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0049 OAK STREET (CENT./W.BARN)
�q �� .. ' � A ., ..:. .. .. ,.. -.-. G ,ir �' w �' � t ::� .. -. � _ , r ,. - e4 .y .wy s� e •. 4 v . O _ n ., .. �, .- .. e ,, „ � � _ � 1 -- '.. . e ,. .. -, e �, �. - d 4 ., ,� ,. o ,� ,.� ��, .. ., °' -,- ., ' . Town of Barnstable Building Post This,Card So That,it is Visible F'rorn thebStreet--Approved`Plans Must:be Retained om-Job and'thIs Card Must be°Kept s ' •ti� Posted Until Final Inspection Has Been Made. _ Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Fina ection has been made.l4lnsp Permit Permit No. B-19-2402 Applicant Name: Elvis Verdezoto Approvals Date Issued: 09/04/2019 Current Use: Structure Permit Type: Building-Insulation—Residential Expiration Date: 03/04/2020 Foundation: Location: 49 OAK STREET(CENT./W.BARN),CENTERVILLE Map/Lot. 173-017 Zoning District: RC Sheathing: Owner on Record: DEVAUGHAN, BOBBY J& ELSA V Contractor Nam(;`4 SCOTT VEGGEBERG Framing: 1 11 Address: 49 OAK ST Contractor License: CS`SL-103832 2 WEST.BARNSTABLE, MA 02668 „Est. Project Cost: $3,574.00 Chimney: Description: Air sealing and weatherization work inside the home. E Permit Fee: $85.00 Insulation: Project Review Req: Fee Paid: $85.00 I?ate: 9/4/2019 Final: /a4�1_ Plumbing/Gas Rough.Plumbing: - £` = -:r••� Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after!issuance. All work authorized by this permit shall conform to the approved application and thelapproved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clear) visible from access street or road and shall be maintained open for ublic ins ection for the entire duration of the Final Gas: PY P P P work until the completion of the same. M •-- Electrical The Certificate of Occupancy will not be issued until all applicable signatures by Ahe Building and Fire Officials are provided oo this_permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing41 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT - - -- - Town__ Barns . -*Permit# Expires 6 months from issue date -r a =SSFRERMIT RegulrrverL ter. Fee Thomas�T,Geiler,Director MAY 2 4 2007 :Building Division Tom Perry,CBO, Building Commissioner ®�� 0� �f�RNST��L� 200 Main Street,Hyannis,Na 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PEPJVHT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint � � �•� t [ap/parcel Number roperty Address 4 7.A J/- _— - /P �/4 (o 6 9 Residential Value of Work�a Of J . Minimum fee of$25.00 for work under$6000.00 !wner's Name&Address tQ. �� EL$A De//hl&444,n v �9 6AKSr j .EafsPaLit hnA o 1.(46 'ontractor's Name A,l� ) �d C Telephone Number -60 - �6.6go. [ome Improvement Contractor License#(if applicable) 's-Lzuense {�Fappficable) orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ the Homeowner I have Worker's Compensation Insurance asurance Company-Name 1pen l--esS. ,� s Vorkman's Comp.Policy 80.2 217 :opy of Insurance Compliance Certificate must be on file. -ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side replacement Windows/doors/sliders. U-Value ; `33 (maximum.44) *Where required: Issuance of.this permit does not exempt compliance with other tovm department regulations,i.e:Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner.Letter of Permission.. copy of the Home.Improvement Contractors License is required. '1IGNATM: t:ForM:expmtrg xvise061306 Department oflndustrialAccidents Office of Investigations . 600 Washington Street Boston, MA 02111 �k _�•'� www.mass.gov/dia ' Workers' Compensation Iiisurance Affidavit: ]Builders/Contractors/]Electricians/Plumbers Applicant Information Please Print Le '1al Name(Business/Orgmization/Individual): . &A G� S Address: XL21 e%'� l fS�it City/State/Zip: / B/' 27 gO Phone:#: Are y an employer? Check the'appropriate box: -Type of project(required):. i 1.[ I am a employer with 4. I am a general contractor and I * have hired the Vub-contractors 6. ❑New construction . employees(full and/or part-time). . 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' .' Building addition [No workers' comp,insurance comp,insurance.$ required-] 5. 'We are a corporation and its 10.❑Electrical repairs or additions '3.❑ I am ahomeownei doing.all work officers have exercised their 11.0Plumbing repairs or additions myself. o workers' co right bf exemption per MGL Y � �• - 12.0 of repairs . insurance required.]t c. 152, §1(4),and we have no / employees. [No workers' 13: Other_ *&tM/ Wt i d S comp.insurance required.] *,&,y applicant that checks box#1 must also fill out the section below showing their workers'.compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the'sub-contractors and state whether or not those entities have employees; If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: job/less J�vS. X� Policy#ar Self ins.Lic.#:_(�� 4(/0� 31 1;2 Expiration Date: d s Job Site Address: DlfK: 4r City/StateM,/Z , /If'rl MA 04 61;66 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 maybe forwarded to the Office of Investigations of the DIA£or insurance coverage verification. I'do hereby cerd u der the sins nd penalties of perjury that the information provided above is true and.correct.' Si afore: Date: J�- .? d 7 _ Phone#: ,S4'S ' 6 7 6' p 9 �k o Official use only.. Do not write in this area, 0 be completed by city or town offrciaL City or Town: Permit/License# Issuing Authority(circle one): • ' I� 1..Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6.Other ContactPerson: Phone#: Information and In Atucti®ns Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire; ; express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer,:or the rPc.eiyer nr trustee.-of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwellQ-house having not inure than three apartments and who resides therein;o the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair ark on s dwelling house or on the grounds or byuilding appurtenant thereto shall not because of such employment a de be an employer." mcTL chapter 152, §25CN also states that"every state or local licensing agency a�ll'wi d the issuance or renewat of a license or p°ermit to'operate a business or to construct buildings a commonwealth for any applicant-who has not pro�duced�acceptable evidence of compliance with t ' ranee coverage required." Additionally,MGL chapter 152,-§ K(7)states"Neither the commonwealtl}Fn ny ofits political subdivisions shall enter into any contract for the e erformance of public work until-acceptable a Bence of compliance with the insurance requirements of this chapter hay been presented'to the contracting au ,o!rity" Applicants �/f / Please fill out the workers'compensa'on affidavit complete „by checlang the boxes that apply to your situation and, if necessary,supply sub-contiactor(s)n. e(a), address(es)a phone num er(s)along with their certificate(s)of insurance. Limited Liability Companies�,C)or Limited Liability Partnerships( LP)with no employees other.than the members or partners,are not required to carr worke "coinpensatil insurance'If an LLC or LLP does have employees,a.policy is required. Bp advised that affidavit-maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. dso be'sure//to sign and date the affidavit. The affidavit should be returned to the city or town that the applica' n o the;permiZcr.licens/is being requested,not the Department of Industrial Accidents,' Should you have any sti use.'a=ding the law/or'.if you are required to obtain a workers.' compensation policy,please call the Depart e t the n ber listed`below. Self-insured companies should enter their self-insurance license number on the a opna 'line''. , �..' City or Town Officials Please.be sure that the affidavit is cornglet%and printed legibly. The department has provided a space at the bottom of the affidavit for you to fill out in the e`eventthe Office of Investigatio'`has to contact'you regarding the applicant Please be sure to fill in the permit/i cens�enumber which will be used as a``�eference number. In addition,an applicant. that must submit multiple permit/license applications in any given year,:' neeli only submit one affidavit indicating current policy•information(if necessary)Jand icier"lob Site Address"the applicantishoould write"all•locations'in (city'or town),"A cbpy of the affidavit ihat,'ha&been officially stamped or marked by thtcity or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses, A 1 w\affidavit must be filled out each year.Where a home owner oncitiien is obtaining a license or permit not related to Nsiness or commercial ventaie (i.e.a dog license or permit to bum°leaves-etc.)said person is NOT required to comple 6s affidavit, The Office of Investigations would like to thank you in advance for your cooperation.and o you have any tio.ques �, - Please do not hesitate to give, sf a call. The Department's address,tel hone•and fax number;- o Commouwalth of Massachusetts DTartant ofWwWal Aocitdmts Office of Inyestigat ons 600 Wnhingtcai Steot Boston,MA 02111 Tel, #617-727-490.0.ext 406 of I-M MABSAFE 9- Revised 11-22-06 Fax 4 617-727-774 www.mass-.gov/dia I Board of Building Regulations and Standards License or registration valid for in�ividul use only HOME I..PROVEMENT CONTRACTOR before the expiration date. If found return to: a R 1st afL-dn 9840 Board of Building Regulations and Standards 1. One Ashburton Place Rm 1301 t3/2008 P Boston,Ma.02108 Liability Cor oration PELLA WINDOVY ; STEPHEN. DICKIp 1325 AIRPORT RO FALL RIVER,MA 02720 Administrator —A&f�N. valid without signature MML01".Glee 7onvr�xo�zcuea��i o� 4aiwa +i '1-; 0IT N 1 . 4 49. Tt.no: 17237 a ITT T 'iAzvI 7 1 " LA v.. 3 }ElR1 ` Pella Windows & Doors 1325 AIRPORT ROAD FALL RIVER,MA 02720 TEL. 508-676-6820 FAX 508-676-6823 June 19, 2006 To: Whom It May Concern RE: Contractor and HIC License I hereby give permission for Steve Correia to use my Contractor Supervisor's License 9CS081843 and my HIC Registration 4149840 to pull permits in the State of Massachusetts for all projects related to work performed for Pella Windows & Doors, Inc. Av, 4442A Steve Dickinson y Operations Manager Pella Windows & Doors, Inc Windows, Doors & Skylights I U:J/UJ/ LUU f 1J.JO .......... 00fOOOLJ rC.LLH W.LIVLUWJ f Huc. UL/UL From:Jeanne Pansey At The Preston Agency FaxID: TO:Tracy Silvla@Fella Dare:5/3/2007 01;27 PM Pegs;2 oT 2 ACORD. CERTIFICATE of LIABILITY INSURANCE YI PEOP ID LF,LLZL z7 DATE(MMIDDI/0 -1 OS 03/07 PRODUCER THIS CERTIEICATE.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 Sox BID ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, East Greenwich RT 02818-0810 Phone:401-886-8000 rax:401-885-1700 'INSURERS AFFORDING COVERAGE NAIL INWReD PFR Ac INSURER A: Peerless Insurance Company 24198 qquuisiCion, LLc dba: Pe7 la Windows & Doors INSURER B. 1325 Airport Road Acquisition LLC INSuacRc: 1325 46.irpoxt Rd INSURER D: Pali River MA 02720 INSURER E: COVERAGES THE POLICIES OF MAIRANCE LISTED BELOW HAVE BECN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PFRIDO INOICATED,NOTWIYH6TANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT-WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 18SVED OR MAY PERTAIN,THE INSURANCE AFFOROED MY THC POLICIES DCSCRIOCD HERCIN IS SUBJECT TO ALL THE TERMS,EXCUJSIOKS AND CONDITIONS OF SUCH POLICIES.AGOREGATE LIMTTb MOWN MAY HAVE OCCN REDUCED BY OAID CLAIMS. LTR 9 TYPE pF INSIJRANCF. POLICY NUMBER DATE fMtd1D01YYl DATE(MMIOD/YY) LNM GENERAL LIABILITY 12ACHOCCLRRENCE $1,000,000 A X COMMERCIAL GENERAIUAOILITr CIBP8022572 05/01/07 05/01/08 1PREMISES � $300,000 CLAIMS MNJE a OCCUR _ MED EXP(Arty nnR parxan) $10,0 00 X EBL _ PER60NAL A ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENL AGGRFGATE LIMIT APHI.IES DER: PRODIXTF.COMP/OP AGG $2,000,000 POLICY MJPEIIC LOC Emp B®a. 11000,000 AVrOMOBILE LIABLL ITY A ANY AUTO EM022972 05/01/07 05/01/08 te�InecyNE�D�SINGLLLIMIT $1,000,000 ALL OWNED Al.rMS BODILY INJURY $ X SCHEDULED AUTOS (Par pervan) X HIRED AUTOS eODn.Y INJURY S X NON.OWNED AUTOS (PN atmom) PROPERTY DAMAGE $ IPar$04ant) GaRAM LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY. AGG S EXCESWUMBRELLA IJABLRY EACH OCCURRENCE S 10,000,000 A X OCCUR CLAWS MADE CU814034D 05/01/07 US/01/08 AGGRFnATF si0,000,000 S OEDUCTTBLE $ --- X RETENTION $10,000 9 WORKERS COMPENSATION AND X TORY LI ITS M ER EMPLOYERS'LIABILITY p' ANY PROPRIErORIPARTNERIEXECVnVF WC8023972 05/01/07 05/01/08 E.I.GACaiACCIDENT $1,000,000 OPPICER/MEMBEP.EX(LUDEW E.L DISEASE-CA EMPLOYEE $1,000,000 Wa,dwarlho undor CIA LPROVISIONRualow E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DEBCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSION$ADDED BY eN00R$BMFNT i specin PROVIBIONB CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAMN DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _DAYS WRITTEN PROOF OF INSURANCE ONLY NOTICE TO THE CERTIFICATE HOLDER NAMED TD THE LEFT.BUT FAILURE TO DO$O SHALL IMP08E NO 06LIOATION OR LIABR,RY OF ANY KIND UPON THE INSURER,ITS AGENITS OR REPRIMI NTATRMS. AUTHQffl=REPRESENTATIVE ACORD 25(2001/08) ®ACORD CORPORATION 1988 Office Order Copy Pella Windows & Doors Westerly RI, Centerville MA, Wakefield RI - Seekonk MA, Dartmouth MA, Plymouth MA Serving Massachusetts & Rhode Island Phone: Fax: 1 u ..Q ne ............................................. 'I-Q .,. ....... ...... . .:.:.:.:.:.:.:.:.:.:.:.:.:.:f �-cier......:...................................:.:.:.:.:.:.....................................:.:.:.:.....:.:.:.:.:..:.:.:.....:...:.:.:.:............................... DeVaughan,Bobby BILL&ELSA DEVAUGHAN Order No. 738AMAZI I Order Date 04/20/2007 49 OAK STREET 49 OAK STREET Customer No. DEVBOB Need Date 06/06/2007 Tax Code MA Sales Rep.Code ACM4093 WEST BARNSTABLE,MA 02668 WEST BARNSTABLE,MA 02 Taxable no Sales Rep.Name Mendes,Ana C. BARNSTABLE BARNST Tax Exempt No. Window Store 000001 Terms Code Deposit/C.O.D. Territory Lic.No.: P.O.No.: Customer Type H Ship To County . BARNST MDR Code SP Prepared By Lucy Ana Owner: Mr.&Mrs.BILL&E Overall Discnt. 7.821 % Architect Name Bus. Phone: ( ) - Bus. Phone: I Comm.Split ACM4093: 100.% Dist.Order No. Bus.Fax:( ) = Home Phone: (508)428-6515 Cellular: ( ) - Home Phone: (508)428-6515 Delivery Instructions: Comments: Paint trim Decorators White Uu s de..Y. lCtem Qty, a er�ptlon In t.Pr ce. Ext n ed. ...... ...... .. i ig�.6i:..........: i is�:6i .....................:.:.:.:.:...:.:.:.:.:.:...................................:.:..........................:.:.:.:.:.:.:.:........................:.:...:.:.:.:.:...:.:.:.......:.:.:........ :.:.:.:.:.:.:.:.: .:.:.:.:.:.:...:........:...:........................................ Item# 10 Qty: 1 Vent/Fixed XO Sliding Window,Frame•39 X 34• Pella Impervia, , Location: KITCHEN SINK Alternative Material,Model 1 , White, 11/16" InsulShld IG Glazing,Half (93.99) (93.99) R.O: 3'3-1/2" X 2' 10-1/2" Screen, White Hardware, 1 11/16"(Fin to Roomside),Integral Nail Fin 1,093.62 1,093.62 WallCond: 1 11/16"(Fin to Roomside) Value Added Items: Disposal fee per wdo/door-Qty 2 7.914% Prefmish Interior Trim per Unit-Qty 1 Install Full Tear Out 36"-48"-Qty 1 Notes: Item#15 Qty: 1 Fixed/Vent OX Sliding Window,Frame:59 X 40: Pella Impervia, 1,358.26 1,358.26 Location: BEDROOM Alternative Material,Model 1 , White, 11/16" InsulShld IG Glazing,Half (107.91) (107.91) R.O: 4' 11-1/2" X 3'4-1/2" Screen,White Hardware, 1 11/16" (Fin to Roomside),Integral Nail Fin 1,250.35 1,250.35 WallCond: 1 11/16" (Fin to Roomside) Value Added Items: Install Full Tear Out 48"-60"-Qty 1 7.945 % Disposal fee per wdo/door-Qty 3 Prefinish Interior Trim per Unit-Qty 1 Notes: Install Notes: reinsulate the bump out Office Order Copy-Page 1 of 3 Office Order Copy for Customer DeVaughan,Bobby Project: BILL ELSA DEVAUGHAN Order No: 73 8AMAZ I I U ............................... ........ Item#25 Qty: I Provided by Pella IxIO primed pine 2/8' 0.00 0.00 Location: 0.00 0.00 0.00 0.00 17.500% Notes: Item#26 Qty: I Trim Provided by Pella 0.00 0.00 Location: 0.00 0.00 0.00 0.00 17.500% Notes: Item#30 Qty: I Touch Up Paint 0.00 0.00 Location: 0.00 0.00 0.00 0.00 17.500% Notes• Item#35 Qty: I Thank You 35.54 35.54 Location: Value Added Items: Misc Adjustment-Qty 1 0.00 0.00 35.54 35.54 0.000% Notes• ................ ............. T. a'. ...... hahW ibu: or: u........... ............. ....... ............... . ........... . .............. ....... Office Order Copy-Page 2 of 3 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �G(�'J LI DATA M 5 00gier Project: BILL&ELSA DEVAUGHAN Order No.: �r Summary Drscriotion Unit Prier. Extended Pricp ItenIV 10 Qty: 1 Vent/Fixed XO Sliding Window,Frame:39-112 X 34-112:Pella 1, 05.80 1:,105.80 Loc0t'"' KITCHEN SINK Impervia,Alternative Material,Model 1 ,White, I1/16" InsuiShid IG RO; 34 4%, X 2' 11" Glazin& Half Screen;White Hardware,Block Frame .v/Std Fin WaOC"Ad: 1 11116"(Fin to Roomside) Value Added Items: Install Full Tear Out 36"48"-Oq,1 Prefinish Interior Trim per Unit-Qty 1 Summary 2esCC9jtlon Unft Pri - Extended Price �l1 Items#15 Qiy: l Fixed1Vent OX Sliding Windom-,Frame:60-1/2 X 41-112:Pella 1,272.01 1,272.01 LOcgtta4; BEDROOM Impervia,Alternative Material,Model I ,White, 11/16"IDSu1Shid IG I' R.Q- 5' 1'' X 3'6" Glazing,Half Screen,White Hardware,Block Frame wr/Std Fin y WallCoad: 1 11/16"(Fin to Roomside) Value-Added Items:Install Full Tear Out 48"-60" -Qty 1 Prefinish Interior Trim per Unit-Qty 1 Thank You For Purchasing Pella Products Taxable Subtotal S 913.91 -ore Pella Sales Representative Signature Sales Tax at 5.0000% 45.70 f� Non-taxable Subtotal 1,463.90 / m ! ,P7 Total S 2,423.51 Date Deposit Received S 0.00 �[�i� &&P A fos+ �13 35 20 �we*'l'O1r•C.S.R.REVIEW WITH CUSTOMER(Customer initials): -- y � i�z 5 V� It Ane;3 liis order is made especially for you,the customer.No cancellations are possible after 3 business days of the signing of this order. This ag-eeli 00 ract 9niy upon review and acceptance by authorized Pella Windows and Doors corporate representative in Fall River,MA. All promises of shipment are 01400n regarding the finishing, maintenance, service, and warranty for all Pella products,visit the Pella Website at www.lpella.com. iM Contract-Page 2 of 3 � t" t l3c�a �� � F t„E r Town of Barnstable ermit# Expires 6 moat is fro m issue i to Regulatory Services Fee • BARNSTABLE, " y� MASS. g i6;q. Thomas F.Geiler,Director ' �0 �EDMA�a Building Division oK S/G�l3 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 0 -3 D I---,Not valid without Red X-Press Imprint Map/parcel Number 1 Property Address q 5 `� Residential Value of Work 9, 5 �I 7 Minimum ee of$35.00 for work under$6000.00 Owner's Name&Address �- S U'tt tJ Contractor's Name AJ 1 n���� !;atj'ht{0 00 iZn0l1w4A%dl Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) U]Workman's Compensation Insurance ®PRESS PERMIT Check one: ❑ I am a sole proprietor APR 2 4 2�13 I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name G of \S - C V TOWN OF BARNSTABLE Workman's Comp.Policy# 17 / U 3 J a 3 9q Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles)All construction debris will be taken to -7 ❑Re-roof(hurricane nailed)(not stripping.. Going over existing layers of roof) ❑ Re-side #of doors Replaceme t W indows oors/sliders.U-Value_ v �__ (maximum .35)#of windows r ❑ 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. y A copy of the Home Improvement Contractors License&Construction Supervisors License is requ' ed SIGNATU E: C:\Users\decoll \AppData\Loc icroso8\WindowMemporary Internet Files\Content.Outlook\QRESZUWEXPRESS.doe Revised 0530 The Commonwealth of Massachusetts I DepaFftent of Industrial.9ccideuts Of flee of Investigations kv .600 Washington Street Boston,MA 02111 >www,ncass:gov/din Workers' Compensation Insurance A'flidavit: Builders/Contractors/Electricianv?lumbers Avl2licant Information / Please Print Legibly Name (Business/Orgaaization/Individt�l)' � �� � . S LL C_ Address: / City/State/Zip: WtSB ?,,k Phone you — � � ?/ 6y 7Are!1�d you an employer?Check the appropriate box: 1. I am a employer with o2D 4. ® I am a general contractor and Y Type ofproj�t(required): 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' [No workers'comp. insurance comp, insurance.i 9. ❑Building addition required:] 5• ❑ We are a corporation and its 10.0 Electrical r 3.® I am a homeowner doing all work officers have exercised their repairs or additions myself per 11.0 Plumbing repairs or additions y [No workers comp. right of exemption MOL insurance required.]r c. 152,§1(4),and we have no 12.0 Roof repairs 3 a.® I am a homeowner acting as a employees.[No workers' 13.[Other4 Ia un1 e n�- general contractor(refer to#4) comp.insurance required.] uI s\ D�JS Any applicant that chod m box#1 tmtat also fill out the section below showing their workers'co od, ----------- 0olicyinform&ticIL t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit tContractors that chock this box must attached an additional shoes showing the name of the sub.comtsctors and state whether or am indicating such those entities have employees. If the sub-contractan have employees,they must provide their workers'comp•Policy number I ears axe employer that is providbT workers'conepensation insurance for informatio>r, MY enrployeese Below is the poiic}+aged job site Insurance Company Name: D (> NS v2Rwc Policy#or Self ins. Lic.#.-Al g9 7 6 7 ,g 36� 3 y p, Expiration Date: Job Site Address. q I C)C �'. City/State/zip. Attack a copy of the workers'compensation policy dectz$ratimA Page(showing the policy number and expirsltion date). Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal fin penalties ' e up to$1,500.00 and/or one-year imprisonment,as well.as civil penalties in the form of STOP WORK ORDER and a of of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. T do her eerti under a paints and perealtdes of perjury that the ihrn rralloae provided above is twee and comeea 'i ubf J OfflCid use only. Do not write in this aerC4 to be completed by city or town¢opicial City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Dep€rtneent 3.City/Town Clerk 4.Electrical I 6.Other nspector S.Plumbinr Inspector Contact Person: — Phnne!r• Client#:30124 SOUTNEW ACORD. CERTIFICATE OF LIABILITY INSURANCE I DATE(MMI°nnYYr) 1/02/2013 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 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 CON T Anita Little Willis of New Jersey,Inc. NAMPHONE Ext:856 914.4660 1015 Briggs Road FAX A/c No): 856 914-1881 g9 ao RESS: Anita.Little@willis.com. PO Box 5005 ' Mount Laurel,NJ 08054 INSURERS AFFORDING COVERAGE NAIC# SURER A:Selective Insurance Co of the S. 39926 INSURED IN Southern New England Windows LLC INSURER a:Argonaut Insurance Co. 19801 D/B/A Renewal by Andersen INSURER C:Beacon Mutual Ins.Co. 24017 1137 Park East Drive INSURER D Woonsocket,RI 02895 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD Y: INDICATED. NOTWITHSTANDING ANY REQUIREMENT,,TERM OR CONDITION OF ANY CONTRACTOR 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. LTRR TYPE OF INSURANCE ADDL SUBR POLICY EFF. POLICY EXP 1 SR D POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS A GENERAL LIABILITYY. . S202945900 8/10/2012 08/10/2013 EACH OCCURRENCE $1 OOO 000 X COMMERCIAL GENERAL LIABILITY e CLAIMS MADEa OCCUR DpR MM ERocTunc $50 000 MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATELIMR APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000' POLICY PET LOC $ A AUTOMOBILE LIABILITY 5202945900 81 0/2012 08/10/201 Ea accideD SINGLE LIMIT 1,000,000. X ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per persor) '`$ ° AUTOS r AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X AUTNON OWNED PROPERTY DAMAGE AUTOS Per accident $ $ A X;EXCAESSLtAB OCCUR S202945960 8/10/2012 08/10/201 EACH OCCURRENCE $5 OOO 000- CLAIMS MADE AGGREGATE $5 OOO OOO RETENTION$ B WORKERS COMPENSATION AIC927698352394 8/21/2012 08/21/201 we sTATu- To—TT $ AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 68028 OFFICER/MEMBEREXCLUDED? � NIA 8/21/2612 08/21/201 E.L.EACH ACCIDENT $1 000000 (Mandatory in NH) I/yes,describe under E.L.DISEASE-EA EMPLOYEE$1 OOO 000 - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMP. $1,000,000 f DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,B more space Is required) Cert holder is included as additional insured regarding work performed by the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C%NCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL UE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENT,:TIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S213748/M213024 AY,L . J tt Office XConosurn=erwA'f&fa4imrsBuul4si/n"�ejss n 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9/19/2014 SOUTHERN NEW ENGLAND WINDOWS LL PAUL THIBEAULT 1137 PARK EAST DRIVE . WOONSOCKET, RI 02895 Update Address and return card.Mark reason for change. SCA 1 0 2oM-osn r Address Renewal n Employment n Lost Card - ,Ux, t(.Q 9I2?IGOJl[[/'UCIIJL Q�U4GCCddCI[.!L[CdG'C�J - ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 173245 Typu: 10 Park Plaza-Suite 5170 Expiration: .9/19/2014 Supplement i;ard Boston,MA 02116 SOUTHERN NEW ENGLAND.WINDOWS LLC. RENEWAL BY ANDERSON PAUL THIBEAULT 1137 PARK EAST DRIVE WOONSOCKET, RI 02895 Undersecretary Not valia without signature 1 Massachusetts -Department of Public Safety Board of Building Regulations and.Standards Construction Supertisor License: CS-042926 PAUL H THMEAgtT 26 LESTER STD N SMTTHFIELD RI OZ %21. ,I lu�` Expiration Commissioner 02/16/2015 Office of Consumer.Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: LLC - 1•#^1 ` Expiration: 9/19/2014 TO 231545 SOUTHERN NEW ENGLAND WINDOWS LL' I MATTHEW ESLER ,.( 1137 PARK EAST DRIVE WOONSOCKET 02895 , Update Address and return card.Mark reason for change. - (�Address Renewal Employment Lest Card DMCA1 p 5OM-04104-GGIO1216 ///"�, - - OILce 61'Leoi(Fa f`R?lydirKBt$tai Aftw6tro License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 773245 Type: Office of Consumer Affairs and Business Regulation Expiration: 10 Park Plaza-Suite 5170 9/19/2014 LLC Boston,MA 02116 USERM NEW:ENGLANQ WINDOWS LLC. RENEWAL BY ANDERSON " MATTHEW ESLER 1137 PARK EAST DRIVE E 4 •= WOONSOCKET,RI 02695 i ot Undersecretary N valid without signature Renewal � RI x�#1225y,30839 CI'HIC.OP:I72f: Re RENEWAL BY ANDERSEN MA III N+f.I9555 newal • Y WINDOW RE}kwser mA,ae�..Cemhymr 1137 Park East Drive,Woonsocket,RI 02895 t,raid Harsrd Ccmlwl Firm Phone 401.671.6401 •Fax 401.671.6262 I.+anac#LHCr.0058 ti�✓I ttdcml Tdx JD#4E•05"G30 Souther.New England Windows,LLC d/b/a Renewal by Andersen of Southern Nir-E-gUnd CUSTOM WINDOW AND DOOR REMODEIXNG AGREEMENT &ryeM,)Name Date ofAmerm dL ti n/ V / /3 Boyers)StMEAddr=.Cry.Sq.tc,-M ZIP I..! (e. 0 2aL 6 E.ManAdO—. Ho—TelephoneNumoer WorkTclep ne Cher Buyer(s)herchy,jointly and severally agrees to purchase the products and/or scMces of Southern New England Windows,LLC d/b/a Renewal by Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheei(s)(collectively,this"Agrccment"). Method of ent Check U Cash U Financed Total Job Amount:_/✓ t l._ �dmatcd starting Dote: P"Y^t , L lY _ DepositRxei4j(33%). �8 � 7 Credit Cards are accepted for deposit only-maximum 113 of the Balance at Start of job 33%:. - proicst con(Please sec Credit Cord Payment Font.)By signing this ( ) Etimned Completion Data pg,ep-mere.you acknowledge that the Balance at Start of Job and the ' Balance on Substantial ��y 1yt Ll Balance on Substantial Completion of Job cannot be made by credit t43 G Completion of job(33S):._ card and must be made by persona!Cheek bank check or cash. Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of thig Agreement.Buyer(s) acknowledges that Buyers) (1)has read this Agreement,understand%the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attacked Notices of Cancellation,on the date first written above and(2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Istand Sates Only)Notice to Buyer.(1)Do not sign this Agreement if any of the spaces intended for the agreed terthns to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.(3)you may at any time pay off the full unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You way cancel this Agreement if it has not been signed at the 6oain office or a branch office of the seller,provided you notify the seller at his or her mg► n office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation£orm for an explanation of buyer's rights. Buyer(s)received the consumer education materials provided by the Rhode.island Com;ractors Rrgistration Board. (Buyer's Irtiliao) Renewal by Andersen of Southern New England - Buyer(s) Buyer(s) Signature Or Pro artager ignatu Signattw '✓ ios/ CCid ri eY�t LL",(q to Print Name of Product 44a.ger rent.Namc Print Name YOU; THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. - - - - - - - - - -- - - - - -�Iq- - - - - - - - - - - - - - �- - - - - - - - - - - - - - - lRO_TjCE_O F-CANCEi,LAT10N t@LOTICE Of-Of LOJI ELLAt Date of Transaction I•IS" 1- —.You may cancel I Date of Transaction J• /S• 1 ,You may cancel this transaction,without any,penalty or obligation,within this transaction,without any penalty or obligation,within three business days from the above date.If you cancel,any 1 three business days from the above date.If you cancel,any property traded In,any payments made by you under the I property traded In,any payments made by you under the Contract or Sale,and any negotiable instrument executed I Contract or Sale,and any negotiable instrument executed by you will be returned within ten business days following I by you will be returned within ten business days following receipt by the Seller of your cancellation notice,and arty l receipt by the Seller of your cancellation notice,and any security Interest arising out of the tramaction will be security interest arising out of the transaction will be eanceled.If you cancel,you must make available to the Seller 1 canceled.If you cancel,you must make available to the Seller o at your residence,in substantially as good condition as when at your residence,in substantially as good condition as when received,any goods delivered to you under this Contract or I received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the Instructions of I Sale;or you may,if you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the the Seller regarding the return shipment of the goods at the Seller's expense and risk.If you do make the goods available Seller's expense and risk.If you do make the goods available to the Seller and the Seller does not pick them up within I to the Seller and the Seller does not pick them up within twenty days of the date of cancellation,you may retain or I twenty days of the date of cancellation,you may retain or dispose of the goods without any further obligation.If you I dispose of the goods without any further obligation.If you fail to make.the goods available to the Seller,or if you agree I fail to make the goods available to the Seller,or if you agree to return the goods to the Seller and fail to do so,then I 'to return the goods to the Seller and fail to do so,then you remain liable for performance of all obligations under you remain liable for performance of all obligations under the Contract.To cancel this transaction, mail or deliver I the Contract..To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any l a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Renewal by I other written notice,or send a telegram to Renewal by Andersen of Southern New England at 1137 Park East Dr., i Andersen of Southern New England at 1137 Park East Dr., on I ket 102893,NOT LATERTHAN MIDNIGHT OF I Woonsoc et, 1 02895,NOT LATERTHAN MIDNIGHT OF (Date) .(Date) I ER BY CANCEL THIS TRANSACTION. I I HEREBY CANCELTHIS TRANSACTION. 7( Buyer's Signature PH"Name Date Buyer'N Signature Mitt Name Date RbA Copy;White Buyer Copy:Yellow Fuyer Copy:Pink �T1 Renewa .:.. r e..`.- b A,ndersenc . . . .,,. -''.WINDOW'REPIACEMENT-•:ur\t�lerk�nl:omp�tng ..- Wood/Vinyl Composite IF - t7 ? k �fiFt , Dual Argon;Low`E4 SmartSun •Efi rt YCasement 100-00456387-003 ENERGY,-PERFORMANCE RATINGS U-Factor JU;s) iI-P Solar.hat Gain Coefficient- 0 ® 2 9 4 . 1 ADDITIONAL PERFORMANCE'RATINGS , Visible`.Transmittance a r - • 43 . Q ® _ Manufacturer.stipulates that these ratings"conform to.applicable NFRC procedures for Y " determining wMle product performance. NFRC ratings are'determined,for a fixed set of. " environmental ponditions and a SpeClfic product size. NFRC tlbeb Mt-u6e. nend'any pf otlUCt. _ - - and does not vmr•rant the suitability of any product Tor any specific Use. Consult manufacturer's literature for other.product'performance information. - . - wiwt.nfro.orgSjE .. This product meets Green , � ��, 5eal'seRvironmental standards governing ion d <' M q energy efficiency,heavy metals in the frame and �► sash materials; packaging,and consumer a,��, r y CRt education materials -- o=• a DESIGN PRESSURE (PSF) • - 1 ow a oor � , - • - i l� Ildnetacturers Assoclallon C -1R30 RbA ,Csmt Dbi IN. >e.teA So NAf9-02 or:441WM91W=101f ISlAA40.06. '11—f.tllre•nylu3Aie6 ca,rtolvtmse to the N1n11.wa.M-r"O. . YeetY or exceeas.Y 6.C.,C.t.e,'8 I.E.C.C.mr I.flMtratl.oa nq.An_Ots vmvA Hallnw k Wrtlfi-Tbn Pn,9— TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0 73 Parcel. 0 1'7 .. 'Application # LO i l o� toy Health Division Date Issued 3 Conservation Division Application Fee . Planning Dept. Permit Fee 3 • Date Definitive Plan Approved by Planning Board Ok 31iYhI . Historic - OKH - Preservation / Hyannis Project Street Address L4 9 OW-4/1 Village�, �I Owner h Dbh 4 bf V"(d ha_r1 Address SUM (�7 Telephone 5D!b -- 42gJ LP 51 5S ~� Permit Request I V)SW.GL-- e, U 19 Ul Cl _, �g -SQL Square feet: 1 st floor: existing proposed 2nd floor: existing - proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) i 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 Crnnstnn, RT 02410 Home Improvement Contractor# 120979 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Erik Nerstheimer for RISE Engineering (� it �Y FOR OFFICIAL USE ONLY . APPLICATION# DATE ISSUED MAP/PARCEL NO. J ADDRESS VILLAGE OWNER C DATE OF INSPECTION: 1 - I:_>FOUNDATIONS ' t FRAME r INSULATION ry,s ti FIREPLACE ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL t GAS: ROUGH r4. ., a FINAL L ;Y FINAL BUILDING' _ r i .. .DATE CLOSED OUT ASSOCIATION PLAN NO. 4 2 et w _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600._Washington Street_ B6ston, Mass. 02111 U. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly blame(Business/Organization/Individual): RISE Engineering a division of Thiel ch Engijaeering 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. ® 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 ❑Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 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 myself 11. ❑Plumbing repairs or additions y [No workers',comp. right of exemption perm MGL insurance required] t c. 152, § 1(4),and we have no 12. ❑Roof repairs employees..[no workers' 13. TS 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 grovide.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.Lic.#: 3 7 3 0 9 61-0! Expiration Date: 1/1/12 Job Site Address: q CA Oa.V. c fY_•e_e : City/State/Zip: I'(� 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 herby7ceTtind the ins °Walliesbfperjury that the information provided above is true and.correct. Si nature: Date e� I r Print Name' Erik Nerstheimer Phone#:(401)784-3700 or 1-800-422 5365 x 7 'l 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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: T , OP ID: 31 DATE(MM/DD/YYYY) `..� CERTIFICATE OF LIABILITY INSURANCE 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-SSG-B000 CONTACT The Preston Agency,Inc. 401-886-1700 PHONE FqX 1360 Division Rd Suite 303 A/c No.Ext: AIC No): PO Box 810 ADDRESS: PROEast Greenwich,R102818-0810, CUSTOMER ID#:THIEL-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Thielsch Engineering,Inc INSURER A:Zurich-American Ins Co. Thielsch Group Inc. INSURER B:American Guarantee 8<Liability Hi Tech Realty Inc. INSURER C:North American Capacity 195 Frances Avenue p ry .Cranston,RI02910 INSURER D:Hartford Insurance Company ` iNSURER E: ' INSURER F:. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE=FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES'DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSR - LTR TYPE OF INSURANCEY EXP POLICY NUMBER MM/DDPOLICY/YYYY MM/EFF DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 3730962-01 01/01/11 01/01/12 DAMAGE TO ocoj PREMISES RENTED $ 300>00 CLAIMS-MADE A 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 P Cj Loc Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT .$ 2,000,00 A X ANY AUTO a 3730963-01 01/01/11 01/01/12 (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OVMED AUTOS $ $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,00 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,00 B AUC-4857188-00 01/01/11 01/01/12 DEDUCIBLE $ RETENTION $ $ WORKERS COMPENSATION - « X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N - T YLIMITS-I I ER -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 EMPLOYE $ 1,000,00 If yyes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 C Professional Liab DVL000026800 04/01/10 04/01/11 Prof Liab 2,000,00 D Leased/Rented Eqp �102UUNT05678 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, TOWNSHOULD 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 414*t ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD i er faun usmn s e u ation O icg1t e J5ve o onsum g 10'Park Plaza- Suite 5170 ,M Boston; ssachusetts 02116 - Home Improve ontractor Registration -' Registration: 120979 u Type: Supplement Card w Expiration:: 3/25/2012 THIELSCH ENGINEERING ERIK NERSTHEIMER , 1341 ELMWOOD AVE. CRANSTON, RI 02910 e Update Address and return card.Mark reason for change. k Address Renewal Employment F Lost Card PPS-CAI it 50M-04/04-G101216 ,per ✓!e Vominzooacue¢/C/ a�� aOacluiaelta Office of Consumer Affairs&Business 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. Registration! 979 Type: 10 Park Plaza Suite 5170 Expira —12 Supplement Card Boston,MA 02116 THIELSCH EN& v ERIK NERSTH 1341 ELMWOOD CRANSTON; R1 029'I - 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=CSL100459 1/7/2011 NAT-24531 - 1 y Control No: 34244 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF LABOR DIVISION OF OCCUPATIONAL SAFETY 19 STANIFORD STREET, BOSTON,MASSACHUSETTS 02114 LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER RISE Engineering '. . A Division of Thielsch Engineering, Inc. 1341 Elmwood Avenue Cranston, RI 02910 WAIVER: LW000672 EXPIRES: April 15,2015 IN ACCORDANCE WITH M.G.L. C. 111, § 191(B)(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. 11 1, § 197B(b)AND 454 CMR 22.04 WHEN PERFORMING LEAD-SAFE RENOVATION WORK. HEATHER E. ROwE,ACTING CONSUSSIONER Li Printed on Recycled Paper - r RISE ENGINEEI�TG 1 +r � _. federal ID#05-MS629 i Contractor Registration No 8186 A division of Thielsch Engineering rIA Contractor Registration No 120979 J qT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston, El Fr 't J 14 (401)784-3700` FAX(401)78t@-3710 �i �� 1 ®NT WT Wage . 1 6I8 CONTRACT IS ENTERED INTO BETWEEN RISE .,��«<_ NGINEERING AND THE CUSTOMER FOR WORK AS IEN�l1�tE�R1[�C ESCRIBED BELOW CUSTOMER PHONE 'DATE Client# Bobby J DeVaughan (508)428-6515 12/10/2010 114865 SERVICE STREET - BILLING STREET ... 49 Oak Street _ 49 Oak Street SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Centerville,MA 02632 Centerville,MA 02632 JOB DESCRIPTION RISE Engineering will provide labor and materials to install a 9"layer of R-30 Class 1 Cellulose added to 1000 square feet of open attic space. $1,100.00 RISE Engineering will provide labor and materials to install a 6"layer of R-19 unfaced fiberglass Batts to 580 square feet of attic space. $725.00 RISE Engineering will provide labor and materials to install blown in Class 1 Cellulose to 30 square feet of exterior walls with wood or vinyl siding.Touch-up painting,if needed,will be the customer's responsibility. Invoicing will occur upon completion of installation. Subsequent to your payment,as an added service,RISE Engineering will return when weather permits to,check for any voids with an infrared scanner. Any ' major voids that may be found will be filled at no additional cost. $43.50 RISE Engineering will provide labor and materials to install 24 square feet of R-10 rigid fiberglass insulation_board to the crawispace perimeter wall,and R-19 Kraft faced fiberglass to the band joist and house sill. $64.80 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.. $1,449.90. _ WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF - **°flour Hundred Eighty-Three&:401100 Dollars $483.40 UPON FINAL INSPECTION AND APPROVAL BY.RISE ENGINEERING.CUSTOMER AOREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY 8 PACES -RISE ENGINEERING j`$ CT731'MER ACCEPTAN / 1 kNOT*r. NTRACMAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE � i l 40 ' ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE + 3 ca unvs SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED To Do THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE Town of Barnstable ti Regulatory Services o� Thomas F.Geiler,Director + MRNSTABLE, • 9�A 16 9. Building Division rFn►�'�° Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# A FEE: $ SS ! SHED REGISTRATION 120 square feet or less Location of shed(address) Village 2- Property owner'i name Telephone number � f2l Size of Shed Map/Parcel# I Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEETHE APPROPRIATE COMMISSIONYOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 Assessor's map and. lot numb ............ ...... .... ... .. . Ft Hero �o P Sewage Permit number : ..... . .. ..r. .... � BAUSSeTIBLE, i House number ............ov.f�....... . ..:............. :.....::`' +oo s �1 p MAX Nr• - TOWN ,' 'OF BARNSTABLE a ' D•UILDINS INSPECTOR : { APPLICATION FOR PERMIT TO ....,,,,Add to a. dwelling TYPE OF CONSTRUCTION ........Wood' frame .conventional ............................................................................................................................. .......7./26/8.4......................1 q.:.$4 TO THE INSPECTOR OFF BUILDINbS: The undersigned hereby applies for a permit according to the following information: 49 Oak Street Centerville', Massachusetts Location ............................ ....................................................... .............................................. .. .............................................. ProposedUse ....................SLln room........................ ........ .... .. ... ..... Zoning • District ..........................C...........:.......................... Fire,District :..:Centerville-Osterville Name of Owner Bobby. DEvaughan Same ....................................................................:Address........................................ .... .... ..... Name of Builder Stanley E., St, Peter , ; Address 36 jl Main Street Bsarnstable ` Nameof Architect .................. ... ...........................°...Address ................................ ......... ....... .......... ................ r One Poured concrete Number of Rooms ............ ......:.............................................Foundation ........................................... Whlte ,cedar shingles asphalt shingles Exterior ................ .:. ..............................................................Roofing .......................... ........ ............ Floors plywood drywall............................................. ....................................................... ........................Interior .................. . Heating .............:SOlar................ ................................. Plumbing .................................................................................. Fireplace ..................................Approximate Cost ....... .?000:00 .............................................. ........ . . Definitive.Plan Approved by Planning Board __---_--_:-- - 19 _---__. Area 'S' Diagram of Lot and Building with Dimensions p e !� Do SUBJECT TO APPROVAL OF BOARD OF HEALTH 91 07J OrA rat IV, ' X vswo, ' oue ✓ l00 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name A ... ..4"4 C ....:. " ... Construction Supervisor's License ..... *' ., � DEVAUGHAN, BOBBY - w� ADDITION No .............. .. Permit for Single_ Family Dwelling............:......... s • - .. E ' ' +....... ................................... Location ..49 Oak Street........... Centerville T Owner .. Bobby DeVaughn .................................................. i f s Type of Construction Frame............................. ; }` ........................................ ..... r Plot .. 4 Lot. ...:............................ i { Permit-Granted —July `27, _19 84 1 Date of Inspection .:.... ......... ...... :19 t 1 Date, Completed i/::(................... .....19 r c _ ' EL _ .��.i � rL/11v uvv�• ....... � UMI C. mr�� ......r •-�-- -- - .. - ff PAGE 8 s LOCUS MAP SCALE . 1 = 2000 40 80 120 Feet 40 0 , DOROTHE/•-. HANABURY ASSESSORS MAP 173 r 2. 42 ,: DB 5291 : PG 145 , PARCELS 17 & 18 mm ZONING: RC . pP� i - '.w _. FRONTAGE 20' _ WIDTH — 100' AREA — 43,560 SF . . SETBACKS: FRONT — 20' PLAN BOOK 406 SIDE — 10 p� LOT 8 EXIST. / PAGE 8 REAR — 10' HOUSE , FLOODZONE C BARNSTABLE 'S ' N/F COMMUNITY PANEL #250001 41 CB g'y tiuS, pAUL GALLAGHER AUGUST 19, 1985 TO BE �.• �S� SET r �S, uB 9346 PG 120 OWNER OF RECORD: BOBBY and ELSA DEVAUGHAN SHAPE ' ' J &SHED -�---- Sj 49 OAK STREET TO HERE LOT 7 CENTERVILLE, MA 02632 8 S ti� sue' / PLAN BOOK 406 REF: DEED BOOK 3876 PAGE 235 PAGE 8 DEED BOOK 6278 PAGE 158 ��'�°c �` ��• r N/F BARNSTABL.E PLANNING STEPHEN LNcr ExiS . HOUSE DB 7437 PG 246 APPROVAL under the RE( CONTROL LA W NOT RE I LOT 1 \- �• DATE: 73,782 SFf �, � 1.69 ACRESf CB TO BE CAR. � ' SHAPE 18.56 SET . O SHEDS • NO DETERMINATION AS TO COMPLIANC N/F 9, ZONING ORDINANCE REQUIREMENTS Hi 1*1�SMIR KORKUCH `�81 OR INTENDED BY THE ABOVE ENDORS 11026 PG 97 w) L 0 T 2 `�._ co `�� •°` I .CERTIFY THAT THIS PLAN WAS 48,893 SFt ^a�f ACCORDANCE WITH REGISTRY OF 1.12 ACRESf �^� REGULATIONS EFFECTIVE JANUAR• CB SHAPE — 20.93 FN D ti I ti w N/F 'lob \ ob � LANCE MACENEREY DATE ARNE H. OJALA, P. N/F � O CB DB 2564 PG 44 ARNOLD HOWE ��O �' T BESET o x 5' DB 1481 PG 118 ZO IF-',Y k/'L a 6tv 13 . 2 ,r