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Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project�Street Address I j9nf a(l l-e h i f14 Pa Village Owner an Address quy _ yrtf_4 9& Telephoneag- 1 002 Permit Request _An5Aa\� i)aeWC111 Olryll WWI Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuations Q Construction Type Lot Size Grandfathered: 0.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: ❑eXitting L ew ;srze_ t+. 4 :t.:'x : Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ c Commercial ❑Yes ❑ No If yes, site plan review# rwa Current Use Proposed Use. _ - �' 's --.--=ate APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name&>1QP'1(j Lajna Telephone Number IJ Address 4I Q &fz)-y e 5+ License # i63&C1 r Q ,1`N-0—r YYA Home Improvement Contractor# l Email Worker's Compensation #:T N ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO k 1 SIGNATURE ° DATE APR 0 4 2014 a FOR OFFICIAL USE ONLY APPLICATION# r s` .DATE ISSUED MAP/PARCEL NO. f t� ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ;T PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATECLOSED OUT r AS:S.00IATION PLAN NO. { E r _ . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 y0` Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Insulate 2 Save, Inc Address:410 Grove St City/State/Zip:Fall River, MA 02720 Phone#:508-567-6706 Are you an employer? Check the appropriate box: Type of project(required): I.❑■ I am a employer with 18 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.t 9. ❑ Building addition [No workers comp. insurance p• 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 LE] 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 Insulation/weatherization employees. [No workers' 13.❑■ 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. *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 the policy and job site information. Insurance Company Name:Guard Insurance Group Policy#or Self-ins. Lic. #:INWC311431 Expiration Date: 12/10/2014 Job Site Address. 119 Annable Point Rd City/State/Zip:Centerville,MA 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 certif un!er the ns and penalties of perjury that the information provided above is true and correct 4/4/2014 Signature: V Date: Phone#: 5085676706 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 y Contact Person: Phone#: I �--R CERTIFICATE OF LIABILITY INSURANCE °�'�'"""�°'�"�"' AC G►Rt7 � = 12/ll/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOWi 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 policAi.es) must be endorsed. If SUBROGATION 1SWAIVED;subject to tie terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the Cert(ticats holder in lieu of such endorsement(s). PRObUCER CONTACT NAME: Ahtholy' P. Cordeiro Insurance PHONE FAX 1 1 Pleasant Street E�C.�E I: 508) 677-0407 _ ,No: (508) 677-04090. Fall River, MA 02721 ' ADOR�ss: lbrizido:@cordeiroinsurance.com �^ ..� ... INSUPER(SI AFFORDING COVERAGE � NAICKT INSURER A:Atlantic Casualty Ins. Co. — _ INSURED INSURER B:Torus�Specialty Ins. Co. Insulate 2 Save, Inc. INSURER C:Great American Ins. 410 Grove St. INSURERD:Guard Insurance Group Fall River, MA 02720 INSURERE:. I NSU RER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS.,IS,TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE.MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _,... _ INSR IADDL`SUBR ,.. ..__._.. ..._ ---- -POLICY EFF PODGY EXP ._.---------- LTR TYPE.OFINSURANCE INSRIWVD POLICY NUMBER MMl9DlYYYY1 (MMiDD/YYYYl LIMITS A GENERAL LIABILITY y Y M081000174-1 6/12/13 6/12/14 EACH OCCURRENCE $ 1,000,000 000 DAMAGE TO RENTED' }(, COMMERCIAL GENEf1ALLAB 1LiTY CLAIMS-MADE n OCCUR ME EXP(Arty one person) $ �5,000 PERSONAL&ADV INJURY 1$ 1,000.,_0000 GENERAL AGGREGATE $ GENLAGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOPAGG_ $ 2,000,000 X!POLICY _ROT .17 LOC I $ AUTOMOBILE LIABILITY I NEU IN L L I $ ANY AUTO 1 BODILY INJURY(Per person) $ ALL"OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Peracadenq $ PROPERTY DAMAGE AUTOS __. Ii1R NON-OWNED EDAVTOS _AUTOS - (PeraCcidont) P?C UMBRETIALIA6 X OCCUR 78264D131ALZ 6/12/13 6/12/14 EACH OCCURRENCE Is 2,000,000 EXCESS LIAR CLAIMS•MADE AGGREGATE -—Is 2,000,000 DED..X . RETENTION$ 10.000 I-g D WORKERS EMPL COMPENSATION INWC311431 12/10/13 12/10/14 X I WC STATU- IOTH- AND EMPLOYERS'LIABILITY YIN .._......_TO Yi1MIT-0 _._ E.R_. ANYFROPRIETORlPARTNERIE)(ECUTNE E:L EACH A'0DENT $__ 500,000 OFFICE RUE MBER EXCLUDED? � N/A (MdMatorylh NH) E.L.DISEASE-EA EMPLO E_$ — 500.,000 'U'Ifyas describe under — - SkRRTION OF OPERATIONS below E.L_DISEASE-POLICY LIMIT $ 500,000 G tquipment Floater I IMP 375-99-76-01 6/12/13 6/12/14 Shop Storage 75,350 i Veh Storage 76,250 DEBCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is regri red) Proof of Insurance. Residential Insulation Contractor. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED .IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main St Hyannis, Ma 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 AC0 CORPORATION. All rights reserved, ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone; Fax: E-Mail: Office of Consumer Affairs and business Regulation 10 Park plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration,g on Registration: 166311 INSULATE 2 SAVE ExpType: DBA. ROLAND iration: 5l11l2014 Tr* 2a532 " 536 EASTERN AVE N FALLRIVER, MA 02723 DP6-6di A 60M oaiO4-a101216 Update Address and return � -- card.Mark reason r Address Renewal �"�`Employ fo ment i 'Lost Card" y Office f Conmer Affairs esr Reg - change, GNOME IMPROVEMENT CONT License or registration valid for individul use only %istiation: RACTOR before the expiration date. 466311 T te.Expiration: e: If e, rati � YP found p on. -.Offs and r r 5/1 Office return al2014 of Consumer Affairs and Businessrn to. IN D6A 10 Park Plaza- R TE 2 SAVE - Suite 5170 egulation• Boston,MA 02116 ROLANb LANGEWN 536 EASTERN AVE. FALI:RIVcR,1YSA 02723 Undersecretary Not valid without soot ign`ru eat - -- yassacbusetts -Seca.-- 13oa e^. = pub:,, eo7 4 R,g,aa7r0^S =nd Staarloarcis Construction Super-1"izor �cens2: CS-103861 y ROL,ANp LANGEVIN 536 EASTERN AVE. 4P Fall River MA 01 723 _ 08/24/2015 a r OWNER AUTHORIZATION FOR (Owner's Name) ' owner of the property located at 1 ' A / ,mil �1 h (Property Address) (Pro erty Address) hereby authorize SQ- (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. OWli7 er's Signatur Date RISE ENGINEERING FederalID#05-0405629 RI Contractor Registration No 8186 A division of Thielseh L:nginecring MA Contractor Registration No 120979 CT Contractor Registration No 620120 Alp 1341 Elmwood Avenue,Cranston.R1 029 10 �j�g��++ (401)7"3700 FAX(401)784-3710 CONTRACT l 5 Page 1 h '' ,�� THIS CONTRACT IS ENTERED INTO BETWEEN RISE • 1t` Z ENGINEERING AND THE CUSTOMER FOR WORK AS E N G I N E S 1Zl N G DESCRIBED BELOW CUSTOMER - PHONE DATE Clicln e Marilyn R Fawkner (503)648-17S3 11i27/2013 153327 SERVICE STREET BILLING STREET 119 Annable Point Road 119 Annabelle Point Roach SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Centerville. MA 02632 Centerville, MA 02632 3OB DESCRIPTION Provide labor and materials to seal areas of your home against wastelid.excess air leakage. 'i'his work will be perlbrmed in concert with the use of special tools and diagnostic tests to assure that your home will he leli with a heal ill luI Ievcl of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,roams,weatherstrippin2.and other products. Primary areas for scaling include air leakage to attics.basements,anached garages and other unheated areas(windows are not generally addressed.) (6)working hours. - At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower dour and/or combustion satety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $46100 Provide labor and materials to install n-lon weatherstripping and a doorsweep id)(2)door(s)to rest ici air leakage. S154.00 Homeowner is responsible for the removal of the stored items blocking the installation of weatherization work in the kneewall areas. Removal must occur prior to the scheduled work start. $0.00 Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(1 i4)square tees of kneewall area, $5O9.71 Provide labor and materials to install R-19 untaced fiberglass to(128)square feet of wall. Then install i"rigid board insulation. Seal all seams with FSK tape. S.i111.7.6 Provide labor and materials to insulate(3) back of the kneewall hatch with 2"rituid Thennax hoard.and seal the edge ol'the hatch with weatherstripping. )I27.`() Provide labor and materials to install ventilation chutes in(76)rafter hays to maintain air flow. ti'fii 34 Provide labor and materials to install(20)linear feet of R-19 untaced iiherglass insulation to the perimeter of the basement ceiling, at the house sill. Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2"rigid board that meets the sections R-316.5.4 and 316.6 requirements of building.code. Seat all edges and scams with FSK tape. »1.1 • • tl4 it`,t� � (.`. �:.�=3 I .._..� _ yg 1} _ I Federa1 10 4 05-0405629 RISE ENGINEERING j RI Contractor Registration No 8186 I`t A division of" 6ieisch i:nineerint MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,(':ranston,RI 0-1910 ��ooy�(401)784-3700 FAX(401)784-3710 COP CONTRACT _.,.oalm9 Page 2 R I - S E P ROt,l1ZAN'1 THIS CONTRACT IS ENTERED INTO BETWEEN RISE F-NGINEERING AND THE CUSTOMER FOR WORK AS C L,C-RC.S E NG I N E E'R I NG DESCRIBED BELOW CUSTOMER PHONE DATE Clint g Marilyn R Fawkner (508)648-1783 1 112W 013 153327 SERVICE STREET BILLING STREET 119 Annable Point Road 119 Annabelle Point Road SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Centerville, MA 02632 Centerville, MA 02632 ,JOB I)ESCRIPTION Total: $2,130.46 Program Incentive: $2,130.46. l i . Customer Total: WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***00/Dollars $0.00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE M FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. 00 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPICES 17 i G: AUTHORIZED SIGNATURE-RISE ENGINEERING - CUSTOt ERA F.PTANCE� r v} `7 NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OP ACCEPTANCE ! / �J -/.......:..:Z.._ ' v ✓ I ACCEPTANCE OF CONTRACT-THE ABU PRICES, ECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPT -YOU ARE AUTHORIZED TO DO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE.AS OUT NEO ABOVE ,;+'*' i f� 1 t.._u r� L r_5 --- - _— -- LU 1-1 ME tLLL1 _ e � drtAwO Foes _ _ a M w HOME IMPROVEMENT CONTRACTOR Registration 100285 Type - PRIVATE CORPORATION Expiration 86/15/94 Wenzel Framing, Inc. Mark Wenzel 45 Whidah Way ADMINISTRATOR Centerville MA 02632 t Assessor's office(1st Floor): s i Assessor's map ald 1Pt number O 63 a.:.i,Afte— { `THE>o` Conservation B �' w ♦M Board of Health(3rd floor): ���� �i� tt ;�t- Sewage Permit number f/ 1 !STALLED IN „ j ��ant Engineering Department(3rd floor): �/'T}i`�f°j�. House.number //�. L yc_..I SS. ; _3 Definitive Plan Approved by Planning Board APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only' TOWN RIEGUL TOWN - OF BARNSTABLE BUILDING INSPECTOR b4 tea._U APPLICATION FOR PERMIT TO C X TYPE OF CONSTRUCTION W ftFO d 19 _ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 119 Proposed Use i' Zoning District —'� Fire District Name of Owner Address Name of Builder +-�n mow+^ a Address Name of Architect Address Number of Rooms i Foundation Exterior (-s' a tL 4Lv,4,Ln Roofing Floors Interior Heating Q/y GM Plumbing Fireplace Approximate Cost ba 000, 00 Area 0 ire►+ ChA,.,Se 8' op Diagram of Lot and Building with Dimensions Fee J� r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Y-" 0-`A An2X_Q Construction Supervisor's License 0 Q Q 0 S GT $ FAWKNER, RACHEL �F [ ' No 3 5450 Permit For ADD DORMER } Single Family Dwelling r Location Lot #41 , 119 Annable Point ..Road-- ! Centerville x Owner_ Rachel. Fawkner - 1 ,Type of Construction Frame Plot f -' Lot ' October 16 3 9 Permit Granted 19 Date of Inspection` 19 , _ Date Completed ' - 19 r- -