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HomeMy WebLinkAbout0023 LAKE STREET a � . _ _ _ _ _ _ _ �. a 1 con, it i ol-n- 4' e— 10 ta Sa 4 4 m ................. 11/14/14 Thomas Perry, CBO Town of Barnstable Building Division 200 Main St Hyannis, MA 02601 RE: Insulation Permits Hear Mr. Perry, This affidavit is to certify that all work completed for insulation work at 23 Lake St(application# 201204706) has been inspected by a certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds federal and State requirements. Sincerely, Conor McInerney fl ConserVision Energy 1 --- cn --a I 376 ROUTE 130,SUITE C SANDWICH,MA 02563 508-833-8384 WWW.CONSERVrODAY.COM TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Gy -To W Map Parcel_ 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 A f�k LrnV. Village_ C,0 1% — Owner I V a(1 L Address Telephone . a � Permit Request OUA a \cc a �,r CA✓N� fir ,, Square feet: 1 st floor: existing proposed 2nd floor: existing__proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio� �T'( -Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling,Type: Single Family ❑ Two Farnily ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other_ A Basement Finished Area(sq.ft.)___ Basement Unfinished Area (sq.ft) _ Number of Baths: Full: existing new _ Half: existing.. w. _new.°.i Number of Bedrooms: _ existing .—new Total Room Count (not including baths): existing new —First Floor Room Count co Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other co Central Air: ❑Yes ❑ No Fireplaces: Existing_—New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use-_ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ' Telephone Number Address CX1'e ��0 \ License # N(>� rl�'3`tS Home Improvement Contractor# _ - Worker's Compensation # '�� �i ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �2 I I FOR OFFICIAL USE ONLY rr , APPLICATION# " } DATE ISSUED , .aaa . MAP/PARCEL N0. ._. *` ADDRESS VILLAGE OWNER DATE OF INSPECTION: ". FOUNDATION r, FRAME i -INSULATION! FIREPLACE r ELECTRICAL: ROUGH FINAL .t PLUMBING: ROUGH FINAL :GAS: ROUGH }:_- - FINAL FINAL BUIL•-DINGI► DATE CLOSED OUT.' ASSOCIATION PLAN NO.- 1 . r - The Commonwealth of'Massachusetts �ff,�� Department of Industrial Accidents 46 Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual):CONSERVE ENERGY INC. d.b.a CONSERVISION ENERGY Address: 376 ROUTE 130, SUITE C City/State/Zip:SANDWICH, MA 02563 Phone #: 508-833-8384 Are you an employer? Check the appropriate box: Type of project(required): l.M I am a employer with 6 4. ❑ 1 am a general contractor and I employees(full andi'or part-time).* have hired the sub:contractors 1 f• ❑New construction Z❑ f am a sole proprietor or partner- listed on the attached sheet, I 7, 7 Remodeling ship and have no employees Chose sub-contractors have 8. ❑ Demolition working for me in any capacity, employees and have workers' insurance.* ❑ Building addition comp.[No workers' comp. insurance p• required.] 5. ❑ We are a corporation and its 10.7 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I l.❑ Plumbing repairs or additions myself. [No workers'comp. right ofexemption per MGL 12 ❑ Kopf repairs insurance required.]f c. 152, §1(4),and we have no employees. [No workers' 13.© OtherWEATHERIZATION comp. insurance required.] *Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy intbrmation. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors roust submit a new atlidav it indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractor;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'compensatiun insurance for my employees. Below is the policy and job site information. Insurance Company Name: SELECTIVE INSURANCE COMPANY OF THE SOUTH Policy#or Self-ins, Lic.#:WC7956539 Expiration Date:3115/13 Job Site Address: 23 Le &rj, gZ _ City/State/Zip: f 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 MG L 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 S250.00 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 ceW under the sins and penalties uf m that the in ormation provided above is true and correct. Si ature: Date:' I� Phone#:508=833-8384 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.CitylTown Clerk, 4.Electrical Inspector 5. Plumbing,.inspector \. 6.Other Contact Person: Phone#: i' Client#:68880 CONSER ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDNYYY) 0 311 5/201 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:It the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject t0 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 ICONTAC Rogers&Gray Insurance Agency,Inc. t NAME: --FA` - - -- �A c Na_E>�508 39...... 434 Route 134 E-MAa ADDRESS: South Dennis,MA 02660 - —-- - - __.:__ INSURER(Sl AFFORDING COVERAGE .NAIC 0 " 508 398-7980 t INSURER. _ _ ------_._ _..,,-.__ ._.-: A:Selective ins.Co of the South INSURED '----- ---` I INSURER B I f Con-Serve Energy,Inc. r ....._... 376 Route 130.STE C IrNSURERc: '- E INSURER D: Sandwich;MA 02563 E- �NSURER 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 P:i11AY 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 ADDLSUBR POUCYEFF'� PO- L-T iCYEXp - LTR I TYPE OF INSURANCE INSR WVD POLICY NUMBER_ LMMIDD/YYYY1 MMIDDA'YYY LIMITS A GENERAL LIABILITY a X S2011299 03/14/2012 03h 4/2013 EACH OCCURRENCE J u 0(},000 X COMMERCIAL GENERAL LIABILITY- I DAMA�E TO RENTED ' PREMISES jEa occurrenM_15100000 CLAIMS-MADE X OCCUR 1 t - ...._..._..._.. . ; i MEO EXP jA„Y one person) *$10,000 + 1 a PERSONAL B ADV INJURY -4$1,000,000 _ - �__ GENERAL AGGREGATE 1'S3 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: L --� PRODUCTS COMPrOPAGG- s3,000,000 X POLICY'r— PEa LOO i I I -___ ------ $ .-_ }AUTOMOBILES LIABILITY COMBINED SINGLE LIMIT -� I �,{Ea accidant _ ( ANY AUTO I I BODILY INJURY(Per person) S - - ALL OWNED SCHEDULED i I BODILY INJURY(Pat acpoenY)IS AUTOS .AUTOS i ( " t^-i NON-OWNED -- { I'HIRED AUTOS I I AUTOS 1 , I i pea ERT,-DAMAGE $ UMBRELLA LTAB i X OCCUR I X I S2011299 .31141..........�i ,_.. .._....�_ —......-.. — A i UMBRELLA LIAB �—��+^��.�.-�- _ I 2O12FO3I14/2013RGGREGATE CH FENCE- P$ 000,000 X -- :CLAIMS-MADE! �. ^� ' 0 - DED_ X I RETENTION$0 A WORKERS COMPENSATION t — WC STATU .- OTy-T-- AND EMPLOYERS'LIABILITY YIN- VtIG7956539 3I141201.2 03I14/2013 X i r�RY,mffT i. ANY PROPRIETORIPARTNERIEXECUTIVE i` — OFFICER/MEMBER EXCLUDED? N I A i (( E.L EACH ACCIDENT OO 000 {SMandiitory In NH) i describe tuWer I E L, 1 O ,DISEASE-EA EMPLOYEE!SO O00 ;DESCRIPTIONOF OPERATIONS below I _- _.- _ IE.L.DISEASE-POLICY LIMIT._SS000OO �. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) _ + Excluded officers uoder workers'comp-Conor and Courtney McInerney. Blanket additional insured coverage applies under CGL. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering;Inc. SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 Francis Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Cranston,RI 02910 AUTHORIZED REPRESENTATIVE ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S78899IM78898 DDR .. rJ sran � vtur/ a�_.' ���.,. r�,/a ueC� _ Office ot�oAsumer' firs Sdirh n' �ul.i`�inn License or registration valid for individul use only y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: IFr Registration: 171251 Type: Office of Consumer Affairs and Business Regulation S Expiration: 3i112414 Partner hip lU Park Plaza-Suite 5190 Boston,MA 02116 CON=SERVE ENERGY ; CONOR MCINERNEY 376 ROUTE 130 SUITE C ' SANDWICH,MA 02563 --- �� ----.^--_--—_-. Undersecretary .t valid without signature Ma uchu etts=0cpartment of Public `:_f;it ' Board of Building RvfUlations and Str,uilatt3� C011stru�4iorn S.ttpervi,ur Speruialty Linens .License: CS St.. 102778 Restrictect to: IC a, CONC?R'MCINERNEY 39 SIASCONSET DRIVE SAGAMORE BEACH; MA 02562 3 Ex.ptration: 8/19/20.12 fay t'si�;urf�4strriia 1 -, 102778 OWNER AUTHORIZATION FORM NIANc--q (Owner's Name) owner of the property located at (Property Address) 4 G 74 (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building F permit and to perform work on my property. Owner's S tire Date 82045 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel °Application # o2D/a " 166 Health Division Date Issued Conservation Division Application Fee Planning Dept. 'Permit Fee- �J Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address 23 LAKE STREET; Village COTUIT Owner NANCY ALLEN Address 23 `LAKE. STREET; :COTUIT, MA 02635 Telephone 508-428-3972 Permit Request PERFORM AIR SEALING MEASURES; INSTALL CELLULOSE TOOPEN ATTIC AREAS; INSTALL INSULATION TO SLOPES AND BASEMENT SILL; INSTALL VENTILATION CHUTES TO OPEN ATTIC. SEE ATTACHED CONTRACT AND OWNER AUTHORIZATION :FORM. i Square feet: 1.st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation $2,734.04 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count _ Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood al stover❑Y�❑ No 1 Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size — Barn: ❑Oi ting ❑`view she_ Attached garage: ❑ existing ❑ new size _Shed:❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RISE Engineering Telephone Number 401-784-3700 EXT kkk X6133 Address 1341 Elmwood Ave, Cranston, RI 02910 License# 100459 Home Improvement Contractor# 120979 Worker's Compensation # 3730961-01 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO RI Resource R ov y SIGNATURE DATE 7 f Erik Nerstheimer for RISE Engineering r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. x l! 7 ry ADDRESS VILLAGE OWNER 4:{> DATE OF INSPECTION: x :: FOUNDATION _."_.FRAME _. INSULATION { FIREPLACE ELECTRICAL: ROUGH FINAL 4 PLUMBING: ROUGH FINAL >GAS: `' ROUGH : "�" r' FINAL _..._ _ ,� :=°FINAL BUILDING''=>i.'r ►;?`�:,'t �.t�, _ a M y„ DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth ofMassachuseds , - Department of Industrial Accidents Office of Investigations 600 Washington Street Y Boston, AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual),' RISE ENGINEERING; A DIVISION OF THIELSCH ENGINEERING Address: 1341 ELMWOOD AVENUE City/State/Zip: CRANSTON, RI 02910 - Phone#: 401-784-3700 OR 800-422-5365 Are you an employer? Check the appropriate box: Type of-project(required): 1. X❑ I am a employer with 4. 0 I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). , 2.0 I am a sole proprietor,or partner listed on the attached sheet.. ;N 7. F116modeling s ship and have no employees Thee sub=contractors have 8. E] Demolition working for me in'any capacity. employees and have workers' [No workers' comp:insurance comp. insurance. $ 9. Building addition required.] 5•.❑ We are a`corporation and its 10:❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I f-El Pluibing 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.[XI Other INSULATION. 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 anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether of not those entities have employees. If the sub-contractors have employees;they must provide their workers'comp.policy number. I am an employer that is providing workers'.compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: THE PRESTON.AGENCY, INC. Policy#or Self-ins.Lic.#: , 3730961-01. Expiration Date: -,01/01/13 1_� j Job Site Address: 23 LAKE STREET. City/State/Zip: COTUIT; MASSACHUSETTS 02635 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 MOL 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby certi n r s a enalties of perjury that the information provided a ve is tr7 and correct. Siznature: Date: ' ERIK NERSTHEIMER FOR RISE :ENGINEERING Phone#: 401-784-3700; EXT. 6133 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): tx 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ' 6. Other Contact Person: Phone#: 'THIEL-1 OP ID: 27 ACCSRO' DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/13/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,.subject to the terms and conditions of the policy,certain policies may require_an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). - PRODUCER 401-886-8000 CONTACT The Preston Agency,Inc. NAME: 1350 Division Rd Suite 303 ...�.-. 401--885-1700 a/c No Ext: FAXAIC No PO BOX 810 E-MAIL - East Greenwich,RI 02818-0810 ADDRESS: Judith A.Wright CPCU AAI ARM - .. - INSURER(S)AFFORDING COVERAGE - NAIC N INSURER A:Zurich-American ` INSURED Thiel sch Engineering,Inc. - - INSURER B:American Guarantee&Liability - Thielsch Group Inc. Hi Tech Realty Inc. INSURER C:Twin City Fire-Hartford Attn:Trent Theroux . INSURER D:North American.Capacity 195 Frances Avenue y. Cranston,RI 02910 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 rypE OF INSURANCE - POLICY EFF "POLICY EXP -- LTR POLICY NUMBER IMMIDDIYYYYI (MM/DDIYYYYj - LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 3730962-01 01/01/12 01/01/13 DAMAGE TO PREMISES R occurrence $ENTEU 300,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO- jECTLOC Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT Ea accident 21000,00 A X ANY AUTO 3730963-01 01/01/12, , 01/01/13 BODILY INJURY(Per person), $ ALL OWNED SCHEDULED BODILY INJURY Per accident 8 AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ X UMBRELLA LIAB X OCCUR. ,• EACH OCCURRENCE $ 10,000,000 B EXCESS LIAB CLAIMS-MADE AUC-4857188-01 01/01/12 01/01/13 AGGREGATE $ 10,000,000 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X•T RY LIMIT ER A ANY PROPRIETOR/PARTNER/EXECUTIVE 3730961-01 011101/12 .01101/13 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ N/A - _ - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE'-POLICY LIMIT $ 1,000,00 C Property Section 02UUNHE6930 •01101/12 01/01/13 Property see Belo D Professional Liab DVL000026802, 01/01/12- 01/01/13 Prof Liab 2,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD'101',Additional Remarks Schedule,If more space Is retiulred)' When required by a written contract: • CERTIFICATE HOLDER ;CANCELLATION` --— TWNHARW SHOULD ANY OF THE ABOVE'DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED .IN ACCORDANCE WITH THE POLICY PROVISIONS.. Building Division ' 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis,MA 02601 � ""'1/ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo'are registered marks of ACORD NOTEPAD THIEL-1 PAGE 2 INSURED'S NAME Thielsch Engineering OP ID: 27 DATE 01/13/12 Al T RIR Ongineerin ,a division of Thielsch En ineering,Inc. Gaskell Associal9es,a division of Thielsch Egngineering,lnc. BA Laboratory,a division of Thielsch En ineerin ,Inc. ES�I&aboratorrYy,a drvisign o Thielsch En ineerin;�..Inc AL Engine ing a division of Thielsch nginee i ,Inc. Water ManagemeiR Services,a division of Thielsch Egngineering,Inc. } i t �a: Licensee Details 4. Page 1 of 1 The Official Website of the Executive Office.of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints. T License Type Construction Supervisor + License# 100459 Restriction WS,IC Name Erik Nerstheimer City,State,Zip North Scituate,RI,02857 R Expiration Date 3/28/2012 Status . Current No complaints found for this Licensee. Back To Search t�sachax -Bit u'd of•Builtlin.Re �►ir pf 1 uFtli•• ._ Consfruction Su Rcas_ c ,.tF�ti Pervisor g <rntlt:tntf:irds ,. License:- S faeciDlty ti Restricted to: wS SL 100459` .- cense ERIK NERST HEIiWER.228 GLEANER CHAP NORTH L SCIT E ROAD � DATE, R102857 („mrnic�u�x Expiration:•3/28/Z01 TrY; 100459 k : ` http://db.state.ma.us/dps/liddetails.asp?tx'SearchLN=CSL100459 4/20/2011 Of��iceo 6=-=er Kia/and usmess cg u ation 10 Park Plaza - Suite 5170 . wM Boston, ] �ssachusetts 02116 Home Improve aontractor Registration :ram— Registration: 120979 Type: Supplement Card THIELSCH ENGINEERING Expiration: 3/25/2012 M ERIK NERSTHEIMER 1341 ELMWOOD AVE. _ CRANSTON, RI 02910 Update Address and return card.Mark reason for change. �— Address Renewal Employment Lost Card DPS-CA1, 0 50M-04/04-G??10//1216Q ✓12C (OG i7vIYKY�tloP�1Z o�i/(rLCldd�ll/DC�Q - . . . Office of Consumer Affairs&Business Regulation License or registration valid for.individul use only before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR P Office of Consumer Affairs and Business Regulation Registration;'.122 Type: 10 Park Plaza-Suite 5170 Expira�t�� 542�12 Supplement Card Boston,MA 02116 THIELSCH ENGt . 'ff ERIK NERSTHEEM F.^_ 1341 ELMWOOD CRANSTON, RI 029d:T Undersecretary Not valid.without signature e Control No: 34244 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF LABOR ,,, o s -=DIVISION OF OCCUPATIONAL. SAFETY., 19 STANUORD STREET, BOSTON,MASSACHUSETTS 02114 LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER RISE Engineering r A-Division. of Thielsch Engineering,Inc. ` •1341' Elmwood°Avenue Cranston, R102910 ` WAIVER: LW000672 EXPIRES: April 15,2015 IN ACCORDANCE WITH M.G.L. C. 111; § 197(B)(b)AND 454 CMR 22.03(3)(b), THIS LEAD-SAFE RENOVATION CONTRACTOR.LICENSING WAIVER IS ISSUED BY THE DIV. OF OCCUPATIONAL SAFETY TO THE CONTRACTOR ABOVE FOR THE aPURPOSE OF PERFORMING'LEAD-SAFE RENOVATION WORK. ' THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER MUST BE MAINTAINED BY.THE CONTRACTOR IN-ACCORDANCE WITH M.G.L. C. 11 L. § 197B(b)AND 454 CMR 22.04 WHEN PERFORMING LEAD-SAFE RENOVATION WORK. HEATHER E.•RowE,ACTING CONMUSSIONER L� • - Printed on Recycled paper, ..{ s Y NAT-24531 - 1 RISE ENGINEEn.ING Feeeial ID#05-0405629 RI Contractor Registration No 8186 A division of Thielseh Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,RI 02910 (401)784-3700 FAX(401).784-3710 CONTRACT Page 1 PROGRAM 'THIS CONTRACT IS ENTERED INTO BETWEEN RISE - CLC-RCS ENGINEERING AND THE CUSTOMER FOR WORK AS NG t N IEE R I NG DESCRIBED BELOW CUSTOMER - PHONE . _ DATE client# Nancy Allen (508)428-3972 11/11/2011 082045 SERVICE STREET _ BILLING STREET - - 23 Lake Street 23 Lake Street SERVICE CITY,STATE,21P ..� BILLING CITY,STATE,ZIP' ^ ' Cotuit,MA 02635 - Cotuit,MA 02635 JOB DESCRIPTION ` Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality. Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) S1,050.00 Provide labor and materials to install a 14"layer of R-49 Class 1 Cellulose added to 238 square feet of open attic space. < $357.00 Provide labor and materials to install a 9"layer of R-31 Class 1 Cellulose added to 288 square feet of open attic space.. $368.64 . Provide labor and materials to install a 6"layer of R-22 Class 1 Cellulose added to 215 square feet of slope area. $434.30 Provide labor and materials to insulate the back of the attic hatch with 2"rigid foam board that meets the sections R-316.5.4 and 316.6 requirements of building code. $31:00 Provide labor and materials to install.a 6.25;'layer of R-19 fiberglass batts to 54 square feet of sloped ceiling area: , $75.06 Provide labor and materials to install linsulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). Is $108.00 Provide labor and materials to install ventilation chutes in(52)rafter bays to maintain air flow. $166.40 Provide labor and materials to install R-13 faced fiberglass to 74 square feet of wall. Insulation will be fastened in place. $93.24 Provide labor and materials to install 28 square feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house NOV ^ 14 l RISE ENGINEERING Federal ID#05-0405629 RI Contractor Registration No 8186 i A division of Thielsch Engineering MA Contractor Registration No 120979 4 CT Contractor Registration No 620120 t 1341 Elmwood Avenue,Cranston,RI 02910 (401)784-3700 FAX(401)784-3710 CONTRACT - Page 2 j PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE �• - CLC-RCS. ENGINEERING AND THE CUSTOMER FOR WORK AS-. EM(;I)hJE,E°1t1NG DESCRIBED BELOW CUSTOMER PHONE - - DATE ClieM it Nancy Allen (508)128-3972 11/11/2011 082045 ' SERVICE STREET BILLING STREET -- 23 Lake Street ~ 23 Lake Street SERVICE CITY,STATE,ZIP ' -.., BILLING CITY,STATE,ZIP - ('`�' (f .� ` � Cotuit,MA 02635 Cotuit,MA 02635 - F 'E ✓,� tt z JOB DESCRIPTION - sill: $50.40 RISE Engineering will apply all applicable,.eligible incentives to this contract. You will be billed only the Net amount. Currently,for air sealing measures,the Cape Light Compact offers 100%incentive. -$1,050.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$2,000 per calander year. _ $1,263.03 r WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four,Hundred Twenty-One&01/100 Dollars $4721.01� UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN.FULL INTEREST OF i%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. Q NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZED SIGNATURE-RISE ENGINEERING • - F CUSTOMER AC P - r • - NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE i 1 A t O •ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE - SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THENORK- DAYS. - AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE OWNER AUTHORIZATION FORM I, NIANCT .L . R V l,F_tj (Owner's Name) ' owner of the property located at (Property Address),,, (Property Address) ' hereby,authorize.. E (Subcontractor) an authorized subcontractor for RISE Engineering,to ac't onmy behalf to obtain a'building .y - permit and to perform work on my property. Owner's Si ure Date