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A Permit Fee 3 Date Definitive Plan Approved by Planning Board 3hlgl Historic - OKH Preservation/Hyannis Project Street Address 00 �i( ��� ' bgkr '/I ► Village i 1f I `,� ' f L i j Owner 0� �1 Pr�Grl.1,��t� l Address "t 9 ci i� j7� Lell4f,67- Telephone 150 q, Permit Request I n Z J ' °C-) n Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District a Flood Plain Groundwater Overlay Project Valuation ✓ 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 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RISE Engineering Telephone Number 401-784-3700 Address 1341 Elmwood Avenue License # 100459 Cranston, RI 02910 Home Improvement Contractor# 120979 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE _-__._.__.... DATE � -Yml I Erii Nerstheimer for RISE Engineering FOR OFFICIAL USE ONLY APPLICATION# I DATE ISSUED MAR/PARCEL NO. . =. r � r T ADDRESS VILLAGE s OWNER DATE OF INSPECTION: FOUNDATION_ FRAME f INS ULATIO.N'l =, FIREPLACE ELECTRICAL: ROUGH FINAL i ' PLUMBING: ROUGH FINAL ' GAS ROUGH FINAL z , 'i DATE CLOSED OUT 1 ASSOCIATION PLAN NO. } The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600.Washington Street Boston,Mass. 02111 . www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Coritractors/Electricians/P11umbers Applicant Information Please Print Legibly Marne(Business/Organization/Individual): RISE. Engineering a division of Thiel ch Engineering 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. N 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.'0 1 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] 5:0 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 MGL insurance required] t c. 152,§ 1(4),and we have no 12. D 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 is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins.Lic.#: 3730961-01 Expiration Date: 1j/1/12 •Job Site Address: �6 OC K 5hrt L4— r City/State/Zip: TC�Y V I 1 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 imprisonmerit 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 ZrI, nd 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 1-800-422-5365 eXt13 Official use only Do not write'in this area to be completed by city or town official City or Town: Permit/license#: IssuingAuthority(circle one): LBoard of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: . l OP ID: 31 AoRo2 CERTIFICATE OF LIABILITY INSURANCE 1 DATE,MM/°D/VYYY) 12/30/10 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 endorsements. PRODUCER 401-886-8000 CONTACT NAME: The Preston Agency,Inc. 401.885-1700 PHONE FAX 1360 Division Rd Suite 303 _ A/c No Exit: A/C No): E-MAIL PO BOX 810 ADDRESS: PRODUCER THIEL-1 East Greenwich,R1 02818-0810 CUSTOMER ID a: INSURER(S)AFFORDING COVERAGE NAIC tt INSURED Thielsch Engineering,Inc INSURER A:Zurich-American Ins Co. - Hi elsch Group Inc. INSURER B:American Guarantee&Liability 1 Tech Realty Inc. INSURER C:North American Capacity 95 Frances Avenue ' Cranston,RI02910 INSURER D:Hartford Insurance Company INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF.ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN,IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADDLSUBRI LTR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR 'POLICY NUMBER MM/DDlYYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 3730962-01 01/01/11 01/01112 DAMAGE TO RENTFIT_ PREMISES Ea occurrence $ 300,00 CLAIMS-MADE FX_1 OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO LOC Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,00 A X ANY AUTO 3730963-01 01/01/11 01/01/12 (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULEDAUTOS - PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON WNEDAUTOS $ $ UMBRELLA LIAB X OCCUR - EACH OCCURRENCE $, 10,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,00 B. AUC-4867188-00 01/01/11 01/01/12 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATNAND EMPLOYERS'L ABIILOITY Y/N X CY T mN OTR- -A ANY PROPRIETOR/PARTNER/EXECUTIVE 3730961-01 01/01/11 01/01/12 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N/A - - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If ye,d sescribe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 C Professional Liab DVL000026800 04/01/10 04/01111 Prof Liab 2,000,000 D Leased/Rented Eqp �0,2UUNTD5678 01/01/11 01/01/12 Equipment 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved: /)"ACORD 25 2009 09 The ACORD name and logo are re i( ) g g stered marks of ACORD I - r THIEL-1 PAGE 2 NOTEPAD INSUREDS NAME Thielsch Engineering,Inc OP ID:31 DATE 12/30/10 Al T RI n Ineen ip,a division of Thielsch En ineerin ,1nc. �a kell Associa es a divisio f Thiels h I-�n ineen�i ,Inc. A Laboratory,a gjvlsjon o�T ielsch gn11hieIsch e rin ,Inc. E Laboratory a um iqn.o T i Inch neerin Inc. A 1 En meeiT'n division o hIglschginee i ,Ipc. Water Magagemer�j ervices,a dvision of igmeering, Inc., i r 91te 47) O ice o nsumer6A(atn-/�u!sines`+e!gu %1ono 10 Park Plaza- Suite 5170 Boston, ssachusetts 02116 Home Improve ontractor Registration Registration: 120979 Type: Supplement Card. �? -' I r Expiration.: 3/25/2012 THIELSCH ENGINEERING ERIK NERSTHEIMER 1341 ELMWOOD AVE. ~4 CRANSTON, RI 02910 . RCN �0 Update Address and return card.Mark reason for change. Address Renewal Employment F1 Lost Card DPS-CA1 is 50M-04/04-G101216 ✓/ae �amvnaovziaea�li a�./�aaaac�ucaelta . Office of Consumer Affairs&BuSSiness Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registrationf�979 Type:' 10 Park Plaza-Suite 5170 Expira 12 Supplement Card Boston,MA 02116 THIELSCH ENS- ` ERIK NERSTH 1341 ELMWOOD CRANSTON; RI 029 Undersecretary Not valid without signature Licensee Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 100459 Restriction WS,IC Name Erik Nerstheimer City,State,Zip North Scituate,RI,02857 Expiration Date 3/28/2012 ;. Status Current . No complaints found for this Licensee. Back To Search http://db•.state.ma.us/dps/` licdetails.asp?txtSearchLN=CSL 100459 1/7/201.1 MR.'. i4 x a NAT!.24531 1 t Control No: 3 4 2 4 4 THE COMMONWEALTH OF MASSACHUSETTS e DEPARTMENT OF LABOR. DIVISION OFOCCUPATIONAL SAFETY J° 19 STANIFORD STREET,BOSTON,MASSACHUSETTS 02114 LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER RISE Engineering A Division of Thielsch Engineering, Inca 1341 Elmwood Avenue Cranston, R1`02910 WAIVER:, LW000672 EXPIRES: April 15,2015 IN ACCORDANCE WITH M.G.L. C. 111, § 197(8)(b)AND 454 CMR 22.03(3)(b), THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER IS ISSUED BY THE DIV. OF OCCUPATIONAL SAFETY TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF PERFORMING LEAD-SAFE RENOVATION WORK. THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER MUST BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L. C. 111, § 197B(b)AND 454 CMR 22.04 WHEN PERFORMING LEAD-SAFE RENOVATION WORK. HEATHER E. Rovt,ACTING COMMISSIONER Printed on Recycled Paper w rt RISE ENGWEERING Federal ID#05-0405629 RI Contractor Registration No 8186 A division of Thielseh Engineering MA Contractor Registration No 120979. CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,R162910 (401)784-3700 FAX(401)784-3710 CONTRACT Page ,�- -* - - THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING ENGINEERING AND THE CUSTOMER FOR WORK AS' _ .r . . DESCRIBED BELOW - y CUSTOMER PHONE r - DATE CIIent# Sheila J Devaughan (508)420-3036 12/10/201*0 114686, SERVICE STREET . - - BILLING STREET 35 Oak Street 35 Oak St h 4 SERVICE CITY,STATE,LP BILLING CITY,STATE,ZIP Centerville,MA 02632 W Barnstable,MA 02668 JOB DESCRIPTION' RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work 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 of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) $1,056.00 RISE Engineering will provide labor and materials to install a—7"layer of R-23 Class 1 Cellulose added to 88 square feet of floored attic space. $96.80 RISE Engineering will provide labor and materials to install 3`5"R-13 faced fiberglass batt insulation to 66 square feet of kneewall area. $72.60 RISE Engineering will provide labor and materials to install a 9"layer of R-30"Class 1 Cellulose added to 286 square feet of open attic space. $308.00 RISE Engineering will provide labor and materials to install Class 1.Cellulose blown in to 100 square feet of sloped ceilings: " $200.00 RISE Engineering will provide labor and materials to make a temporary access to an attic area: The opening will be closed with materials similar to those existing. $150.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$2,000 per calander year,renter.100%up to 2000 plus air sealing " -$1,883.40 ' � x WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***00/Dollars $0.00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DA EE REVE E FO IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES . D SIGNAT IS G ERING ' 5ME-RACCEPTANC� N :THIS CT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN s DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE DAYS. - SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO.00 THE WORK .. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE