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L k ';:co,$ r O•, ._,. y.= 1 Feb. 12. 2020 3. 29PM ALTERNATIVE WEATHERIZATION, INC No. 5214 P. 1 ALTERNATIVE WEATHERIZATI.O.N Date: Z hu Town of Barnstable 200 Main St. - Hyannis,MA 02601 Re:Permit# Villa -`The insulation weathexi•• 'a:a���i+ork at �- , �•Qa°�!:'. �;:'�;•.,..:. 'lias,been'com letedin 'ccoxdancewitk7'QC1v1R' :< p a•,. ;$ '•.r'.n Timothy Cabral,. President CSL-105454 56 DICKINSON STREET ) FALL RIVER,MA 02721 1 (508)567-4240 1 ALTERNATIVEWEATHERIZATION'@,,GMAIL;COM f J a .. ... . A lication number.,. . C..�......... . A t f 9 r Date Issued.. .1.�f.3 • ... ....... ..... j `� w Iding Inspect r Imtlals.Build* ., at?/Parcel: t/ .,41 NV C , TOWN OF BSTABLE J .. t. ,., :EXPEDITED•RERNIIT APPLICATION::; :. ROOF/SU)ING[WINDOWS/DOORS/TENT,S/STOVES/WE-ATIERIZA,TION *, r f PROPERTY INFORMATION ... Address of Project.- (� IViJMBER#' - '.> 3 STREET '_VII,IAGE �* Owners Name ( � Phone Number Email Address: fl Ck�'1e r g- i- '��, ,t , Cell Phone Number Project cost$ J Check one Residential Commercial OWNER'..S ALT'THORIZATION v� As owner of the above property I-hereby"authorize. (%Gt✓�Y ,, PP a.,, "P �.. 78 1VIR to a hcahon for a buil ermt m accordance with Owner Signature: Q,/, G Date: TYPE OF WORK Sidurg •,. Windows(no header change)# � = Insulation/Weatherization�€,." .. © Doors (no.header change)# Commercial Do,ors regicare an inspector's reviews ; 0 Roof(not applying more than l layer of shingles) ti Construction Debris will.be' going to , CONTRACTOR'S;INFORMA'L'ION Contractor's nameve- ; �h Home Improvement Contractors Registration(if applicable)# /�f� �3 (attach copy) , t Construction Supervisor's License# /�yJ2/ (attach copy) 01 Email of Contractor ct erha, ilo�r ye /21,�c J�l7l.: Phone number AT `moo? ALL PROPERTIES THAT HAVE.:STRUGTURES>OVER,75`Y.EARS OLD OR:IF THESUBJECT7PROPERTY lS"IN` . A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED:' APPLICATION NUMBER.................................................4.......... *For Tents Only* Date Tent(s) will be erected Removed on number of tents total . Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:34pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES *1 , , Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CAM the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APP 1COT9S SIGNATURE Signature Date b �U All permit applications are subject to a building official's approval prior to issuance. I y�E THE 1p�� Town of Barnstable * IIARVSTASLE,.�.._ Building Department Services Mrs' Brian Florence CBO r6 MAY&' Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us, Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, Frederick Denton , as Owner of the subject property hereby authorize A&,W�fiti& to act on my behalf, in all matters relative to work authorized by this building permit application for: 38 Captain Jacs Road Centerville (Address of Job) Signatu Owner Signature of Applicant Ertl er '- Oc, ben -)-r)n Print Name Print Name Date The Commonwealth of Massachusetts 4 Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 svP,e www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER_ NUTTING AUTHORITY. Applicant Information Please Print Leaibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC.' Address:2 LARK STREET t City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.�✓ I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.E]I am a homeowner doing all work myself[No workers'comp.insurance required:]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.[7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof p repairs These sub-contractors have employees and have workers'comp.insurance.t 14.❑✓ Other 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. . 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic.#:XW058867158 ( Expiration Date:06/07/2020 Job Site Address: Q.C..S A C! City/State/Zip: Pemm vIt t Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration Me). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.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 e ' ` s and al"so of e ury that the information provided above is true and correct Signature: Date: Phone#:508-567-4240 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 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards C o n sStrrl �f ry i s o r K._ ?� CS-105454 r l pires:05/08/2021 TIMOTHY CAJR I :n 68 DICKINSON�?A STREET FALL RIVER 02721 �Yn7S5"3 SOz1 P Commissioner r Office of Consumer Affairs'and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvem ntC`o.ntractor Registration iM x Type: Corporation ALTERNATIVE WEATHERIZATION, INC. z s Registration: 175683 2 LARK ST M Expiration: 05/28/2021 FALL RIVER, MA 02721 L "ri ti l r �G ti •4,is 5�0 Update Address and Return Card. SCA 1 O 20M-05/17 ./� Ucvnrrtcietue2�/�o����t�JJCcc�t.3�/lf Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:,Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 17 5683_== 05/28/2021 1000 Washington Stre -Suite 710 W,-A` ton,MA 02118 ALTERNATIVE WEA�THERIZATION,INC. � t 1 ry ,"f� TIMOTHY CABRA,L•.�� :.f (� 2 LARK ST '�,�-� GaliH"�(CL.I a.G�iJo6c FALL RIVER,MA 02721 Undersecretary Ot V WlthOu signature l t { �' DATE(MMIDDIYYYY) llklh� '� CERTIFICATE OF LIABILITY INSURANCE F05/24/19 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 policy(ies)must have ADDITIONAL INSURED provisions or 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 UUNIAUI NAME: Anthony F.Cordeiro Insurance Agency AIC,No Ell:: 508-677-0407 FAX No): 508-677-0409 171 Pleasant Street E-MAIL Fall River,MA 02721 ADDRESS: HSouza@Cordeirolnsurance.com - INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURER C: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any oneperson) $ 15,000 A Y Y BKS58867158 06/07/19 06/07/20 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - - GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COM acBINED SINGLE LIMIT $ 1,000,000 Ea cident - ANY AUTO BODILY INJURY(Per person) $ B AUTOS ONLY AUTOS OWNED 1xx SCHEDULEDY BAS58867158 06/07/19 06/07/20 BODILY INJURY(Per accident) $ XHIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ x UMBRELLA LIAB X OCCUR EACH OCCURRENCE . $ 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/07/19 06/07/20 AGGREGATE $ 1,000,000 HOED RETENTION$ $ WORKERS COMPENSATION - PER OTH- AND EMPLOYERS'LIABILITY y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? NIA XWO58867158 06/07/19 06/07/20 (Mandatory in NH) - - E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 I IL DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA,its direct and indirect parents,subsidiaries and affiliatesshall be named as Additional Insured on commercial General Liability and Automobile Liability polcies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENT 11 ©1980-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD