Loading...
HomeMy WebLinkAbout0330 OLD STAGE ROAD ��o Otd009 {�. V A a Town of Barnstable a. Building ThisCar So That itis Visible"Fromthe Street Approved;Pans Must be Retained on Job and`this Card Must be"Kept.euvsrwsi e ,MAML 1ppo:ted Until Final,lnspection Has:Been Made • 3 A r a « > • ;_ , yam _. • re a Certificate of Occupancyis.Required such Building shall Not be Occupied until'a'Final Inspection has been made Permit i�.,.aw,s:-:a'va �.<•�.e. �=^.+.r.:�:^.aws,:M..�..,.�.».:�«..,,:+.,,..�..P.�:>� .tv.•a„�.:,.�..�,u..:...:,_....M..z .:zw..,.s.., . . ,...�.nr..,.�...�, Permit No. B-18-525 Applicant Name: CAPECOD CUSTOM BUILD, INC. Approvals Date Issued: 03/02/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 09/02/2018 Foundation: Residential Map/Lot: Zoning District: RC Sheathing: Location: 330 OLD STAGE ROAD,CENTERVILLE a Contractor Name CAPECOD CUSTOM BUILD, INC. Framing: 1 Owner on Record: MINAHAN,MARK T&CUSHING,TH.ERESA Contractor License 182775 2 Address: 330 OLD STAGE ROAD 3 Est Project Cost: $55,000.00 Chimney: CENTERVILLE, MA 02632 � Permit Fee: $330.50 I '• t Description: REMOVE WALL TO OPEN UP KITCHEN TO DINING ROOM. REPLACE Insulation: .Fee Paid: $330.50 KITCHEN WINDO. DEMO OLD CABINETS-REPLACE WITH NEW CABINETS REPLACE APPLIANCES REPLACE KITCHEN FLOOR Date '„ 3/2/2018 Final Project Review Req: OKAY TO MOVE FORWARD WITH CONTRUCTION NOFRAME *� ��"" Plumbing/Gas INSPECTION UNTIL SPEC'S FOR PROPOSED BEAM$UBMITED Rough Plumbing: DON'T NEED ENGINEERING. E �` Building Official r Final-Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after'issuance. Rough Gas: a �s.., ,, .6,. All work authorized by this permit shall conform to the'approved application and the;approved construction documentsfor which this-permit has been granted. All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by laws and codes. Final Gas: . This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. -� -- Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on thispermit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing k Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected atthe 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 Low Voltage Final: 7.Final Inspection before Occupancy 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 OF ZHE _ r� Number � a S OApplication .....��../4?77...........................:.......... * BARNSTABLE, * .. Q y permit Fee Mnsa � ..........�.3 ® :....Other Fee........................ �.. i639. 1� TotalFee Paid..........................:............... .................... ...... TOWN OF BARNSTABLE Permit Approval by... .� !�:I� .........on....�........ BUILDING PERMIT y ............Parcel..................• Map.._... . ...... .... ........................... . .. .. ..... I APPLICATION Section 1 — Owner's Information and Project Location Project Address 3t>o Ot.� -51 wT__ R,oa Village CrAkAN%I Owners Name �ilne�esw CQE. �5%via, c ,,L on car k W'%Yxa'na►.ye1 ++ Owners Legal Address 3:"!5o o LT _3 tmaCr. R_oac1 4 City State %A4 A Zip Owners Cell# 5bS-4t4 00%(o E-mail Section 2—Structural Use Single/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Stricture under 35,000 cubic feet Section 3 —Type of Permit ❑ New Construction ❑ Move%Relocate ❑ Accessory Structure ❑ Ch4nge of use ElDemo/(entire structure) ❑ Finish Basement ElFamily/Amnesty ElFIZ Alarm , C Rebuild ❑ Deck: Apartment ❑ S&A d Sys n ❑ Addition ❑ ' Retaining wall ❑ Solar -n ca -to �-Renovation. ❑ Pool. ❑ Insulation z o cry M Other—Specify-- � (� Section 4 - Work Description l -Y_ > A4' v:P ' TaotnnrlatPrl• iwwnn17 Application Number.................................................... F-- Section 5—Detail j Cost of Proposed Construction ,5!5 Ono Square Footage of Project �" 20� Age of Structure IRA S Dig Safe Number Total# Of Bedrooms (proposed)Of Bedrooms Existing � �, � p ) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist'❑ Design j _ I + Section 6 —Project Specifics Wiring (] Oil Tank Storage k• Smoke Detectors Plumbing ❑ Gas _. ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney- ; ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private. Sewage Disposal ❑ Municipal On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8— Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Application Number:.:.................... ....: ............ R: Section 9— Construction Supervisor Name t,y,� QjQ, �c� Telephone Number (o M-3 t a-"14S a O Address a WVe66gJA Ia�City YgrAqh State MVIx Zip nZtoRs License Number Gf2-10'1a-1% License Type' Expiration Date S-16-W lct Contractors Email, V%.6e Cell# La 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 rocedures specific inspections and �. documentation required by 780 CMR and the Town of Barnstable.Attach,a copy of your license. Signature _ VV1 Date Z 1a -%49 f Section 10 _Home Improvement Contractor ;r Name &�j c� Telephone Number I01-1 -31 -y 5 Q 0 <' Address C10 q-eQ_6)W A Lm-City.�.0 State Mift _Zip_ C�a.to-1 C Registration Number ►,?;Q'1"1�_Expiration Date ° -1 1-1:k ( I understand my responsibilities under the rules and regulations for Home Improvement Contractors 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.Attach a copy of your H.I.C... Signature M Date 3 1 aS Section,11 —Home Owners License Exemption Home Owners Name: t 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 SIGNATURE Signature Date �a 8 Print Name Telephone Number E-mail permit to: CC, CJS*OM6U ik.c , , 60A1 Last undated: 1 212 8/2 6 1 7 , Section 12 Department Sign-Offs i Health Department ❑ Zoning Board(if required) El Historic District - • "Site Plan Review(if required) ❑ Fire Department Conservation. For commercial work please take your plans directlY to'thefre ePartmentfor approval, Section 13 — Owner's Authorization as Owner'of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) t Signature of Owner Print Name f i f 4 i r. T net imriatPA• 77/7R/7(117 3 O L,D oTAF(-- f , MA qR �` 1 I I 1 r • �� i t 7 4 i t 5 i .. ,, piy F 4 A&W NCO Al-9 } i t G r�aRYf f A e 3 73 � a1uJoak cici i Ki+6%cf% z FI9`r- ; I Y h. Vo,,-+ vl � t 17 18 19 20 14 l'i DISHW24 9 r 10 1 12 -------------- ----------- �I I a 3 ' 4 3 E —REUSE EXI�`1�`IftI.Or � QIP IfIA s s . . 283 8 IAll dimensions, Si c; desi.pla(ions, I This to it t_._.._.___ _ . � ___ __.a e'�•i�/gin arm .c� r�:�3� ���i.l.�rw_�_�_tw ,ti A�® CERTIFICATE OF LIABILITY INSURANCE �TE` o/°'2'l7 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 SUBROGA71ON IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on thiscertificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER CONTACT NAME: Deoliveira Insurance Services PHONE4ka No 508 477-3023 FAx N (508) 638-6463 800 Falmouth Rd. ADDRESS: ss: oe@dinsinc.com INSURE S AFFORDING COVERAGE NAIC#"� Mashpee, MA 02649 INSURERA:Western World INSURED INSURER B: Cape Cod Custom Build Inc. INsuRERc: PO Box 27 INSURER D: ° Cummaquid, MA 02637 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPEOFINSURANCE Jaa WVD POLICY NUMBER MIDDY MM/DD/YYYY LIMITS A GENERAL LIABILITY 567168 4/18/17 4/18/18 EACH OCCURRENCE $ 1,000,000 COMMERCIALGENERALLIABILITY DAMAGE TO RENTED $ ZOO OOO CLAIMS-MADE OCCUR ME EXP(Anyone person $ 5,000 PREMISES(Ea occurrenQ0 PERSO NA L&ADV I NJU RY $ 1,000,000 GENERAL AGGREGATE $ 2 GOO 000 GENT AGGREGATE L IMI T APP LIE S PE R PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRO- LOC $ECT AUTOMOBILE LIABILITY CONS IN•��SINGLELIMIT $ � ANYAUTO BODILY INJURY(Per penson) $ ALLOWNED SCHEDULED AUTOS AUTOS 'BODILY INJURY(Per accident) $" NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS erac9dr.nt $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION VMDRKERS COMPENSATION WC STATU- I 10TH- MDEMPLOYERS'L[ABIUW Y I N ANY PROPRIETORMARTNER/EXECUTNE E.L.EACH ACCI DE Nr $ OFFICERMIENIBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTIO N OF OPE RATIONS below E.L.DISEASE-POLICY L IM IT , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,B more space Is required) Building Remodeling CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Rt. 28 S. Yarmouth, MA 02664 AWHORIIEDREPRESENTATIVE Amanda Eldridge ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations f" 600 Washington Street ` - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizati'on/Individual):f nQ (0 60,j!40m &j,\A MAC, Address: C( 5;--ne6,ornfA �ane- City/State/Zip: -9hone#: (Ql-1 fb�Q-k{Sao Are you an employer?Check the a propriate bog: Type of project(required): 1.❑ I am a employer with 4. Id 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. Wemodeag 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 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.F1 Other employees. [No workers' j comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and than hire outside contractors must submit a new affidavit indicating such. #Cont actors 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: 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 imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties of perjury that the information provided above is true and correct: Signattae: Date: z- 1a—t� Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Perinit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts eneral Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this e,an employee is defined as"...every person inthe ervice of another under any contract of hire, express or impli oral or written.." An employer is de ed as"an individual,partnership,associatio corporation or other legal entity,or any two or more of the foregoing en ed in a joint enterprise,and including legal representatives of a deceased employer,or the receiver or trustee of individual,partnership,association r other legal entity,employing employees. However the owner of a dwelling h e having not more thanoth three ap ents and who resides therein,or the occupant of the dwelling house of an r who employs persons to do intenance,construction or repair work on such dwelling house or on the grounds or buil ' g appurtenant thereto s not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) o states that"every tate or local licensing agency shall withhold the issuance or renewal of a license or pe it to operate a bus' ess or to construct buildings in the commonwealth for any applicant who has not prod ed'acceptable a 'deuce of compliance with the insurance coverage required." Additionally,MGL chapter 15 §25C(7)stat "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the p ormance o public work until acceptable evidence of compliance with the insurance requirements of this chapter hav been pres ted to the contracting authority." Applicants Please fill out the workers' comps ati n affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors) e(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Comp ' s(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not require to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be dvised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insur: a coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that application for the permit or license is being requested,not the Department of Industrial Accidents. Should you ave y questions regarding the law or if you are required to obtain a workers' compensation policy,please call a De ailment at the number listed below. Self-insured companies should enter their self-insurance license number on a ap opriate line. City or Town Officials Please be sure that the affidavit s complete d printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill o in the even the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the p it/license num er which will be used as a reference number. In addition, an applicant se a lic ions in an given year,need only submit one affidavit indicating current that must submit multiple perm: cen pp y>� Y policy information(if necess and under"Job ite Address"the applicant should write"all locations in (city or town)."A copy of the affidavit t has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid davit is on file fo future permits or licenses. A new affidavit must be filled out each year.Where a home owner or c tizen is obtain;ng a ense or permit not related to any business or commercial venture (i.e.a dog license or permit to leaves etc.)said p on is NOT required to complete this affidavit The Office of Investigations wo d hike to thank you in a vance for your cooperation and should you have any questions, please do not hesitate to give us la call. The Department's address,telep one and fax number: The Commonwealth of Massachusetts Department of Industrial Aecidents Office of Investigations 600 Washington Suet Boston,MA 02111 Tel,4 617-727-4900 ext 406 or 1-977-MASSAFE Fax##617-727-7749 Revised 4-24-07 wr.mass,gov/dia TH8='CERTIFICATE"IS ISSUED AS A.MATTEE3 OF INFORMATlON3"ONLY AND''CONEEEtS NO'RIGFffS UPON THE CERflFiCATE HOLDER THIS CERTiFICATE;.DOES`NOT AFFIRMATIVELY'•OR NEGATIVELY AMEND, EXTEND"O RAC TER THE"COVERAG AFFORDED°BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND TfE.CERTIFICATE HOLDER. IMPORTANT: it the certificate holder is an ADOMONAL INSURED,the poiicy(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 endorsemen CO PRODUCER NAME: JOE DEOLIVEIRA Deoliveira Insurance Services PHONE 508 $77-3023 FAX Ndi; (508) 638-6463 800 Falmouth Rd.. 1 iSs: loe@dinsinc.com UNIT101-A INSURE S AFFORDING COVERAGE NAIC Mashpee, MA 02649 INSURERA:MSA INSURED INSURER B:Travelers Jeremy Nickerson INSURERC: DBA East Coast Professional INSURERD: 27 Metoxit Road INSURER E: East Falmouth, MA 02536 INSURERF: 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 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 ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR L S BR P C EXP LTR TYPEOPINSURANCE POUCY NUMBER PO OYN LIMITS A 'NERALLIAeum MPT3201F 8125/17 8/25/18 EACHOCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENE RAL LIABILITY $ 500,000 CLAIMS-MADE ®OCCUR ME EXP("one ersorr) $ 10 OO PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENTAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COa accident $ ANY AUTO BODILY INJURY(Per pets $ — -- ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _AUTOS eraocident $ UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESBLIAS CLAIMS-MADE AGGREGATE $ DED RETENTION B WORKERS COMPENSATION 6HUB4437P22317 11/7/17 11/7/18 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY IFR ANY XECU h!E Y!N /A EL.EA H ACCIDENT 100,000 OFFICERMIEMBER EXCLUDED? N N Pardatory in NH) EL.DISEASE-EA EMPLOYE 100,000 if yes describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CARPENTRY 3 STORIES OR LESS JEREMY NICKERSON HAS ELECTED TO BE COVERED UNDER THIS WORKERS COMPENSATION POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CAPE COD CUSTOM BUILD IAG­Me ACCOAUMCE1NM-THE-POLCY PROVISIONS: PO Box 27 Cummaquid, MA 02637 AUTHORIZED REPRESENTATIVE AMANDA ELDRIDGE ®1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: (617) 312-4520 Fax: E-Mail; BUG67@LIVE.COM SCA C}M'0.S/1 i j 0 �Ce of Consumer A .a a rs &. business Regulation E w tJMEAMPROVEMENT CC3[VTRA TAR ..k TYPE• +ort ration ration Ex `tin 07/26/2019 M O M' `Y U CAP ; , � s-n .u..��t,b��"�'_'�-�'*:�•+� _�..�.Ka�, ,. � Kj �• Y NMI a- plc, LYI�DA BEDARD 90 FREEBOARD � � .�,�wR✓t. �� of�}'Jj{�Y K d"� ARM OUT HPOR�' Undersecretary I .::.,a•..�rre*,,,,.Kw�«.�md:c;:a:„....�,.,,:.w.s...+.....,++�»^:rc«»vaua�.,:,.:..u...:..,..,.,� �n,r.a,.,.,,»,„N,a�.o.:K,r�:...w...e..,-w�c...r..,r....w.»��.atw.�.......�wo,....»x a.�,...,,•,. - th -pw (o &mo d 0 _ V Y. 'e? ++ew�u:v.+s ow ,ixa^x .tee>se;sr: ,:.wR,w..,<,.•.*.+w,,.,".......,....,u,..,..�. �t � , 4� .� _. .r•a..m�a. _ .tns•..v»...�-..�, ..,,tea... _ V 4 Wi '6TA t}� �yq•' ,�+''.k+.'aY`'''¢'i7T.•.q '.hea. +. ,.w�q YeYt;fN+sWAJ?A_ ft Myiw:FA in Y.iwT A a` and bi this buVILLC ZP� a. p A��c �YprA f£ii t,�,aZei 41 a F i 4I a r. o s y! J rlf ✓. c< t fif y�. j y,j� I a p. Massachusetts'Department of Public Safety Board of Building Regulations and Standards License: CS-107178 Construction Supervisor LYNDA BEDARD P.O.BOX 27 s CUMMAQUID MA 0263T--, r . t �cLa� — Expiration: Commissioher 05/16/2019 t Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,C00 cubic feet(991 cubic meters)of enclosed space. Failure to.possess'a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit:1NWW.MASS.GOV/DPS p/ I If 1 t I Ol1ac) TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map J q0 Parcel. 105 Application # Health Division Date Issued 3 1 Conservation Division ;Application Fee " Planning Dept. Permit Fee. 15 Date Definitive Plan Approved by Planning Board �.. Historic - OKH Preservation / Hyannis Project Street Address 3d b I C1 P Village CU K yil I U Owner -To erf' C�l CA Ws I'll n G Address 5)9—M 6� Telephone F50 - D9-) Q Permit Request Air Obl -t Square feet: 1 st floor: existing. proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay r Project Valuation a 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 Crasnton; RI 02910 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 11 'i FOR OFFICIAL USE ONLY APPLICATION# R DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE t ; r OWNER , ,r DATE OF INSPECTION: ' s i FOUNDATION r1 , . FRAME E a . w INSULATION.1 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS- :tea ROUGH ;:z ;` FINAL ' �sw r .DATE CLOSED OUT i ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts Department of Industrial Aecidents Office of Investigations 600_Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contract®rs/Electricians/Plurnbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): RISE-Engineering a division of Thiel ch Engi neeri rig 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. ❑ Itam a general contractor and.I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 7 p.`Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These`sub-contractors have 8. 04Demolition 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 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work_ officers have exercised their' - myself [No workers' comp. right of exemption perm MGL 11.'❑Plumbing repairs or additions insurance required] t c.152,§ 1(4),and we have no 12. ❑Roof repairs employees. [no workers'. 13:N 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 sin additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. U 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 thepolicy and job site information. Insurance Company Name: The Preston'A ency Policy#or Self:ins.hic.#: 3730961-0 Expiration Date: l i'1 Job Site Address: City/State/Zip: l� l C 1"^V I 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 herby certi and the in; enalties of perjury that the information provided above is true and.correct. Date: Print Name Erik Nerstheimer Phone#:(401)784-3700 or 1-800-422-5365 ext13l 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): 1.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector'' 6.Other Contact person: Phone#: OP ID: 31 CERTIFICATE OF LIABILITY INSURANCE UAT 12/30D/YYYY) 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 1350 Division Rd Suite 303 E-MAIL A/C Ext: AIC No - PO BOX 810 ADDRESS: East Greenwich,R102818-0810 CUSSTorcnERID#:THIEL-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Thielsch Engineering,Inc INSURER A:Zurich-American Ins Co. Thielsch Group Inc. INSURER B:American Guarantee 5r Liability Hi Tech Realty Inc. INSURER c:North American Capacity 195 Frances Avenue 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 TOWHICH 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 TYPE OF INSURANCE POLICY EFF POLICY EXP - LTR POLICY NUMBER MMIDDIYYW MM/DD/YYYY LIMITS GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 3730962-01 01/01/11 01/01/12 PREMISES HLNIErence $ 300,00 CLAIMS-MADE I-XI OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE'LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X JEcT PRO LOC I jEmp Ben. $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 2,000,00 A X ANY AUTO 3730963-01 01/01/11 01/01/12 BODILY INJURY(Per person) $ ALL OWNED AUTOS SCHEOULEDAUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OVVNED AUTOS $ $ UMBRELLA LIAB X OCCUR - EACH OCCURRENCE $. 10,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,00 B.., AUC-4857188-00 01/01/11 01/01/12 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y X T RY TATU- OTR• - -A ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N 3730961-01 01/01/11 01/01/12 E.L.EACH ACCIDENT $ 1,000 00 OFFICER/MEMBER EXCLUDED? a NIA i (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,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 02UUNTD5678 01/01111 01/01/12 Equipment 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) t 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 4/ 4 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ) We 077 Office o resumeM ai�n�'an usmess e u ation` X 4 _ 0 10` Park Plaza - Suite 5-170 4f µ Boston, ssachusetts 02116 ., Home Improve ontractor Registration .r gistration: . 420979 Type: Supplement Card' . w Expiratiori: 3/25/2012 THIELSGH ENGINEERING m . ERIK NERSTHEIMER a 1.341"ELMWOOD�AVE: CRANSTON,'RI 02910. . y rr F. Upda tie Address and return card.Mark reason for change... Employm a[:]`AA dress R al M t Lost Card dres enew en os DPS-CA1`O 50M-04/04-G101216 ` .TD09YI//)tOOt[IJP.Q�[IL 6f✓IiGIL06LUQ61.00 6.., t a -' # °Office of Consumer Affairs&Bit iness Regulation License or registration valid for individul use only k ; J before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR Y Office of Consumer Affair RegistrationQ79 Type. "" 10 Park Plaza-Suite 5170s and Business:Regulation „ Expira Y — 122 Supplement Card Boston,MA 02116 THIELSCH EN&Cs _ r� r •1341 ELMWOOD --r ., , • r - , CRANSTON;Pill 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 g , 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 . r e http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=CSL100459 1/7/2011 � t '»at.,yncfl Lris'r.ten ? i NAT-24531 P . Control No: 3 4-2-4 4 THE COMMONWEALTH OF-MASSACHUSETTS b , DEPARTMENT OF LABOR DIVISION OF OCCUPATIONAL SAFETY o` 4' 19 STANIFORD STREET, BOSTON;MASSACHUSETTS 02114 LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER RISE Engineering A Division of Thielsch Engineering, Inc. 134'1 Elmwood Avenue, Cranston, R10291.0 WAIVER: LW000672 EXPIRES: April 15,2015 IN ACCORDANCE WITH M.G.L. C. 111,, § 197(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. 111, § 197B(b)AND 454 CMR 22.04 WHEN PERFORMING LEAD-SAFE RENOVATION WORK. HEATHER E. ROwE,ACTING CODRvIISSIONER t • L� Printed on Recycled Paper - p 02/25/2011 17:21 FAX 401 784 3710 RISE ENGINEERING 4001/001 RISE ENGINEERING Federal RI Contractor R Regiegi s� stration No 8788 A division of Thielsch Engineering MA Contractor RegWration No 12097t1 SL g CT Contractor Registratlon No=120 134Y'Etmwood Avenue,Cranston,R1.02910 `. CONTRACT (401)784-3700 FAX(401)784-3710 /1 �Y - - - - Page. !E Y _ TM CONTRACT IS ENTERED INTO BETWEEN RISE �7 is ENOINEERIia AND THE CUSTOMER fOR WORK As .. - DESCRIBED BELOW ENGINEEZING PHONE DATE - Cris,n t CUSTOMER Theresa Cushing t508�114-0086 07/25/2010. 11.1260 _ QSRVICF STREET .- BILLMIO STREET - 330 Old Stage Road 330 Old-stage Rd SERVICE CITY,STAM ZIP .. BBIJNO CITY,STATE,ZIP Centerville,MA 02632 Centerville,MA 02632 JOM DESCRIPTION* . - lull RISE Engineering will provide.labor and materials to seal areas of your home against wasteful,excess air lea age. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left wi tLabCAN—Iful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other p u. . 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. 15 man hours. $990.00 RISE Engineering wi l provide labor and materials to install a-6"layer of R-19 Glass I Cellulose added to 1152 square feet of floored attic space $1,1.52.00 RISE Engineering will provide labor and materials to.install,108 square feet of R-19 faced fiberglass insulation to the perimeter of the basement ceiling at the house sill., $118.90 RISE Engineering will provide labor and materials to instill 217 square feet of R-10 rigid fiberglass insulation board to the crawlspace perimeter wall,and R-19 Kraft faced fiberglass to the band joist and house sill. $585.90 RISE Engineering will provide labor and materials to install 420 square feet of 6 ml polyethylene over open ground in designated, crawlspace/earthen basement areas. $126.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You wilt be billed onry the 1Vet`ainouuf`25i[terttly,for eligible measures,the Cape Light Compact offers 1.000/6 incentive for air sealing, -$990:00 RISE Engineering will.apply all applicablc,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 S2,000 per calander year. -51,487.07 WE AGREE HEREBY To PuRNISN SERVICES-COMPLETE IN ACCORDANCE wr H A130VE SPECIFICATIQIIS.FOR THE SUM OF ***Four Hundred Ninety-Five&63/100 Dollars '$496.63 UPON FIWL INSPECTION AND APPROVAL BY RISE ENBS EWUNG.CUSTOMER AGREES TO REMIT AMOUNT DUE 01 FULL DITERE9T OF 1%WILL BE CHAROED MONTHLY ON ANY UNPAID BALANCE _ 80 DAYS:BEE RSE fOR IMPORTANT INFORMATION ON OUARANrESS,RIOMB OF RECISION,SCHE XILLNO.AND CONTRACTOR RERISTRATICK DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES NATURE-RISE FAIOPIEERSdG - - TOMER ACCEPTANCE.. - - �Iz�Za '. NOTE:TM CONTRACT MAY BE MATHDRAWN BY US W NOT EXECUTED NSTIM .. DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT THE ABOVE PRICES,SPEC61CAMNS AM CONDmONS AM 3D SATISFACTORY TO ua AND ARE HEREBY ACCEPTAMED.You A AUDIORIM TO.t o THE NNDRK DAYS. AS SPECIFY.PAYMENT WILL BE MADE AS OUTLINED ABOVE J RI S E Division of Thielsch Engineering,Inc. 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02910 May 1, 2013 Thomas Perry, CBO Town of Barnstable ` Building Division 200 Main Street ® w Hyannis, MA 02601 Re: Insulation permits Dear Mr. Perry, 3:0 .. 0, This affidavit is to certify that all insulation work completed for 330 Old Stage Roai has beerP rn 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