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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map (� Parcel 3 Application # o O W0066
Health Division Date Issued 0
Conservation Division Application Fee 46
Planning Dept. Permit,Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address I Ld 6 0 r I U L-
Village C
Owner �i o h AA rc 1--&• Address
IJ Telephone S'G�'s " �'`l �'3°7
-Permit Request y%C ASv"i-
r
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l crU di 2-A` . � -. 1�1 60c. M '6A to 6A,wGvJ to( S
.
Y
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family 0/ 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# a , d
Current Use Proposed Use
APPLICANT INFORMATION
- (BUILDER OR HOMEOWNER)
Y G \ ?
Name -Jo S�!� � Telephone Number
Address �tpx rG'j :,License # /0 I
S c oat 771 Home Improvement Contractor# ILO �(;r
Email i e -_ re t 0 v c,5 .7 Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ! I/
'SIGNATURE -� - DATE41(
v
FOR OFFICIAL USE ONLY
APPLICATION#
;. DATE ISSUED
'4
IV w
MAP'/PARCEL NO.
ADDRESS VILLAGE
OWNER
I ,
I
DATE OF INSPECTION:
FOUNDATION
i'
FRAME
i,
INSULATION
� w
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
OWNER AUTHORIZATION'FORM
`Ca Ot
(Owner's Name) ;
owner of the property located at
(Property Address)
- 1
(Property Address)
hereby authorize S
(Subcorltractor}
an authorized subcontractor for RISE Engineering,Ao act on my behalf to obtain a building
permit and to perform work on my property.
"Own s S' re
Date
ti
' Federal ID as 06-0d06829
RISE Engineering Federal
Contractor Registration No alas
MA Contractor Registration No 120979
A division of Thietscb Engineering CT Contractor Registration No 520120
25 Mid-Tech Drive,Suite H,West Yarmouth,
CONTRACT.
508-568-1926 X-6610 FAX 508-Sfi&1933
Page '
R I S C
PROGRAM THIS CONTRACT IS ENTERED INr09ETWEEN FUSE
UC-RCS ENGINEERING AND THE CUSTOMER FOR WORK AS
ENGINEERING DESCRIBED BELOW
CUSTOMER a PHONE DATE CLIENT/ WORK ORDER
Yoshitaka Murata (508)243-8737 07/16/2014 _182478 00002
9ERNCE aTREET BI1LIN6 STREET
146 Highland Drive 146 Highland Drive
SERVICE CRY,STATE,HP 9ILiIlS CITY,STATE,DP -
Centerville,MA 02632 Centerville,MA 02632
JOB DESCRIPTIOlm1
HEALTH&SAFETY:Weatherization work cannot proceed until the insufficient draft issue is fixed:
$0.00
AIR SEALING:Provide labor and materials to seal areas ofyour home against wasteful,excess air leakage. This work will he
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,attached garages and other unheated areas(windows are
not generally addressed.) (10)woiking hours:; '
Al the completion of the weatherization work,and at additional cost to the homeowner,a final blower door and/or combustion '
safety analysis will be conducted by the subcontractor to ensure the safety of the indoor air quality.
8 ATTIC,2 BASEMENT.
$770.00
ATTIC FLAT:Provide labor and materials to install a 4"layer of R-14 Class l Cellulose added to(140)square feet of floored attic
space.
$261.80
DAMMING:Provide labor and materials to install a'12"layer of R-38 unfaced fiberglass baits to.(68)square feet for damming
purposes.
i, •
$1MAO
ATTIC FLAT:Provide labor and materials to install a)2"layer of R-42 Class I Cellulose added to(122)square feet of open attic '
space.
$178.12
ATTIC FLAT:Provide labor and materials to install a 6"layer of R-21 Class 1 Cellulose added to(158)square feet of open attic
space.
$909.60
FIX EXISTING INSULATION:Slash the vapor barrier,flip,or re-position(758)square feet of insulation in the attic area.
$189.50
ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small
flat surface of plywood will be created around the opening within the attic..This will allow the covers integral weather-stripping to
restrict air leakage.
$237.65
VENTILATION:Provide labor and materials to install(2)insulated exhausrhose with roof mounted flapper vent to exhaust
existing bathroom fan(s).
N
$232 20
VENTILATION:Provide labor and materials to install ventilation chutes in(68)rafter bays to maintain air flow.
$237.32
COMMON WALLS:Provide labor and materials to install 2"FSK faced semi-rigid fiberglass board insulation to(35)square feet of
common wall area.
• $115.85:
i
ii Federal lD A 0"406629
RISE Engineering RI contractor Registraton No 8186
MA Contractor Registration No 120979
A division olThieisch Engineering CT Contractor Registration No 62012b
25 Mid-Tech Drive,Suite A,West Yarmouth,
508-568-1926 X-6610 FAX 508-568-1933 CONTRACT
S E Page 2
PROGRAM THIS CONTRACTIS ENTERED INTO BETWEEN RISE
CLC-RCS ENGINEERINGANO THE CUSTOMER FOR WORK AS
E NC I N E E R I N G DESCRIBED BELOW
CUSTOMER - .. PHONE - GATE CLIENT8 WORKOROER
Yoshitaka Murata (508)243-8737 07/16/2014 182478 00002
SERVICE STREET
BILLING STREET:
146 Highland Drive 146 Highland Drive
SERVICE CITY,STATE,ZIP - ._ —.---._--.--. BILLING CITY,STATE,DP
I
Centerville,MA 02632 Centerville,MA 02632
JOB DESCRIPTION $,
BASEMGN1'CL'ILING:Provide labor and materials to install(138)linear feefof'R-19 unfaced fibeiglass insulation to the perimeter
of the basement ceiling at the house sill. c
$302.212
RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,
for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$4,000 per calendar year,and an incentive of
100%for the Air Sealing measures.
7
Total: $3,573.66
Program Incentive: t$2,730.63
Customer Total: $843.03
INE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCOROANCE WITH ABOVE_SPECIFICATIONS.FOR THE SUM OF
'Eight Hundred Forty-Ttiree&03/100 Dollars 4843.03
I
UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REAM AMOUNT DUE IN FULL INTEREST OF 7Y WILL BE CHARGED MONTHLY ON ANY �--
UNPAID BALANCE AFTER 30 DAY&SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCNEDULING,AHD CONTRACTOR REGISTRATION.:
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SID e
AUTHORZED SIGNATURE-RISE ENGINEERING - CUSTOME CEPTANCE
..
• NOT£:7HIS CONTRACT MAY BE"DRAWN BY L'b G NOT EXECUTED WITHIN DATE OF ACCEPTANCE
ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE
SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK
DAYS. - ' AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE
- a
-_. -- Department of Industrial Accidents
Office of Investigafions
1 Congress Street,.Suite 1Of
y. -= Bosun, ILIA 02114--2017
=; _ www mass gov/dia
Workers' Compensation Insurance Affidavit: Bugders/Contractors/Electridans/Plumbers
Applicant information Please Print Legibly
Name (Business/Organization/Individual):
Address: /d l S
City/State/Zip: S>z e-1d:,? II- Ud 7r' Phone#: 2)
Are yo employer? Check the appropriate box: Type of project(required):
1. I am a employer with -1�d 4. I am a general contractor and I,
employees(full and/or part-time).* have hired the sub-contractors 6. New construction
2.❑ I am a_sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. Demolition
workingfor me in an capacity. employees and have workers'
� y p ty comp.insurance.$ , 9. ❑ Building addition
[No workers comp.insurance p•
required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I LF❑Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑ f repairs
insurance required.]f c. 152, §1(4), and we have no '
employees. [No workers' 13.[9 Other nfe�Tt-r[�� 24 n
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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
cinployees. 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: TI C/`C-)
Policy#or Self-ins.Lic.#: U '' (�,,4S_ -P Expiration Date:
Job Site Address: J y L, •Iti c 6 CtJ,W.%,d City/State/Zip:
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 certify and t to ' s and enalties of er'ury that the in ormatwn provided above is true and correct
Si ature: - 'Date /0, `
Phone#:
Official use.only. Do.not write.in this area,.lo be completed.by-city or tow-moffcciaL_ -. . ,_ __ .. ... ....
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#:
i
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
r Boston, Massachusetts 02116 .
Home Improvement C�for Registration
Registration: 160461
`f^ Type: Private Corporation
21 Expiration: 7/29/2016 Tr# 252915
RETROFIT INSULATION, INC.
JOSEPH REILLY
P.O. BOX 105
SEEKONK, MA 02771 ,Z
t� 'Update Address and return card.Mark reason for change.
. Address Renewal Employment Lost Card
SCA 1 4 2OM-05/11
VCt1� (po�rearta�xcueQ�Gs2 a�C%/iGd46p�'ict6el�6 . . .. .
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. Iffound return to:
egistration: 1 Type: Office of Consumer Affairs and Business Regulation
piration: Private Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
-RETROFIT INSULATICWJ`
JOSEPH REILLY
644 RODMAN ST
FALLRIVER,MA 02721 -' Undersecretary o alid without signature
'
114
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'4ightfax C3-2 8/4/2014 8:44 :21 AM PAGE 9/022 Fax Server
,aco CERTIFICATE OF LIABILITY INSURANCE 08-04-2014
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 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
NAME:
VIVEIROS INS AGCY INC PHONE FAX
140 PLYMOUTH AVE ,vc No.Exit: A'C.NC:
FALL RIVER,MA 02723 E-MAIL.
INSURER(S)AFFORDING COVERAGE NAIC K
INSURER A ACE AMERICAN INSUP.ANCE COMPANY
INSURED INSURER B:
RETROFIT INSULATION CORP INSURERC:
PO BOX 105
SEEKONK,MA 02771 INSURER D:
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.
POLICY EFF POLICY EXP
INTR TYPE OF INSURANCE INSR SUB
VD POLICY NUMBER (MMIDD/D/YYYY) MMIDDJYYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE S
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S
CLAIMS-MADE OCCUR PREMISES(Ea occurrence
i- LIED EXP(Any one person) S
PERSONAL&A0'V INJURY S
GENERAL AGGREGATE S
• GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPJOP AGG S
POLICY PRO-
JECT LOC S
AUTOMOBILE LIABILITY CCOPdBINED SINGLE LIMIT S
!Ea acndcntl
A14Y AUTO BODILY INJURY(Per person) S
ALL OWNED SCHEDULED S
AUTOS AUTOS I BODILY INJURY(Per accident)
HIRED AUTOS NON-OWNED PAP DAMAGE S
AUTOS Prr arc:,.cnt
S
UMBRELLA LIAR I OCCUR EACH OCCURRENCE S
EXCESS LIAS CLAIMS-MADE AGGREGATE S
DIED RETENTIONS S
WORKERS COMPENSATION X �lVCSTATU- OTH-
AND EMPLOYERS'LIABILITY YIN TORY L!PAITS ER
ANY PROPRIETOR.P,'V?TN=RIEXECUTN NIA E.L.EACH ACCIDENT $1,000,000
OFFICERWENIBER EXCLUDED? GS62UB 08-02-2014 08-02-2015
ifycs.aturyin un 4705P815 E.L.DISEASE-=A EMPLOYEE $1,000,000
tf ves.tlrscribr.under
DESCRIPTION OF OPERATIONS below_____r E.L.DISEASE--POLICY LIN:IT $11000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AddMonal Remarks Schedule,If more space Is required)
THE INSURED'S MA WORKERS COMPENSATION POLICY AND ITS LIMITED OTHER STATES ENDORSEMENT AUTHORIZES THE
PAYMENT OF BENEFITS FOR CLAIMS MADE BY THE INSURED'S MA EMPLOYEES IN STATES OTHER THAN MA. NO
AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENEFITS IN STATES OTHER THAN MA IF THE INSURED HIRES,OR HAS HIRED
EMPLOYEES OUTSIDE OF MA. THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA.
CERTIFICATE HOLDER CANCELLATION
BPI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE
107 HERMES RD SUITE 110 CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
MALTA,NY 12020 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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