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Home My WebLink About0354 NOTTINGHAM DRIVE Y-5 7/ � �, Application number.... ~..L. •:•••••l•••. •S xa Date Issued....5 31..,�.�a..... ............................ 1 MAY 3 1?D1� Building Inspectors Initials... NMap/Parcel..... 1...`......®..... ................ .... RNS r . .. BLE TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: , ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Proj ect: NUMBER STREET ° VILLAGE Owner's Name: Phone Number t Email Address: Cell Phone Number G Project cost$ t �a ` Check one Residential Commercial / OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Siding El Windows(no header change)# Q Insulation/Weatherization t © Doors (no header,change)# Commercial Doors require an-inspector's review 0 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name A&AS a Y 00, Home Improvement Contractors Registration(if applicable) # /6)31QQ` (attach copy) Construction Supervisor's License# �. (attach copy) Email of Contractor s ec"01'�hone number ALL PROPERTIES THAT HAVE STRUCTURES OVER.75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN .for-r^011- Aoovnve1 RIPMRF A PFRM►T CAN BE ISSUED. APPLICATION NUMBER............................................................ *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-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side f HOMEOWNER'S LICENSE EXEMPTION k 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 CMR 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 APPLICANT'S SIGNATURE Signature Date � '� All permit applications are subject to a building official's approval prior to issuance. R MA H OS . HOME IMPROVEMENTS PSI. 508.328.1635 Exterior Remodeling Experts MR Web: www.thomashomeimprovements.net , Fully Licensed & Insure( P.O. Box 177 Construction Supervisor Lic #9991 2 Centerville, MA 02632 Thomas Home Improvements LLC. Proposes to perform the following work: Location of proposed work: Mr. & Mrs. Kelley 354 Nottingham Drive Centerville, MA 02632 Date on which construction should begin: March 2018 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor,shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may_ need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ, and that such variation is not to be considered,a violation of this contract. F Cost for labor and materials under this contract: Proposal to install James Hardie Cement Lap siding on entire front of the home (5"weather exposure) would be $3,505.00 Proposal to install AZEK PVC trim on both inside rake members as discussed would be $650.00 Proposal to strip roof shingles behind chimney&install properly would be' $325.00 Thank You for ('giving Us the Opportunity to Help You Improve Your Project • r In the event that while stripping the siding or roof we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$55.00 for a carpenter and $35.00 for a carpenter's laborer, plus the cost of materials. -Siding to be stripped and cleaned of all.old siding&debris -All PVC trim to be fastened with Cortex screws& plugs -Home to be papered with Typar house wrap .-10 Yard dump trailer will be needed on site; and will be,removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW. With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start; and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5% per month. The contractor warranties the work completed under this contract for a period of one year from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment,but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse, and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content, and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance, only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition, any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Date: Homeowner �'� Co tr ctor �` �O J0 I 1i i ; The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington-Street _ Boston,MA 02111 wwMv:mass:gov/dia Workers' Compensation Insurance-, Builders/Contractors/Electricians/Plumbers a rm lv Applicant Information Name(Business/organization/lndividual): r�D�� h'��'1t •�%"'�'r r Address: P; f� / .?' Phone#: b� City/State/Zi I appropriate bog: ,Type of project(required): Areyoun n employer. Check t ro P ❑1 am a general oontractor and I 4 ' (, ❑New construction 1. I am,a employer with have hired the sub-contractors employees(full and/or part-time).* d on the attached sheet. 7. Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have . 8. ❑l)emolition ship and have no employees employees and have workers' 9. ❑Building addition working for me in any capacity.' mc+.r�nnP, comp.IIIstlIdnCe 10.0 Electrical repairs OI additions [No workers Cep. 5. ❑ We are a corporation and its required.] officers have exercised their 11.❑Plumbing repass or additions 3.❑ I am a homeowner doing all work right of exemption per M(iL 12.❑Roof repairs myself[No workers'comp.d.]t c.152,§1(4),andwehaverio 13.❑ ur 01i�er insance require employees.[No workers' comp insurance required.] compensation poli *Any applicant that cheds box#I must also fill out the section below showing their workers' polity information- t Homeowners who submit this affidavit indicating they are doing all work and then hire outside c ontractors must submit a new affidavit mdie�fing such tContractors That check this box must attached� � ode ' ��worthe kers'comp.Policoynumber.and state whether or not those entities have employees. If the sub-contractors have amp nY and job site I am an employer that is pr oviding workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name• /�✓` �, Expiration Date: I- Policy#or Self-ins.Lie.#: �Ai�,� � �'i'C City/State/Zip: Job Site Address: the oli number and egp ration date). Attach a copy of the workers'compensation policy declaration page(showing P penalties of a Failure to sere coverage as required under Section 25A of MGL a 152 can lead to the imposition of criminal fine up to$1,500.00 and/or onelear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine the violator. Be advised that a copy of this statement may be forwarded to the Office of of up to$250.00 a day against verification. Investigations of the DIA for insm-Mce.coverage under the airs penalties of perjury that the irzformadon provided above is true andcorrect: I do hereby certify P � y _ Si e: t Phone#: to be co feted by ctty or town official Official use only. Do not write in this area, nT City or Town: Permit/License# Issuing Authority(circle one): actor 5.Plumbing Inspector 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical InsP 6.Other Phone#: Contact Person: 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 id the service of another under any contract of hire, express or implied, oral or written." ' An employer is defined as"an individual,partnership,association,corporatio or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal repres ' es of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal ,employing employees. However the owner of a dwelling house ha not more than three apartments and sides therein,or the occupant of the dwelling house of another who e>�loys persons to do maintenance,co coon or repair work on such dwelling house or on the grounds or building untenant thereto shall not because of employment be deemed to be an employer." MGL chapter 152, §25C(6)also that"every state or local lice g agency shall withhold the issuance or renewal of a license or permit to o rate a business or t o co ct buildings in the commonwealth for any a licant who has p not produced a P p cc table evidence of compli ce with the insurance coverage regnued." Additionally,MGL chapter 152,§25C( states-Neither the co onwealtiu nor any of its political subdivisions shall enter into any contract for the performan of public work tmtil ceptable evidence of compliance with the insurance requirements of this chapter have been Ares ted to the con ' g authority." Applicants Please fill out the workers'compensation affidavit mpletel ,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address )and hone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or L' L ability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' ensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this ME ' may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also b re to sign and date the affidavit The affidavit should be returned to the city or town that the application for the or license is being requested,not the Department of Industrial Accidents. Should you have any questions r ding law or if you are required to obtain a workers' compensation policy,please call the Department at the ber.' 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 1 gibly. The Dep ,.ent has provided a space at the bottom of the affidavit for you to fill out in the event the Office Investigations has contact you regarding the applicant, Please be sure to fill in the permit/license number which ' be used as at refer ce number.,In addition,an applicant that must submit multiple permit/license applications in y given year,need o mit one affidavit indicating current policy information(if necessary)and under"Job Site A ss"the applicant shoul write"all locations in (city or town)."A copy of the affidavit that has been officially ed or marked by the ' or town maybe provided,to the applicant as proof that a valid affidavit is on file for permits or licenses. A n davit must be filled out each year.Where a home owner or citizen is obt ai ing a li e or permit not related to any usiness or commercial venture (i.e.a dog license or permit to burn leaves etc.)said p n is NOT required to complete affidavit The Office of Investigations would like to thank you in vance for your cooperation and ould you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number; z The Common ealth of Mmachusetts y Department Industrial Accidents Me juvestigatlow z 600 ' gtan Street BOSS ,MA 02111 Tel.#617-727-49N ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617 727 770 wWv.maS.90v1dla DATE(MMIDD/YYYY)' ACO R® CERTIFICATE OF LIABILITY IN 05n3/2018 . 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(les)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). CO ACT PRODUCER NAM Donna OStrowski Mark Sylvia Insurance Agency,LLC PHONE 508 957-2125 Alc No:508 957-278t 404 Main Street EMAIL Centerville,MA 02632 A •mark marks Iviainsurance.com INSURE S AFFORDING COVERAGE NAIL& INSURER A,Farm Family Casualty insurance INSURED INSURER B: Thomas Home Improvements L1C INSURER c PO BOX 177 INSURERD: Centerville,NIA 02632 IN £: 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 REQUIREME WITH NT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT TH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE.POLICIES DESCRIBED HEREIN I5 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ADDL SUBR POLICY RIFF POLICY EXP LIMITS ITRR- TYPEOFINSURANCE POUCYNUMBER MM/DDIYVW MM/DDlYYYY - T X COMMERCIAL GENERALLIABiLFTY 2001X1416 5/01/2018 5/01/2019 EACH OCCURRENCE s 1,000,000 PR MOE TO RENTIzU ISES I=a occurrence) f� _ 100'000 CLAIMS-MADE OCCUR pp0 MEO EXP(Any one anon s PERSONAL B ADV INJURY 1$ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I t PRODUCTS.-COMPIOP AGG $ 2,000,000 X POLICY❑PEG [:]LOC OTHER: COMBINED SINGLE LIMI1 is AUTOMOBILE LIABILITY Ea acciden BODILY INJURY(Per person) ANY AUTO OWNED SCHEDULED BODILY INJURY(Per accdent} $ AUTOS ONLY AUTOS PROPERTY DAMAGE S HIRED NON-OWNED P ac ids I AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAR I DCCUR ! EACH OCCURRENCE $ EXCESS LIAB CLAIMS•MADE I AGGREGATE— EXCESS S S OED RETENTION$ FJ/01/201 B 5101/2019 PE gTA E ERH /{ WORKERS COMPENSATION1 2001W8053 AND EMPLOYERS'LIABILITY f E.L.EACH ACCIDENT $ 1,000,000 �ANYPROPRIETOR/PARTNER/EXECUTIVE Y❑ N/A 1,000,QOO OFFICEMMEMBEREXCLUDED? Y E.L.DISEASE-CCAEMPLOYEE s I(MandatotylnNH} E 11000,000 i[yes;describe under E.L.DISEASE•POLICY LIMIT $ IDEBCRIPTION OF OPERATIONS belrnv . space is required) DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORO 101,Additional Remarks Schadule,may be.attached if more spa q .Carpentry insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN . Troy Thomas ACCORDANCE WITH THE POLICY PROVISIONS. 499 Nottingham Drive Centerville,MA 02632 AUTHORIZED REPRESENTATIVE „ 6 .� ©1988-2015 ACfl 0 CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD THE FOLLOWING IS/ARE THE BEST ' IMAGES FROM. POOR QUAL.ITY 'ORIG-INAL (S) IMF DATA Offic� of Consumer Affairs & Business Regulation -Mass construction Supervisor Specialty Restricted to: CSSL-RF-Roofing �Or Co CSSL WS-Windows and Siding Boar Civic o�o/ealth o(M d°f BU- Professi assachuse COnstructi n9 Re9u/atio al LicensUre CSSL-099913 �°=Cb�`��sos and Standar s v =r Specialty d TRCYAT r <- ir CEN ER 7-�G M�R—MAS � `es 04113�20?0 Failure to possess a current edition of the Massachusetts E _ _ State Building Code is cause for revocation of this license. 0263 For information about this license Call(617)727-3200 or visit www.mass.gov/dpl Co rhmis` er . offi s u rn e r Affairs and Business Regulation (OCABR HIC Registration Complaints Registration # 185422 Registrant TROY THOMAS HOME IMPROVEMENTS, LLC Name TROY THOMAS Address 499 NOTTINGHAM DR. City, State Zip CENTERVILLE, MA 02632 Expiration Date 06/09/2018 Complaints Details No complaints found for this registrant. You can also view arbitration.and Guaranty Fund history. Back To Search Site Policies Contact Us https:Hservices.oca.state.ma.us/hic/licdetails.aspx?txtSeaxchLN=87470 5/31/2018 Town.of Barnstable *Permit#2,0/ q 0 7 S? Expires 6 months r m issu Regulatory Services Fee 1639.9 S PERMO tl Richard V.Scali,Director Jj CD�z I t J) J� OV 12 2014 Building Division T m Perry,CBO,Building Commissioner TOWN OF BA R N STA B L�200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY �] Not Valid without Red X-Press Imprint Map/parcel Number Property Adq 4,ifte ❑ Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Lee— L� l�y Contractor's Name e q- lh G _ Telephone Number 7 -7 C 30(, Home Improvement Contractor License#(if applicable) ` 9 / Email: Construction Supervisor's License#(if applicable) 7 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner �!I have Worker's JCompensation Insurance ` Insurance`Company Name G;(J 0 11w 142�! Workman's Comp.Policy#�(� 37? S ©. cJ/ Copy of Insurance Compliance Certificate must accompany each p rmit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to_z--!I,, ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ 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 py the Hom Improvement Contractors License&Construction Supervisors License is r it SIGNATURE: Q:\WPFILES\FORMS\buildi erm' fo \'EXPRESS.doc Revised 061313 0 CERTIFICATE� DATE OF LIABILITY INSURANCE (MM/DD/YYYY) 5/7/2014. 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 FRANK L HORGAN INSURANCE AGENCY INC NAME: - - 44 BARNSTABLE ROAD PHONE Fax PO BOX 250. - E-MAIL No E t• A/C No HYANNIS, MA 02601 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC.# INSURER A: LM Insurance Corporation 33600 INSURED -INSURER B: CAPE& ISLANDS CONSTRUCTION COMPANY INC PO BOX 210 INSURERC: CENTERVILLE MA 02632 INSURERD: - .. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 20102526 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 ADDL SUBR POLICY EFF POLICY EXP - LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY M'MMIDDYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENED CLAIMS-MADE 17 OCCUR PREMISES(Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: -GENERAL AGGREGATE - $ POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ JECT 1OTHER: " $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED - - BODILY INJURY-(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ - - HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE - AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC5.31 S-377540-014 5/7/2014 5/7/2015 �/ STATUTE 'ER'' AND EMPLOYERS'LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA. E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) - _ E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under - DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN STREET } ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA -02601 AUTHORIZED REPRESENTATIVE �� ' LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 20102526 - Lucy Garfield 5/7/2014 7:38:36 AM (PDT) Page 1 of 1 .. - - •, �"Estimate �; M �321 r D Sep 6 2014 Cape & IslanMs CQIfg.6Y iAc`0®n''C®u PC y Po Box 210 y Terms Centeivilte Ma.,D2632' 508.775.1663 Ship Va t Ship Date _ t AL Mr&Mrs. Kevin Kelly 1c1t,35q Nottingham Dr. Ce terville Ma. 02632 o e CERTAINTEED Certainteed Shingle Roof 9,980.00 . Strip existing shingles from roof. Secure any loose sheathing: Install Hicks brand vented aluminum drip edge. Install Wip brand Ice&Water Shield to all eves, rakes,valleys and all protrusions. Install Surround brand Synthetic Felt Underlayment. Install Certainteed Quick Start starter shingles to all rakes&eves. Install Certainteed LIFETIME architectural shingles. Storm nail all shingles. (State building code requires 4 nails, we use 6) Re-flash all vent pipes with new boots. Install Rigid Vent Il ridge venting. - Remove and dispose.of.all job related waste. leave your property looking like we were never there! Provide all manufactures warranties and ' LIFETIME warranty on our labor, if it ever fails due to our workmanship we fix it, forever! It's The.Best In The Business. Please note our wind warranty is also the best And longest available ANYWHERE! Includes cutback and replace rotted rake tail. .. Total -$ 80:00 Signature " F - a e�`olntrzcxrrst�o��assrae�rtsr Deparfiamt qfhuksftia1 A crderrtv -- ,�— Owe offm�stig�ivns 600 Wr�syh igton Street Boston,MA a 111 WF419?7tz asmgoT,fdia ' arkers' Compensatianlusmrance AffLdawi:Bui1dersfmantraactors/Electricians/Kumbers AApHcant rnfermatiou Please Print Legibly Name(1�7351IZt�n/f"ri;vicittaj�_ ® Z li l Address: PI P- o� j cat izip= C- ,` Phu Are you an employex7 Check the appropriate ba-z Typeof 4-_ r project atxt a e�ral contractor and I racor (��- 'I l;_ am a esuployer wifih_ ❑ I 6- ❑New constai ioa er loyees{fall andlorpart-#ime}* have hired the sub-contractors. 7_❑ I=a sole proprietor or partner- Iisted on the attached sheet y- ❑Ran deliag ship and have no employees These�b ca mtmctors have g- ❑Demob iDa working for me in anyca r_ employee and have workers' capes 9_ ❑Building addition �o•work' comp.inwiranre comp_msurance_� 5_❑ We area cozporatim audits 1{l_❑Electrical repairs or additions regmreci_� officers haL�t�ercid se fi�er 3_❑ I am a bome,c�ner doing all tivoik i 11_.Q Plumbing repairs or additions xwyself [No works'comp_ right of ea(mptnd we lv m a4 1?❑R. repai m rn c,rra„r.e regtuted,]1 c-152, §1(4},anti we k'E ntr eatgloyees_[No workers' 1-3_❑other comp_insurance requimd-1, 'Any ap�ticu f dut checks boa 41 nmst also fill o-ut the section belowdmwfixg ihea wmi-ers,compessatio�goiicg�m�s�t T H.,,wners vrbn submit Sus afdxvff=&cxtLg taey are doing an imik and Bien hire outs&conductors nmst submit a new afd.mt mdirstm snrh- Cbnu3,cmrs thsi cT_e k this box must ruched an s3ditir9nsI sheet sh'ozcine thA n�of ffie sr r rn xnd stste whether oenot Buse Miles have npItryeis- iff snk coat$cEuts h+�e enPIoyeP-s,the3=must pxut ide th— woc31 5'comp_po]icy nmvhrs Ian an employer that isprmidumg irmtrimce f`or rtty an es-,,- Belau is th e p4Zc}andjob sits irijotma�on. . Iasnrance Compare-yName: Policy 4 or Self iag-Uc- Expirafion.Date: /� Job`Zit£�.ddnnz: �� 1- y "tL� cib,/SStal zip: Y J l/l './/r/1 Attach a copy of the-workers'compensation policy declaration page(showing the policy namber and 11 t In date). Failure.to se=e coverage as nNjairedunder Section 25 A of MGL cc 152 can lead to the imposition of-csiminA penalties of a fine up to$1,50Q.00 andlor one-year imprivonment,as well as civil penalties in the.foam of a STOP WORK ORDER.and a fine of up.tD�250.00 a day against the violator_ Be advised tint a copy of this stdement may be fianvarded to the Office of k,estigations of the Ifl inaaxtaootc coverage verification_ I dv hereby eerfi ks pain zrnd panes iss of pz ary fhatfhe itz orrr&ian prcn idsd ea a is.7"T-'z and correct Simatuze: Bate: - Phone 0: �� e4 Officfai use oral}. Da not sprite fn this Arerc,to Fir rampioted by cff}:or town offiezaL City orTown: _Perwi#ILicense# Yssuingr5.utharity(drdeone): 1.Board of Ele-alth 2.Buffffin;Department &Gitglrfawa Clerk 4.Eiech ical 1nspectos S.Plumbing inspector 6.Gther Contact Personz Phone#r 6 Information and Instructions Massachusetts General Laws chapter 152 requires all.employers to provide workers'compensation for their employees. Pursuantto 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_" Au 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 tht Iegal 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 appur tenant thereto shall not because of such employinent be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal Licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the cornmonifealth for auy applicant who has not produced acceptable evidence of compliance writ_h the insurance.coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the conuaonwtalth nor any of its political subdivisions shall enter into any contract for the peiorm.ance of public work until acceptable evidence of compliance v riLli the insurance require heats of this chapter have been presented to the contracting authority-" Applicants — Please fill out the workers' compensation affidavit completely,by chtezdDg the boxes that apply to your situation and,if necessary,supply sub-contractors)n mt(s), address(es) and phone m be,-(s)along with heir cerb-:ncafc-(:)of insurance. Limited Liability Companies(LLC) or Limited.Liability Partnerships(L P)veith no employees other than the members or partners, are not required to carry workers' compensation inslr aoce_ If an LL.0 or LLP does have employees, a policy is required, fie advised hat this affidavit maybe s::bmifted to the Depaunment of 1ndustrial Accidents for confirmation ofin_sn<nce coverage. Also be sure to sign and date the affidavit. 11he anda�dt sbo�old be returned to the city or town that he application for the permit or license is being requested,not the Departinent of Industrial Accidents. Should you have any questions regarding the law or if you are required to ob��a workers' compensation policy,please ca_Ll the Department at he number lis`u;d below. Selz insured companies so.oald enter their self-insurance license number oa tie appropriate at. 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 iIl out s he event the Once of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitdicense number which Frill be used as a reference number. In additicn,an appL cant that must submit multiple penZit/license applit:ations in any given year,need only submit one affidavit indicating current policy information (if necessary) and under"Job Site Address"the applicant should Vvrite"all locations in___(city or town)."A copy of the affidavit that has been officially stamped or marked by he 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 m'.?st be filled out each year_Where a home owner or citizen i c 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 world like to thank you in advance for your cooperation and shouldyoi have any questions, please do not hesitate to give us a call. The Department's address,telephone and fix number: Common-,,Y(,-a1&of Massachu ttt Dep aAnent afIndustrial A•c<cidrnfs 54��ashin�tan Si-�ti Ttl,4 61 7 727-4 9W Q)t, 406 or I RT -Ivi kSSATE Revised 4-24-07 Fax#617-727- 14-9 www.ma.S,-,-goW 1 a Oice pfoiivnco7f�eal�/ kVjej' Codsumer Affairs c��ac%coe�13 a� OME"MPROVE &Business Regulation istration: MENTCONTRACTORpiration 165936. 4/9/201$ r cG Type: Private CCAPE&ISLAND orpoNSU r ationTRCTONCp j I JOSHUy ;1 .NC. A KOURI . V , l �! 55 ELM AVE HYANNIS,MA 02601 Undersecretary a Department Massachusetts - of public Safety lug Board of Building Regulations and Standardsr Construction Supervisor License: CS-074.660. JOSHiJA X KOVR� PO BOX 210 a CENTERVILLE M-A 0263 *' . .• Expiration i 0 n it 02/12/2015 Commissioner r �. License or registration valid: �� before the expiration date, for individul use only l If found return to: Of-flee of If Affairs and Business Re ulation 1.0 Park Plaza- Suite 5170 g r r (' B'oston,MA 62116 i • J v d w lio.ut si gnature 1 13 Massachusetts -Department of public Safety Board of Building Regulations and Standards Construction Supervisor ry A - License- CS-074660 _ �� • Ile JOSHUAXKOUR ` s PO BOX2100vj� . �. CENTERVII LE NIA _ Expiration .J,•�... 02/1212015 Commissioner Page 1 of 1 Shea, Sally From: Kevin Kelly [bpk030@comcast.net] Sent: Thursday, November 13, 2014 1:38 PM To: Shea, Sally Subject: Permission for Cape & Islands Construction Co to replace roof Hi Sally, I'm giving permission to Cape & Islands Construction Company to replace the roof at my home. The address is: Kevin and Bridie Kelly 354 Nottingham Drive Centerville,Ma 02632-2136 Telephone number: 508-420-3606 Apparently the permit requested was incorrectly listed as house number'352'. The correct house number is '354'. Todd from Cape & Islands Construction Company requested that I send you this email stating we are giving them permission to replace the roof. Kind Regards, Kevin Kelly Sent from my Whone 11/13/2014 ti VST R I S E Z�t3 Division of Thielsch Engineering,Inc. �r. 1341 Elmwood Avenue f# /" 18 ENGINEERING Cranston,'Rhode Island 029 10 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 354 Nottingham Drive 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 y C0-7/44- Commonwealth of Massachusetts E� Sheet Metal Permit Date: J Permit D62 Estimated Job Cost:$ Permit Fee: $ Ar� Plans Submitted: YES NO Plans Reviewed: YES NO Business License# t Applicant License# Business Information: Property Owner/Job Location Information: Name p c l o;,t; t>v_N 1 ( Name: Street: Street: J�-1 City/Town: LIL t.y,, C 7City/Town: Telephone: � �`-, i , Telephone: Photo I.D.required/Copy of Photo I.D. attached: YES_j/ NO c ~ i taff Initial -1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq.ft./2-stories or less Residential: 1-2 family V/ Multi-family Condo/Townhouses Other Q I P Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under I0,000 sq.ft.i/ over 10,000 sq.ft. Number of Stories Sheet metal work to be completed: New Work: Renovation: rn N ss HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: ` S n/ ✓ a n1 4- INSURANCE COVERAGE: Gl 1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes�I No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy [ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. r - Cheo0 One Only - `1 Owner Ef Agent ❑ i Signature of Owner or Owner's Agent By checking this box❑,1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By Master Title ❑Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ Fol Check at www.mass.gov/dal ' Inspector Signature of Permit Approval t i i k �tHE r, » aAR MBM , ' ,� Town of Barnstable gf0 MA't 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 Property Owner Must Complete and Sign This Section. If Using A Builder 1, I;W/ ,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: (Ad r s of Job) Si ature of Owner U 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\LocaiNicrosoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 I . i � 1 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 ' Boston,MA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Bus iness/Organization/Individual): .w.IC UV-2 Ap 4A;(,A-� ,inL4 Q Clr')C->( Y) Address: ' City/State/Zip: , 'I ' Cob 1 Phone#: 5C'a5 r;. � (;� Are ou an employer. Check the appropriate box: yType of project(required): I. I am a employer with l Q 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 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 I.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL c. 152 1(4),and we have no 12.❑Roof repairs t p insurance required.] ' § ]3.❑Other ' employees. [No workers' comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 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: 11 ee C A'e! Sl', P Policy#or Self-ins.Lie.#:,A6 oo / 9 Expiration Date: Job Site Address: 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 under e s and enalties o er'ur that the in ormation provided abov is true and correct Si nmre: - Date. .Phone#: �� _.. ��; .. '�� Is-3- 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 4: t � COrVIMONWEALTH OF PilASS,u: HlJSE' :S r , • 4• • • • '°' 1• • /:-:;, z-(6 S / "l1 jC . SHEET METAL WORKERS AS A MASTER-UNRESTRICTED ISS'OES; HE;--E. LICENSE . (ice ROBERT G BOURQUE �?\, 14 CROOKED CARTWAY MARSTONS MILLS MA -02648-100 6435 05/28/12 972249 i Home Energy Raters LLc BTorrey @Energycoaexerp.com Box 989,E.Sandwich,Ma 02537 888-503-2233 Duct Leakage Test Address 354 Nottingham Dr Centerville, Ma (Addition only) Date — April 30, 2012 Test Type — Rough-In — Total Leakage Conditioned floor area = 240 Sq FT. To comply with Section 403.2.2 Of the 2009 IECC Code in this home the Maximum duct leakage CFM = 14 CFM (240/100 x6 = 14) Duct leakage tested = 12 CFM This Home complies with Section 403.2.2 Of the 2009 IECC Code Date of Test: 4.30.12 Technician: Larkum Test File: Untitled Customer: Borque Heating and Cooling Building Address: 354 Nottingham Dr Canterville . MA Phone: i Fax: Test Results 1. Measured Duct Leakage: 12.0 CFM 12.3 sq. in. {+!-0.0 %) 2. Duct Leakage as a Percent of System Airflow: 3. Duct Leakage.as a Percent of Building Floor Area: 5.0 % 4. Leakage Split: Supply Side: Return Side: 5. Duct Leakage Curve: Flow Coefficient (C): 1.7 Exponent(n): 0.600 (Assumed) 6 Test Settings: Test Mode: Pressurization Test Pressure: 25.0 Pa Equipment: Series B Minneapolis Duct Blaster Test Type: Total Leakage (Duct Blaster Only) Contact our office with any questions, Bruce Torrey, Certified HERS Rater ` Home Energy Raters LLC I OATS(MMIDDIr" CORD, CERTIFICATE OF LIABILITY INSURANCE 05/22/2012 IS 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 WANED,subject to and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the the terms p cy. Po Y certificate holder in lieu of such endorsement(s). PRODUCER NAME:PHON _ Leonard Insurance Agency, Inc. (A/C.No . 509.428.6921 ` RAC.No•508.420.5406 683 Main Street ADDRESS:' AIL Suite B INSURER(S)AFFORDING COVERAGE NAIC# Osterville, MA 0265S INSURER A: Continental Casualty iNsuRED BOURQUE HEATING & COOLING CO.INC. INSURERB: P. 0. BOX 770 INSURER c: MARSTONS MILLS, MA 02648 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:Work Comp 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. FF PO CY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD MIDD LIMITS j GENERAL LIABILITY EACH OCCURRENCE $ { COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $) . CLAIMS-MADE OCCUR MED EXP(fury one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIESPER: PRODUCTS-COMPIOPAGG $ POLICY 0 SPAR LOG $ AUTOMOBILE LIABILITY acadeM $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS AUTO NON-OWNED Peraccident $ UMBRELLA LIA1 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC O - TORY LIMITS 1. ER AND EMPLOYERS'LIABILnY ANY PROPRIETOWPARTNERIEJ�cUTIv�YIN TO BE ISSUED#0102463 05/1712012 05/1712013 E.L.EACH ACCIDENT $ 1,000.00 A O,F,CERIMEMBER EXCLUDED? N � t NIA E L:DISEASE-EA EMPLOYE $ 11 000,0O (Mandatory In NH) If ys describe under EL.DISEASE-POUCY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks SchedWe,If more space Is required) eating and Cooling contractor in Massachusetts. CERTIFICATE HOLDER CANCELLATION FAX: 508.790.6230 j SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN, ACCORDANCE WITH THE POLICY-PROVISIONS. Town of Barnstable Building Department A=ORMDENTAnve 200 Main Street I Hy nnis, MA 02601 ©1988-2Qi0 A D ORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORO tt�9� 48� I��_ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 17 Parcel OT7 Application # �64 07 3 Health Division Date Issued Conservation Division Application Fee PlanningDept. p Perm Fee' Date Definitive Plan Approved by Planning Board F�. � /I13 Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner" l4y/w Address Telephone 4D 3�0) Permit Requests1 �4� �r-' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuati no,Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family*,I- 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: O-,existing _C1=new:��size_ Attached garage: ❑ existing O new size _Shed: ❑ existing ❑ new size _ Other L Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ t _ Commercial ❑Yes ❑ No If yes, site plan review # �'� Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name C�/ � Telephone Number Address OW 41�7k' License # 7 6d62 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WIL BE TAKEN TO SIGNATUR DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO..., ADDRESS VILLAGE . OWNER ; DATE OF INSPECTION: - FRAME �Z3I► c-`.INSULATION a i FIREPLACE l C ELECTRICAL: ROUGH FINALE k PLUMBING: ROUGH FINAL 4, ,GAS: •ROUGW - b FINAL - � � -- t nsFINAL_BUILDING _ ' - DATE CLOSED OUT.. ;r `. ASSOCIATION.PLAN NO. Y •'i r The Commonwealth of Massachuseft Department of lndustcial Accidertr . Office oflnvestigations 600 Washington Street Boston MA 02I.11 www.ma&s gov1dia Workers' Compensation Insurance.Affidavit: Builders/ContractorsXlectricians/Plumbers A.PpHcant Information Please Print Le 'bl Name (BusinesslorganizahonthdividnaI): Address: V ------------ City/State/Zip: IV, /Jhone#: FA�re you an employer?Check the appropriate box. I am a e�loyer with 4. [] I am a general contractor and I �'3'Pe of project(required): KEIELY,3Dle oees(Bill and/or part-time).* have hued the sub-contractors 6• ❑New construiction 2. rorietor o tn listed on the attached sheet. 7. ❑Remodeling and have no employees These sub-contractors have 8. []Demolition working for in any capacity, employees and have workers' [No workers' comp. it,srr,Mee comp,inanranCe't 9• ❑Building addition required.] ' 5• ❑ We are a corporation and its .,10.❑Electrical repairs or additions 3.❑ I am a homeowner doing aIl work officers have exercised their . ❑ myself. [No workers' comp. right of exemption per MG 1 I Plumbing repairs or additions L m 12. Roof repairs ice required]t c. 152, §I(4), and we have no 0 employees. [No workers' 13•�,Other COMP.insurance required.] / j 'Any aPphrnnt that checks box#1 must also fill out the section below showing their workers'compensation policy infDrmation. t Homeowners who submit this affidavit indicating they axe doing all work and them hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this bar must attached as additional sheet showing the name of the sob-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they mast pavide their workers'c°'mP•policy er mxmb , lam an employer that is providing workers'compensation insurance for my employees. Below is the po&cy and job site information Insurance Company Name: Policy#or Self ins.Lic.# Expiration Date: Job Site Address: 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 imprisommel as well as civil penalties in the form of a STOP WORK ORDER and a foe 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 ce ' under the p and allies orm 'on provided above is true and correct Si tore: Date: Phone#: Oil- Official use only. Do not write in this area, to be completed by city or town offzciaL City or Town: Permit/I,icense# Issuing Attthority(circle one): I. Board of Health 2.Building Department 3. Ciiy/T`own Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: FEr Town of Barnstable ti . �. Regulatory'Services y Mass g, Thomas F.Geiler,Director 1639• '°TFnr�a�a Building Division Tom Perry,Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 F . Property Owner Must Complete and Sign This Section If Using A Builder ` f as Owner of the subject property hereby authorize6 to act on my behalf, in all matters relative to work.authorized by this building permit application for." (Ad s s�ofjob) -�� JJ Signature of Owner Date p � Print Naxne If Property-Owner is applying for pernitplease complete the Homeowners License Exemption Form on the reverse side. Q:F0RMS:0 WNERPERMISSI0N 4 • r oFj�r� Town of Barnstable Regulatory Services snxrrsrnsr.F, Thomas F.Geiler,Director w � 1A� �0, Building Division ArFD MA't A 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: number street village "HOMEOWNER": name home p one# work phone# CURRENT MAILING ADDRESS: city/to state zip code The current exemption for"homeowners" as extende to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individua for hire • ho does not possess a license,provided that the owner acts as supervisor. DE ITI N OF HOMEOWNER Person(s)who owns a parcel of land on which h sh resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or deta , d structures accessory to such use and/or farm structures. A person who constructs more than one home in a tw ear period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official n a form acceptable to the Building Official,that he/she shall be res onsible for all such work erformed under the uil ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsib 'ty for ompliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/sh understands e Town of Barnstable Building Department minimum inspection procedures and requirements d that he/she ll comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 5,000 cubic feet or larger wi be required to comply with the State Building Code Section 127.0 Construction C e ntrol. . HOME WNER'S EXEMPTION The Code states that: "Any homeowner performing ork for which a building permit is requi d shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Su rvisors);provided that if the homeowner a ages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are una are that they are assuming the responsibilitie of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,S ction 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,ou Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately sponsible. To ensure that the homeowner is fully aware of his/he responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibi'ties 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/certi cation for use in your community. Q:forms:homeexempt Fully Insured MA Lic.#047505 MA Reg#107723 McCarthy Builders 775-5539 BRIAN McCARTHY NEW HOMES 32 CARVER RD. REMODELING WEST YARMOUTH.MA 02673 ADDITIONS P(l� t Fully Insured - MA Lic.#047505 MA Reg#107723 McCarthy Builders ��5a5539. 32 CARVER RD-. REMODELING- WEST YARMOUTH,MA 02673 ADDITIONS Vra, --------- #WjW4� A9 --� E ago 0 5 2 I0 t - a , Massachusetts- Depa►tmcnt of Polk S;itct" Board of Buildin?,Re�(yulations and Standards Construction Supervisor License One-and Two-Family Dwellings License: CS 47505 BRIAN G MCCARTHY t 80 SRANDISH WAY W YARMOUTH, MA 02673 ' Expiration: g11112013 Tr#: 2305 ('ummissimier LN airs B sines egulahon Offce ofio mer A'tt"� °�v� zCO License or registration valid for individul use only _ .HOME IMPROVEMENT CONTRACTOR_ before the expiration date. If found return to: , Registration: a107723 Type: 1 Office of Consumer Affairs and Business kegulation Expiration: 8L5/2Q12 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 M ARTHY BUILDERS J. Bnan'-:McCarthy 32 Carver Road W Y 'mouth MA 02673 3 1. Undersecretary Not valid without signatur - i Town of Barnstable Regulatory Services oF'THE Thomas F.Geiler,Director Building Division 13AMSrnat,e. : Tom Perry,Building Commissioner MASS9� 1 200 Main Street,Hyannis,MA 02601 RFD A1A'�A Office: 508-862-4038 Fax: 508-790-6230 April 17, 2012. Brian McCarthy 80 Standish Way W. Yarmouth, Ma. 02673 RE: 354 Nottingham Drive, Centerville Map 171 Parcel 087 Dear Mr. McCarthy: This letter shall serve as notice that permit application number 201107350 remains incomplete. As the construction supervisor of record you are responsible that all requirements for the project are met; however, to date a sheet metal permit has not been applied for nor issued. This is a requirement that was explained to you on previous inspections. Failure to fulfill your obligations as construction supervisor is a violation of 780 CMR and may result.in penalties which may include, but is not limited to, revocation of your construction supervisor's license, and/or fines assessed. Please have this matter resolved by May 1, 2012. Thank you for your immediate attention in this matter. By Order, J e Lauzon Local Inspector (508) 862-4034 i 106877 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION j I25j p Map Parceh Application tQG Health Division Date Issued Conservation Division Application Fee Irp Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board OAT Historic - OKH Preservation/ Hyannis Project Street Address 354 Nottingham Drive Village Centerville Owner Kevin Kelly Address same as above Telephone 508-420-3606 Permit Request air sealing. add 1330sq ft of R-19 to attic, insulate 1 attic access hatch install 2 insulated exhaust hoses, install 10 soffit vents Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2304 Construction Type Lot Size Grandfathered: ❑Yes ❑ 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 v 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: 2 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use "w' ,i C APPLICANT INFORMATION (BUILDER OR HOMEOWNER) -- M Name RISE Engineering Telephone Number 401-784-3700 Address 1341 Elmwood Avenue, Cranston, RI License # 100459 Home Improvement Contractor# 1 n979 -Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Erik Nerstheimer for RISE Eng. 4t43 S ' Y FOR OFFICIAL USE ONLY `APPLICATION# _ DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: -FOUNDATION FRAME INSULATION FIREPLACE Y ELECTRICAL: ROUGH FINAL v PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING �Io1ll0 DATE CLOSED OUT ASSOCIATION PLAN NO. RISE ENGINEERING Federal ID#05-0405629 RI Contractor Registration No 8186 A division of Thielsch Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,RI 02910 CONTRACT ��w/� r. (401)784-3700 FAX(401)784-3710 CONTRACT " .. Page. 1 ; THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS ENG[ EE ' 4G - DESCRIBED BELOW _ CUSTOMER PHONE - : - DATE Client# Kevin D Kelly (508)420-3606 02/14/2010 106877 SERVICE STREET BILLING STREET - 354 Nottingham Drive 354 Nottingham Dr Fn � "," 1 SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP - Centerville,MA 02632 Centerville,MA 02632 i 1 LJ 1;_1 �a JOB DESCRIPTION I c RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage, This k will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level o 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 areas(windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing, 12 man hours. $792.00 RISE Engineering will provide labor and materials to install a 6"layer of R-19 Class l Cellulose added to 1330 square feet of open attic space. { $1,197;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 2insulated exhaust-hose"WVoof mounted flapper vent to exhaust existing bathroom fan(s). $120.00 .. RISE Engineering will provide labor and materials to install 10 4" X 16"white rectangular aluminum soffit vents to increase ventilation in attic areas. . $170.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible compact fluorescent imeasures,the Cape Light Compact offers 100%incentive.Includes 100%of air sealing _$I;926.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF. ***Three Hundred Seventy-Eight&00/100 Dollars, $378.00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 11%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTEWD DAYS.SEE REVERSE.FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION, ` DO NOT SIGN,THIS CONTRACT IF THERE ARE ANY BLANK SPACES AU ORIZED SIG U E- ISE ENGINEERING - ' "C TOMER ACCEPTANCE NOTE'TH NT/RACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE !J • I © � • - ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE ~ C . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations U. 600 Washington Street Boston,Mass.'02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Conti-actors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): RISE Engineering a division of Thielsch Engineering i ng Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone#: (401)784-3700 or 1-800-422-5365 Are you an employer? Check the appropriate box: Type of project(required): 1. 0 I am an employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 7. ❑Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ 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 11. ❑Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGLS insurance required] t c. 152, § 1(4),and we have no 12. ❑Roof repairs employees. [no workers' 13. Other Insulate comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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 isproviding workers'compensation insurance for my employees.Below is thepolicy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins.Lie.#: 3730961-00 Expiration Date: 1/1/11 . Job Site Address: Y ! N 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 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 $250.00 a.day against violator.Be advised that.a-copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cerd unde the ins enalties ofperjury that the information provided above is true and.correct. Si nature: Date: Print Name: Erik.Nerstheimer Phone#:(401)784-3700 or 1-800-422— 365 exti33 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): 1.13oard of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: I ACOR'D CERTIFICATE OF LIABILITY INSURANCE OP ID 47 DATE(MMIDDryy(Y) THIEL-1 09/1-3,10 The ucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Preston Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 81'0 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, East Greenwich RI 02818-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURERA: Zurich-American Ins Co. Thielsch Engineering, Inc INSURERS.. x,,r. Thielsch Group Inc. Lc<o c >r, L.. L�.b/liry, Hi Tech R6alty Inc. INSURERC: North American Capacity 19S Frances Avenue •Cranston RI 02910 INSURER 0: Hartford Insurance Company =a INSURER E: COVERAGES TIHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY RECUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR - W,�Y 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.. } _ IFTSFZi4DDL LTR INSFIC VPE OF INSURANCE PODGY NUMBER DATE(MMICONY) DATE( IYY) LIMITS - _ GENERAL LIABILITY EACH OCCURRENCE T 1,0 0 0,0 0 0 A I X COMMERCIAL GENERAL LIABILITY 3730 01O1.962-00 04 O1/10 / � /11 PREMISES(Ea occwenea)_ S 300,000 CLAIMS MADE OCCUR' MED EXP(Any,one person) - i 10 r 0 0 0 - PERSONAL&ADV IN.;URY $ 1,000,000 GENERAL AGGREGAIE S 2,0 0 0,0 0 0: GEN1 AGGREGATE LIMIT APPLIES PER:POLICY PRODUCTS-COMP/OP AGG_ $ 2;0 0 0 ;0 0 0 - }( PRO- V JECT LOC Emp Ben. 1,GOO,000 AUTOMOBILE LIABILITY' _ i X ANY AUTO 3730963-00 04/01/10 01/01/11 CaaccidD'SINGLELUNIT s2,000,000 ALL OWNED AUTOS -_ . - - BODILY INJURY I. SCHEDULED AUTOS : - (Per person) 't HIRED AUTOS 1BODILY INJURY S . NON-ON/NIED AUTOS • - (Par accida,ntl. ' PROPERTY DAMAGE E - )Per,occi6enl) - - GARAGE LIABILITY AUTO ONLY-EA ACCIDENT y ANY AUTO - OTHERTIOfI EA.ACC I .. A.UTO,ONLY: AGG $ `--- EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE _ ;,:10,0 O O,0 0 O; , B X OCCUR El CLAIMS MADE UMB 9263637-06 04/Ol/10 01:/01/11 AGGREGArE 110,000,000 DEDUCTIBLE - . ---- — - X RETENTION $10,0 0 0 y WORKERS COMPENSATION AND _ - • ` X 1_UdITS F.P.TO RY EMPLOYERS'LIABILITY , A :.VgYPROPRIETOPJPARiNEPJEXECUTIVE 3'730961-00 04/01'/10 01./01/111 GL.EACH ACCIDE14T $ 1,000,000 OFFICERMEMBER EY.CLUOE07 ---- If yes.Describe under - - - i E.L.DISEASE,EA EMPLOYEE j 1,0 0 O,0 0 0 SPECIAL PROVISIONS below _ E.L.-DISEASE-PC•LICY LIMIT 3' 1,000,000 _ OTHER - - c Professional Liab DVL000026800 09/01/40 04/01/11 Prof Liab 2,000,000 D Leased/Rented Eqp 02UUNTD5678 04/01/10 04/01/11 Equipment 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT?SPECIAL PROVES""IONS - - - CERTIFICATE HOLDER CANCELLATION -- _ • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER`HILL ENDEAVOR TO MAIL 10 DAYS`WRITTEN - - .. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO 00 SO SHALL . • IMPOSE NO 08LIGATIDN OR LIABILITY OF ANY KING UPON THE INSURER.ITS AGENTS OR . REPRESENTATIVES. - AUTHORIZED REPRESE V ACORD 25(2001/08) (DACORD CORPORATION 1988 j i ��'I®T�ri�®r. its$U�EDt5r1VAMEi43Thti's1sc�++`Ljn+yyinee��nq� ��nf1� till+ �,#QP10 27t ll..s{I :./'_y �r til 7 Y 41.i3`.i.• H r7 J CTif }t�SL �5P i.- t. .?t�� ' ��..... ;_7 ,..h[.fil;.;,�:b.15[uo ..i_.: ... ..:... d t. !-..H.. ...Ei+l'.1!i ..;..5- .fv'.. ..n Y4 .7... 1 .. _ .. .. i• ... Also for RISE Engineering, a division .of Thielsch Engineering;. Inc. Gaskell Associates.; a division of Thielsch Engineering,, Inc. BAL Laboratory, :a division of Thielsch Engineering, Inc., ESS Laboratory, a division of. Thielsch Engineering,. Inc. ALCO Engineering, a division of Thiel.sch Engineering, Inca Water Management Services, a division ,of Thielech Engineering, Inc. s " Y x r rage 1 OI 1 The Official Website of the Executive Office of Public Safety,and Security (EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor_ License#1 100459 Restriction WS,IC Name Erik Nerstheimer City, State,Zip North Scituate, RI, 02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Bak To Search .t Board of 13iiildino Regulations and Standaiil l License or registration val'i`d for individol use only � i HOME IMPROVEMENT CONTRACTOR Ii � — before the expiration date. If found return to:. Registration:. 120979 Board of Building Regulations and Standards One Ashburton Place Rm 1301 r-- TY`... :u "lement Card '',c?&,toil hla. 021.0$ PP : -- ELSCH ENGIN4ffRI.NG`=M= K NERSTHEIM8R<-`=:ry- 1 ELMWOOD.AUE•.' == 1NSTON, RI 02910 Admrnisti Not valid without sign ta're q http://db.state.ma.us/dps/licdetalls.asD?t)(t,�ea7rhT.l\T=raT 1 nnntn 91te 0 ice o nsumeerr�ai4n usiness e u anon .°. g 10 Park Plaza - Suite 5170 Boston; ssachusetts 02116 Home Improve ontractor Registration Registration: 120979 Type: Supplement Card . w Expiration.:. 3/25/2012 THIELSCH ENGINEERING m ERIK NERSTHEIMER 1341 ELMWOOD AVE. `` a CRANSTON, RI 02910 Update_Address and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CA1 it 50M-04/04-G101216 pp.. p.. . .......... . 07. 10G✓77mt67tllsP� py 6d itiQe�6 4 Office of Consumer Affairs&Bu iness 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'Re ulation . Registration= �7g Type: 10 Park Plaza-Suite 5170 g Expira 12 Supplement Card Boston,MA 02116 THIELSCH EN4 ? _ 11,000, ERIK NERSTH ZZ 1341 ELMWOOD CRANSTON, RI 02910 'SJ Undersecretary Not valid without signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1'1 I Parcel ® 8`l Application# c;)6 Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee -6, °4 Planning Dept. Permit Fee A30• a° Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street A ress L_'�5L tJ6J 1 na h0_M - Village Owner 6,v, n I uL i Address altyL Telephone , 4 Permit Request Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay �Project Valuati Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. e Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Z 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 C. Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other i )Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No p Detached garage:❑existing ❑new size Pool:0 existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: . Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ '1 Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 6V'6 6011djj�S &- Telephone Number .J�✓d 'LJQ � Address �_� License# C �®I�C� MCI OLUn Home Improvement Contractor# e�d_333 Worker's Compensation# � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO D SIGNATURE DATE FOR OFFICIAL USE ONLY ' PERMIT NO. } DATE ISSUED MAP/PARCEL NO. i I 1 , I ADDRESS 'VILLAGE ' 1 - OWNER; ? • 1' i DATE OF INSPECTION: FOUNDATION SpNu `71I1 fole ' v FRAME i INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t } DATE CLOSED OUT - ASSOCIATION PLAN NO. �; a .L1IilIL�./��aaear/euaet�f Board of]Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR ' { RegistratoQn: 107333 Expara ion _7/31/2006 Type:_Private Corporation GEORGE DAVIS BUILDERS,.INC. George Davis 9 NEW VENTURE'D;R.UNIT-t So..Dennis,MA 02660 Administrator .��ze �arrimaraul� i BOARD OF BUILDING REGULATIONS i' Licens,e ON SUPERVISOR Number C_S,, 056130 r MOP,. Y00j1/2F007 Tr.no: 83320 Re'str eted 99 GEORGE F 67 DAVISr ... 9'NE17V VENTURE.DR#7. SiD.ENNIS, MA .02660 Comrrisswaer r � ' To: Building Department Town of Barnstable Barnstable,MA From: Kevin Kelly', ' 354 Nottingh z Drive Centerville Re: Agent Authorization Project Address: 354 Nottingham Drive, Centerville To Whom It May Concern: Please be advised that George Davis, Builder,is authorized to act as agent on my behalf with regard to the project under review in this building department. Date: j z�iEr Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town,barnstable.ma.us ice: 508-862-4038 Fax: 508-790=6230 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 birt not more than,four dwelling units or to structures which are.adj acent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. T e.of Work: D -� Estimated Cost Address of Work: 54 N&�b hW Owner's Name: jtU A Date ofApplication: O I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law 07ob Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITRUNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORE:DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: / nractorAnDa e OR Registration No. Date Owner's Name Department of Industrial Accidents Office.of Investigations' d 600 Washington Street Boston,MA 02111' �•'y www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/.Electricians/Plumabers Ap licant Information Please Print Lemibly Name (Business/Orp=ationadividual): id Ad dress: City/State/Zip:� J I"1�� Phone#: Are yy an employer? Check the-appropriate box:. Type of project(required):• 1.pd i am a employer with 4. ❑ i am a general contractor and I ' 6. New constmcdon employees (full'and/or part time).* have hired the sub-contractors ❑ 2.❑ I am a sole proprietor or partner- listed on the attached sheet$ 7. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. c workers' comp.insurance. 9. ❑ Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its required.] ` officers have exercised their 10.❑ Electrical repairs or.additions 3.❑ I am a homeowner doing all work right of exemption per MGL ll.❑ Plumbing repairs or additions ` elf. o workers' co c. 152,§1(4),and we have no 12• myself. [N comp. ❑ Roof repairs . insurance required.]t employees.(I�To workers 13•ff 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 ate doing Q work and then hire outside contractors must submit anew affidavit indicating such #Contractors that checkthis.box must attached an additional sheet showing the name ofthe sub-contractors andtheir workers'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: Policy#or Self-ins.Lic.#: Expiration Date:- ZL � Job Site Addres I�M •�ab, a t City/State/Zip&A-fQ "1•1 Q a-GGC 2 IJ Attach a copy of the workers' compensation policy declaration page(showing the policy number and txpiration date). Fatiure to.secure coverage as required under Section 25A of MGL c. 152 cad lead to the imposition of criminal penalties of a fine up to$.1,500f00 and/or one-year mmmprisonment, as well as civil penalties in the form of a STOPVORK ORDER and a fie of .p to$250.00 a day against the violator. $e advised that a copy of this statement maybe forwarded to the Office of Investigatio of the DIA for insurance coverage verification. I do hereby ce nder the Gains a pen ..es pe ' ry that the information provided a$ove is true and correct Si ature: Date:- Phone#: �/l ' 14. 0229--D LLt only. Do not write in this area,to be completed by city,or town offccial n: PermitrLicense# hority(circle one): Health L.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: Information and Instructions Massachusetts General Laws chapter 152 fequires 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. It to er is defined aS:" divi�iral,.:P �sluP�: soc?ation,gwpora.ion or other legal entity,or any tivo or more An employer e and inchiding the legal representatives of a deceased employer,or the of the foregoing•engaged in a joint enterprise, to ees.'Howvyer,*14e receiver or trustee of an individual,Partnership, association or other legal entity,empto ying emp y owner of a dwelling house having not more than three apartments and who resides therein,or,the occapant of the dwelling house of another who employs Persons to do maintenance,construction or repair worxbn 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 shalt 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." 25 states `Neither the commonwealth nor any of its-political subdivisions shall Additionally,MGL chapter 152,§ �� enter into any contract for the perfomance of public work unt l acceptable.'evidence of compliance with the insurance 'requirements of•this chapter have been presented to the contracting authority." Applicants Please fill out .the workers' comtensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificates) of insurance Limited Liability Companies(LLC)or Limited Liability Partnerships(L•LP)with no employees other than the ers' compensation insurance. If an LLC or LLP does have members or partners; are not required to carry work . employees,a policy is required• Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of ironance 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 Off cials . 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 save to fill in the permit/license number which will be used as a reference number. In addition, an applicant• that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy infomutiou(ifnecessary)and under"Job Site Address"•tlie applicant should write"all locations in (city or tom)."A copy o€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.fature 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cogperation and should you have any questions, please do not hesitate tb give us a call. The Department's address,telephone and.fax mimber: th of Massachusetts . • The Commonweal . Department of IndustriaLAccidents ce 9fvestig ations {. o - . .. � 600-Washin(Gfon Sireet Boston,MA 02111 `Tel.#617-727-4900 ext 406 or•1-877-MASSAFE Fax#617-727M49 Revised 5-26-05 vrjm,mass.gov/dia r Uate. 6/8/2006 Time: 9t20 AM To: 0 9,1,508-391-5460 R&G Ins. Agay. pa e: 002 _ Client#:7601 _ GECRDAV _ ACORD. CERTIFICATE O LIABILITY( INSURANCE i 0 (MFArODYYYY;' 06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.Agency,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND.EXTEND OR 434 Routs 134 ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. � I P.L.Box 1601 -`--- _ I South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: Peerless Insurance George Davis Builders,Inc. A5URER 0: --- _— dba George Davis Builders INSURER C: 9 New Venture Drive,Unit#7 INSURER❑' So. Dennis,MA 02660 INSURER E: COVERAGES _ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THr INSURED NAMED ABOVE FOR T:HE POLICY PERIOD INDICATED.NOTVdITHSTANDING. A14Y REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VVHICH THIS CERTIFrATE MAY BE.ISS!IEC OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL L ITHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PE OF INSURANCE I POLICY NUMBER POLICY EPFcCT1Y@—rOL9CY EXP RATI LTR TYPE S _ I ON (.YtMiDD/YY); E(MM.+bDlYY1 DAT __LIMITS _ A GENERAL LIABILITY ICPP9844948 04/19106 04/19107 EACH OCCURRENCE �s1,000,00L_ ' I X COMMERCIAL GENERAL L:AB!LITY DAMAGE TO RENTED�i j R M MEDNL 4; a n'^urrar:rysd $�O OQ_. EXP IAr.y.^.ne persenj, II ffi 000 _ Y ! i PERSONAL&ADVINdURf's1,000,000 GENERAL.AGt REGATE_ ffl-E2�RD'QI��} IY I GEN'L AGGREGATE LIMIT APPLIES PER:i j PRODUCTS-COMP/OP AGG $� _2 000 0O4O I POLICY I FRO L.00 av;OMUSILE LIABILITY COMBINED 9(NGLE LIMIT i AM!AUTO (Ea 2ceidenU -- —' I ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Perpersan) Y HIREDAUTOS I I — . ; BODILY IDUUR'r NON-OWNED ALTOS _. 1 PROPERTY DAMACE I$ r I (Pe(2=1ant) GARAGE LIABILITY ! AUTO ONLY-EA ACCIDENT i ANY AUTO t EA ACC $ i I OTHER THAN I AUTO ONLY AGG $ i EXC0S;UMBREI_L1ILIABIUTY I EACH OCCURRENCE I OCCUR CLAMS MADE I i AGGREGATE -v _ DEDUCI IBLE I .-- -------- 5-------------- RETENTION S WORKERS COMPENSATION AND I �T��pv Aj c OTH- EMPLOYERG'LIABIL!TY --- PNYPROPRIETOR/PARTNFR%EXECUTVE I IE.L.EACH ACCIDENT S OFFICER/MEMBER EXCLGDEG? i I E.L.DISEASE EA EMPLUIEE 3 i�ss.:iesu bs under S•ECIAL PROVISIONS bdaav i_ _ E.L.DISEASE-POLICY LIMIT T. OTHER Ir DESCRIPTION OF OPERATt.OP.'S!LOCATIONS;VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Workers Compensation certificate will be sent directly from carrier. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DE°SCRCBED POLICIES BE CANCELLED BEFORE THE EXPIRAT101i Town of Barnstable,Bldg Dept DATE THEREOF,THE ISSUING INSURER VALLENDEAvrRTOMAJL �, DAYSVd+w-,r--N 200 Main Strut NOTI E70THECERTIFICATEHOLDERNAMEDTOTHELEFT,BUT FAILORFTaDOSUSHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF A14Y KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORLZED REPRESENTATIVE `y ACORD 25(2001/08)1 of 2 ##S22606jM21837 DD Cs ACORD CORPORATION 1988 L ! From:Sharon Greenwood At:NorthStar Insurance Agency FaxiD:NorthStar Insurance To:Building Department Cate:618/2006 i 0:44 AM Page:2 of 2 caRD CERTIFICATE OF LIABILITY INSUI ANCE ORG S arEt/08/Y,i ,>� a�O -� o6jca/os PRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NorthStar Ins. Services, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 65 Walnut Street Ste. 380 ALTER THE COVERAGE AFFOROEDBY THE POL(CIESBELOW. Wellesley MA 02481 Phone 1781_431-2500 —rax:781-431-6134 -- INSURERS AFFORDING COVERAGE -- — 1 NAfr ii INSURED i INSJRERa: -Alli COxrtFan.aes -- -L--� i George Davis Builders, Inc. rINSURERC i George Davis L--- ----------- --- 9 New venture Drive-unit 7 ;I -� South Dennis MA 02660 NsuRERD: -- -- ----I------ •isl�Er. COVERAGES _ T!i F'OL ICI ES OF INSURPl JCE L!STED'c:E-O`1V It4VE 6EEN ISSUED TO THE iNS!RED NAMEiJ P.BSJF.FOR THE ROL1 C;Y PERIOD NO CATEG.N07'Vi. T.'vJVD I':G - PINY REQUIREMENT.TIER' OR.CONDGION OF ANY vA ITRACT OR r;liER 0OCUMEi IT',1VTH REYECT TO WHICH:'HIS CERTI F ICA.TE f ,),BE ISSUED Op. MAY PERT 1 THE!N;a-4',ANC£AF FORCE D BY THE'tiIq ES DcS(--F.:3ED HEREIN IS SUBJECT T')•;LL THE'ERW,,EA,L',E:C�6 AND CONKJ i11(YN;,OF 3)=H ROL ICES.ACrREG:iE LIMITS 5HCY VQ NWY HAVE BEEr4 RE_n_r'E15Y PAID CtNMS ``�� -r--- 7-OIIi"E�FFZ`YIL7 -Tl'�3LI'CFEY.PTFAT[OFIIMF, --T------ LTR IdSRy TYPE OF lNSURAUCE POJCY 14LAI ER LATE-gw.VDC:'1'Y` DATE immm RYI ! U:I S I G'EM1IERAL L1.4BWT'.' r PI. PILm I C1;1.r't'.ETC;fE?,IE.-I _CUME CL;L GENERA, L A-, I PP,EIACE�+Ea xwrprc+;1 I i —� f N,=.--- —1 �•�EKF 1.4.1Y cne Dc.rsprl 3 ---� ! j I C•ENERdL A.GGIRLC4 c i I OE'L AGGREGATE 1.!r,1T APFUE-SIPEK: PPOC'UCTS-COi^PAY'AGG $ ----- -�-r^Llrl^PERL- AUTOMOBILE UABIl.1T?' ,L- CjVISIpIEL ELI ,i i l?A:Y gUT1_ I (Ea a-:ch'.BN,: SCHELI.AED AUTOrG* I(Fer pe;'sory -----I-- 'HIRED ALITLY$ ! SpnIL'f IPi�t!rtY ,.j i ! 'PdG!+LOLlPJEG A!T05 (Per=_ctiGe.Tt) ; r-:4dAGE rA.4AGE LIABILITY i - ._ �- - I °'-;TD ONL'----- —_ i j ANY AL'"FO I I I r_ _iTHER'H�r; cc i 3 i I Al_ITO CAILY ! EXCESSILN1BRELLA LIABILITY �- - I EA.C,i''Y;CJnRE-+�.. I j�CY_CUR F- CLA MS PMDE i i AGb'REGA.iE CED'JCTIBLE I ---_-------- ---.--- _ I RETEITION ! T.— WORKERS CCMPEPiSATICN AND 104P C LIABILITY I ---------� It N OYER'LASi'.�F''NER;E::cCI?IVE i I-TC8950251 03/05/06 03/05/07 E.L.EACH AC-DENT is 100,000 4 j OFRCEFACNIBEF.r• v FE.L 5E-F _MPL l $100,000 -- Ir..es.oestrioeur��ar i I {---.---- -T------ -� S"EI,IA-pp51V!SIG�;Soxuw1-.L.Di5EF5E-POLL 5Q0,0;.IMiT 8 '00 OTHER Dr-sc 7P'nON OF OPERATIONS(LOCATIONS I1 VEHICLES!EXCLUSIONS ADDED dY ENDORSEMENTI SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION _ B�ORIiS^tA SHOULD ANY OF THE ABOVE DlESCRIBED POUCIES BE CANCELLED BEFJRETHE EkFIRCTILiP. I ' DA:E THEREOF.THE ISSUING INSURER WILL ENCEA,'OR TO MAIL 1.0 DAYS 1YRaTE14 Town of Barnstable NOTICE TO THE CERTIFICATE HOLDER NA('de'D TO THE LEFT,BUT FAILURE TO DO SO SHALL Building Dept. IMPOSE NO OBLIGATION OR LIABILTY OF ANY KIND UPON THE INSURER,n"SAGEJS OR 200 Main Street Hyannis XX 02601 REPRESENTATIVES- AUTHOPoNED REPRESENTATIVE 14ar aret Herlihy _ ALORO 25(2001,08) G ACORD CORPORATION 1988 i r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map t Parcel �`7 • ' Permit# He ision Date Issued Cons ivision t Fee 26 Tax Collector Treasurer , Date Definitive Plan Approved by Planning Board , His Preservation/Hyannis Project Street Address Village Owner 15d6;U KcC, y Address.c�,lilhe Telephone Permit Request Tr' - a��- � > taco s� �l sue?�3� � - � �1Y• Square feet: 1st floor: existing proposed ,2nd floor:existing proposed Total new Estimated Project Cos �0 Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes C44Ko If yes, attach supporting documentation. - Dwelling Type: Single Family a]-Two Family ❑ Multi-Family(#units) r Age of Existing Structure Historic House: ❑Yes ONT" On Old King's Highway: ❑Yes L.Nh---' 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 4 ' Total Room Count(not including baths): existing new' First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes O 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 O Commercial ❑Yes UPKo If yes,site plan review# , Current Use Proposed Use BUILDER INFORMATION , Name / e 1 Telephone Number ��- Address &i7riaJ• License# L� / oo�� 3� Home Improvement Contractor# 16,6 7-669 Worker's Compensation# 1� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE = 7 � +� ' . T� DATEl7 _ dtI FOR OFFICIAL USE ONLY a PERMIT NO.{ '� •1 � ,• ^' ,,.... - , ;�t .� ,• � - 4 _ .` ,- q, . ,{A �� '`' . '4 ' � -� � t'_ •- • y� r f � yet ` DATE ISSUED MAP/PARCEL NO. a, y - > : `• / } ADDRESS ;,g�T -`}IVILCAGE { OWNER : _. •? Yam. �` - , DATE OF INSPECTI I t ,• . .�" ` 4 F .., FOUNDATION FRAME INSULATION h J• y-• ' a FIREPLACE ? "} . _ • - w t ; ELECTRICAL: ROUGH FINALt �+ '/ • zw +' _ - PLUMBING: ROUGH FINALS GAS: !: ROUGH FINAL' FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. a' r F a THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A m / A I G�"- IL DATA • • 11�•� J f• '.. . - , .1��- . �/ �{p t��- Off' ,,,,iO#OUSr= AU'• Sn 11K DA Bt, Fe Fn _ {1A 011DEREDBY: CRJYFRYJ1DOtiE33 MY LN IAA J1W PU SA Sw WA We W{1 HC UP - r' DATEefTERED CR9WAF'PR0VED OADER CHECKED .CLJSiC)UFR Po CHARD SAID• C11514 SALE r SPECSAL 000'7E TB.EP{iDNE a PRODl1CT10N DAZE APPRO7m•1ATE 5�f'•DATF, CUMMERA88RFVIATION DELNERYAREA REUAAKS V sHQ'P>ct61F1fOFatATIOtf CUSTU&MR A=4 (1 WAR940LME PICKUP []WAREHOUSE D9jVEAY ()FACTORY DIRECT [I FACMRY POOKUP 1r :TOOA INFORMATION DOOR INFORMATION DOOR INFORMATION SIZE STYLE STYLE �j© � OTYa cIZE�STYLE OTY SIZE STYLE .ODE #_ CODE#! CODE # HINGE LE HINGE RIGHT D-LABEL HINGE LEF-1 HINGE RIGHT B-LABEL HINGELEFT HINGE RIGHT B-LABEL NSWING OUTSWING INSWING OUTSWING INSWI14G OUTSWING ODE# CODE# CODE# JAMSS• 4-5/a^ 5-114" 6-5r8" 7-Ira" JAMBS; 4 518" 5-1/4" 6-518" 7-1/4" JAMBS: A-518" • 5-114" 6-518" 7-1/4" ODE# CODE CODE THRESHOLD: STANDARD ADJUSTABLE THRESHOLD: STANDARD ADJUSTABLE THRESHOLD- STANDARD . ADJUSTABLE '.ODE R CODE CODE A EXTERIOR CASING: 908 514 �SING EXTERIOR CASING: 908 514 NO CASING EXTERIOR CASING: S08 514 NO CASING NTERIOR PLANTS(RAISED MOULDING) YES NO . INTERIOR PLANTS(RAISED I-tOULOIt4G) YES NO INTERIOR PLANTS(RAISED MOULDING) YES CSIDELIGNT 1NFORMAT1017 SIDELIGHT INFORMATION SIDEUGHT INFORMATION aTY SIZE i'Z PI STYLE j (� JL 0TY 1:1 SIZE= STYLE= OTY❑StZE� STYLE -ODE# DLI� �` (�/✓1Zi' CODE# CODE# BULL SIDE Is r+ouoursioE) LEFT RIG} BOT MULL SIDE vsouourssom LEFT RIGHT BOTH MULL SIDE rtpowovr;4oq LEFT RIGHT BO1 HAI;UWAR1=Pt; HARDWARE PREP HARDWARE PREP LOCKSET BORE YES- NO LOCKS5T BORE YES NO . OEADBOLT 80�2o16sooto0 YES NO DEAOBOLT BORE 12016400100 YES No LOCKSET SORE YES NO KEYED ALIKE NO DEAD80L7 BORE 12015?00100 YES NO KEYED ALIKE YES NO KEYED AUKE YES NO PEEPSITE WITH PREP 12%6900300 Y N PEEPSITE WITH PREP 1201s900300 YES NO PEEPSFTE WITH PREP 120169003oo YES Nc MAIL SLOT PREP ONLY 12o159oo400 YES NO MAIL SLOT PREP 0I.4LY 12o162064op YES NO MAIL SLOT PRL-P ONLY j2o,ssoo400 YES MAIL SLOT(NOT INCLUDING PREP) MAIL SLOT(NOT INCLUDING PREP) MAIL SLOT(NOT INCLUDING PREP) QBRIGHT BRASS 12m1s 2300 ❑BRIGHT BRASS;20169023oo ❑6R1GHT HRAS9 1 201 690 2300❑ANTIOUE BRASS 12o16902400 ❑ANTIQUE BRASS 12016902,00• ❑ANTIQUE B13ASS 1201a390 w HARDWARE INFORMAT70 HARDWARE INFORMA77ON HARDWARE INFORIS�A770N i LOCKSETCODE e�' .: �,� (i.q y,' LOCKSETCODE LOCKSETCODE DEADBOLT CODE DEADSOLY QQE)E DEADBOLTCODE RRIGJ•(T BRASS ANRQUE BRASS BRIGHT BRASS AI TMUE BRASS BRIG'HTBRAS'S ANTIQUE BRASS' 2-112'COLONIAL INTERIOR TRIM:YES NO 2-11Z"COLONIAL INTERIOR TIRIta-YES 110 2-1fX SPECIAL- COLONIAL INTERIOR TRIM1I:YES N( c f�'v''1"-K— �ECIAL: ,,`j�!1f/✓� SPECIAL: "'1 HAVE READ THE ABOVE ORDER AND 714E *jF0PJAA*nou tS CORRECT t ' . . The Town of Barnstable 9 MAWL � Department of Health Safety and Environmental Services 9. Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only 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. • r Est. Cost—1-i. '0. Type of Work:T_'� 1 D v Si �� % Ile- Address of Work: Owner's Name lJl Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under 51,000. Building not owner-occupied Owner pulling own permit I Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING W UNREGISTERED ORNOT HAVE CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT 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: Q D 7 Pill, Contractor Name Registration No. Date ro-A. eq P /Zv 4rlsic p . OR nWnees_Name 191 SEP SYSTE 23 �.�f'b��l F M MUST B . INSTALLED IN COMPLIANCE WITH ARTICLE II STATE SANITARY CODE REGULARONS AND TOWN �QyQFTNET TQ N OF 41RANSTABLE r BAWST'A LL i "6 o w BUILDING INSPECTOR - ar a• , APPLICATION FOR PERMIT TO 16114.....0.!U�..�A.!nx .......! .( . .......................................... TYPE OF CONSTRUCTION &V..0d: .....................(' 1 ............9-2.7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....../of.�..;.1...........L�".�.(.!.I.ti?.. ..1)�?n ...........b.N.,..................r-xl10.(..�l �!.�......................................... ProposedUse ........keS.l. ......dA.. ..................................................................................................................................... Zoning District ............. :. .+?. ..:.......:...............................Fire District ....1,!�N.tetlll.�J:�t... A Name of Owner .....kAr-►y.P.f: .....NO E' IN�....Address ......./I.S.N.LF.,V......Z> .......................................... Name of Builder ....................................................................Address .................................................................................... Nameof Architect .......k..PA:�: ...........................................Address ..................................................................................... Number of Rooms .............�.................................................Foundation ....... ..G:�.l�...K Q.......(„iPJfv�L ........................ Exierior ...................... .............................................Roofing .................../..'..'.S ./1121 ....................................... Floors .................C�. .,q.f:p:e---tt ............................................Interior .................... y �. /...................................... HeatingR �.' I.. -................................Plumbing /l r5�..... ... 1. .....Q. ... 5......................................... Fireplace ......................./.......................................................Approximate Cost .........4...1....... ......................................... Difinitive Plan Approved by Planning Board ---------------_--------------- Diagram of Lot and Building with Dimensions e / Z -7 3 7 �Td 2. �U I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. . ....... -1 .4.................. � ................................ Nozzoest Homes, Ire, ^ ' \ � No -' . Permk for -..mc�».. .......... � ` sin le lling l---^-' '--'-''''-^---' ^~^.. I��DrivLocation -.---.--=--.-,--------. �...-----.---.----,~-.---_---.... � �Owner __.. . ..Zzx:c_____ > �� ~ ' { ' Type of Construction ........................... � ----.~^---------.-------.---.. | � � Plot ............................ Lot ......jft9................... , . � Ju1Y10 �� Permit G,onha6 ----...,-----.--]g ^- � ' ( � . ^ Date of Inspection 19 Date / �� . Completed - � � � �� ' PERMIT REFUSED ' / rr ' �� l� / '�~-'' ---~^-'^------^'^-' l ---.-----..---.-.-...-..-..----.. -.-_.-.-.....--~..----..--.-.-.--. ....~-----..---.-,...--...-.---.-.. . . � ------..--.--..~.--...-.....~--~... . _ Approved .............................................. lR � ' '-----'---'----'~^'~''^^-^^'-'---'`' � ' -'------`'--^-----'--^--^^`^^^^^' � � 5'-0 +E Proposed Platform & . - o Steps to Grade N ai CD a� 2x8 - 16o.c. Hangers Dbl. Band Joist �— 4 x 4 Post v 10" x 48" Footing ., 0 }. o .a O N - - - - - - - - - - M� > Q 0000 p 1.1.1 Q 1 � C CO jC `O 43) Z U) 21 E 0 C >I nU M 4 VVW + a Property of George Davis Builders, Inc. Do Not Reproduce 164'-p / r..—.._.._.._.._.._.._.._.._.._.._..—.._.._.._.._.._.._.._.._..—.._.._.._.._.._.._.._.._.._.._r.._..—.._ 1_.._.._.._.._..—.._.._.._..—.._.._..—.._.._.._..—.._.._.._.._.._.._.._..—.._.._...� l>,J O O N I j � i o m c - 68•_0" I I I t jI b i I� b i i I iI I � . - .._...___ __ ______________ _ __ M N 47'-0 ^` Q M _I I. ________________ _ 3 ^> O ----------------------------------------------------- j o .0 CO C a) 00 I ---------------------- ----- LO -- - I Q � Z ) I I O j CD CD MM I j I Iv j j • _ L Q O C Nottingham Drive s M i • I - A Property of George Davis.Builders, Inc. f Do Not Reproduce