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0021 GUIMQUISSETT ROAD
_. �; � -' i i ALTERN W.EATH,,ER.IZ;AT>I.:O.N;. ; or). pT 'Date i3� T04 Town of Barnstable ,��%Nry;:',• :. ., ;;:,:; •200 Main St :'• Q� ""rM .:y: 'y `; Hyannis MA 02601 ,{.y//IJ{' G/ `/J1 �:�,.,�y:a.;q':'1',r r;�::`G% �' �:::'•:�c�• r.: Skti . Re:Perunit ss .,n sic����.•�.�'.'s raillage:�_�..,�'k,.°�-'�.•.:"�: ,",' ` �.ld+lalriy jt��j,^.1.?I`R,' "•.:*'M' :.:V.:e9.ii�,9i:�r!1: i:�,,"•%..:r':Y;',�.y t�yv:`h1,w '•).sl:L�:,;;»!:; �:.•;�.r., �'!^�.',��'�i4 " ��;..5;��.,��•:,;% 1•••7 rt:,•4��.�J�-i,• ,4: .•:,_nr"'h:.: �� .�N�Yy�,� ✓S ,r'�>. ?✓,;.;.,;•;::t.:- +..!•r�" 5r ..,:,�y:y�.; 4`' �+„�i,�\:;;::'a"•v�'n� �'z":,,FF':+S:�C"y`:'t••';:h:'S'••Ai'�>�a' c;4�4! ,�r;,J•.: •• ,.F ��, r;:•�:G:�f•�•':i'::•i: {•u7• +:r`i> 3:., .s •r,.'•' .,;.J t..,t;;td,�tii:,,Y . i:•�:.:,iJ^,r,,; .�:: .w>:.:� `+:... wr r;��" <^'+ i 'r9;:+.:a4y"r;'•C"+°ii?„ •,,r;,.y.,.y> Sr:, at .115 lat sf .;,F; .,.�:; 't'�"' v.">a •C ci:� ::W�}-rn+.pr .•„p. ;;:rl",:"ti�,:,.oi1>�1,+'J rJ• �a r ' •:"1":'�, ,t;•: ..�'•' �°1 .R.rJ��. 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I :FALL R1YER•t�hA 02721 •I '(508)•567,4240 1 'ALTERNATIVEWEATI<IERIZATI,OtdSGMAIL:CQIbI;`::,,:, :' "'' s - cation number rl _. Date.Issued �`4J .\ P 2019 Building inspectors lnitiais...61. t n F - } Parce't TOWN OF BAIZNSTABLE ` u EXPEDITED:=PERIVIIT APPLICATION ROOF/SIDING/WINPOWSIDOORSn ENTSLSTOYES/wEAT ERIZATION PROPERTY�NFURMATION 4 Address of Project:,. _ !t T NUMBER STREET VII LAGE Owner's Nam G2.1�� ?-P�' Phone Number j"7 r U 7 S�CJ Email Address: ; eer ! Cj(!Y!'1 Cell Phone Number Project cost$ d ��3 ._ Check one;: "Residential Commercial . Y 17 V OWNER'5 AUTHORIZATION x w.a: 411 -1 w. Ak As owner of the-above property I hereby authorized to make applicatZon for a budding permit m accordance with 78 MR i Owner Signature: cML Qif 'Date:r�jp g - _ .E OF woxx h Sidg Windows(no header:change);=# Insulation/Weathenzatan 3 Doors.(no"_eader change)# Commercial Doors requare an inspector's revaew Roof(not applying more than.i laver`of shingles) ` u. Construction Debns:will be going to .E R'S O CONTRALTO INFORMATI N Contractor's name /Z �,� T L.l l /l76 Home Improvement Contractors Registrkion(if apphca_ble)#` / f� (attach copy) Construction Supervisor's License# / (attach copy) A � �. Email of Contractor. a,� 'e wr g, 7l oG U)eaJ i:?&h Phone number 'Ai PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS,OLD OR IF THE SUBJECT PROPERTY IS 1 A HISTORIC-DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAM BE ISSUED: APPLICATION NUMBER ...................................................... ...: *For Tents Only* Date Tent(s)will be erected Removed on number of tents total ` Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each,Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one` Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm...Commercial events may require Fire Department approval, , .*WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name, 1 Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CAM and the Town of Barnstable. Signature Date APP IC T'S SIGNATURE Signature Date � o All permit applications are subject to a building official's approval prior to issuance. r DocuSipf Envelope ID:A76A8781-1CB7-4CAD-91BC-E36A7C8EA660 r Permit Atorzation:, a Form Site`lI IN.3878719 Customer _. ". ,:Diane Greer.. . Diane Greer I , ,owner of the prt pe ,y:locate'J at {Ownf'W Name printed); ., 21 Guimquissett Road Cotuit, MA 02635 (Property Street Address) (City} fiereby authorize the Mass Save HDrne Enemy Services:Program assigned Rartic�pafing Cortractnr.iisteif below tci'act:oti rhybehMfandlbbfAh a buildirig,permit to perform`irisulatiori and1de weatherization+ wD'rl(Dn;my prDperty: Docusigned by: 5 k Uwner's Sspnatures OCCIAEEOE8A9497... - Date•:;, 9/20/2019 1 9:21 AM EDT FOR OFFICE USE.ONLY' ' 1Ne,have assigned the d'I'll owing ' s Save Home`Energy!-Seniiees Participating ct Contraor.to t}e` :above referenced project:. ,,1 Ai�i zaA-ty, Ac- h) Pagiid— ttr g Contractor'` date; Name: RISE Engineering Phone: 401-784-3700 b Email: ' Page 1 of 1 Fr14r tts t3nly., Rev Tb20S. . The Commonwealth of Massachusetts = Department of Industrial Accidents a 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print Legibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC.' Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.�✓ I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.o I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[:]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.t - 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL a 14.0 Other INSULATION 152,§1(4),and we have no employees.[No workers'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. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic.#:XW058867158 Expiration Date:06/07/2020 Job Site Address: �� ddw City/State/Zip: Attach a copy of the workers compensation Oficy declaration page(showing the policy number and expi ation date). Failure.to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.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 a sand alti s of e ury that the information provided a ove is true and correct. Si nature: Date: Phone#:508-567-4240 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#: ' DATE i�MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE Fi _ 05124/19 THIS CERTIFICATE IS ISS{JED 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 have ADDITIONAL INSURED provisions or 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 NAME: Anthony F.Cordeiro Insurance Agency (A/CC,No Ext: 508-677-0407 (A No): 508-677-0409 Fall Pleasant Street ADDRESS:Fall River,MA 02721 SS: HSOU7-a@Cordeiroinsurance.com INSURER(S)AFFORDING COVERAGE -NAIC# INSURER A: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURER C: Ohio Casualty 2 Lark St Fall River,MA 02721 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT;TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AIJUL SUBK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDlYYYY MM/DD!YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE o OCCUR PREMISES Ea occurrences $ 300,000 MED EXP(Any one person $ 15,000 A Y Y BKS58867158 06/07/19 06/07/20 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY❑ PRO- ❑ JECT LOC PRODUCTS-COMPlOP AGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED Y BAS58867158 06/07/19 06/07/20 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAR CLAIMS-MADE Y Y US058867158 06/07/19 06/07/20 AGGREGATE $ 1,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY C OFFICER/MEMBERPROPRIETORJEXCLUDEDXECUTIVE❑ NIA E.L EACH ACCIDENT $ SOO,000 XW058867158 06107119 06/07l20 (Mandatory in NH) If yes.describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA,its direct and indirect parents,subsidiaries and affiliatesshall be named as Additional Insured on commercial General Liability and Automobile.Liability polcies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENT ©198#"2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD W. Commonwealth of Massachusetts t r Division of Prof essionaI.Licensure.. .u# Board of Building Regulations and'Staridards ConstruEt46A.iSi5�pervisor CS-105454' E�pires' 05/08/2021 TIMOTHY CABRAL , w. .58 DICKINSON STREET �Y, PALL RIVER MA 0272ti � s w, I Commissioner ��/>.�- �/�C CiC�f�?,/�2�tf?GC�PC000 G�.-��/l'�C11�CGtfZLC�P Office of Consumer:Affairs and Busi:iiess ReguGation 1.000:Washirigton Street - Suite 710 Boston, Massachusetts 02118. ori-ie lri-iprovement Contractor Registration Type: C&06ration . . . - ALTERiNATiVE:W EAT HERIZATION INC: R egisVaticn: 175683 2 LARK ST R Expieatib 1. ... 05/28/2021 F ALL:RIVER, NIA 0272.1 ate Add, Card.. ... Cfpd and Returri SGA 9':��.:20Nir05/117 /... Office of Consumer.Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR: Registration valid for individual use only . __... TYPE:Ccrooraiion before the expiration date. If found return to: Registration Expiration Office of Consumer Affair and Business Regulation 175683 05t28/202 i 1000 Washington S ( -Suite 710 ALTERNA i IVE'VVEATHERIZA T IOh.[Nt 3'dston;MA 02118 t TIMOTHY CABR.AL 2.LARK I FALL RIVER.IMA 02721 :blot va�isl'witliau signature Uncer�eGre?Gry. `% . L.: _. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ppIni z�l i 0 Parcel t Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address �� w i/`" V O 9 Village Cal' T' Owner 1 aNe r-r e Address I:76 O v er A/fAv Telephone 6 7 "' B7- 5-3 Permit Request ReNo UCL r I Gel C) K l rc�\e/v , A/® V eT tj>r4p, 1 glom 1"J3uIeLh 01,J4121Asr('-� w 04,��n�eY`J', C'Ca ' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood.Plain Groundwater Overlay Project Valuation 3k 6 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 14_ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 4.No On Old King's Highway: ❑Yes V No Basement Type: ❑ Full XCrawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: 3 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 XNo 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 _ Others';1 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 TZ� � Y'Telephone Number J� r^ �5"7 1�5—,3 0 Address ► ` -S Ll—C- License# o / a 1 I-VoPaAlch PO/ Home Improvement Contractor# a / Worker's Compensation # I rWC 10 Y y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO V j20 /V�. G� SIGNATURE DATE F, FOR OFFICIAL USE ONLY J APPLICATION# DATE ISSUED 't MAP/:PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME D `{X- o g(Z c INSULATION 4 10�G FIREPLACE 1- Y ELECTRICAL: ROUGH FINAL P PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 8 _ .. FINAL BUILDING o a S a "- N DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ` - Department of Industrial Accidents �Q; Office of Investigations 3 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ) Please Print Legibly L Name (Business/Organization/Individual): ( "' A/ /� ) ` C_ Address: S City/State/Zip: �Q 5 y0 Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 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 the attached sheet. 7. %Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 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. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: It-'��' �5V"(QWC,C, G io U. Policy#or Self-ins.Lic.#: ^ 0 r V 9 Expiration Date: '713011 Job Site Address: e?) '2w6V 1 M I V l S5107-'t' City/State/Zip: Co 7111 T- M 4 ©o/� Y_ 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certif der the pains and penalties of perjury that the information provided above 's true nd correct Si nature: Date: t Phone'#: Official use only. Do not write in this area,to be completed by-city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1, Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + a 600 Washington Street Boston,MA.02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ( � ��C l 1R0056 1 Address: O IOX /20 City/State/Zip: Phone,.#: Are you an employer? Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. New construction . 2.9 I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for mein any.capacity. employees and have workers' 9. ❑Building addition comp.insurance.$ [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.®Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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.' lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.M Expiration Date: Job Site Address: City/State/Zip: . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).' Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties.in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. _- I do hereby cerii /under thepains andpenalties ofperjury that the information provided above is true and correct. Si ature: - �G. r Date: Phone#` 20 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the 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 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. app p P to "Neither the commonwealth nor an of its political subdivisions shall 25C 7 states Additionally,MGL chapter 152, § ) Y P ( 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(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 carry 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/license 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 affidavit. 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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #6.17-72.7-4900 ext 406 or 1-877-MASSAFE Fax A 617-727-7749 Revised 11-22-06 www.rnass.gov/dia °ATE ro{NMdYYY Y ) Ac Roy CERTIFICATE OF LIABILITY INSURANCE 3131110 PRODUCER THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION United Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 199 Main street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, P.O. Box 1013 Buzzards Bay, MA 02532 INSURERS AFFORDING COVERAGE NA1C# INSURPD _ INSURER A CNA Award Flooring Inc INSURERS: 270 Main Street INSURER C: Buzzards Bay, NA 02532 INSURER0: INSURERE: nw COVERAGE$ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITI STANDING ANY REQUIREMENT,TERM OR CONDRION 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 3EEN REDUCED BY PAID CLAIMS. _ INSR AWL — - POLICY EFFEC1iVE POLCY EM Tt N POUCY NUMEWR LIMITS GENERALLIABILITY EAGHOC%RRENCE $ 2,000, 000 AW A X COMMERCALGENERALLIABILITY B2077125611 2/24/10 2/24/10 ° �8�a cwum,ruml _. $ 300,000 CLAIMS MADE FX]OCCUR ME EYS'(Any oneDerscn) $ 101000 PERSONALBADVINJURY $ 1 000�000 GENERALAGGREGATE S 2,000,000 CiEN'LAQQREGATELIMITAPPUESPER PRODUCrS•ODMP(OPAGG $ 2,000,000 X POLICY PrECTRO LOC AUTOMOBILE UAB U TY COW INED SINGLE LIMIT ANYAUTO tEeeccider�) a $ ALL O WNEO AUTOS BODILY INJURY SCHEOULEDAUTOS MIRED AUTOS BODILY INJURY (Permedtlentl S I NON.DWNED AUTOS _ PROPERTY 0AMAGE $ (Per eocldent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTD OTHER THAN EA ACC $ AUTO ONLY' AGG S EXCESS I UM13RELLA LIAMLITY EACH OCCURRENCE S OCCUR CLAIMSMADE AGGREGATE S DEDUCTIBLE LM]RKER$COMPENSATION WG STATU- OTN• AND EMPLOYERS'UASILITY X A.MLtMITS. A ANY PROPRIETORIPARTNERIEXECUTNS Y� WC277125625 ' 2/24/10 2/24/11 r.L,EACMAcaoENr s 100,000 OFFICEI'MEMBER EXCLUDED? _.l Porlds"inNH) E1,OISEASE•EAENPLOYEE $ 100 000 ftyae tleealbevntler - sPEGALPROVISIONSbelow E.L.DISEASE-POLICYLIMfr $ 500,000 OTHER DESCM1 i6NOfOPERATIONSILOCATIONSlVEKIQES1EXCLUSIONS ADDED BYEPOORSEMENT'JSPECIALPROVISIONS Retail, flcoriner operation CERTIFIC TE HOLDER CANCELLATION 5HOU1,D ANY OFTNE ABOVE DESCRIBED POLICES BECANCELLE0 BEFORE THE EXPIRATION DATE THEREOF,THE 133UNG INSURER WILL.ENDEAVOR TO MAIL 10 DAYS wivrmw IKi tChens F3 tC NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO$D$HALL Fax no. (508)457-6435 IMPOSE NO OBLIGATION OR{IAWL1TY OF ANY KIND UPON THE INSURER.ITS AGENTS OR 125 Two Ponds Road REPRESENTATIM. Falmouth, Ma 02540 r UTH�ED REPRESENTATIVII ACORD 25(2009101) 0 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Gabriel Roggiolani Plumbing and Heating Sole Proprietor Mike Prevey Electrician Sole Proprietor Award Flooring Flooring ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: \e J Site Address: print Town: O l► L/ (� Applicant Phone: 5 Applicant Signature: Date of Application: NEW CONSTRUCTION: choose ONE of the followingtwo options) 780 CMR TABLE 6107.1 ., PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM in or Cei 1 g Slab , .. Basement Option l: Fenestration exposed Wall Floor_ -Wall. Perimeter AFUE HSPF• SEER U-factor floors, R-Value R-Value R-Value R-Value R-Value and De th e Energy-10, Cod ervationlAct(NAECA)of. .35 R-38 R-19 R-19 R-l0 1987 as amended,minimums or. 4 ftr greater as applicable Note: This form is not required if you choose either'of.the two versions of REScheck as listed below. 0' Option 2: REScheck Version 4.1,2 or later variant software analysis must.be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at http://www.criergycodes.gov/rescheck/ ADDITIONS ORALTERA,TION,S,TO EXISTING BUILDINGS OVER.5 REARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the% of glazing: (a) .Gross Wall & Ceiling Area equ4ls ` Formula:' (100 x b- a) SF `100 x % of glazing b a (b)'Glazing area equals SF s If glazing s> 40:% rbceed to"SUNROOM" section If glazing >s`<_40%° use the chart below: '. g g i 780 CMR TABLE 6101:3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM t MINIMUM Ceiling and. Slab Perimeter fenestration. Wall Floor Basement Wall R-Value Exposed floors R-Value R-value R-Value' - U-factor. and Depth R Value. eet R-l 0 4 f 39 R-37 a R-13 .. R-19 R=10 , a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e.not compressed over exterior walls, and including any access openings). SUNROOM=An addition or alteration to an existing building/dwelling unit where the total 0 glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note:' Owner to fill out Consumer Information Form (found in Appendix 120.P) 1353/4 Wall 6 -2 12 30 N _ C, —37 24 L Kitchens Etc, LLC Design DG4 March 18, 2010 N Client Greer —37 7K12 N washer ar d dryer units 24 Wall 8 14/ 1 36 � g � — 1353/4 WN6 2 12 OO 30 Kitchens Etc,LLC Design DG4 _ March 18,2010iq 3 Client Greer 37 Washes e d dryer24 Wa11638 -9% - ;Board of Building Regulations and Standards p Construction Supervisor License 1} Lice s ;CS 98967i Expiration0/20/2011 Tr# 98967.: x FBI Restriction ; l x , RICHARD CARL 125 TWO PONDS " FALMOUTH,Mp,02540 Commissioner t . Booui Ong eia6s anc tan�ards� License or registration valid for individul use only, HOME IMPROVEMENT CONTRACTOR before the expiration date. it found return to: Registration: 153124 Board of Building Regulations and Standards.' Expiration . /30/2010 Tr#,275368 , One Ashburton Place Rm 1301 ---_ Boston,Ma.02108 l -Type L-td#Liability Corpor (KITCHENS ElG LC t , a RICHARD CAR25V -125 TWOPON2FALMOUTH,MA 040 Administrator, Not valid without signature e i KITCHENS ETC. LLC PROPOSAL AND CONTRACT FOR CONSTRUCTION OR REPAIRS (HOMEOWNER-CONTRACTOR) Date Proposal Prepared: March 26,2010 Proposal Termination Date: April 26, 2010 Contractor: Kitchens Etc, LLC Homeowner: Diane and Chip Greer Mailing Address: 125 Two Ponds Rd MailingAdd ress: ess: 1 3 6 Oliver Rd City,State,Zip: � ' � p: Falm outh, MA 02540 �� City,.State;Zap: Newton, MA 02468 Phone: 508-457-1530 Phone: 617-852-4538 Fax: 508-457-6435 Fax: E-mail: louatan ikitchensetc csirn E-mail 136ittreer sr�maii.com MA Contractor License: CS 98967 Cell Phone: 781-325-2615 chip TI N: 20-5719481 Pro'ect Address: 21 uimquissett Rd., Cotuit ' This contract replaces the earlier contract dated March 21; 2010 due to a computation error. The following services will be provided per this contract: I •. . Cabinetry design,n ,purchasing,carpentry,and installation $3600 o Order,purchase,.inventory with IKEA o Assembly at project site o Installation of wall cabinets, shelves and doors o :Installation and leveling of base cabinets,doors,drawers o Installation of IKEA knobs or pulls "o Install SS shelves on sink wall o .Hang microwave o Receive dishwasher delivery and place in kitchen o Boxing out of fridge with panel ; o Relocation of 4 existing appliances (washer,dryer,,fridge,) o Installation of toe kicks and end panels o. .Installation of filler strips where needed LL o Removal of all cardboard waste from the cabinet o Additional design time rY Packaging`- IKEA cabinetry and appliance materials cost: ($3200) o Will be paid directly to'IKEA byhomeowner o' Stat White door style,white interiors o Varde Handles o Domjso Farmers Sink o " Framtid SS Slide-In Gas Range ($999) o Frarritid SS microwave/fan ($249) 0 2.of the base cabinets;and 1 wall cabinet have carousels 0 1 of the base.cabinets is pullout unit for laundry detergent r . o Soft closures for doors o ' Drawer dampeners and full extension hardware for drawers . o Price reflects 15% IKEA Sale discount o Shipping to project site or shipping to Kitchens Etc. workshop $169 I . - 1 of 8- i 5 cfi • Countertop o Granite,polished $3210 o Color options uba tuba, azul platino, rosa beta,desert brown,new caledonia, peacock green, steel gray, autumn harmony o Simple, square edge treatment o 4 inch backsplash • Electric materials and labor o Supply and wire 2 under cabinet xenon lights. $2050 o Wire electric for and microwave/hood o Wire dishwasher o Relocate washer machine and dryer outlets o Wire 6 six inch recessed cans o Wire 6 counter outlets o Optional at$60/man hour is removal of old BX'wiring that goes to other parts of.house. Additional work may be required by electrical inspector. If so, this'may incur additional costs. • Plumbing materials and labor o Disconnect old sink est $1950 o Reconnect and venting for new sink and faucet o ;Plumbing for moving washer/dryer into kitchen area o Gas line for range o Additional work may be required by,plumbing inspector and cause�additional costs to be incurred o Allocation for faucet$300 Plastering w. o New blueboard and plaster on walls and ceiling in kitchen est. $2000 o New blueboard and plaster on bar area as necessary o Coat and finish chimney in.kitchen o final costs will be determined when plasterer is on-site • Demo and removal of cabinets and kitchen walls/ceiling $1000 o Removal and disposal of cabinets/countertops o. Removal and disposal of appliances o. Removal and-disposal of kitchen walls and ceiling • Demo and removal of existing floors . o Removal and disposal of floor the in kitchen area $1500 . o Removal and disposal of floor in family,room area' a . o Includes cost of on-site dumpster o Cost will increase if underlayment and subfloor is - glued and/or screwed - • Carpentry o Build,new 1/2wail,below existing barwall est. $1700 to enclose new plumbing and dryer vent o Opening of window pass through i o Frame chase for existing.vent pipe - o Venting for new dryer location o Support for granite countertop in bar area o Time and materials o Additional work may be required by building inspector which may incur additional costs. -2of8- • Venting of microwave est. $500 o External venting of microwave hood, o. Time materials - *, I Permits $700 o Plans and paperwork for building permit _ f o Electrical and plumbing permits o Meet inspectors on-site for rough and finish electrical, plumbing and building inspections • Insulation $500 o Insulate exterior walls and ceiling to meet new building code • Flooring Options Y o Red Oak Select 31/4"x 3/47, natural, prefinished y o Kitchen option $1500 o Family Room option .. $2950 - o If the subfloor is not suitable for the nail-down Red Oak floor, additional costs may be incurred ' Total project costs $26,529 Fees to Kitchens Etc. LLG r $23,329 Estimated IKEA materials costs to be paid directly to IKEA via CC authorization $3,200 The above quote does not include painting. The design used for this layout was created by ilKitchens Etc. LLCand f t accepted by the homeowner. Refrigerator and Dishwasher to be supplied by homeowner. NOTE: As IKEA®certified installers, Kitchens Etc.purchases IKEA®cabinetry at the same list price as all valued IKEA®customers and we pass those reasonable prices directly onto our clients with no markup: Please initial as accepting the drawing below. _ r _ . x Please initial as accepting the drawing below: ---------------------- I . wall b ' I.: - = iMtchens Etc, LLC i r Design DG4 " 3 r March 18 2010 ' Client Greer washer a d dryer units -4of8- Please initial as accepting the drawings below: a15}{. �I — t t y i `_ L fI t_—i Y I II I I_-? 1 _ ��.:..i 6';' tI Y :fl 1 # I �,�� _ Sir BOOK ZA -MUS "R'R.' I I F Nil I� n ttttI Ilk i; _ MIN! T` II m I � i • - -Sofa- . Commencement of Work: Total Contract Price: $23,329 [ ] Within days of acceptance. Includes deposit for countertops,flooring,faucet an [X] As agreed upon by contractor and client 33%of services. IKEA materials will be purchased ' directly by homeowner. Work to.begin week of March 22, 2010 Please note below how.your payments will be Target completion time: May 1, 2010 made. Based on availabilityof materials [ ]Check [ Cash Bank Check 1st Payment $9315 2"d•payment: $7241 Due upon signing contract Due after cabinet frames are installed, rough electrical Includes deposit for countertops,flooring,faucet and and plumbing completed and flooring installed 33%of service (approximately 3 weeks after starting) [3rd Payment: $4607Final Payment: $2166e after cabinetry is installed and counter top is Due when countertops are installed,plumbing is plated. Will be adjusted based on final costs for complete and plumbing and building inspections ting hood. passed. Additional Provisions: The invoice for final payment will be adjusted up or down based on actual costs for IKEA cabinetry and other materials purchased to complete the project. The contractor has made good faith estimates in this proposal. Any changes to this contract will be documented in a Change Order and could adjust the total project cost. Instructions: Contractor completes and executes a digital copy and delivers it via e-mail to th2 homeowner. Homeowner accepts proposal by executing and returning one complete copy of the contract with initial payment to contractor before proposal termination date above. One copy of any other contract documer is references above must be signed and returned with the contract. Proposal by Contractor: Partner March 26,2010 ontractor s ignature Title Date 1 . Acceptance by Homeowner(s)c, , 64 Homeowner's Signature 4 Title (d applicable) bate I NOTICE TO HOMEOWNER 1. Contractor Registration Contractor and any subcontractors must be registered by the State of Massachusetts;chief administrator of the board of building regulations and standards,an agencywithin the executive office of public safety,established by section 18 of chapter 6A:A6y inquiry about Contractor or a subcontractor should be directed to the Administrator. -6of8- c D Engifieering Dept.(3rd floor) Map Parcel r_ Permit# r House# � _. Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee ��67F Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) JAck INE 19 eye. TOWN OF BARNSTABLE Building Permit Application ° �. 3 7' treetAddress Z I L1 ► ,Q LA 1 Village ,-L*1— Owner n—A Q' L:N:\ASS� _ Address Telephone Q ck s- Permit Request -ems-e L a�1 1�L1� i`3 X _LD First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 3 pCp 0.->0 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure ZS r MA)<- Historic House ❑Yes 3<0 On Old King's Highway ❑Yes No Basement Type: ❑Full &drCrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name r(j!1 �,��,,�7 qq� Telephone Number SOT `lZA Z-41'1 Address License# c-S p(� � 9 16 Acx, Home Improvement Contractor# I ZZ Z 4,C7 Worker's Compensation#, NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOQtAvl S SIGNATURE 1A DATE136 BUILDING PERMIT DENIED FOR iRrOLLOWING REASON(S) 1 ? 1 r � �. .. _ •€;..t'�x:��"��f•alp,'y� t45.�`'"..'13�k`°,�:� 'sAi�'`°''�.ny�."�'�tS.{+$�.*.»Eif':3::'�+w?.?�'�+ ' �9:19".��'.�''+i.'+�"YK w ":3`��T.ta:W:•b""#.`�t"',*7w'+".�.,^."�".S:'.? 7.°.�.,tii'°a^.+"y�'�fs;X4y> I D > r D r v � +J Town of Barnstable Permit# Expi s 6 months from;ssue date STARLA Regulatory Services Fe(e�\! D MABEL Thomas F.Geiler,Director 1639. leg ' 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 PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number /� Property Address l � /i i)/ 49 L( SSE Residential Value of Work 0-0-0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address elf «ill e-- Co Ll V c-w-- e w,4 A3 A-Aj AM a z-�6 A Contractor's Name A C e • Telephone Number S- 7 7 S- ZY l.� Home Improvement Contractor License#(if applicable) / �S 7 70 Construction Supervisor's License#(if applicable) y d ❑Workman's Compensation Insurance Check one: MAY 2 2 2007 ❑ I a sole proprietor ❑ the Homeowner TOWN OF BARNSTABLE I have Worker's Compensation Insurance Insurance Company Name ��'' " �` 6 Ca'l 6q D eft' 6.0 Workman's Comp.Policy# eVe f9 J Copy of Insurance Compliance Certificate must be on tile. Permit Request(check box) rRe-roof(stripping old shingles) All construction debris will be taken to f --/fit-�Z�✓�� ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Impro men ontractors License is required. SIGNATURE: / - Wj z Z ;'VW 100Z Q:Forms:expmtrg '4? Revise071405 r e x Town of Barnstable °��. Regulatory Services Ma Thomas F.Geiler,Director 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 Property Owner Must Complete and Sign This Section If Using A Builder I U1E (5'/2. 'YL _,as Owner of the subject property 1 hereby authorize ^� C to act on my behalf, in all matters relative to work authorized by this building permit application for: Z (Address of Job) Signature of_Q<mer Date 'Diane, Cl�lr Print Name I ? QiFocros:expmtrg Revise071405 y 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 �? n Please Print Legibly Name(Business/OrganizationAn(tividual): Address: J Y47WV0 City/State/Zip: //L/�lu ty Phone#: 6 �9,; - -7 7 S- ZSl S e ou an employer?Check the appropriate bog: Type of project(required): 1 yI 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. 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 11.❑Plumbing repairs or additions [1`1 myself. m se o workers' comp. c. 152,§1(4),and we have no 12. oof repairs Y insurance required.]` employees. [No workers' 13.❑ Other 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. ±Contractors that check this box must attached an additional sheet showing the name of the subcontractors 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. p Insurance Company Name: INS, A,-cxJC-1 Policy#or Self-ins.Lic.4: 3 Expiration Date: eA Job Site Address: yl M Q a/SS -?E /� City/State/Zip: 69r/�,-T 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 c u er the p an enalties of perjury that the information provided above is true and correct Si atur Phone Officidl 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#: .J/�e Cc'orrc�rraruueczl�� �f . llt,;.;.ac�ec.;.lCl Board of Building Regulations and Standards Construction Supervisor License License: CS 69152 Expiration: 12!11/2008 Tr# 6607 Restriction: 00 JOHN M FALACCI PO BOX 1224 HYA.NNIS. MA 02601 Commissioner _--- Board of Building Regulations and Standards License or registration valid for indiv idul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: -_ Registration: 148770 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 10/25/2007 Boston, Ala.03108 Type: Private Corporation HOME IMPROVEMENT SPECIALIST OF CAPE COD JOHN FALACCI //1 25 IYANNOUGH RD _� p — ' . HYANN IS, `,1A 02601 administrator Not valid without signature e CSR CT acoRo_ CERTIFICATE OF LIABILITY INSURANCE --- EiCHEI-1 I 08/30 06 PRonu THIS CERTIFICATE IS ISSUED AS A MATTER Cr-INFORMATION :he Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE of Cape Cod, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 480- Routa 6A, P 0 Box 960 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Sandwich MA 02537 Phone: 508-888-2766 INSURERS AFFORDING COVERAGE I NAIC X NsuREO I,NSURERA. Safety Insurance Company 1 33618 INSURER& AIG American International Co _ Home Improvement Specialists INSuafRQ Harl sville Worcester Ins Co of Cape Cod Inc. eY P 0 Box 1224 nsUReRrr- _ Hyannis MA 02601 _j INSURER E: COVERAGES THG POLICIES OF INSURANCE LIMO BELOW HAVE BEAN ISFUED TC THE INSIIREO NAMED Aa0VE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MT14 RESPECT TO WHICH THIS CERTIFICATE NAY BE ISSUED OR MAY PERTAIN•THE INSURANCE AFr-ORDEO BY THE PCUCIES''OESMSED HEREIN s"JECT TC ALL THe TERM:,,GXCLuSIONS ANO CONDITIONS OF SUCH POUCIES.AGGREGATE LIMITS SHOWN MAY HAVE R6EN REDUCED QY PAIO CLAIM.& CQ-- r6(TEY6FFECTNE P7SLR'9TI01'f _, _. •• INSRD TY}E OF INSURANCE _ • POLICY NUMBER I'LTR NSR DATE DATE NMID I LIMITS I caexeRALUAeItm !CACHOCCL*"WE s 1000000 1, I EC COMMERCIAL 09MEUALUAWTY C35J4134 PRtM1S ;DEa _ 1100000 CLAMS MM]fi OCCUR O EXP(AnyME w I+nr:on) 3 SOOO X IBusiness Owners 09/02/06 09/02/07 LtEzcNALsAoviNjuRY ITs' GENERALACQ11EGATE 13 Z0O0000 G'aN•L AGGREGATE OMIT APPLIES PER PR000CTS-COMM9 AGG ii S I ! POLICY aaa LOC AUTOMOBILE LIAMU7Y N SIMGLC LIMIT ;1000000 A I ANYAU'TO 3953673 ! 09/16/06 09/I6/07 COMBINED O COMBIMBINED ED AL:OWNED Auros � '.. _ BOOILY INAMY S X I SCHEDULED AUTOS I (P-Pereunl HIRED AUTOS I .. a00R.Y INJURY j _ I NON-0NMED AUTOS I I I i�xailem} I •- I PROPfiRTY DAMAGE S i I I: I SPxactinc+ul LGAAAGE LUIBIUTY AUTO ONLY•EA ACCIDENT-I S _.. ANY AUTO OTHER THAN EA A['C�f "VJTO ONLY: AG i I S L ExCESSAIMBRELLA LIABILITY I I ;EACH OCCURRENCE ;S _.._ •. CCCUTA CLAYA S MADE G i aGAE:.,ATE I " DEDUCTIBLE -TS I� RETENTION S WORAERS COMPENSATION ANDEMPLOY -170RY ER L:MITti i I B ! ��LJAaruTY WC8964613 I 09/15/Ob ! 09/15/07 "o.L.EACHACCIDENT ;$ 100000 ANY PqOPRIETDRlPARTNER�CUTIVf I I OFFICEWMEMBER EXCLUCE07 E E.L.DISEASE-EA EMPLOYEEI $ 100000 II yes.drsttbs wasr 3PFGALPRCVISI0N6t)ekw I I I L70MFASE-POUCYLIMIT( c 500000 OTHER PROPERTY 95000 I OESCRIPTION OF OPERATIONS/LOCATIONS I VENR:Le'S f EXCLUSIONS ADDED BY ENOORSEMENT I SPECIAL PROVISIONS - 199E Chevy CIO VAN 1GCOG15Z4SF22205I 1996 Chevy Flat DUMP TRUCK IGBEC34MOGS189051 Home improvement and remodeling CERTIFICATE HOLDER CANCELLATION wOQDPAl SAOULD ANY OF THE ABOVE DESCRIBED POUCIES 9G CANCELLED BEFORE THE EYPIRATIO DATE THEREOF,THE ISSUING U)dURER WILL ENDEAVOR TO,MA4. 30 DAYS wFuTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INJURER ITS AGENTS OR ' TATIVES. / q � �/ • A I E The Insurance Acmnay ACCRO Z5(2001108) (9 ACORD CORPORATICN 1999 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i Map / Parcel Application Health Division Conservation Division Permit# Tax Collector Date Issued l 6-7 Treasurer i Application Fee l� ! (q --70 Planning Dept. Permit Fee t Date Definitive Plan Approved by Planning Board l Historic-OKH Preservation/Hyannis Project Street Address 21 ULL m u.1sre ed Village Owner ian e, Address IkZ I�Q lt)A4" Telephone Permit Request Con vex f -ex r S h' de c In 7LO ct S'cPre_e0 Pod'C47 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District I Flood Plain Groundwater Overlay Project Valuation I��— Construction Type ✓'moo vOLT?on Lot Size , D S��? �4 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. VV Dwe'ing Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 50 Historic House: ❑Yes �(No On Old King's Highway: ❑Yes kNo Basement Type: ❑Full kcrawl ❑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 (o new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ,Electric ❑Other Central Air: ❑Yes Klo Fireplaces: Existing �l New Existing wood/coal stove: ❑Yes (Alo Detached garage:❑existing ❑new size N119Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size W A Shed:O existing ❑new size Other: G +-j a Zoning Board of Appeals Authorization V Appeal# - Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION s- r rn Name 161*j CC Telephone Number 6� -7 Address or 6 H License# t°o r.SrZ I `/ff WAJI S ✓l1�¢ 02601 Home Improvement Contractor# �LP 7 7d IWorker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i f�J NATUR DATE �� O FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 7 FRAME /1/� afc 6 �� a� ,6_ �� � /.v ,.LOOKr1lo�G7 INSULATION FIREPLACE ELECTRICAL: ROUGH - FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. " Town of Barnstable Regulatory Services URNSTASMAM`' Thomas F.Geller,Director Building Division tED Mf►• Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fa 508-790-6230 PLAN REVIEW Owner: (ggec-- e Map/Parcel: Project Address Z l Gieim�?ui ssCWl 10 Builder: �- y Cr The following items were noted on reviewing: e�p H�Wb 9 /eEQ u l R-6;b �N Srsprle cats¢y s Lf/lm TWR6;E ave M(JKC Jel SL�f2s . 6) (/DOKS /AuJ-,' 10 .1A)?o {, Src-2�-�CIILOV7PL . !'E XeVu/!eE—A. 3 Ec✓ r/NG-s Wout-A /3& �vch�o�2 EA .70. FPO T/AIC,S? CLGGL/.t/y- �"vGS ?S 41eE Cet-y— 7-/F1 AV �y 4) 'T X C-J T o xJ' Tip /AGI�TES ofcl SIDE CC/�9 LDS Reviewed by: /2�G Date: G a! a Q:Forms:Plnrvw The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 t www:mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/1Eleetricians/Plumlbers AiAcant Information Please Print Legibly Name (Busiuess/organizationam&viduan: Address: c� /YA-Aj,v o cec f4 City/State/Zip: Phone#: LDd' 7'?S-'_ 2d,`Y,r e you an employer? Check the-appropriate bog: ' Type of project(required): I am a employer with 4. ❑ I am a general contractor and I 6. ❑New constmction to ees fall and/orpart-time).* have hired the sub-contractors Y � 7. f Remodeling 2.❑ I am a sale proprietor m partner- listed on the attached sheet $ ship and have no employees These sub-contactors have & ❑ Demolition working for mein any capacity. workers' comp.insurance 9. Building addition [No workers comp.insurance 5• ❑ We are a corporation and its 10.0 ElectricalmP airs or additions required.] officers have exercised their 11. of exemption per MGL ❑ Phlznbm airs or additions g 3.® I am a homeowner dog all work � P � myself. [No workers' comp. c. 152, §1(4),and we have no 12.[3 Roof repairs insurance required.] t . employees. [No workers' 13.❑ Other camp.insurance required.] *Any applicant that checks box#1 namt also W out the section below ahowing thair workers'compensation policyinformstion: •. t Homeowners wbo submit this affidavit indicating they use doing all work aadThen hire outside contractors must submit anew affidavit i<adiceting such. �C=t octets that check this boa must attached as additional sheet showing the acme ofibe sob-contractors aid their workers'comp,policy ieosmatioa. ram an employer thai is providing worker.i'compensation insurance for.my employees. Below is the policy and job site information. Insmance Company Name: J AIT. A C—?yf:�j Grp 6f-,�Oc Policy#or Siff-hi,Lic.#: f�1� �9 � �� / 3 Bxp�Dzte: 7�i Job Site Address: 2 �' LL�� 9�i S'f e.f �o City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Fail=to secure coverage as required under Section 25A of MGL c. 152 scan lead to the imposition of criminal penalties of a fine up to$1,504.00 and/or one-year irapiisonment,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 DLk for fim ce coverage verification. 1 do'hereby certify u er the j ins d penalties of perjury that the information provided above true and correct Si taro: Date: �� Q Phone#: ��� 17 5-- o1-O,l Official use only. Do rwi mpl a i?,this area,fo be coeted by city or town offici d f City or Town: PermitUcense# 1 IssuingAuthorify (circle one); 1.Board of 1Tealth 2.Building Department. 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspect-Lor 6.Other LContact Person: Phone#: I °FS► r°,,ti Town of Barnstable Regulatory Services " 1AENSTABLL ' Thomas F.Geiler,Director MASS. +ee Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 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: 1EXJ-6 A EL Estimated Cost /7 OV-6 Address of Work: oZ/ e5)it.t r7,7 9 G(!SSA/-f (.� _ - Owner's Name: G� C. L'ti,`,o �/2�/" Date of Application: Sld-2/0-7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Rkb 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 heridy apply,for a for a the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name QAnns-bomeaffidav • RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $ 50.00 �d Alterations/Renovations $ 50.00 Change of Contractor/Builder $ 25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE -H 7 square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $ 35.00 Ay2 >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.0041= STAND ALONE PE ITS • Open Porch — - �= x$30.00 (number) ti Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60. �0 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 r Pv°FIKEIpyy Town of Bar* nstable Regulatory Services . F RAWISTA 9 W. BLY'i Thomas F. Geiler,Director SAT D r s e Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder subject as Owner of the subproperty I, J - hereby authorize /�' / �' to act on my behalf, mail matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name. Q TORM S:OWNERPERIIS SIGN I Lor��oA - So 1.or iGoB D � k �\ �f'L f7/V) ppi Cr I 1 /¢Z.z7 - I GUi/NgU/ ss� rT 'RDi�� `� LCLATKIN F tt IICTUF 2 - UASE:✓ .v iiC.JHATIO\ JC1}VJ S. N♦ - T.A MORE ACC JRA7 OCA fK;" LAL4W7AN1 THEE AWUIF E AN INSTR,.IAENT f'SA31'1 y - SUPVFY. AMERICAN SURVEYING COMPANY �W OF BOSTON, INC. JOM S LAURETAM 1264 MAIN STREET WALTHAM, MUSS. 02451 - REGISTERED LAND SURVEYOR, PHONE(7B1) B90-5477 FAX(781)893-7091 I-HEREBY CERTIFY THAT THE - JOVE MORTGAGE INSPECTION MORTGAGE INSPECTION PLAN AN WAS PREPARED FOR 8acivSl79d.C6;eimr /rrae7>F'.v..usvd.Pt CLIENT. RECORD/F AT: COUNTY REGISTRY OF DEEDS CONNECTION NTH ANEW CLIENT REF. PORN'RFF"Wa P�.� LC RTGAGE. AND IS NOT INTENDED J_p, iZ�o DRAWN PER TOWN OF: ASSESSORS REPRESENSD TO eE A LaND THE LOCATION OF THE ORIGINAL MAP#: PARCELp DA"D' PROPERTY SURVEY.NO DWELLING SHOWN HEREON EITHER ADORES 'yi7Qu/ S tomes- ,PROPERTY WERE SET,AND I: WAS IN COMPLIANCE WTH LOCAL BORROWER• C07�`LT/7� VNOT BE USED FOR APPLICABLE ZONING BYLAWS w :ABUSHING FENCE. HEDGE, EFFECT WEN CONSTRUCTED BUILDING LINES. THE LAND (NTH RESPECT.TO HORIZONTAL. � _ )WWI HEREON IS BASED ON DIMENSIONAL REQUIREMENTS ONLY), NT FURNISHED OR I$EXEMPT FROM VIOLATION - DRMATION, AND MAY BE ENFORCEMENT ACTION UNDER MASS THE SUBJECT DWELLING LIES IN ROOD 'ONE .— IJECT TO FURTHER G.L. TITLE VII,CHAP,AOA.SEC.) AS SHOWN ON THE NATIONAL ROOD INSURAN C PROGRAM - t-SALES, TAKINGS. EASMENTS, UNLESS OTHERWISE NOTED OR INSURANCE FLOOD RATE MAP DATED: 1 RIGHTS OF WAY.NO SHOWN HEREON.A CONFIRMATORY COMMUNITY/PANEL # ,SooO - ;PONSIBILTY IS EXTENDED INSTRUMENT SURVEY IS.ADVISED - 'EIN TO THE LAND OWNER OR. WHEN STRUCTURES ARE SHOWN I l ED :UPANT,IT IS NOT INTENDEDLESS THAN-1'.iROM PROPERTY OR 6Y; c _ - BE RECORDED... PEOUIRED ZONING SETBACK LINES. DATE: -o F.B:--PCE;__ // -t` ✓� , v�fft' O NE Nl(i l!(iu'f.�l/! lCf.:�i.'/1•(�A�CZi Board or Building Regulations and Standards - Construction Supervisor License License: CS 651°2 ;,, Expiration: 12,-1,'4CCS Tr# 660- Restriction: 00 JOHN NI FALACC PC :X ' < 1224 i HY-.NPJIS,NIA 02601 Commissioner _ Bcnrd of Bcl'din;Regulations and Standards License or registration valid for indkidu' use cnl HOh,1E IMPROVEMENT CONTRACTOR before the expiration date, if found return to; - Registration: 14g"' Board of Building Regulations and Standards C One Ashburton Flace Rm 1301 �:xoirailon: ^G 1 .�;.,2...'ar,r17 _- Boston.Ala.02103 Type: Corporaticn HC''+ice C'A'�zGt:E''i1Gid i SP=CIAUS—C?F CAPE CCO JCrN "'A ', E.!2' Administrant dot valiti without signature —._e00 =0I LO i?a Rew AC0RD CERTIFICATE OF LIABILITY INSURANCE �i- I �.aei3a�'cs THIS CESVVICATE 13 ISSUED AS A''A?"BR CF INFORMATION The I:su=anee Agency i ONLY AND CGNIFT-i iS NO RIGHTS UPON THE CERTIFiCATIE of Cape Cod, .Lac. HOLD EA-THIS CFR7IFICA7E DOES MOT AMEND,EXTEND OR 480 Rcar® 6A, F a Sox 960 F ALTER TIDE COVERAGE APFCRDSO BY THIE POLICIES 3EL9, VY. "last 5andvich MR 02537 i ------ --- __r_ ?h.u:1e: 508-888-2766 F iK3URERa AFFOF2I7!'v6G CO'dwwm i NAl_C 0 I.ReRA: Sat®dy Insurance CotSSDJiSX -_-�-�36b�-�~ na�uaex XIG Amezxcan International,�3_ j of� IR Cod ent Saeci x?�s:p W�.af R e iar1, sville Warc93'!"e-' Ins do ��- a: Canty Cvd Inc. �__� -- �' ... _ _ _ LSyarnzs MA. 02501 ----�---• COVERAGES _ rT4.fi?CL;CtES DF!HStlRAWl;ti LISYeO 8£LOw'MAvE'tnF.eN tS,RUEO'O'FAE IP4'Q)Q II W,MED MOVE FOR THE POLICY PeRIOC maC ICA"I'M*0TV.WTNSTAhO4#VG .fAl+"A,CI,!R£tnCNT.-ER%d OR come cni Or ANY CONTRACT OR OrM LR DOCUNeNTVAr11 RESPECT TO WiiSCh r IS CE Ar1F1raTE MAY!e 48UED OR { MAY PERTAIK Ni a 44SURARrE•Pz0fi0e0 9Y^rl.''O4iC,'5S 0e'SCM t0 JASR :N IS AMACT TC AM_.TNC'L•.FaM&V.'-L1J2FO1WS af+0 GvNDOT'MNS Oar SUCI4 PC jC;5i.AW-FMf"iATcc l.*%T,3MCYM MAY HAV:;4V4 ke000E0 CTY AAOC%A w, �6LITTFaoTWE ItoJ�H 'L rA•wsa^� C -'17fi or IMSURAMC£ , ?'�:CZ'Na1;018FN CAM k�MfD07YV) ! W►T'6 rMeual"e'FY'. I 6.N1?S j +SYBQALLAaLT �— ZAC?l0=VRAV?<A !`s 130000C ! r„AaucrrtrrresTg>7 .- ( OnerEAcu�GEtaetALtfA&i!Y 4 L35 i413$ nREM(3& esooaranc®r _ I0C_OCC, �.. CLA✓ S Mti,H '.. . OCC.LuR' �60 2Xa(t*rrs ate.pnnor.) 1315000 . 1 I X i�uginess owners ! 09�02�06 09/02/07 jP&RSGNxLsAQv MAA s _ _ ,.GBNE"'ACGReGATE ;s 000000 vaN'LA,-GRE.;A'Q UMrrAP41ES PER: ( s'RdauCTS•COMP�D€ ��-oucY' x?o- �LOC ! �_ I auT0eu091L8 U+168ST'Y '• j ..--.•.—_.-_._ _ j �cCAtBINE:OSIWri.suMlT ;I00000C I A �ANYA:J"C• � 3953673 03d16J9b 09/1610 j( sxoafn:l AL.G 1W:D AUTJS BQOILY iNAAY i ' =c,aoi Lev Au*cs IP®.,x.unl _ it kIR AUTV$ I I aoGLY INJURY - ( _-•''I.Croara�0 AVTDS I {Par uoW�ti ,... --�--....__. f i udRAG£..;AfALIr'? i 'AUTC ONLY-Elk Ate::DENT.I ANY AU'0 ' JF 4ER?WW 0 0C.0 i• _ `�Il tl AUTO J LY:' %0 AGG I i 1 1 EXC45'&NbI8RE'.La UAER lTY - `6Au4 OCCLPAE!ICE 4: Aa13 MACE a j I IR I v rer caf a II4 ! s ACRKEAS 4fe'IAPCM9a1 T9CN ANO i � i,i I ,••�- -�O "iL:N1'I ! ! 8 !roFLaY�as ABadTY * 8c6$513 I 09/15105 I 09/15/07 4,L4CmAr,Gas.vr M +C_wUSIAR"R!�ICLUOCO- CISEASE.SAxMPLDiEd S I00^v0C j ur�r + Diwa -POLICY'Owr, .g500000 i xver,JL=RGV! tmr t I ' Rea�tP-ocW cf o€ AIONS r La Arja"I vEw�.s r y'A"4:c as uxsca SY EMOCRs'! T I sPec:a� wsacus i 199E Chevy 1010 VAN 1GCDG15Z437222051 1986 the rz Flat oul- .RucPC ?G3KC34MOGs:89051 ii _Mprcve men> anal ramodaling E ((CERT FICATF-HOLDER CANCHLiATION . ( Sw'OCOPAZ %UYJl0 AOtY Of THE AaCV5 MCa'BE.D PWCES 3S C-NCRLEO SEMRE TM2 E`-fiAST10 OATeTTOl: COF.THE=W1MGW4URnRPALLR.Va5AVCCaTO,WVL 30 QAYs'F+WrTti'f nGT?C$Tp'11L'CERTtbiCd'1x MOLDFSt:`.6UHD TO TTs£L&F'',BUT FAILURE'C CO SO SS+A:I IgP096 NO OMIGATCM CR LIAZWT FCF ANY RIND VPOM rrE 1NSUREA ITS A7,xrL 9.; 11 4 Rf E ii/ � The T:78L9Xan�cli RC'971Cx,- � ;c�RIS L+,2001;09, - C9 ACORO CORPORATIC-N 1989 6 'd LB8?-SI..L-BOS UE0 '01 LO .172 Rew Nome Improvement Specialists of Cape God 25 Iyannough Rd. Hyannis, M,4 02601 508--I�5-288�i SUNfROOM ADDITION_ Homeowner; Greer Residence DRAWING: COVER PAGE 21 Gu i mqu i ssett Rd. DATE: 5/14/2007 DRAWN BY: ROB BERKE Cotuit, MA 02635 ' Home" Improvement Specialists of Gape, God 25 IVnnough Rd. Hyannis, MA 02601 • 508-�iZ5-288�1 Homeowner: Greer Residence- 21 Czu i mqu i ssett Rd. Cotu i t, MA 02ro35 2x8 FLOOR JOISTS m Iro o.c. I 1 DRAWING: A-1 DATE: 5/14/2001 .' DRAWN 5Y: R05 5ERKE 131-0'I - DECK: Existing Home Improvement Specialists of Cape Cod 25 lyannough Rd. Hyannis, MA 02601 \ 508--115-288-1 0 Homeowner: C-t;reer.' Residence 21 Gu i mqu i ssett Rd. Cotu i t, MA 02635 \' bL to cp x Qj ' N , JANO 2x8 FLOOR, J P IP TS a I6" o.c. Existing Footing LLILJ To Be Kept DRAWING: A-2 DATE: 5/14/2001 DRAWN BY: ROB BERKE DECK: Proposed Home Improvement Specialists of Gape Cod 25 lyannough Rd, _ Nyann i s, MA 02601 508-1Z5-2881 C21 wner: Greer E- Gotuit, e Czu i mcju i sset MA 0 1� 6 - 2x8 Ceiling Jst/Collar Ties ASPHALT SHINGLES CONTINUOUS EAVES PROTECTION 18 KD RAFTERS I - - 1/7'CDX PLYWOOD SHEATHING (2) 2x8 Headers 1/2"PLYWOOD SHEATHING COX Screening - top to bottom s MRX 4"BEADBOA :�7 R - 01 -3x4 TOP PLATES Ix8 FASCIA Railing with cap TYPICAL 4x4 POSTED EXTERIOR WALL: between posts 3/4"PINE.TRIM I/]°SHEATHING xB PLANCHARD 4.4 POST o./-X-O"o.c. 4x4 PT Posts New Footings - 4'-0" below c3rade And New Beam SIDING/4" STUD EAvE Existing Footings 41-4" 41-4" 41-4" DRAWING: A-3 13 -0 DATE: 5/14/2001 DRAWN BY: ROB BERKE Nome Improvement Specialists of Gape Cod Homeowner: Greer Residence 25 1yannough Rd. 21 Gu i mqu i ssett Rd. Hyannis, MA 02601 Cotu i t, MA 02635 508-115-2551 12 6� • screen to floor with rail inside Front Elev: Proposed DRAWING: E-I DATE: 5/14/2001 DRAWN BY: ROB BERKE . .,r, (:25 ome Improvement Specialists of Gape God Homeowner: Greer Residence lyannough Rd. 21 C-suimcjuissett Rd. yannis, MA 02601 Cotu i t, MA 02635 05_11 -288� r I I I I I I I I I I I I III I I1 � I C G 0 4 n Elev: Right Side Proposed r DRAWING: E-2 DATE: 5/14/200-1 DRAWN BY: ROB BERKE IL Nome improvement Specialists i a I i sts of Ga e 'Cod ''" '' p px p T Homeowner: Greer Residence - 25 lyannough Rd. µ> 21 Cxu i mc�u i sett Rd. H ann i s, MA 02601 x y Cotu i t, .MA 02635 _ _ E a ❑,1 DRAWING: E-3 Elev. Left Side Proposed r DATE: 5/I4/2001 DRAWN BY: ROB BERKE WE The Town of Barnstable • BAR MBM • 1m� Department of Health Safety and Environmental Services 'OrE��,,,o•(► Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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: Apo -etr�`� U0� %3 x2o Est.Cos�3 O�fl•�O Address of Work: ZI uX•,Z) V k. Owner's Nam S 4-e, - Date of Permit Application: 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: lzk � Date Contra �' Re istration No. c r Name g OR Date Owner's Name The Commonwealth Of fassaC iusett _._. i;_ De paranunt of Industrial Accidents ` Office 01127=1/ga1108S 600 11 ashinf ton Street Boston.Alas. 02I11 Workers' Compensation Insurance Atfid:tv it p cc �ppitcant Inform ati on:` Please PRINT name �•�.ey� �F2-��tti '�C+�� I c t' • I 1 a homeowner performing all work myself. 1 ; a sole proprietor and have no one working in any capacity r.....t?7w....:ews.rr.+.,�-.�su•. -.t....,� .>.rfE7"?.7A�x�r'asA7iT,Rd16T 1F�►+�`L�....��!�'.r'!'+7+e'�"•"'+.+Q•.v. r7 I am an employer providing workers' compensation for my employees working on this job. company name: address: Y city: phone#• insurnnr,e co. 110licy# �- . .,,-_._....,..,�,. .-nr...,. ,�,>.>-...�.,�.�r. .w.+rnM!rw+!+w>�•"".'•.•r�*r+w...�w«w...•.s,r..+�i��!!w�wTr'/� ...�. .. I am a ole proprietor general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: compare• nnmc• address: cih•: Rhone#• insurance co. polio•# .. ._... _ .or-=-"T....-,,,r.•Y f•. c�sre••.-.:s.�-. -..,.,.. aca-:�.�• ina; company name: address: city: phone#• insurance co, policy# :Attach additional sheet if riecessa + ... _ -1`,.;•-31"t•:sp-�rY�r�i r.-.•,.... ;,.i,.+r.c�r „c�te^i��!•.� CIS /IZ:^V.r+ .r i •,` . Failure to secure coverage as required under Sectionl25A of 111GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andiur one years'imprisonment as a-cll as civil penalties in the form of a STOP WORK ORDER and a fine ofS100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of investigations of the D1A for coverage verification. I do herehr certif muter the paints and penalties of perjure'that the information proaided above is true/and correct. Si:nature Date -?T Zl�e! Print name Phone# 4' a+official use onh do not i�•ritc in this area to be completed by city or town oMcial - city or town: permit/license# riBuilding Department Licensing Board (]check if immediate response is required ❑Selectmen's Office C311calth Department contact person: phone#: InOther E: irmsed 3;95 P1A) - • t1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "laNv", an enrplt ree is defined as every person in the service of another under any contract of hire. express or implied, oral or written. - + An emplt rer is defined as an individual, partnership, association. corporation or other legal entity, or any two or more the fore�_oinZ� enLa�_ed in a joint enterprise, and including the legal representatives of a deceased emplover, 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 t dwellim, house of another who employs persons to do maintenance , construction or repair work on such dwelling hous or on the urounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section '_5 also states that even,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 ha� 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 supplying company names. address and phone numbers as all affidavits 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. .77 City or 'towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at tite bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas: 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. Tile 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. ►^'mu,v.-,�..-_.-..,.,......�_..,r,_.rv+-n.-•. -.---...w.m..r-r•..•v-��•.�.v.�-atw•- _ 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 DEVILS IN THE DETAILS BRIAN HENNIGAN (508)420-2417 MCS#066349 client:JANE GEISSLER location:GUIMQUISSETT RD.,LOT 178B,COTUIT HIGHGROUND description:DECK COST ESTIMATE/FIXED PRESSURE TREATED/1ST QUALITY MATERIALS 1 4"X4"X8' 2 2"X4"X10' 3 2'X4"X12' 4 T X4"X14' 5 2"X4'X16' 6 2"X6"X8' 7 2"X6"X10' 8 T X6"X14' 9 2"X8"X8' 10 2"X8"X10' 11 2"X8"X12' 12 2"XS"X14' 13 T XKX16' 14 5/4"X6"X8' 15 5/4"X6"X10' 16 5/41'X6"X12' 17 5/4"X6"X14' 18 5/4"X6"X16' " 191 LATTICE 2'X8' 20 SAKRETE-80LB 21 SONATUBE 12'X10" 22 LAG BOLTS 8"xl/2 23 JOIST HANGERS 24 10d GALV BOX NAILS PER LB 25 16d GALV NAILS PER LB 26 MISC.HARD WARE t boilerroom stairs stairs i 20' i 13' :.::.a.................................... Brian Hennigan Devils in the Details _ for MCS8066349 Jane Geissler •, 3 6 30 35 ., j 3 31 53 4.3 F 4 6 34 6 55 39\ 2 i TREES i .9 s , 60 20 " 2 s • • 2 r� 5.1 8.6 �. 24. Z. \ ; i 169 170 33.1 � 4 Al 118 -117 ; 112 7113 11� 4