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1162 SHOOTFLYING HILL RD
s . ,. - - - � arm 'i�" �� R r• ,"�w � xV. ` Fr tk �'"`q} r 4 e h c Town of Barnstable *Permit# �S Expira oaths issue date ulatoly Semees Fee r BARmME s SEp ' /� 6'2013 Thomas F.Geiler,Director ®P Building Division Tom Perry,CBO, Building Commissioner ft 00 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address D / �,- ) [residential Value of Work$ � �D. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address —,tn— V)h e I y e- Its n It16 5Ad07 PI!/l ha / ,)C' Telephone Number 50�� 9y� Contractor's Name�l - Home Improvement Contractor License#(if applicable) j.. yo� Email: Construction Supervisor's License#(if applicable) (f .5 , ❑Workman's Compensation Insurance Chec .one: 0—I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque eck box) >J Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �Q55 e r(�- ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Wmdows/doors/sliders.U-Value (rnaxiraum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not ezernpt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is r0111 ed. kbIGNATUKU QAWFIL,ESTORMS 7ding permit formsTMESS.doc r Y •i v `^�� _ �. -. a Massachuse tts _pe Board of Partinent Building Regulatins on Of Public Safe Constructi S an uPcr�isor d Stand ards. License:CS-086728 Jpstp AYS i ry I Cpmmissi-o'er EXPiratton l ? Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 4 159942 Type: Office of Consumer Affairs and Business Regulation Expiration: 6/1 t 2012 Individual f 10 Park Plaza-Suite 5170 Boston,MA 02116 JO PH RENNIE'I ` Jos RENNIE\1 ! 4 WAYSIDE LNr SANDWICH, MA Undersecretary ° Not valid without signature i Office of Consumer Affairs & Business Regulation Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Home Improvement Contracting HIC Registration Complaints Registration # 159942 Home Improvement Contractor Registrant Registration Home Page Name JOSEPH RENNIE Address 4 WAYSIDE LN. City, State Zip SANDWICH, MA 02563 Expiration Date 06/11/2014 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=6... 9/26/2013 i 1 . oF�+E r Town of Barnstable Regulatory Services g rY ="xrASS.I E MASS. Thomas F.Geiler,Director 1.639. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize 4. �e-.-Ii,n to act on my behalf, _ in all matters relative to work authorized by this building petmit o -t- Ing, (Address o Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. 147-UnLL �- gnatuie of Owner ignature of Applicant Tay►nh I y�.�s ora - �A-h h E, A PR S 6/7 Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 62012 �t Town of Barnstable Regulatory Services Thomas F.Geiler,Director 6.`0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: /- )_/ p JOB LOCATION: t&a a-0J!j.P1Vjn0 J Il ej- �tnfs_,e_11,11 /M - Ca 6 3,.7 ^-number T street y village p "HOMEOWNER" n9 name home phone# work phone# CURRENT MAILING ADDRESS:_ SArnC AS A&I U@ 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 Person(s)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 farm 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 all 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 inspection procedures and requirements and that he/she will comply with said procedures and requirements. fi6latirre of 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 performing 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 person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit 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 several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\demllikWppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOudook\QRE6ZUBN\E}CPRESS.doc Revised 053012 The-Constnonweakh of Massachusetts Deparftmt of l'izdkshid Accr'dents Office of 1Tt esfigatlons s 600 Mashington Street Boston,M,4 02111 wn jv.mass gov1dia Workers' CompensatiauIusuranceAffidavit:,Builders/Con#ractors[Etectricians{Plumbers Applicant Information Please Print LezibIy Name Mush�Organization&fflvidwo: Yt 1 L' Address: �/ �a1� Sin � �`� 21 City/stat rMp: Z Phone v 8 �8 6 Are you an employer?Check the appropriate box: Type of pr o]ect(required): L❑ I am a employer with 4. ❑ I am a general contractor and I ta. ❑New you loyees(full and/or part4ime)* have hired the subcontract m 2_Ln I am a sole proprietor or partner- listed on the attached sheet 7- ❑Remodeling ship and have no employees These mb-contractors have g_ ❑Demolition. w for.me in an capacity. employees and have wodcers' orkrrtg y 1 g_ ❑Building addition [No,workers' comp.insurance comp.insuraII{7e. regaired_] 5. ❑ We are a corporaticm and its 10.❑Electrical repairs or additions 3_❑ I am a homeowner doing all worse officers have exercised their IL.❑Plumbing repairs or additions myself[No workers'camp_ right of exemption per MGL 12-.❑Roof repairs insurance regnued-]b c-152,§1(4),and we have no employees-[No workers' 13..❑Other comp-insurance required-1 *Piny applfmm that checks boa irl mast also fill out the section below showing[hen wodes'compensation policy infumu io I Homeowners wbo submit this sffidavit mdkst mg they are damg all waet and then bire outside contractors incur submit anew aff5dwk indicating such- tCoatmctors that rb&A this boat most sturhed an additional sheet showing the name of the sofb-w&2cton and state Whether or=tlme emities have empkoyees. If the sub-contractors bwe em pl bees,they must provide their workers'comp.policy number. I am un employer that isproviNitg workers'comperrsaiion inmil rance for 171y employees. Belotr is the policy arui job site information. Insurance Company Name: Policy#or Self-ins.Uc-#: Expiration Date: A,16 /I Job site Address://�o of .�1 c�7��U (l �e�.Y Se a Cityfstawzip: I V ek . AA 13 2 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requireduuder Section.25A of MGL c. 152 can Lead to the imposition ofcriminal penalties of a fine up to S 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 for insurance.coverage verification- I do hereby certify re0#r the pains and penalties ofperjury that the information prosided above is true and correct Si tore: Date: Phone# Oj ciai use only. Do not trrite in this area,to be completed by city or town official, City or Town: PermitUcense# Issuing Authority(tarcle one): 1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector G.Other Contact Per—nn: - Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an eWloyee 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 receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,.MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certaficate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial - Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition;an applicant that must submit multiple permit/heense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this aff davit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Depai went of Industrial Accidents Office of Imvestigations 600 Washington Street ` Boston,MA 02111 Tel.A 617-727-4M at 406 or 1-877 MAS E Revised 4-24-07 Fax#617-727-7749 - www.mass-gov/dia ToIwn ®f Barnstable *P ID(ja ' 14ires,6 months from issue dale Regulatory."Services 'Fee• J25.00 Thomas F. Geiler,Director + Building Division xS� ItD " Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis,'MA 02601 www.towmbarnstable.ma.us Office: 508-862-4038 Fax:<508-790-6230. " EXPRESS PERMIT A:PPLICATION, RESIDENTIAL ONLY Not Vniid without Red X-Press Imprint Map/parcel Number 190096' Property Address 1162 SHOOT FLYING ,HILL ROAD; CENTERVILLE, MA 02632 4 X Residential Value of Work_.$5,238.00 Minimum fee of$25.00 for w6rk'under+$6000.00 Owner's Name&Address JOANNE NELSON; .1162 SHOOT FLYING HILL ROAD;`,'CENTERVILLE, MA 02632" Contractor's Name RISE ENGINEERING;' A DIV. OF THIELSCH Telephone Number 401-784-3700 ENGINEERING :-Tome Improvement Contractor License# (if applicable) 120979; EXP. 3/25/12 construction Supervisor's License# (if applicable) 100459; .EXP. 3/28/12 EPA LEAD—SAFE CERT. #NAT-24531-1 - Workman's Compensation Insurance Check one: ❑ I am a sole proprietor. X g,� EI ❑ I am the Homeowner 0 I have Worker's Compensation Insurance SAY 2 .2011 .t nsurance Company Name THE•PRESTON AGENCY :[OWN—F.� 6ARNSTABL , Vorkman's Comp.Policy 4 . 3.73-0961-00 EXP. 1/1/11 -opy,of Insurance Conppliance Certificate must be on file. COPY ATTACHED 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. U-Value , 30 :(maximum.44);SIX' (6);'REPLACEMENTS TO-THE ;EXISTING S, NO,°SIZE,' HEADER, STRUCTURAL *Where required: Issuance of this permit does not exe'mpt compliance with other town department regulations,i e.Historic,Conservation;etcr ***Note: Pro erty er tist si roperty Owner Letter of Permission: . ATTACHED ° me ent tractors License is required. COPY OF LICENSE 'ATTACHED ._..,. IGNATUREi x :v Forms:exomtre •FRTV NF.RSTRF.TMFR FOR RISE ENGINEERING ®�IHEr � Town bf Barns&bk MAY 19 2010 ' Regulatory Services o r ' a r MUMSPABLE, y MASS. Thomas F.Geiler,Director Building Division ,. Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 - - A, ,Property Owner Must Complete and Sign This 5ectioni ,.I* �. If Using A Builder Joanne 1461 on. , as Owner the subject property hereby authorize' RISE Engineering`; A Div.- o'f N:Celsch EnQto act on my behalf, in all,matters relative to work authorized by this building permit application for: 1162A;Shoot Flying` Hill Road (Address of Job) ignature of Owner Date Joanne Nelson Print'Name If Property Owner is applying for permit please complete the Horneowriers License. Exemption Form:on th:e reverse ide: . v The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):_RISE Engineering a division of Thielsch Eng;n 'ar;ng Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone#: (401)784-3700 or 1-800-422-5365 Are you an employer?Check the appropriate box: : Type of project(required): 1. N I am an employer with 4. ❑ I am a general contractor and I 6. ❑,New construction employees(full and/or part time).* have hired the sub-contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7 ❑Remodeling ship and have.no employees These sub-contractors have " 8. 0 Demolition working for me in any capacity., employees and have workers' 0 9. 0 Building addition workers' comp.insurance ce n an g � p comp.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- 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. 0 Roof repairs employees: [no workers' 13. T OtherREPLACEMENT WINDOW comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins.Lic.#: 3730961-00 = Expiration Date: I/1/11 Job Site Address: 1162 SHOOT FLYING HILL ROAD City/State/Zip: CENTERVILLE,, MA 02632 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 ins enalties-ofperjury that the informatto proy'ded above is true and.correct. Sign ture: �. v, -� Date: Print Name: Erik Nerstheimer Phone#:(401)784 3700 or 1 800 422 5 6 x l33 Official use only Do not write in this area to be completed by city or town official r- 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#: r; nsumer Ki/a4n �usmess e u ationgll�O iceo og _ 10 Park Plaza - Suite 5170 Boston, .-ssachusetts- 02116 z Home Improveontractor Registration r - Registration: 120979 m Type: Supplement-Card' z ; � Expiration: 3/25/2012 THIELSCH ENGINEERING `ERIK N'ERSTHEIMER 1341 ELMWOOD AVE: CRANSTON, RI 02910 ' '# Sys" Update Address and return card.Mark reason for change.` El Address: Renewal Employment F�.Lost Card DPS-CA1 0 50M-04/04-G101216 _ �fxe 'C�omznwouoeaCC�i �✓�aaaac�ucaelta . Office of Consumer Affairs&Bu iness Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registrations g979 Type: 10 Park Plaza-Suite 5170— .� Expira "` pp � 12 Supplement Card Boston,MA 02116 F �{� THIELSCH ENG ' ERIK NERSTHE i1 .1341 ELMWOOD CRANSTON, Rl 029fd- /. Undersecretary Not valid without signature t tlas achti rtt>- I�clru tinctlt 4)f pul.lii safe t� Biuu•iI (if Builtliil'u Re4"11 atllltl :tll(I t:II II tis Construction Supervisor Specialty License License: CS SL 100459 " Restricted to: WS ERIK NERSTHEIMER $yf 228 GLEANER CHAPEL ROAD NORTH SCITUATE, RI 02857 Expiration: 312812012' t' uuni. i n,t. Tr: 100459 11------------------ '*AC®RD CERTIFICATE OF LIABILITY INSURANCE OP ID 4-7 DATE(MM/DDryy(Y) THIEL-1 04/13/10 PRODUCER _THIS CERTIFICATE IS ISSUED'AS A MATTER OF-INFORMATION _The Preston Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303 HOLDER'.THIS CERTIFICATE DOES:NOT AMEND,EXTEND OR PO Box 810 ALTER THE COVERAGE AFFORDED BY-THE POLICIES BELOW, EastGreenwich RI 02818-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE NAIL# INSURED - INSURERA ZUrlch-American. Ins CO. Thielsch Ezigineeri ng, Inc INSURER B:. RAar.lcnn cVsxantoa a Li abl l"i.tyi` Thielsch 3kjtyoup Inc. INSURER North American;Capacity Hi Tech Realty Inc.:Cran19Sston FrastoncRI Avenue INSURER0: Hartford Insurance Company Cranston RI 02910 INSURERE' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTVVITTISTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMEtF WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OP. W1Y PERTAIN,THE INSURANCE AFFORDED BY"fHE POLICIES DESCRIBED HEREIN IS SUBJECI TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE(MM100fYY) DATE( 1YY) LIMITS GENERAL LIA0IUTY - - EACH OCCURRENCE T 1,0 0 0,0 0 0 '- - A X COMMERCIAL GENERAL LIABILITY 3730962-00 04/O1/10 O1/01/11 PREnnSEbEaoccureennca) T300,000 CLAIMS MADE OCCUR - _ MED EXP(Any.one person) g 10,0 0( - . PERSONAL;&ADVIN.;URY $ 1,000,000 GENERAL AGGREGATE g 2,000-,000 GEN'L AGGREGATE LIMIT APPLIES PER: „� PRODUCTS-COMPh)P AGG $2,000 00 O POLICE X jEa LOC _ - — - ' Emp Ben: 1,000;000 AUTOMOBILE LIABILITY - A X ANY AUTO 3730963-00 04/01/10 01/01/11 COMBINED SINGLE LIMIT g2,000'000 (Ea accident) ALL OWNED AUTOS - - ----.— - BODILY INJURY - SCH[DULEOPLR"OS } - - - IPerperson) g" HIRED AUTOS BODILY INJURY .. NON-01,11ED AUTOS T (Per acc�da.nlJ' - • .. I.PROPERTY DAIAWGE. — ?Per accident) g ! GARAGE LIABIl11'1 - - - -• - AUTO ONLY-EA ACCIDENT g ' ANY AUTO _ - . - OTHERTRAIIJ EAACC $ .. ., _ A.UTO.ONLY. AGG '4 " .-- EXCESS/UMBRELLALIABILffY • EACH OCCURRENCE uR glO,000,000 B / T $ 10,000,000u - - DEDUCTIBLC- ---- — - - - X RETENTION g 10,000 -- : WORKERS COMPENSATION AND - X TORY LIMITS EP. EMPLOYERS'LIABILITY •. ' ' A VJI'PR RIETGR/PARTNER/EXECUTIVE 3-730961-00 04/01/- ,10 01,/01/11. E.L.EACH ACCIDENT $ l;'000;000 ': OP _ - OFFICER/MEMBER EXCLUDED? - _ "--- o-, d: E.L.DISEASE-EA EMPLOYEE T 1_000,000 000=. If yes,describe under -- — .. SPECIAL PROVISIONS bolow - .• ;._ - - F.L.DISEASE-POLICY-LIMIT .{ 1,o00,000 OTHER C Professional Liab DVL0000 D � Leased/Rented E 26800 09/01/10 04/01/11 Prof Liab 2,r000,000.- qp 02LTUNTD 5678 ,. 04/01/10 04/OS/11 Equipment 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS - CERTIFICATE HOLDER CANCELLATION „ • :: -6 - SHOULD ANY OF THE ABOVE.DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10. 4,DAl'S`NR(TTEN-, r . - - NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT.FAILURE TO 00 SO SHALL ,1 IMPOSE NO OBLIGATION OR,LIABILITY'OF ANY MND UPON THE INSURER.ITS AGENTS OR ' -• REPRESENTATIVES. AUTHORIZED REPRESE V ACORD 25(2001/08) tDACORD CORPORATION 1989 ®����®p;}1�14�IM$UpRED�SddAME i'Tlii�e'1�sc`tip`�n�jinee�iag�T�filX,n(�,-�,�,,r;�l.i;3���' �OP ID 2711 II 'r� DAT,E w04/12/10 Also for M ,' RISE Engineering, a dvie'ion of Thielsch Engineering,. 3nc. ., . Gaskell Associates.; a division of Thielsch Engineering, Inc. . BAL Laboratory; .a division of Thielsch Eng"ineering, Inc'. ESS Laboratory, .a division of Thielsch Engineering, Inc. ALCO Engineering, a division of Thielsch Engineering, .Inc. Water Management Services, a division of Thielsch Engineering, Inc. J c„ [ RISE ENGINEERING AG"EMEWV I A division of Thielsch Engineering *.' q THIS CONTRACT IS ENTERED BETWEEN RISE AND THE CONTRACTOR FOR WORK AS DESCRIBED BELOW 1341 Elmwood Avenue,Cranston,RI 02910 R 1' 'S E (401)784-3700 FAX(401)784-3710 CASE 089145 Page I eaa.i�sce�N� IT IS AGREED THAT: _ CONTRACT DATE CONTRACTOR 0996 RISE window 04/30/2010 ADDRESS AUDITOR Doug Brown FOR THE CONSIDERATION NAMED HEREIN,SHALL PERFORM IN A FAITHFUL AND WORKMAN LIKE MANNER THE FOLLOWING WORK AT THE ADDRESS INDICATED BELOW: CLIENT NAME Joanne F Nelson CASE ADDRESS 1162 Shoot Flying Hill Road 089145 Centerville,MA 02632 PROJECT NO HOME (508)775-5653 WORK 0 X RIS-81-10-7880 CELL FAX FURNISH AND INSTALL: 05/04/2010 2:05:38 PM Install(6)new"Designate II"double hung windows built to the rough opening.Dining room(2)with 6/6 grids and(1)with 8/8. The living room(2)with 6/6 grids and(1)with 8/8. All will have Federal Incentive Package glazing. Contractor is responsible for all material delivered and installed in connection with the above work. Any deviations from. the above specifications must be authorized by.RISE personnel. Contractor reaffirms the covenants set forth in its Application for Participation.Violation of any such covenant is breach of this Contract. Contractor Shall indemnify and hold harmless RISE,its employees and its agents from and against all claims,damages, losses and expenses,including but not limited to attorney's fees,arising out of or resulting from the performance of Contractor's work under this contract. RISE Authorized Signature Contractor Authorized Signature DATE DATE 05/04/2010 2:05:38 PM, r RISE ENGINEERING Federal ID Ir 05-0405629 RI Cordractor Registration No 8186 A division of Thielsch Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 x ;+s 1341 Elmwood Avenue,Cranston,RI 02910 #: K (401)784-3700 FAX(401)784.3710 CONTRACT Page , 1 RI S E THIS CONTRACT IS ENTERED INTO BETWEEN RISE - ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINL`ERINC. DESCRIBED BELOW CUSTOMER PHONE DATE Chant# Joanne F Nelson (508)775-6959 04/15/2010 089145 SERVICE STREET BILLING STREET 1162 Shoot Flying Hill Road 1162 Shoot Flying Hill Rd' SERVICE CITY STATE,DP BILLING CRY,STATE,DP Centerville,MA 02632 Centerville,MA 02632 + - — — ---- _------ JOB DESCRIPTION `� U RISE Engineering will install six(6)new white vinyl"DESIGNATE II"double-hung windows,built to the rough opening.For the dining room:2 with 6-over-6 grids and 1 with 8-over-8.For the living room:2 with 6-over-6 and 1 with 8-over-8. Includes: ��. Welded sashes and welded frames Block and tackle balances Night vent latches Tilt in ability of the top and bottom sashes Grilles between the panes of glass(GBG). Charcoal aluminum latching half screens Double glass,Low-E,Solar Ban 70,standard strength,Argon filled,Federal Tax Incentive-eligible,U-value of 0.30,and Energy Star-compliant All windows will include new Azek flat stock exterior trim and new clear wood interior casinos 't Is Any painting or staining that will be necessary will be the client's responsibility - D This will include the removal and disposal of the old windows and any storms. Insulation and caulking will be installed to provide a weather tight seal. APR 2 1 2010 Removal and reinstallation of window treatments such as shades,blinds,curtains or interio,shUlt wner's responsibility. To accept this offer,please include a 50%deposit in the form of a check with this signed agreemen in your credit card number to us at 1-800-422-5365 x 120.Thank you $5,238.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Thousand Two Hundred Thirty-Eight&001100 Dollars $5,238.00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE N FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY _ UNPAID BALANCE AFTER MI DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SC EDIAARM,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES ( ,, AUTHORIZED SIGNATURE-RISE ENGINEEPAN `f/ 1-2 /U NOTE:THIS CONTRACT MAY BE WITHDRAWN BY U IFS NOT EXECUTED WITH N DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE - SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORN DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE , Town of Barnstable Permit# Expires 6 months from issue date Regulatory Services Fee $25.00 Thomas F.Geiler,Director Building Division o lG LJt��u 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 Not Valid wil/tout Red X-Press Imprint Map/parcel Number Property Address 1162 SHOOT .FLYING HILL ROAD . ® Residential Value of Work $2,723.00 Minimum fee of S25.00 for work under$6000.00- Owner,'s Name&Address' JOANNE NELSON; 1162 .SHOOT .FLYING HILL ROAD; CENTERVILLE, MA 02632 -ontractor's Name RISE ENGINEERING; Telephone Number 401-784-3700 A .DIV. OF. THIELSCH. ENGINEERING. Jome Improvement Contractor License# (if applicable) 120979 EXP. 3/25/2010 �onstructionSupervisor's,License#(if applicable) CS SL 100463 EXP. 6/23/2012 EWorkman's Compensation InsuranceX-PRESS PERMIT Check one: 0 I am a sole proprietor 0E1C 1 0 2008 El I am the Homeowner ❑X I have Worker's Compensation Insurance TOWN ( ARNS7-ABL nsurance Company Name THE_PRESTON AGENCY Vorkman's Comp. Policy# 02 WB NL0984 EXP. 4/1/09 - -opy.of Insurance Compliance Certificate m_ust be on file. - .COPY ATTACHED 'ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction•debris will be taken to t;o Re-roof(not stripping. Going over existing layers of roof) rn ❑ Re-side Replacement_Windows. U-Value 31 (maximum.44) NO HEADER OR SIZE CHANGES - ALL TO.: THE EXISTING OPENINGS 'Where required: Issuance of this permit does not exempt.compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner ust sign Property Owner Letter of Permission. ATTACHED v Home Impro ment Contractors " ense"is required. COPY ATTACHED — , IGNATURE — Forms:expmtrg STEPHEN HIN FOR RISE ENGINEERING, r Town of Barnstable ( aVE Regulatory, Services D vBA ss. Thomas F.'Geiler,Director 639. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 . f L Property Owner Must Complete and Sign This"Section If Using-A Builder I, JOANNE NELSON , as Owner of the subject property hereby authorize RISE ENGINEERING; A DIV. OF THIELSCH ENG.to act on my behalf, in all matters relative to work authorized by this building permit application for: 1162 .SHOOT FLYING HILL ROAD; CENTERVILLE, MA,.02632 (Address of Job) ature of Owner gn ate JOANNE NELSON Print Name Q:FORMS:OWNERPERMISS ION J 71, RISE Division of Thielsch Engineering,Inca 1341 Elmwood Avenue , ENGINEERING Cranston,Rhode Island 02910 �\ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrat:iori:• 120979 Board of Building Regulations and Standards E-'rat an =-3/25/2010 TO 263460 One Ashburton Place Rm 1301 Boston,Ma.02108 - T Types Private Corporation _ =_ A, THIELSCH ENGINEE_RiNG STEPHEN HINES - 1341 ELMWOOD AVE, 'j CRANSTON, RI 02910 Administrator Not valid;without signature r Massachusetts -`Department of Puhlic'�afct� Board of Buildin- Re�-ulations and Standards WE Construction Supervisor Specialty License License: CS SL 100463 - Restricted to: WS STEPHEN, HINES 222 NARRAGANSETT AVENUE , JAMESTOWN, RI 02835 ` Expiration: 6/23/2012' ( •muni <i utrr Tr=: 100463 , 401-784-3700 Rnn-47.2.-5365 Fax 4m-7R4-371n The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600:Washington Street Boston,MA 02111 www.mass.gov/dia' - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ! 'Please Print Legibly is Name(Business/Organization/Individual): RISE Engineering; A Division ofi;;Thielsch- Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone #: 401-784-3700 or 800-422-5365 4 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or,additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4);and we have no 12:❑ Roof repairs insurance required.]t x,. employees.[No workers' 13.❑X Other REPLACEMENT WI OWS r, comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name The Preston Agency Policy#or Self-ins.Lic.#: 02 WBNL0984 Expiration Date: 04/01/09 Job Site Address: 1162 SHOOT, FLYING HILL- ROAD City/State/Zip:_ CENTERVILLE, MA 02632 , 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 the pains a penalties of perju that the information provided above is truf and correct. Si ature: 1 - 4 4 -Date: 8 - Stephen ine Phone#: 401-784>3700 or 800-422-.5365 Ext. 117 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspectors.Plumbing Inspector 6.Other. l Contact Person: Phone#: tM. f A OP ID CI CORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) THIEL-1 04/24/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The :Preston Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 135O Division Rd Suite 303 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Greenwich RI 02818-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Underwriters Ins. Cc - INSURER 8: Hartford Casualty Insurance Cc Thielsch Engineering, Inc INSURERC: Beacon Mutual 195 Frances Avenue INSURERD: Cranston RI 02910 North American Capacity ' INSURER E COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR TYPE OF INSURANCE 'POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1 r OOO r 000 A X COMMERCIAL GENERAL LIABILITY 02UUNTD5678 DAMAUL - 04/01/08 04/01/09 PREMISES(Ea occurence) $ 300,000 CLAIMS MADE FXI OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY X PECOT F7 LOC Emp Ben. 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B X ANY AUTO 02UENTD4850 04/01/08 04/01/09 (Eaaccident) $ 1,.000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person).. HIREDAUTOS - - -NON-OWNED AUTOS BODILY INJURY $(Per accident) PROPERTY DAMAGE $ • (Per accident) GARAGE LIABILITY - .- AUTO ONLY-EA ACCIDENT $ ANY AUTO _ - OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY • EACH OCCURRENCE $ 1O,OOO,OOO B X OCCUR CLAIMS MADE 02XHUUF6573 04/01/08' 04/01/09 AGGREGATE $ 10,000,000 DEDUCTIBLE X RETENTION $10,OOO _ $ WORKERS COMPENSATION AND X TORY LIMITS I B EMPLOYERS'LIABILITY ' 02WBNLO984 04/01/08 ANY PROPRIETOR/PARTNER/EXECUTIVE O4/O1/O9 E.L.EACHACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? 54703 ' 04/01/08 04/01/09 E.L.DISEASE-EA EMPLOYEE $SOO,000 If yes,describe under SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $ 500,00 Q OTHER D No Amer Capacity VVL000022001 04/13/08 04�/13/09 Prof •Liab 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS (*Except 10 days for non payment of premium) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN Town Of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 200 Main DivStreet IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 Main Street � ' Hyannis MA 02601 REPRESENTATIVES. AUTHCIDIZFn TIVF_ ACORD 25(2001/08) ©ACORD CORPORATION 1988 J ����. t PAGE 2.'. INSUREDS NAME -Thielsch Engineering, Inc OR -'DATE,04/24/08 ID CI Also for RrSE Engineering, a division of Thielsch Engineering, Inc. Gaskell Associates, a division of Thielsch Engineering, Inc. SAL Laboratory, a division of Thielsch Engineering,. Inc. ESS Laboratory, a division of Thielsch Engineering, Inc. ALCO Engineering, a division of Thielsch Engineering, Inc. Water Management Services, a division of Thielsch Engineering, Inc. 3 , RISE ENGINEERING �, ? AGREEMEN A division of Thiclsch En ineerin D I g g l r THIS CONTRACT IS ENTERED BETWEEN RISE AND THE CONTRACTOR FOR WORK AS DESCRIBED BELOW 1341 Elmwood Avenue,Cranston,RI 02910 k 1 41, 11 (401)784-3700 FAX(401)784-3710 .„ aV CASE 089145 Page 1 IT IS AGREED THAT: CONTRACT DATE 10/15/2008 CONTRACTOR 0996 RISE window AUDITOR ADDRESS , Doug Brown FOR THE CONSIDERATION NAMED HEREIN,SHALL PERFORM IN A FAITHFUL AND WORKMAN LIKE MANNER THE FOLLOWING WORK AT THE ADDRESS INDICATED BELOW: CLIENT NAME Joanne F Nelson CASE ADDRESS 1162 Shoot Flying Hill Road 089145 Centerville,MA 02632 PROJECT NO HOME (508)775-5653 WORK O X- RIS-81-08-6667 CELL FAX FURNISH AND INSTALL: 10n7/2008 4:43:29 PM Install(3)new white vinyl"DESIGNATE II"double hung windows to the rough opening for the baths(2 down and 1 up).6/6 grid. New interior and exterior trim to match existing. Contractor is responsible for all material delivered and installed in connection with the above work. Any deviations from the above specifications must be authorized by RISE personnel. Contractor reaffirms the covenants set forth in its Application for Participation.Violation of any such covenant is breach of this Contract. Contractor Shall indemnify and hold harmless RISE,its employees and its agents from and against all claims,damages, losses and expenses,including but not limited to attorney's fees,arising out of or resulting from the performance of Contractor's work under this contract. RISE Authorized Signature Contractor Authorized Signature DATE DATE 10/17/2008 4:43:29 PM - it 'Federal ID#05-0405619 RISE ENGINEERIIN °� RI Contractor Registration No 8186 `C; C i t ' MA Contractor Registration No 120979 A division of'Thielsch Enginen _. CT Contractor Registration No 620120 �1 1' 1341 Elmwood Avenue,Crani on,'�R�J 029r10 (401)784-3700 ��� FAX`(401)784- �101 I �� ZOOS ,. CONTRACT _ _� .�._ +"✓ Page 1 RISC ��� THIB.CONTRACT.IB ENTERED INTO BETWEEN RISE . :..„.._ .....W ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE Client If Joanne F Nelson (508)775-6959 09/28/2008 089145 ----------- --- - -------- — ---------------'----- ----'-'----------...- - ----- ....------... SERVICE STREET - BILLING STREET 1162 Shoot Flying Hill Road 1162 Shoot Flying Hill Rd SERVICE CITY,STATE,ZIP - , BILLING CITY,STATE,ZIP Centerville,MA 02632 Centerville,MA 02632 u . . JOB.DESCRIPTION . . RISE Engineering will install 3 new white vinyl"DESIGNATE II"double hung windows to the rough opening for the baths(2 down and 1 up.) Includes: 7/8"double glass with 2 layers of low E coating Argon gas Overall U-0.31 "ENERGY STAR" Welded sashes and welded frames Block and tackle balances with Night vent latches New interior wood trim to match existing New exterior Azak trim to match existing ' Tilt in ability of the top and bottom sashes 6-over-6 grilles between the panes of glass Charcoal aluminum latching half screens Any painting or staining that will be necessary will be the client's responsibility This will include the removal and disposal of the old windows and any storms. Insulation and caulking will be installed to provide a weather tight seal. Removal and reinstallation of window treatments such as shades;blinds,curtains or interior shutters are the.home owner's' responsibility. Please include with this.signed agreement,a check for a 50%deposit($1350);or,if you prefer,please ail us with your credit card info at 1-800-422-5365 x 120.Thank you $2,723.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Two Thousand Seven Hundred Twenty-Three&00/100 Dollars $2,723.00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZED 810 TURE-RISE ENGINEERI G TOM R ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ......-------- 0ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE -. SATISFACTORY AUTHORIZED TO DO THE WORN F ED PAYMENT WILL BE MADE A8 OUTLINED ABOVE DAYS. AS S Town of Barnstable *Permit# 026o d 603 �� PERMITPRESS Expires6mon[hsjromissuedate . Regulatory Services Fee $25.00 SEP 2 5 2007 Thomas F.Geiler,Director 91�107 Building Division TOWN OF BARNSTABLE 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 i Not Valid without Red X-Press Imprint Map/parcel Number 6 d 96 Property Address 1162 Shoot Flying Hill Road; Centerville, MA 02632 ❑x Residential Value of Work $5,278. 19 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Joanne Nelson 1162 Shoot Flying Hill Road; Centerville, MA 02632 Contractor's Name RISE Engineering Telephone Number 401-784-3700 A Division of Thielsch Engineering Home Improvement Contractor License#(if appIicab le)_ 120979 Exp. 3/08 Construction Supervisor's License#(if applicable) , OWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑x I have Worker's Compensation Insurance Insurance Company Name The Preston Agency Workman's Comp. Policy# 02 WB NL0984 Copy 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 R Replacement Windows. U-Value .34 (maximum.44) No Header Changes *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Own m H ust sign Property Owner Letter of Permission. (Signed copy attached)`. Home Imp? ement Contrac License is required. (Copy is. attached.),0 iIGNATURE: 4Yr7.;��� 1:Forrns:expmtrg Stephen Hines for RISE Engineering evise071405 VEati Town of Barnstable STAB Regulatory Services � � r' 'SEP 1 9 2007BA" '; � y Mass. g Thomas F. Geiler,Director Eo39+�,0 Building vision ►�r• g Di _ L Tom Perry, Building Commissioner 200 Main Street, 'Hyannis,MA 02601 L www.town.barnstable:ma.us Office: 508-862-4038 k.. Fax: 508-790-6230' `Property•Owner`Must Complete and-.Sign This Section If Using A Builder I, Joanne Nelson . , as.Owner of the subject property hereby authorize RISE Engineering to act on my behalf, in all matters relative to work authorized by this building permit application:for: 1162 Shoot Flying Hill Road• Centerville MA (Address of Job) ignature of Owner Date Joanne Nelson "t s Print Name A Q:FORMS:O WNERPERMISS ION r A e , The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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/Organization/Individual): RISE Engineering; A Division of Thielscli Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone #: 401-784-3700 or 800-422-5365 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its • required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I.[] Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑X Other Replacement Wind ws *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 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins.Lic.#:, 02 WBNL0984 Expiration Date: 04/01/08 Job Site Address: 1162 Shoot Flying Hill Road City/State/Zip: Centerville, MA 02632 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 the p ' sand penalties perjury that the information provided above is true and correct Si ature: Date: ;q Step en es Phone M 401-784-3700 or 800-422-5365 Ext: 117 Official use only. Do not write in this area,to be completed by city or town officiaL City or.Town: Permit/License# Issuing Authority(circle one): - 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f F POP Division of Thiel I S �'' sch Engineering,Inc. 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02410 i ✓ilia ioo>rwaonu�lJ�'o��macr�i�aelfe Board of Building Regulations and Standards . License or registration valid for indlvidul'use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Rpislr`atbn: 120979 Board of Building Regulations and Standards Q�► V25/2008 ' One Ashburton Place IIm 1301 ` P�iv'ate Co Boston,Ma.02109 IYP� rporation THIELSCH ENG1 STEPHEN HINES' 4v.' 1341 ELMWOOD AVFs.r .,..-�� .✓ CRANSTON,RI 02910 Administrator of valid without signature { 401 784 3700'. 800.422 5365 • NX 401-784 37I0 RISE ENGINEERING AGREEM NT " A division of Thielsch Engineering 3 -_ $ THIS CONTRACT IS ENTERED BETWEEN RISE AND THE $ _ - CONTRACTOR FOR WORK AS DESCRIBED BELOW 1341 Elmwood Avenue,Cranston,RI 02910 doff to N (401)784-3700 FAX(401)784-3710 CASE 089145., Page 1 IT IS AGREED THAT: CONTRACT DATE CONTRACTOR 0996 RISE window O 8/28/2007 ADDRESS . AUDITOR Doug Brown FOR THE CONSIDERATION NAMED HEREIN,SHALL PERFORM IN A FAITHFUL AND WORKMAN LIKE MANNER THE FOLLOWING WORK AT THE ADDRESS INDICATED BELOW: CLIENT NAME Joanne F Nelson CASE ADDRESS 1162 Shoot Flying Hill Road 089145 Centerville, MA 02632 PROJECT NO HOME (508)775-5653 WORK O X RIS-81-07-5486 CELL FAX FURNISH AND INSTALL: - 9/5/2007 10:04:56 AM Install(5) new white vinyl "DESIGNATE ll" double hung replacement windows built to the rough opening with hover 6 grid pattern. Install (2) new white vinyl "DESIGNATE II".double hung replacement windows built to the rough opening with 9 over 9 grid pattern. Contractor is responsible for all material delivered and installed in connection with the above work. Any deviations from the above specifications must be authorized by RISE personnel. Contractor reaffirms the covenants set forth in its Application for Participation.Violation of any such covenant isrbreach of this Contract. Contractor Shall indemnify and hold harmless RISE, its employees and its agents from and against all claims, damages, losses and expenses, including but not limited to attorney's fees,arising out of or resulting from the performance of Contractor's work under this contract. RISE Authorized Signature Contractor Authorized Signature DATE DATE 9/5/2007 10:04:56 AM Federal ID#05 0405629 A division of Thielsch Engineering RI Contractor Registration No. 8186 1341 Elmwood Avenue,Cranston;RI 02910 MA Contractor Registration No. 120979 (401)784-37 11 00'-A B 41 CONTRACT R I S E This contract is entered into between RISE ENGINEERING no Engineering and the customer for work as D s 'bed below. Joanne Nelson (508)775-5653 8/6/2007 1162 Shoot Flying Hill Rd C : _ -89145 . Centerville MA 02632 Doug Brown JOB DESCRIPTION RISE Engineering will provide labor and materials to install.new.Energy Star certified white vinyl"DESIGNATE II"double hung replacement windows. Unless specifically noted otherwise below, all RISE installed Designate 11 vinyl double hung windows include: 7/8"double glass, 2 layers of low E coating, Krypton gas (R-4.16, U-0.24, center of glass) "ENERGY STAR", Welded sashes and welded frames, Block and tackle balances, Night vent latches, Tilt in ability of the top and bottom sashes, grids are between the panes of glass, Charcoal aluminum latching half screens --� - i � v Any painting or staining that will be necessary will be the client's responsibility. Work will include the removal and disposal of the old windows and any storms. Insulation and caulking will be installed to provide a weather tight seal. ��..r r Seven (7) Designate 11 double-hungs, in white,with 67over- grills-between-glass, and built to the rough opening with new interior and exterior Azak trim. AUG' 1 F�// .':1.:u Any additional work involving changes in your costs found necessary for proper installation will only proceed upon the execution of a written change order. Such work could include but is not limited to replacing rotted wood found during the course of installation work. We agree hereby to furnish services-complete in accordance with the above specifications, for the sum of. $5,278.19 Upon final inspection and approval by RISE Engineering,customerr agrees 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,right of recision,scheduling,and contractor registration. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AU O Z IG TURE-RISE En ineering U TOMER ACCEPTANCE c DATE OF ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN. ACCEPTANCE OF CONTRACT-THE ABOVE P ICES, 30 DAYS. SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED. you ARE AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED ABOVE. Page 1 of 1 FFICE e�6 Pf :.:::x:::••: .:xr:: :::ii i:ii:::::i:::::::::::::4'•:i•:iiiiii::i::i:::::::.Y::::•:Liii{: ::{:y:::::::: .... ..........•.: ::{•:4iiLi.ii:;v:::+.i4i::4:•i:4ii::.:•• vi:•:iLt•:iiJ:i�ii:Jiii:• :::::..........:: ::...x...: ..rli :`: :iiii i;.:y•i.,•i:hiii?i}. r:>:::<<>:: DIN SERVI .::::..:...... ......:.:::::::... x'> L CO .. .::..:::.... :�::�:�s, lr�s'; u•: :�;:.,•�:` : :. .:.:::CHILD K. .............. txyi.>::>:.::.:: ``:::. .... ::H::<; ::< ::<:: is ism" ��� 00 FLYIN�:i ttt:HILL•RD•:::G ..... ......................:.. ................... ENTE V LLE .,.• i:F:�E".:•..:�} �j :::::::::::• ::::::::::::::::::•:::::::::::::::::::::::::•:::::.::::::::;:•;::::•:;:::;;;:.;::::;::•;:i}}•r:;:;iii:;::i•;;;;:::•:•::c:iii•:::ii•:::ii•;;w:•t.•::ii";•:.::.>: NEIGHB R ISO IK MEW 0 ..... .... ::::.:. .. :::.:. .:. � > < ..:.t t Gt USED ..:..MLTIt.:. �;::>::::::>.:>. BEIN AS MULTIPLE--PLEASE CHECK. C E C ::......:........ .................... R a h. 2 D �bG N•Gt� 1 ans�Q,Q_ 1 , 1 >} ` E �I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ^� r Map 1 Cl 0 Parcel Permit# .!". .. . Health Division 2 Date Is ed ' !;— Conservation Division 3/7cl- r,4-1 Fee Tax Collector N SEPTIC SYSTE MUST ST P7 Treasurer b INSTALLED IN CQ'641VLIA'Uv_. Planning Dept. WITH TITLE 5 NVI ONMENTAL CODE AND Date Definitive Plan Approved by Planning Board 7 TOWN REGULATIONS, Historic-OKH Preservation/Hyannis Project Street Address C7 F/�rl.�,y e �� (Zck Village C, -e-,11+�� Owner Jo ct-n n-f— � lid f.�S C3�1 Address I l t L � HP ( � Hd I ZLI, Telephone Permit Request ReP k c, �-X r S"��-��, ole'k �..�"1'G, a.-.� �� fie�C',1 ?l3'a� Square feet: 1 st floor: existing proposed , 2nd floor: existing proposed _ n Total new o.Valuation 3 ` ®Q Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size t I,_ .�� ` -�g. r= Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family l( Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes Vo On Old King's Highway: ❑Yes YNo 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 BUILDER INFORMATION Name 14C.'1 k-41 40 enr_ Telephone Number Address S Po(+S fd` be [yV-c— License# C S 0 0 © G 0,�` P /�ycx r►n r s . MA ( 11S O f ' Home Improvement Contractor# Worker's Compensation# IOKA 1?3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO rr►-. v cx rv>> .(� (� l7ln V �'f l( �' I Ca.i�l S t \'•- �1 `'•L�f fT/�.� � SIGNATURE -/ DATE 10 I, 10 1 FOR OFFICIAL USE ONLY k a PERMIT NO. DATE ISSUED z MAP/PARCEL NO. , f x f. ADDRESS VILLAGE OWNER- ' f DATE OF INSPECTION_- ' FOUNDATION _ FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH " t FINAL PLUMBING: ROUGH '" ' FINAL ? GAS: ROUGH rc .- FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r i • 3 The Commonwealth of Massachusetts -- Department of Industrial Accidents - o flee of/osest/gatioos , 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name s 1 1-4o'e r.•e_ An ®r-d.v t-rv%-e�rl+ location poy- ids r .t✓-� ci a r 0 �.0 i hone# ❑ I am a fiomeowner performing all work myself. ❑ I am a sole rietor and have no one worku in a�ca acity I am an em lover providing workers' compensation for my employees working on this job. P :.;:.. .......::........: Ctltlt(I8t1Y name `�' 1 c� t= i 1 it C'-rws . . hone*: tw p ...; ;.: . . Insurance:co :> ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the followin g wor kers co Pe nsation o.li..c..e..s.:.. .... .......................: ., .::;: :::::: :<.;:.>::.;.;;: ;;:;:;; ;. .. . <.;::.;,,.:;::;.;:.:<::.;«.;;:;:..;::.;:.;:.;;:>::::::<:»::>:::<::::::<-<:{;-;: cam ari name. :.. . .....: ..:. ........................ .......................................................................................................................... .....,::•:: X. :;:> .......... 2: ............is taiii::: •F::Win�:::: \:::•!: X ............................................................ ............................................................................................................................................. ................................................................................................................................................................ .......................................................................................................................................................................................................................... ...............:..�::;•::::::.:�::::.�::::. ':.viiii:ii':i:iiii v:iii:i•:i:•ii?J:<'i:!iii:::ii:;:!•:iS:ii:i4i:•:iiiiiiii:G::Sii::vi:is?i:i:: i......iiiLiiii itii iifiiiiiiiiii:i i:... ... ................................ ..................:......:.........v....................:::::::::.i.....: ..................................................... ..........!............ ....................:................... ................ ::•:::....................................................... r}!::.::..:..::•:".:;:..:::i:`::::'':}iii:!v:-iii:!9iii:}jj»i:::•:::'i:'::i:i::::;.i::.i':.i}ii:i':.}}iiiii:�:::':i'::`::is%:i:�v:i:i:::::-:ii::::!.::{:':i•:i:::i:i:f`::i:::'.ii:. ;::::::::i?:::::::i::.iii: •: :.: :.. :,...., ..:: .:..........:. olrcv:# >.:: �M .address. t�hone# cites ....... ;.:::.;::'<<:`::;:::>>: ......::'<::::<:::::<:::>:::><::::>::>:::<:::> nsnraacc co.;: 0 Fafiure to aeeure coverage as required under Section 25A of MGL 152 can lead to the imposition of criarirnsl penalties of a fine up to S1,S00.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a ilne of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is trrw.and correct Date r O I�I o Signatures Print name 1�e C� rr^ iJ /? S�t✓ Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# • ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Hesith Department contact person: phone#; ❑Other 0evind 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", 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 receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the until commonwealth nor any of its political subdivisions shall.enter into any contract for the performance of public work acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and ers along with a certificate of insurance as all affidavits maybe supplying company names, address and phone numb submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and =t date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is Accidents. Should you have an questions regarding the"law"o if You the De partment of Industrial Y. Y� being requested, not ep e call the De partment at the number listed below. compensation policy, leas are required to obtain a workers mp P cY�P 00 City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill.out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents eMce of investigatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 The Town of Barnstable 9' MASS. Regulatory Services rEo �r Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 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: Ke oJ1x L1-- Estimated Cost�3,, 6700 Address of Work: U Owner's Name: J d hz ' • t y e, SO Date of Application: to I hereby certify that: Registration is not required for the following reason(s): []Work 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 Contractor Name Registration No. OR Date Owner's Name q:forms:Affidaw rev-070601 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck ( x$30.00= �` (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee 3 d- projcost •. ✓h4.I�I61/MNAYsIIUv¢�� /� �i/41ECfJ+' ? HOME IMPROVEMENT CONTRACTOR � Registration: 105521 ICJ Expiration: 7117102 Type: OBA HASKELL HOME IMPROVEMENT RICHARD HASKELL 7 Portside Or. ADMINISTRATOR Hyannis MA 02601 Licensor:: NST Number. 'CS Birthdats: 05/21/1946 € Expires:05/21/2002 Tr.no: 23921 „ a ,.Restricted To: 00 RICHARD B HASKELL Ii j PORTSIDE DR G�«•�, %�/' AAA 02601 Administrator, FILE # H3RJO CENSUS TRACT # CLIENT : navidDEED BOOK 6693 PAGE 325 OWNER : PLAN BOOK PAGE LOT APPLICANT: ASSESSORS PLAN PLOT MORTGAGE INSPECTION PLAN of LAND I N C E N T E R .V I L 'L E SCALE : 1"= 50 JANUARY 8, 1990 4.C�T Cp M • z 0 ± S,F� M M3 S Z STD R1� C4 V 125,Zg St-IaoT FLYING Pitt- RoA.D I CERTIFY TO ATTORNEY DAVID K . SYKES, FLEET MORTGAGE, AND ITS TITLE INSURANCE COMPANY, THAT THERE ARE 'NO VISIBLE ENCROACHMENTS OR EASEMENTS EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERVISION, THE LOCAT`:ION OF THE DWELLING AS SHOWN IS IN COMPLIANCE WITH THE . LOCAL ZONING BY LAWS WITH RESPECT TO HORIZONTAL DIMENSIONAL REQUIREMENTS . ,A "4r: Ai •...j THE DWELLING SHOWN ' HERE DOES -.NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE AS r,' FERfi,, i �. DELINEATED ON A MAP OF COMMUNITY #250001.0 \ M ' 1e: DATED 8/19/85 BY THE F , I A,- F. . csT THE EXACT LOCATION OF THE BUILDINGS SHOWN CANNOT BE DETERMINED WITHOUT AN ACCURATE INSTRUMENT SURVEY, Land Surveyors Civil Engineers (gibe �ostort Xana ,�$urbeg (go., 4nc. 172illittmt. Ntb �tbfara, c 02740 GENERALNOTES: (1) The declarations made above are on the basis of my knowledge, information, and belief as the result of a .mortgage plot plan tape survey inspection made to the normal, standard of care of registered land surveyors practicing in Massachusetts. (2) Declarations are made to the above named client only as of this date. (3) This plan was not made'for recording purposes, for use in preparing deed descriptions or for con— structions. (4) Verifications of property line dimensions, building offsets, fences, or lot configuration may be accomplished only by an ,accurate instrument survey. � I I AJ _ a Os -- — _D G i •` � a I I I i - f 1 54 u 1. IL I � irk r _ 1 i I I I I I I I ILo I I � - oc IZ 6 !}yam/ If Ti LF uy, xFo'oT VF/ > o r04T