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I . ��� 1� .. , ,,"I'll I'll - " " �'1111111 I" I , , il . . . ------ . - Clij, 1555,��, � ­ t � .,.!!!!1 1� e',,�,P c ��� o 9 --------- - � ",", � �� "2... L - �- 08 Sep 1412:37p TupperCom 15087785010 p.2 o� all CONSTRUCTION CO. LLc 7 B 9 MID-TECH DRIVE WEST Y ES ARMOUTH MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 VAVW.TUPPERCO.COM Date. qjc614. Town of Barnstable Thomas Per CBO.Perry 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax. . Re: Insulation Permits Dear Mr. Perry x This affidavit is to, certify that all work completed for permit application # �= j (� c� Issued on llj has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and'State requirements. Sincerely,.: Permit #: � Address: Richard Tupper License # CS-69058 't TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` ! / Parcel . plica l# ' 6 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee WZ Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address '7` 7 l;l Qred ,& Dl'. Village Cam-,Lam^/l Owner y � )�� Address _ 7 �'1 Cl/� - /', Telephone Permit Request /Jh c�luldfe f l " A /.t C&24C2% ©/' /yam 0/7 L CW O( . f Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio �e5-pconstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s rting docAmetion..; Dwelling Type: Single Family 8' Two Family ❑ Multi-Family(# units) r c3 Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings 'ghway: 'dYes ] No" Basement Type: gull ❑ Crawl ❑Walkout ❑ Other to Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) xri , Number of Baths: Full: existing_ new Half: existing l new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: U<as ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes 9'I l_o Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use - . -> -Proposed Use-- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name x--' Telephone Number MX Address /i i/3 License# Cam✓ �C1lYQS I/IT � Home Improvement Contractor# 3 / r ' Email �( 1'�')/Yl '� ��� � L Worker's Compensation # UCC�CDSS'�13�7aoD 7 ALL CONSTRUCTIO D IS RESU TING FROM THIS PROJECT WILL BE TAKEN TO /ZZ /b r&4- :L�_i &WZAne d,2­& 7 SIGNATURE DATE �� ,C 4 FOR OFFICIAL USE ONLY APPLICATION# -i DATE ISSUED t 1 MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: 5 FOUNDATION FRAME INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT > ASSOCIATION PLAN NO. r ACORQ CERTIFICATE OF LIABILITY INSURANCE 4 f 12/03/2013 Ti IS.CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY•AND CONFERS NORIGHTS:UPON THE_CERTIFICATE HOLDER:THIS CERTIFICATE'DOES':NOT.AFFIRMAMVEL*OR.NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES. 1' BELOW; THIS CERTIFICATE OF 1NSURANCE;DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiflcate holder is an.ADDITIONAL INSURED,the,policy(Ies)must be endorsed.if SUBROGATION IS WAIVED,'sub)ect to the terms and conditions of the poKcy1,certain policies:may rsq.,,re an endors®merit A state nsnt on this certificate does riot confer ghts to the certificate:hotderin i'leu of such endorsement(s)• PRODUCER _- c AME- .NT C LOa LLowe9enc Southeastern insurance A Inc.Y+. Nnrc°"ro. -. (508)997-6061 F�.�,,;t508)990-2731 430 State-Rd. MAIL `ADDR 55:- ... ....... P.0. Box .79398 P DU ER CUSTOMER'ID*. .. N. Dartmouth, MA 02747 _ _; ,.,,. •.. INSURER(S)`AFFORDIN GOO VERAC,E NAIC#i INSURED : �INSIJRERA-. Arbella Protection Insurance i Tupper Construction Co LLC `nsIRER AEIC INSURER.C: CNA. Surety 27 Roberta Drive INSURER O c West Yarmouth, MA 02671 INSURERF .. .. INSURER-F: COVERAGES CERTIFICATE NUMBER: 2013/14/1 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE EO INSURED NAMED AS FOR THE POLICY PERIOD' INOICAT .: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 cokb TIONS OF SUCH POLICIES.LIMCfS;SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: MR: - ADDL B _. .POLICY POLICY EXP LTR. TYPE OF-INSURANCE'.. INSR.WVD POLICYNUMBER: MMIDDJYYYYJ (Mmmwrrrn LIMITS GENERAL LIABILITY : 81500009?43 1;110112013:.:11/01/2014 EACH OCCURRENCE. s: .liow 00 X .COfAMERCIAL,GENERAL LIABILITY DAMAGE Eaacaurencal ( 100io0ol CLAIMS-MADE X;OCCUR MEDEXP(Anyonapsiwp) JS 5;00 A I PERSONALBADVINJURv i si T,Q00, _ y , GENERAL AGGREGATE s. 2,060 00 GEN'tAGGREGATE:U.MIT APPLIES PE:::R PRODUCTS-CL3SdPtOaAGG S_ 2,000 PDUCY t JPER0.- _. LOC ..... -S AUTOMOBILE LIABILITY 5666240000 12/0112013 12/01/2014 COMBINED"SINGLE UMIT 1 S ANY AUTO lEaaiLdemj _L 1,0001 BODILY INJURY(Per person): S'. ,,. . ALLOWNEDAUTOS': BODILY INJURY(Firlcddenij. S: A X. SCHEDuLED AUTOS PROPERTY DAMAGE S X HIREDAUTOS (Peraiadent) m X NOWOWNEDAUTOS' ,� $ UPABREUAUAB` X occUR 460005836 t110112013 1110112014 EAcr+accuRREi�cE s 1,000;Q0 FXCESSt.1AB- ClAIR75=tcikDE - AGGREGATE 3 ,,.1,000y�0, A DEDUCTIBLE. ... `,, RETENTION .:5 _ ....... IS WORKERS COW ENspTION WCC500559301200711910311013 1010312014 X c'TAni` X rnrt AND EMPLflYERS'lJABILITK ylpj ,,JJ TORY LIMITS ER: I ANY PROPRiEtOWPARTNEWEXECUTIVE RICHARD TUPPER, ISi 1 E.L EACH ACCw—NT S 1,000,1)tl B OFiICERAAEMBEREXCLUDED?. N)A (MandatwylANH► .-.:. „LWDEU FOR wC COVERAGE. EL DISEASE-EA EIAFL(W -S 1.,000 IS qqes,des&ibe under .. S DESCRIPTION OF OPERATIONS betow• E_L DISEASE POLICY UMit' S 1 000,00 ( r jj II , DESCRIPTION;OF OPERATIONS I LOCATIONS I•VEtIICLES(A#!w*ACORD 101,Add`moi a{Remavim tchedule,if mi6m 6paee is requiredl CERTIFICATE HOLDER__ „ _ CANCELLATION SHOULD ANY OF THE Aeove DESCRIBED POLICIES BE CANGEL:CED,BEFORE THE EXPIRATION DATE' THEREOF; NOTICE WILL Be,: DELIVERED IN ACCORDANCE V4ITH.TH€POLICY PRdVI510/5 '°For Information Purposes Only"` Tupper st Conruct4ofl to LLC AUT►IORIZED REPRESt NTATVE 27 Roliertal DrTvo tii Y . arn�u#h, 'MA 02s73:. ... Lora Lowe ©:198&2009 ACORD CORPORATION: All rights reserved: AGORE125:(2809/09) The,AC4RO name and Iogo are registered marks of ACOR.I) ,. ` ••, �'he oatt�oPeweardth.of171�.csar��us�t�s' DepartOwnt;ofluduvrialAecidews O,f, W of.investigations 1 Contress sw4suite.160 �®SdOifd' ?�A tIZ II�2i1�7 wwwmrass gov/d ra Workers'Coanpensation Insurance ABid- it:BuildeaslCo tt-aetorsfEiecta-icia slP eaanbers. Ai�lpliean$.Infmr>nmati©n Please Print LeililY Name(BustnesstOrgan;zation djc�dual} TuPPer C nstruction I .Addmss:79B Mid'tech Dr City/Ste/Zip:West Yarnouth,MA-02673 Phone.508-778-01:1:1 Arevou an empiogerq Check;the appropriate bog: 1. arts a emplover.with [] 1 am a.geheral contractor and.I 7f -PC of project'(regnifod) employees.(full and/or part-#itne).,* have hired the sub contractors. 5 \feiv consfiructio t 2>® 1 am a sole-proprietor or"Partner-- listed on the;attached sheet: 7 .j�Rem, del ri— ship and have no emplovees ese sob-contractors'have. g Demolition c}' 7 ves and have workers, narking for tnem aril rapactt� em P [No corke rs' comp.msurarice comp.insurance* 9 ❑,Building addition r tnrad] 5, a.cocporauwand its 1 Q[�Electrical repairs or Additions 3 ❑ I am a homeowner doing allvrork,. officers Stave exergsed their; 11.[]"}'lumbutg repairs_or additions; m}=self. INN workers` imp, right n#'exOnptton per MGL El Roofrepars urattea required.)' c. l 2 §1(4),and eve hava no employees. [l?tt��*orkers� 13. :C?tlrer Weather i zation/ comp_:insurance required) ns u a zon "rAinr appli antthat atsei ks bo:Ml nwstalso fill ou6the seeson.6elow show ngthcituorkeirs'.compena tion policy in#btnrtairon.. t Homau�vnery Ldho submit this at davit iztihaaang bey are doing all work and-the hire outai&e contractors musrsubmit-amv affidavit'di Such.Gantractors tihar check this box masi attached an additianar sheet si ing the name of the sub-contractors and state w-beihar or not t}iose.etrtitt� employees. tf tha suti:cuntractorshivc oniplopee e�.inust yrovide their %ibrkars.comp jxiGcr muiiberc i aim-an,employer that is proWdiV workers'pprnpeusrrtroii insuran e, lr eritplvvees Belvu is'the p€flrt�"�an�j4fi Sir i rfori;+tatiom murance:Colnpa4jy Name;,AEfC' Policy#or Seff iris', Ltc.9;:WCC50055930920flZ 90/3I1 Expiration fob CiyJSfiatetZtp: 0,fob S te Add iress � "ILI Attach a OPY of fire W94ers. comptn"Oon policy deciaratio page(showing.the policy ntiiaaber and'expiratlti8.date); Failure to st?citre coverage as tqured undei Sec#iotA of NIGL:c l a2 cart laid to the itsposition-of criminal penalties t�#a fine up'ta I,�OQ.Q.Q and/or cne-year ittiprisottment;as well as civil penalties in.the.forth ora STEP UTDi21 ORDER and a fine ofup to 254�:{)O a day agt� tst the vitilatur.. Bti advised dial a copy of this;staaterne�it traay be for<vtt� fecl to t}e.flt ice of Investigations of the i nce Co ve6fication. p ris.unri pei+ie OesOperjuri-that 10-in'frrfriiition}ainuided`rrbv is true ear eorrert cierl use army d)n nut write Ii this/diet/,to 5e cmmpfetehv i0:fir fowFi ufftr iul. iLY ttr`#'owg:: peiriztitlLicetrse;#. ssving;Authojw,(car ry qne} : . 3oard.,of I"th 2 Bua OOg,Pejparfanent '3:Citr£7Fown C&erk .�Electricat Inspector S..I'fumbemg inspector father r, ontact 'ersonr - I I iSv33;i1!( to °t 3MANGkINS t J*UtE,INC � Mass,�ch�setis-t�epar*rneA:��r�abii SafeL<i' , 10Ti^ia�t&S Rtk'i�,Slate��p. _ � poar�#,o€:�u��dirg�"c3��aT:aa�s nn��fa�darc:s Mau,t+iY 12b�fF. � CirrcrrucTi�ttr Su r��ti isoi:f ,877t274 1274 �� icense:CS-069058 n:ur�.tt�,to:n: �. � � RIQ ARD;S TUPPER 79 t3 tiIITD-I-EClt:DR Jaj', " WTEST Yc9P04015f H NAy:0203 iib#tard Tupper 1CF01 m t g a 5GEf08 1o1ffTI6N5+Sf+0 cnnmisate3 es 9213(lZC9 iSREtti�Epwt7t�IFATI0#d6AiE31 _tDffire of C®Asu cr {�ai�^s�t�usincssRegulaiinn License or'registra ion valid'for individu}use only: OCHE IMPROVEMENT:CONTRACTOR Defare ttrexpi date. if found return to: _egistration: 178434 Type-1 4qffice of C ff'irs and Bus Tess ft gulatian u ;0 Par aza-Sue 51�0 Expiration 4/1612016. LLC B to T UPPER CONSTRUCTIPWcO.� C: RICH AR© TUPPER ; 79 8 MID-TECH DR W.YAt MOUTH,MA D2673 Undersecretart* 1 0 puts! nature , �, e�rsa+,l:tasici�uoit� a FeapleHelpingRapleWW1 a+SafertAto�! -. . . �tFRNATiI�� - € co�couerar MEMIBE Rice and Tupper j Tupper Ccinstruct 06i gutldirtg Safety Rsofessional McMber M$15,8119 Exp.41301201: f oUlSin Assistance Corporation Cape Cad HOME-OWNER I RESIDENT WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation(herein after referred*as "Agency")on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping &caulking of windows and doors, insulation of attics, sidewalls&basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: i. I give permission to the"Agency"its agents and employees to travel onto or across said property with such equipment and materials as may be necessaryffto perform weatherization work on said property, 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five(5)years after the weatherization work Is completed. I have read the provisions of . �s/ greement as listed d freetr give my consent. ti 42 Home Owner: (Signature) Date: /moo/� Agent: (signature) '` J~ Date: HAC approved Weatherization Company : Adam T Incorporated . All Cape Energy Alternative Weatherization Building Performance Contracting LLC Cape Cod Insulation Cape Save Frontier Energy Solutions Lohr Home Improvement Resolution Energy . -.1(is,;i..:•ti,=....`-i!; ..:...�;�s: :F . ,'.fir:-: :-:, �i; .-_,,. i , , VTown of Barnstable *Perm (�� Re g Y ulator Services Fee 6 wontff .39. Richard V.Scali,Interim Director 6I h '771 � Building Division 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 PERMT APPLICATION - RESIDENTIAL ONLY Map/pazc Iq I Not Valid without Red X-Press Imprint el Number. JU �j /�� OeKI Property Address / �" `-�erC U ®"r�f� residential Value of Work$ 6 U d Minimum fee of$35.00 for work under$6000.00 % Owner's Name&Address �� d ��' ��ZC4,� Jr �Contractor's Name /C ( � Telephone Number Q `� Home Improvement Contractor License#(if applicable) t16® 6 C _) Email: 6-4-7 ra✓/'� 7 Gacc Construction Supervisor's License#(if applicable) /Q C) 03Vorkman's Compensation Insurance y� Check one: ❑ I am a sole proprietor JUL 1 � t 4 ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name C it e� ® �®��r9� �TA®� }} PE Workman's Comp.Policy# � k `�y 0 J 0 Q Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&lire Permits required. "Where required: Issuance of this permit does not ekempt 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 required. SIGNATURE: TAKEVIN DBuilding Changes\EXPRFfS 6MAXPRESS.doc Revised 061313 ?lie Commonwealth of Massachusetts Department.of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 irti n:ntass gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / gPlease Print Legibly Name(Business/Organizatiou/Individmi): f ca ecm ��— k Address: /f l- Fl y t' 6rrWrf Citylstate/Zip: o7-4 V r(f of Phone 1k Are you an employer?Check the appropriate box: Type of project(required): 1-EF I am a employe with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time)-s have hired the sub-contractors 2-❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling ship and have no employees These sub-contractors have S- ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp-insurance comp-insurance.= required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3-❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions right of lion per MGL ❑ myself.[No workers'comp- �P p 12- Roof - insurance required]Y c. 152,§1(4),and we have no employees-[No workers' 13-❑Other comp-insurance required.] 'may applicant that checks boar#1 mass also fill out the section below showing their w01cers'compeosatioa policy infortnetioa t Homeowners who submit this affidavit indicating they are doing all wo3*and then hue outside contractors inns-submit a new affidavit indicating such- ;Contractors that check this boat must attached an additional sheet showing the name of the sub-ctmnactors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their warkers'comp.policy number- I inn air employer that is providing workers'compensation insurance for my employees. Below is the policy and job site in rniaHOf6 �B Insurance Company Name: C S' Policy x or Self-ins.Lic.4: WC 0�p- d-0 003013 ~V dL Expiration Date: L/ Job Site Address: / I y City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 andlor 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 s polio s etjury that the in formation prordded above is trrn anV; 71�- Date: Si hrre: 4 � Phone#: ,J 0 6d Official rue 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 ?.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M. y .fi ! R AZEA 1 ROOFING & REPAIRS PROPOSAL Proposal No. 14-130 February 24,2013 To: HAC-Al DiMuzio Work to be performed at Re: Joe Pino 47 Thoreau Drive Centerville MA We hereby propose to furnish the materials and perform the labor necessary for the completion of: NEW ROOF 1. Remove existing shingle roof 2. Install new aluminum drip edge 3. Ice&Water barrier first 2ft, all skylights and penetrations 4. Cover roof with 15 lb felt 5. Re-roof with 30 yr architectural shingle 6. .Install ridge vent 7. Flash all pipes and penetrations 8. Remove all rubbish from project Labor and Materials $6,600 All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications and completed in a substantial workmanlike manner for the sum of Six Thousand and Six Hundred Dollars $6,600 with payment as follows: Six Thousand and Three Hundred Dollars $6,600 due upon Completion Respectfully s tte " l Richard P. C ult, r. 198 Five Corners Road Centerville,MA 02632 (508)420-5482 Acceptance of Proposal No. 14-130 The above prices, specifications and conditions are satisfactory and are hereby accepted. o are aut ,rized to do the work as specified. Payment is outlined above. ta ----_---_---ture Date ACC � RTIFICATE OF LIABILITY INSURANCE 7415/2014 (MDo"r"' THIS CE TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an-ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER-- . , CONTACT Berkley Assigned Risk Services NAME: McShea Insurance PHONE FAX Ac ND.End: 800 634-4589 (A/C.No.>: 866 215-8118 1550 Falmouth Rd RT 28 Ste 2 ADD LSS: PolicyServices@berMeyrisk.com Centerville,MA 02632 a INSURER AFFORDNG.COVERAGE NAICir INSURER A Ar-ad*a Insurance Co 3t325 INSURED � ". INSURER B: Richard Cazeault Jr INSURER C: 198 Five Corners Road. INSURER n Centerville,MA 02632 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER . POLICY NUMBER POLICYEFF POLICY EXP LTR INSR WVD MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY AUTOMOBILE LIABILITY $ " WORKERS COMPENSATION YIN TWORYT ATU OT AND EMPLOYERS'LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVE Y EL EACH ACCIDENT $ SOO,000 A OFFICE/MEMBER EXCLUDED? N/A ❑ WC-20-2M03O9M2 02/04/2014 02/04/2015 (Mend story I n NH) 500,000 If yes,describe under i EL.DISEASE-EA EMPLOYEE $ DE SCRIPT DN OF OPERATIO NS below - E.L.DISEASE-POLICY LIMIT 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101.Additional Remarks Schedule,a more space Is required) Coverage Election Category Elect Status Name States) All Entities/Locations Sole Proprietor Exclude Richard Cazeault 7r.a MA - Cazeault=Jr`"` _ _ - 198 Five-Comers Road-Centerville,KA'02632 --- 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 - Signature: ACORD 25(2010/05) BRAC 3139 Massachusetts-Department of Pubii:Safety _ e. Esnarr+o,Sttiiding �guiations and Stand refs Construction Supervisor • License: CS-100393 RICHARD P CWAULT3R; 198 We Corners Road Centerville MA 0632 _ Expiration Commis^s'iionner� 02/03/2016 - e zeclirtrcrstzccroa./ Gf fx ri jr Otce of tonsa„ern tars&Bust r` "r , P I'll s License or registy ion�aitd fret m viduE t,sE ot:ly ,Fse t• s egtstrator, 163507 ,ACTOR before the egptrattonr datg surd return to' r # 1ypc p viice of Consume Affairs t siness Reulat,or.,_ a ` tcptraUo^. 8/201fi Individual' 10 Park Plaza-$uite5170 RICHARD P..CAZ ? Boston,M: 116 •RICHARD CAZEAULT: 198 FIVE CORNERS RD.:' CENTERVILLE,MA02639 Undersecretary f b t alid w out sf t1tie.- I 1 CAPE SAVEWeatherization . 508-398-0398 December 14,2011 Town of Barnstable. Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201103659, Status A, Parcel 191230 at47Thor_eau.Drive, Centerville,Permit type: RADD, and issued on 7/21/2011 has been inspected by a certified Building Performance Institute (BPI) Inspector. R-10 Cellulose insulation was added to the attic. R-19 fiberglass batts were added to the open rafters,walls and kneewalls.All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey OK Cape Save 7 Huntington Avenue Suite C, South Yarmouth, MA 02664 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION :. ,3 C� Application # Map Parcel ` Health Division Date Issued Conservation Division Application Fee s Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 7114 Historic - OKH Preservation / Hyannis Project Street Address h G ir�ecty Dt l Ve Village C c n 4e r-y, Y Owner S e P —Address Telephone 5 p? " �j 5 - y Permit Request r, R R-D e r_» -1os�-_ fio h i r egA_ a=tnti - 9- ND S6Un e f.�J�-� o[ v►� ��� r,ors ail"k iG ino C0A&_._/,Jz _-5n q ►.k. 9— ^C'cac, V YA-V S. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation - 000 Ob 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 9 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 5 new First Floor Room Count Heat Type and Fuel: 41 Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes X 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: dexisting ❑ new size _Shed: ❑ existing ❑ new size Oth Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ c c Commercial ❑Yes ❑ No If yes, site plan review# a Current Use Proposed Use --n APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name W 1� i McCIO-Skey [CO-Pe &\'e Telephone Number 5 0 0 _ 3 �O " 0 Address 4CL-n n-H A c loo NVIR License # �a� S6.4k Ya,m. i c��.6 6 Home Improvement Contractor# Worker's Compensation,# n T 30 1-5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _\( r. SIGNATURE DATE - � a FOR OFFICIAL USE ONLY APPLICATION# c DATE ISSUED r , MAP/PARCEL NO. F' f 'i c ADDRESS VILLAGE ' OWNER x DATE OF INSPECTION: `# FOUNDATION FRAME INSULATION k FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ■ ASSOCIATION PLAN NO. II 13 T 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(Businessiorganiwion/Individual): (S'- t -bZ��(� ►�1r� C' i�� Address: -C. t t11r-411r4(*''bL� City/State/Zip: YA9A j, tAft Phone#: - 019 31726 Are you an employer? Check the appropriate box: Type of project(required): 1.[K I am a employer with �1 4. ❑ 1 am a general contractor and I employees(full and/or part-time).` have hired the sub-contractors 6. ❑New construction'' 2.❑ I am a sole proprietor or partner- listed on die attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have ' 8. ❑ Demolition working for me in any capacity.ca acit employees and have workers' 9. Building addition [No workers' cotizp. insurance comp.insurance.t required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing al!work officers have exercisedr 11.❑Plumbing h their airs or additions g repairs myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]¢ ' c. 152,S 1(4),and we have no employees. [No workers' 13.El Other r .il%Ai'm comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and 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 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: �' T 15 � -S.i.t ghrsj C-C Policy#or Self-ins,Lic.#: C- - Expiration Date 2-1 Job Site Address: _ 0 re aU Dr', T e City/State/Zip: C eO er_419)le, m fr Q w a 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 d enaldes erjury that the information provided above is true a correct signafore: Date: _ Phone#: 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#: ,x c CERTIFICATE OF LIABILITY INSURANCE DATE11111111IMNYM d..•� 111/1/2010 A MATTER INFORMATION ONLY AND CONFER N THIS CERTIFICATE IS ISSUED S A OF FO S O RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(tes)must be endorsed. If SUBROGATION IS WAIVED,subject to the term 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 Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 FAX Nlo.(781)963-4420 _._.._ 15 Pacella Park Drive ADDRESS am :8sperrazza@risk-strategies.a y�_ Suite 240 CUSTOIAERI0#00018476 r Randolph MA 02368 i _ INSURER(S)AFFORDING COYERAGE i NA1C# _ INSURED —;INSURERA:Seneca Specialty Insurance Cc I INSURER e,.Keating Group Ins Services Michael McCluskey, DBA: Cape Save INSURER c:Chartis Insurance 7 C Huntington Ave INSURER D INSURER E: South Yarmouth MA 02644 1 INSURER F COVERAGES CERTIFICATE NUMBER:CL1011132675 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR V- POLICY Ef I POLICY EXP , LTR' TYPE OF INSURANCE POLICY NUMBER MM/ D MM/DDIYYYY : LIMITS GENERAL LIABILITY ! EACH OCCURRENCE i_^ X COMMERCIAL GENERAL LIABILITY PRE DAMAI GE TO RENTED ISSES(Ea occuasnes) S 50,000 A :CLAIMS-MADE 1 X OCCUR 13AG1002600 10/16/2010310/16/2011�MEOEXP(Anyonepw9w) '$ 10,000 PERSONAL&ADV INJURY S 11000,000 GENERAL AGGREGATE $ 1,000,000 WWL AGGREGATE LIMIT APPLIES PER: j PRODUCTS-COMPfOP AGG :$ 1,000,000 X POLICY r17. PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 i?ANY AUTO i6208200 11/6/2010 ll/6/2011 I(Ea 106f1i— _— BODILY INJURY(Per person) `$ ALL OWNED AUTOS I F----— -�- (BODILY INJURY(Per sodden)$_ X :SCHEDULED AUTOS PROPERTY DAMAGE — ^X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS ! I S C- - 1 X UMeREtLA $ OCCUR ' EACH OCCURRENCE $ 1,000,000 EXCESSLIA18 CLAIMS-MADE! + AGGREGATE — �1$ 1,000,000 DEDUCTIBLE B :RETENTION $ 1023578601 10/16/2010'10/16/2011. _ $ c I WORKERS COMPENSATION �ichael McCloskey YfN X 4VCSTATII ;OTH-I I . AND EMPLOYERS LIABILITY ' ! .a TORY j y ANY PROPRI£TOR/PARTNERIEXECUTIVE is excluded from coverage! ' E.L.EACH ACCIDENT $ 1 OFFICER/MEMBER EXCLUDED? i N 1 A T SOO,Q00 Myyaeen�sda inN 9930951 10/21/201010/21/2011;E.L.DISEASE-EAEMPLOYEel$ 500'000 DESCRIPTION OF OPERATIONS below ;E.L DISEASE-POLICY LIMIT i$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Issued as evidence of insurance. Contractors-Executive Supervisors or Executive Superintendents. CERTIFICATE HOLDER CANCELLATION (508)7 90-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DE LIVERED IN Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ruth 460 West Main Street AUTHORIZEDREPRESENTA71VE Hyannis, NA 02601-3698 'chael Christian/SM$ ACORD 26(200W09) 01988-2009 ACORD CORPORATION. All rights reserved. INS026(2cam) The ACORD name and logo are registered marks of ACORD i - =` Office of Consumer Affai s and Business Regulation 10 Park Plaza - Suite 5170 a" Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164432 Type: Supplement Card CAPE SAVE Expiration: 10/6/2011 WILLIAM MUCCLUSLEY --- _-.... 8201 S. HOURD CT CHAPEL HILL, NC 27516 Update Address and return card.Mark reason for change. OPS-CA, 0 s0at-04!04-os``01216 j Address � Renewal "-1 Employment {_ Lost Card .,+._, :/<lP. Cf'!?PtY IlG4/'d0{JP./X.4Gf1. !�.IYGtX:i.iCld'BLlli8+t�.t Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 164432 Type: 10 Park Plaza-Suite 5170 Expiration: 1016/2611. Supplement Card Boston,MA 02116 CAPE SAVE WILLIAM MUCCLUSLEY . a 7C HUNTING AVE,S.YARMOUTH,MA 02664 Undersecretary Not valid wit ou signature ela.�acltu.ctt. - Department of Public <saf t'N &►xrd of Buddim, Rr,,ul ttion%clad Stdtttt1:11-t1s t.°OnstructiOP SUPACr,. sor Spir—f lty License License: CS SL 102776 Restricted to: IC WILLIAM MC CLUSKY 37 NAUSET ROAD '--' WEST YARMOUTH,,MA 02673 Expiration: 6/28/2013 {. <<enrori ems.ni.t Ts=' 102776 08/2512010 09:23 9193212955 PAGE 01/01 Weatherization 508-398-0398 COE SAVE August 22, 2010 To Whom It May.Concern: , 4 William J. NlcCluskey is an empioyee.of.Cape.:Save. He is authorized to negotiate contracts and-building permits for our.company. Michael McCluskey Cape Save--owner 919-593-5939 cell ; a X Huntingtol.Avenue,,,South Yarmouth,NIA 026 ' r A HOUSING 460 West main Street Hyannis, M 02601-3698 ASSISTANCE ENERGY & HOME REPAIR T (508) 790-7106 E (508) 790- 3 CORPORATION 2425 HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: THEAPPLICANT HOMEOWNER. I �- 4�`_ hereby consent to and agreethat weatherization work may be .._�. ien-Pegs-o€H etagAanse�oFperia-(-herei n after re€eFf:ed a - "Agency")on the p perty located at- a_ Theweatherization work done willbe based on programmatic priorities and availability of fundingand it may include all or some of thefollowing measures: Weather-stripping& caulking of windows and doors, insulation of attirs4 sidewalls& basements, attic and other ventilation measuresand possibly replacement of badly deteriorated windows" In consideration of theweatherization work to be done at my home agree to the following: 1. 1 give permission to the"Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be nary to perform weatherization work on said property- 2. TheHousing Assistance Corporation reserves the right to inspect thefuel or utility bill for the weatherized unit on an ongoing basisfor no morethan five(5) years after theweatherization work is completed_ 1 have read the provisions of this agreement a Ifisted rely give my consent. Home Owner: (Signature) Date - Agent: (signature) Date HAC approved Weatherization Company : �� All Cape Energy, Caliber Building&Remodeling, Cape Cod Insulation, Cape Save, Creswell Constraction, Frontier Energy Solutions, Lohr&Sons, Peter Smith, Resolution Energy, Rock Solid Construction r TO D 3 TIME)a FROMn � lA COq! Fat OF W �>Q N W .. ; SIGNED'77 n �G t ttRN�D CAT f WILL Chf t] 1>lic p WANTS o VMA CAf1 �i4CK � C L! \ @KOUa 1# `--AMPAD NO.23-176-400 SETS N0.23-376-200 SETS f Town of Barnstable Building Department ComplainVInquiry Report Date: Rec'd by: Assessor's No.: le Complaint Name: -- Location Address: M/P Originator Nwne: Street: Village. c S� Zip: Telephone: D/E Complaint Description: — 9 7 T Inquiry a Description: For Office Use Only Inspector's Action/Comments Date: /,zz I Xg..L Inspector. Follow-up Action Additional Info. Attached Copy Distri&don: %bite-Department Me Yellow-Inspector Assessor's Office(1st floor) Map Lot rmit# Q LJ r °Coz-tervation Office(4th floor) Date Issued Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) Fee - Engineering Dept.(3rd.floor) House#1 2 , Planning Dept.(1st floor/School Admin. Bldg.) � BARNSTABLE. Definitive nPel by Planning Board. 1OFTOWN O BARNSTABLE Building Permit Application Project Stree � � D� L , Village -Q-. Owner Address P . 7WdF2t4c N Telephone .Permit Request �04 Total 1 Story Area(include 1 story garages&decks) square feet ?6 � �flrfz Total Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type , Commercial Residential y� Dwelling Type: Single Family �— Two Family Multi-Family Age of Existing Structure 30 Y Basement Type: Finished Historic House Unfinished Old King's Highway kr Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other �p Builder Information Name V -� Telephone Number �L6 0330 Address J b ( License# l C-A -- (�(,{ 7 Home Improvement Contractor# Worker's Compensation# 6 `f- l S—3 / �8 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 t.` SIGNATU L DATE BUILDING P DENIED FORTH OLL ING REASON(S) FOR OFFICIAL USE ONLY PEFjt4IT NO. 10371 DATE ISSUED Sept 1,5, 1995" , MAP/PARCEL NO. 191;.230 ADDRESS 47 Thoreau Drive VILLAGE Centerville, MA 02632' OWNER Joseph R. Pino DATE OF INSPECTION: FOUNDATION - • r FRAME INSULATION ' FIREPLACE , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT l ASSOCIATION PLAN NO. The Town of Barnstabie NAM Department of Health Safety and Environjnental Servtcm 0790 1� Binding Division f 367 Main Sheet,Hyannis MA 02601 Raipi Off= 508-790.6227 Bu& F= 508-775-3344 For am=we aniy P=nit no. Date AFFIDAVIT SOME SWROVT CONTRACMRLAW IIHEN SUPPLEMENT TO IT ; APPLICATION MC;L c. 142A requires that the"nxanstraction,aitaatioa�rtaoratioa,sty °II+one �provemcat, rcmm-4 demolition. or a oa of an addition to any P awmer c ast one but not more than foal dwcdliag�ar to which azz at le to suciL reside=or balding be done by ==cto=with aataia 21O�'wi . tequiraae�as- Est.Co Type of Work ' st Address cf Work: 7 7 �n�1� A ✓ (X Date cfpc7nk Application: I herzbr certify that: Registration is not required for the following reZson(s): Work eodaded by raw ' lab aaderS1.000 Building not awttet`aa�pied Notice is hereby gh*=that: CONTIU OWNS FULLING MMIR OWN PEpjAI'T OR DEALING ZY=tJNRE POR APPLICABLE HOME ARBITRATION PROGRAMROARA FUND UNDER MGL c I42A SIGANED UNDER PENALTIES OF PERJURY I hereby apply for a permit the of the giegist>mian No. Date OR ' The Commotwealth of Alassuchusetty ail -a;:t- Department of Industrial Accidents 4� _ Office8/10YOSM21/ons �'� ':'f' i �` 61/0 fi'ashitt;gtun Street Boston,Alas. 02111 Workers' Compensation Insurance Affidavit ......—... ...-�^ «..r.. ...- ..._r.yy .._. .�..•.._ .. r'.e.Mn'?'.VMI^.a»y.yw.s+ww..t++•;.wv.��.�w�.��v..�._-..... �pDltCant �nfnrmatinn• Please PRINT le;t ply" �a -' name City ��V 1N/1�� ✓VP Phone# 1 am a homeowner performing all work myself. 0 1 am a sole proprietor and have no one working to any capacity : .� y� 't•'' ..-•un•'T ^' "*,,gce7w'axw^"«.r..,o,�.ae,: .l am an employer providing workers' compensation for my employees working on this job. comj,kny name: address: city: phone#• insurance co. Policy# �., :•.• .; r.- .: .•tAw^.' sdzT-ne-a�"t�!r""� .,: wx1f"w'.a? ;:a..: ..�'«n."un.R�+��,n.w+ �w.•«..,•..-. I am a sole proprietor,general contractor, r homeowne ircle one)and have hired the contractors listed below who have the following workers' compensation polices. r-- comliany name: t" address: Sim—is ._eW�Q phone#• 4`"• insurance co policy# t� 66 '� ��� .. r ,•^T. irn:M.r;.;•,•.,.y;.00 a:.a�r,;•1.•""Tq.Y;"S.r• "'?' -";•cp^-3+u .•E .7 -`9•$. '.^,,.... company name: address: . city phone#• insurance co.. pQlicx# ._. . w$f'1 6y x4y� I i ax 4�T.rG"iY :i Y��a ;Attach aJditioal sheet itnecess''�ff—I •� �;;,"�, � :�_` �t.. y,;;;rte��` ¢* •�• , Failure to secure coverage as required under Section 25A of AIGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement be forwarded to the Office of Investigations of the D1A for coverage verification. 1 do herebr cert••1•un cr die pah rid no of perjun•that the information provided above is true and correct. t correc nd/ Signature Date o Print n A Phone# official use oniv do not write in this area to be completed by city or town official city or town: permit/license# riBuilding Department OLicensing Board check if immediate response is required (jSdectmen's Office OHealth Department contact person: phone#; nOther (revised 3,95 PIA) information and Instructions f Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an en►phovee is defined as every person in the service of another uiidcr any contract of hire, express or implied, oral or written. An en►p/nver 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'emplovees. However the owner of a dwellin�(T 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 ,rounds 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 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. r ,..:'.: ,..•_ �, ... '..•1.-.>X 7.- :•l"• ..�'• "b:J ,y.p. ,!S,: rd1. lM .•+$. Yj:d'...f: Applicants , ,4 + - r Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address.and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for Coll firmation,of insurance coverage. Also be sure to sign and date the affidavit. .Tile 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. 77777777777, s....�...R.... �ipm4/F" r.�rp.• .+^+•.x.:r ay{.� ".^aa�Mr 7 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]nvestieations 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. x ►^"ow.s..,r..r.•..:.... ._.,yr ...eP.,..s.,,<4ar-�-r.r :sv+R +eyo,•<+ru. s +l[�7.77 77 rr, +. ys�+r ir""'+'+ ,fs!...^.+...%*q�++vRs.w.9^ra YLt,�T^• t:N+.v*wn�tRTa.r.u� ?+vy�.l• The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 ,, fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE :.� . . � • • _ r.. . • :...:i <� r Job LOCATION 4-7 !-�fo� 7O tw7?K v( t41C.'s: 'Number Street address Section of town "HOMEOWNER" (�A _. ...:: Name Home phone Work phone PRESENT NAILING ADDRESS 4.�T��"' : r ty .town State Zip code The current exemption for "homeowners" was extended to include owner-occupic dwellings of six units or less and to allow such homeowners to engage an in dividual for hire who does not possess a license, provided that the owner acts as su ervisor.. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to re side, on which there is, or is intended to be, a one to six family dwelling,': attached or detached structures accessory to such use and/or farm structure, 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 Offic on a form acceptable to the Building Official, that he/she shall be responsi for all such work performed under the building permit. . (Section 109.1.1) The undersigned "homeowner" assumes :responsibility for compliance with the S Building. Code •and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" rtifies that /she understands the Town of Barnstable Building Departmen minimum spec ion procedures and requirement and that he/she will. co ly ith sai oeed es and requirements. J HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING ICI Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. . ` HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which-a:-Mlildin permit is required shall be exempt from the provisions of this section (Section 109. 1.1 - Licensing of Construction Supervisors) ; provided that Home Owner engages a person(s) for hire to do such work, that such Home 0 shall act as supervisor. " t Many Home Owners who use this exemption are unaware that they are assumin j the ,responsibil'ities of a supervisor (see,Appendix Q; Rules and Regulatio: for .'licensing 'Construction Supervisors, Section 2.15Y. This lack of awar( often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home"Owner, a( as supervisor is ultimately responsible. To ensure that the Home Owner is fully--aware of his/her responsibilities,. communities require, as part of the permit application, that the Home OwnE certify that he/she understands the responsibilities of a supervisor. On last page of this issue is a form currently used by several towns. You ma care to amend and adopt such a form/certification for use in your communit . 1 , MASSACHUSETTS-ASSESSMENT CHARGE Named Insured t Endorsement Number JAMES MCNALLY Policy Symbol Policy Number Policy Period Effective Date of Endorsement WOC IC4 15 39 68 9 05-16-95 TO 05-13-96 Issued By (Name of Insurance Company) CIGNA INSURANCE COMPANY Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. Workers' Compensation and Employers' Liability Policy Massachusetts General Laws, Chapter 152, Section 65, as amended by Chapter 572 of the Acts of 1985, estab- lishes a workers' compensation special fund and a workers' compensation trust fund. On behalf of the Department of Industrial Accidents (DIA), the insurance company providing workers' compensation coverage is required to bill and collect an assessment charge covering the special and trust funds from insured employers and remit the amounts collected to the State Treasury. The assessment charge, which is determined by applying a rate (subject to annual change) to the standard premium developed under your policy, is shown as a separate item on the information page of the policy. The rate may be different for private employers and for the Commonwealth and its political subdivisions. The income derived from the assessment charge will be used to fund the operating expenses of the DIA and to fund certain employee benefits as described in Chapter 152. r Authorized Agent CKE-9H19a (7/86) Ptd. in U.S.A. WC 20 03 02 i i G , " 1 h CK RE-ROOFING - �' Application-make sure it has sign-offs from: Assessor's Engineering correct square footage or number of squares of shingles(times 100 sq. ft.) estimated cost owner's name& address applicant's telephone number signature if located in OKH- needs OKH approval Worker's Comp. form Home Improvement Contractor Affidavit (65,DENTS A L ONLr� Home Improvement Contractor's License OR Homeowner's License Exemption V��be�rrs a Qn)IL/ fee `.r All, r. i �w T �17 - .. zf 1 1 • f f� Assessor's map and lot number �/ ' (V•a 7— SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE .. WITH ARTICLE II STATE -, Sewage Permit number ............ �.• /(,J'.. ......................... SANITARY CODE AND TOWN r T TIONSaT® ®� BAR N TALE 11 i SABBSTODLE. i �oo r6 9 ,,� RDILING INSPECTOR f Lam Ar APPLICATIONFOR PERMIT TO ..... . ... ... . ..... .............................................................................................. TYPEOF CONSTRUCTION ....... .•.�...'r... �rl'✓................................ . ................................................ �. 8•' ....197 TO THE INSPECTOR OF, BUILDINGS: r The undersigned reby a piie;y for per accor in o the following ',Lqformation: Location ....... ProposedUse ...... ./ ...................................................... . ......................................................... ZoningDistrict .................................. ....................................Fire District .......................... .................................................. Nameof Owner . ................. ..... ...............:........................Address ........... ...... ... ..................................:........... Nameof Builder .....................................................................Address ..............................*4 .............................................. Nameof Architect ..................................................................Address ................. ................................................................. Number of Rooms ......................... Foundation ......................... Exierior ........, f. . .... ......Roofing ........_ g..: :... . ....... ................................... Floors ................................................................................Interior ............. . .................................... Heating ��....�...........................................Plumbing .................. ... .. ........................................... Fireplace ...... ................ ....................... ................................Approximate Cost .......... .... . .... .... .... as Definitive Plan Approved by Planning Board ________________________________19________. Area ......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 'j I hereby agree to conform to all the Rules and Regulations of the Towa of Barnstable regard' g the above construction. e Name..... ................................. .......................................... Small, Alan E. i 16612 one st No ................. Permit for ........................ .......... single family dwelling ..................................... Locationk ................real Drive \� Centerville ..................................... .................................. ; Owner .Alan..E....Small. .......... .... .... . Type of Construction frame M+ ................................................................................ Plot ............................ Lot ........... 5............... � t Permit Granted St 26 19 73 .............:......... ...._........ Date of Inspection ... /..5po'co• Date Completed .0. PERMIT REFUSED t ....................................... .................... 19 /.................................. ................................................... ......................... I F 1 ............................................................................... . ............................................................................... f Approved ................................................ 19 i ............................................................................... ..................... ......................................................... 9 Assessor's map and lot num�) / /..,(..:':..o? .�. , ....M..-.. ? ESewage Permit number ' .......... .. . ........7 / Z D STUD E, House .number .f.................................`..!../ ................ t. • 90� 6 9 L • p� '�d0MPyAr T.OWN' F BARNSTABLE BUILDING INSPECTOR d :........ ..................... APPLICATION FOR PERMIT TO .....�"� �c�.' j .................................. TYPEOF CONSTRUCTION ............. ........................... . ..... ....... ....................... ....................... • ......... ......_....014..........191 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies,for a permit according to the following information: Location ........ ................... O AU:.... ............. a i't�C. .................................. Proposed ;Use ..... ....... !1z S ........................................................................................ Zoning District .:............./.. ...c..........................................Fire District ......:....� Name of Owner ©$ �i�` ... �1�c� .......Address Cc ....................................... Name of Builder ......... ........ ......... ...............................Address ..........., '................,/.. Nameof Architect, ..................................................................Address .................................................................................... �( Number of Rooms ........:..... • —........::..........................................Foundation 1C9 .G Exierior ........ .....................'.:.................. . ..:....Roofing ........... `ice. -' ........................................... Floors l��r=G�� e... ............................. .Interior Heating.............".�..•y.......................................... ............Plumbing ...................................................................._..... .............................................. Fireplace ................. ... ..........................................................A roximate Cost.. ' ...................... ... pPP ..........- Definitive Plan Approved by Planning,Board'________________________________19________. Area ..... ® ..:. ............... Diagram of Lot and Building with Dimensions Fee f. . ....... ..................................... S BJECT TO APPROVAL OF BOARD OFFHEALTH F-1 Cott OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town 'of-Barnstable regarding the above '. construction: Name <'' f` . .............. .. ..... ....... Construction Supervisor's License ...a.0. .S?V. ....... PING, JOSEPH No, Permit for Garage„Etesiol� �-- , Acces•sory....Q...AWejj7 ag. Location .....4.7....Thoxea..u...Dri.57p.................. i ��X1t.� vJ.11s............................ t Owner RSI?e17...PiXI.Q............. ................... f Type of Construction ................. 1 F ... ......................................... ...... ! _ r Plot . Lot ........................... ` ' Permit Granted ..March 1, lq 84. ; Date of Inspection ...................................:19 r Date Completed cv!!.`................................199✓G _ t f • 5 �n Assessors map and lot numbe ^.1...1..1::`...c.2...Q..�....... THE i Sewage Permit number d Z BAUSTADLE. i House number � ..... .... .......... 9� UM& l O 39. TOWN OF BARNSTABLE �-' BUILDING ,,INSPECTOR r t . APPLICATION FOR PERMIT TO .... rr 1�`:� d �........ '+ 4"`'se 1�C` .....:.. .................. k TYPEOF CONSTRUCTION �k }yy. ........................................................ .............. ... . .................... A .................. .......... TO-THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the following information: Location ' .}Ac o'atG�+............ >'?�, t ... '.... .. ....... r . ... ........ ... � ....... .. ... ................................... ProposedUse ...... .................,� .... ... ..... `r ' ''t C ........................................................................................ Zoning District Fire District !.......l..a. C ...4 ......................................................... Name of Owner s ' ' .........'.:: ` Address ............... .............................................. �. Name of Builder ?.T 3.*............ � ... Q�� Address ...i , l......................... /v ... ....................................... Name of Architect "'"`"... Address .................................................................................... Number of Rooms �" , ............. Foundation ...... � �� :. `� Exterior ........ �.... ..,....... .....................................................Roofing ......... ��` `?. .� .^................................................ I. } Floors i yr'^{�< .+1 �. ..............................Interior Heating ..................................................................................Plumbing ...... .......... .................................................................. Fireplace .. .................................................................... ..Approximate Costt...... ...... .......... ..... ....... ................ Definitive Plan Approved by Planning Board ________________________________19________. Area .... ........ ..:.................. Diagram of Lot and Building with Dimensions Fee / ..o............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH - ' i f;ij E i r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the"Rules and Regulations of the Town of Barnstable regarding the above ` construction. Name .,k! .. � `/. Construction'Supervisor's License ........ PING, JOSEPH A191-230 26125 GARAGE CADDITION—it `./ No ................. Permit for ....................... ........,A caess.oxy...to..Dwe-11-j'ag.............. Location ..4.7...Thareau..Drive.................... .................C -eatzrVilla................................. Owner Joseph...Plao................................... Type of Construction ....ExaAwez......................... .............I.................................................................. Plot ............................ Lot ................................ Permit Granted ......MEArgb...l, ..............19 84 Date of Inspection ............................:.;.....19 Date Completed ......................................19 Florence H. S:tepeck 37 'Tho-reau Drive Centerville, Ma.. 02632 Barnstable Town Hall 367 Main Street Hyannis, 'Ma. 02601 March 3 , 1934 ` Attn: Mr . Joseph Da.luz Building Inspector Re : Building permit Joseph R . Pino 47 Thoreau Drive Uenter•ville, Me.. 02632 Dear Sir: I am 74 years old and an abutting neighbor of Mr . Joseph Pino. Mr . Pino originally had a trailer parked on his premises, connected by electric cord, in which he stored nerchandise he sold to local businesses . Some time later on for reasons unknown to me the' trailer was replaced by - a. full van with letterins .10 'A T D Tools-Mechanics American. Tools: The. mercha.ndise was and is delivered to the home of Mr. Pino -by UPS. The above can be verified by the neighbors . While I ma.y suffer for a while the presence of the van I am opp6'sed. to the erection of a .permanent addition which could, perpetuate the busines.s activity., Thus, -because of the past and- present history of business aetivity, I am asking you to ` look into the' reasons . a.nd the intent of the petitioner seeking a permit-to build a.n additio`n to- the existing structure' and. to determine if its is -fn 'compliance with. the proper use as defined by the zoni ng-,la.ws'. I hope yo.0 -will' take into - consideration the physical features of the addition namely the dimensions, size, height in "reaching your decision whether the addition is intended for residential use ,or merely to a.ccomodate the storage of. mercha:ndise a.nd./or van. I feel that granting a. permit of this nature, more so in my case, without investigation as to the purpose and intent of use of the ' addition would cause me irreparable harm of depree.ia,tion of.-my property for• which I worked very hard to a.quire, maintain and preserve . Your, cooperation in. this matter will be greatly appreciated. Sin. e el yours, 1 ' Florence H. Stepeck � r i �Ao� fO c'l Assessor's map and lot number .......z................................ ' SEPTIC SYSTEM 3 � Sewace Permit number ...�.�. �A .. oy / � INSTALLED IN C YVn Tf 9HHSTA33LE • House number ......:..................................................l.............. EIyVIR0111MEfVTAL � TOWN REGLI TOWN .OF BARNASTABLE BUILDING INSPECTOR 1 R jeAPPLICATION FOR'PERMIT TO ��� ,. ....................... . ........... 4. TYPE OF CONSTRUCTION .... .................................:.....:..........:...................: .............19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ......Zh.a,.? ......... 'Q!.tip.' ( :............ ew...re..:nvt..4-0.... ................. ....................... .. .... Proposed Use .....SG'f..�.e ....&V... R.v. C..`l....... ...... . ;.... PC'� - .......................................................... ZoningDistrict ...... "L`P......................................................Fire District .............................................................................. Name of Owner 4 ...�Tys.'.e'„t'��........ / ��1qAddress ....''/.?.......7``1.a:�:�:�.�......1�..!1.�.:.... ,e�.7L�.iL� Nameof Builder .......'...........................................................Address ...............................:......................................... ........:.. Nameof Architect ......Address............................................................ ...................................................... ......................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior .... �4: /��?a4................................Roofing ....... .. . . . .C...71................................................. i.v Z o�� Floors ....e 0.....i!v�..'.".....�u��4!�...............Interior .................................................................................... Heating ...............:.......Plumbing .....:......................................................................:..... ............................:............................ /1 Fireplace ..................................................................................Approximate Cost '.......................................... . . Definitive Plan Approved by Planning Board ________________________________19--------- Area ....l..S�. /J.• .....:......... _ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH i I hereby agree to conform to.all the Rules and Regulations of a To n of Barnsta le regarding the above construction. Name . .............................................. ^ . No 2388U� BuiI� _ Over ueo�c �� .J�weIIiug 47 �b Location ---.-.g�/� ............... ---- -____. II��__.. _____.. / \/ Owner _ ... ---.. Type of- Construction ...EKAMe.................... -. ^. ^ -----~------..-------------.. Plot ' Lot . ---------. ----------.. _ . . Parm��G,on/�6 ..�.D�arcb-5.�----'lg 81 ' Date of | ------------lV ' - ^��/ ��^ ' DateComo�tad ------��ar--�,:.�lg c�, - . _~ ^ c ' ' , . . PERMIT REFUSED / --- --.'' lV --------.-.'.''.-- '.''.'� ^ . . . . . Ex ----' ---''r ~ lA ' �l)----~._.---.�..~...-..'� .................. -..................�..................................... ` . . ' | i Assessor's map and lot number Sewage Permit number .. .ii� ? lL �d ✓�r?�r (�.4,�!� ����� 1 r,`� �� r / Z BA NSTADLE, i Hse number ........................................................................ 90o N MAGABa tray a` TOWN OF BARNSTABLE BUILDING :INSPECTOR APPLICATION FOR PERMIT TO .:�a!''�: ::::r.". ?'..r�� � '�' �"' r►�s.• ," ..........................:.............................................................. TYPE OF CONSTRUCTION ....!�!O0-D ' ................................................('f1 19 :.�. TOE THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a^-permit according to the following information: Location .... ...? r^,o....o. . ........i tee- .. ',d .. fi�r. ' .................... ..... ....................................... ................................ ................................................. ........... Proposed Use ............ ' ::'.:`.•...........:...........- ........:...ii;`:............"s....:.`.......`..... :..........f."l....:...............I......................... ZoningDistrict ........`...:...`:'....................................................jFire District .............................................................................. Name of Owner ....::r'r"'."• , ta........ . " F»; .........i.......?.Address ....:'-�.......................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect .....:n..........................................................Address .................................................................................... Numberof Rooms .....................'............................................Foundation .............................................................................. Exierior '�P�r"v9 ��_ ., �v ..Roofing 1`..'`i r_• i> - Floors ...1? J✓'r�k T.,f J - Qr�7 "i .s �h'...............Interior .................................................................................... Heating ............................................................................ ..Plumbing ........................... ....... ..... ............................... Fireplace ..:......................................................... .....................Approximate Cost ........ 'a....,..t.......�..`............................. Definitive Plan Approved by Planning Board --------------------------------19________. Area .........:.4..f.............. Diagram of Lot and Building with Dimensions Fee .. . Y ..- ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... `: r'-�; +a............................................. , PINO, JOSEPH A=191-23C! No ..2�:,�r,9 ermit for ..Bui.ld...Parr-h.... Over Deck to Single Family DweAling ................................................................... 47 Thoreau Drive Location ................................................................ 1 Centerville ............................................................................... Owner ..Joseph Pino ............................................................... Type of Construction ..•Frame ................................................................................ Plot ............................ Lot ................................ Marh 5 Permit Granted .......................�................19 81 Date of Inspection ..... ..............................19 Date Completed ...:...................................19 PERMIT REFUSED ................ .................................... 19 ................. ............................................................. } ................................................................................ 19 ............ ......................................... 1LOT . . . ......................................... ....... Approved ................................................ 19 ............................................................................... ...............................................................................