REPR=MATNE
01988 2010 ACORD CORPORATION.Allylghts reserve&
ACORD 25(2010I05) The ACORD name and logo are mglstered Inafs of ACORD
3201
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a Ile rntuicurrrealfJr ciff_ �ns;tt rrte/� ttOfl YBCtd COI imdividul un Only
Qffeee of C=mer Affairs&Ru4nfrssReg bx,a I,iee se or
1 deE 1MPROVEAEAFF GOMRAOR bebrethe eapiratit9g dare,Ii<#Dead xe rg to:
OW 16D854 Typ--
i?ftiee'af Coosa er Affsss asii Bnsisess R .
"rabon: :-9181 U76•.;,. 11G-._. -. l0'PhiPlaza-Suite5i76t
-.: Reston,1WA.42116
FRONTIER ENMIGY S&LmdN$
FRANCIS SHEEHAN
5M HARWICH RD
i BREUft57'€t3, LLCi i
Ujiduse� with signature
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Restided To:CM-IC-lnn&thm Com#aefar
Massa.^itt�sefts-Gepa s4 _A of Pz�i�3��� _
e Board of SiA'iding Begin. ions and Standards
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fWlureto pasha wffet!xte&Sm oftheMassmimsetts
se ?. State Bt1 dit.Code is came formwocaUm Ofthls tl
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R 1, S. E
ENGINEERING
5 Dupont Avenue
Yarmouth, MA 02664
OWNER AUTHORIZATION FORM
r
.(Owner's Name)
owner of the property located at
I T v
(Property'Address)
(Property Address)
hereby authorize 1 E` EnE��-A
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on My behalf to obtain a building
permit and to perform work on my property.This.form is only valid with a signed contract.
J
Own gnature
1 17 �5
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