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1125 CRAIGVILLE BEACH ROAD
�(( ,v a��;' aP ,1rttn,"'� �rk4: �� � ,{y�1:�y����y}P�Y4�rfi��� w F. {. «ir,�'4 7.,'�k a ' q sx�•'} ri 1;�(�� u,,� tx r�.r I� t p i'i`•,rtl'tf�}rx+�, If{'� �'�;, _.?V!. �,st Yvs Ay. J fiE `'��YI ry" � ���+l��'� ,�� yW'`� I�1�!fU''+IY,� ,"+'� f � S .�I•`�• n v: n p i r w Town of Barnstable ]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 a 39. Posted Until Final Inspection Has Been Made._ Permit Nw+" Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final nspection has been made. Permit No. B-20-1163 Applicant Name: carlos Figueiroa Approvals Date Issued: 05/06/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/06/2020 Foundation: Location: 1125 CRAIGVILLE BEACH ROAD,CENTERVILLE Map/Lot: 206-048 Zoning District: CBDLBSB Sheathing: Owner on Record: BLACKWELL, RICHARD M& DIANE Contractor Name: CARLOS H FIGUEIROA Framing: 1 Address: 5 FREDERICK CR Contractor License: CS`-1404107 2 WOBURN, MA 01801 Est. Project Cost: $5,500.00 Chimney: Description: Remove and install new roof 12(sq) Permit F� $35.00 : $35.00 Insulation: Project Review Req: Fee Paid. Date: 5/6/2020 Final: Plumbing/Gas `` - 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 afterssuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for.public inspection1forthe entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on thisp rmit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 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). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Sab 1-7- Town ,of Barnstable llding .F.:: r ,J;, ,:'` "'. -a-`'� s�..' `r,: .:;:':', ",'Si r• $i" ,rr"i,'s: ,'�a`r' .,.�*`' ,'e�• ,�Eu'a: �;.fro„ �°s« '"�,, ,. • ;This � : So That rt is':Uisible From the°Street �A roved�Plan5�,MWstgbe�Retatned on�Job,and:th�s Card Mustbe';Kept �,�, *' �ARN$['ABLB. •' � � �,�� ;�4.. .. ,� ..� '%.c �.,..> � �, p�.� r F,� �i X, / d gyp,.,�.�' `� :,��r � M' Posted UntilFinal InspectionHas Been Matle� � t 1639 a h t. °t`o ffi Q ,. S a .0 � r 4 Permit iill R �WFie�e a Certificate of Oceu'" an .;Is,Re ured,;such Bu�ld�ng shall Not�be OBccupied until a Final Inspection:has been�made � t .,xv...,�"�: �°,,,, ..xx,�&..,.. ,. ,,�`;.,,,�p.,s� ,,., �sq. ru.. .wsa:.::� .°�<'�-:... .,� 3.::',. ,�. ,:� . , ,,.:r,�b �':.„,.°�.�:.., e;. ,..,,<� .. ,�.x,„�.., ,s ✓•. . :,.: Permit No. B-19-2252 Applicant Name: Stephen Hunter Approvals Date Issued: 07/11/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/11/2020 Foundation: Location: 1125 CRAIGVILLE BEACH ROAD,CENTERVILLE Map/Lot 206-048 Zoning District: CBDLBSB Sheathing: Owner on Record: BLACKWELL,RICHARD M&DIANE Contractorka me ,ALUMINUM PRODUCTS OF CAPE Framing: 1 i; Address: . 5 FREDERICK CR ;COD INC. 2 ontractor License 158424 WOBURN, MA 01801 Chimney: Description: INSTALLATION OF NINE WHITE VINYL DOUBLE HUNG.WINDOWS. Est: Project Cost: $4,300.00 THE HEADER SIZES WILL REMAIN THE SAME AND NOT CHANGE IN �Pecmit Fee: $35.00 Insulation: SIZE.THE WINDOWS ALL MEET EGRESS REQUIREMENTS FeePaid $35.00 Final: Date. Project Review Req: 9 i 7/11/201 Plumbing/Gas s i if ffir�.— Rough Plumbing: a Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authornzedl this permit is commenced within six,months afceRi an�. icia All work authorized by this permit shall conform to the approved application a`ndAhe,,approved construction documents for which';this permit has been granted. Rough Gas: 4 - All construction,alterations and changes of use of any building and structures shall bee'in compliance with the local zoning„by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or load and shall be maintained open for publi0inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the�Buildi.g and"Fire Ofheials are provided on this,permit. ���� t Service: Minimum of Five Call Inspections Required for All Construction Work:V1, Rou 1.Foundation or Footing i_ � h: 2.Sheathing Inspection ._ �,' s .,,,., �� ,.. g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 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). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 01 �1NE„ Town of Barnstable *Permit# � Expires 6 months from issue date Regulatory Services * BARNSTABIX • X-P R E S PER 9cb 1639. `0� Thomas F.Geiler,Director '°rEb MAC a > Building Division SEP 2 3 2013 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us TOWN QF BARNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �c O�� Not Valid without Red X-Press Imprint Map/parcel Number Property Address Z �'/� /�V)LL E 13 E l��. Ig Residential Value of Work$ oZ�S� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �'Z IO/A! API/b 1�i psy E 131-ACK—F44, clz , wvz3o g,4, e1A ©/go► - Contractor's Name 1 e )eL-ke- t4.Yyau_ Telephone Number Ste$ 36K' 9,t`Z Home Improvement Contractor License#(if applicable) Email: - Construction Supervisor'.s License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor �-I am the Homeowner ❑ I have Worker's.Compensation Insurance Insurance Company Name Workman's Comp.Policy# . Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) _ ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping.'Going over existing layers of roof) - 0,Re-side El Replacement Windows/doors/sliders.U-Value (maximum.35)#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:\Users\decollik\AppD. ocal\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\8R76BDVA\EXPRESS.do"I Revised 061313 J tME ram, "9: ,0� Town of Barnstable r �fD MAC A Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us } Office: 508-862-4038. . . Fax: 508-790-6230 ♦ R 1. Property Owner Must - r Complete and Sign This,Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Out]ook\8R76BDVA\EXPRESS.doc Revised 061313 I i ?`Ire Comy.nonwealth of Massachusetts Department of Industrial Accidents - -- Office of InUestigetions 600 Washington Street - Boston,AU 02111 ►pwiv.nnass.govld a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name Oksiness Khganirrationllndividnal>: L e oZ�j 7j�1/'t� W t%LL. Address: ' 2 �' LC_�:,V l L L_P /'c #I -)-Zo Ali City/StatelZip: i L_ m Phone ik �® " Are you an employer?Check the appropriate boa: T ofproject r . 4. I am a. enertl contractor and I Yl� (required): 1.❑ I am a employer with ❑ g 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 anycapacity. employees and have wormers' 9. ❑Building addition [No workers' comp.inmm,nre comp.insurance./ required.] 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions 3.�.I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption.per MGL 12.❑Roof repairs insurance required.]T a 152, §l(4),and we have no employees.[No workers' 13.❑Daher comp-insurance required-] *Any applicant that checks boas#1 mast also fill out the section below showing their workea'compensation policy information. 1 Homeowners who submit this affidavit indicating they are doing all waak and then hire outside contractors must submit a new affidavit indicating such_ +'Contractors that check this boar must attached an additional sheet shouting the name of the sub-coonuctors and state whether ornot 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 itorkers'compensation insurance for my employees. Below is thepdicy and job site i formatioaa. Insurance Company Name: Policy;9 or Self-ins.Lie..#: Expiration Date: Job Site Address: City/StatelZip: Attach a-copy of the workers'compensation policf declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the.form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of perjury that the hdormation provided above is tnw and correct iture:—✓- Offlicial sass only. Do not write in this area,to be completed by city or town officirat City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector -.Plumbing Inspector 6.Other Contact Person: Phone#: 6 i Town of Barnstable , ' o* Regulatory Services BAMSTAOM ; Thomas F.Geiler,Director • "� A Building Division �f0 MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:_ JOB LOCATION: \ Z-7 R�\G1\I I L,L E )�5 EALC'A I'Z y. C r N rE iZ\" LLF= rll number \ street village I ' "HOMEOWNER": lk �� 13L AC IL\A,/E LL name home phone# work phone# CURRENT MAILING ADDRESS: Z C X A--\!*1V l "E )34P,<K lZ I CiEW—Ir=k V i LL P&A. city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signatur of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages aperson(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part ofthe permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t.amend and adopt such a form/certification for use in your community. Q:forms:homeexempt E7)-] TQ�"IN OF SAS t TAP Z13 P t RISE Division of Thielsch Engineering,Inc. ® �� t�• ' 1341 Elmwood Avenue t ENGINEERING Cranston,Rhode Island 02910 111 May 1, 2013 Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Re: Insulation permits Dear Mr. Perry, This affidavit is to certify that all insulation work completed for 1125 Craigville Beach has been inspected by a Building Performance Institute (BPI) certified Professional. All work performed meets or exceeds Federal and State requirement. Sincerely, Erik Nerstheimer Supervisor of Installations, BPI certified Building Analyst Professional and Envelope Professional, ` RISE Engineering, a division of Thielsch Engineering, Inc. 1341 Elmwood Avenue .Cranston, RI 02910 401-784-3700 •800-422-5365 •Fax 401-784-3710 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0(0 Parcel d ` Application # Healthy Division Date Issued ( Id Conservation Division Application e Planning Dept. Permit Fee, Date Definitive Plan Approved b Planning Board pp Y g e4 ( l& d Historic - OKH Preservation / Hyannis Project Street Address Village C_k %th?U1 C 1 Owner Address- 7 Telephone Permit Request �I 0.g c)L 47I & N v C L21 r 4 ti,Q RC GOR PLB,c/ alee Saottzf FOC)fkCz C!u Ogg 5 Square feet: 1 st floor: existing 475proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay )k Project Valuation 4710, o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family (# units) Age of Existing Structure 6Y Historic House: ❑Yes Y'No On Old Kinjj-'�.lHighwayQ❑Y ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other - .:. L" } Basement Finished Area(sq.ft.) Basement Unfinished Area (S ,) 7F Number of Baths: Full: existing new Half: existing ne _ Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count' Heat Type and Fuel: ❑ Gas ❑ Oil L94lectric ❑ 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) CKvt� 7`I`( • � 27 Name Q�I;S G b / G i,&j [A Telephone Number (`/y) 7 Pf—:k 7 d y Address &oo Boo 4✓,Y License # 0 Home Improvement Contractor# [ / Worker's Compensation # W C2 Z 11 2519 -01 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WALL BE TAKEN TO SIGNATURE DATE O FOR OFFICIAL USE ONLY r - APPLICATION# Y DATE ISSUED, MAP/PARCEL NO. ADDRESS VILLAGE ' OWNER s DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ;r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION-PLAN NO:- Y r ,h, 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): ��5� �t(/�/�6 �(��' Address: ( &IJ L j GC,a City/State/Zip:GPP,4/S"(—O VI/ er, CCU h Phone #: CY 61) /7 '((^370 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 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.T required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work ' officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: (t'^j fe ( ti & Gl Policy#or Self-ins. Lic.#: (,JG " 711 d ly Expiration Date: 4111 Job Site Address: & ll0�5 G ICkW LLsr (W, City/State/Zip:C,^—ie12V/L(-4/'1/4. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert• and the rns an enalties of perjury that the-information provided abGove ' true nd correct. Signature: Date: / Y 6 Phone#: d 7 r 7-C2 0 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical.Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed,to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a refer`ence'�number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture . (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia OP ID 31 DATE(MMIDDIYYYY) ACORD CERTIFICATE,OF LIABILITY INSURANCE THIEL-1 04 06 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Preston Agency, Inc. ` ` ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 150 Division Rd Suite 303 - HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 1 Box 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Greenwich RI 02818-0810 3 : , Phone: 401-886-8000 Fax:401-885L1700 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A: Hartford Unde—iters Ins. Co - - r INSURER B: Hartford Casualty Insurance Co Thielsch Engineering, Inc INSURERC: Liberty Mutual Insurance Group 195 Frances Avenue INSURER0: North American Capacity Cranston RI 02910 ' 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 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE DATE MM/DDIYY DATE MMIDD/YY GENERAL LIABILITY t EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 02UUNTD5678 04/01/09^ 04/O1/10 PREMISES(Eaoccurence) $ 300,000 CLAIMS MADE Fx-�OCCUR - - y -- MED EXP(Any one person) $ 10,000 PERSONAL BADVINJURY. $ 1,000,000 e - GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: " PRODUCTS-COMP/OPAGG. $2,000,000 . POLICY X JECOT LOC. Emp Ben.. '1,000,000 AUTOMOBILE LIABILITY _ - COMBINED SINGLE LIMIT B X ANY AUTO 02UENTD4850 04/01/09 04/01/10 (Ea accident) $ 1,000,000 ` ALL OWNED AUTOS BODILY INJURY - SCHEDULED AUTOS (Per person)- $ HIRED AUTOS BODILY INJURY ` $ _ N Per accident t N- WNDAT �. .. -O 0 E US 0 ` PROPERTY DAMAGE .` $ - - (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ' ANY AUTO - - EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY - EACH OCCURRENCE $.10,000,000 B X I OCCUR CLAIMS MADE 02XHUUF6573 04/01/09 04/01/10 AGGREGATE $ 10,000,000 DEDUCTIBLE _ � - � '- $ X RETENTION $10,00O $- WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS'LIABILITY C WC2-Z11-259874-019 04/01/09 '.'04/O1/10 E.L.EACH ACCIDENT $.500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE .. OFFICER/MEMBEREXCLUDED7 - E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under - SPECIAL PROVISIONS below a • E.L.DISEASE-POLICY LIMIT $ 500,000 - OTHER ,. D Professional Liab DVL000025902 04/13/09 04/01/10 . Prof Liab 2,000,000 A Leased/Rented Eqp 02UUNTD5678 04/01/09 04/01/10 Equipment. 1 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY.ENDORSEMENT 1 SPECIAL PROVISIONS - - - (*Except 10 days for' non payment of.-premium) w M CERTIFICATE HOLDER CANCELLATION TWNBARN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0* DAYS WRITTEN Town of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Building Division IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 Main Street , Hyannis MA 02601 REPRESENTATIVES. - - AUTHORIZED EPRES ACORD 25(2001108) ©ACORD CORPORATION 1988 ° r rTHIEL 1 PAGE 2 NOTEPAD: w INSUREDSNAME Thielsch Engineering, Inch OPFID 3'.1 DATE 04/,.06/09 '' ' .. .,... ..... '.. ... ..: P�... " .. ... au.Y_-.i 1. �� Also for 'RISE Engineering, a division of Thielsch Engineering, Inc. askell Associates, a division of Thielsch Engineering, Inc. SAL Laboratory, a division of Thielsch Engineering, Inc. ESS Laboratory, a division of Thielsch Engineering, Inc. ALCO Engineering, a division of Thielsch Engineering, Inc. Water Management Services, a division of Thielsch-Engineering; Inc. • r Federal ID#05-040529 Y RISE ENGINEERING RI Contractor Regi tra4 on No 8186 A division of•1'hielsch Engineering IRA Contractor Registration No 120979 r CT Contractor Registration No 620120 1341 Elmwood avenue,Cranston,R102910 „ (401)784-3700 FAX(401)784-3710 kRU T T a . : - Page THIS CONTRACT IS ENTERED INTO BETWEEN RISE . ENGINEERING.AND THE CUSTOMER FOR WORK AS E N G t PJ E R I N DESCRIBED BELOW CUSTOMER PHONE DATE• Client# Richard M Blackwell (508)790-1535 09/02/2009. A03018 SERVICE STREET _ BILLING STREET 1125 Craigville Beach Road 5 Frederick Cir F\\�i(d/r SERVICE CITY,STATE,LP BILLING CITY,STATE,ZIP Centerville,MA 02636 Woburn,MA 01801:^` ` n t JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This wor performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.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 and other unheated area (windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing. 10 man hours. $660.00 RISE Engineering will provide labor and materials to install a 14"layer of R-49 Class l Cellulose added to 1475 square feet of open attic space. $2,065.00 RISE Engineering will provide labor and materials to install insulation and weatherstripping to 1 attic access hatch(es). $25.00 RISE Engineering will provide labor and materials to install(1)exhaust hose with wall mounted flapper vent to exhaust_existing clothes dryer (s)• $130A0 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for households where total income is less than or equal to.80%of median income, the.Cape Light Compact offers 100%incentive toward eligible measures. " -$2,880.00 7 i WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF '***001 Dollars $0.00 + UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY - UNPAID BALANCE AFTER 90 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION, - DO NOT SIGN THIS CONTRACT IF,THERE ARE ANY BLANK SPACES AUTHORIZED SIGNA E ISE ENGINEERING - - CUSTOMER ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN 'r DATE OF ACCEPTANCE — ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE - SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK —_— DAYS. - .. - AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE _ Rough Sklet' AUDIT# j (;_ ; — — .�C-— _ �—_ Q3 x - - - - - - - - --- - -- - -—-- — —-———— — — -- —— _ —— — — — —--— t— — — — — — — —- ——--—— —�+— —— — — —— — -- — — ———— — __ _ ____ _ f__ _ _ _ __— _ _ _ _ - Y� _ — -- — —— — —— — —__ — ————— — — — — — f — — —_— —— — ——..... . ................ _ t -T- __ - - I , I I , I t __ __ .�__ _ __ __ __ __t_ _ _______ -1--7-1' - ' - ' , r I ' "f'-i'-i-- s I I I_i ____ ____ r V � _ ' I I _____ _ __f _T_`T- _ _ __ ___ _ _ _ _ w _ _ _____T l r _ T T I I � r I 1 I I I i I I I I l ' I r I I_ 1-�-I I - - - ' ' I I I I i I I I I r. t— —r——r. —r-—r r--T -T --T--,- T- __ ___ ___ ___ _ T' 1"t. l _ __ __ _ ' I I I I I r r Y r t t /r 1 1 ___ _ _ r__ _ _Y' 1 t_ __ _ _f_ r, __ __ _ T , l__--- _ _____ __- T _- ______ T__ __T _T l__1_ _ _ ___ __1. -_T__T ; _____ o . ----- __ -— ——— — — '-———- — —- —— — —— — — _ -—- — —— — ———— — ___ __ _ ______ __ t- _ _ __ __ uY IS •y ; j _ __ _ __ ___ _ _ I I I I [T I I •I _____ ____ _ __ _ __ - --__ I I I �. Notes: K r � • ® MAKE ACCESS . 4• . ❑ EXISTING ACCESS AVE' NTING : 1 ^ 4, x KEY: SLOPES .FLAIS K.WALL AIIt SEAIdNG ,= x„ ' k.WALL= ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFVICICIENCY FOR ONE; AND TWO-FAMILY DETACHED RESIDENTIAL CONSTR(JCTION (780 ClYLR61.00) Applicant Name: - /��' ��25m� Site Address: 4/1YA& kkv RP print Town: C'�,y—r�2 V Co- Applicant Phone: G/D/ 7$ - 370 Applicant Signature: Date of Application: f 0. NEW CONSTRUCTION: choose ONE of the following two'o tions 780 CMR TABLE 6107.1 PRESCRIPTIVE EN_f�rELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS � 7,I MINIMUM Ceiling or , Slab QOption 1: Basement Fenestration exposed Wall Floor Wall )?eruneter AFUE HSPF SEE] U-factor floors R-Value R-Value R-Value R-Value R-Value and Depth National Appfiancc•Encrgy R-10, Conscrvafioh Act(NAECA)of .35 R-38 R-19 F:-19 R-10 4 ft.. 19B7 as wncndcd,minimums of catcr as a licabl° Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: REScheckVersion 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at http-://www.entrgycodes.gov/rrsr-ht--Ckl A DDZ� OI�TS:012 A s} ) AAT)ONS.TO EXISTING BI ftD S.OVER 5 YEARS OLIO* *buildings under 5 years old,must use option#1 or 42 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b _ a) SF 100 x - _ % of glazing b a (b) Glazing area equals SF If glazing �s<d 0%.4.9t the chart belpw. . If lazing is > 40 % rocee.'d to "SUNROOM" section 780 CMR TABLE 6101.3 . PRESCRIPTIVE ENVELOPE COMTONENT CRITERIA.ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM . MINIMiTM Fenestration . Ceiling and '.Wall Floor Basement WaII Slab b Perierim eeter Exposed floors R-Value R-value R-Value U-factor R-Value and Depth .39 R-3 7 a R-13 • R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37-if the insulation achieves the full R-value over the entire ceiling area(i.c. not compressed over exterior walls, and including any access openings), SUNROOM—An addition or alteration to an existing building/dwelling unifwhcre the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out COny1. ner Information Form found in Appendix 120.P p Licensee Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 100459 Restriction WS,IC Name Erik Nerstheimer City,State,Zip North Scituate, RI,02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Back To Search Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of BuildingRe ulations and Standards Registration, 120979 g Expiration=3/,25/2010 One Ashburton Place Rm 1301 7i '.Lsttt�t'.l.Ia.021.08 h i TypeF Scup;element Card j 1 THIELSCH ENGINEERINGa , !J1. ERIK NERSTHEIMER 1341 ELMWOOD CRANSTON,RI02910�C: >.,, -.--___-- Administ� ttor. Not valid without signat-re . i http://dbatate.ma.us/des/licdetails.asp?txtSearchLN=CSL 100459 9/24/2009 EWneering Dept. (3rd floor) Map 2Dly Parcel 0 4 -fdr— Permit# /,, . House# �/Z� !��',���HSte Issued �^o'�,S `99 Feed] 0a) 19 BARNSTABLE. TOWN OF BARNSTABLE 'F° '0. Building Permit Application Project Stre dress //C; t'' y1 I�2 �/� �L� GD %S y� Village m Owner Ic44 ►✓� Lwr? Address Q Telephone 73S©Od 3 '29Q ,15'3' Permit Request l� First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ rv2 D® _ d e) Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 No.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 - Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑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 I formation l p- ✓Name Telephone Number DO 6-3 ddress VALicense# ./Home Improvement Contractor# Z Worker's Compensation# 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 PERMIT DENIED FOR THE FOLLOWING REASON(S) r t FOR OFFICIAL USE ONLY — r — PERMIT NO. ziG - DATE ISSUED MAP/PARCEL NO,. ADDRESS `' VILLAGE OWNER DATE OF INSPECTION:: r FOUNDATION 4 ,. FRAME _ •/. ! ._ � ' — � i e• INSULATION FIREPLACE y ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ' ROUGH FINAL — FINAL+BUILDING j DATE CLOSED OUT ASSOCIATION PLAN NO. �WE The Town of Barnstable R. .� . aARNSTABU& • "� ,��' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 - Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only ( i Permit no. Date ' AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT 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: �1,C_ Est.Cost a el ' rJ?� Address of Work: Owner's Name Date of Permit Application: �O —ate'— lam— 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 OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name •o EM C RR G NN HOME IFJPROVldind RegulatioRns ano Standarr soap dOnt Ashburton Place _ Room 130,1 r'3oston, Massachusetts 02108 ?ROVEMENT CONTRACTOR -r- - :-- - 108918 .. Expiration 08/27/98 at.ion . i GTE Q y��ff � r SBA HOME IMPROVEMENT CONTRACTOR 1 Registration 108918 Type - DBA ODORS U . HITCHCOCK _ Expiration 08/27/98 -ODORE L . HITCHCOC. K BOX 211/55 LISA LN 'i THEODORE i.-HITCHCOCK 3a+RP!STABLE MA 02668 THEODORE L. HITCHCOCK: OX 211/55 LISA LN RNSTABLE MA 02668 ADMINISrRA70A.: The Commonwealth ofMassachasetts Z Department of Industrial,Accidents . . � 011I0001/OYOiI/oODIBi 600 Washington Street Boston,Mass. 02111 APPlicilat information- Workers' Compensation Insurance Affidavit OPH My • Q O B/ 1 am a homeowner performing all work myself. phon a 1 am a sole proprietor_rd ha%e no one working in any capacity I am an emplover pro%iding workers' compensation for my employees working on this job. Theodore L. Hitchcock address: P.O. Box 211 lily: W. Barnsfahl P ohoner ( Of;l 77t, 770;'2 insurance co. Travelers polity p 807K449 0 96 I am a sole proprietor. general contractor. or homeowner(circle one) and have hired the contractors listed'below who haN the follo%%in_worker' compensation polices: t:omoany name, address: city. [shone�• insurance co. nolicv# company name: address• phone No insurance co. Posy 0 Failure to secure coverage as required under Section 25A of MGL 152 an lead to the imposition of criminal penalties of a tine up to si.M.00 and one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100M a day against toe. I anderstaod th► copy of this statement may be forwarded to the Office of tavestigations of the DIA for coverage veri&atim I do-hereby certify under the pains and penalties ojperjury that the information provided above is taste and coered Date ��4/ Q Print name Theodore L. Hitchcock PhoneN ( 508) 775-7763 Echk y do not write in this area to be completed by city or town oftlefal _ _ permittliccase N nBuilding Department C3 pUeeasiog Board mediate response is required OSeleetmea's Office (3Healtb Department : phone 0:_ ""'� _ ' -• nOtber Imised 3,95 PIA)