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Home My WebLink About0069 WASHINGTON AVENUE 6 �', I, I i --�. �� 7..6�s �� i I I 1 0 I i RIGHT-J SHORT FORM BUILDING, 0 � Enure House CLIMATROL HVAC DESIGNS DEC 05 2018 Job:CL52FnZ 11-7-2018 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:508-364-5198 Fax il)!V fOv0 3,FEmmail:,MILLERHVACDESIGNS@GMAIL.COM r For: TED FITZGERALD 69 WASHINGTON AVE, HYANNISPORT, MA l Htg Clg Infiltration Outside db(°F) 10 88 Method Simplified Inside db('F) 70 75 Construction quality Average Design TD (°F) 60 13 Fireplaces 0 Daily range - M Inside humidity (%) - 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make Make Trade Trade Efficiency 80.OAFUE Efficiency 0.0 EER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temperature rise 0 'F Total cooling 0 Btuh Actual heating fan 2377 cfm Actual cooling fan 2377 cfm Heating air flow factor 0.023 cfm/Btuh Cooling air flow factor 0.037 cfm/Btuh Space thermostat Load sensible heat ratio 86 % ROOM NAME Area Htg load CIg load Htg AVF Cig AVF (ft.) (Btuh) (Btuh) (cfm) (cfm) ZONE 1 n p 437 20971 12771 490 470 ZONE 2 n p 1326 37886 26343 886 969 ZONE 3 n p 363 12886 8538 301 314 ZONE 4 n p 733 17466 15203 408 559 ZONE 5 n p 404 ' 12449 10207 291 376 Entire House d 3263 101658 64593 2377 2377 Ventilation air 3300 715 Equip. @ 0.93 RSM 60736 Latent cooling -10548 TOTALS 3263 104958 71284 2377 2377 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. wrightsc ft Right-Suite ResidentialTM 5.0.14 RSR20780 2018-Nov-07 10:21:57 C:1My DocumentslWrightsoft HVACICL HEAT CALCS.rsr Page 1 RIGHT-J SHORT FORM j ZONE 1 CLIMATROL HVAC DESIGNS Job:CL52FITZ 11-7-2018 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:508-364-5198 Fax 941-575-0013 Email:MILLERHVACDESIGNS@GMAIL.COM For: TED FITZGERALD 69 WASHINGTON AVE, HYANNISPORT, MA Htg Clg Infiltration Outside db(°F) 10 88 Method Simplified Inside db(°F) 70 75 Construction quality Average Design TD ('F) 60 13 Fireplaces 0 Daily range - M Inside humidity(%) - 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a n/a n/a n/a Efficiency n/a Efficiency 1 n/a Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temperature rise 0 OF Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat n/a Load sensible heat ratio 0 % ROOM NAME Area Htg load Gig load HtgAVF CIgAVF (ftz) (Btuh) (Btuh) (cfm) (cfm) LIVING 437 20971 12771 490 470 ZONE 1 n p 437 20971 12771 490 470 Ventilation air - 0 0 Equip. @ 0.93 RSM 11877 Latent cooling 1589 TOTALS 437 20971 13466 490 470 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. 0' WnghtSC)ft Right-Suite ResidentialT°°5.0.14 RSR20780 2018-Nov-07 10:21:57 CAMy Documents\Wrightsoft HVACICL HEAT CALCS.rsr Page 2 f RIGHT-J SHORT FORM ZONE 2 CLIMATROL HVAC DESIGNS - Job:CL52FITZ 11-7-2018 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:508-364-5198 Fax 941-575-0013 Email:MILLERHVACDESIGNS@GMAIL.COM For: TED FITZGERALD 69 WASHINGTON AVE, HYANNISPORT, MA Wr.. Htg Clg Infiltration Outside db(°F) 10 88 Method Simplified Inside db('F) 70 75 Construction quality Average Design TD (°F) 60 13 Fireplaces 0 Daily range - M Inside humidity(%) - . 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade Na n/a n/a n/a Efficiency n/a Efficiency n/a Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temperature rise 0 OF Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat n/a Load sensible heat ratio 0 % ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) - (Btuh) (cfm) (cfm) DINING 182 5932 4154 139 153 ADULT DEN 210 6178 4405 144 162 KITCHEN 294 5833 4043 136 149 POWDER 49 1409 360 33 13 FOYER 64 2456 710 57 26 BREAKFAST 165 4454 2863 104 105 KIDS DEN 285 7748 5401 181 199 LAUNDRY 77 3876 4409 91 162 ZONE 2 n p 1326 37886 26343 886 969 Ventilation air 0 0 Equip. @ 0.93 RSM 24499 Latent cooling 3488 TOTALS 1326 37886 27987 886 969 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. wrightsoft Right-Suite ResidentialTM 5.0.14 RSR20780 2018-Nov-07 10:21:57 CAA C:1My DocumentslWrightsoft HVAC\CL HEAT CALCS.rsr Page 3 RIGHT-J SHORT FORM ZONE 3 CLIMATROL HVAC DESIGNS Job:CL52M 11-7-2018 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:505-364-5198 Fax 941-575-0013 Email:MILLERHVACDESIGNS@GMAIL.COM etIfforrylatloh For: TED FITZGERALD 69 WASHINGTON AVE, HYANNISPORT, MA Htg Clg Infiltration Outside db('F) 10 88 Method Simplified Inside db(OF) 70 75 Construction quality Average Design TD (OF) 60 13 Fireplaces 0 Daily range M Inside humidity (%) - 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a n/a n/a n/a Efficiency n/a Efficiency n/a Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temperature rise 0 OF Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat n/a Load sensible heat ratio 0 % ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) MASTER BED 255 9860 7793 231 287 MASTER BATH 72 1645 375 38 14 MASTER WIC 36 1381 370 32' 14 ZONE 3 n p 363 12886 8538 301 314 Ventilation air 0 0 Equip. @ 0.93 RSM 7940 Latent cooling 1007 TOTALS 363 12886 8947 301 314 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. wreghtsoft Right-Suite Residential-5.0.14 RSR20780 2018-Nov-07 10:21:57 C:1My Documents\Whghtsoft HVACICL HEAT CALCS.rsr Page 4 RIGHT-J SHORT FORM ZONE 4 CLIMATROL HVAC DESIGNS Job:CL52FRZ 11-7-2018 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:508-364-5198 Fax 941-575-0013 Email:MILLERHVACDESIGNS@GMAIL.COM • - • • For: TED FITZGERALD 69 WASHINGTON AVE, HYANNISPORT, MA Htg Clg Infiltration Outside db(°F) 10 88 Method Simplified Inside db(°F) 70 75 Construction quality Average Design TD (°F) 60 13 Fireplaces 0 Daily range - M Inside humidity(%) - 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a n/a n/a n/a Efficiency n/a Efficiency n/a Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temperature rise 0 °F Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat n/a Load sensible heat ratio 0 % d ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) BED 8 168 4849 5286 113 195 BED 9 140 3053 2478 71 91 BATH 1 56 1248 276 29 10 BED 11 192 4231 3845 99 142 BATH 2 45 1267 451 30 17 OFFICE 132 2818 2866 66 105 ZONE 4 n p 733 17466 15203 408 559 Ventilation air 0 0 Equip. @ 0.93 RSM 14138 Latent cooling 2147 TOTALS 733 17466 16286 408 559 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. wrighitsoft Right-Suite Residential-5.0.14 RSR20780 2018-Nw-07 10:21:57 C:\My Documents\Wrightsoft HVAC\CL HEAT CALCS.rsr Page 5 RIGHT-J SHORT FORM ZONE 5 CLIMATROL HVAC DESIGNS Job:CL52FFTZ 11-7-2018 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:508-364-5198 Fax 941-575-0013 Email:MILLERHVACDESIGNS@GMAIL.COM Projed t Informati6n, For: TED FITZGERALD ' 69 WASHINGTON AVE, HYANNISPORT MA Htg Cig Infiltration Outside db(°F) 10 88 Method Simplified Inside db(°F) 70 75 Construction quality Average Design TD (`F) 60 13 Fireplaces 0 Daily range - M Inside humidity (%) - 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a n/a n/a , n/a Efficiency n/a Efficiency n/a Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh . Latent cooling 0 Btuh Heating temperature rise 0 OF Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat n/a Load sensible heat ratio 0 % ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) BED 13 135 3994 4207 93 155 BED 12 150 4764 .4195 111 154 HALL 213 63 1795 452 42 17 BATH 3 56 1896 1352 44 50 ZONE 5 n p 404 12449 10207 291 376 Ventilation air 0 0 Equip. @ 0.93 RSM 9492 Latent cooling 1378 TOTALS 404 -1 12449 10870 291 376 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. Wf ightSC) t Right-Suite Residential-5.0.14 RSR20780 2018-Nov-0710:21:57 CAMy Documents\Wrightsoft HVAC\CL HEAT CALCS.rsr Page 6 l sue, , 3 �_ Application number..................:.�................�.. Fee ...........: 5 L-0.0............... ................. NAM = SEP 2 5 2,0119 Building Inspectors Initials...t..a-B................ ! n� FOWN 0� bAHNS 1ABLF Date Issued: A ......................... Map/Parcel......... ....:................................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: W �` ��i�� NUMB R STREET VILLAGE Owner's Name: Phone Number Email Address: ✓G � R`�-�� o w, Cell Phone Number Project cost$ `�; a, Check one Residential Commercial OWNER'S AUTHORIZATION r As owner of the above property I hereby authorize Sr EL16 M to make application fo ermit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Siding ❑ Windows(no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than I layer of shingles)Construction Debris will be going to 's l k - N 6[ W G 5 CONTRACTOR'S INFORMATION Contractor's name �� Home Improvement Contractors Registration(if applicable)# (� (attach copy) Construction Supervisor's License# ! �S —y / (attach copy) Email of Contractor , , me dv, 4� �Ii4�; LoWhone number S®g ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. 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. Purpose of Event 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 Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required. Natural Gas Yes No ,if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3.30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET-`STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature 9Date J All permit applications are subject to a building official's approval prior to issuance. 3 The Commonwealth of Massachusetts 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/Organization/Individual): p��)� Address: t)u J. City/State/Zip: NIn .m C4 D). 3 Phone#: D -7? 6 . -� i Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a er with employer 4. ❑ I am a general contractor and I P y —� 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.ElI am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑Building addition [No workers' comp.insurance comp. insurances 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 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no ` employees. [No workers' 13.ErOther R �' :--comp. insurance required) - *Any applicant that checks box N1 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. $Contractors 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. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. J Insurance Company Name:A LM m Policy#or Self-ins.Lic. WC" L4 b 0 7 D 3 X)Q Expiration Date: 0 Job Site Address: l5 1 VV ajrlca.0 1 A7-,-, � � City/State/Zip: h. Vnc, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided a ove is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# F Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any 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 Massachusetts Department of Industrial Accident Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TWE;Individual Reg�stiation..._. Expiration P- T7&10= 11/02/2020 STEVEN L MELLOt2 STEVEN L.MELLB.Re,......... -• 74 FROST LN r HYANNIS,MA 02601 Undersecretary Commonwealth of Massachusetts j IMF Division of Professional Licensure fl Board of Building Regulations and Standards Constrq, titer{I dpervisor CS-049879 ires: 05/22/2020 STEVEN L.M&LOR P.O.BOX 627 i CENTERVILLE Nth► "0263 �,• �` 10 Commissioner `ACOR® CERTIFICATE OF LIABILITY IN DATE(MMIDD"YYY) INSURANCE - 09/24/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 10 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 IETWEEN 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 bA endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A sta ement on this certificate does not confer rights to the certificate holder in lieu of such endomemen s. PRODUCER NAM E• Mark SN via MARK SYLVIA INSURANCE AGENCY LLC PHONE 508 !157-2125 f No): E-MAIL REL ; 'enniferd marksylviainsurance.com 404 MAIN ST INS RE S AFFORDING COVERAGE NAICB CENTERVILLE MA 02632 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: STEVEN L MELLOR INsuRERc: MELLOR BUILDING&REMODELING INSURERD: P O BOX 627 , INSURER E: CENTERVILLE MA 02632 INSURERF: COVERAGES CERTIFICATE NUMBER: 452572 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 AID CLAIMS. ADDL R POLICY EFF POLICY EXP TR TYPE OF INSURANCE POLICY NUMBER M LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE DOCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY a JECT 7 LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea aoadent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per aoddent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION Y/N PER OTH AND EMPLOYERS'LIABILITY X STATUTE ER ANYPROPRIETORIPARTNER/EXEC E.L.EACH ACCIDENT S 1,000,000 UTIVE A OFFICEWMEMSEREXCLUDED7 NIA NIA NIA AWC40070355822019A 06/17/2019 �6/17/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 Use describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A )ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD.101,Additional Remarks Schedule;may be attached H more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 S.no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this.certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing',the Proof of Coverage-Coverage Verification Search too(at www.mass.gov/(wd/workers-compensafionrinvestigationst. Sole proprietor has not elected coverage. 'ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable Building Department ACCORDANCE W17 H THE POLICY PROVISIONS. 200 Main.Street AUTHORIZED PFPRESEN TATIVE Hyannis MA 02601 "' Daniel M.Cy,CPCU,Vice President—Residual Market—WCRIBMA 019 8-2014 ACORD CORPORATION. All rights reserved. CORD 25(2014101) The ACORD name and logo are registered marks of ACORD i Town of Barnstable Building Post This Card So Thatrt is;U�s�ble-From3he Street ApprovedPlans Must be RetamedsonJoband this:Card Must`beKept iPosted UntilFinal;l s coon Has::"Been:Made� r. .. a • a iWherea Certifica�teof OccupancysSRredsuch Bu�ldg�sall Not"be Occupedunttll ainal Inspect�onhabeenmacle 1 ; Permit Permit NO. B-18-3673 Applicant Name: STEVEN L. MELLOR Ap provals Date Issued: 12/03/2018 Current Use: Structure Permit Type: Building—Addition/Alteration-Residential Expiration Date: 06/03/2019 Foundation: Location: 69 WASHINGTON AVENUE,HYANNIS Map/Lot 287-085 Zoning District: RF-1 Sheathing: A Owner on Record: CELENTANO, ROSETTA M TR Contractor Name STEVEN L Mellor Framing: 1(9 z7/ '/�Address: HAYDEN FAM 2008 IRREV TRUST ' Contractor,License 117610 2 �� NEWTON, MA 02465 � 4 Est Pro ect Cost: $500,000.00 ��4 ' ' 1 Chimney: Description: Remodel Kitchen,5 Baths, Replace Windows, CvmgRoom Permit Fee: $2,600.00 ©_ �� t k Wall, Remove Upstairs Partions Per Plan Construct NewiEntry Insulation = �' _ y Fee P i& $2,600.00 Construct New Deck 13x34. z ®ate 12/3/2018 Final: Project Review Req: Watch Finished Railing Height Plumbing/Gas. � -' _ �N Rough Plumbing: PF _��F.� z - ,r Building Official Final Plumbing: .�kR .�y _ This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six month`af6issuance. All work authorized by this permit shall conform to the approved application and the"approved construction documents forwhich this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zori;rig-bys la and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public mspect�on for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building andeFre Officials arse provded on thipermit. ` Minimum of Five Call Inspections Required for All Construction Work:':� .; Service: 1.Foundation or Footing ` g Rough: 2.Sheathing Inspection e ,, r . 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 Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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). ct� Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: { V RICHIE'S INSULATION INC. 111 OLD BEDFORD ROAD WESTPORT, MA 02790 508-678-4474 BUILDING DEPARTMENT TO WHOM IT MAY CONCERN: PLEASE BE ADVISED RICHIE'S INSULATION, INC. INSULATED THE.FOLLOWING JOB: ADDRESS: 69- ASH -- z TOWN: HYANNIS �/�®��* CONTRACTOR'S NAME:STEVE MELLOR CONTRACTOR'S ADDRESS: P.O. BOX 627 CENTERVILLE TQVV�Vr ?419 CONTRACTOR'S TELEPHONE NUMBER: 508-776-4749 THE FOLLOWING INFORMATION IS WHAT WAS USED ON THIS SPECIFIC JOB: �S MANUFACTURE: ICYNENE ( PRO SEAL LE IS MATERIAL USED) THERMAL CONDUCTIVITY PER INCH:7 PER INCH AREA THICKNESS R-VALUE Roof over Master EXTERIOR WALLS 3" R-2.1 STAIRWELL 11T EXP. CEILING 5%z" R-38 FROM OUTSIDE GARAGE CEILING WALK OUT WALL 1ST EXP. CEILING 5 Yz" R-38 OVERHANG CATHEDRAL WALL CATHEDRAL CEIL PARTY WALL FOUNDATION WALL 2" R-14 BLOCK/RUNN, 3" R-21 SLOPES P/V THANK YOU VERY MUCH FOR YOUR COOPERATION IN THIS MATTER. IF YOU HAVE ANY FURTHER CONCERNS PLEASE CONTACT MY PHONE NUMBER. INSTALLER:ERIC JOH'NSON RICHIE'S INSULATION INC. MAT E R I AL SAF L I Y DATA Sl I U FT Flame Control Lqv.90-50 FOAM KQTE pap:I of4 —,-ECTION -1: IDEN] IPI'CATION OF ]'HE SUBSTANCE/PRIFPARATION AND OF THE COMPANY 7771 MANUFACTURER'S NAME/ADDRESS LAME CUN-lf'ROL COAT I N"I'S LLC Tr,/ODE NAME:No.50-50 FOAM KOTE, 4120 1 IYDE PARK TBLVD. (-(.)I OR: W HITE AND PASTEL'rINTS N I AG A R A FALLS.N.Y. 14305 MAIN 0')F: INTUMESCENT FIRE RETARDANT PAINT I MERG,E- E- r-i\IC.YTELEPI-IC)NENUMFFR: 900-535-5053 INITIAL ISISUE DATE: MAY 20,2008 REVISION DAI'E: NOVEMBER5,2008 PRFP/-;RED BY:J.W.ESSIO SECTIC)N2: ( ( FviPOSIIIC)N/INFOR AflONONINGREDIENTS HAZARIDOU.13 I NQREQl EN'l S W. % CAS Ru 173,5-TRIAZINE-2,4,6-TRIAMINE 5-10 000108-78-1 TITANIUM DIOXIDE 5-10 013463-67-7 DIETHYLENE GLYCOI..MONOETHYL ETHER ACETATE 1-5 000112-15-2 ETHY1,FNEGLYCOL 1-5, 000107-21-1 TRIS(2-CHLOROETHYL)PHOSPHATE 1-5 000115-96-8 _s:fc-71 1—(ffij j. H A 7 A R D S IDEN I II UATION PRIMARY POU I ES OF F NTRY:EYE CONTACT,,SKIN CONTACI',INHALATION,I NOESTION. HEALTH HAZARDS (A,'-'U-I'L AND(-:H�,)ONIC' EXPOSUPLS) FYFS: ACUTE-MAY CAUS Fivl 11,D IRRITATION WITH 13LU RRED VISION. CHRONIC ND SKIN C,0 N T ACT: ACUTE-TRANSIENT IRRITATION AND REDNESS. CHRONIC-ND `."K 1 N ABSORIDT I ON: ACUTE:..-ND CHRONIC-ND 11\11-i A LATION: ACUTE-INHALATION OF MISTS MAY CAUSE MILD RESPIRATORYTRACT IRRITATION. CHRONIC - EXCESSIVE EXPOSURE 'ro HEATED VAPORS CAN CAUSE IRRITATION OF EYES, NOSE AND Tl IROAT. N G LSTI ON; ACUTE-MAY CAUSE MILD IRRITATION OF GASTRO-INTESTINAL TRACT CHRONIC ND COW)ITIONS AGGRAVATED BY EXPUSURL;NONE.KNOWN. 0\/L,RLXP0SURC- EFFECTS: IRRITATION IlUUTANCY: YES-REVERSIBLE SENSITIZER: NO SCC"1'1(.')N4: FIRFTAID MEASURES ('FNERAL: REMOVE AFFECTED PERSON FROM AREA. TREAT SYMPTOMATICALLY. FYFS: Fl,USI I WITH WATER FOtt 15 MINUTES. GET MEDICAL ATTENTION. SKI N: WASH WITH SOAP AND WATER. IFJRRITATION PERSISTS,SEEK MEDICAL ATTENTION. INHALATION: MOVE TO FRESH AIR. IF BREATHING REMAINS OR BECOMES LABORED, SEEK MEDICAL AT'l ENTION, Td WUSE:80 TTOE t70 '-IdU XUA HidU3 3Hi a3n0Zl: WOdJ Flastic Control No,50-50 FOAM KOTE MATERIAL SAFETY DATA SHEET Page 2 of ,;L(-"T I ON 4: F I RSTA I r)MEASURES (CON'T) INGESTIUN: GIVE 3 4 C.I.ASSES OF MILK OR WATER. 00 N(--)T INDUCE VOMI I ING. SEEK MEDICAL ATTENTION. I [(')N 5: FIRE FIGHTING MEASURES N D I T 1(7)N 5�()F FLAM IM AB I L I-I'Y: NA F: ASH POINT: NA IFLAMMABLE LIMI IS: I..EI NE ULL: NE. OSHA CI.A)`): NONE SHOWN AUTO IGNITION TEMP..: NA HAZARDOUS COMBUSTION PRODUCTS:CO,CO: t.c. SENSITIVITY TC)STA"1*1(, DISCHARCE: NONE .�,-1\1 1")IT I V I I Y'1,0 1 I\/I PACT: NUNS E PXTINGUISI INCH MEDIA: WATER,CO2,DRY CHEMICAL FIRE FIGHI'ING PIROCEDURE:i: NONE LIKELY WITH SMALL QUANTITIES, FOR LARGE Ql IANTITIES, FIREFIGHTERS AND OTHERS EXPOSED TO VAPORS OR PRODUCTS OF COMBUSTION SI-IOULI) WEAR BUTYL RUBBER BOOTS.. GI,QVr-.S AND BODY SUIT. Sr-',I.F-('ON'I'AiNED .BREATI-IING APPARATUS SI-IOULD BE WORN. UNUSUAL 'FiF,E AND FXPLOSIVE I IAZARDS: POLYMER FILM CAN BURN, MATERIAL CAN SPLATTER ABOVE 100'C% :7- -SLCTION6 ccijENlTALRZLEA`7M,c..A�(JP\ES "El': 1-0 BE TAKLN IN CASL MATERIAL. IS PF.LEASCD OR ?ILLED: COVER SPILLS WITH ABSORBENT. PLACE IN METAL CONTAINERS FOR RLCOVERY OR DI5P05AL. PREVENT ENTRY INTO SEWERS, STORM DRAINS,AND WATERWAYS. SECTION 7: HANDLING AND STORAGE (IENERAL: STORE IN COOL, WELL VENTILATED AREAS. KEEP AWAY FROM HEAT AND OPEN FI;AMES. AVOID PROLONGED INIIALA'IAON OF HEATED VAPORS OR MISTS. AVOID PROLONGED SKIN CONTACT. ,AGL: STORE BETWERN 50°F AND 90 F PROTECTED FROM FROST AND DIRECT SUNLIGHT. 'SECTION 8: EXPOSURE CONTROLMER!7)'ONAL PROTLCTIONI LXPOSURE LIMITS(....... INGREDIENT`, (CAS) OSHA ACGII-I OT I-I E p TWA STEL TWA TLV 0001OX-7h-I NE NE NF NE 013463.67-7 l0nighn' ND 10nighn' ND (SF-E man.1) 000112-15-2 NE NE NE 14E 000107.21-1 NE 125mig/m NE 100 ills/m A 00011596-8 NE NE NF NE LECEND!(M)MAX EXPOSURE LIMIr; (S)OCCUPATIONAL r.xp.LIMIT; (R)SUPPIAl"'R8 REC.IJ MIT,(i-j PERCIJTANEOUS RISK NOTE 1:VAI,U)K$WANINOFLA,(*)NlAl*WFIFN HARDENED PRODUCT IS ABRADED. ED,GROUND,ETC. ENGINEERING CON-FROLS: NO SPECIFIC CONTROLS NP.F-.DFD. CENERAL AND LOCAL EXHAUST Rr-.(:OMIVIF-.NDI--.D, RESPIRATORY PROTECTION, NONE REQUIRED IN ADEQUATELY VENTILATED AREAS. ly CQNCFN-1-RAT(ON FXCRRDl; 20ppm FOR LONGER THAN 15 MINUTES,A NIOSH APPROVED RCSPIRATO.R FOR ORGANIC VAPORS IS RECOMMENDED. I ROTECTIVEC-.L.CWFS: NITRILF RUBBER Ed WUSE:80 TTOE PO 'add 96S9-9L9-80S: 'ON XUA Hi�JHEI 3Hi 3nOD: klO:�J MATIL. ;IAL SAFL I'Y DATA SHEET' Flume Cmilml No.50-50 FOAM KOTF llage 3 of 4 SECTION 8: EXPOSURE CONTROUPERSONAL PROTECTION(CON'T) F.YEPRO-11CHOW SPI..ASI t-PROOF GOGGLES OR CHEMICALSAFFTY GLASSES, ')THFR' PROTECTIVL LQUIPMENT: LONG SLFFVED SHIRTS AND TROUSERS. EMERGF-NCY EYE WASH .STATIONS SHOULD BE READILY ACCESSIBLE. SECTION ,): PtHYSIll"'Al AND CPIEMICAL PROPERTIES 20 1 L I N(,' PO I N I I OO'C(-•21211 F) fSPECIFIC(JRAVITY: 1,25-1.35 VA P 0 R PR E J R E: ND MELTING POINT: ND VAPOR DENSITY: >I EVAPORATION RATE: -::I (AIR.— 1) (BUTYL ACETATE= 1) 5,91-JISill—ITYINWAIER: DILUTABLE PH: 8.0 TO 11.5 (:(-)FFFICI ENT.,-WATER/01 L DISTRIBUTION- ND APP E ARAN C F AN F)ODOR: w firrE OR PASTE I,,PIGMENTED LIQUID.,MILD ODOR ()D0RTHP-\Ff-)HQl—D: ND t- VOLA H LE'S, BY V01 UKAE: 51% %'501—IDS BYWLIGHT: 58% SECTION 10: ';TA[31L[*I'Y AND REACTIVITY STAF,'II-ITY: STABLE CONDITIONS'.T(--1 AVOID: AVOID Fl.FVATEDTEMPERAT1JRL-,; (MA'I'LRIAL 1'0 AVOIDY NONE KNOWN HA/Aki)(MS f)F'k-0l'vIP0jFITI0N PRODUCTS:NONE KNOWN 1-1AZARDOIJISP01 Yf\/iFRI7ATIC)N (REACTIVITY): WILLNOT OCCUR I IONS 10 AVOI D' KEEP FROM FREEZING SECTION li: TOXICC)l 0(',I,('.AL INFORMATION CARC I NOGENIC DATA: NTP: NONE OSI--IA:NONE IARC:NONF TERATOGENICITY: NO MUTAGENICITY:NO RMBRYOTOXICITY: NO SYNERGISTIC MATERIAL: NO /\(:tJTP TOXICITY EFFFCTS,: NA LONG TERM EXPERIENCE OF THIS PRODUCT'TYPE INDICATES NO DANGER TO HEALTH Wl,li:,'.N PROPERLY HANDLED UNDER INDUSTRIAL CONDITIONS, SECTION 12:.EC.Q1.0(..'M.AL INFORMAHON INFORMATION:NE L"COTOX I C I NE SEC—I'l UN 13: L)I SPOSAL CONS I C'E RATIONS WASTE DI':Po ':)'Al MFTHOOS: AT THIS TIME, MATERIAL AND ITS CONTAINERS WOU1.1) NOT BF CONSIDERED HAZARDOUS WASTE AS DEFINED UNDFR RCRA REGUALTIQNS. CHECK FOR DISPOSAL COMPLIANCE UNDER FEDERAL,STATE AND LOCAL AUTHORITIES, Ed W09E:80 TTOE PO -adIj 9GS9-9L9-80S: 'ON XUA HidUD 3Hi a3nOD: WOIJ MATERIAL SAFETY DATA SHED I'lame Control No.50-50 FOAM KOTV Pare t of t SF*(TI()N 1`1: I-RANSPOIR I- INFORMATION D01 PROPFR";HIPPIN(� NAi\/Ic-*: LIQUID LATEX,NOT REGULATED BY DOT HAZARD CLAS5: NONE PACK INC,GROUP: NOT APPLICABLE UN NI-JIVIRFR: NOT APPLICABLE Ii\4()'.*.*,HIRPIN(1'- DATA: NOT REGULATED ICAU/IATASHIPPING DATA: KOTREGIJ.L�ATED F- SEC I-10N '15: REOULATORY INFC)RIVIATION MIA)"I-R I AI.VOC, ...30 !ram/liter COXIINGVOC 56gpm/liter g ISCA (TOXI(: CONTROL ACT): At.[., COMPoNEIN"J'S ARE LISTED IN THE TSCA CH FIVI tCAL SUBSTANCE INVENTORY. -k.,FR'k-J.A (CUIVIPPLI-iENSO/F. RESPONSE(-0i\/IPENSA:f'I(-)N IJABILITY ACT): ND S'ARA TITLE I I I SECTI(N\131*12 HAZARD CLASS: SLIGHT HEALTH HAZARD ';ECTIIDN 3113 Lj5TFF) lNGREDILNITS: FTHYLENE GLYCOL (CAS #00107-21-0 DF,, A(,ETATE (CAS #00 112-15-2) C,-/\l IFORNIA PRC)PCISITION CC' known: The below list of compounds is know to the State of Catifomitt to emm cancer,bii-th defects or uther reproductive liami- TIUS(2-CHLOROECHYL)PHOSPI IATE-(CAS#001 15-96-8) ION 16: OTHER*1*f"4F' 0P',jM-'A I ION I'l H A 7-A.,--,'D P A T N(3, HEAl TH 1 FLAMMABILITY 0 REAL-1 IVI]-y r LEG FN D ACGfH; AMBRI(7AN CONFERENCE OF GOVERNMENTAL INDUSTRIAL HYGE)ENISTS OSHA: OCCIJPATIONAl.SAFETY AND HEALTH ADMINISTRATfON STFI.: SHORT TERM EXPOSURE LIMIT TWA: TIME WEIGHTED AVERAGE I I FL.: PERMISSABLE EXPOSURE UMIT TLV: TI IRFSI[OLD LIMIT'VALUE NA: NOT APPLICABLE NE: NOT(,',STABI.V)J-IED N,D: NO DATA tin guarantec or warrunty of tin),kind,express or The intbrination and rccornmendations contained herein lite based upon dah bulle�ed to he correct. Ilowtiva I illlllli[d: is made with o:.qjxCv vo the accuracy of tl I i1c intorni-aiion contained hertin. We m;uupt no re5pun;5ihility ;putk!*laim all lial)ility for ally kinvoltul rflrcis which may be caused by exposure to out products. Cuslomers/users of this product mustI comply%%itli all applicable health and saftly li%v s,regulations and ordevs. i. WU9Z:80 TT07 t78 'UdU 96S9—W-9-80S: 'ON XHA Hialz!3 3Hi a3n00: WOcd- i Y-A, FLAME CONTROL NO. 50-50 FOAM KO-C I� ,x�? Fi g A Water Base,Flat Latex Coatings, LW intumescent Fire Retardant Paint For Polyurethane Foaul DtSCRi ij i l'ON; For 2 puund polyurethanc foam; exceeds current "Flame out the Protect fi•om direct sunlight Flame Control No, 50-50 Foam Kota. Front" and "Burn Through"criteria accepted by the ICC, and exceeds hq`kuG ^9 • •eig 1 &5 10. containers is a. VOC crnnpliant, water base; weight/gal. ro.9=0.2 lbs. . intume.scent fire retardant paint, currently proposed !"thine Out the nlnnutactured expressly for the. Front criteria.. See page3. ShIpDIn.;) W.,11141,L. . . . 4 gals-48lbs. thermal protectiotl of polyurethanee 5 gals-58 lbs. 1CC• is a mamtKr5111U abeuciation dedicated to foam insulation. (l dries quick to a bulldhtg nalery and fu'c plevi.°liun; it. develops ale 1 Irir^ �, Brush,roller, flat finish, having the appearance of a colic used to o°astrucl rcaidential and c011WChaal COI1Ve111.IV[lal t7a[ � • � �� - build ap. inclurlinp Itonlc5 alld echonl5. Most u.S. conventional and airless spray paint, till; cllkn,cuunties end StntcS 111M adept codes°hnii;c.tlto I. presetrcc of lieat or I•latnc, the coaling Codes du�ulupedhy the lcC. PRECAUTIONS: Puffs up (int.umeyccs) and li)rrns a thick sponge-like cellular fotun layca•. AS'1'w 1F-84 Surface Flaine Spread Adequate ventilation must be providcci This foam layer insulates the foam. Results; during and abler application until the substrate Born flames, reduces the coating has dried. Avoid breathing penetration of heat, delays heat ' NFiIA Established C:lassilication, vapor; or spray mist. C;inse container u•ailsfcr and bul'n through and reduces Class A surface flame spread index after use ll0 NOT TAKE (tic surlbee flame spread of 20, whell tested on 2 pound. INTEIUNIIALLY, characteristics of the foam. These Class 11 Polyurethane Foam in combine( characteristics prolong the AS•rM E-84 test, Roau h/i;iDJ nnrnre-vv�rn.�:� structural integrity of the f21am co„cr.r,...,-„. C0111pusite assembly for Roth, 2 & 112 NFPA Established Classification, pound density Spraycd polyurethane Class "A" when tested in KEEP OU i'OF i:FiV'_H O testes, accordance with UL-723(ASTIVI F.- CHILDREN. 84, uBC 8-1, NFPA-255) and RECC1MMENDED USES: CAN/ULC-S102 oil cement board. SURFACE PREPARATION: This product is designed for use on ,IS I les C:HAKAC T EF. s Can be applied directly to fully cured irttctior polyurethane team ;urfaccs where it is either nece„cry or desirous polyurethane foam surfaces. If the ... . . Flat,5 units max.(cy 60" surface is cut or shaved, exposing the to reduce the burn through and three loam cells, we recotnnlelid a coat of spread rating characteristics of t(te Cott.,•. .. . •White,Off-White and 13 Flame Control 3003 water base resat• standard pastel shades primer, prior to the application ol'the' T,,.•t,,,r, Flame Control No, 50-50 Foam Kole. USED BY: Can be tinted up to 2 fl, oz. All surface preparation should be of Universal Tint. Clicck colorant for All out in accordance with hhbe Schools, Colleges, Nursing !-tulles, compatibility. Child Clue Centers, Hospitals, Pcnal painting practices. Remove till loose, Institutions. Apartments, Hotels, peeling or powdery existing paint fi•ont the,Surface. All dirt:,grease, oil'; Factories, Warehouses. Retail Stot•e,, R� . . .. 100 sq. tl./gal.(2.45 m'/L) wax, and outer foreign [natter iMUST Re,�tartu•anrs, Utilities, Railroad and applied in two coats of be removed with a: detergent, rinse other Transportation Compan►ts, Oil 200 sq.ft./gall each cola surface thoroughly Kith clear water, and Chemical lost-,illations, Military 8.0 tails wet,3.8 mils dry each coat and allow to dry. Installations,and other facilities where V.t .C. L... fire retardant coatings are required. — APPL I CATI UI` I non . . .. . ... 0.49 168./gal.(57 eL) PrE_Nt)PMANC'I- IhiE'01-RATION: vol."S.11d.. , ., • •,• .• • 47%t 2 Flame Control No: 50-50 Foam Kote Attic & ('r•awl Space Test Results: W010111 S"Id... .. ,. . . . . ° Carl be applied by brush, roller,airless (IC:CES Accepted Alterntlic •Pest 5g 0=2 ur conventiunal heavy-duly spray D.yr,,.:,T.:,,..r ; equipment. Stir thuroughly and apply Protocol for Ignition IIaniec) at approximately 200 square feet per 77°F SOY(-, PI-•I:1.0 lunch 1-2 hours gallon f o rucoat 2 to 4 hours per chat, two coaW rue %• For 'pound recta;exceeds current accessary to achieve the perlunnanec " l;lmc Chtl. the Froni" and "Burn T,,,,..or Cu,... . . .. . . .. Coalescence characteristics referenced. if thintlitig 7•11rou911" criteria accepted by the is required, use WATIrR only. Do not Inletnationctl Cade Council (IC(� F"' F'°t None exceed '/ Dint per gallon. Do. not apply in temperatures below ;500F and exceeds currently proposed F:-0 UC•a./C:,..�„.: . . . . .. . .. . .Water (I(n). new criteria. ��npir Li... . . .. 9 months(unopened) Sd b IJ9Z:^00 T TOZ b0 ',Add 96S9-9L9-80S: 'ON XI JA Hi�JUD 9Hl a:1103: b.10;�A 1 , FLAME CONTROL NO, 5050 FOAM KOTE A Water Base.,-:Mat Latex Intumescent Fire Retardant Paint '04t3'1 5Y il'v LC- For Polyurethane I urethane Foam AFPL ICATiCM Ft:MPN/ICNT: •:., �,.�,,,I ';�. „ Attic & Crawl Space 'rest Results: (1CC:ES Accepted Alternate Test Protocol Fol' Air Supply. . . . .. . . . . . . 12 C;h'M, lCiNl'rm BARRIER) 50 psi at nor. le,fluid 15-20 psi Polyurethane Ibaln insulated assulliblies coated with Flame Control No. 50-50 Foarn CAM_ Groat 2l7-800 to 217-816 Kole. Type,I . I . .. . . .. , . . External Mix Reduction.. . .. .. . . . . . Up to 7% F,, Flame out the Prunt—2.6 minutes versus fiberglass insulated assembly of 1.9 minutes. Burrl through 16.8 minutus versus fiberglass insulatcd assembly of 9.7 minutes. T.— 1'iU I n,,.-,.(or lrquivrllenu) And Ptuttp Fluid Pressure. . , . 2250-2700 psi Flaine out the "Front:— 6.1 minutes versus plywood covered polyurethane wall and ivlanifuld Filter. . . , . . , 60 Mesh fiberglass insulated ceiling assembly of 3.3 minutes. Gun Filterr.. .. ,. . .. .. 60 Mesh Burn through% 50 minutes versus plywood covered polyuretflane Veall ilnd fiberglass Fluid Huse. . . . . .. . %I'dianiete- insulated coiling asscrrib)y of 25.1 minutes. Gum. . . ... .. . . . .. . . LX-SO LI Tip. . .. . . . . . .017-.023 F,: 24pv ar—lo: Reduction . . .. . . .. . . . Up to 7% Flanie out the front—3.4 minutes versus fiberglass insulated tusemhly of 1,9 minutes. Burn through 24.6 minutes versus:lberglass insulated assembly of9.7 ininutey. And. Flame out the. front — 7.5 rninutes versus plywood covered polyurethane wall and tbcrglass insulated ceiling assembly of 4.2 ininutes. N.1Jtr. R.r„.,t-su p()ut i.Inp aoov.. Il aca, iva ilw 1,to upon —Q,—t. tts we cannot anticipate all couditiuns under which this infonnadun and our product.,or the prucluctr,of other rnanufficturers In contbinutiuo with our products,may be used,we accept no responsibility for results Obutined by the atiplicutiun of this infunnation or the safety or suilabiliry of our products,either alone,or in combination with other producs. Users uro advised to rnakC ThCIT inert tests to deterhiinc the SAfery and suitability of each such product or product combination for their'own purposes. We Son the pnuducts wi[hu-l[,warranty or guunintoc,and buyers and users assuinc all respmisibili[y:and liubllily for loss or damup,- Ihini [lie h;llldliug and use of our products. whether used alone or in combination with other products. 9d WULc:80 TT0F_ 1:70 •add 96S9-9L9-80S: 'ON X1Jd 9Hl �EY',OD: l�.lodd International Fireproof Technology, Inc. Paint To Protect PIN), 17528 Von Karman Ave.Irvine,CA 92614 949-975-8588 w'�N^�•7t�i DC 315 applied over Spray Polyurethane Foam (SPF), If a coating has not passed a full scale test on a manufacturer's foam it is an Alternative Barrier System in "Section 2603.9 cannot be used on that foam;there are no exceptions in the IBC Code! Special Approval" as a thermal barrier. To.be approved Building Code Fire Performance Requirements for SPF: as an Alternative Barrier System, DC 315 is applied over The International Building Code (IBC) mandates that SPF be separated 4 a manufacturer's SPF and tested to the criteria of an from the interior of the building by a 15 minute thermal barrier,or other oe3ls NFPA 286, UL 1715, UL 1040, or FM 4880 for duration approved covering. DC 315 passed certified NFPA 286 and UL 1715 test ea of 15 minutes by an accredited fire testing facility. over a variety of open and closed cell spray applied urethane foams that Products that pass an ignition barrier tested under AC were conducted by ISA certified testing facilities. All tests performed 377 Appendix X are not appropriate alternative comply with the requirements of 2006 IBC Section 803.2.1 & 2009 IBC thermal barriers and cannot be used. Depending on your particular Section 803.1.2,and Section 2603.9;2012 IBC Section 803.1.2 and Section application, either ignition or thermal barriers are required by the 2603.10 under "Special Approvals for Thermal Barriers over Foam International Building Code (IBC). Plastics". DC315 is WHI marked and certified via P party inspection for •• s quality-assurance and consistency. Finish Flat Alternative 15 min Thermal Barrier Assemblies(e.g.Exposed SPF or SPF with a Thermal Barrier Protective Covering) Color Ice Grey The assembly must remain in place for 15 minutes during specified large- V.O.C. 7g/L scale fire tests,such as NFPA 286,UL 1715,UL 1040,or FM 4880. Solids By volume 67% Alternative Ignition Barrier Assemblies DC 315 meets the requirements for ignition barrier per AC 377,Appendix X Specific Gravity 1.30+/-0.05 g/cc Application Equipment DryingTime @77°F & 50% R.H. To touch 1—2 hours, to DC 315 can be applied by brush,roller or airless sprayer. recoat if required 2 to 4 hours For maximum yield and coverage spray application is recommended. Flash Point None Sprayers: Reducing or Cleaning Water Pump: (Graco)Ultra Max 695 or equivalent PSI: 3000 Shelf Life 1 year from date of manufacture in unopened containers and stored at 10`C to 27'C(507 to GPM: 1.00 807) Tip: 517 521 or equivalent. 5 Gal.Container Weight 58lbs. Filter: 30 mesh, removal of filter is recommend from gun and machine Advantages of Using DC315 SPF Hose: 3/8"diameter airless spray line for the first 100'from pump and X"x 3'whip • DC 315 is the only 3" parry inspected fire protective coating for SPF Pump: (Graco)TexSpray Mark 5 or equivalent • Marked and Listed by Warnock Hersey Intertek W/N 20947. PSI: 3300 • Single coat coverage reducing labor and material costs equaling GPM: 135 higher profits Tip: 517-523 or equivalent. • Industry leading spread rate • Passed CAL 1350-safe for use in schools and high occupancy Filter: 30 mesh, removal of filter is recommend from gun and buildings machine • Passed strict EPA—V.O.C.and AQMD air emission requirements(for Hose: 3/8"diameter airless spray line for the first 100' from pump all 50 states) and X"x 3'whip • Approved for Incidental Food Contact complies with NSF/ANSI-51 requirements of USDA Pump: (Graco)GMAX 7900 or equivalent • Easily applied with a sprayer,roller,or brush with no complicated PSI: 3300 mixing GPM: 2.2 • 1 year shelf life Tip: 517-529 or equivalent. • Fast and easy clean-up,with no waste and fast turnaround time Filter: 30 mesh, removal of filter is recommend from gun and • Compatible with any paintable construction material machine • Meets Life Safety Code 101 Hose: 3/8"diameter airless spray line for the first 100' 300' from • Meets LEED's point requirements pump and''/<"x 3'whip No formaldehyde Pump: (Graco)GH 833 or equivalent DC 315 is the most tested and approved product in the world for use as PSI: 4000 an,"Alternative Thermal Barrier Coating System"over Spray GPM: 4.0 Polyurethane Foam(SPF). Tip: 517-529 or equivalent. Filter: 30 mesh, removal of filter is recommend from gun and Visit us at our website www.oainttoprotect.com to obtain a current matrix machine of all the manufacturer's foams DC 315 has been tested and approved as Thermal or Ignition barriers in compliance with current IBC codes. Hose: 3/8"diameter airless spray line for the first 100'-300' from pump and'terx 3'whip p Prior to Applying DC 315 to Ensure Proper Adhesion: Surfaces must General Safety,Toxicity,Health.Data be clean, dry and free of all foreign matter.Adhesion of a coating to SPF Material Safety Data Sheets are a4ailable on this coating material. Any requires the foam surface to have a slight profile or texture similar to an individual who may come in contact with these products should read and orange peel. Smooth or glossy foam surfaces must be flash coated with a understand the M.S.D.S. In case of emergency contact CHEMTREC light 3 - 4 mils Wet Film Thickness (WFT) of DC 315 and allowed to dry EMERGENCY NUMBER at 800-424-9300. before applying the full application. Flash coating is a quick burst of a primer or DC 315,via airless sprayer over an area needing treatment. We WARNING:Do not allow product to freeze.Store above 10°C(50°F)at all also recommend flash coating around all pipes and air ducts. times. Product Application WARNING: Avoid eye contact with the liquid or spray mist. Applicators In order to validate warranty and confirm the installation complies with should wear protective clothes,gloves and use protective cream on face, IFTI's best practices installer must obtain and read all current installation hands and other exposed areas. documents.Installation documents include Application Guide, EYE PROTECTION: Ventilation Guide and Job Work Report. Safety glasses,goggles,or a face shield are recommended. These documents can be downloaded at www.painttoprotect.com or by calling IFTI at 949.975.8588. "Job Work Records are an excellent way to SKIN PROTECTION: track your installations and confirm compliance to your Building Official or Chemical resistant gloves are recommended, cover as much of the Authority Having Jurisdiction. In the event of a concern on a job the exposed skin area as possible with appropriate clothing. installer is able to provide documented proof of the installation, for this reason IFTI recommends using these forms for all thermal barrier jobs." RESPIRATORY PROTECTION is MANDATORY! Material Preparation Respiratory protective equipment,impervious foot wear and protective DC315 must be thoroughly mixed prior to application. Failure to do so will clothing are required at all times during spray application. compromise the materials performance and may create issues with INGESTION:Do not take internally. equipment used for the application of the product. Mechanical stirring with a high speed drill and a paddle appropriate for the container size is Consider the application and environmental concentrations in deciding if recommended. Material should be stirred from the bottom up making additional protective measures are necessary. sure the bottom and sides are scraped with a paint stick during the mixing process to ensure all materials are completely mixed prior to. the Limited Warranty application. Material should be mixed to a creamy consistency with no This product will perform as tested if applied and maintained according to lumps. Thinning is not usually needed, but if the material has been our directions,instructions and techniques. If this product is found to be exposed to prolonged periods of high temperatures during storage, defective upon inspection by its representative, the seller-will, at its evaporation of the water based material may have taken place.Typically option,either furnish an equivalent amount of new product or refund the the liquid level should be about 3 inches from the top of the 5 gallon pail. purchase price to the original purchaser of this product.Seller will not be If the level of material is lower,water may be added during the mixing to liable for any representations made by any retail seller or applicator of the address this issue. product. THIS WARRANTY EXCLUDES(1) LABOR OR COST OF LABOR FOR THE APPLICATION OR REMOVAL OF THIS PRODUCT OR ANY OTHER Temperature and Humidity PRODUCT,THE REPAIR OR REPLACEMENT OF ANY SUBSTRATE TO WHICH Ensure temperature and humidity are within specified limits for THE PRODUCT IS APPLIED OR THE APPLICATION OF REPLACEMENT application, Failure to monitor and compensate for increased humidity PRODUCT, (2) ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES. OTHER may lead to blistering and/or delamination and will void warranty. Obtain LIMITATIONS APPLY.For the complete terms of the limited warranty,go to a ventilation guide prior to commencing installation. Ideal conditions are www.painttoprotect.com. Some states/provinces do not allow the 16°C-32-C(62°F to 90°F)and a maximum of 65%Relative Humidity. exclusion or limitation of incidental or consequential damages, so the above limitations may not apply to you.To make a warranty claim,write Ventilation to Technical Service, International Fireproof Technology, Inc., 17528 Von When spraying in enclosed spaces,regardless of size,adequate ventilation Karman Avenue, Irvine, CA 92614 or email Customer Service at is required to remove excess moisture from the application area. The use ptp@painttoprotect.com of fans may be required in some cases to ensure a.minimum of 0.3 air changes per hour. Prior to starting a job please be sure to download a complete current ventilation guide at www.painttoprotect.com Rev:12/18/2014 5:17 PM Job Work Record Should be Filled Out For Each and Every Job.Completed Work Records Must be Submitted To workrecords@painttoprotect.com Within 10' Days of Job Completion. Town of Barnstable Building _ P,ost This Card So That rt iswV.is�ble From.theStreet Approved Plans Must be.Retamed on:Job and`'this Cacd Must be Kept, , AJim F ., Y: r `•' ..� '.,'"� ,%i" ri v r r y a rr s s"%` �� . - � 1KAM 6 Posted Until Finalln"spection IiasBeen Made r � y Permit Where aCe �ficate of Occupancy s equed, h Building shallNot:be Occupied unt�Fmllpect has been made Permit No. B-18-3755 Applicant Name: tedfitzgerald Approvals Date issued: 02/21/2019 Current Use: Structure Permit Type: Building-Sheet Metal-Residential Expiration Date: 08/21/2019 Foundation: Location: 69 WASHINGTON AVENUE, HYANNIS Map/Lot 287 085 Zoning District: RF-1 Sheathing: Owner on Record: CELENTANO, ROSETTA M TR � Contractor Name THEODORE H fITZGERALD Framing: ]oQe a J Contractor License: 14049 Address: HAYDEN FAM 2008 IRREV TRUST i l. 2 NEWTON, MA 02465 Est Protect Cost: $35,000.00 Chimney: Description: Installation of 4 new gas fired forced hot air furnaces;2•rn attic toPerrnit Fee: $85.00 service second floor and 2 in basement to service first floor. Insulation: Fee PaiC $85.00 Project Review Req: x Date 2/21/2019 Final: q Plumbing/Gas Rough Plumbing: ui rn iva This permit shall be deemed abandoned and invalid unless the work authonzCd by this permit is commenced within six months after issuan Final Plumbing: S k All work authorized by this permit shall conform to the approved application arid:'the approved construction documents for which'tt is 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. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the tk work until the completion of the same. ' �fii Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Buildn g and Fire Officials arelprovided on'his permit. Electrical Minimum of Five Call Inspections Required for All Construction Work h dh 1.Foundation or Footing £ � Service: 2.Sheathing Inspection a � i 3.All Fireplaces must be inspected at the throat level before firest flue lmi gis installed _ M,. u- Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Low Voltage Final: 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. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: �. Buildingplans are to be available on site P Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: c F" Applicaficm Numhea.h....1 .. ......... . � _ c U Ass. �� 'r��/ �� Peffiid Fee..... . . .J�.. ...............Other Fee........................ 'gas �® Total Fee Paid.............. ......t- oav-,.Co............ TOWN OF BARNSTABL� � Permit Approval hyy.... .._.............oa....�-�..� .l� BUILDING PERMIT .._ �.... 2—S:",�...............past... ......Q�.hJ...................... APPLICATION Section I—Owner's Information and Project Location s - � Project Address Q �r�) c' .��' h d-f- Village �e','"A'& Owners Name ti Ze1� Owners Legal Address ` State G;� zip P Owners Cell# 1 1-7 'Z �?s E-mail r Section 2—Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet, ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3--Type of Permit ❑ New Consfiuction ❑ . Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition (] Retaining wall 0 .Solar �Renovadon ❑ Pool ❑ Insulation Other—Specify Section 4 -Work Description , �. f r r T sict imdsdett 2/9/201 S Application Number r..................................................... Section 5—Detail Cost of Proposed Construction 5 Ob, nz1V,.V) Square Footage of Project 3 5 gt> Age of Structure 1 D p c— Dig Safe Number # Of Bedrooms Existing_:7 Total#Of Bedrooms(proposed) o �- 110MPH Wind Zone Compliance Method MA Checklist ❑ WFCM Checklist ElDesign Section 6—Project Specifics (]'Wiring ❑ Oil Tank Storage [>-Smoke Detectors ('Plumbing Gas Fire Suppression VHeating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply VPublic ❑ Private Sewage Disposal ❑ Municipal "MOn Site Historic District Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am,using a crane R Yes P-No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use ' 24 ,� Lot Area Sq.Ft. �- i Total Frontage DAT Percentage of Lot Coverage ) 0 #of Dwelling Units (on site) Setbacks Front Yard Required Proposed G b Rear Yard Required Proposed S CcxA- Side Yard Required Proposed I / Has this property had relief from the Zoning Board in the past9 ❑ Yes ❑ No Last imdatad_2/9/2019 Application Number........................................... Section 9—.Construction Supervisor Name Telephone Number . Address 0 r3 0;< .r G A: City. State-�--Tap .�y License NumberCS-_0��?9 License Type Q xpiralion Date_ ��. J�,��: ^ Contractors Email _S.l,.PhaX.C� {�rt� Cell# S017 Z 7 6 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation reTiked by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date: Section-10—Home Improvement Contractor Name S:T:v _n_ Ir'�P,r(iu� Telephone Number • S o: -? Address 1P.1) (56h Cad —city- - State rVN!)—Zip. y Registration Number 1 ( _Expiration Date l J a6 J I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Bamstable.Attach a copy of your ILI.C... Signature Date Section 11—Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date Print Name STtv P, r, )1 (o. ty Telephone Number 7? e E-mail permit to: T-........t..a�.i. mnnt o t L Section 12—Department Sign-Offs Health Department ® Zoning Board Cif required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation : For commercial work,please take your plans directly to the fire deparbnent for approval Section 13—Owner's Authorization H, t-- A>4�E 4::-AM L�d 2d® ids"r , as Owner of the-subject property hereby authorize Ste.,,!fe\ 1/V1 el�(tt" to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) I/A /Iza, gi�e of _ date vjYn 7 0 Print Name Last wdate&2/92018 mamreewwe. �„��e.�9.�em - ro.wmlm'uce , eaarmwwaseuetmo - . .wealmtwwu�'rwa enrtaorroaotw �amtworswuerelarmin - ro�ro'w.ra°�w � - . wo•�elrtn metwowenuewmm . 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I,Yt9KY yY0 A shin ton Avenue Side-Inside Porch flail 2 _ slerotcswnl r.eaaule .-. - ronwwrmvam ulloraeu¢ .14 rrmoa.eeuvm - 9.orrmEm - CM$IN=m„ mloa,uoam w61.uw�.��.ure""..me ann•� CD --- —•—•— xeaamu vr.r-o- M.LL Lt8laW9RTia 61 E ErieriorElevaUans" - _ �O r Barnstable Bldg. Dept. I °ar�.a-Side � O _ c Approved by:- !e/LGe—LL � � � Perm i t #. 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CM SINIM WM.i�9b-tAFa 1Waa.Nr.[4rinaina 1a11bdIL Caanvctbn - TW201t Vr.r-r SacaW LevH Framing Ptan S1.2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibly Name(Business/Organization/Individual): Arc, Addressi City/State/Zip: Z Phone#: p V Are you an employer?Check the appropriate box: Type of project(required): 1.[PfI am a employer with 4. ❑ I am a general contractor and I 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. Blemodeling ship and have no employees These sub-contractors have g, emolition working for mein any capacity. employees and have workers' # 9. ❑Building addition [No workers' comp.insurance comp,insurance. 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its eP ` 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c.152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: Mtn 'ry-14-4 Cka 9 Policy#or Self-ins.Lic.#:A VV C L/0®-7 0�S« XA4 t SA Expiration Date: lo 1 Job Site Address: �� (.t�Y 1.-��,.� YIP City/State/Zip: aAm Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of perjury that the information provided above is true and correct. Signafore: Date: 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 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a,business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public-work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 cant'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-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Bice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.govfdia CIER70LATE O o 0 o DA ��DDIYYYYY, (� C��QC3� �NOMG3QI�0� 07/96fL09S TRIOS CiFRWRCATE DS;SSUED AS A MATTER OF 6G211FORMAMOM ONLY AMD CONFER,No RUC HTa MFOPI THE CZ R'flRCA` m HOLDEI;. THIS CCE6RWOCATE DOLES NOT APM63HWTDN/[ELY OR WEOAT➢VCELY A➢IiEMD, EXTLEW On ALTER THE COvgRAaZ AFFORDED By 7HE I�LOC➢GS. BELOW TR@ CCER'HRCATE OF 9%8URANCE DOES NOT COMST➢Y f`IE5L A CONTRACT BETWEEN THE ➢3,9W e ➢NwRERp), AUTNOROZED RE[�14 S RTA 9P�OR PRODUCER,AND T E CERWBCATE HOLDER. IMPORTANT' N the C09251aage ff dd@DIr➢z @n AD©➢TOONA[L➢NSURED,the POH@Vjlas)MUOR The auadovmad. Off 8URROCAMm a wA ED, yacQ 8o the tienne aid comoo aos of 9ho➢cHcy,canWn po0➢cOaz maY mgmdT6 m allf dwsomana. A sta¢aunent an Ws c®uOOffOcatf®does not confar Ir➢gma Ro the c®r3pffeCaR®Bo®B�ar Beo U➢aan®4 SS�c6o aua�l®Ps®aua�t�. Mai yma MARK SYLMA 0 SURANCE AGENCY LLC MUM s®s�) 7-2225 Egli ao -L s: dais arls alJaraa�raCa.Cwm 404 MAINSY IIMLMMD AF(FORDIRI®COPf Ah 6NArCt3 CEWTERMLLE MA 02632 ADM MUTUAL INS Co 3�756 a�tr=D alas : STf dPU L U�ELLOI� ONS C: MELLOR LAW UNG REMODE UNG o6Na^WWRD: P 0 BOX 627 INSIDAUR C�NT��lLL� 16 02632 ONSURER F C®N/tEl�(�IE� CLI;�TO�➢CATfE 6��9P��130 a99�4 F3CE�0�➢®R9�flD��L�t: T6 IS IS Y®C'eRYIFY THAY 40iE ®LICUES U�fS4gRA�CE L9 E®EELi�I9 HAVE BEEN%SUED TO THE INSURED NAMED All FOR THE POLICY PERIOD lob®ICATE®. ft9®TVfVITHSTDO JOIh��Ai r RE�DIRE9�E�IT,TERM®�COiY0P�0ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MICH THUS CERT2FICAUE E AY SE OSSfl1E®OR 6�AY PERTADfiI,YHE Ob4�1RAf�CE AFF®RDED BY THE POLOCIES DESCRIBED HEREM IS SUBJECT TO ALL THE TERMS, F�torL2lSIA69S AP9®CORD®l4P�S®F Sl9CH P®LlC1ES.L0 9difS SHIO> B�I�Y HAVE BEEN REDUCED BY PAID CLAIMS. R TR TYP�0F6N�f � POLICYR9umm POU Gfl-p—mrffI—xP LOMITS Cof4MG ERCIAL af°C"tNMAL UASILITY EACH OCCURRENCEa CLA1PfiS.MADE a OCCUR S MED one pe%w § WA PERSONAL 41 ADV INJURY $ GEN%AGGREGATE LIMIT APPLES P€R- GENERAL AGGREGATE $ POLICY 0 JECp 0 Lor PR®DsaCYs-Comea/0p AGO $ —B OTHER: $ ALIT011WILsLI EMIn COMBINED SING�.EceLIM11 $ rnt ANY AUTO ®ODLY 04 JURY QPer pessanj a ALL OSE® As�o� s ED N/� roLY uNJ�RY(��P Ali $ HIREDAUTOS AUT�MrtNED - PSG RT7DAMAGE �P IUALLALiAG OCCUR EACH OCCURRENCE $ MCESSUAS CLAWS-MADE W/A AWREGATE g DED RETER9TI2W RICO $COWPCsFIU511ON pp APIDFY.PLOYCRQ'LAEILITY YrAI /� STi4Tt TE ER A OFFICERIMRI REXCLUCEEEE CUTIi+E PalA 6NdA NdA E.L.EACH ACCIDENT � 9,00,000 (mewsbryInM) AWC40070355622016A 06/972090 06/17f010 Ir yas.®esvibpmger FLANSEASE-EAEMPLOVW S 6.000.000 DESCR6PTIOM OF OINS below EL.DISEME•POLICY U2fiT $ 1,000.000 N/A , DESC�irOft9O�OPERAS1�1S9L®CATJrOr�IbO�a;ORD909,A�dIBI�IRcrnsrlca�boCaa�a,6a'JS(CIE®ffi�8�P18�d'�RI�P®H[9820IBB6�P6�} F>Qftre COrnps19aa210n bem2s Wil b®paid to MassachugMs 611000yeas sully.Pursa mM tc Endow lerl2 WC 200300 B. go Pay sUalrras�r bene�?s 2® a playaos in stgos aftr r IPO=d him,or has hired f®se OMPllayees oufsi�of Massachusetts. This sfilv"M@ pdcy In force On the dal®Ohak 21uh ce =2e VMS Issued(Unless the axpIndi0a H®2c 00 the @mows policy pmcedes ft Issue date ofmis c®r4I��2eB 0Y�Is�I�BIE®), The Status afthis covemp can be Mcnl2 od dmily by accessing ft PmN®?Coverage-COvevage V9erifto0on Seauch Qoo a4 .raeass.g®v�rtral/ti� ri�uorl�n�0®vI/Iav�I�I�k1®rosd. - S01e PrOP6e2/au Pons ua02 elated covmge. CCE➢RWF➢LATE HOL R CANC>ELLATiON @=W7H @@ i1;m FOO�OC�ORS RE CANCELLED BEPME T®Wn of S amd abW A pR@MO@I@M& 200 Main SR AL9U�80 DR maanl9 Elgrarin6s 61AA 02601 ®dial M.Crw V.CPCU.Mee Prasaa9r:ro➢4 Residual Market m!> ROBM4 0 90£3M0916 ACORD CORPORAMON. AOO U-19MO ramauved. ACORD 25(2016d09) The ACORD warm®Wd'1690 ffi2e vaglWemd maifss of ACORD Application nurnbe;;[......o.... V............... 010A Fee ............. ........................... ...... .. .............. SAYOWAMZ. MAM Building Inspectors Initials......... .... ....... ............... S P 1.7 26 18 Date Issued... C)............. 0 SfABL� ....e... ... 011- BAHN 157- Map/Parcel................................................................. TOWN OF BARNSTABLE , EXPEDITED PERMIT APPLICATION: ROOF/SIDINGAVINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMAjjON Address of Project: G1A, in ea PoAD in� NUMBER STREET VILLAGE V100 Owner's Name: Phone Number Email Address: Cell Phone Number Project cost$ 4 S(W,. Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application Bo build* .t in accordance with 780 CMR / -=gerrm Owner Signature: Date: TYPE OF WORK ErfSiding DWindows(no header change)# 0 Insulation/Weatherization 0 Doors (no header change) # Commercial Doors require an inspector's review [�TRoof(not applying more than 1 layer of shingles) Construction Debris will be going to AA� CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable) # � I (attach copy) Construction Supervisor's License# C>v (attach copy) Email of Contractor CePhone number—� ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. 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. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signatureha Date All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts 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 _l Please Print Legibly Name(Business/Organization/Individual): QyQ,h Address: 17 ` tX City/State/Zip: 0 ( Phone#: —2 7 6 —q 7�9 1 Are you an employer?Check the appropriate box: Type of project(required): 1. am a employer with f 4. ❑ I am a general contractor and I 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 9. ❑Building addition [No workers' comp.insurance comp.insurance.: 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 myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs I insurance required.]t c. 152, §1(4),and we have no v employees. [No workers' 13.EL Other .y 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. $Contractors 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 thepolicy and job site information. _ r- Insurance Company Name: u ` n rz Policy#or Self-ins.Lic.#: 49C�7 �_ �R.D—)U/2 4_ Expiration Date: Job Site Address: tiJ City/State/Zip: 00_4 R Attach a copy of the workers' compensate n policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains �and penalties of perjury that the information provided)above is true and correct Signature: Y, o, Date: Phone#: a IV 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#: 4 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 cant'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-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any 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 permit to burn leaves etc. said person is NOT required to complete this affidavit. ( i.e. a dog license or p ) p q p The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Deparftnent of Industrial Accidents Ofee of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 wpvvv.mass.gov/dia AC R CERTIFICATE OF LIABILITY NSU DATE(MMDDIYY 0 INSURANCE 07ns2018 THIS CE-,RnFICATE IS ISSUED AS A MATTER OF IMFORMATION ONLY AND CONFERS no RIC)ItTs UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE BOBS NOT AFFIRMATIVELY 61R (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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT- if the certificate holder Is an AD®IgIC`MAL INSURED,me pellcy(les)nuuzQ be endorsed. If 8U13 DQA7ION CS WANLO,Subloct 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 endorsements. PRODUCER MARK SYL)AA INSURANCE AGENCY LLC NA EA Mark via HONE 508)957-2125 No: 404 MAIN ST Ao afL • kris0marksyMainsurance.com INS 3 AFFORDIN13CO1VERAd�� NAPCt3 CENTERVILLE MA 02632 INSURER A: AIM MUTUAL INS CO 33758 MIMED 1 STEVEN L MELLOR INSURER 8 SURER IN : MELLOR SUILDING&REMODELING INSURERD: P 0 BOX 627 INSURER E CENTERVILLE MA 02632 INsURERG: COVERAGES CERTIFICATE NUMBER: 291934 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF I4ISURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTYgMSTANDING ANY REOWREME T,TERM OR CONDMON 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, EXCLUSKMS AND CON®ITIONS OF SUCH POLICIES.UlWITS SHOM MAY NAVE BEEN REDUCED BY PAID CLAIMS. R TR TYPE OF INSURANCE POLICY AI MMER PO PED -ftAR� Lrt9nS COMME<RCPmL GENIAL LIAUILnY EACH OCCURRENCP'_ S CLAIMIS-MADE O OCCUR E u $ _PR • - - MED EXP Ift one person)$ W/A PERSONAL S AOV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ]70TIER: Y PRO- . dECT LOC PaonucTs-CDP�Pre�Aaan S g AUTOMOBILE LIABILITY COM8INEDSINGLE LIMIT S c ent ANY AUTOALL - EODLYTIJURY(PW.parson) S y AUTOS NED �OSULED /!� _ ®DOILY INJURY(Poe acdldesW)-$ MREDAUTOS AU70S � PROPERTY DAMAGE Per S LUBRELLAL 6 OCCUR EACH OCCURRENCE $ EXCESS LIAS CLAIMS4AAOE N/A AGGREGATE $ DED RETENTION TIOKKOAU COWFENSAMN pp�� S AND EMPLOYERS'LIASILRY YIN X STATUTE ER _ A OAFfPROPRCER/Ml RIDARRTNEIZ CUTIVE NaA NIA' WA €.L.EACHACCIDFNT $ 1,000.000 (MWsberI�IM) AYti9C40070355822018A 06/17n018 06997f2019 61ce,dawbe undw E.L.DISEASE-CA EMKOYEE $ 1,000,000 DESCMPTiON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 N/A DESCRUMONOGOFEMTIOUSALOCA'ROMIVE4 0(dCORD909,9@dot®FBIL�xcro �Pee�l�a,rrou� ® asWau9[Rw[ ag oEea®ypa7rs� tfHoskees'COPta ns�etP®n beaue �eaill paid 8Pt&�a ssaohaso�s eenplsyees euPiy.Paae�Pe L�Q t®E ido t PTPent WC 20 0 l 06 B, to eeae44a Fa6 n® I� r®e Qo pay sme Qor Cl arnployme In steps other rrhan Magneh Ise If the Ins led Mime,or has teed those employees outside of Massachusetts, au(Qaorugara®n. This ca ftFle of Insurance them the Percy In forca on the dele the tlft cePIfficato%Ms LSSP6ed(unless the expir4ion dato an the above policy precedes the Fssus date of Fhls osrttR�4e of Ba�Praoe®p. T1Yue P lus of this cmveomge can ho mmitwed dpily by eceessing fe Proof of Coverage a C®vv&Mge Veriblcatlsn Search tool at aast�earPasa.goa�erEser�oonpensPaOonfFnvest(�tlonsF Sole proprletcr fiat eot elected covemp. CEQ4Fl CATE HOLDER !4AWC:+'ELLA jow @N@ULD AMY O?`N9 MOB DR@CRIp®FOLICEa RE CAMCIFL&RD RNFlRE MIID 19WOM-ROM 0 979 `u�GIMI9OP, NOOTO02 WILL 92 99L 9MR[O N Town of Ba mstabls ACCORA1MCEMTNr gPOL'I.IOYPROMngj(D & 200 Main St + AtWP20DPt�i9AVI49E Hyannis ' AAA 02601 ..:•. Daniel PrA.P;r y,CPCU,Mcs President m Residual Market®WCRIBMA C�OORp0�3G°JWN. APO Agme m aeuved. AC8R0 35(3614/ij1) The ACORN name and logo are regietered rrruhs of ACORD I C1Lie Coar��zoaaeaeeclC�o�C�/��ce�aczc�ecae�. \ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR T ype: Individual __k-96stration Expiration _ 1T76iQ 11/02/2018 Steven L Mellor,"� r Steven Mellor 'F, 199 Percival Dr ,,'r W Barnstable.MA.1. Undersecretary i a.tn;eu6Is;no4;inn pyen;oN 9LLZO VW`uo;soe uol;eln6aa ssauisn OLLS a;fnS-ezeld)IJed OL B Pue sne4V JawnsuoD;o aalno :o;wn;aj puno;dl •a;ep uol;ejidxa 041 ajo;aq /(luo asn lenpinfpui-10;pilen u01jejIsl6ay ' Commonwealth of Massachusetts Division of Professional Licensure ~ Board of Building Regulations and Standards Constw,6t-1 ri�'SO4Dervisor CS-049879 E��pires: 05/22/2020 STEVEN L.MELLOR i',, •f P.O.BOX 627 d1+� , CENTERVILLE MA 62632 -" N Commissioner c L i 4 �-/II��T �I��i�J ti,��- � ��ti1�C�� , 1 `��v �� -�7A OFIKE ,,�,GEMEAfp OE4 ,Z 9 P BARNSTABLE, ` c a MA89. m z FD MAr VVV��' '9. '1 Town of Barnstable OF BAR Growth Management Department `' L`" `'' 'i``=`-'i`" Barnstable Historical Commission www.town.barnstable.ma.us/historicalcommission L0_5 _B 3 ';i 11 2:: COMMISSION MEMBERS: Jo Anne Miller Buntich, Director Laurie Young,Chair Marylou Fair,Administrative Assistant , Nancy Clark,Vice Chair —� Marilyn Fifield,Clerks George Jessop,AIA } ; Nancy Shoemaker tYF' D Len Gobeil + Ted Wurzburg Paul Arnold,Alternate .ten DECISION -77 Summary: Demolition D ay Not Im'3F ed Pursuant to Chapter 112 Historic Properties, S ion - Applicant/Property Owner: Steve Jenney, Oceanside Inc representing owners Rosario& Rosetta Celentano Subject Property: 69 Washington Avenue, Hyannis Assessor's Map/Parcel: 287/085 Hearing Date: January 20, 2015 Pursuant to the Barnstable Historical Commission Chair's determination on December 18, 2014 a duly advertised and noticed public hearing was held on January 20, 2015 to determine whether the significant building identified as the single family dwelling on this property is preferably preserved and whether demolition delay would be imposed for the partial demolition of the dwelling on the parcel addressed as 69 Washington Avenue, Hyannis., After review and consideration of public testimony, application and record file, the Commission by a unanimous vote, found that in accordance with Chapter 112-F the demolition of the portions of the single - family dwelling, i.e. the foundation, is not a preferably preserved significant portion of the building. The portion of the single family dwelling to be demolished is the foundation to allow excavation due to an oil spill. The house will be lifted and a new foundation constructed. The house will return to the original footprint upon completion. In accordance with Chapter 112-3 F, the Commission determined by a unanimous vote that the demolition of the foundation of the single family dwelling would not be detrimental to the historical,,cultural or architectural heritage or resources of the Town. i!MU wr i Yo-u*t.g February 05, 2015 Laurie Young, Chair Date 200 Main Street,Hyannis,MA 02601 (o)508-862-4786(f)508-862-4784 367 Main Street,Hyannis,MA 02601 (o)508-862-4678(f)508-862.4782 i ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel _ U TOY";N OF BARidSTABLEpplication # Health Division Date Issued 1S Conservation Division Application Fe Planning Dept. Permit Fee Z . Date Definitive Plan Approved by Planning Board ``a �• Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner c Address �� rdyz'i Telephone Permit Request r / Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay --Project Valuation - Di�) 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: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name,, t �,/,?,2,�_-Telephone Number Address - License #A h-rP 6V -r Home Improvement Contractor# ol07 o Email AM a— Worker's Compensation # y Q�, (- -ALL_CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE) DATE r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED i MAP%PARCELNO. ADDRESS VILLAGE s' r OWNER ' DATE OF INSPECTION: FOUNDATION i FRAME yy INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL w ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. • 3 L bag WmhhVt r,SYreet Bra 12.E wnw mamgavld ra wurke& cumpens6m ISsm-,mce avEL RuilclersfCanf7 act r&Uectricrans Members AUpilkaut Infarmatian Please aly Na=giu�_Ib' le." Addr-ess-_ 8 Are 7 y arteimplayer?Checkthea :gniateb&= T o£, a'ert r k I m a employer ia ? 4- ❑ I ffi a geamal cniracfx and I E New c nsfaxc , errrployees{full andtorpnf - -)* hour:hiae&the �-❑ I am a sole propfietor orpartner- listed on the aftached sheet y- ❑Rtandehsrg ship and have no employees Thy mb-ooufren q have g- ❑Demniitioa WoAig forme is auY capaet,_ employees==have.wofkers' 4_ ❑Buildmg addition [Nc worms' comp_in==e comp-mc�l 5. ❑ We are a eorporatianand its Electrical repairs of addifians �_❑ I am a ham v her doing aII xii officers have exercised their I I❑Plnmhing repairs or�ddit%ns myself [No tvorha'comp_ �•of e3-emp ad per n-a a I2-❑Roof rgmifs c 157,§I(4),andwefras�go 1� �a 13--0 Officr comp-insurance r5quitz3_j �Auy�pbzsaf thatchacxsbar-1 most 5.0 fm anttha sectioab:I�shr fi�r�workea''comnemstiaapoly-iailm?ti Ffo-metxwne_+s atxr,srbsit-his cis— i cst g y aamg II r^ eni ths*12* anSsiL tong c most snhnst a new aigdscst ma3tsL sash_ tCzntDLcms thst rh.rk this bbc mast stisrhed sn a 3 ii ri, A�sheet shvirmg the n of the sat�co3 an3 state uhati ac2iai fruasg kr fi v¢ _ �Iv}�es•- Ff the snIrca.rtffidus bs^�emplo�ee�fht��must giwide tbeh-wnrh�rs'tong.p oIicp mnabar_ :I tarn rara..,rrTpInyes rhrctis prasrg trorkets'r-orarpgrtsrrhort ireszcrrrree$fcr �,erryacs. �eiotr is fhap�h ,artd}o6 sits ' tr�`nr�rtmtir�tz< InsnrasLce Compafry2�£a�e: / ., Policy#orsettiIIs_uc-4-, (D ExpiratiDmDate. off/ S .lob Srtz Adders_ - CzigfSiatelZ-rg_ All, At tach a copy of the wGrkerg'winpenutim polity-decfaration page-(shoNving the policy it er xffd taon i�ste): Failure fn secure co�efage as r�quired.nnder Secfio�z SA of I�C'rL c L52 can lead to the ir�pasi-tiara of criminal pe�affies of a . fine up to L�00.0t}audlor one year imptsso ,as�veIl as cazn1 pesalfies in the foffi of a STOP WO=ORDER_and a fine of up to S250.00 a day against the violator_ Se aftised that a copy of this datemcu-maybe forr-arded to the Office of Irrresfig tions of the DIA for T77!�coveraz vedEcation- T do FaRre crrtrfp utcde�t as s ru p es irr f$atfhe irtforracc iwnprcnidgd abiz a cs truce rmd enrrsct s:guatm-e c ff c-iuL Erse uti£,}. Da trot trrifg if,fFus area,to ba campleW by cif or tmn official ci£y=or Town: P=mitlicense# FS.�$utho-rrty{�cIC ane�: . . LBwxd4f$eaItl[ 2.$uW gDepmalmmt 3.CitpTawnOrrk 4.EIectncalJnspector S.PhuBbiugh Spector 6.Other Coact person.: Fh w#_ f lassachuse aeral Laws chapter 152 requires aTI employers to provide workers'corapmsafion for their evjploXVDE s: Pnrsaa>�to tizis statrte, an anpfuyee is defined as c__eveaY person in fhe service of aaother under any contr-..Ctt ofbire, e7qn-ess or iizplied, oral or writeo-" An mVTzyr,-is defined as"an individual,partnership,association, corporation or other It entity,or any two or mare of the foreguomg eagaged in a joint enterprise,and iacluding the legal representatives of a deceased employer;or the receiver or trastee of an individn partaersbip,association or other legal entity,employing employees. However the owner of a dwelling pause baving not more than fhree apartments and who resides therein, or the occupant of the dvwellmg house of another who employs persons to do mainfeaance,construction,or repair work on such dwelling house or on the grounds or building agpurinnant lcmto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(G)also states thAt'every state or local licensing agency shall withhold the issuance or- renewal of a ficexxse or peradt to operate a Business or to coazstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance-with the insurance.coverage required." Additionally, MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shag enter into any contract for the perfonnan.ce of public work until acceptable evidence of compliance with the in urn-ance -(--c rerueats of this chapter have been presented to the contracting authority.' A-Pplicants Please fill oust the wox$ers' compensation affidavit completely,by checking the boxes that apply to ycsr situation and,if necessary, supply sub-contractors)name(s), addresses)and phone nunnber(s)along with thew ce bdficaic-'(s) of insurance. Lhnitbd Liability Companies(LLC) or Liin e Liah2hy Partoeis s(LLP)withao employees other than the members or partners,are not required to carry workers' compensation insurance_ If an LLC or LL`l'does have employees;a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation ofinsm-ance Coverage- Also be sure to sign and date the affidavit The affidavit should be retinned to the city or town that the application f6r the permit or license is being requested, not the Department of Indus vial Accidents. Should you have any questions regarding the law or if you are required to obLin a v orkers' compensation policy,please call the Departoaent of the number listed below. Self-insured companies should enter their sell in�nce ficense number on the appropriate at. City or Town Officials . Please be sure thaf`the affidavit is complete andprirT d Ie�ly. The Departrnent has provided a space al the bof m. of the affidavit for you to fill out in the event the Office of Inv estigafions has to contact you regarding the applicant_ Please be sure.to fill in the pe>mitllieense rumber which will be used as a reference nuraber. In adffition,an applicant that must submit multiple permitllimnse applik�- ons is 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 stanped 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. Anew affidavit must be tilled Dut each year_Where a home owner or citizen is obtaining a license or permit not related to any business or commercial ven ure (Le,a dog license or permit to bum leaves etc.)said person is NOT reg1ri d is complete this affida)dt The Off ce of Investigation would at to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give tis a call The Department's address,telephone and faxnurnbe7 4 Thy CQn7fiftQawt a OfMassachus�tt� Dgailmeat ref IiidaLtcjaI AQuidc�,nt ofxcv ` tFan �0��sbingtarz � Boma,IAA 02111 F=9 617-727-- 4-q Revised 4-24-07 15,W-govidia r • ELIEDWesra, • t., Town of Barnstable Regulatory Services Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,-MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Z�) as Owner of the subject property hereby authorize �� S- VO =I't C ' to act on my behalf, in all matters relative to work authorized by this building permit application for: x (Addres ob) / ature of er Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit formAsmokeearbondetectors.doc Revised 050412 Town of Barnstable Regulatory Services pU b Richard V.Scali, Director Building Division sexxsrABM * Tom Perry,Building Commissioner MAM �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": - -• -- — _._ name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code " ended to include owner-occu ied dwellings of six units or less and The current exemption for homeowners was extended p s; to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildin:;permit. (Section 109.1.1) e ' for compliance with the State Building Code and other The undersigned homeowner' assumes responsibility p g applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0'Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. 02/20,/14 . 1-1:24 FAX �002 rNWrr Y-------.-......wr Since 1971 Ili office Use Only i %�I KOMI & ; roD rlvrv�� . I /� ,ry ¢ ,'�y I I Restore Vioi/l L-----------ram»----J 217 nomtmi JMvo,Hyauldo,Musa.02601 6d8-7'71,9�1,0 80046"818(MA.Only),774470-2211 Pax ASSIGrUMNT AND AUTHORIZATION TO PAY The undersigned, herein called claimant, has authorized and ordered from Oceanside, Inc. , the materials and/or servioes requeated as per attached scope. Undersigned hereby assigns to Oceanside, Inc. any unpaid proceeds due or to become due, under the claimant's policy with the insurance company to pay direct to Oceanside, Inc:. or to include its name on a check or draft, for all requested work. In the event that Oceanside's claim herein is not covered by, or paid by, an insurance company, claimant agrees to pay Oceanside, Inc. within sixty (60) days after work has been completed. Claimant understands that Oceanside, Inc. is working for them and not the insurance company or the adjuster. Payments remaining due and payable after the claimant has received payment from the insurance company shall bear interest at one and one-- half (1--1/2%) percent per month. In the event that there is a breach by either party, of any of the conditions of this agreement, either party shall be entitled to recover, as additional damages, attorneys' fees, costs and any other collection expenses reasonable and attributable to said breach. If payment is not received within 60 daye, collection action will commence without further notice to the claimant. aIn 4-7 LOSS/DMAGEADDRM-04 f �� oaf C'a9n rn 0(4'8'43 MAILING ADMOS (8%XZXXG), CITY STATE ZIP S VL-- 0 4�tr r►Cc,ll.- t�La.� ► -"77�p"1 '{,3 INSURANCE ADJUSTMR'S NAME CO. LOCAL INSURANCE AGEN'CY NAME p PRINT NAME INS. CARRIDR POLICY UNDERWRITER PHONE: aC�`7 ��a � $ t�J EMAIL: 1�YLtdlcc a-ar �----- is/Lv I v7: WORK ORDER *** .m 0 &l IN Order# : 14110000083 Craated/LST Chgd: 11/17/2014 8:51 am APO ./_Date of Work: Customer Status : Active - O Inquiry*y` '' DCAPERELLO . Service : Water- Regular Metered Appointment Date: l2/I7/2D%4 Time; C Customer: ROSARIO D CELENTANO COMPLETED CODE: L� , Customer Number: 602760-1 COMPLETED BY: HYANNIS PORT MA 02647 'Complaintant ROSARIO D CELENTANO• Phone: (508) 771-3110 Priority : I. Unclassified ATTENTION.,, Cycle Currently Being Billed : From: 09/24/2009 To: 09/25/2009 OR14*114AL MET91t ON VREMjVj[$ ORIGINAL REMOTE ON PREMISE Serial# : 67049296 Seq: 01 Meter I/O : 0 Serial# 1487428900 Srt 30010700 Size : 5/8 Make: Neptune Size: 5/8 Make NEP Last Rd Dt: 09/24/2014 Tap# : 552 Location STREET SIDE Last Set Dt : 08/13/2014 Location: BASEMENT Last BIIle I Rd. 0 Out Rd: Rem Out Rd METER INSTALLED REMOTE INSTALLED Serial No: N/U : Jumper? . UOM: Serial No : N/U : size : - Make : Dials : Direction: Size Location : Make :. Meter Type,, Location Reading on Meter: Read Type: Reading n Remote MATERIAL USAGE READ INFO I Last Rd Dt 1: 09/24/2034 Last Rd Dt 2. 08/13/Z014 Qty Part# Qty Read: 0 Read: 1318 Taken use4 COMMENTS: OCEANSIDE RESTORATION CALLED EGAROINO NEEDING A LETTER STATING THAT THE WATER WAS SH T OFF AT THIS ADDRESS BECAUSE THEY WILL BE LIFTING TH HOUSE ON WEDNESDAY NOVEMBER 19, 2014. 1 LOOKED AT T E ACCOUNT AND NOTICED THAI IT WAS NEVER SHUTOFF I CALLED OE TODAY AND ASKED IF THEY COULD DO IT TODAY_THERE ARE GUYS OUT THERE WORKING AND ALSO THERE IS A LOCK BOX ON THE HOUSE THE NUMBER IS 310_ TEST MIN METER I TANK FAST I SLOW TEST MIN METER I TA K FAST J. SLOWC SEWICE CONNECTION REPORT DATE SER CE SIZE: SERVICE REQ.#: J.4110000083 SERVICE KIND: ADDRESS: 6o WASHTNOrruu Av= EXT NTION STAT: HYANNLS PORT IdA 02047 MAIA SIZE: ACCT# 6D2.760-1 MAI DEPTH: TAP#, M TAP TO CURB: TAP BY: PLUN BER: DEPTH-TAP: INSP BY: DEPTH-CURB: INSP DATE: FOUND WALL: RECEIVE_ N0. 8494 11/18/201.4/TU$ 10 : 23AM Oceanside Since 1971 - 217 Thornton Drive Rear Building n idea Hyannis,MA 02601 Phone:508-771-3110 Fax:774-470-2211 info®ocaansideinccom Restor i l FAX Fax Transmittal Form To: ff�� h - From: V Phone number: p Oceanside, Inc. Fax number: Message: .,,.. ..... Lct5�1 1(;Vw -T'�M alltuati- due 40 /S�6 4a� jk-1)T— be � Ga's 5 2014.11.25 09: 05 AM PAGt. 1/ 1 Tom Sullivan Electric LLC PO Box 946 Cotuit, Ma 02635 508-477.3300 Oceanside, 11/24/14 We will be available to maintain the grounding system for the property located at 69 Washington Ave. Hyannis throughout the process of raising the building: Thomas Sullivan RECEIVE:' NO . B527 11/25/2014/TUE 10 : 18AM Oceanside nationalgrid June 17, 2014 Attu: Heather Atwood/Global Remediadion Services, Inc Rgo fig Washington Ave. Hyan i�p s., MA This letter is to notify you that the gas service located at 69 Washington Ave, Hyannis, MA,was cut and capped on the property on 6/16/14. If you have any questions, please feel free to contact me @ 508 760-7463. Thank You, . Sarah Brillsnt Gas Customer Fulfillment National Grid 127 Whites Path S. Yarmouth, MA 02664 Tel#:508 760-7463 Fax*508 394-5019 f Dec/li'201� 7:37,36AM Solarcity781-826-2989 2/2 N-STAFM HL He rRIC GA S ATTACHMENT 2 CERTIFICATE OF COMPLETION SIMPLIFIED PROCESS INTERCONNECTION Ill"Intion Information ❑ Check if owner-installed Interconnecting Customer: SolarClty Corp. Contact Person:Interconnection Admin. Mailing Address: 3055 Clearview Way Location of Facility(if different from above):298 Oakland Rd City: Hyannis State: MA Zip Code: 02601 Telephone(Daytime): 702-703-8981 (Evening); `Facsimile Number: 650-240-1672 E-Mail Address: interconnection.ma@solarcity.com Electrician: Name: SolarClty Corporation Mailing Address: 24 St..Martln Drive City: Marlborough State: MA Zip Code: 01762 Telephone(Daytime): 774-258-8505 (Evening): Facsimile Number: 978-429-0898 E-Mail Address: mmarkham@solarcity.com License number: MR1136 Date Approval of Install Facility granted by the Company: Application ID number: Inspection: The system has been installed and inspected in compliance with the local Building/Electrical Code of Hyannis (City/County) Signed: Local Electrical Wiring Inspector, or attach signed electrical inspection Name(printed): Date: As a condition,of interconnection you are required to send/fax a copy of this form along with a copy of the signed electrical permit to the following person at NSTAR•Electric: Name: Joe Feraci Company: NSTAR Electric Mail 1: One NSTAR Way - Mail2: Mailstop: SW360 001, State ZIP: Westwood, MA 02090 Fax No.: 78I-441-8721 Reylsed Septetx�EsaR 25,2QQ8 Rage 7 of 7 Expedited/Standard Interconnection AppliCa6.Qn I/ IG r q4- '4`7D- 0a-I From:NYANNIS WATER SYSTEM 47 Otd Yarmouth Road, Hyannis Phone® (508) 775-0063 c Fax: (508)790-1313 To: �� Subject: Date Fax: Pages( eluding cover): Urgent[ j For Review[r}� Reply[ M : m MIIMGIi1i1:M6i�u'Jul��tp��MI Cud I MIN J,G�''`��l�f . Owi4i'uvw.4r'�Vl� � ? �- ,� ha,U 1 Y y .50 e- Z 3 6- D®6 . l RECEIVE : NO. 8484 11/18/2014/TUE 10 :23AM OceanEide ...... ...............✓..u. .✓ ..J.u.,u ,u.,r.. - ✓u,i u�uu�� - - .-1- - -...vu .. .✓✓✓ vI ✓.✓, .0u✓i . . emu. . J v v Client#: 270173 HAYDENBUIL2 MIDDIYYYY) (M ACORD. CERTIFICATE OF LIABILITY INSURANCE F AT E 1 E(M/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS S CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES E 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 NAME: HUB International New England PHONE g78 657-5100 FAX 978-988-0038 A/C No zt E : A/C N.: 125 Route 6A E-MAIL Sandwich, MA 02563 ADDRESS: 5O8 888-2244 INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Hanover Insurance Company 22292 INSURED Hayden Building Movers Inc. INSURER B:Safety Indemnity.insurance_Co 33618 INSURER C: - - P O Box 496 COtuit,MA 02635 INsuRERD: INSURER E: l INSURER F: - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: �c7 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 CONTRACTOR 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD - POLICY NUMBER MMIDDIYYYY MM/DD/YYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY _RAMAGE TO RENTED REMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $' GENERAL AGG_F;L ATE $"' o---� µ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-C-_l�M,lOP AGG $� POLICY JE' LOC r_r T g AUTOMOBILE LIABILITY 3952835 12t31/2013 12/31/201 Eo e'(".DtsrNPyL.LIMIT $1 000,0001 ANY AUTO BODILY INJUIS (? r person) $4 ALL OWNED X SCHEDULED -AUTOS, AUTOS BODILY INJURY(P accident) $ r� _ NON-OWNED PROPERTY DAMA $ HIRED AUTOS . AUTOS Per accident 6d3 UMBRELLA LIAR OCCUR EACH OCCURREN $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ `j DED RETENTION$ $ WORKERS COMPENSATION - - WC STATU- - OTH- AND EMPLOYERS'LIABILITY Y/N .. To RY LI ITS ER ANY PROPRIETOR/PARTNER/EXECUTIV'E E.L.EACH ACCIDENT OFF CER/MEMBER EXCLUDED? ❑ N/A $ (Mandatory in NH) E.L.DISEASE-EA EMPLO $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Scheduled Equip IHN6795903 _ 11125/2014 11/251201 Total Limit:$249,230 Deductible:$1,000 Actual Cash Value DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Refer to schedual of equipment for individual equipment limits on policy#IHN6795903. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ' Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S12.63107fMI258377 DKO04 BARNSIkB,LE gEo � Town..Of 13218'i.s:ta l �,�.�,. " RX Tj Grow&Management Department Barnstable Historical Cammission www.town.bamstable.ma.us/histodcalcommission 2014DEC• ,t' ;'i`� ,NOTRCE OF INTENT TO DEMOLISH,A SIG IFICANT BUILDING Date of Application 1'Z -I5' Zo Full Demotion, Partial.Demolition Building Address: 61 tA1g_-4n5 ie- Number Street Village an 20 LP Assessor s Map# � � Assessor's Parcel �# � C Property Owner: ZoScrro Cefen-CAvio Name Phone# Property Owner Mailing Address.(if different than;building address) 9 I q.,,n-evu trine 14,11 Property Owner e-mail address: re:el ^'{ mG r 1` Cowi Contractor/Agent 0__(211k1'1 SfcleeS Contractor/Agent Mailing Address:. t;2! 1or�t on �t v z Contractor/AgentContactName and Phone#:: S"4vc -Terine - 77e-311u Name Phone# Contractor/Agent Contact e-mail address: 74e ve- @ c5L�grtSl�El � -<<?►')'1_ Detail of Demolition Proposed: A ee S io/e `54vucAj,.i- So, I rP.q?cva o /� _Rr,c_I/ To U'j.:" f 41-1. GJ� �� P �A 107 4 S gj. y�P'r✓t¢, ts' wo,- Type of New Construction Proposed: S'kc>brn ei -+- L cs Po". ' Provide information below to assistthe Commission in.making the required determination regarding the status of the Building in accordance with Article 1, § 112 I Year built:_ r l 5r t 3 Additions Year Built: Is the Building listed on t e ,ational Register of;Historic Places or is the building located in a National Register District? No F Yes 1II • '. nS'� .. _. %�L. Pro yOw er/Agent gnaturet. .: May,2014 Y �. i FORTH .B b BUILDING :area Form no. A 59 MASSACHUSETTS-HISTORICAL COMMISSION 294 Washington Street, Boston, -MA 02108 n`.r ar• .T, �� ;`�'�'' -� r• � cwn �a7.n�:r'hh�P (t�z��...,.,.�.e a^Ttl ddress shin. tnn �. , F ►!ann? " �nr .. Historic Name F.G. I}a,:1inRton lio»se :Use: 'Original H.Omestead ;�• L r h ' Present. Residence 363arlo r. Celentano • _r' ``� flwnershiv �[Q Private individual Private organization �— - °{ Public _ f• Y'J.,}yy� nFl.,-•il ie �. ,RM. 1 3� .wl .*Y =lti i .- :. Original owner Draw map showing property's DESCRIPT.ION: . location in relation to nearest cross streets and other buildings Dater C lisa, or geograp'ncal features.. Indicate north. Sourcl C•ral. History—F..G. Larlin; tan -Style 4ueen Anne �( architect Exterior wail_ fabric Vinly sid_incc v p�oQ a u ° v o Outbuildings p0 Major alterations (with dates)_, . ManY'altf%rst.tons f ter, 10) . Moved I Date Approx. lacreage, •39a _ Recorded by Laurie ?.. Snowden Setting_ esident al area Organisation arnst.able histories Date Ausust; lal Poo 3.' -1 A-, , (Staple additional sheets here) : F f ARCHITECTURAL SIGNIFICANCE: (describe important architectural features and. evaluate in terms. of other.buildings ,yithin community) This house is an -example of. :queen Anne styling.. The windows are 2/1, 1/1 and "various random sizes. In restoration. of Ithe home, Mr. Celentano removed the eyelid dormers from the top of the roof. The house features a 'widow's walk. There are two chimneys in the house, with two fireplaces. Additionally, the entire facade A.nd sides of the home are encircled by a porch. - The exterior of the. house is vinyl sAd hS. Since the. origi„a. construction of this house, there have"beef mery;ad-ditons .and renovations,. HISTORICAL SI(TIFICANCE (.explain the role owners played in local 'or State history and how the building relates to the development of 'the community): Frank Darlington's family came from Pittsburgh.:. Hi , father.'is be ieyed to have been involved is the steel industry.: They Darlingtons sum=er'ed .in: Hyannis Port from about 1895, to 1915. Shortly thereafter they became off and on year round residents., t. t EIBLIOGR4PHY and/or REFERENCES. Registry of Deeds=&arns:tabl'e County Barnstable County AtIsse 1907 Herrick, %Ul & Newman. Lsrrv, .C1d Hyannis Port, 1968. Graf History-Frank Darlington, Squaw Island. iris. , July, 1981 i 2or�-z/`so { PRELIMINARY PROGRESS DRAWING a NOT FOR CONSTRUCTION of I f - FIELD VERIFICATION REQUIRED {I ir11 La i o:a m Huraoow �r 1 �1 1,/ :°�jssmwc ffi$ i� i--- - - -= - — —. -- - qP!A SEYEII O FEEd�KIUftI . ,E'-N'd. I IlYAilY1 . O ' 7 H W � a pp EXISTING FIRST FLOOR PLAN EXISTING BASEMENT/CRAWL SPACE PLAN $y 3/16'm 1107 g�3 3/16'-1'-0' - } A _ 'y O , r IT Li , s �' .•..+�" � �" s, �"" fir. tl _ _,.,,�„,.... g .ai�` �+„ � �. x• re r ..,. ..n.!S!':'•"� , • .' ae ,." � �' .>..w.. a' ti•' wu�..�y*i�� s, '`�" - &�; ��. ," fi'"° J ...-.,�;,.w. '��urm+.�.a.,.:� d r p N ♦V� v a , a� I s � x f , x, �" ..^# � '.., ✓' � .,"_ a p �rF:�- ter& �''' _ .,. .. - , k,'' . F . 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' �f�� ff f,�.t�'F�'� �* �q( l-.f �•`' i�J.' .a�..l�• •, rho.. ac i ir' `� �t+�' r>iy.X • h t�r'"Ex'' `,T +,yrq�,« r '!'}+1" «•g�'1`S' s +`. ,a 6fi!;�j c#t.P�f';t.�+.."`Bt�'..&i' `,a� t��'�7"1►�q"i." s��r"S�,�° "�9P •; q�' t4-1 xi ✓a. 1.��=t'.Y tt �i �* S,yA t:h"��cif 1 �,�rlpy@"`�S. �� 4 h��C. *.� e 1 { ,• „ij-, F ttyt'' �.{ ��t r �r_`s � �i_h'`�r �cj�' �"t w "pit3i.�,♦ � E Y` •�: r >t� !'#'� r f •tsa.n �j'rej fa.. a��t� '�� u 7 A i Ir jr asap.. z • x w 1 ^ M1s k rf+i r s 1 � 71 ol q4 ,�d d v a, =--...� jo- v a . �^ L« • .... ��1�w4� �I�� INX�Q ��1NQ )� rur .r•. l �� PxIYIMm I�WPll7�'�VYtl7Gf07P�°d''liT�4�'11 ga�P^^�I.wl6'woC➢�V' k , r. �, ry Town of Barnstable \ ` �STABLL Growth Management DepartmenteBARNSTABLE �. 9 1639 ` Barnstable Historical Commission o r� www.town.barnstable.ma.us/historicalcommission. Jo Anne Miller Buntich,Director Marylou Fair,Administrative Assistant COMMISSION MEMBERS: Laurie Young,Chair Nancy Clark,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Nancy Shoemaker Len Gobeil Ted Wurzburg Paul Arnold,Alternate December 18,2014 Re: Intent to Demolish Portions of Foundationa' a'�;� } ,TI ¢, J �I �.. 69 Washington Avenue, Hyannis Map 287, Parcel 085 Steve Jenney Oceanside Restoration 217 Thornton Drive Barnstable,.MA 02630 Ann Quirk,Town Clerk 367 Main Street, Hyannis, MA 02601 Thomas Perry, Building Commissioner 200 Main Street, Hyannis MA 02601 —^ Pursuant to the attached decision,please be advised that the Barnstable Historical Commissioamil`hold a pu jic hearing on this matter on January 20,2054 at 4:00pm,367 Main Street, Hyannis,2°d Floor, SelectAen's P 0 Conference Room. erg This public hearing will be advertised,notices sent to abutters and a notice form will be posted o the buildingor other visible site on the property The applicant is responsible for advertising and mailing costs associated ylt h tht pubic hearing. Please contact Marylou Fair at 508.362.4787 or marylou.fair@ town.barnstable.ma.us for processing information. Sincerely, Laurie K young Laurie K. Young,Chair I 2,00 Main Street,Hyannis,MA 02601 (o)508-862-4786(f)508-862-4784 367 Main Street,Hyannis,MA 02601 (o)508-862-4678(f)508-862-4782 Town of Barnstable s 9 TABLE BAMSPABLE, ; Growth ManaMAE& gement Department BARNS�2014 ' `� 'Barnstable Historical Commission www.town.Barnstable.ma.us/historicalcommis�ion Jo Anne Miller Buntich,Director COMMISSION MEMBERS: Marylou Fair,Administrative Assistant Laurie Young,Chair Nancy Clark,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Nancy Shoemaker Len Gobeil Ted Wurzburg Paul Arnold,Alternate To _RK I: 20141, t0,i r. a rr r r Chapter 112 Historic Properties, Section 112-3 D. DETERMINATION of SIGNIFICANT BUILDING n 211-�sett Avenue, Hyannis Map 287/Parcel 085 Pursuant to Intent to Demolish Portion of Existing Single Family Home The Barnstable Historical Commission received a Notice of Intent to Demolish application for this address stamped by the Town Clerk on December 15, 2014. This structure, located at 69 Washington Avenue, Hyannis, MA was built circa 1893 and is known as the F.G. Darlington House. This Queen Anne style dwelling is a contributing building in the Hyannisport National Register Historic District and is architecturally significant in terms of period and style of the neighborhood. In accordance with Chapters 112-2 and 112-3(D), Barnstable Historical Commission Chair has determined that this structure is a significant building. 200 Main Street,Hyannis,MA 02601 (o)508-862-4786(f)508-862-4784 367 Main Street,Hyannis,MA 02601 (o)508-862-4678(f)508.862.4782 .. II a `J$A Town of Barnstable *Permit c'-a ?( ' Oo Expires 6 months from issue date SEP 1 9 2007 Regulatory Services Fee Thomas F.Geiler,Director tbWN OF UARNSTAE3LIEBuilding Division ° C� Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us . Office: 508-862-4038 Fax: 508=790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �f Not Valid without Red X-Press Imprint �t Map/parcel Number l/1 t/ Property Address Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address n?A)0 Contractor's Name, �'/'/�/c� �✓j ' Telephone Number i 2 n— �— Home Improvement Contractor License#(if applicable)_/ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 'I have Worker's Compensation Insurance Insurance Company Name Z,&1VZ4ff2Z� Workman's Comp.Policy# 9-�,k'Z J/Z Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) eRe-roof(stripping old shingles) All construction debris will be taken to -//VP,1.3-741_17l_ ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. py of the Home Improverrient Contractors License is required. SIGNATURE: . Q:Forms:expmtrg Revise061306 The Commonwealth ofMassaehusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111 . www.mass.gov/dia Workers"Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Organization/Individual) Address: f 2 -111SSyL �vj0 City/State/Zip: IIV /77 !!2 Z6U1 Phone.#: Are you an employer? Check the appropriate box: Type of project(required) 1, I am a employer with� 4. �] I am a general contractor and I aft have hired the sub-contractors 6. El New construction . . employees(full and/or p time). • 2.❑ I am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 1 g, 0 Demolition working for me in any capacity. employees and have workers' 9 .�Building addition [No workers' comp,insurance comp.insurance. ' required.] 5. [] We are a corporation and its 10.—Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right 6f exemption per MGL 120 Roof repairs insurance required.] t c, 152, §1(4),and we have no employees. [No workers' . .13.0 Other comp. insurance required.] . "Any applicant that checks box#I 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. 1C6ntractors 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 subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. _ Insurance Company Name: l/ISiZZS: Policy#or Self-ins.Lic.#: /��f� �_ Expiration Date: Job Site Address: City/State/Zip: /�Xrz T� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), Failure•to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify a r the pains•and penalties of perjurj,that the information provided above is true and correct: 01 Signature: Phone#: Official use only. Do not write in this area,'tb be completed by city or town official City or Town: Permit/License# r uing Authority(circle one): Board of Health 2.Building Department 3.City/Tovrn Clerk 4.Electrical Inspector 5.Plumbing Inspector Other ntact Person: Phone#: I Town of Barnstable. Regulatory Services a BARNSTABLE, MASS. Thomas F.Geller,Director �Alf1 µ. t+� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ""w-town.barnstable,ma.us Office: 508-862-4038 Fax: 50$-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property herebyauthonze /Pl//k0 ��` to act on my behalf, in all matters relative to.work authorized by this bidding permit application for; . (Address of Job) 911 a� ig ature of Owner Date Print Name Q TO RM S:O W NERD ERMIS S ION Date:7127'2007 09:30 AhI Sender's Fax ID:Northwood InsL ranoe pag_6 of 6 .ACORD CERTIFICATE OF LIABILITY INSURANCE OP►0 K DATE(MMICDf.-yfy) DAVID--2 07/27/07 PRODJCER THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Northwood Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 805 West Blain Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis LAN 02601 Phone*508-771-3.632 Fax.*508-393-2955 INSURERS AFFORDING COVERAGE I NAlC INSURED nJ_uRERA The Norfolk & Dedham Group INSURER Trwel�ta I".utance Conpeny IIJSURER David Cox, Inc. I --- P. 0. Box 401 u_,'RE� S Yarmouth MA 02664 IN5JRER H COVERAGES Tf-E POLICIFS OF!'J._UR,*ICE LISTED 3El JW HA.VE BEEN I.>UED TO T-iE IPJSUREC rlAt,IEC A,BONE=0R THE POLICY PERIOD INDbr-'ATED.',CTA'ITHSTANDI"iG AJJY REQU!REf-0E.'v1,T'RM 04.r rci I ION CIF AN1'GJNTRACT OR OTHER DOCUMENT•P+I'.F;RESPECT TC WHICH-HIS CERTIFICATE Y11,Y BE!SaLEE)OP MAY PERTAIN.THE INSURANCE AFFORCED EY THE F•OL!C ES DESCRIBED-1EREIN IS 3U5jEC?-0 ALL-HE-ERM5,EXC_GS10'4S,-ND CONDITIONS CF S1_0- POLICIE3 aG'3RE0A'E UPA!T8 C.<M14 MAY PAVE SEEN RECtA::EJ BY RaID CLAINV; POLICY NUMBER DATE i'h1rQ/D F.TTD1 LIMITS LTR NSR TYPE OF INSURANCE , DnTE(MM;DDIYY) DATE ifdMIDD:`YY) GENERAL LIABILire I EACH OCCLJRFENCE s yS 1,0 0 0,0 0 0 j rTJk�.'I. _ COI.?F?EGC AL GENE?A�i—_ BI ITr —?F.E.IAISES;Ea eccurence) —�5-$-5O,00 0 CLAMS MADE j OC^_'JR I I +.ED=P!Any^,parson) I;tiS5,0 00 A ! x !Business Owners i R00309545 03/14/.07 03/14/08 IPEPSCINAL8ACti'INJURY s$1,000,000 GENERALP.GGRB3Ar` G$2,000,000 GEN':AGG?EG.AcLIMTAFF_IESPER. I P:0D,.CTS-CCMF;OPA33 G$?_,000,000 SRO- I I i P'0! t—ICI 7 JF_T LOC I AUTOMOBILE LIABILITY I COk!B!Nc0 5!PJGLE LIMIT I A J1'Al. i (Ea woiden:) G ALL OVVNEC AUTOS SCHEDULEDAL'TC.r3 � I(Par p?I son i Hlo-<ED A.!-JTOS ! Brrl AIL"IN"R'i NON-OWNED AU70b iPyr a!r'imi G I I i ??OFEF.TY CAtoAGE I y. (Per axidanF � GARAGE LIABIL!TY i AUTO ONLY-EA ACID='JT •S t-1 ANY AU-0 I EA Av I I')THER TFi N _ AUTO ONLY: ASG EXCESS!UMBRELLA LIABILITfi EA.:H nCCI!RREW E S r j OCCUR CLAIMS MADEi H.GGPEGP.T= I I i G DEDUCTIBLE I RETENT ON $ i I' WORKERS COMPENSATION AND TCP.Y LIfA ITS ER _____ EMPL'�YERS'LIABILITY B ANY FROFIRiETC1`'!P-..Rl'N`-)E'XECI ,VE 6KUB910}C742207 i 07/15/07 07/15J08 iE.L EACI-ACCIDENT Is$100,000 LC OF=ICER/MEh4FER EXCLE5l I `_L DISEASE-EAE'fw_OYEE S$100,OOO If)res,deserb?under EC PL ESCVISPJNS banTb ! El DISEASE-POUCr!1i,11T 13$500,000 OTHER I I DESCRIPTION OF OPERATIONS I LOCATIONS,VEHICLES!EXCLUSIONS ADDED BY ENDOP.SEMEI`7 i SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POUCIE3 BE CAI MLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEA4CR TO M14L 10 DAYS:S'RITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,SUT FAILURE TO DO SO SHALL TOWN OF BARNSTABLE IMPOSE NO OBLIGATION OR LIABILITY OF ANl'KIND UPON THE INSURER,ITS AGENTS OR 367 t-01IN STREET HYANNIS MA 02601 REPRESENTATIVES. AUTHO R-PRESERW ACORD 25(2001108) cFiACOR.D CORPORATION 1988 ✓fie T�arrunrarureaCC� aacfucaef�a Board of Building Re;ulations and Standards License or registration;valid for individul use on.y HOME-IMPROVEMENT CONTRACTOR beforo the expiration date. If found return to: Board of Building Rceulations and Standards 12egistration 100497 Ez ira.�on One Ashburton Place Rn►1301 ': .. p 6/18/2006 Boston,Ma.02108 Type Prvate Corporation DAVID COX INC"-;" 1' r.: David Cox, a 191_N-JENDER LN W.YARMOUTH,MA 02673 _Deputy Administrator Not valid without signature