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0354 OLD STAGE ROAD
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Perm• mm�: PostedUntil�Final:lnspection Has.Been Made , �"� � � � � � ���� � � �" Where a Certificate;;"of OccupancyissRequired,such Bwld�ng shall Not�be'�Occup�ed until a Final Inspection�has been made Permit No. B-18-934 Applicant Name: Mark Mordini Approvals Date Issued: 04/02/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/02/2018 Foundation: Location: 354 OLD STAGE ROAD,CENTERVILLE Map/Lot 190-174y Zoning District: RC Sheathing: Owner on Record: CHASE,DONALD H JR&DEBRA E HART ContractokName = ,;MARK E MORDINI Framing: 1 o Address: 354 OLD STAGE ROAD z 'Contractr`License: CS-057645 2 CENTERVILLE, MA 02632 .Est. Project Cost: $26,069.00 Chimney: .:' Description: strip existing siding from home,install insulated vinyl siding per Permit-Feb: $ 132.95 code(21 square),install raindrop house wrap't0 all,exposed Insulation: n FeeiPaid 5 132.95 sheathing,replace all rotted fascia and soffit,=install vented vinyl soffit,wrap all fascia and rake boards along with all window and 4/2/2018 Final: Date door casings to make maintenance free,install gutters ands downspouts F R Plumbing/Gas Rough Plumbing: Project Review Req: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authored by this permit is commenced within six months after issuance: Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and stru tunes shall�,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 st er et or�oad�and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. �� Xj Electrical The Certificate of Occupancy will not be issued until all applicable signatures y the Budding and;Fire Officials are:p�ovided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:; s 1.Foundation or Footing Rough: 2.Sheathing Inspection_ Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 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 �rh rY Town of Barnstable ' 200 Main Street, Hyannis MA 02601 508-862-4038 s Application for Building Permit PP g Application No: TB-18-934 Date Recieved: 3/31/2018 a o w Job Location: 354 OLD STAGE ROAD,CENTERVILLE Permit For: Building-Siding/Windows/Roof/Doors — Contractor's Name: MARK E MORDINI State Lic. No: CS-057W Address: , North Attleboro, MA 02760 Applicant Phone: (51) 280-01y5,6 �" r— (Home)Owner's Name: CHASE,DONALD H JR&DEBRA E Phone: (508)360-9667co HART (Home)Owner's Address: 354 OLD STAGE ROAD, CENTERVILLE,MA 02632 Work Description: strip existing siding from home, install insulated vinyl siding per code(21 square),install raindrop house. wrap to all exposed sheathing, replace all rotted fascia and soffit, install vented vinyl soffit,wrap all fascia and rake boards along with all window and door casings to make maintenance free,install gutters and downspouts Total Value Of Work To Be Performed: $26,069.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. - I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it.is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Mark Mordini 3/31/2018 (508)280-0156 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $26,069.00 Date Paid Amount Paid £ Check#or CC# Pay Type Total Permit Fee: $132.95 3/31/2018 $132.95 XXXX XXXX XXXX Credit Card 4147 Total Permit Fee Paid: $132.95 is I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION . �/ 1� . �--I - J � Map I � Parcel � Q Application # � V UG Health DivisionfLDIIV nDate Issued Conservation Division. JArj 20.21I Application Fee cc�� r)Alp,, � US � Planning Dept. T ^� Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis evLja/1-r�/� Project Street Address Village A Owner `� Address Telephone Lb✓ lit o U_7 v Permit Request � � (/ it �f Mkto-&'��G G.P", 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) 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 ❑ do If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) q Name Telephone Number Address 0 V � License # V Home Improvement Contractor# Email Worker's Compensation # UUr1 00 l D ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE h Ili FOR OFFICIAL USE ONLY �j ^T ,APPLICATION # i' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: '. FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING } ' DATE CLOSED OUT ASSOCIATION PLAN NO. Massachusetts Cepartment of Public Safety Board of Building Regulations and Standards License; CS•100988 Construction Supervisor. , HENRY E CASSIDY. , 1~ 8 SHED ROW WEST YARMOU..TH Expiration: Commissioner 11/1112017 Office of Consumer Affairs and Business Regulation 10 Park Plaza -' Suite 5170 Boston, Mai, A2� usetts 02116 Home Improvemeh-P .o�fractor Registration = -- Type: Corporation Registration: 153567 Cape Cod Insulation, Inc M _=" 3t.,.V" a Expiration: 12/14/2018 18 Reardon Circle So. Yarmouth, MA 02664 - -- Update Address and return card. Mark reason for change. iCA 1 1) 20M-05/11 �e�poaninzomcaeall/e a��aeaaeluaeCta- Off Ice of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only Type; Corporation before the expiration date. If found return to: °=B Office of Consumer Affairs and Business Regulation Aeyistfatlon Expiration 9 r ter--- 10 Park Plaza-Suite 5170 - e7 12/14/2018 ice. e Boston,MA 02116 � Cape Cod Insulatlot1 J, V Henry Cassidy 18 Reardon Circe r \2 cG — So.Yarmouth,M �2 CJ Undersecretary Not valid without signature r , The Cominonivealt/t of M(Usach usetts Department Of Industrial Accidents b 1 Congress street) Suite 100 Boston, MA 02114.2017 www,mass,gov/dire lYurkers' Compensation Insurance Affidavit; B�ilders/Contractors/Electricians/Plumbers, ARR1lcant Informs I n TO BE FILED WITH THE PERMITTING AUTHORITY, Please Print Le 1bl Name(Business/Organizdtion/Individual); Address: / Phone #; Are you an employer? eck tbo appropriate box; Type of project(required): _ I.�am a employer with Z12 employees(full and/or part-time),' 2.[]1 am a sole proprietor or partnership and have no employees working for me in ❑ New COnstruCtion any capacity,(No workers'comp. insurance required.) $."C] Remodeling . 3.01 am a homeowner doing all work myself [No workers'comp.insurance required.)t 9. ❑ Demolition 4.(]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will I ❑ Building addition ensure that all contrectors either have workers'compensation insurance or are solo proprietors with no employees; i 1 Electrical repairs or additions 5.C]I am a general contractor and I have hired the subcontractors listed on the attached sheer. 12.❑Plumbing repairs or additions These sub-contractors have omployeos and have workers'comp, insurance.l 13.[] repairs 6.[]We are a corpor6li'bn and its officers have exercised their right of exemplfon per MGL c. 152,¢1(4),and we have no employees,(No workers'comp,insurance requirod.) 'Any applicant that checisabox N 1 must also fill out the section below showing their workers'compensation pollc infer r Homeowners who submihhis affidavit indicating they are doing all work and Ihen hire outside contractors must submit a now affidavit indicatin such. (Contractors That chock this box must attached an additional sheet showing the name of the subcontractors and slate whether ior not(hose entities have employees. If the subcontractors have employees,they must provide their workers'comp,policy number, g !fo an employer--liar/s provlrllrrg workers' conrpensatdon insurance for my employees-- Below!s the pollcy and Job sire injonnation. .�,. Insurance Company Nam: Policy b or Self-ins, Lic, b: Expiration Date: Job Site Address: Attach a copy of the workers! compensation olicy declaration Page (ShowingCity/State/Zip �WV Failure to secure coverage as required under MOL c. 152, §25A is a criminal violation puns shable cy number-and expiration 0. 0 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WO e by a fine up to$1,500.00 WORK- day against the violator. A copy`v(.,this statement may be forwarded to the Office of Investigations.DE d a fine of up to$250.0.0_8 - coverage verification. of the DIA for insurance 1 rlo hereby certify under the pains and penalties of perJrsry that the 1rE/brrruttlon provided a eve!s true and correct St nature: / f 1 l hone N: D G Official use only. Do,.itot write In tltls area, to be completed by city or Iowa ofJlclal T City or Town; Permit/Llcense 9 Issuing Authority (circle one): 1, Board of Health 2, Building Department 3. City/Town Clerk 4 T 6. Other , Electrical ctrical Inspector 5, Plumbing Inspector Contact Person; Phone h: i CAPECOD•27 DEATON CERTIFICATE OF LIABILITY INSURANCE DATE(MM'DDNM) 7/2912016 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 pollcy(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 endorsements. PRODUCER CONTACT Rogers&Gray Insurance Agency,Inc. PHONE 434 Rte 134 a No): 877 816.2166 South Dennis,MA 02880 e E mall ro ers ra .com INSURERS AFFORDING COVERAGE NAIC N INSURER A:Peerless Insurance Company INSURED INSURER 9:Safety Insurance Company 1 39464 Cape Cod insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER 0Atlantic Charter Insurance Corn an 44326 South Yarmouth,MA 02664 INSURER E: INSURER F t 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, LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY POLICY EXP_ LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS-MADE OCCUR CBP8263063 04/01/2016 014/01/2017 RR I occurrence) $ 100,000 MEDEXP(Any one arson $ 61000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY d CT LOtS" _-_ PRODUCTS•COMPIOPAGG $ 2,000,000 THER: $ AUTOMOBILE LIABILITY COMB NED SINGLEMIT $ 1,000,000 B ANY AUTO 6232707 COM 01 04/01I2018 04/01/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ .X HIREDAUTOS X NON•OWNED P PER D AUTOS $ X UMBRELLA LIAR X $ OCCUR EACH OCCURRENCE $ 2,000,000 (, EXCESS LIAR CLAIMS•MADc" EXC10008836001 04/01/2016 04101/2017 AGGREGATE $ DEO I X I RETENTION$ 10,000 WORKERS COMPENSATION Aggregate $ 2,000,000 AND EMPLOYERS'LIABILITY 13 AUTE ANY D OFFICER/MEMBER XCLUDED?ECUTIVE Y❑ NIA WCE00431902 08/3012018 08/30/2017 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) If yyea deecrlbe under E.L.DISEASE•EA EMPLOYEE $ 11000,000 OESGtRIPTION OF OPERATION below E.L.DISEASE•POLICY LIMIT S 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addltlonel Remarks Schedule,maybe attached HMO space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, CLEAResuit,Eversource and National Grid are listed as Additional Insureds on this policy on a primary,non-contributory basis. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988.2014 ACORD CORPORATION. All rinhta rraaprvari I S '. Town of Barnstable y Reguiatory Services Richard V.ScaL',.Diimtor }�0g Buiiding.Division 'tom perry,RuMng Coumiisstoner 200 M gn Street,Hyannis;MA 02601 www towmbarnstablewa.as Office: 508-862-4038 Fax: 508 790-6230 Property.Owner Must i✓OMPIete and.S.ign'llis Section If Us ne.A BW deer � as Owner.of the:subject'.proputy hemby aw*vize Cage 6 b d I Vl S u/a tw to act on ray beef, in gU mailers relazit m to work authorized by this bdding.permit application for. 3 q old Nat koad ► 04"I ( f **) ~''-fool fences and aLv ms am the respons ilityof`the appkcant. Pooh are nvt to be:Med or uazed`before f ence is instZed and all final inspections are performed and accepted. Oct Q- $' o er *iataue of Applicant Fri tt.N= hint Nam 1 l t ((o Date Q:F0R usWWNWEKNsrss[oNX*LS CAPE COD INSULAT10N IIUA 01 All IXA$Ili II :,"Y IGAM iml1IV ID IAm eyM, iHwunoN ermHoi W 1�880,6 96.66'11 Q r= � Town of `a2w-� +C4J l�c�ulutory ;iervices m BL)ildhig 1.)ivis1011 0 U. 3 'Address 2 � O N 1)uw; 14 /1 ) lhdr Building Inspector 1'11 tiNe accept this Affidavit as documentation that Cape Cod Insulation, Inc. porlorrrleci d: l;l)ulplt,t�d tl'l(.A insulation and ,weatherization work at the property listed below, Cape Cod Insulation did this in tWcordance to the specifications listed on the building pormit <<pplicadon, All work has been inspected by a certified Building PerForrnanee Institute (B111) inspector. ;n... UwrL(a Propert Acl .ress Villa .c I'MI-lotion Installed: Fiberglas.s Cellulose R•Value Restrioted UnreStrioted Ceilings (3D ) ( ) (X) i� X \,4'ullti ( ) ( ) ( ) ( ) ( ) AN, CkA i tnry tlsstd,y Jr, President Cape Cod Insu:ltztion, Inc, Y 29 201 (/ To yl�� W1U OF BARNSTAS LE _ Tovm of Baimstable gee = b I h Gd RCga�atory-SE rah c I'�'I.CCS MAIM Thomas F.Geffer,Director ENT Biding BivisYon �/ Tom 3'etxy,CB0, Ba&n;Cowni5sioner MA[ 0 01 2001tiiaja3treet Hymd&MA0260, _ ww•e�Saarx'�aa-�nsKab7e.�•� . • • TO 00"Al"I MUTABLE • F&�_50s--790-62.0 K�RESs PERNYT APPX,ICAITOT RCS DEN-TEAL ONLY JVDfvavao �xr„ ,A MapfparceIXbmber - PropenYAddress Valve ofwork S I12iniwnm fee of S3S.Q0 forwox underS6Q00.QQ Ovmer's N2me&Address Contractor's Name &—Ys�—y ,1�7n 5 f "jt_ xamextprov Co==ctarL=oseT(ff4.pHmble)1 0153 AO Ema�1 `, ��tCz rCo �`ri{e.17 Cif (1 ;C�r� Co�ruc�a Stz�visor'sLi�C r(iE'applicable)���� • Wok's Convemt onISn•2= Cbeck one: ❑ I arrMa sole pznprietar ' B,1%am4le$osa�oc�rz�e- i .. .. • , I have'Wor3ees mp=sati=I=u=ca r== ro CampazryName W orkman's Conn. Copy ofZnsurnee Compaaace Certificate must accampauy each permit PermaRt )'(cbecicboa) b� IDOf(Attrrirannpy �(:smippi�--_old sbiq- ) AiLromw ction,dekkry'JMbetakenzo (� C 1/ e ❑Re-roaf(ltmrricane nailed)(not stappiir� G0ii3g over a hyas ofzooi}. ❑ Re-side ❑ Replaceme=Windo /doors/sWe%- u Valve e windows r of dcos: ❑ Smoke/CarbMM,omxidn detectors 4 hloorpdans ma&ed oveth and S and inspectbns required, Sepaxate Eleeraied&Fire Ftmits required. 'tL'Irse:�ovzaL-Issmmnm a£zl�s»crma does fat exags:eoa�li�elcah ozbeiowa depzi�emr�at,i�$saci�CousnvrdDn•�:c *Note. PropezryOwnerx'srsigpaPrnpenyovefterlxtterofPermissiom 4 copy of e Home bMpravementContraators License&Consfanci oa Supervison License is required. SIG3.�F.A.TU12E: � , Cat�sersld=co78cL�pyDaaV.o�?�.12iceesotdWudovrslTcnpormyS�;s�c�CatteaO�ioolc�&it768DCTAtF�p�E55.dac Ravised o6lm The Commonwealth of Massachusetts Depafiient of Industrial Accidents Office oflnvestigations 600 Washington Street y 'S. t. Boston,:MA 021I1 www.mass aov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/.PIumo oers Applicant Information Please Print Leaibl Name(Business/Orgy ' tion/Individual): (�, � Address: City/State/Zip= r f J Phone Are y*u an employer?Check the appropriate box: Type of project(required j: 1.!^�' I am a employer with J © 4. ❑ I am a general contractor and I employees(full and/or part-time)-* have fired the sub-contractors 6• ❑Neiv 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' inc�trance•'+ 9. ❑Building addition [No workers'comp.insurance com P- required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or'additions 3.❑ I am a homeowner doing all work officers have exercised their 11.7 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 employees.[No workers' 13_❑ Other comp.insurance required.I '."Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. •Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance far my employees Below is thepolicy and job site information- Insurance Insurance Company Name: CLei l' L 4<,,UCa(V cot !!nn Policy#or Self-ins.Lic.#: V agq30(6.n I Expiration Date: j ?L(1, 5 _ Job Site Address: G t c7 City/State/lip: � , r v` Attach a copy of the workers'compensation p °cy 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$250-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerkfy under the pains and penalties of perjury that the information proviided above is true and correcr_ Signature: Date: Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# _ IssIIlnb Authority(circle one): 1.Board of Health 2.Building Department 3.GSity/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person- Phone#- 4 . fad FRASCON.-01 PAAS CERTIFICATE OF LIABILITY INSURANCE � 'ATL(M6IIDDNYYY) 9129/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUR_R(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AN D THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION 15 WAIVED,subject to the terms and conditions of the policy,certain poltc)es may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER (50$)676-M109 NAAm'E Ashle Paiva Viveiros Insurance Agency,Inc. e N 375 Airport Road �.SO$689-2793 IaG.��1: 5fl$ 24-4553 Fall River,MA 02720 ADDRESS:APalva 1/-nreirosinsurance.com INSURER(5)AFFOROINGCOVERAGE NAIC* INSURERA:Granite State Insurance Co INSURED Fraser Construction LLC INSURERB: PO Box 1845 INSURERC: COtult,MA 02635 „ INSURERD: INSURHR E ' INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS I^TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FCit 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. ILTR TAPEOFINSURANCE INSR WVD POLICYNUMBER rMM100 TAIDOJYYYYI f,RS Lc GENERAL LIABILITY I EACH OCCURREi:C'e S COMMERCIAL GENERALUABILTTY PREMISES Esoc�rrerce S CLAIMS-MADE MEDE.XP(Arry(nepersan) S e a e PERSONAL&ADViNJUIt(. S GENERALAGGREGAT`e S GENLAGGRECATEUNrr APPLIES PER: PRODUCTS-COMPIOPACG S POLICY �� LOC g AUTOMOBILE LIABILITY - EaNIBINEntl DSING�,-LIh,1I I S I ]ANYAUTO - BODILY INJURY(Fe psrson) S ALL OWNED SCHEDULED AUTOS AUTOS BODILYUIJURY(Feracade-�- 3 NON.OWNED HIRECA'JTOS AUrOS (PERACCIDHNTI S I ? s UMBRELLALIAB H OCCUR EACH OCCURRENCE S EXCESS LIAB CLQLz'-Ir:ADE AGGREGATE S DED RETENTI( $ S WORKERS COMPENSATION P/GS ATU- OTH. AND EMPLOYERS LIABILITY YIN X TORY IMTTS I I ER A ANY 0 CRERIMEM3 PARTUDID�CUrIVE NIA VIfC009930601 9126/2014 912612015 EL EACHACCICENT S 500,000 (Mandatory,e NH) E.LDISEASE-E<,EM?LCYE�. S 500 000 es,describe uneer � ESCJ PnONOFOPERAMONSbelow El-DISEASE-FOUC•'LRrff-t S S00,000 DESCRIPII0NOFOPERA71ONS1LOCA-nONS1V64ICLES(AL1achACORDI(H,Additionai Remarks Schedule,i(more space 15required) J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED PO L IC IES B c CANCELLED BEFORE Town of Barnstable Building Division THE EXPIRA'nCN DATE 'THEREOF. HO nC'c WILL �BE DELIVERED IN 200 Main Street • ACCORDANCEWITH'rHE POLICY PROVISIONS. Hyannis,MA 02601- AUTHOR=REPRESENTATIVE 0 1 938-201 0ACORD CORPORATION. Ail rights'reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks ofACORD r C co N f� • Go VI Q r Q -54 E cc w r ` t , Office of Consumer Affairs and Business Reguzlahon 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Regis Tation: 112536 i ype: D BA E)plrafon: 3/23/201 T T ru 263597 FRASER CONS T RUCTION CO_ DEAN FRAScR P.O. BOX 1845 CO T UIT, MA 02635 Update Address and return_ card_Ya:k reason for change- scar 2W•05/11 []Address M ]Renewal Emplo;meat Lost Card C�,�e�pomemra�:wQal�a��/�ae/zuQelt� _ Office of Consumer Affairs&Rusiaess Regulation License or registration valid for individul use only o OME FMPROVEMEi�Ti C011TF2ACTOR before the expiration date. 1f•found return to: istrztion_ 112536 Type: Office of Consumer Affairs and Business Regulation F`xpirafion: •3/23f2017 DBA 10ParkPlaza-suite 5170 Boston,MA 02116 FRASER CONSTRUCTION CO. DEAN FRASER / 104TAIINN VIEW LANE E FALMOUTH,MA 02636 Undersecretary Not valid without signature o DATE OF ACCEPTANCE: Homeowner Fraser Construction, LLC . R 1 Roofing P.'roduct & Instaffi idn Details Supply & Install- (Soffit Venting) hick's Ventilated Drip Edge or 8" Aluminum Drip Edge with,existing soffit vents. �. Smart vents over white-drip edge. Protection against damage to,the roofing materials and structure. The most effective system is a�balance of air intake`and'exhaust that cr"eates a uniform flow of air through the attic.This system creates a condition in which the roof temperature-is equalized frorn stop to bottom;'supplying a uniform,air`flow along the entire underside of the roof deck. Supply 8s Installs,_`' 'Ice.Bs Water.shield :� r� Waterproof Underlayment System (aft. on eves and valleys, 18",on rakes, walls, and,skylights) Ice and�Water Shield is a self-adhering roofing underlayment used on critical roof areas.such as eaves, rakes`, ridges, valleys, dormers and skylights to protect roofing structures and interior spaces from water penetration caused by wind-driven rain and ice dams. Supply 8s Install- Surround Underlayment (A Typar Brand) A smart alternative to felt, it is water's toughest opponent, creating a secondary water barrier that reduces the incidence of leaks caused by storm damage, wind-driven rain, ice dams and worn roofing materials. It is a waterproof, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel c- 2 �'a5L t Permit# Health Division m® '0 J Date Issued Conservation Division �3 L� r-ar � Application Fee O Tax Collector !�( ,� ��— —�� -" 'l/�`� -- Permit Fee 5' 777!!L Treasurer D A)L /D % c"r?T1C 15'YZIT E1.1 E UG 1 C". Planning Dept. !NSTA!LED U4 C07.4PL1AtXF `MmF:TIT' E5 Date Definitive Plan Approved by Planning Board Etl9;r; ^A�; Preservation/Hyannis `^ `y Historic-OKH� �� Project Street Address 35'+ O L,D '57A r E MI Village (2f,4Q "Ef_J ILA F_ Owner —DONA-Lb tA- C-*+A-,srz. JX_ Address 501�Ma Telephone SM "77 8 007 2- Permit Request DSO EX.1 S TI N& �F_-+LI<_ - AID >l 'PLAC,&M CA)1 Square feet: 1 st floor: existing Co proposed 2nd floor: existing b 1 (= proposed 0' Total new 1� Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size �' 3 s Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 3U Historic House: ❑Yes O(No On Old King's Highway: ❑Yes 10 No Basement Type: &Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) L l Ce Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count (not including baths): existing new_?ss First Floor Room Count w Heat Type and Fuel: $Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes J(No Fireplaces: Existing ( New - Existing wood/coal stove: 0 Yes 1 kNo Detached garage:❑existing ❑new size Pool: 0 existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed: ❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes jM No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name IONAAA)D $4— C�St. .?lt— Telephone Number R)$ —778 0072. Address 5.% OW F— License# n1'il�clta/ C,l.� Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO (-AA DFt LL— SIGNATURE DATE to[_b`63 Y FOR OFFICIAL USE ONLY r PERMIT NO. J DATE ISSUED MAP/PARCEL NO. •,' �_ _(. - •t' - mill, +, ' ',j ADDRESS VILLAGE -� OWNER ` DATE OF INSPECTION: FOUNDATION ' FRAME Xf INSULATION ;t i FIREPLACE r r ELECTRICAL: ROUGH FINAL':' PLUMBING: ROUGH FINAL GAS: ROUGH -, • FINAL F ~ FINAL BUILDING - { DATE CLOSED OUT !C , ASSOCIATION PLAN NO. f � • '3 The Commonwealth of Massachusetts Department of Industrial Accidents — office offoyestfi foes , t 600 Washington Street Boston,Mass. 02111 _ Workers' Cam ensation Insurance davit 7 /+ _ ff Mff name: �4het.lC� A/ CA_10[.'re J-1— location c35-11 J&g e L ,A� city phone# �ZZ-- I am a homeowner performing all worf myself. ❑ I am a sole netor and have no one worku in ca achy ❑ I am an em toyer providing workers' compensation for my employees working on this job. :.}:%;v:•:::}';?;.:.;..;{{..:::.:{..;3:}:v}.:w::`:':}}:•{3}.3:3::3}??:v}}}:-YS{3::•:v:;^}:v}:::;?}::;S:i3:v:•:r.}}}:?:";;%3:3?'r'•:3:•:3::.:v':n:3}:•::.v•.:v:•::nvnw.v-:v.v•::::.v.......... .eom a .n............• ........n.........r................}. ..........................................n...•v.::. ....... .... .v.;fin v: ................. ..............................................: ..::•:::::::.:•.v::::::::.r::::.v::::•::::::::::::::::::::::::::...........::-:::}.......a•::.ti3�•;%':•:r :.,:::.tr:3ri:S{{•}::•}::i: }}.: ......v....................:......v v:w:.:..:::............,....-..............::::..v::••niv::::::....}..... .v........{:w.;v....•:•.,:..............4...v:::•ti3:•}}}:}:3..............................:..:-:•..::.... .......... :..:.........:............. itX%> 2:'>: :>) :': `'?::: .. .>:}al }::.;•:::::.: r:;•:;•}:.}:.} ....:.....{;:::::;:::;:::::i:::::::;:>.:?::;:Si:}:f:: 4.' k:::::`•::i::i;::r tiirr;:+.isi::< ::::;:`::;:;i:; :';::}:::s:::r>:5::;:2;s„: .inseixa ❑ I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who have , on olices;co ensati the following workers mp � •:;•:•:::::.:�:•}:.::::::::.:;{::}:•is•:;;•:;•>:•:-:%::::•::.�:::.�::•• .................:::::::.:::.::::•:.::::....,..........- .........::•::::::::r::::::.�:::::::.::.�:•:::.�:::.�:.}••:.....................................:............ ,.;<3:::.•:...•.�:............r.•:.�::::.�:::::::::::::::::.go-}.,.,}:}:;•i}::.... ....:.... `roriyauyM. ..................:.................................:....::::.............................. ...... ................ .... ...n...........,...n................:...............:::�.:.......:•:::.::::::::::::::::.vv:::w:.v::,.•• .:....... rw::::::::::::::.:::::::::v:}:•}::Sn•:vi}}??}v.v{:w}x:,,,aaa..w:::k-•.-•}::•::. 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_ ❑Other (revised 9195 Fria Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplo ers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as eve person in the service of another under any contract of hire, express or implied, oral or written. artnershi association, c oration or other legal entity, or any two or more of An employer is defined an individual,p p, the foregoing engaged in a •oint enterprise, and including the legal.r resentatives of a deceased employer, or the receiver or hi association or other legal ' , employing employees. However the owner of a ers trustee of an individual,P P, dwelling house having not m e than three apartments and who re des therein, or the occupant of the dwelling house of another who employs persons do maintenance,construction o repair work on such dwelling house or on the grounds or building appurtenant thereto s not because of such emplo t be deemed to be an employer. MGL chapter 152 section 25 also es that every state or 1 al licensing agency shall withhold the issuance or renewal of a license or permit to operate business or to construc buildings in the commonwealth for any applicant who has not produced acceptable evidence f compliance with the nsurance coverage required. Additionally,neitherthe commonwealth nor any of its politic subdivisions shall a er into any contract for the performance of public work until acceptable evidence of compliance wi the insurance re ements of this chapter have been presented to the contracting authority. PP A licants Please fill in the workers' compensation affi vit ompletely,by checking the box that applies to your situation and ' supplying company names,address and phone bers along with a certificate of ftmu mce as all affidavits maybe submitted to the Department of Industrial Acrid for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be r to the city or town that the application for the permit or license is Ind A idents. Should you have any questions regarding the"law"or if you being requested, not the Department of are required to obtairi a workers' compensati poli please call the Department at the number listed below. City or Towns Please be sure that the affidavit is compl and printed legib The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigate has to contact you regarding the applicant. Please be sure to fill in the permit/license numbe which will be used as reference number. The affidavits may be retaraR io the Department by mail or FAX unless o er arrangements have b made. The Office of Investigations would like o thank you in advance,for u cooperation and should you have any questions. please do not hesitate`to give us a call. -- MOM The Department's address,telephone 4n4 fax number: The Commonwealth Of Massa husetts Department of Industrial Acci ents Office of Investigations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 °FSHE, � Town of Barnstable Regulatory Services Bnru?sT^Hz p` Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW' SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: c�S ���cS� e �� Ile- Owner's Name: 7)6s74Z Date of Application: �03 I hereby certify that: Registration is not required for the following reasou(s): FWork excluded by law ®Job Under$1,000 ❑Building not owner-occupied ®'Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Con ctor Name Registration No. R Date Owner's Name Q:forms:homeaffidav a:. Town of Barnstable CF IN E h o� Regulatory Services • • Thomas F.Geiler,Director BAMSTAB14 0,19. � Building Division Tom Perry,Building Commissioner 200 Main Street,`Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 HON MOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: zqlaoo, xz�We Iec number street village �lol,�owrrl;x": ✓�La One 1_�• ifs 72ff662.1-- name home phone# work phone#- CURRENT MAIIdNG ADDRESS: /Jf.a ex city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farms structures: A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for alll such work performed under'the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with.the State Building Code and other applicable codes,bylaws,rules and regulations. The-undersigned"homeowner"certifies that he/she understands the Town-of Barnstable Building Department... minimum' c n procedures and requirements and that he/she will comply with said procedures and requireme e Signatadof Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner perfomiring work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fury aware of his/her responsibilities,many communities require,as part of the pewit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by r several towns. You may care t amend and adopt such a form/certification for use in your community. �OFIKE topes Town of Barnstable *Permit# 0 p� Expires 6 months from issue date a . BAM Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner X-PRESS PERMIT 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 - AUG 12 2002 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL J OF BARNSTABLE Not Valid without Red X-Press Imprint Map/parcel Number k 9 0 r 7`T Property Address 3SL� QLt> STP4F- R. CtpmAm tLLr eQ Residential Value of WorkL ' Owner's Name&Address '1)0 N AAZI A G 4ASE. TtL- 3 S-4 Old ST6k&l= R� C�.N'�F RBI i 1. AL - Contractor's Name IsT"` R �.ttw� �l� Telephone Number50% 0112 _!0 9i�9 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 9)e7 D d' ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor [j4 I am the Homeowner ❑ I have Worker's Compensation Insurance ' Insurance Company Name Workman's Comp.Policy# Permit 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) 21Re-side Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Iss ce of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revised121901 Eng veering Dept.(3rd floor) Map Parcel Permit# 7 Y< House# � ' Date Issued RAI I l� Board of Health(3rd floor)(8:15 -9:30/1:00-y4:30)noG /dn� o2s,cea Conservation Office(4th floor)(8:30-9:30/1:00-2:00) 19 : 6AR ' MASS �rFO MPS p`� TOWN OF BARN-STABLE Building Permit Application CProject Street Address 3.5_q Village c cicCh Owner ,s — Address .�`?rL �C�� 9� i�;1T�Z�2 Telephone �-- Permit Request Re- , First Floor square feet Second Floors square feet Construction Type .� Estimated Project Cost $ .� Zoning District Flood Plain /1101 1�� rr Water Protection T At Size • 3 Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes UN No On Old King's Highway ❑Yes No Basement Type: 6 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1A<50 Number of Baths: Full: Existing / New V Half: Existing . / New No. of Bedrooms: Existing JNew Total Room Count(not including baths):Existing New 6 First Floor Room Count 6 1} Heat Type and Fuel: h Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes No Fireplaces: Existing New ® Existing wood/coal stove ❑Yes UNO t. Garage: ❑Detached(size) Other Detached Structures: p Pool(size) LW \ ❑Attached(size) ❑Barn(size) �None 91 Shed(size) ❑Other(size)_ Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Jd No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number ©g ? 03 33 Address �=- k License# (�5 Q 111p 0 ` a I mo,`N-� Home Improvement Contractor# 06 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE— � & BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ,' i' � �� ' - . . .. , •.,� a ' _ ...� ,.w. �' .Y � .�:kv: � F�.......1p.1 _ .., +r;%. �. r , ' /� ,../ v \ 1 `� � 1 t ` � � � '1 , ,.y � e r � , .. . ' .. t , ' rT� � � .� ._ � - � ._ E o ' � r �. ' � ,f .. � :' . . _ ,�� f�• _ , `� _ ` . ,� i. .. ... . . � _ � 1• t c 47 - �`. '� '� _ ' . .� — _ a � - _ � i � � - � � tl a