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'ii, 1v Z'� , �i '� I-A ��NNWAAW-ml � � l�c�,,i ""I, -,� �, It,,.��lfi .� 13 � ,:.� -� , 4 -t.j�,i, I � - .. :� r', ��.�,,i, ., ,,-, " ,� iip��, �fp�� ,,,�1,rivn ";� Mv. ,11 - � 11 "V,l,iik��,,i'j , , I I , i,,,,� � 0 - - , i,�­,:�,i,V�,,--,f��J`�-�.`.--­,U l-10-V 1-1- " -I � I tll�:�: ., -� I .1 ��, t. I ,� l ��;;L I I l 111 I j f ���"5 ';'', ,If��, , " --�; I ".1 qm­-! ��;�'.�"",:,.4A,�,'��'t'tj ;' 'i`�� 4��4 " , I^,1 1, ;�,�;W' W;i i-.-,],� WMAMY44 , ; � , , - ,-11.0,-"i"it, �, il., , MAN 'I�",.')�ill",��""I'l"""'�,)��1 41 Ili, , ,, , ,­­ � , .I", i Q� I, , ," � ,", , `��`,�,�;Ii.,� "W"it"i , ,,, "ii ... v� �' � "I. A, `�i! ,� ���4 t, li� 4 , lQ ,,;i I �, MAW 20N. i, U Q i 1 f , 1 li;ev�,tl�i�i,�-,,io:; A0­ql;:,.;� ,Wh T st Town of Barn able wn Building Post This Card So That it is'Visible`From`the Street"-Approved Plans Must be'Retained on Job and this Card Must be Kept �aAWMABLE Posted Until Final Inspection Has,Been Made PerilYl� • � Certificate'(' Y .! 1 �i liJi Where a' f Occupancy'is Required,such Building shall N�otbe 0 ccupied until a Final Inspection has been'made r Permit NO. B-17-4003 Applicant Name: Ryan Lane Approvals Date Issued: 11/27/2017 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 05/27/2018 Foundation: Location: 23 ANTICO LANE,CENTERVILLE Map/Lot: 172-003-001 Zoning District: RC Sheathing: Owner on Record: DAVIS, BRIANA J 'k ContractorName : SKYLINE SOLAR, LLC. Framing: 1 =Contractor:License 172284 Address: 23 ANTICO LANE - • 2 CENTERVILLE, MA 02632 R Est Project Cost: $27,000.00 Chimney: Description: Installation of a safe and code compliant,grid-tied PV solar system Permit Fee: $ 187.70 ( , ; on an existing residential roof. 27 Panels/7.425 kW Insulation: � e � - i >Fee Paid> $ 187.70 Project Review Req: s: ' ".Date 11/27/2017 Final r Plumbing/Gas ri. Rough Plumbing: Building Official _Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the%approved construction documents for•which.this permit has been granted. "i Rough,Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access stree.t'or:road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. i Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:. * §, Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection _• k �,. ten-- - - " 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). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: ,f' q( y�, Town of Barnstable RE �PT a 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-4003 Date Recieved: 11/16/2017 Job Location: 23 ANTICO LANE,CENTERVILLE Permit For: Building-Solar Panel-Residential Contractor's Name: SKYLINE SOLAR, LLC. State Lic. No: 172284 Address: 4 CROSSROADS DRIVE SUITE 116, Applicant Phone: (732) 354-3111 HAMILTON, NJ 08691 (Home)Owner's Name: DAVIS,BRIANA J Phone: (732)354-3111 (Home)Owner's Address: 23 ANTICO LANE, CENTERVILLE,MA 02632 Work Description: Installation of a safe and code compliant,grid-tied PV solar system on an existing:residential roof. 2,7 Panels/7.425 kW Total Value Of Work To Be Performed: $27,000.00 w r Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Ryan Lane 11/16/2017 (732)354-3111 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $27,000.00 Date Paid Amount Paid Check#or CC# ( Pay Type Total Permit Fee: $187.70 11/16/2017 $137.70 XXXX-XXXX-XXXX Credit Card i 3253 Total Permit Fee Paid: $187.70 11/16, $50.00 1 XXXX-XXXX XXXX- Credit Card i 3253 �t Two, Town of Barnstable Regulatory Services R" MASS Thomas E' Thomas F.Geiler,Director Et69. � � Building Division Elbert Ulshoeffer,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 I ` fI SHED REGISTRATION 120 square feet or less . • � ,(17'",lC�v �fl /Ve 1�i� ��—'—�,��rtr2 v t ���1 Location of shed(address) Village 0 - ( 15 Property o ner's name Telephone number r9 3 - D6 1 Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? 'ap-,l Old King's Highway Historic District Commission jurisdiction? 0 -Af'->7 Conservation Commission(signature required) c S' p �� PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q46rms-shedreg // tv 4 ,t i :� �` I - TOWN .QF ;BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 000 000 116 ; GEOBASE ID ADDRESS 23 ANTICO LANE PHONE CENTERVILLE ZIP - LOT 1 BLOCK LOT SIZE j DBA DEVELOPMENT DISTRICT PERMIT 39403 DESCRIPTION SINGLE FAMILY HOME (BLDG PERMIT #31777) PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: ptr THE BOND $.00 CONSTRUCTION COSTS $_00 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE PIS ' t "-'�STABLE, +' MASS. ED M �► BUILDING DIVISION BY DATE ISSUED 06/28/1999 EXPIRATION DATE tiffZ� tea. cam. ri J Alt ADDRESS 23 A.NTiC0 LANE Et ` k� LLB zip. Ulm 14`I' SIZE _ DBA ' DEVELOPMENT DI STRIf"T PERMIT 31777 1E 091PT�ON 28TCRY COLS./UR/I 1/2BA/2CAR/DHCE (SEV1 98-38I PERMIT TYPE BUIILD TITL. NEW RESIDENTIALBLDO PMT GONTRACTCORS: J, SQL' ,CIKFNO Department of Health Safet ARCHilECTS: . �' and Environmental. Services TOTAL PEES: 32S. 30 . 1. BOND $.00 �41� CONSTRUCTTON COSTS $1,05 i 000-00 101 SINGLE PA14 HOME. DETACHED 1. * BARNSTABLE, MASS. 1639. BUILDING DIVISIO'N� BY DATE ISSUED 06/25/1.998 EXPIRAIVION DE.H; f I , THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES N&RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND M FOR (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. CH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS Is 4 3-moo 2 f 2 2 3 C ! t 1 HEATING INSPECTION AP ROVALS ENGINEERING DEPARTMENT r d ( 2 BOARD 0 TH OTHE SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND Vow IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION�WOW_.IS.NOT_STARTED 'i1N SIX CARD CAN BE ARRANGED, FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DA � T P AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. r TION. - - --� L .4 . Y sk''Y .k f •. T- r=' 6aa ®00 P,� (fi ! I� Engineering Dent.(3rd floor) -Map 7� Parcel Permit# House# oZ - Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4- Conservation Office(4th floor)(8:30- 9:30/1:10 -2:00) Planning Dept. (1st floor/School Admin. Bldg.) SEPTiC S ST BE Definitive Plan Approved b ng Board jrtt. 10 19 97, INSTAI.LE 1 C,E 7�1� t o f lit/ef-Se II�/1 r :, a D NVOROW1 TOWN OF:BARNSTABL ooEallo TORRN4 P17GI ATIONs Building Permit Application y Project Street Address r f Village v d Owner_Q(_� ��.h�� b �� ��i I Coon IA' ess e.D BDp 635' Telephone $Q • r1q Jr- (? 5 80 O r S 00 — 3 3 9T,55 r1 Permit Request Jr `O b b 01 5 *,A\t� �/Q.M�`4 Care� W 14,Ne, C 0.r G1C�l�q f g tD 0 MG I�L C� 5 b' e-+��b�ct C� t�eal� CL i t � First Floor 10 rj b square feet Second Floor C1 3 square feet Construction Type Wo 1)d Estimated Project Cost $ Gj 1 06 a i Zoning District Flood Plain Water Protection Lot Size 1 1, ZOO !W `;. Grandfathered YYes ❑No Dwelling Type: Single Family 0J/ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: fJ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 0136 Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New _I Total Room Count(not including baths): Existing New �_First Floor Room Count 3 Heat Type and Fuel: ❑Gas &/Oil ❑Electric ❑Other Central Air ❑Yes RNo Fireplaces: Existing New 1 Existing wood/coal stove ❑Yes 01fio y Garage: ❑Detached(size) Other Detached Structures: ❑.Pool(size) ❑Attached(size) 'A W X Q L' ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name �' Cj G24� ( v MjpA,0 Telephone,Number Address P 1 bX 635 License# 0 Home Improvement Contractor# Worker's Compensation# (,V('_(? /p6 a(,Oa A NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING P IT DENIED FOR THE FOL OWING REASONS) r�J. FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED 4 , MAP/PARCEL NO. ADDRESS VILLAGE. .• ..,: - ...._ J - �_. t •r. OWNER c DATE OF,INSPECTION: FOUNDATION FRAME °2 4 INSULATION FIREPLACE i ELECTRICAL- ROUGH FINAL • PLUMBING: ROUGH! + FINAL-, IJ GAS: 3 . ROGH FI.1AL FINAL BUILDING tL1 • �f' j - ;} . DATE CLOSED OUT: m h ' "f C ' ASSOCIATION PLAP S. _ y f ` � m m 0 ; t ypptNE The Town-of.Barnstable _ BARNSTABLE. Department of Health Safety and Environmental Services MASS. 039. rED,�n+ Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection '—c AJ A- Location `�-� -iAnl 1"1 C- 0 J Permit Number Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: n r . fu -Pp Cd-/T', N 1 h 4t=- R 4(A 0-J ('�j_Al' l Please call: 508-862-4038 for re-inspection. Inspected by Date r r f - -....-•.... . .., .,. .... _. ..Yt r�r .-..,ti..-♦'*T rw •: . d . .�.r` 4•-r- `�. ' ti � -r� .... -. ... ... - , 5 ' SHE The Town of Barnstable o� BARNSTABLE. ` Department of Health Safety and Environmental Services MASS. �f&639.N. Building Division 367 Main Street;Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508490-6230 Building Commissioner Inspection Correction Notice Type of Inspection Y"/2.4 f Location Permit Number 7'7 7 Owner - Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: l A VIA 1 rU I HA (J 57re IA q Luz; UV7 4�,C- 4�("�;47) A-C�t o ,� r Please call: 508-790-6227 for re-inspection. r Inspected by (� F I Date r i (' Q i r O IC I ' � � u� ���/G v. . __.. __ . ._ �, � _ _ , Appt= Lr-- Old Center Req1tqTrKSr., loec><4bm of-PrDperty� vil e YlTi G O - J...,ane--1 , ' i �2-G't dramaqq& "� easerite�it I foundation Lot Z Open spaces ""0001f re f JIU 3 f 210 -fiood paru-r,25000 1 001 C, 1 iO4 e0tut S� +�1tM 0►Ytf'�I PAUL J hemf� certify-that 1W mom ee p-echon wars. -for o T. Trtff JZU( s: Costa., PC. sr the. COMMIA►ritq � G OVER N 9[wfdwgdatiant mry helwm does notr faU im a specs al TAxk f�w& Ma with an,effective datz, of 8 -19-85 arty qhe loutfior., of the undation dogs ccmlc>rm rCo the local ganing 6y-laws irt,e �fi' ; at tum of`constYuawn. wit�t, respect'to hors 12evt'seal - 9- 6-98 wort tcd dimQrtSr ona Scale: V = 10-� Sebfwk TVALuif u or 15 Qx12i11 t"fiiVm Vl0(.at-(Oa QC4pl''r ryUrtZ' Date: f2--98 GaCtl•n, under Mass. General Jxws Chdp'W-40 A-ject,60M?'. File No.$_.. 97 PLEASE NOTE: The structures ax shown on this plat plan are approximate only. An actual survey is necessary for a precise determination of the. building location and encroachment., if any exist, either way across property lines. This plan must not be used for recording purposes or for use in preparing deed- descriptions and must,not be used for variance or building plan purposes. This plan must not be used to locate property lines. Verification of building locations, property line dimensions, fences or lot configuration can only be accomplished by an accurate instrument survey which may reflect different information than what S is shown hereon. Please note that this is "NOT A BOUNDARY SURVEY" and Is "FOR MORTGAGE PURPOSES ONLY". W COLONIAL LAND SURVEYING COMPANY, INC. W 269 Hanover Street - Hanover, Mass. 02339 - Phone: 781-826-7186 Fax: 781-826-4823 11w..M./rhah 1..N I••IM+•• . I.• '�r''.1 y.':..�.. .,; .4L�1' ALLOWAIU Lor courutAMMI!' No •.I 111 a 1 w /N •\,. ��~\ \• \t'• \ all .l r.:•A ON A ,. N or17V srAcr / A / / 6 \ 1/1./14 I•N / ' 1. 11� to 61r, .1 • / /o, I I 10, If .01 All 40 / �' i � `. •10 r�W' •• ',1 •• ,,NoA, Noo � ♦' \p , � L01' t No { "Im COOP f.F •' / cot s / •,' { ¢ of ' • Logy • 1.11rr •1 �1 .. to . +/ F M/111.M 11'1111 M•h.lw>• wro • IIt.1/11 too�r I IAM IANt KAMMM SOAR! A19.• ♦. 1 a vl000 M IN4MIMMw Iw►M0.1p to I IS., 1 {III '•� I/L•' • / � . 40CL NMI W1.Cj-- Ell M wY►. Lu..YI Q Oil 1 1p REAR ELEVATION LEFT ELEVATION - yci von e 1f: • __ 6of•42f•61• Ina aam 1� � T W rY. _ ®Yf}OT I *signs a...rs1 � aur.trr+u .ter+r r..r I EH -U- rt FRWrIMEATTMr ._ _. _' RICaF-VATION v rsr unY/1 rrwrsr•• — W AI 3 L� _ I i i � 1.r:ewa •- ar ----r..o eat ' ----aa e.nty Y wwar., r r I � � seat.•n. , .a• 4— .tfllGyl....- bl 1111•Dd'l • rr�'l .a-f�Y rtR.au[I j I 1 1 so- I 1 t � I � � SEcloe e� c•...1 a..o.rou - a.e u..,as `+-.....sue a..eo.i\vim— ���JJJ w- /On a.o errs 6 KAUlltl MLAKCAV f C_ :I i ��wc.w.l...'.e 4�vpma.•ti• I f w�•+c•••uc ; sue.N\ • 4r Resigns ..:j r1r � yi o j • t .• Y A _{_. '.pEpN.r--_ab' \u' I t.r _n'r —.• i..' Fa�F nM& P-A.J. cmw owe.ra _ 9 a 'Y • 4 1.°• tL •0 I �. 7<O 1 -'1itG- r I 8I Lp• 7�' CPAL SB1Lt <et I. ! � I � 7w••ost�<aam t�tm. i iS•71aC'Sa�o�'�Y_cet. St[JL'^ETC"FIOCntN�C_'_ i +I _ ego- are•— de' ' CC1Qt�lTft7II"SOfA't`°'•ae) raa_te.c.ti...w fe.e.uca op ..rte 4a. - •"ti•- r.r.r.n•�tnyc.at�-=.' <p.w�wrw4w7pQ..T.'- IT- Ji g•4t•«wl I sc � tfet Oat- _ I fr r FtRSL t »L.JF�R wa.tCTco�s[waw�py�.: •O wwrrwM wwwa•ti•wwMa ti OCO w M aM w<w•ti••aMlwwa••r1.M•a•n w<w M aar•<I•t Ham•'•^ The Commonwealth of Massachusetts _ -. - , —. -.-............ __ - : Department of Industrial Accidents - o ice ofinsestigations 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: location: FAhb city / phone# 4 Oo 334 5 l5 ❑ am a homeowner performing all work myself. am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. company name address: city phone#. - insurance co. RolicV# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name address: cites phone#: insurance co golicv# W. Com any name: address: city. phone#: insurance co. olicv# Failure to secure coverage as required under Section 15A of 11GL 152 can lead to the Imposition of criminal penalties of a tine up to 51,500.00 and/or one years'Lnprisonment as well a+civil p lies in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a copy of this statement may be fotwsrde o the O ce of Investigations of the DIA for coverage verification. I do hereby erti r e d allies ojperjury that the information provided above is truo and core Z Signature Date - Print name Phone# VAMM official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department ` contact person: phone#; ❑Other (mvised 9/95 PIA) .v 1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contrac 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 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 o building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha- not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the 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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please 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 " fax#: (617) 727-7749 - phone #: (617) 727-4900 ext. 406, 409 or 375 r DATE: U6/!Q/98 TIME: 01:29 PM TO: 8336612 PAGE: 001-001 ACORD CERTIFICATE OF LIABILITY INSURANCE 04i 3/1998 PRODUCER (508)888-2244 FAX'' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ''0 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden Insurance Agency Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 125 Route 6A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Sandwich, MA 02563 COMPANIES AFFORDING COVERAGE COMPANY Commerce Insurance Company , Attn: COMMERCIAL LINES Ext: A INSURED COMPANY Eastern Casualty Ins Co Catherine Little d/b/a Little Concrete B P 0 Box 1832 Sandwich, MA 02563 COMPANY C COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS t LTR DATE(MMIDDIYY) DATE(MMIDDIYY) GENERAL LIABILITY GENERAL AGGREGATE S 600,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG S 300,000 A CLAIMSMADE X OCCUR K24387 08/18/1997 08/18/1998 PERSONAL RADVINJURY S 300,000 OWNER'S 6 CONTRACTOR'S PROT EACH OCCURRENCE $ 300,000 FIRE DAMAGE(Any one fire) S 50,000 MED EXP(Anyone person) S 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) S 100,000 A 97MMJ94963' 07/17/1997 07/17/1998 HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per accident) 300,000 / PROPERTY DAMAGE $ 50,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ i- AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM S TH- WORKERS COMPENSATION AND X OR LIMIT ER TORY LIMITS ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 500,000 B rHEPROPRIETORI WCG1003602A 06/12/1998 06/12/1999 PARTNERSIEXECUTIVE INCL EL DISEASE-POLICY LIMIT S 500,000 OFFICERS ARE EXCL EL DISEASE-EA EMPLOYEE S 500,000 OTHER r DESCRIPTION OF OPE RAT]ONSILOCATIONSIVEHICLESISPECIAL ITEMS ; Re: Lots 1-5 Crossroads, E. Falmouth MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Old Centre Realty 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, %Mark LebeauX BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY P 0 Box 635 OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Wareham, MA 02571 AUTHORIZED REPRESENTATIVE David Vajcovec FROM TEL: MAr'. 12. 1999 4:03 PM P 1 Certificate of InsurancerHIS Jill:(J'K*JII%'AI'ViI()IlvI'R '11 PON yt 11)1;NiI 1,1(;l I I L, IS 101;1.114)AR A MA*1'1'1:1l()I: I(IN 4 INI N ANI)t t IN111t .11,1.1"11 q) (.1'I"ANINSUI(ANCHPOIXY M VN 1),IX I I(N I I:111,A 1.1 I'M I I 11: )1'1 KA(X A I I t I It 1-1:1111)'1111 ANDI)OINNO'l A* le 19 to Certify that M.A.P. Name and LIBERTYINSULATION Co INC. address of 0 MUTUAL PO BOX 1309 SAGAMORE BEACH,MA 02562 insured. Is L-6jug data of thls Certificate,Insuried by 1�9 Company undor►tho policy(loo)Iltind below. The inguranoo afforded by lho listed pollgai; Is cub�ocl to Bill their I at the torm or mndillon of any oanimcil or othor document with ro;pocl 10 Wv Ich LIS OD IIC810 may be terms,eliduslons and conditions and It not alter od by any roquiromont, EXP,DATE CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY TYPE OF POLICY [I EXTENDED N POIJPYTERM .. CoVL.RAG I"AFF011OLD UNDLIJI WC EMPLOYERS LIABILITY WORKERS LAW OF i 4crol.LOWINCI STATES 6;aFli lnlu-ry By-Ac ddon-t COMPENSATION 11.1-98 WC1-i 11-252480-017 MA $ 1:01500,000 �cocldenl Bodily. —I-n r y*—B y-0116,J-a--5 0-Policy $00,000 Llmlt Bodily Injury By DlSame $500,000 Eft0h P.9taort.— - Genoral Aggragote 01 or than ProdudNComp(eted�perat ens GENERAL LIABILITY Proclucls/66m*piotod Opom.tions Aggirogale OCCURRENCE CLAIMS MADE Bodily InItIry and Pror)ertv Damage Liability Per Oocurrence Personal and-4dverftng Injury Per Perew Rijili DA E Organizailon 0 OtIlor Other ........ Each Aooldent-Single Urnit LIABILITY AUTOMOBILE 81 and P.D.CorrItined ...... OWNED E.aD Ill-PersonI Each Acioldent or Ociourronce E.1 NON-OWNED Each Accident or Ociouryonoo HIRED OTHER ADDITIONAL COMMENI 6 r oituindod torm,yritt will bo noiltiod 11 covortion iN torminaled Di redumd h9toro lip eafliiicais expiration date., 11 the ceillilowe expirsibil date Is continuous o )Oil KNOwIN0 114AI Ill� It rA(;IJ.I1A1INc1 A FRAUD ACIAINSI AN INSLIR17.A,SUBM17D SPECIAL NO110EOH10i ANY PrnSON W140 WITH INIEN Iii)ULI ItAtil AN APPLICATION OR rIL129 A CLAIM CONTAIkIND A VALS1 OR SIAIF MI-N'l K GUII.lV 01*INE;URANCII FRAL10 NOTICE Of CANCELLATION: (NO1 APPLICABLE UNLESS III,NUMIIILII 0;DAYS Is ENUAIE 11)Pvl.UW.J 111.1 QI* Ijberly M;Iuall Grotill 114E STATED EXPIRATION DATE THE COMPANY WILL NOT CANON ()It RI:rjJJC%I lir INS1,111ANCI:AfF091111-IJ UNDER THE ABOVE POLICIES UNTIL AT I FAST DAYS NoTell OF SUI114 CANCELLATION WAS BFFN MAILED io: Ip -66— OLD CENTER REALTY USA A. HI NS OwIl'UTE P.O. BOX 635 AUTIlOnIZED nEPRFSENTATIVE HOLDER WAREHM, KA 02571. WESTWOOD (781)326-7100 . ......... &F Id plioNt NUMBlin C)ATF 198LIED CERTIFIC ITE MCI I �LId, A B Q DATE(MMIDD/YY) TY INS�URANE" ' Oan,/s6 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HARRY J. BOARDMAN AGENCY INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 679 WASHINGTON STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. BOX 3269 COMPANIES AFFORDING COVERAGE So. Attleboro MA 02703 COMPANY A Vermont Mutual Ins. Co. INSURED COMPANY Viens Masonry B Roger Viens COMPANY 150 Collins STreet C So. Attleboro MA 02703 COMPANY D COVERAGES ..� iia�. •I $ a '� , W � �- " THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO 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. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION uMris � LT TYPE DATE (MMIDDIYY) DATE (MM/DD/YY) A GENERAL LIABILITY TBD 04/17/98 04/17/99 GENERAL AGGREGATE E 600,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGO E 600,000 CLAIMS MADE D OCCUR PERSONAL d ADV INJURY E 300,006 OWNER'S 6 CONTRACTOR'S PROT EACH OCCURRENCE E 300,000 FIRE DAMAGE(Any one fire) E 50,000 MED EXP(Any one person) E 5,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT E ALL OWNED AUTOS BODILY INJURY E SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-0WNED AUTOS (Per accident) E PROPERTY DAMAGE E GARAGE LIABILITY AUTO ONLY-EA ACCIDENT E ANY AUTO OTHER THAN AUTO ONLY: '$Tro :Irt E E EXCESS LIABILITY EACH OCCURRENCE E UMBRELLA FORM AGGREGATE E OTHER THAN UMBRELLA FORM E WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TORY71EIT I ITR �+* _ EL EACH ACCIDENT E THE PROPRIETOR/ INCL EL DISEASE"POLICY LIMIT E PARTNERSIEXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE E OTHER J DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/SPECIAL ITEMS CERTIFICATE HOLDERrt'' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE O'Central Realty EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL P 0 BOX 635 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Wareham MA 02571 BUT FAILUR MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY K D PON THE COMPANY,ITS A ENTS OR REP SENTATIVES AUTHOR D EPRESENT "Arnpn9."-map►`°•". vn1 :d h ." rwF.� �T�+P�-�.. ,: ..,.. .....,�,..,.�.—:r�;,.:. + A CORD DATE(MNVDD/Yl) `Il .1 i ) .:k:,F:;:Itir[::.LPL'rVW.'r.•f•yr..'..,`,g.1+:d,�.... .. t..4:;�.....:,•:.L)'' �i l�L i ...11......1,...1.. s....'1. r ) 1 1'1• )J'.M: } .t W ' - ' 05/14/1995 PRODUCER (508)588-1260 FAX (508)588-7236 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISE & QUINN INSURANCE AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 449"PLEASANT ST. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BROCKTON, MA 02401 COMPANIES AFFORDING COVERAGE . Maryland I COMPANY y and Casua t In surance Attn: Paul Crowley Ext:� A INSURED _........ le i McDermott Construction t COMPANY � 9 on Insurance Company 90 Oak Street i B Middleboro,. MA 02346 COMPANY C COMPANY D K ERA �v ....... `.. ....n•::..., .. ;). l.... -.-r .l .., ,,f, w� rl". ,U:,::t-4 r 1 .t 7 - .(' .,.,/X,..i..;:: J._Z.,..., i..t.,:v�c+;: c+ ,.,iva„d.+,.•:.: ."1"..�,a!!�iY.,r•'Y .- .1.�...;:.i- ll'.' �._., �. ,. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _..... .. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE 'POLICY EXPIRATION ' : GATE(MM[ODlYY) DATE(MM1DD[YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE" L 1.1 000r 000 ..................._ . . .. X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPiOP AGG E 1 000 Q00 .... _ ...... .. ._..r ...1. .. :- CLAIMS MADE X OCCUR CFP 28817816 04/27/1998 04/27/1999 PERSONAL 6 ADV INJUR Y $ 500,000 OWNER'S b CONTRACTOR'S PROT• i EACH OCCURRENCE E SOOL OOO ._.. FIRE DAMAGE(Any one Ilre) E 300,000 MEO EXP(Any one person) E 10,000 AUTOMOBILE LIABILITY i ANYAUTO COMBINED SINGLE LIMIT E ALL OWNED AUTOS SCHEDULED AUTOS (Per per INJURY _ . ( person) HIRED AUTOS r _.. .... .. NON•OWNEO AUTOS BODILY INJURY E (Per socloenq PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY•EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY; ti EACH ACCIDENT. E AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE E UMBRELLA FORM ! - AGGREGATE E a. OTHER TNAN UMBRELLA FORM WORKERS COMPENSATION AND I IOTH EMPLOYERS'LIABILITY TQ...,... 6 WC3-0282394 EL EACH ACCIDENT E 100,000 THE PROPRIETOR/ 09/30/1997 09/30/1998 PARTNEMEXECUT1VE ; INCL : EL DIS EA SE•POLICY LIMIT E 500 000 . ......MIT .......... ....._..r-.. OFFICERS ARE EXCL OTHER EL DISEASE-EA EMPLOYEE E 100,000 _ r , Oo� �Oo vS� � �w5 �c�� ! / DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS CET I r ,_..� �:,.A'Y'l:.Hp �,.. . . .t. . ;L, a�[-1 .- .,.,• + �;,r�1, � .. �1! :;,I:.:.t. 'L•.','S,:rAr: .•u C:...^a��»e17,.,1t1Vlm 2 ,...r.1 x'-�r. .- ;,,.�•4hEL,_L SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Old Center Construction BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY P.O. BOX 635 OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Wareham, MA 02571 AUTHQ 0REPRE , ��QQpp J♦/A ._.:^y'.';�:?.,.F;,.r,....: .1. ._,err';q�;;r+r•n:r.r-P!..r.,,.�. ..r. t ny _ .r� �.-._ .n.. n.a•:.........r. ..�I ... .r; .. -'/' )N.: .1.r:. ❑ -1_lii:��"`�:1. i ;',_ , p. , �.Ls..✓.o'A. , :, .f�klkatl 1 :?I}i�JRx U.r� �1� a:lj i!i��li ';�2!� yI� 'c•. ��4.a. '3 ... n. U41 LZJ/1 JJU 1 /. 44 Duoz-Jll !u l I'IJ VKH:J51 11V5 HAUL Lll A_ Vw ' CERTIFICATE OF LIABILITY INSURANCET4123/98` Y' 0_ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Margaret J Grassi Ins Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 1188 Main St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. W. Wareham, MA 02576 INSURERS AFFORDING COVERAGE INSURED Quinn' s Siding INSURER A: teal 29 Dinah' s Way INSURER B: Wareham, MA 02571 INSURER a: INSURER D: INSURER E: ~ COVERAGES THE POLICIES OF INSURANCE.LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL L THE TERMS EX AN P EXCLUSIONS AND POLICIES. CONDITIONS OF SUCH AGGREGATE LI MITS MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ' INSA TYPE OF INSURANCE POLICY NUMBER POLICY EF VE POLICY )tPIgATION naTefuu ingvvi LIMITS GENERAL LIABILITY EACH OCCURRENCE $1 O O 000 A COMMERCIAL GENERAL LIABILITY New po 1 iCy 4/11/9 8 4/11/9 9 FIRE DAMAGE Any one fire) t 50, 000. CLAIMS MADE ❑ OCCUR 6 MED EXP(Any one Person► E 1 , 000. PERSONAL A ADV INJURY S1 0 0 0 Q 0. GENERAL AGGREGATE 110 0 0 0 0. GEN'L AGGREGATE LIMIT PP LIES PER: PRODUCTS•COMPrOP AGO I POLICY PRO JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT E (EA eccidonl) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY AI (Per person) HIRED AUTOS NON-OWNED AUTOS POOILY INJURY E ( . socidenn PROPERTY DAMAGE E (Per secidem) GARAGE LIABILITY AUTO ONLY•EA ACCIDENT E ANY AUTO OTHER THAN EA ACC I AUTO ONLY: AGG E EXCESS LIABILITY EACH OCCURRENCE E OCCUR �j CLAIMS MADE AGGREGATE E DEDUCTIBLE I I RETENTION I E WORKERS COMPENSATION AND - - 1 - ATU- EMPLOYERS'LIABILITY TO V R „ E.L.EACH ACCIDENT E E.L.DISEASE.EA EMPLOYE E OTHER E.L.DISEASE.POLICY LIMIT E DESCRIPTION OF OPIRATIONSJLOCATIONBNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER 1ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Old Center Realty Attn: Scott Cimeno DATE THEREOF,THE ISSUING INSURER W LL ENDEAVOR TO MAIL DAYS WRITTEN P.O. Box 635 NOTICG TO THE CRATIFICATi MOLDER NAMBO TO THE LEPT,BUT FAILURE TO 00 SO SHALL Wareham, MA 02571 IMPOOBLIGATION OR LIABILITY UPON THE INSURER,ITS AGENTS OR REPRTIV , :AIJTHOkPD !P S6NTATIV! fflo ACORD 26-5(7/97) M Acrian rnponnATIMKI ,eno ............................. .... ::.:::::::................. DATE MM D D i'�.�''. .�� ::':;i "'iciisi :% iii?:it�i;i;ii#ipii%>::::;;:• ( l'n) . NE'::::::;:: ::::::::::::::..:......:..::::::::::: �4 . .....::::. . :::::::::: 4/23/98 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR RIDER RISK SPECIALISTS ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURANCE AGENCY, INC. COMPANIES AFFORDING COVERAGE JAMES W.RIDER INSURANCE COMPANY 2 SHORE ROAD, BOURNE, MA 02532 A WESTERN HERITAGE INSURANCE CO. BRED r. COMPANY RPG CONSTRUCTION, INC. . B PO BOX 211 COMPANY SAGAMORE BEACH, MA 02562 c COMPANY ' D .:::.::.: .;..:.;. ..: :>.> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 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. 1 CO TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION i POLICY NUMBER " LTR DATE(MM/DD/YY) DATE(MM/DD/YY) LIMIT GENERAL LIABILITY GENERAL AGGREGATE $1 0 0 O 0 0 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $1, 000, O O CLAIMS MADE OCCUR PERSONAL&ADV INJURY S A X OWNER'S✓3 CONTRACTOR'S PROT BINDER #RPGC-0 9 0 4/2 3/9 8 0 4/2 3/9 9 EACH OCCURRENCE $1 0 0 0, 0 0 FIRE DAMAGE(Any one fire) $ MED EXP(Any one person) S AUTOMOBILE UABIUTY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS ' BODILY INJURY $ SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) S PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO , OTHER THAN AUTO ONLY: EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND C STATU- OTH• :5 EMPLOYERS'LIABILITY TORY LIMITS ER EL EACH ACCIDENT $ THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE S OTHER 1 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS t c awo c43 elw er,. to Q � ........:.::.......:.:::::,:::.:.:>::.::::::.::::::::..::::::::::.::.::.:::::::.::: ::: :: ::::::::: :: :.: . ....::.......: ....:..:...:: :::::::::::::::::::.::::.. ::::.::: ::.::::::::::::::::. 1.:.I:.:.:. '. :lEtl1.�lp............................................:::.:::::::::::::::::.:::::::::.::.. ....................G1�NG 7 bN.................. ::...: :.:.: ::::::.:. ..............................::::::::::::::::::::::::::::::.::::::::.:::::::....................:.:..:.::::::::::.:::::. 1 ,A.,1..::. ::: :...................................:::..................... .... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CATAPILLAR FINANCIAL SERVICES EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10440 LITTLE PAWTUXENT PKWY #12 0 0 Q DAYS WRITTEN VoTICE TO THE CERTIFICATE LDER NAMED TO THE LEFT, COLUMBIA, MD 21044 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMP OS O OBLIGATION OR LIABILITY OF ANY KIND_l PON E COMPANY, ITS EN1S OR REPRESENTATIVES. AUTHORIZED ftEPRESEN T r ANT/CO LANE z U - 2 SCPTI I I I TANK LEACH ,FI LLD fTH-Z_I \ � , ap I � •, R�sEkvE / �8 7 I PB'RM OI ., AREA. 11,Z'-74 SF [� HousE � � N OF PEITR 10'SAS �/ oPEN SULLHAN EM C-NT, NO 29733 _ PLAN VIEW-LOT-I tIVIL y Scale:I = 40 - sl2��9a p � -rH - I EL, �1,4 ���_ TN-2 EL:, 63,0 O 'PINE NEEDLES. O PINE I\\Lr--DLES 2, ORGANIC N1AT. 1�� C)RGA►.11C MAT, VRY. DRKGRAY LOAM VRY, DRK, GRAM LOAM y,,_ A 1=1Nt= SAMD 5,� A FINS SAND VEL, BRN. LOAM YEL, C3RN, LOAM FINE SAND 27 d FINE SAND ti9 PERK TEST ���� PuRK TC--ST LT• YEL, 13RN LT, YEL, BRN, 12.2 - C V, FING SAND 12Z C- VRy, FINE SAND PERLoL.ATION TEST _ PERCOLATION TCST CLASS I MATERIAL. CLASS 1 MATERIAL- 101EPT1-1 - �18" DEPTH lolo'� LES5 THAN 2. MIN,,/ImCH LE55 THAN 2/V11N/ INCH No WATEK c-NCOLAN1TED NO WATcR ENCOUNTE.p Na, P-5?1!4-7 ENGINE51` : SULLIVAN ENGINEkRMC- INC. W ITNESS: SiDUNNIMC-/T of(3, 13, of H. -1. Plan Reference Cluster Subdivision No. 755 SITE PLAN "ANTICO WOODS", Endorsed Feb 10, 1997 PROPOSED SEPTIC SYSTEM Book 531 Page 83 AT 2. Map 172 Reconfigured Lots 3-1, 3-2, 3-3, 4-1, 4-2&5-3 LOT N0, I .,ANTICO WOODS 3. Set Backs Front=20' ReaNSide=10' CENTERVILLE , MA 4. The proposed foundation shown hereon complies with FOR the Town of Barnstable Zoning Set backs and is not within OLD CENTRE REALTY a flood plain , SCALE: I =40 DATE: MAY 26, 1998 SULLIVAN ENGINEERING INC. SHEET I of 2 OSTERVILLE, MA NOTES DESIGN DATA is Lot is Municipal Water. Single Family-3 Bedroom L Water Supply ForTh P PP y With no Garbage Grinder 2 Location of Utilities Shown on This Plan Are Approx. Daily Flown 110 x3=330 GPD At Least 72 Hours Prior to Any Excavation For This Septic Tank:3�O GPD x 200%=660 GPD Protect The ConlractorShall Make The Required Use 1500 Gallon Septic Tani• - Notification to Dig Safe(1-800-322-4844) 3 The Contractor is Required to Secure Appropriate LEACHING AREA. Permits From Town Agencies For Construction 330 GPD/0.74=446 SF Required Defined byThis Plan. Sidewal I =2(16 25)2=148 S.F. 4 Install Risers as RequirevoXthin.d'of : 448oS.F Total Provided 300 SE Finished Grade. LEACHING CHAMBER DESIGN 5.All Structures Buried Four Feet or More or Subject* At I Pipes to be Schedule 40.Use to Vehicular Traffic tobe H-20 Loading. 2 -500 Go I.Leaching Chambers in a 6 Septic System Lobe Inslalledin Accordance With 121x 25' Washed Stone Field as 310 CMR 15.00 Latest Revision And The Town of Shown. Barnstable Board of Health Regulations. - 7 All Pipingtobe Sch.40 PVC FG.71.0 F.G.68.0 68. 65.0 ' 67.4 67.2 Top ._ El, 66 Bot.E1.63.0 66.0 Bedding as 5,0' Per Title 5 101 . 10.5! 10� Bottom of Test Hole EI.ss;oNo.Water DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTtM' ' Not to Scale ' Finish Grade Filter Fabric �'-"'Compacted FI I I J a 1/8�=I/2° Pea Stone iP) • Leaching „ o a Chamber 3/4 -1 1/2 Double Washed 1 4!-10• 1 �OF I, 12-0 PETER SULLIVO NO.29733 CROSS SECTION OF CHAMBER CIVIL ..:NOT TO SCALE ro t7 LOT. Cl~r tM-r—YlLL S/2G 8 SHEET 2 of 2 Restricted To; 00 DEPARTMENT OF PUBLIC SAFETY 79341 r , CONSTRUCTION SUPERVISOR LICENSE 00 - None Number; Expires; . 1G - 1 & 2 family Homes Restricted To; 00 Failure to possess a current edition of the Massachusetts State Buiilding Code J SCOtt CIMENO is cause for revocation of this license. PO B01 635 ^w-pr orwl WAREHAM, MA 02571 I � flAScheck COMPLIANCE REPORT Massachusetts Energy Code I Permit # I MAScheck Software Version 2.0 I I Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 ; CONSTRUCTION TYPE: 1 or 2 family,' detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 6-24-1998 DATE OF PLANS: 6-22-98 TITLE: LOT # 1 ANTICO LANE CENTERVILLE PROJECT INFORMATION: RANCH STYLE HOME COMPANY INFORMATION: OLD CENTRE REALTY t BOX 635 WAREHAM,MA. 02571 1-800-339-7515 COMPLIANCE: PASSES_ Required UA = 4241 Your Home = 341 Area or - Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA F ---------------------------------------------------------------------- CEILINGS 1710 38.0 ? 0.0 51 WALLS: Wood Frame, 16" O.C. 1881 15..0 3.0 126 GLAZING: Windows or Doors 88 0.510 45 GLAZING: Skylights 15 0.600 9 DOORS 56 0.510 29 FLOORS}: Over Unconditioned Space 1710 . 19.0 81 HVAC EFFICIENCY: Furnace, 85.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The- HVAC equipment selected to heat or cool the building . shall be no greater than 1 5% of the design load as specified in sections 780CMR 13 Builder/Designer Date C3` Z`Z MASNeck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 LOT # 1 ANTICO LANE CENTERVILLE DATE: 6-24-1998 Bldg. I -i Dept. I Use CEILINGS: [ ] I 1 . R-38 I Comments/Location I WALLS: [ ] ( 1 . Wood Frame, 16" O.C. , R-15 + R-3 I Comments/Location i WINDOWS AND GLASS DOORS: [ l I 1 . U-value: 0.51 I For windows without labeled U-values, describe features: I #Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I SKYLIGHTS: [ ] I 1. U-value: 0.60 I For skylights without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] I 1. U-value: 6.51 Comments/Location FLOORS: [ ] I 1. Over Unconditioned Space, R-19 I Comments/Location I HVAC EQUIPMENT EFFICIENCY: ' p [ ] I 1. Furnace, 85.0 AFUE or higher I Make and Model Number THERMOSTATS: [ ] I Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ ] I Joints, penetrations, -and all other such openings in the building I envelope that are sources of air leakage must be sealed. Recessed I lights must be type IC .,rated and installed with no penetrations I or installed inside an appropriate air-tight assembly with a 0.511 I . clearance from combustible' materials and 3" clearance from 'insulation.; VAPOR RETARDER: r ' [ ] I Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be I provided. Insulation R-values, glazing U-values, and heating I equipment efficiency must be clearly marked on the building plans i or specifications. Ducts in unconditioned spaces must be insulated to R-5. I Ducts outside the building must be insulated to R-8.0. I DUCT CONSTRUCTION: [ ] I All ducts must be sealed with mastic and fibrous backing tape. I Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating i and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified in sections 780CMR 1310 and J4.4. I MISC REQUIREMENTS: [ ] I Refer to 780 CMR, Appendix J for requirements relating to swimming i pools, HVAC piping conveying fluids above 120 F or chilled fluids i below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)-------------------------