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HomeMy WebLinkAbout0008 AUTUMN DRIVE � ��' �� at,- . a. : ,��' ti f n ,i � a � � Y ' � � _ � - - ... � n • -. v .� �. � ,. ,� ;.,;,.; w n � _ _ .. .. ��. � �� _ ,:, o .. - _. - . . - - - a .. _ _ [ a, .. `' .. (1 ^. � .. .` � �. .. % .. © � T: 781871 8252 ; r F: 781 857 1977 July 1, 2015 : Thomas Perry, CBO , Town of Barnstable ' Building Division e 200 Main Street sn Hyannis, MA 02601 RE: INSULATION PERMITS : MARGARET SMITH Dear Mr. Perry, This affidavit is to certify that all work completed for insulation work at 8 AUTUMN DR., CENTERVILLE has been inspected by a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds Federal & State requirement. Sincerely, Victor Cimino hmb 267 N. Quincy Street • Abington, MA 02351 www.insul-proinc.com oFtNME, Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee Y3, CS • * y • BARNSTABLE, 9� MASSS. ,0 Richard V.Scali,Director039. A o 17 �fD MA'I Building Division Tom Perry,CBO;Building Commissioner MAY 20 2015 200 Main Street,Hyannis,MA 02601 'Fi www.town.barnstable.ma.us n' OF BARNSTABLE Office: 508-862-4038 TOw'Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL, ONLY Not Valid without Red X-Press Imprint Map/parcel Number � to , ��-f'O ' Property Address Air,-}-um yj �]Qcj V2_ , C uq g_ esidential Value of Work$ 1(0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 'S OL t t714 Contractor's Name t Sc�ALS Telephone Number k — 14 rq Home Improvement Contractor License#(if applicable) ( O:3 1 1 Email: d C� C"�?f�c¢-c t- t Construction Supervisor's License#(if applicable) C ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am he Homeowner ave Worker's Compensation Insurance Insurance Company Name & Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque (check box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to YPRMOUM myjb tL _ ///❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PI01 DHR\EXPRESS.doc Revised 040215 ACORO0 DATE(MM/DDIYYYY) `� CERTIFICATE OF LIABILITY INSURANCE 8/7r2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 DOWLING &O'NEIL INSURANCE AGENCY INC NCNTACT AME: 973 IYANNOUGH RD PHONE FAX PO BOX 1990 AIC o Ext: AIC No HYANNIS, MA 02601 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: LM Insurance Corporation 33600 INSURED INSURER B: PAUL J CAZEAULT&SONS ROOFING INC 1031 MAIN STREET INSURER C: OSTERVILLE MA 02655 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 21146142 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DDIYYYY) (MMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _4EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ A WORKERS COMPENSATION WC5-31S-386670-013 8/10/2013 8/10/2014 V I PERSTATUTE OERH AND EMPLOYERS'LIABILITY Y/N WC5-31 S-386670-024 8/10/2014 8/10/2015 ANY PROPRIETOR/PXCLUDE/EXECUTIVE E.L.EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? N I N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1000000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT 1$ 1000000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'compensation coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 21146142 CLIENT CODE: 1614182 Lucy Garfield 8/7/2014 2:44:49 PM (EDT) Page 1 of 1 r 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): �/f //// d" CA40AV4- S olJ S )IJ,(f- Address: City/State/Zip: O S% ���'�'� JVPA Phone #: J`"U , �2g✓�� Are>w an employer?Check the appropriate box: Type of project(required): 1 I am a employer with a 4. ❑ I am a general contractor and 1 6.. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 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 I L❑ 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 �L��2doF employees. [No workers' 13.( Other comp.insurance required.] *Any applicant that checks box 41 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: M !N 5' /e• Policy#or Self-ins.Lic.#: lq/(i 5 31S 0 3S Expiration Date: 9 /60'r Job Site Address: FT ftt�humr) pf`tV2 (�.rlLh..v �4'GI� City/State/Zip: �� 7, 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 oneyear 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 o!fperJury that the information provided above is true and correct. i 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# 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#: f �WXY Office of'_ Consumer Affairs and Business Regulation 10 Park Plaza v Suite 5170 Boston; Massachusetts 02116 Home Improvement Contractor Registration Registration: 103714 Type: Supplement Card PAUL J. CAZEAULT & SONS, INC. Expiration: 7/9/2016 RUSSELL CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Mark reason for change. SCA 1 0 20M-05/11 D Address Renewal ❑ Employment Lost Card (172e CGa�iz.�rr.aruaetall�a��/f�rJJClCi2rCJeff1 Z. 1. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: . Office of Consumer Affairs and Business Regulation Registration: 1037-14 Type: 10 Park Plaza-Suite 5170 c Expiration: 7/9/2016 Supplement Card Boston,MA 02116 PAUL J.CAZEAULT&SONS, INC. RUSSELL CAZEAULT 1031 MAIN ST OSTERVILLE,MA 02658 Undersecretary Not valid withon nature r Massachusetts -Department of Public Safety Board of Building Regulations and Standards` ;. Construction Supers isoj- $ License: CS-108157 qs RUSSELL CAZEAi7LT 2071 MAIN STREET Brewster MA 02631 f °"J .,�i • .,� expiration Commissioner 11/23/2018 ' VI Property Owner Must Complete & Sign This Form If Using a Roofer/ Builder, I(print) as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job 8 Av-�u m n Q r l v e-. , Ceri4��-vi l(e Signature of Owner Mailing Address of Owner u.+V M,o Vv-1 ye- Gc_�,+-ev✓ �4 v 2G 32- Telephone # o Date Please return this form to Paul J. Cazeault Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com TOWN OF BARNSTABLE BUILDING.PERMIT,APP,LICATION Map6 Parcel `OWN OF EPARNKTAAp�lication #a D Health Division nit �¢ ,i.Dae Issued �L 2 1 A -7 ff Conservation Division Application Fee J� Planning Dept. .� � Permit Fee (art/*M'fg3 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis 04 Project Street Address ���`" Village (e-7-kerv)W , may- O2C,3Z Owner J4� P,�4,h 5, fAi o-�-b Address fi� H ���hs��i/��/�� U.2c k Telephone yGt-qlf 7�(2,f Permit Request /r I� y ft/c, J`t�3 216P-16J f.JGr i'neS►f��ll l z`� f-, /C- J ill gL,,e-C1_ 1/1;'t ;7 CI H/1- J /1-1y fig �caf1�- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �/, �/ '7 Construction Type Lot Size Grandfathered: ❑Yes 0 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 VI-Chrr C/,n/�►����nf��'Pr ' Telephone Number 7P-df�7/-d21L Address 26 7 Al,, 4&,in x j-'f JrA ,11�t 013I/ License # 0tf9(e 5 Home Improvement Contractor# f 9 ZY Elonlail: Worker's Compensation # K 403 6602 6 �3 52/j ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE k DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED x -MAP/PARCEL NO. ADDRESS VILLAGE r OWNER DATE OF INSPECTION: c 4 'FRAME �.. .... _. 6 k INSULATION FIREPLACE E ELECTRICAL: ROUGH FINAL ,a PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING `- e DATE CLOSED OUT t • ASSOCIATION PLAN NO. The Commonwealth ofltilassachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, ILIA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Org�a7nization/Individual): 1 Af c/ L — /fG Address: 16 / 11i �i/i'✓1 Gy L City/State/Zip:1�hi"�Znj l c 0 3 Sl Phone r: 7 f2 5- 2- Are an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. * • ❑Remodeling ship and have no employees These sub-contractors.have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [i`to workers' comp.insurance 5. ❑ We are a corporation and its 1 required.] officers have exercised their 0.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 L❑Plumbing repairs or additions myself. [No worker'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees. [No workers' 13 �1fy comp.insurance required.] �ther t *Any applicant that checks box ri must also fill out the section below showine their worker'compensation policy information. 'Homeocymers who submit this atzd4.•it indicating they are doing all work and then hire outside contractor must submit a new affidavit indicatine such. *Contractors that check this box rout attached an additional sheet showing the name of'the sub-contractors and their wo'sets'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: I/",,✓e le r1 Cy s g �'� f v/e'7�y C O n / Policy F"or Self ins. Lie. : x AV I, 66 Z P (3 S 2- U Expi anon Date: S/ 6 1l Job Site Address: City/State/Zip: 1415 02-&J2, Attach a copy of the workers' compensation policy declaration page(shovr5na the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 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. Signature:x Date: Phone Ztl--f 7/— 0 Z S Z Official use only. Do not write in this area, to be completed by city or town officiaL City or Torn: 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#: Acoa CERTIFICATEF3/6/2014DATE(MMI°D""") OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les) 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 Denise Butcher Strategic Insurance Solutions, Inc. PHONE (617)558-7100 X122 FAX Not:(781)a59-8282 2000 Commonwealth AvenueE-MAIL .db@strate'"cinsure.com ADDRESSINSURERS AFFORDING COVERAGE NAIC s Newton MA 02466 INSURERA:Scottsdale Insurance Com an INSURED INSURERB:Commerce Insurance Company 4754 ' Insul-Pro Insulation CO. , Inc. INSURERC:Torus National Insurance Co 267 N. Quincy St INSURERD:Travelers Casualty & Surety Co INSURER E: Abin ton MA 02351 1 INSURERF: COVERAGES CERTIFICATE NUMBER-CL143602804 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 TYPE OF INSURANCE ADDL BR POLICY EFF POLICY EXP LTR POLICY NUMBER (MWDW= (MMIDDNYYYl LIMITS GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA O R T D PREMISES(Ea occurrence) E 50,000 A CLAIMS-MADE OCCUR P31914781 /13/2014 /13/2015 MED EXP(Any one person) E 10,000 PERSONAL&ADV INJURY E 1,000,000 GENERAL AGGREGATE E 2,000;000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG E 2,000,000 X POLICY PRO- LOC E AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident 110001.000 B ANY AUTO BODILY.INJURY(Per person) E ALL OWNED X SCHEDULED HLS563 /5/2013 /5/2014 AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident E E X UMBRELLA LAB i X OCCUR rnmwal of 79425F13OALI EACH OCCURRENCE $ 5,000,000 C EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION /5/2014 /5/2015 $ D WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/NI ER ANY PROPRIETOR/PARTNER/FJ(ECUTIVE E.L.EACH ACCIDENT $ 11000,000 . OFFICERIMEMBER EXCLUDED 9 N I A (MandatoryInNH) UB6626Y35213 /6/2013 /6/2014 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L-0ISEASE-POLICYLIMIT E 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101.Additional Remarks Schedule,H more space Is required) CERTIFICATE HOLDER CANCELLATION ( ) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Denise Butcher/DMB ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025mmnnsim Tho ArOPn nama anrf Innn am ranicfiararf marlrc of A(:r1Rrl RISE ENGINEERING FederallD#054405629 9I RI contractor Registration No 8186 ` A division of Tblelseh'Engineering MA Contractor Registratlon No 120879 ! CT Contractor Registration No$20120 1341 Elrriwood"Avenue,Grenston,111.029ff (401)7844MIJI FAX(401)784-37,10 CONTRACT �l�f C ��1i Page t R I. V E pP,0GRAM" THIS CONTRACT IS.ENTERED:INTO.BETWEEN RISE CLC-RCS ENGINEERING,AND THE CUSTOMER FOR WORK AS ENGINEERING OESCRIaE6SEI.OW :CUSTOMER" PHONE DATE CIIadFO Donna Srnith. (508)428=7428 12f206201`3. 153435. SERVICE STREET RIWNG:STREET 8 Autumn Drive 8,Auturnin Drive SERVICE CITY.STATEj ZIP 61WNG CITY,"STATE,LP Centerville;MA 02632 Centerville,MA:02632 JOB.DESCRIPTION Proyide.labor:and materials to seal areas of your home against wasteful,excess air.leakage This µ�orl:,will be pertorrried in conceit 0 with the,use of special toolsand diagnostic tests to.assure that"your home will be left with a healthful level of aie."changc and indoor airquality.Materials to be used to seal your home can include caulks;foams,weatherstripping and other.products: Primary areas for sealing include air leakage to attics,basements;attached garages and other unheated areas(windows;are:not.generally addressed:) (20)working hours. At the completion of,the weatheriiatlon wo k,and at no additional cost o the homeowner;a final blower door and/or combustion .safety analysis will.be.conducted by the;sub-contractor to ensure the safety of the.indoor.air quality. $1;540.00 Provide labor and materials.to install 2"IFSK faced sent-rigid.fiberglass board insulation to(144)square feetoftneewall'raRer area.. $807.64 Provide laborand:materials.to install aa2"_layer of R42•:Class I Cellulose added:zo(60.8 square feet,ofopm attic space. $887:68 -Provide labor and.materials to:install(1):new,,:finished plywood,weatherstripped attic space access batch. Mato the age of:your. home we anticipate the nced to use lead-safe.practices ip this work. Prime coatand/or paint is:not included. $l a0:00 Provide labor and materials to install ventilation chutes in(58)rafter bays to maintain air flow.. $202:42 Provide labor and materials to:install(4)4"X 16".rectangularaluminum:soffit,.vents to increase ventilation inattic areas...Due to the'age of your home we anticipate the:need to use lead-safewmodeling practices in the course oFtli s; rk.; Specify color:White Provide labor and"materials to install(156)linear feet;of R-M.unfaccd fiberglass:insulation to thePerimeterol'thc:;basementceiling at'the house sill:. $258:40 Provide labor and materials to install 10 1€47'densety packed Class l CelluloseJmulation'to 20 square feet ofgarage ceiling located. 'below a heated floor area,by'diilling holes.in the:ctiling from.below.. Holes.drilled will,bc"plugged: Plugs will..be spackled and i66.in.a relattvel smooth conditron.'Finish sandin and touch u riming g 'y _ g p p „/pamtin well be the.customce -responslbI I yy $41,40 Provide labor:and materials to install 6"R-22 densely packed Class:l:.Cellulose insulation to;(16)square feet:of..exterior overhang located belowa heated floor area;`.by drilling holes:in the overhang from below: :Holestlrillcd will be'plugged..Plugs wilt be scaled with exterior grade spackle and left in tt relatively smooth condition.Finish sanding and touch-up priming/painting will be the customer's responsibility. .l rya All $30:24 l 20,14 Lj i � RISE ENGINEERING Federal ID#.os-0405629 RI Contractor Registration No 8186 A division of Thielsch Engineering MA Contractor Registration No 120979 CT Contractor:Registration No 6201..20 1341'Elmwood A_venue,.Cranstnn;RT 029,10 (401y 784-31,00. FAX(401):784=17.10 CONTRACT Page. 2 RI S .E PROGRAM. THIS CONTRACT IS.ENTERED INTO:BETWEEN.RISE CL+C-RCS ENGINEERING AND THECUSTOMER FOR WORK AS ENGINEERING OESCRISMSELOW CUSTOMER � PHONE .DATE. Client p. ..... - Donna Smith (5Q8)428-7428 12/20/20.13 1153435 SERVICE,STREET - ,BILLING;STREET 9 Autumn Drive 8.Autumn.Drive :SERVICE CRY,STATE;ZIP BILLING CRY;STATE;ZIP: w Centerville tMA 02632 Centerville;MA 02632 JOB DESCRIPTION. Total: 0,669.78 Program incentive: $3,43734 Customer Total: $63246 r. WE AGREE HEREBY TO FURNISH SERVICES-.COMPLETE IN,ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "*'Six Hundred Th rtyJwo&45110.0 Dollars $632.45 I UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.'CUSTOMER AGREES TO REMIT AMOUNT DUE.IN FULL.INTEREST OF ii6 WILL.BE CHARGEO MONTHLY ON ANY :UNPAID BALANCE AFTER 30 DAYS:SEE REVERSE FOR IMPORTANT;INFORMATION ON GUARANTEES,:RIGHTS OF RECISION.SCHEOULINO,AND.CONTRACTOR_REGISTRATION. OO-NOT SIGNTHIS CONTRACT IF THERE ARE ANY BLANK SPACES A,, AUTHORM,SI ATURt'.RISEENGINEERINO `- ��yCIUSTOh�� ... - USTO ERAC EQTANCE NOTE:THIS CONTR ACT IAAY BE WITHDRAWN BY.US'IF NOT EXECUTED WITHIN DATE.OFACCEPTANCE. " -��, �13 /J- ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE / SATISFACTORY TO US AND ARE:HEREBY ACCEPTED.YOU ARE AUTHORIZED TO OOTHE WORK DAYS. AS SPECIFIED::PAYMENT WILL BE MADE AS-OUTLINED:-ABOVE I f OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) , (Property Address) herebyauthorize y ' �d _ �c (Subcontrdctno an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature Date 'r p $ G rasect, �G 7.Y4 it taiF3 Stir �Mw CS-089%9 VICtORCIMINO 267 N.QUINCY Sf ABINGTON MA 023Si. .T" 05/11/2014 Office of Consom er��r��tm�rranal// Affairs&Business Regulation License or registration valid for indiv' - ME IMPROVEMENT CONTRACTOR egistration, 149123 before the expiration date idul use only xpiration 11/28/2015 Type' Office of Consumer if found return to: Primate Corporation 10 Park P(�_ Affairs and Business Regulation INSUL-PRO,INC Suitis5170 :- Boston,MA 02116 VICTOR CIMINO 267 N.QUINCY STREET ABINGTON,MA 02351 -- Undersecretary Not valid Without signature s, o2,1�ram, Town of Barnstable *Permit# Expires 6 months from issue date seitxszna�.s, Regulatory Services Fee d d MASS. Thomas F.Geiler,Director s6gy. �0 10rED taa+A Building Division �( Tom Perry, Building Commissioner ^PRESS PERMIT 200 Main Street, Hyannis,MA 02601 Office: 508-86240138 JUL -2 0 2004 Fax: 508-790-6230 �t� EF BARf�9ST , EXPRESS PERMIT APPLICATION - RESIDENTIALTW Y" iinpq� /�]� Not Valid without Red X-Press Imprint Map/parcel Number 4'U �6 V Property Address [Residential Value of Work o®0 r Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address NO "/M 17hn Mutomy) b0z/11111t Contractor's Name �� ' Telephone Number�� ! ► t( P& Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) R• [ Vorkman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name MIA/Aje7 ll Workman's Comp.Policy# � / Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side [✓Replacement Windows. 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. Home Improve t Contractors License is required. Signature �• I 11�- Q:Forms:expmtrg Revise063004 Town of Barnstable Regulatory Services saxxsatsM Thomas F.Geller,Director 079. A Building Division TomPerry, Building Commissioner: 200 Maio Street, Hyannis,MA 02601 . www,tofn.barnstable,ma,us Office: 508-862-4038 Fax,, 508-790-6230 Property Ovner Must - --Complete and Sign This Section If Using A.Builder as Owner of the subject property authorize . to act on mybehalf; . . . hereby in aL matters relative to work authorized bytU building permit application for, Autyy, - brw (Address of Job) afore o Ovmer Date Print Name Board of Building�R; Regulations and Standards I HOME IIV p�R�QYEMENT CONTRACTOR � F." Re .�, Ezpyr 'tl`y�n 9R2672004 I `- Corpo ration TYp� gate CENTRAL CAPE EDNSRtiCT. ±N f ftffEN DEVLIt�i 261 BLACKTHORN DR` MARSTONSMILLS,MA 02648tare W �� ✓/e {oo�vmonwea�/c o�✓�amac�uaeka BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number;:C 047993 F �. i; 16913 Restnctgq-,jADO _ STEPHEN LI�Nz _ 261 BLACKTHORN MARSTONS MILLS, MR 02648 Acting Co4imiss1pner ��,-� l^�� o � � � V� V � 1 � �� � � -� � '�F� �� ,_ __ C-Q:� ^�� f I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , gw Map 1 Parcel D4-0 Permit# 16184 Health Division `� 10 0 /a�� 3% � Date Issued Conservation Division �'4 So e 7 — -,3 Application Fee d' Tax Collector_ �> `7 1 10 1 0 3 � Permit Fee Treasurer Planning Dept. SEPTIC SYSTEM MUST BE 1IVST�p p�AMP Date Definitive Plan Approved by Planning Board VM TITLE SL�ANCE r Historic-OKH Preservation/Hyannis ENVIRONMENTAL CODE ANOTOWN REGUL,*ngWS Project Street Address U A*U m l� Village Owner Address YYI Vl . Telephone Permit Request 010� 2" 0-,-A V CV(Cojor w Square feet: 1st floor: existing proposed 21 Cf 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay - ' Project Valuation ��� ooty Construction Type VVOCCIlNQryY, Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family I/ Two Family ❑ Multi-Family(#units) i Age of Existing Structure r5 Historic House: ❑Yes B<o On Old Kings Highway: ❑YQ ❑3"lo Basement Type: Full ❑Crawl ❑Walkout ❑Other ' Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) `='t C € t =�, x� Number of Baths: Full: existing 2/� new D Half: existing �� new. co - Number of Bedrooms: existing new 0 " Tatar Room Count(not including baths): existing -7 new First Floor Room iount Heat Type and Fuel: M/Gas ❑Oil ❑Electric ❑Other µ Central Air: ❑Yes,, Zo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:O existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing eew size mX24p Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use- BUILDER INFORMATION Name Telephone Nu�mber /VU --I-I co" Address l�t�✓� License# 6.K-�Zt®Of2 M I GS W MPgS Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO AtIQhtl?, 1A SIGNATURE DATE ® D ; J FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ' MAP/PARCEL NO. � ADDRESS VILLAGE OWNER , DATE OF INSPECTION: H FOUNDATION s ^ i FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH,., ` . FINAL GAS: ROUGH FINAL--- FINAL BUILDING DATE CLOSED OUT -, t ASSOCIATION PLAN NO. 10 _ t' t ,f THE TOyy� The Town of Barnstable . O� ivaTABM Department of Health Safety and Environmental Services . MASS. ' Building Division 'Eo M>� 367 Main Street,Hyannis,MA 02601 508-862-4038 - 508-790-6230 PLAN REVIEW Owner: 1, lrYl t Map/Parcel: Project Address: () I\U� l l II h n 1 J1r" Builder:0_(2,Y)�-\/'`c,. O—C)" cc) The following items were noted on reviewing: t i�rr•y d (� �� (� tn cal 12 �C 24 �� ( Lc1 2 9.. 3 r I Yr Q- SLc�p 6� r0 �.� c • 7. Reviewed by: C Date: .. _ .. .. PROJECT'.TITLE rfn (nf.t a T''FC c er C.i 3 f Z L CR n FOR Q PARED R P E- _ t l E:. -1 7 � I - Central Construction Company, In, . - --- L`j(• Suer Dml-•llm de-r ( 261 gbkfl om Orire•Marstow Milk,MA 02648.508 420-1340 $tr 8 of Gaz r . ..• SCALE 0 (Z. y$ 7��z �!l.MbY ff -- DATE DWG NO. 7 CHECK DRAWN JOB N0. SHEET OF _ .. PROJECT'-TITLE I I 2,1 zI � ... .. r .t—oJN�.Gl.�1.aL.. .. '`l._Gi+v. �,�• ' PREPARED FOR Central Construction Company, le SAe Devlin•Presz&nr 261 fi ddhorn Drive•Marston WK MA 02648.508 420-1340 SCALE DATE DWG NO. DESIGN w CHECK. DRAWN 7013 No—SHEET OF PROJECT-TITLE y ' ELE llln t1� � l PREPARED FOR r p w �= s a> _ - -7- Central Construction Company, In Steve,Devlin•Presi&nt - _1 �. 261 81ud fl.Orive•M.Vorn MOk,MA 02648 508-4X1 340 _ _ , Yit:ctJ_:_Pout4.... y r o �r�r� r t'' DATE DWG NO _ DESIGN CULL CHECK II DRAWN c ._.... y ... JOB NO. SHEET OF P -_ _- PROJECT.TITLE i'nu/loc NtSY_ AMR- L1 17. O II , r� FOR - PREPARED • •i. I �� _..�-..-�'�=-Sl�� S�k Imo` i (S Central Construction Company, Ir /- i 261 Bkdctflom Drive•hlarstere Mills,MA 62648.508420.1340 — SCAL-E Lk' 0 c J � � DATE DWG NO__.•, J DESfGN CHECK DRAWN _. JOB NO. SHEET OF Jul-09-03 15:11 From-TOWN ATTORNEY'S OFFICE 5088624724 . T-334 P-01/01 F-270 FROM :CENTRAL CONSTRUCTION FAX No. :5ze 420 1340 7u1. ®9 2003 02:101PM Ke Town of-Barnstable Regulatory Services 3 Tb=w F.G4or,Director t0'¢ Building Division . Tom perry, BuMng Cc=d5d0ner 2001V MA Street HYOU tis.MA 02601 Of&s: 508-862.4038 Fax: 508-790-6230 R• Property Owner Must Complete gad Sign This Section If Using A Builder 9 Y�,�,�4 ,as Own=of the subject ro - -�C..K� J� --- 3 P PM hexcbq autho$ze to.sa ou=Y behalf,. i4:.a71 matrexs relative-to-work au&*i*ed''bp tWS bUWing'F6=MWi#PRcat±•oD fog (Addzcss of rob) 5 attire of Qwucr Date ps�x Name . r s �JfiP, l�omvrrapryuieall�z o��acftuar,� I ' Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR ' Registratl6n ;131.841 nExpiOIP 9/26/2004 Type Private Corporation CENTRAL CAPE CONSTRUCTION §fh9WEN DEVLIN 261 BLACKTHORN DR MARSTON'SMILLS MA 02648 ✓fie 1Domv�na�zureaftfz �/�.aaaacfu�aP,ltd i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR i I Number CS O47993 I Expires 02/04/2004 Tr.no: 15943 Restricted 00: STEPHEN J DEVON 261 BLACKTHORN DR ( � MARSTONS MILLS, MA 0260 Administrator RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 I FEE VALUE WORKSHEET NEW LIVING SPACE C1 l 2 square feet x$96/sq.foot= Z x.0031= J 2 ) S- plus from below(if applicable) 4 ALTERATIONS/RENOVATIONS OF EXISTING SPACE m square feet x$64/sq.foot= t x.0031= plus from below(if applicable) GARAGES(attached&detached) / .4 _square feet x$32/sq.ft.:� 3 x.0031= /2 J 4' ACCESSORY STRUCTURE>120 sq.ft. �« j G- >120 sf-500 sf $35.0 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck. . x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming'Pool $25.00 Relocation/Moving' F ' ' $150.00 (plus above if applicable) 1 Permit Fee _ 3 f 1 ' Pr 1/ 4aVt IV ly E � . f 1 � ~ -� �y�-v�.�► 1��tyL �.wt w Vi The Commonwealth of Massachusetts Department o,f Industrial Accidents Office ofloyestlgatfeas 600 Washington Street :Boston,Mass. 02111 Workers' Com ensation Insurance davit name: ' location: _ In y, hone# 4-n— 4-Z1 ci ❑ I am a homeowner performing all work myself. ❑ 1 am a sole netor and have no one workin in ca achy %% %/% b//%%%%%%%/�%%///%%%%//%/�%////%�%%%/%% co ensation 'din workers comp ens :}:}:<;:};:::<>'«•:>};:: :;::;:>:::::...:....,. :..:{•Y-::::..,....., ,,.}.,+•:. . 1 er rQVI g ..4..v.,•x„.4 .,a:;; : .....,........................:.:. ......... ............................... ................... ....:..� ,.:.:.............,. : .r.:x:•r}:4:•s}:�+••i ::4...4. .{r:{}Yy{;t?•{':iSi,?.:`-•..' ..:...... ... .r.. .. -. ... .. :. ....n:::.v.... •Y:vY4::. .. :4\k:::;.v �C;-v4,`,•i:• ,£;:i;•}? ..... { •nam O P s Er I am an Agi .a .S}.. f {4{� �iC..... .. .. .. .....v. .. ,....................... .. .................i..:.:. .. ..I,;.1 Y AC Y �Q \ T..44 k• 2 S n4. .......... .. .. ... .. ........ . ... . ............... . ... .�:::.::••::.:.::.::.r..,•::.::..: hone;#:}:•:�:•;:.:.}:::::}:{;.}:.;;...;..:;.}.}::L:-: .............. alicv ::. ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have ;Yn;:•},x?4:' rY4}}K!Av ation ohcesi , },{;;]:>k•:+4>:s:•}:• co ens :{.}:•.}:.;:{.};z::.;:.;:.;:L{;<.;..}:{.}}}:i;<i•}:.:>}: :.� •.., the g .........:..:.,,,..,......::..............:.:...................:.:..... :.......... ........ ....... ....... ....,..... .......... ......... ............... ..........................v:::.v:{:.}:.........:•:::.::., ::•:....r::.:}:•}}t•'r"$::ii{Y•...vv ..L,,W...L:•'{•::4:•i:•Y r.... ,t.]::...r Y:ivi •.•:.�}.:+..., ...... ..,..... .............:.::::..:::::.:},:{;•:::r. :n..,:., {::•.�ik•K{•}xr:{.}}.{a}v:::'i.•.F?:::�:E;�?o}.:..£z�•.S•N'Yr '.�:t�:t::rr`iq:: : •:::... ,zzz.r 3�} r�^.,;c.!:;:: .� 4•:a.. .}.:\. 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({.::.::::.. :.::v.:::w:::.::i{:.k....:.. ........::.,•::........... :..r.............:....:..::.:::......... .. x.. ..............::::::: ..... .....v.......v:.•.v::::.v:.:.:v::::;:::n•-•v:::::::::::v:.};.;.};ii4:•;}}:{•... .:.. ....:•::•:: .n.n.• ......... ........ ......., ........n. .......... .......n.• ............... v •.xJ;vri{V}{4�;, Ji:}};}} VIN .. .. .. rhr .. ............... ................. ..:::::n............v.. •;m}:••v:,v::::v..n.} v•v.;}{{.y,'v••:•-:::::• .....................:................�...........:...,...:.-n...n......... ....:r::.vnv.v:::•}'•}:.,v:U:w:::}:•:{•:•:?•}}i}}}'A!.7.,v4i:4:{;. .......... ecare one y�e to s mpr1 coverage as en aired under Section 25A of MGL 152 can lead to the impostion of criminal penalties of a fine up to$1,500.00 and/or penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against ma I understand- a one yearn'imprLronmsmt as wen�dvII p ` copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification. I do hereby certify under the pains and penalties ofpeIury that the information provided above is trrY and carted Date Signature �, _ Phone# ( D Punt name oiflsal use only' do not write in this area to be completed by city or town official - permittlicense# ❑Building Department city or town: _ ❑Licensing Board ❑Selectinen's Office check if immediateresponseisrequired ❑Health Department phone#; ❑Other _ contact person UrAsed 9/95 PJA) 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 coritract of hire, express or implied, oral or written. o 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 section 25 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,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 irmu ce 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 maybe 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 retarae3'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 lavestlgatlons 600 Washington Street Boston,Ma, 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 OFISE,p� To" of Barnstab.le Regulatory Services - Thomas F.Geller,Director 9�b i6,q. �,� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax:- 508-750-6230 Permit no: Date AFFIDAVIT HOME IMROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERIYIIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation;repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which.are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type.of Work: Z'�✓ rQ W bb� ���ted Cost -t 6 co Address of Work: A Alm v, G4,2 Owner's Name: �� rn, Date of Application:_�-(0'�J I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law , ❑Job Under$1,000 []Building not owner-occupied [❑Owner pulling own permit Notice is hereby given that:OWNERS PULLING THEIR.LO gOMERMIT OR DEALING WIT11 IlYIPROVEMENT WORK UNREGISTERED DO NOT HAVE CONTRACTORS FOR APPLICABLE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c, 142A. a - SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Co actor Name RegistrationNo. OR T,.�e Owner's Name �-3 TOWN OF BARNSTABLE •B98HSTdDLS, i ?wa 9�c a• BUILDING INSPECTOR �a APPLICATION FOR PERMIT TO ..... Pam........................."!. ,........... ........................................... TYPE OF CONSTRUCTION .. �...7...........19.2 TO THE INSPECTOR OF BUILDINGS: The undersigned bereby applies for a permit according to the following information: Location ......... Proposed Use � .. ........... .. ........................4!!..........,.................................................................................................... ZoningDistrict ........................................................................Fire District .............................................................................. Nameof Owner .. !"Y:. .. ...............................Address .................................................................................... I - -V- a�' Nameof Builder ......... . .......................Address .................................................................................... Nameof Architect ..................................................................Address ..................................4 Number of Rooms .......... .............Foundation ....... ...... Exterior .....%..! ,e'.,A .... ..... ..............Roofin �. .....+d..V� ....... g ............... . ... f/.. + Floors ...' ..................... ......................................Interior ?7?�. /���.L't, �� Heating i .� :._`.....................L...-?'.f...�:r................................Plumbing ........... ......� G% ................................................................. Fireplace ...................V............,..r� � Approximate Cost .. ... � .......................... Difinitive Plan Approved by Planning Board ________________________________19________. Diagram of Lot and Building with Dimensions J (O-� O w � f)_ oXLLL. ZQ LUL- � QO m = Q L- Wn 00 0 0 >: < co ^� wow emu) � V) 2 w l Gl W Q — 00 < 9 � U) W ZZ 0 © pm gr Z17 Ld a.. hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................................ °`�,... e Nelson, W. H. DEC 31 WO No .....�32.7.3 Permit for ..........dd..to single family..dwelling...................................... Location .....attttiunn„Drive............................. ........................ enterville ........ i Owner ..........kJr...Hc..Nelson............................. Type of Construction .............frame.................. .. ................................................................................ Plot ............................ Lot .......�1.................... a Permit Granted .......... ugust..17.... .....19 70 r 1 Date of Inspection ....................................19 Date Completed ........f�.7:Z..�r-r.�.........1976 t PERMIT REFUSED ................................................................ 19 ' ............................................................................... ............................................................................... ............................................................................... ............................................................................... Approved ................................................ 19 j . ................. ... ......................................................... II e