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0675 MAIN STREET (COTUIT) (6)
an; 1-3 �1u6, 3 I x , Town of BarnstableBuildingy Post;This,Card So That It is"Visible„From the Street Approved Plans Must beReta!ned on;Job and this Catl Must-be Kept 9ARNf3CA8LLr,. �' r. � ' ';�o-sl., Mw� Pgo,�sted Until FinalInspection;Has Been Made y;: �� x' 163Q. "£" "; .ivX.> Permit R Wher'a Cert�ficatejof®ccu anc .is�Re u red;;rsuch Bu�ldm shall£Not be Occupied,untit a Fina(Inspection has been made Permit No. B-19-752 Applicant Name: PLM BUZZY LLC Approvals Date Issued: 03/12/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 09/12/2019 Foundation: Residential Map/Lot. 036 015 Zoning District: Sheathing: Location: 675 B2 MAIN'STREET(COTUIT),COTUIT s S E f . Contractor Name framing: 1 Owner on Record: PLM BUZZY LLC , ' � �Contractor`License � _ z --£ 3 2 Address: 120 EAST AVENUE,3RD FLOOR � �ect Cost: $2,500.00 ' Est Pro . Chimney: ROCHESTER, NY 14610 Perrnrt Fee: $85.00 Description: take hall closet(33x36)and close off to open a doorway/for shower Fee Paid '' $85.00 Insulation: opening/in half bath (behind closet)see diagram Date 3/12/2019 Final: Plumbing/Gas Reviewers Note:ventilation must be provided: RMCK - - Rough Plumbing: Project Review Req: Building Official V41 r Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and st uctures sho,'Wbe in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for At, for the entire duration of the Final Gas: work until the completion of the same. r � A, Electrical B The Certificate of occupancy will not be issued until all applicable signatures by the uilding and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work ` Service: 1.Foundation or Footing s �, 2.Sheathing Inspection y` Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: tHE Application Number . (��.. ..J ............... 4 r BUILDING DEPT. (� 9 MASS. Permit Fee.......................................Other Fee........................ MAR 12 2019 Total Fee Paid..... .:.....:. j()%4v 13L F { f TOWN OF BARNSTABLE Permit Approval by......... Gl�%....On.....!�.1 a .7 BUILDING PERMIT ........... .. .. (0...........P=el.......a....d ...................... APPLICATION Section 1 — Owner's Information and Project Location f 1 n Project Address_(p�� /A� S`'`" 2, Village W I t'� Owners Name &sue 1 Owners Legal Address!,Q jva-� KI City CU-3-T-n le State M.-A. Zip Owners Cell# - �'�- (p E-mail ' = Ct Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3— Type of Permit New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm ebuild ❑ Deck Apartment Sprinkler System Addition ❑ Retaining wall ❑ . Solar Renovation ❑ Pool ❑ Insulation Other—Specify KC� .Lt CItL Lb P S 0,11-)c—of ►,+c) S�-k-yw� E' Section 4 - Work Description � I w I I 50e d�iw mk II13 u Last updated 11/15/2018 T Application Number..................................................... Section 5—Detail Cost of Proposed Construction 0 C7 , Square Footage of Project Age of Structure Dig Safe Number> # Of Bedrooms Existing _t) ML'-. Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private, Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required° Proposed Side Yard '' Required Proposed Has this property had relief from the Zoning Board in the past?, ❑ Yes ❑I, Last updated: 11/15/2018 Application Number........................................... Section 9=Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # 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 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10 Home Improvement Contractor p t '! Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... JSignature Date Section 11 —Home Owners License Exemption H S 'Home Owners Name: Telephone Number Z FS - (ol 14Cell or Work Number I J derstand 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 7 di cumentation required by 780 CMR and the Town of Barnstable. Signature Date)j c�vl APPLICANT SIGNATURE '_Signature*)"__A1 Date 3 t Print Name (2A,5r*Telephone Number`s7l _ 1071 E-mail permit to: �t e" s S , Last updated: 11/152018 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval, Section 13— Owner's Authorization tl I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name ' 7 Last updated: 11/15/2018 ' �_ R , �.n+.^ MyM"✓•A .��.,.,.•�•��1"V"a,t,..H y..., l� 04�� �'�,�3M ' ����� � "L �,i8'rT�'"�"Rv 4F:'Ym .���k.��r'Nti,✓ '� L,-`.-�,i-..'p,`.ww. ::. -4¢'? r 4` F 4 .. � , 1 , f ¢ k , dd o O r rnsta le Bldg:Dept. k Oul Cif V V���.-e.d'�rf'� a'A 1 aR :t.,��»3 - �� ue S.� s.war, �..a .^._� IT'., { t����� ..m:. / d/� �i►`� ���-{�j�,,n( ! a 4Gy'.0 '• "K:. 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IF lA r r�tl 4 .. . .. ��� • � !may * p � ��• F The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Invest1gations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NdIne(Business/Organization/Individual): ~ Address: LIE `�'of--&-7t City/State/Zip: , � � Phone#:Z7 Are you,an'employer?Check the appropriate Type of project(required): 1.El I am a employer with 4Ikam a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on-the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any aP c aci tY• employees and have workers' _# 9. ❑Building addition [No workers' comp.insurance _ Comp.insurance. required]. 5. O We are a corporation and its 10.0 Electrical repairs or additions 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 12.0 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 #Contractor,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 andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 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. 1 do hereb certify under the pains a(ndpenalties ofperjury that the informationprovided above is true and correct �Si`ature:�- —-- �-' Date: t_ Phone#: Official use only. Do not write in this area;to be completed by city or town ojj°icial City or Town: Permit(License# R 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." Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insw ance. 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 bum 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 Q�ce of Investipt ions 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 446 or 1-877-MASSAFI Revised 4-24-07 Fax#617-727-�v 7749 ww mass.gov.fdia �� ��� �` � � . ��-� . . _ ._ . x �. � � . 3 . - _ . k � f _. �. - a ` Y R _ _ � .. - � �. • : TOWN OF BARNSTABLE Building Department - Foundation Permit ao Date Permit # - 2 Name Location (!� 7 fy� Pik= ` T Insp. of Bldgs. 1_ c 570.741 OA. 7" B-1 #675 163.6' TO MAIN STREET 5 o�, EXISTING CONCRETE FOUNDATION oGar'y o TOP FND.=51.97 7 (Ao�y B-2 Existing6 Dwelling EXISTING CONCRETE FOUNDATION TOP FND.=52.74 W Z � ®rk s 189.5' TO MAIN STREET �/0 #675 EXISTINGDA N CONCRETE "F`\9 TOP FND.=51.36 \ C-1 Ln in �! S88'2050-W 572.21 FOUNDATION PLOT PLAN DCE #14-020 PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE LOCATION #675 MAIN STREET COTUIT, MA SCALE : 1" = 40' DATE : 9-2-2015 PREPARED FOR: REFERENCE : MAP 36 PARCEL 15 PLM B ZY, LLC DB 27900 PG 187 ZH OF MqS I HEREBY CERTIFY THAT THE STRUCTURE sqc SHOWN ON THIS PLAN IS LOCATED ON THE � DANIEL yes GROUND AS SHOWN HEREON. o A. f 508-as2-anal C) OJALA No.40980 fax 508-382-9880 downcape.com wa cape eaaiaeeriad,inc. civil engineers �_2_ _-- land surveyors _ _ 939 Main Street ( Rte 6A) YARMOUTHPORr MA 02675 DATE REG. LAND SURVEYOR 27se Coznmomveakis otfkassadrncetts 13 U I LD I IV G P E.RT. Department-af1ndmst7id Acciderds AUG 0 4 2016 -600 Washhlgtori meet _ Boston,MA 02.U.1 TOWN OF BARNS t'ABLE . fvrvs�trtt���diri ' Wwiwre CamipensationInsurance Af5davit Ba &i-JCuntxa-ctarsX1,ecEricians(P tubers Applicant lufm-main t Please Print�e�ilY Na=(gam- � azp: �6 J OV 1 Addresw Are you an employer?Check e appropriate bay Type of project(required)': I.❑ I ant a employer with 4. %I am a general confractor and I employees(full ar. r part-time). * have lured.the sub-contactors 6. New� - 2�.❑ I am a scale pzopFietmr orpastnw- listed outhe attached sheet I. ❑Remodeling shop and have;no employees These sub-coatraactars have ❑Demalifiou ' woddng far me in any rapacity employees and hate wadzers' LN4 'comp.insurance i camp.Msuran o �. ❑Building 8dd1t1otQ reqzke&] I ❑ We area corporation and its 1�❑Electoral repair or adcEitiom m.3.❑ I aa homeowner doing all v Mk, officers have eMErcised their " 1L❑Plum grepairs or a dchtiam mysdf[No work='camp- d9U of exemption per MGL 1 2- iomnnce reed.)T. c.152,�1(4k andwe have no Roofrepairs a employees.[No tiRo ers' 1�.❑iJtfier coup_insoranm required.) fAny VVfiCznt&8t checksboa#1—also IMaitthe swfianbeRmshav lag th&w wee w ff— txsap poIicgiaff-rmaeiaL &amovmers wise submit This ffd-vA i-M—d rg they sredaiag O wat sad&m bim outside C nt3UCtMamst mzbz t a new afdavit mdicating such fCosztzscros•dit check tLds but:mast attach m additiansl sheet dhowiag thea—of the sdb-�a and state whether ar not erase entities" employees.I€them -c�shwe employees,theynsnsrpmvide their warms'cmxp.palicg mnnber. I am art empiayer that praradiW nrerkeim'compamafaan insurance for miry eaaplo}wM Below is ttepalicy and job site irzfarmrrtiara. + .. Insurance Company hFame: "P4ficg 41or Self-ius.Lin tFxpiaatioaDafe:p Job Siite Address: CityfSta��p: At62ch a copy of the workers'compensationpolicy declaration page(showing the policy,number aad expimtion date). Failure to secure coverage as required under Section 25A of MQ.c�.1�'can lead to the imposition of criminal penalties of a fine-up ti,$1;50D OD andfor asie-yearimpfisoument, -as well as civil penalties ffi the fb m of a STUP WORK ORDERand a frme of up to$250-00 a day against the violator. Be advised mat a copy*of this statement may be forwarded to the Office of Iuvestiptions of the DIA for insurance ca`iera ve>dfrcati _& ° I do tier remit 7andgr atflra infarma€f apmikW abmv is true and correct SiEnatum Date' !� "Phone� • Ofilkiat use wity Do not mite in dds area,to be completed by city artom 90cial , City or Tuwm Permfff &ensse# t r w j Lzuing Aufisority(circleerne): - �f� a-A ry 7. L��Vl�'G61�1 �.&}mIling Department 3 fStytTowFt.ClerlL 4.Electrical l:nsper,#or 5.Phunbiag Inspecfarr ti.Other Contact Person: Phone#: lbaformation and lastruefions Massaclmsc s Grez� Laws chapter 152 rDgm=an cuploye$s b provide w=10='O°3P=8fon for then eolpIoyee�. Pmrs =±-to this StStUID,an=VIoyee is cictmed as¢.e=yperson m to S=vice of anuffim odes agyy coafzact ofhQe, egress or h-33P ecl,oral or vzh=f An employer is de fined as lan mdreidnal,paxtaersbip,assoecabon,corporation or of m legal mtty,or any two or more of the foregoing ea�aged�a joint e�prsise,and inclndmg file Iegal Feprese�afrves of a deceased emploes,or the other 1 loyees. Hov verthe , rei4er or irasi ee of an individual,paztur�,assocsabon egalY,emP uY �P owner of a.dwelling bonne havmg not more thm three apadmects and who resides or the occupant of the - ' dwelling house of ands who employs pe$sans to do mah fermi,contraction or repair Wow on such dwelling house Thereto sballnotbecaase of such I be deemed to be an employer." or on the g-ounds or bn11dmg app �P oYm� MM Cbapt Cr I52,§25C(6)also sfItes that¢every State or local Iic..,. sb3g agency shall whhhoId the issuance or renewal of a license or permit to operate a business or to construct bm7dings is the commouweali3i for any apphcantWILO has not produced acceptable evidence of cumpliiance witlr the hmmrance.coverage required. AddifionagY,MCL chapter 152,§25CC7)states=Nmffimfhe:cep nor ziny of its political subdivisions shun enter rote any coirtract for the performance ofEu ho Workmml acceptable evidence of co¢npliance W%rtlr fihe ias�n�re. regtm-eme�s of this chapter have been preserm;d fa the r-n�,ting autho�.ty." - APplicants Please fill act the WoA='.compensation affidavit completely,by dreclong$e boxes that apply to you situation and,if nDcessa y,supp y sub-contractor(s)name(s), address(es)and phone nximber(s) along with their cmtdacat*)of insurance. Limited Liability Companies(LLC)or LimltedLmbRjty Pmt=sbTs(LLP)vn&no employees other than.the members or pa fn=rs�ate not regLmed to cant'vorkeas' compeossafiaa.ins=mce If an LLC or LLP does have employees,ees, a.P olicy is required. Be advisedtliatthis affidaykmaybe snbmithd to the Depaifinent of Iudltstrial Accidents for conffimation of woe coverage. Also be sure to sign and date the of davit. The affidavit should be refume�to the city or town that the application for the permit or license is being requested,not the D epadnent of LoAnstrial Accidents. Shouldyou have any questions regardmg the law or ifyon are rimed to obtain a workers' comp eusation policy,please call tbz Deparime tat the number lisie3 below. Self-inmn-ed eolapanies should enter their s elf-iusuraace license number on the appmpriaiE line. City or Town OffIciaT.s t _ Please be sore that the affidavit is complete and prhdi--d legibly. 'Ihe Department has provided a space at the botlb= of the affidavit for you to fi11 out in the event the Office ofI�avestigafinas has to cozzfactyoaregardingthe agplicanf_ Please be sine to fill in the pexmiV icense mmaber which wM be used as a retbrence number. Ia addition,an applicant that must submit mult�PIe peuaitlliceuse applications in any given year,need only submit one affidavit indicating cat p oliCV, information.(if necessary)and under`clob Site Address"the applicant should W I1te"alt locations it (c it Y or town)_'A copy of the affidavit that has ben officially smuiped or madced by fire city or town may be provided to the applicant as proof that a valid affidavit is on file for terse per nits or licenses_ A new affidavit=Ld be hIled out each year.Whew a home owner or citizea is obtdaing a license or peunit not related to any business or commercial Ten is NOT to Iete this affidavit, to bum I etc. said egson �� z.e. a dog license orpeunit eaves , ) p �� C The Of of aVcS inns Would hb--to thank you in a&mce for your cooperation and sbovld you hays any questions, please do not hesitate to give us a caIL The Department's address,telephone and fax number: C=MOnf 0f MassachuseM - Deparfment c6f hiduial Aocidr nta f tie Off' tia41% M&EIIF Tt,-L#617-' -49W axt 4€6 or I-977-MASS. xevised4-24-07 .m g Wff 7 ® DATE(MM/DDIYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 6/9/15 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 endorsenent(s). PRODUCER - CONTACT NAME: .. Donald J. Medeiros Insurance A PHONE 508 678-1271 Fax NI: (774) 365-6552 154 Rhode Island Ave ADDRESS: don@donmedeirosinsurance.com Fall River, MA 02724 INSURE S AFFORDING COVERAGE NAIC# INSURER A:American European Insurance INSURED INSURERB:Safety Indemnit Edgar Mauricio Agudo Ortiz INSURERC:Liberty Mutual dba Ecuamerica Construction II INSURERD: 39 Seymour Street INSURER E: Berkley, MA 02779 INSURERF: 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 AWL SUER POLICY EFF POLICY EXP LTR TYPEOFINSURANCE INSIR WVD POLICY NUMBER MIDDY MMIDWYYYY LIMITS. A GENERALLIABILITY SKP2000957 10 4/23/15- 4/23/16 EACH OCCURRENCE $ 1,000,000 �( COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED Ce $ 100,000 occuCLAIMS{MADE Fx—]OCCUR MED EXP(Any one person) $ j 000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE. $ 2,000,000 GENT AGGREGATE LIMITAPPLIES PER _ PRODUCTS-COMP/OPAGG $ 2 000-,000 ' z• X POLICY PROX'T LOC $ # AUTOMOBILE 5 17/15 5/17/16 COMBINED SINGLE LIMIT B 6223581 / aaccdent $ 1 000 000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X ER AUTOS eraccdent $ UMBRELLA LIAB OOCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - $ C WORKERS COMPENSATION WC231S372831 5/5/15 5/5/16 X WCSTATU- OTH- ANDEMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE YIN E.L.EACH ACID DENT $ 500,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yyes,describe under DESCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICYLIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach-ACORD 101,Additional Remarks Schedule,if more space is regui red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED'BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE 'DELIVERED IN Residential Management INC ACCORDANCE WITH THE POLICY PROVISIONS. PLM Buzzy LLC 2604 Elmwood Ave Suite 352 AUTHORMD REPRESENTATIVE Rochester, NY 14618 Heather Williamson ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: ,AcoREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 10/16/2015 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 endorsements. PRODUCER CONTACT The Driscoll Agency, Inc. NAME:PHONE . ell 421 2490 F°'� 781 421 2491 93 longwater Circle E-MAIL Norwell MA 02061 .kseip@driscollagency.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:HDI-Gerling America Ins Co 41343 INSURED 218590. INSURER B:Navigators Insurance Company KOBO Utility Construction Corp. INSURER c.The Charter Oak Fire Ins Co 25615 4 Victory Drive P.O.Box 578 INSURER o Sandwich MA 02563 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1697556991 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. ILTRR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD CY EFF MMILDCD EXP OMITS A X COMMERCIAL GENERAL LIABILITY EGGCC000107815 10/1/2015 10/l/2016 EACH OCCURRENCE $2,000,000 CLAIMS MADE X❑OCCUR 'REMAGE SESRENTED Ea occurrence $100,000 MED EXP(Any one person) $excluded PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY I JET a LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY FAGCC000107815 10/1/2015 10/1/2016 COMBINED cciden SINGLE IT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ AALL UTOS OWNED SCHEDULEDAUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE Per accident $ AUTOS $ A UMBRELLA LtAB X OCCUR EXAGC000107815 10/1/2015 10/1/2016 EACH OCCURRENCE $10,000,000 8 NY15EXC7901951V 10/1/2015 10/1/2016 X EXCESSLIAB. CLAIMS-MADE AGGREGATE $10-,000,000 DED I X I RETENTION$0- $ A WORKERS COMPENSATION EWGCC000107815 10/1/2015 10/1/2016 XPER ETH- AND EMPLOYERS'LIABILI Y YIN STATUTE ER . ANY PROPRIETOR/PARTNER/EXECUTIVE ❑NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) , E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C . Contractors Equipmment QT6606B268829COF15 10/1/2015 10/1/2016 Special Form w/Theft 2,160,412 Installation Floater Install Ea jobsite 450,000 Leased/rented equip Leased/rented 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:671 Cotuit Road Residential Management Inc &PLM Buzzy Inc.Are included as Additional Insured for Automobile Liability on a Primary Basis for the conduct of the(Named)Insured,but only to the extent of that liability. See Attached... CERTIFICATE HOLDER CANCELLATION 30 Days except 10 days for nonpaymen SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Residential Management Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 120 East Ave Rochester NY 14604 AUTHORIZED REPRESENTATIVE dlllrrsld sde 0' 1. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE S I AGENCY CUSTOMER ID: 218590 LOC#: AC40R V ADDITIONAL REMARKS SCHEDULE Pagel of 1 AGENCY NAMED INSURED The Driscoll Agency, Inc. KOBO Utility Construction Corp. 4 Victory Drive POLICY NUMBER P.O.Box 578 Sandwich MA 02563 CARRIER NAIC CODE EFFECTIVE DATE: . ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Residential Management Inc &PLM Buzzy Inc.are included as Additional Insured for General Liability and Excess(Umbrella)Liability,for ongoing and completed operations,as required by a signed written contract or agreement with the Named Insured. The Additional Insured coverage for General Liability&Excess(Umbrella)Liability detailed above applies on a primary,non-contributory basis where required by a signed written contract or agreement with the Named Insured. The General Liability,Excess(Umbrella)Liability,Automobile Liability,and Workers Compensation/Employers Liability Policies include a Waiver of Subrogation in favor of Residential Management Inc &PLM Buzzy Inc.on whose behalf the Insured is required to obtain this Waiver under a written contract or agreement executed prior to a loss. Notice of Cancellation provision is 30 days except 10 days applies for non-payment of premium. ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I DATE(MMIDDNYYY) `' CERTIFICATE OF LIABILITY INSURANCE 6i 3i 2015 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 CONTACT Karen Bernier NAME Southeastern Insurance Agency, Inc-. PHONE (SOB)997-6061 FAXC. e.(508)990-2731 439 State Rd. E•%AIL RESS.kbernier@southeasternins.com P.O. BOX 79398 INSURERS AFFORDING COVERAGE NAIL# North Dartmouth MA 02747 - - - - INSURER A:Arbella Protection Insurance 41360 INSURED INSURER 8: R J Bevilacqua Construction Corp. INSURERC: P. 0. BOX 628 INSURER O: INSURER E: Forestdale MA 02644 INSURER F: ..COVERAGES CERTIFICATE NUMBER:CL1542700879 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 ADD SUER - POLICY EFF POLICY EXP - LTR. TYPE OF INSURANCE POLICY NUMBER (MMIDDIMYI IMMIDDlyYYY1LIMA GENERALLIABILITY EACKOCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea frencel $ 300,000 A CLAIMS-MADE ❑X OCCUR 8500018147 /15/2014 7/15/2015 MED EXP(Any one person) $ 5,000 X xCU Included PERSONAL&ADV INJURY $- 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEWLAGGREGATE LIMIT.APPUESPER: - PRODUCTS-COMPIOPAGG $ 2,000,000 X P01tCY :X PRO LOC $ AUTOMOBILE LIABILITY OMBBIINED SINGLE LIMIT dimli $ 11000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED 1020014548 /21/2015 /21/2016 AUTOS X AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per: _ Unutsured.motorist81 sp2limit $ 250,000 X UMBRELLA LIAR OCCUR " EACH OCCURRENCE $ 1,000,000 A ExcEss une CLAIMS-MADE AGGREGATE $ 1,000,000 DEC) X I RETENTION$ 10,00 ` 600062061 7 /15/2014 /15/2015 - $ - A WORKERS COMPENSATION X _WC STATU- X. OTH- AND EMPLOYERS'LIABILITY YIN 1 ' ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIME BER EXCLUDED? NIA E.L.EACHACCIDENT $, 1 000. 000 (Mandatory InM NH) 9088680414 4/27/2015 /27/2016 E.L.DISEASE-EA EMPLOYEE $ 1. 000 0.00 II yes,describe under _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s 1 006 OOO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddlUonal Remarks Schedule,If more space Is required) Project: 671 Main St, Cotuit, MA Email to: Danno.McGrath@verizon.net and MLuttrell@dhdventurc3s.com CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DHD Ventures ACCORDANCE WITH THE POLICY PROVISIONS. 2604 Elmwood Avenue Rochester, NY AUTHORIZED REPRESENTATIVE Karen Bernier/KAB -Ae- J ACORD 25(2010I05) 01988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE =DDfYYYY) 15 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 CONTACT .NAME: PAUL SCHLEGEL SCHLEGEL INSURANCE BROKERS INC PHONE FAX (AIC,No,Ext): 508-771-8381 (A/c Ne)508-771-0663 34 MAIN STREET E-MAIL ADDRESS: SCHLEGELINSURANCE@GMAIL.COM WEST YARMOUTH MA 02673 INSURER(S)AFFORDING COVERAGE NAIC tI INSURER.A:NGM INSURANCE COMPANY 14788 INSURED INSURERB:NGM INSURANCE COMPANY 14788 Gary Matsik Dba Matsik Concrete 14788 INSURER C:NGM INSURANCE COMPANY 185 Barcliff Road INSURERO:NGM INSURANCE COMPANY 14788 INSURER E-: Chatham, MA 02633 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 ADUL 5U5R POLICY EFF POLICY EXP -° LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDIYYYY) (MM/00/YYYY) LIMITS A GENERAL LIABILITY_ MPT0078H 01/22/201501/22/2016 EACH OCCURRENCE S 1,00.0,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) S 5001000 CLAIMS-MADE Fx I OCCUR MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE s 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000"000 POLICY X JEr LOC COMBINED SINGLE LIMIT B AUTOMOBILE LIABILITY M1T2489L 09/05/2014 09/05/2015 (Ea accident) S 1,000,000 X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S X AUTOS X AUTOS NON-OWNED PROPERTYIJAMAGES X HIREDAUTOS X AUTOS (Per accident) S C .X UMBRELLA LIAB X OCCUR CUT0078H 12/17/201412/17/2015 EACH OCCURRENCE S 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE S DED 'RETENTION S OTH D WORKERS COMPENSATION WCT0078H 01/21/201501/21/2016 X TORY LIMITATUS _ ER AND EMPLOYERS'LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT s 500,000 OFFICER/MEMBER EXCLUDED? a NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE s 500,000 If yes,describe under DESCRIPTION OF OPERATIONS belay 7 E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) GARY MATSIK HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS COMPENSASION POLICY CERTIFICATE HOLDER CANCELLATION DANIEL MCGRATH CONSTRUCTION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 312 CAMP STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WEST YARMOUTH MA 02673 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE DANNOMCGRATH@VERIZON.NET ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered owksf ACORD Mass chusetts Department or Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-107897 ' DANIEL MCGRATH �' r 312 CAMP STREET West Yarmouth MA 02673 e_ 4 Expiration Commissioner 06/13/2018.- Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 �� Home Improvement Contractor Registration Registration: 179293 Type: Individual Expiration: 7/15/2018 Tr# 419291 DANIEL J. MCGRATH DANIEL MCGRATH 312 CAMP STREET WEST YARMOUTH, MA 02673 Update Address and return card.Mark reason for change. scA 1 0 20M•05/11 Address Renewal Employment Lost Card C���n,�ovirinra�zrae�cl/�,a��C%jltc::�ccr.�rc�e/!J:; ` -Office of Consumer Affairs&Business Regulation License or registration valid for individual use only PHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: P Registration {�y179293 Type:. Office of Consumer Affairs and Business Regulation Expiration 7/15/2018 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 DANIEL J.MCGRATH rl DANIEL MCGRATH T ` �L . r (A 312 CAMP STREET r 1. WEST YARMOUTH,MA 02673 Undersecretary Not valid t ignature r 45 .1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �� Parcel 6/5 a Application #aD 023 Health Division Date Issued 6 !o �— Conservation Division Application Fe . Planning Dept. Permit Fee 50 4 ZS Date Definitive Plan Approved by Planning Board G Historic - OKH Preservation/ Hyannis . Project Street Address (0 J 1'�ARi'� c�r�" LAJ r 1 d-C� �i� j� " Village co+u o - Owner PL V3U KzK LC-, AddressdjwY 9lmcxr7 Ale SYT' t 3S2 Telephone "���' ��7[ � `L�- �► j{ r i�a r �� Permit Request , lj oc y- J2 ai A::s B Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuations\ Construction Type Av_ Lot Size :2,34 4cre5, Grandfathered: ❑Yes ❑ No If yes, attach-supporting documentation. Dwelling Type: Single Family ❑ Two Family ;d Multi-Family(# units) g ' Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kind's Highway: ❑l es ❑ No Basement Type: )4 Full ❑ Crawl ❑Walkout 0 Other tf r q. Basement Finished Area(sq.ft.) Basement Unfinished Area (Pq.ft) � Number of Baths: Full: existing new �_ Half: existing ne --a Number of Bedrooms: existing new Total Room Count (not including bathe): existing new First Floor Room Count `' Heat Type and Fuel: 4 Gas ❑ Oil ❑ Electric ❑ Other Central Air: ;,Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing new size .Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# nn -� ' Current Use (L " �I Proposed Use ft�oS9i ; - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) L Name L Telephone Numbers Address 3141 c' n License # 10-7 �g `7 r Home Improvement Contractor# 1 -7q,-2q3 DAQC i" ker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURU' U�JMV DATE W/FZ6 FOR OFFICIAL USE ONLY ti APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION . . r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth ofMassachusetys. � Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber-s Applicant Informations Please Print Legibly Name (Business/Organizatiion/lndividual): Address: t •Con Q City/State/Zip: 00�7'>Phone#: ("j 7�(.�-- Are you an employer? eck the appropriate boa: Typa of project(required): 4. I am a general contractor and I P ] 1.❑ I am a employer with � g 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 hi and have no employees These sub-contractors have P8. ❑Demolition working for me in any capacity, employees and have workers' con insurance.# 9. ❑Building-addition - [No�workems' comp.insurance P• • required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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 hue outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of-the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 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$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the OfEce.of Investigations of the DIA for insurance coverage verification. I do her card under th ains and alum erjury that the information provided above is true and correct Si G Date: Phone#: 7_7(n— `1`/5 7 7 Official use only. Do not write in this area,to be completed by city or town official City or Town- . Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector, 6.Other Contact;Person:. Phone#• -U.I. t Regulatory Se vices Thpmas F.Geffer,IDireetor : BIIlIdIII DivisiOII Tom Perry,Sialdmg Commissioner 200 Main Sty Hyamis,MA 02601 �eww town.barnst&ble.ma.ns. Office: 508-8624038 Far 508-790-6230 : . Property Owner Must Complete and Sign `his Section If Using A Builder L 1100wtA_S rOA5 A.r,L 'i , as Owner of the subject' ' topeTtp Herebyorize aIIth ®A� 01 to.act on my behalf in aIl matters relative to work authorized by this building permit (Address of Job) Pool fences and alarms are.the responsibility of the applicant. Pools.. are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Ownet Signatule of A plicant Print Name Print Name �. ' Date.. � - .• . . . . : • QTORMS:OWIERPERMISSIONPOOL4 6/2012: Regulatory:5emees sates « Thomas F.Q iler,Director xeW 65¢ 6� Building Division . , � - Tom Perry,$m`Iding Commissioner . 200 Man Street,'Hyannis,MA 02601 www.town.barnxE le.m&us Office: 508-862 403 8 Fax: 509-790-6230 :. EIDMOWNM rain=WnON Please Print DATE: JOB LOCATION: ' number - strut. village "HOM WNER": name home phone# work phone# CURRENT MAIIING ADDRESS: city/tDwn state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and . to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFUMON OF H011TEOVRM Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shaE be resoonible for aIl such work performed under the building permit.--(Section log.1.1) The undersigned`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rul6s and regulations. The undersigned"homeowner='certifies that he/she understands the Town of Barnstable Building Department milmimtnn inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official - Not: Three-handy dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Contraction Control HOMMOwN&R'S EMOTION The Code states that Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Seadon'l09.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such .. work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware.that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Rcgulations for Licensing Construction Supervisors,Section 2.1-5) This lack of awareness often results in serous problems,particularly Y .when the homeowner hims unlicensed persons. In this case,our Board rminotproceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible.. To ensute that the h6meowner is fully aware of his/her responsibilities,marry communities require,as part of the permit application, . that the homeowner certify that he/she understands the respo=''biMes of a Supoevisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such-a fomi/certificatim for use in your community. Q:forrns:horn=xempt Daniel 312 Camp Street West Yarmouth, MA 02673 CSL#CS-107897 _ Home Improvement Contractor# 179293 (508) 776-4577 April 7, 2015 Town of Barnstable Building Dept. 200 Main St Hyannis, MA 02601 Dear Sir: . I am submitting the attached.application as a general contractor and will be hiring subs to complete the work. I understand that they must possess Workers Comp coverage for their employees. Due to the protracted nature of this application process, subcontractors have not been retained yet. When they are, I will be able to provide documentation to that effect. Sincerely.. Daniel. McGrath �t Massachusetts -Departmen#of Public Safety y t Board of Building Regulation_s and Standards `Construction Supervisor License: CS-107897 I{� DANIEL MCGRA FEI�t +•, 3 r� t 312 CAMP STREET '` West Yarmouth MA 02673 a,.,* Expiration 0611312018' a Commissioner , c, a ° Office of Consumer Affairs and Business Regulation M v .,10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Caritractor Registration 'A } - = -- -� Registration: `179293 4 -ti Type: Individual Expiration: 7/15/2016: Tr# 2W77 , DANIEL J. MCGRATH - DANIEL -MCGRATH � .- 4. 312 CAMP STREET _ WEST YARMOUTH, MA 02673 m a Update Address and return card.Mark reason for change.' Address Renewal Employment Lost Card SCA 1 G 20M-W11 only 7. EJJae CO�n��arnuaenlff o�Vl�la�uc�rt�e� , � QN Office of Consumer Affairs&Busidess Regulation L►cense or registration valid for rridividul use i ___ OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration• 179293 Type: Office.of Consumer Affairs and Business Regulation xpiration 7/.15/2016 Individual 10 Park Plaza-Suite 5110 . Boston,MA 02116 DANI J.MCGRATH s ' ��w ' DANIEL' MCGRATH Y ;: f " 312 CAMP STREET ,WEST YARMOUTH,MA 02673-'", Undersecretary Not valid witho sig to The Commonwealth of Massachusetts. Department of IndustWAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/IndividuaI):_40", ,� IMC 5 r Address: 3) Cam' City/State/Zip: 041 M Dion#: `569- 7 7&--`-�(s _7 7 Are you an employer?Check 1he appropriate box: Type of project(required); 1.❑ I am a employer with 4.JA I 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' [No*workers' comp.insurance Comp, insurance.: 9. ❑Building.addition 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 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 infbrmation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside cofactors 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: Policy#or Self-ins.Lie.#: 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 tine up to$1,50,0.00 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 hereb certi under th pains and enaW erjury that the information provided above is true and correct Si a Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): M ' 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector„ 6.Other Contact Persom. Phone#: Affidavit of Substantial Financial interest of IAA. &M , on-oath depose and state as follows: 1. 1 am an applicant for a building permit for the property located at Map r'J (o , Parcel The address of the property is' CLO i�' 2. 1 have 0 % legal or equitable interest in the real property which is the subject of the building permit application which is identified in paragraph 1 above. 3. Within in the last twelve months from today's date, which is r— / , the following individuals or.entities have had a 1% or greater legal or equitable interest in the real property which is the subject of the building permit application which is identified in paragraph 1 above: Name Address 4. Within the last twelve months, from today's date, which is / , I have had :a 1% or greater legal or equitable interest in the following prop ies which have been the subject of a building permit application.- Map/Parcel Address 5. Within this calendar year, I have submitted building permit applications for property in which I. have a 1% or greater legal or equitable interest. 6. Within the last ten days, i have submitted Q building permit applications for property in which i have a 1% or greater legal or equitable interest. 7. Within this month, I have submitted 0— building permit applications for property in which I have a 1% legal or equitable interest. , 8. Within this month, I have received C) building permits for property in which I have a 1% legal or equitable interest. Signed under the pains and penalties of pe ' ,thO day ofhoflq , 2* 2001-005olafFin 1 Q/LOTTERY/AFFiDAVfT REScheck Software Version 4.6.1 Compliance Certificate Project Energy Code: 2012 IECC Location: Cotuit, Massachusetts Construction Type: Single-family Project Type: New Construction Conditioned Floor Area: 2,200 ft2 r) 4 k Z;3 Glazing Area 6% Climate Zone: 5 (6137 HDD) Permit Date: ?a. Permit Number: 77 Construction Site: Owner/Agent: Designer/Contractor: (,�5<7 MAIN STREET BLDG#3 DANIEL MCGRATH COTUIT, MA 312 CAMP STREET WEST YARTMOUTH, MA 02673 Compliance: 1.9%Better Than Code Maximum UA: 365 Your UA: 358 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Envelope Assemblies Gross Area Cavity Cont. Perimeter Ceiling 1: Flat Ceiling or Scissor Truss 3,000 49.0 0.0 0.026 78 Ceiling 2: Flat Ceiling or Scissor Truss 768 30.0 0.0 0.035 27 Wall 1: Wood Frame, 16" o.c. 2,605 21.0 0.0 0.057 139 Window 1: Metal Frame:Double Pane with Low-E 150 0.330 50 Door 1: Solid 21 0.320 7 Floor 1:All-Wood joist/Truss:Over Outside Air 2,200 38.0 0.0 0.026 57 Compliance Statement. The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application.The proposed building has been designed to meet the 2012 IECC requirements in REScheck Version 4.6.1 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Title: Report date: 06/16/15 Data filename: Untitled.rck Page 1 of 8 t CREScheck Software Version 4.6.1 �J( Inspection Checklist Energy Code: 2012 IECC Requirements: 0.0% were addressed directly in the REScheck software Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. Section . w # Pre Inspection/Plan Review;- Plans Verified Pield�Verified'� Com�plies? Comments/Assumptions &-Req.ID Value Value 103.1, !Construction drawings and ❑Complies 103.2 documentation demonstrate ' °'�' sad °-� �, ��„ k ,r❑Does Not [PR1 energy code compliance for the building envelope. ❑Not AbsPPli able a :�a 103.1, ;Construction drawings and �� ;"� ❑Complies ft n de 403.7 energy code103.2, �ompliancerfor �Po A. ❑Does Not [PR3]1 lighting and mechanical systems. It " []Not Observable ; • r r A .Systems serving multiple ❑Not Applicable �E� � ,. �, � ��, PP , 'dwelling units must demonstrate compliance with the IECC � ;Commercial Provisions. 302.1, ?Heating and cooling equipment is: Heating: Heating: ;❑Complies 403.6 'sized per ACCA Manual 5 based Btu/hr Btu/hr ❑Does Not [PR2]2 on loads calculated per ACCA ; Cooling: Cooling: V Manual J or other methods Btu/hr_ Btu/hr ❑Not Observable approved by the code official. :❑Not Applicable j a 's Additional Comments/Assumptions: 1 High Impact(Tier 1) T; 2 Medium Impact(Tier 2) 3Low Impact(Tier 3) Project Title: Report date: 06/16/15 Data filename; Untitled.rck Page 2 of 8 2012 1ECC Foundation lns'pection Completes?, a " % . Comments/Assumptions a, 303.2.1, A protective covering is installed to ❑Com` p g plies [F011]2 I protect exposed exterior insulation ❑Does Not and extends a minimum of 6 in. below .69 ;grade. ,❑Not Observable I ;❑Not Applicable 403.8 ;Snow-and ice-melting system controls;❑Complies [FO12]2 installed. '❑Does Not V j❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Report date: 06/16/15 Data filename: Untitled.rck Page 3 of 8 Section plans Verified Field Verified # Framing/Rough-In Inspection Value Value Complies?` Comments/Assumptions & Req.ID 402.1.1, Door U-factor. ; U- U- ❑Complies See the Envelope Assemblies 402.3.4 ❑Does Not table for values. [FR1]1 ❑Not Observable ❑Not Applicable 402.1.1, Glazing U-factor(area-weighted U- t U- ❑Complies See the Envelope Assemblies 402.3.1, i average). ❑Does Not ;table for values. 402.3.3, 402.3.6, ;[:]Not Observable 402.5 ❑Not Applicable [FR2]1 , 303.1.3 i U-factors of fenestration products •w"` ❑Complies [FR4]1 ;are determined in accordance ❑Does Not ��� with the NFRC test procedure or ;taken from the default table. ❑Not Observable a � � �w � `F " Ada . ❑Not Applicable 402.4.1.1 ,Air barrier and thermal barrier` �: ❑Complies [FR23]1 ;installed per manufacturer's ti bg ❑Does Not instructions. -]Not Observable ❑Not Applicable 402.4 3 Fenestration that is not site built �� iG� "� "�Itr ❑Complies [FR20]1 :is listed and labeled as meeting r� `* * ❑Does Not 'AAMA/WDMA/CSA 101/I.S.2/A440 r, or has infiltration rates per NFRC R, - ❑Not Observable i 400 that do not exceed code �) 7, 41;l ❑Not Applicable limits. ,e;�C rr ss«" ,;� a z#9y iF: 402.4.4 IC-rated recessed lighting fixtures ❑Complies [FR16]2 Isealed at housing/interior finish d� *� � gall - If ;� � A'' ❑Does Not I and labeled to indicate<_2.0 cfm d �� " leakage at 75 Pa. ❑Not Observable ❑Not Applicable 403.2.1 Supply ducts in attics are R- R-_ ;❑Complies [FR12]1 insulated to>_R 8.All other ducts ; R_ R_ ❑Does Not in unconditioned spaces or outside the building envelope are ❑Not Observable insulated to >_R 6. `❑Not Applicable 403.2.2 :All joints and seams of air ducts, r � � ❑Complies [FR13]1 air handlers, and filter boxes are T ,K, El Does Not sealed. m ❑Not Observable a� ,t 8S *a ❑Not Applicable 403 2 3 Building cavities are not used as f ❑Complies [FR15]3 ducts or plenums. . * „` � � A❑Does Not ❑Not Observable «a ❑Not Applicable 403.3 HVAC piping conveying fluids R- R- ❑Complies j [FR17]2 above 105 QF or chilled fluids ❑Does Not below 55 QF are insulated to>_R- 3 ❑Not Observable '❑Not Applicable 403 3 1 :Protection of insulation on HVAC _, [ Complies [FR24]1 piping. ❑Does Not ❑Not Observable � a � ❑Not Applicable 40314.2 "Hot water pipes are insulated to R- R-_ ❑Complies [FR18]2 ,' >_R-3. ❑Does Not 1 ❑Not Observable ❑Not Applicable 1 JHigh Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Report date: 06/16/15 Data filename: Untitled.rck Page 4 of 8 Section Plans Verified . Field Verified Y" # Framing i Rough-in Inspection Complies? Comments/Assdmptions� & Req.ID° Value Value 403.5 Automatic or gravity dampers are �� ��` ❑Complies [FR19]2 installed on all outdoor air ' ❑Does Not intakes and exhausts. ' ? ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) i Project Title: Report date: 06/16/15 Data filename: Untitled.rck Page 5 of 8 F Plans Verified Field Ueiified # `Insulation Inspection n Complies? -_ Comments/Assumptions q Value �i Value ry ,�. 3031 !All installed insulation is labeled °r i� E ❑Complies [IN13]2 or the installed R-values �" �� r �� ;4 �r 7�ODoes Not provided. I v ufi � ❑Not Observable } a, r ❑Not Applicable 402.1.1, Floor insulation R-value. R- R- ❑Complies See the Envelope Assemblies 402.2.6 ❑ Wood ❑ Wood ❑Does Not table for values. [IN1]1 ❑ Steel ❑ Steel ❑Not Observable ❑Not Applicable 303.2 Floor insulation installed per � � "' ❑ PCom lies � �� 402.2.7 manufacturer's instructions, and ��; � � � ❑Does Not [IN211 in substantial contact with the � � " ;� wa wu underside of the subfloor. []Not Observable t ��ma Air u; ❑Not Applicable 402.1.1, Wall insulation R-value. If this is a: R- R- ❑Complies See the Envelope Assemblies 402.2.5, mass wall with at least 1/2 of the ❑ Wood ❑ Wood ❑Does Not table for values. 402.2.E wall insulation on the wall ;❑ Mass ❑ Mass ❑Not Observable [IN3]1 exterior,the exterior insulation requirement applies(FR10). ❑ Steel ❑ Steel ❑Not Applicable 303.2 Wall insulation is installed per � � y �a �� � -� �� ❑Complies [IN4]1 manufacturer's instructions. a�` s �' a ❑ + trk Does Not _ - p ❑Not Observable _ i. , �� „ate we ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Report date: 06/16/15 Data filename: Untitled.rck Page 6 of 8 Section Plans Verified Fieltl Ve t ' rifled , # Final Inspection Provisions Value Value !compliesr comments/Assumptions a, & Req.ID 402.1.1, Ceiling insulation R-value. R- R- ,❑Complies See the envelope Assemblies 402.2.1, ;❑ Wood !❑ Wood ❑Does Not table for values. 402.2.2, 402.2.E ;❑ Steel ❑ Steel j❑Not Observable [Fill' ❑Not Applicable 303.1 1 1 ,Ceiling insulation installed per � � " �r7k �r� a ❑Complies 303.2 manufacturer's instructions. tit , N p ❑Does Not [F12]' j Blown insulation marked every 300 ft'. ❑Not Observable ❑Not Applicable 402.23 ;Vented attics with air permeable Allia e i ❑Complies [Fl22]2 insulation include baffle adjacent g ❑Does Not to soffit and eave vents that j extends over insulation. []Not Observable o,,,❑Not Applicable 402.2.4 ;Attic access hatch and door R-_ R- ❑Complies— [FI3l' :insulation >R-value of the I❑Does Not adjacent assembly. ❑Not Observable ❑Not Applicable 402.4.1.2 Blower door test @ 50 Pa. <=5 ACH 50 = ; ACH 50 i❑Complies [FI17]' ach in Climate Zones 1-2, and ; ❑Does Not <=3 ach in Climate Zones 3-8. ❑Not Observable ❑Not Applicable 403.2.2 'Duct tightness test result of<=4 cfm/100 cfm/100 ❑Complies [FI4]' 'cfm/100 ft2 across the system or ; ft2 ft2 ❑Does Not <=3 cfm/100 ft2 without air 'handler @ 25 Pa. For rough-in ❑Not Observable 'tests,verification may need to ; ;❑Not Applicable occur during Framing Inspection. ' 403.2.2.1 Air handler leakage designated s ) ❑Complies [FI24]' by manufacturer at<=2%of t t ' � �`.'�*� ;»,❑Does Not design air flow. ❑Not Observable El Not Applicable 403;1 1 ,Programmable thermostats * ❑Complies [FI9]2 a installed on forced air furnaces. 4 �m f ¢ ❑Does Not ❑Not Observable sN, sr "� ❑Not Applicable 403 1 2 Heat pump thermostat installed ❑Complies [FI10]2 ion heat pumps. °_, a 'El Does Not ❑Not Observable ❑Not Applicable 463.4.1 3 Circulating service hot water , JOComplies [FI11]2 systems have automatic or ❑Does Not iaccessible manual controls. ', * " l v,w � * ti ❑Not Observable ❑Not Applicable 405.1 'All mechanical ventilation system " Y ❑Complies [FI25]2 fans riot art-of tested and listed * `"� -` p <�� ❑Does Not HVAC equipment meet efficacy & and airflow limits._ []Not Observable ❑Not Applicable 404.1 '75%0 of lamps in permanent' m ❑Complies [FIE]' fixtures or 75%-of permnent ° z ❑ fixtures have high efficacy lamps. Does Not a Does not apply to low-voltage' n F 'A ' ❑Not Observable 'lighting. (�r + ,r � �"xa �.❑Not Applicable 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) �Z._ _ ~ _.�.�_�--pact ) Project Title: Report date: 06/16/15 Data filename: Untitled.rck Page 7 of 8 , Plans Verified. F.„ Section ield.Verified n# ' Final Ispection Provisions _Value Value Complies? Comments/Assumptions & Req.ID - 404.1 1 !Fuel gas lighting systems have �6 k ? �P � f" � ° ❑Complies [F123]3 no continuous pilot light. ; ." `❑Does Not I s € ❑Not Observable . -[]Not Applicable 401.3 j Compliance certificate posted, ❑Complies [FI7]2 a " yG ; yiu a iE]Does Not ❑Not Observable ] �` ` ',,11:)Not Applicable 303.3 Manufacturer manuals for ; � ;� a � �r„„�e ,i ❑Complies [FI18]3 mechanical and water heating < - p �'' _❑Does Not systems have been provided. J ,rF ❑"MANot Observable Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) —� 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Report date: 06/16/15 Data filename: Untitled.rck Page 8 of 8 2012 IECC Energy Efficiency ti MMMEMMMMA Above-Grade Wall 21.00 Below-Grade Wall 0.00 Floor 38.00 Ceiling/ Roof 49.00 Ductwork(unconditioned spaces): Window 0.33 Door 0.32 Immill Heating System: Cooling System: Water Heater: Name: Date: Comments TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3G Parcel Application Health Division Date Issued Conservation Division C Application Fe ' S Planning Dept. j" ' Permit Fee . Wig: Date Definitive Plan Approved by Planning Board r Historic - OKH _ Preservation/ Hyannis Project Street Address 6 7'5e) - Village f &+_014- Owner P b, M 5u, Z�4 1 - L_ c Address q l M OJW Q Ade- Telephone 7 :7 a- �/! 2 Permit Request _ �� - nu - O� On,,bgc ,ag- Square feet: 1 st floor: existing proposed 1120 2nd floor: existing proposed ] 1 Total new Zoning District Flood Plain Groundwater Overlay Project Valuation M OW Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family k Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: �d Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new t Half: existing new Number of Bedrooms: existing f new Total Room Count (not including baths): existing new First Floor Room Count Z Heat Type and Fuel: ;6 Gas ❑ Oil ❑ Electric ❑ Other Central Air: )4 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 N,new sizef'_Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use i APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name n, °�. f✓�C&r Telephone Number ®g- 7 7/- Address ( cam a 321t- License # e S /C2.7 2 9 :3 CImmoak, ma '7'� Home Improvement Contractor# Email G e ( a Ai orker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE AA f G DATE 7//A/16 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE ` OWNER r DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH ' FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel f5IS' Application # s-b Health Division Date Issued Conservation Division Application Fee isy Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village C Z�Q g Owner o zZS& L.L C - Address 1A0 F-*,{--We 3 Telephone 5_09 7 7 ay V 1�610 Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed ry !q Total new Zoning District Flood Plain Groundwater Overlay Project Valuation d Construction TypeWW1S F(_(1- d►'0' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach,supportingtdoc,_hentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) - Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kin 's Highway: owes ❑ No Basement Type: 4Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) j l�3' Number of Baths: Full: existing new Half: existing new__ Number of Bedrooms: existing I new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: A Gas ' ❑ Oil ❑ Electric ❑ Other Central Air: XYes ❑ No Fireplaces: Existing New I-a—S Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ nnew size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing 9 new si e —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 o -r,L� 1�.1 .,� ¢ �miff) Telephone Number � " -7� 7 Address 3 12, ( M. License# cs - 10 7 n 7 \/h P nn0()4Xn V" IA 0 3 Home Improvement Contractor# Email D oo k) . c& c A� ye62ml0�Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE )�� DATE i FOR OFFICIAL USE ONLY APPLICATION# _ DATE ISSUED MAP/PARCEL NO. M f ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' k FOUNDATION FRAME t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH II FINAL FINAL BUILDING DATE CLOSED OUT • ASSOCIATION PLAN NO. HA f2 Wcff-kere CQmpensaffim Iusu raLce Affidavit dersf�iFad,,,� �{rFf�=„�1FFu��ers �t` ��I�frsr-rrrai�,•cr 13I�s���I�iI� Name Address--. 3 Are ycFa an Moyer =k the x-jiprDpxindc ha Type ef prqct(€ I= I_❑ IamaIatr< Ic�im�araI I4Te employer • esaplayee�{fQitand�Orpar�time�* hav�1ffie�,s [x fka Z❑ I am a sele.prepzietpr orparhmr- listed M the d ached s 7- ❑ 4g ship m d have m r�ployees The==b-omAcm:t=have 9- ❑ � WOZkisg form,is My t'`a" - emFlayees an3have:Warms' Camp- [Nclwnt3 m. p_insurance vnmr�* Q- ❑$uadmgadddifi� � • ComP_ �1 5_ ❑ 'fie are a eatpara icnzr d ifs nr idditims s_❑ I am a home==doling An woI affi s have exerci sad ffick 1LD Fb=m g repair or FAC iiiC ns =yseFf ofem=pticinperMM I2-0$Dof=epaim cnsrrrsin_r`� +ram I•f c-Icy§I(4),andwe hn•'aD tmpl°u�_LNG wodm& U'-❑other comp_;nsuran�requirtxLl "��ryffisp6�&atrhe[T�sbactI.=stalsn�lout4t�sr�iinnbga�sha�u3� 'mmnF��nnperTs�i EIr. .r nor, thk szffid.ru in try am duing=IIZe^�•�tt�*7ie M t dan contoa=— s2bu3k aat•cr �m"'�kMd surd_ xr-BzstcEc�Yt�bdcmaststlsrls�dra=��;nrt•,�s��gthen�afffie� mcist�uhe�xnntfimseh� - amp.byees_ Ifthe &tymatpnmdPtHw-w=k:ue camp-pow mug • ; �rztii-err$���rhr�isgrasjiding trark�rs'cru�nri irrsurrrrtca far trc��-rra�Io-y�rs. �e�atF is fhe pd&c�and job sr.(s ' ' T��xnrt+GonxpanyName . POECT 9 cr SlkFf-iar,lic-4 F�uIIEs�ztl�di�_ Soh 5ita�ida-e� Cdy}State�Lp: Each z copy of the vmrlmre co=l peusati m paliLT dedzmtion page-(siewing the Fob n'tEmher MME lion i-te): Far7st�fn sew c�t'age as retZaizzdundes Sec•EiO¢SA o£ c l�c$a Lid tr<the impas'ition ofd�.mmal pesaf�s of a free up to suoD QD zncvor one-yearim as wf!U a;diva pe=lf;es m ffm foem of a STOP WDRX ORDIlt and a fin, of•ap•to S250-00 a day agaimt the vi.OlabaL Be advised tzt a cvgy of ff3iz smiemu t may be fm-w-drded tv the Of Of I=xEgafrom of fac DIES for iusu=--e cov:cmge vmiEczH=-. .F&hgra v }fcs and tr� ffcatfhg�Arnza#ignpfm�£aI�*ershugtmdcaFrect - - " 1. GULL f Fsa atrf t teat tf rifc i €tar area,'a ba COR4 iew by C51Y or fafm of cia, Cay or Tbwm P=ffaf;cease g LBoara o-fIle-Ith 3.RmffiUn-gDgp-r� R.atyffa a=k 4-ElechicalEmperfur 6.Phmxhia Exzp-edfor fi.C#her hrja&MC� �GMMMI Laws chapter 152 req==ell emplay=to PMVI&WM-k='M.O pPmsafion for ffieir plopees . Pm��ta this ctatcd-,an Emp&ym-is deemed as C every Peasan iu the scmm of-mother midEr aay co*stract ofhae, PP or fimplied, oral or " An mp&Yar is defined as``mi indsvidnaI,pa tammbip,association,corporation or otiier.Iegal ,or any two or more of the for�gc>ng in a jainf a sey and includ=mg'@re Iegal represrnrgives of a deceased employer,-or the receiver or trustee of an.mffvidina pmtamshi association or other legal entd employing employee;_ 3ogtever the owner of a CIWDEiag house having not more i'han three apartmeots and Who resides theresi,ar the occupant of the dwr2 mg horse of another w.a Toys persons to do?naiatmaam,constnlciion or repay worm on such dwelimg house or on the grounds of building app�nant thea-et o shan not because of such eurpInyment be deemed to be an eniploper" MCtrI r�apter 152, §25C(�also sfaias that¢every state❑r lacal'Jimnsing zgeucy shall withhold&e issuance or renewal,of a Ficense or permit to operate a business or to consfruC#brzildings is the mmmonwmlth for any appliraiit who has not prodlfced acceptable evidence.of''co uplia>ice with the srrrance covet�ge requirEd Additionally,MM chapter 152,§25C(7 sfa N6ither the commonwealth nor any of its political subdivisions shall enter h¢O any cant-act for at performance of public woikuntil amTtsble evidence of compliance vrirhthe meaner_ requirements of this chapter have been preserved to the,contracting ar dhority.' _ Applicants •, • .. Please fill out lht woikers'compensation affidavit completely,by chug jhe boxes that apply to your situation and,if necessary, supply sub-contractOr(s)name(s),addresses)andphone number(s)along wig thew cer�_.ncate(s) of i„srrris,ce. Limited Liability Companies(LLC) or Lin ite�dLiab�y Partaniships(LIP)with no employees o$ierthan the memb ers or partners,are not re#md to cant'wor3Lers' compensation insurance- If an LLC or LLP does have employees;a policy is regvacd, Re advised that this affidavh3 ay be submitted to the Department of Industrial Accidents for confnmaii.on ofmnnce Coverage. Also be sure to sign and date the affidavit_ The affidavit should be retnmed to$ie city or town that the application for the pelt or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding t�e 1 aw or i f you are regeized to obtn a workers' compe_mab.onpoli.cy;please call the Department at the number IistEd.belovr..Self-insured.companies should eatir their self--m crrrnce•license number on the appropriate line. - City or Town Officials V. Please be seae t the a$da'is completes andpr fed Ieg�ily The Deparimenthas provided a space at the but of'the affidavit for you fin fill.out in.the event the Office ofhvestiga ions has to contact.you regaFding�e applic�e'nt Please be sure:to fI1 m the permitllic:rme number which wM be used as a reference number. In add=rtiDm an applicant that must submit multiple pcuiiYEcense appliiaiions in any given year,need only sobmif one affidavit indicating c;= at = policy informa-tlon(ifnecessary)and imder'Job Sites Address"the applicant should write, locations i rovided in n (city or town)."A copy of the affidavit that has been officially stamped or madred by the city or town may be p the applicant as proof that a valid affidavit is on ffie for futcum permits or licenses. A new affidavit must be filed otrt each year-Where a home owner or citizm is obtaining a license or permit noItImlated to business or commercial Yeat.re (Lt.a dog license or permit to bran leaves etx.)said person is NOT required to complete t3iis affida�-zt The Office of Investigations would Mee to thank you in.advance for your cooperation and should you have anygurstions, please do not hesitate tD give its a caIL - The Deparimen_t's adtiress,irlephone and faxnumber ' `_ . ,, . at C0MMQ71tjL of Massaahu Depaz�nWt ckf Ind al Aid its -, - Bc IA G2I I Teti. 6I -4 EI���Qr I- �A SA4 . . : Fay 4 6I7-727- 49� .Dvised 4-24--D7 * sAxNsrasz.E. * • � . �$ 163;¢ ,�� Town of Barnstable Regulatory Services Richard V. Scali,Director Building Division " Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601. www.town.barastable.ma.us Office: 508-862-4038 Fax: 508-790-6230 "Property Owner Must Complete and Sign This Section If Using A Builder I, �WI Ll S S/�SGGi i , as Owner of the subject property hereby authorize (� �o'� 1 v l 1�r A+t l to act on my behalf, in all matters relative to work authorized"by this building permit application for (Address of Job) Signa e Of et - a Owl�S Pv1 AS A SC�-i Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMM\building permit forms\=RESS.doc Revised 061313 9 + Massachusetts. Department of Puoiic Safety `--� Hoard of Bufiding Regula.tiors.ar3d Standards License: CS-107897 ' DANIEL MCGRATH - 312 CAMP STREET West Yarmouth A+IA 02673 E X p ration Commission?r. 06/13/2018 �..J 7 IZe Office of Consumer Affairs and Business Regulation - - = 10 Park Plaza- Suite 5170 Boston; Massachusetts 02116 Home Improvement Contractor Registration Registration: 179293 Type: Individual Expiration: 7115/2016 Tr# 2-W77: DANIEL J. MCGRATH DANIEL MCGRATH 312 CAMP STREET WEST YARMOUTK MA 02673 Update Address and return card.Mark reason for change. SCA1 0 20AM1-05l111 Address ❑ Renewal E] Employment Lost Card <. .. , C/�e Crrinirni�raerrlf�a/ Office of Consumer Affairs&Busidess Regulation License or registration valid for mdividul use only, OME:IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistiation:. 179293 Type: Office of Consumer Affairs and Business Regulation iration: 7/15/2016 Individual 10 Park Plaza-Suite 5170 - Boston,MA 02116 DANI J.MCGRATH DANIEL MCGRATH 1' 312 CAMP STREET /J c WEST YARMOUTH,MA 02673 Uadersecreta - ry Not valid witho s' to p. MAGE]J to - RKW MA CIIV . Rdw AE b s7o 71' O. p� PArw r alwm�z,a+...or O ° #67 D - 675 H-:U MIT I -- #3 It- - ® a°W aco D.N` 'IL IXF EX ®I.RIIIRE oMuu 75I44 ' I OARApE ® pl it '" AAE1 ecxxm1 eLORoar cwA6E e.. FPlfiF ro eE a MxFD m xArunu sr i¢ m'. axsFnvArrox Ramcn6x l�ca.rr,� - I _ a PNODr 2.� _ fiF�rr,, i H / 0 " J?J/a PROPOiO PAVED PARKING ... `rAwJ I T ._——0 CONSERVATION 234 TOIAL ACRES Lot Area w. '(bEASEMENT 8 qB$ maI05 AC- RESTRCTIbk CASEMENT r'a�corwT FIRE rAs1RICT/wnTI:R DEPT. .. ,� .r urre- %PAO rzxMaawE asw w. O 675C•2 aw6e 675 A. a �O PovmFtl � aim #2 w 675 C-1 P S.DF,YALI c0„EDr OP i 2 E ";w o 1#675A-1""a' 1Y 000 0 0 v HT— O'�PNc. w o. t_ 26[WNY P'SO SA PATO �19 CPO / mAvrmbS W FAplr CF RIxI ° - �y '9Y�y1 IATO ��e?�9ld•��ti� iti� Yus rl II Oar oE0R00Y K(MW RO H ;,., [/P OtK[: :I �rA I ZONING SUMMARY ZONING DISTRICT:RF RESIDENTIAL DISTRICT -� E%ISTNO PROPOSED: :: RAN GARDEN PLANTS USE:.NUMBER OF DWELLING - _.. .-. ... 2 g. .. ....... PLANT NAPE � .. SIZE1 �AO'H UlIY CENTER:RESIDENCES MIN LOT SIZE ''SO, SF.(A.P00.) 10.13 SF 10]513'SF iG CLEMRA ALNIFWA /2 18 /TL`Af11E V,DAY POdN'�'�'d'®WNHOtJSES Mw.mr moxucE 'sa SIS, s.s . REFERENCES . .. . - .. `4'M eJ.l MIN.FRWT SE1BACx Sp'• VACCIMUM CORTM905UN /2 13 MW RE SSETU 15'••SEE uULTFAMKY flFGS, 5.S' I6,5' ilE%VEfl OCILLATA 12 5 7 A YO T p-i A NDSC♦ E wN,REM SETBACK IS'• 50 261.9' ASSESSORS MAP 0]6 PCL'1s - ----- L!1 V A 6%L/11�L1 L7 111f SA K 15 ACE 310 - TWiG OOGYlO00/2 11 '- ATE IS LOCATED Y1tH:N RESWROE PROTECTION OVERLAY PLAN BOOK 1011PACE 55 'STRICT, r�(y�`Ay� • : SITE IS LO 71)YATHiN THE.O'YERLAY gS1RICT.; - \W ... •.•.. SITE IS LOGILU wTiXIR FEMA ZONE C AS SHOVMOrI ....... - - — OA R RED • il'E:PLAN OWNER OF RECORD IF uNo'm OL z sezn PANEL xuMeEn zss601 ooleo SENSED ALr COI TIT BARNSTABLE MA, aY BAY POINT,UC Y I 2e7 rxaTH ST�sTREFT � .� - .. - PREPARE" FOR PARKING CALCULATIONS: HYAHMS.MA ME01. PI M HUZZY, LLAC _ 2604 ELMW000 AVE SUITE 352 LOCUS � - B ATTACHED DWELLING UNITS(I,5/UNM-12.0:SPACES ItOCI.tE$'fER, NY 7.4018 co" +VISITORS AT(12 X 199) ♦1.2 SPACES Bay. : 13.2:SPACES REWIRED #671!MAIN STREET,C111PU1T,MA NDEO '✓��sJ. 50.9 i�666D SPACES PRO � � .. T 'C' Pe '' SCALE /'a-20' DATE 11-22-04_ SITE COVERAGE f REVISED:1-19 OB REVISED 5-30-07 own cape eng/n�siing Ine REVISED'.4 6-06 REMSEO B-19-06 LOCUS MAP - - TOTAL BUILDING FOOTPRINT: I],A09 SF SF 1].O1L C/Vll enQineerS REVISED:2 27-07 REVISED,4-10-09 SCALE I'+2083' PAVEMENT,WALKS d PADCOVER 19.17�F 14 - _ /ond Surveyors REVISED:4-5-07 REVISED,5-8-09 TOTAL INPERNWS COVERAGE 28`660 60R O.K.' GATE - .N.19 Mnl•r Sfrac((kfa tiA Scae t'-ZO' REVISED.: 12-19-14(TOWN COMMENTS) ASSESSORS MAP 030 Ptt is .. NATURAL STATE:45,611. SF 1.IRPROV.DEO, DAN.E P.E.PI..6, - 7--1 _ ) L A.PIALA � - ) REVISED, 6 5(11$F s'$ GAR. o so [ SHEET 1 OF 3- The Comwomveakh ofManadiusetts D•epartimentafAdustriadAccidens BUILDING DI=PT. O ke,of brmfigafiam 600 Washfizgton Street Boston,MIA 02111 AUG 0 4 2016 • wrvw.mass:gorldin RN Wwlmrs' CamlpemafianInsurmce ffi ;n*:S�ders/CantmcWrsJEI OW cz°ns PJ h L AUUHcaniL Illfwzmatfan Please Print jAgUy A3dr> �_� C�M D ��► . Are you an employer?Check4he appropriate bar: Type of project(required): I.❑ I am a employer with 4 I ant a general contractor and I oy ( P * have hn-edthe sub-contractors6_ New oomsttucGinn bee� fall and/or art�ime. 2_❑ I am a sale prop6etor orpartuer- listed cathe attached sheet. 7- ❑Remodeling she p and have no employees These sub-cont actazs have g- ❑Demolifioa wadzing for me in any capacity employees and have wado rs' jldo wodmrs' comp_*nuke cap-insurance-1 9. ❑Building addition r j 5. ❑ We are a corpotatiza and its 16-❑Electrical repairs cr adds I ElI am a bomeover doing all work officers have emrcised their 1 L❑Plumbing repairs or additions myself[Na won='gip- right of es .ou per MGL l- ❑Roofre gains insurance regairerLI i c.M§1(4k andwe have no employees_[No wo&iers' 13_[1 O&er cam- requi�) •Asp ap BCZHtdMt ehedsbos fl test ales IMC=the sw ianbelartv�iag ii wo&ea*c mpeasatiauparkyi�oxms[ian Mmenamers Who submit dds.afiida[if is g d,ey are doing all WU*sad&ma bim GWside C=uxc9 x mst submit a new affida&iodirrtiaa sac'Ei rCanhsctM that cbPdc tbds b=must attarh in additional sheet s1mring the names of the sub-cflmdac m and state Whelhec ar not thus,e,dC,,haws enp9cye-.Iftbe lb�_baceemplcyea%they=srpms-ideYbeir warlmrs'tmnP•FGrkFnumber I am air euipio r t7tatisprenRiiurg�trrrrkeis'cotrrpertsr urc i srirartce f or m}*empFo3�ee� RaTow is tiheprrli 7 and jab site irzfarmmlian. Insurance Company hrame: Poficy i't or^self-ins.Lic.:91 Fn pimtion Date: Job Site Address_ Csty/Statelzip; Attach a copy of the workers'compensationpoHey declaration page(showing the poficp namber and expiration date). Failure to secure coverage as required under Section 25A of MGL a-15'f can lead to the imposition of criminal pemaYties of a fine-up to$OOD 00 andlor ane-y eir imprisonmezd,as well as civil penalties in the fog of a STOP WORK ORDER and a Time of up to$ MOO a day against the violator. Be a h sed that a copy of this statement may be forwarded to the Office of IQvesUgations afthe DIA.for imum=covmjp vedilcaficjq- Ldo her rsrti tzardff&F avdpell attJte it fo &n rmaprm-irWabmv fs true and correctSi�ats:re= Date: phonelk t1,{j W use wify: Do not write in floe area,to be comtpTeted by city artown official City or Tern a: Permft ;cease;9 Issuing Authie:rity(dr&true): L Board of$•eal* I Budfng Dqm mcnt 3.Cltyfrow .Clerk 4.Electrical Inspector 5.Phmmbina inspector 6.Other Contact Person Phone it: ACORD CERTIFICATE OF LIABILITY INSURANCE °�'�(MMIDD(YM) 6/9/15 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(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsenent(s). PRODUCER CONTACT. �. NAME: Donald J. Medeiros Insurance A PHONE 508 678-1271 Fax No): (774) 365-6552 154 Rhode Island Ave E-MAIL don@donmedeirosinsurance.com Fall River, MA 02724 INSURE S AFFORDING COVERAGE NAIC# _ INSURER A:American European Insurance INSURED INSURER B-.Safety Indemnit Edgar Mauricio Agudo Ortiz INSURER c:LibertV Mutual dba Ecuamerica Construction II INSURER0: 39 Seymour Street INSURER E: Berkley, MA 02779 INSURERF: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MIDDK MM)D/YYYY LIMITS A GENERALLIABILITY SKP2000957 10 4/23/15 4/23/16 EACH OCCURRENCE �'$ 1,000,000 X COMMERCIALGENERALLIABILITY PAMAGEE TOR occurrence) I$ 100,000 CLAIMS-MADE �OCCUR MED EXP(Arty one person) $ 5,000 PERSONAL&ADV INJURY $ 1 000,000 GENERAL AGGREGATE $ 2 000 000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCES-COMP/OPAGG I $ 2 COO" OOO X POLICY PRCT LOG $ AUTOMOBILE LIABILITY 5 17/15 5/17/16 COMBINED SINGLE LIMIT B 6223581 / aaccide. _ $ 1,0001000 ANY AUTO BODILY INJURY(Per person) $ ALLOWNED X AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident)!$ NON-OWNED PROPERTY DAMAGE ;$ X HIRED AUTOS X AUTOS eracdderd $ UhBREL1ALIAB OCCUR -EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ c WORKERS COMPENSATION WC231S372831 5/5/15 5/5/16 X I WCSTATU- I OTH- AND EMPLOYERS'LIABILITY — — I ER ANYPROPRIETOR/PARTNER/EXECUTTVE YIN E.L.EACH ACODENT $ 506,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE!$ 500,000 Ues describe under IPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Sdredule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Residential Management INC ACCORDANCE WITH THE POLICY PROVISIONS. PLM Buzzy LLC 2604 Elmwood Ave Suite 352 AUTHORIZED RE PRESENTATIVE Rochester, NY 14618 Heather Williamson ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: DATE(MM/DD/YYYY) Ac" CERTIFICATE OF LIABILITY INSURANCE 110/16/2015 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 endorsements. PRODUCER CAM ACT Kelly Sel The Driscoll Agency, Inc. PHANE 781 421 2490 FAX(Atc N :781 421 2491 93 Longwater Circle E-MAIL Norwell MA 02061 .kseip@driscollagency.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:HDI-Gerling America Ins Co 41343 INSURED 218590 INSURERB:Navi ators Insurance Company KOBO Utility Construction Corp- INSURERc:The Charter Oak Fire Ins Co 25615 4 Victory Drive P.O.Box 578 INSURER D Sandwich MA 02563 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1697556991 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. #LTRR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD POLICY EFF POLICY MM/DD EXP LIMBS A X COMMERCIAL GENERAL LIABILITY EGGCC000107815 10/1/2015 10/1/2016 EACH OCCURRENCE $2,000,000 CLAIMS-MADE ❑X OCCUR PREM SES Ea occuE ence $100,000 MED EXP(Any one person) $excluded PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY�JECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY EAGCC000107815 10/1/2015 10/1/2016 COMa aBINEDcciden SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ AUTOS AUTOS AUTOS SCHEDULED BODILY INJURY(Per accident) $ X HIRED AUTOS IX NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident A UMBRELLA LIAB X OCCUR EXAGC000107815 10/1/2015 10/1/2016 EACH OCCURRENCE $10,000,000 B X EXCESS LIAB NY15EXC7901951V 10/1/2015 10/l/2016 CLAIMS-MADE AGGREGATE $10,000,000 DED I X I RETENTION$0 $ A WORKERS COMPENSATION EWGCC000107815 10/1/2015 10/1/2016 X PER OTH- AND EMPLOYERS'LIABILI Y Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C ContractorsEquipmment QT6606B268829COF15 10/1/2015 10/1/2016 Special Form w/Theft 2,160,412 Installation Floater Install Ea jobsite 450,000 Leased/rented equip Leased/rented 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) RE:671 Cotuit Road Residential Management Inc &PLM Buzzy Inc.Are included as Additional Insured for Automobile Liability on a Primary Basis for the conduct of the(Named)Insured,but only to the extent of that liability. See Attached... CERTIFICATE HOLDER CANCELLATION 30 Days except 10 days for nonpaymen SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Residential Management Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 120 East Ave Rochester NY 14604 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE i AGENCY CUSTOMER ID: 218590 LOC#: A ADDITIONAL REMARKS SCHEDULE Page, of 1 AGENCY NAMED INSURED The Driscoll Agency, Inc. KOBO Utility Construction Corp. 4 Victory Drive POLICY NUMBER P.O. Box 578 Sandwich MA 02563 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Residential Management Inc &PLM Buzzy Inc.are included as Additional Insured for General Liability and Excess(Umbrella)Liability,for ongoing and completed operations,as required by a signed written contract or agreement with the Named Insured, The Additional Insured coverage for General Liability&Excess(Umbrella)Liability detailed above applies on a primary,non-contributory basis where required by a signed written contract or agreement with the Named Insured. The General Liability,Excess(Umbrella)Liability,Automobile Liability,and Workers Compensation/Employers Liability Policies include a Waiver of Subrogation in favor of Residential Management Inc &PLM Buzzy Inc.on whose behalf the Insured is required to obtain this Waiver under a written contract or agreement executed prior to a loss. Notice of Cancellation provision is 30 days except 10 days applies for non-payment of premium. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i CERTIFICATE OF LIABILITY INSURANCE DATE F6/3/2015(MMfDDNYYY) 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 CONTACT Karen Bernier NAME: Southeastern Insurance Agency, Inc. P"o"E (508)997-6061 FAX (508)990-2731 439 State Rd. E-MAIL .kbernier@southeasternins.com P.O. BOX 79398 INSURERS AFFORDING COVERAGE NAIC 0 North Dartmouth MA 02747 INSURER A:Arbella Protection Insurance 41360 INSURED INSURER 8: R J Bevilacqua Construction Corp. INSURERC: P. 0. BOX 628 INSURER D: INSURER E: Forestdale MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1542700879 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. IY EXP LTR TYPE OF INSURANCE A L U POLICY NUMBER MMIDDIYYYFY MMI DI YYYY LIMITS GENERAL LIABILITY EACH.000URRENCE _$ 1,000,000 GE ToRENTED X COMMERCIAL GENERAL LIABILITY PREMI E Eaoccuffencel $ 300,000 A CLAIMS-MADE ❑X OCCUR 8500019147 /15/2014 /15/2015 MED EXP(Arty one person) $ 5,000 X XCU Included PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X PRO LOC $ mx POLICY AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _ 11000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED 020014548 /21/2015 /21/2016 AUTOS N AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS NON-OWNED PROPERTY AUTOS P DAMAGE $ UnnsuredmotoristBl split limit $ 250,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 AXCESS LIAe CLAIMS-MADE AGGREGATE $ 1,000,000 EXCESS I X I RETENTIONS 10,00C 4600062061 /15/2014 /15/2015 $ A WORKERS COMPENSATION X WC STATU- X OTH- AND EMPLOYERS'LIABILITY Y I NFR ANY PROPRIETORIPARTNERIEXECUTIVE E L.EACH ACCIDENT $ 1 000 000 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) 088690414 /27/2015 /27/2016 E_L DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddlUonal Remarks Schedule,if more space Is required) Project: 671 Main St, Cotuit, MA Email to: Danno.McGrath@verizon.net and NLuttrell@dhdventures.com CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DIiD Ventures ACCORDANCE WITH THE POLICY PROVISIONS. 2604 Elmwood Avenue Rochester, NY AUTHORIZED REPRESENTATIVE Karen Bernier/KAB ' 1�- J ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD/YYYY) 04/29/2015 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 CONIACT NAME: PAUL SCHLEGEL SCHLEGEL INSURANCE BROKERS INC PHONE -- (A/C,No,E.1)_ 508-771_8381 _ IA/c,FAX No)508-771�0663 34 MAIN STREET E-MAIL ADDRESS SCHLEGELINSURANCE@GMAIL.COM WEST YARMOUTH MA 02673 INSURER(S)AFFORDING COVERAGE TT NAICp INSURERA:NGM INSURANCE COMPANY 14788 INSURED INSURERB:NGM INSURANCE COMPANY 14788 Gary Matsik Dba Matsik Concrete INSURERc:NGM INSIIRANCE COMPANY 14788 185 Barcliff Road INSURERD:NGM INSURANCE COMPANY 14788 INSURER E: Chatham, MA 02633 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 POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE INSR WVD I POLICY NUMBER f (MN Lifc- YY) (MMIDDIYYYY) I LIMITS A GENERAL LIABILITY MPT0078H I 01/22/2015 01/22/2016 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY I PREMISE (Ea ncej S 500,000 CLAIMS-MADE F n l OCCUR I MED EXP(Any one person) S 10,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE s 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG s 2,000,000 POLICY PEo n LOC $ I �— B AUTOMOBILE LIABILITY M1T2489L 09/05/2014I09/05/20151(Ea accident _ S 1,000,000 X]ANY AUTO BODILY INJURY(Per person) S AUTOS SCHEDULED - X AUTOS X AUTOS BODILY INJURY(Per accident) I S �— NON-OWNED f AMA. S X HIRED AUTOS j X AUTOS (Per accident) � S C X UMBRELLA LIABi X OCCUR CUT0078H - 12/17/2 014112/17/2 0151 EACH OCCURRENCE _ S 1,000,000 EXCESS LIAB— CLAIMS-MADE I ( AGGREGATE I S DED I RETENTION S - I S D WCT0078H Ol/21/2015 Ol/21/2016I X TORY L M TS ER WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEPJEXECUTIVE Y/N E L.EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED? a NIA (Mandatory in NHI _ E.L DISEASE•EA EMPLOYEE S 500,000 If yes.describe under DESCRIPTION OF OPERATIONS belori I E.L.DISEASE-POLICY LIMIT s 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) GARY MATSIK HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS COMPENSASION POLICY CERTIFICATE HOLDER CANCELLATION DANIEL MCGRATH CONSTRUCTION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 312 CAMP STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WEST YARMOUTH MA 02673 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE DANNOMCGRATH@VERIZON.NET I 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered Uarksf ACORD Massachusetts -Dripartment of Public Safely I Board of Building Regulations and Standards ComtructinmSu enisor :'License: CS-107897 , YL. .. Al DANIEL MCGRATH, a 312 CAMP STREET " West Yarmouth MA 02673 Expiration �Q 06/13/2018.. ... .. .. Commissioner ._... ._ Office:of Consumer Affairs and Business Regulation 10 Park Plaza- Suite:5170 Boston, Massachusetts 02116 P i Home Im rovement Contractor Re lstrat glon �. TM Registration 179293 F Type: Individual S a Expiration 7115=18 Tr# 419291 DANIEL J. MCGRATH. .„t S I� DANIEL MCGRATH 4 312 CAMP STREET WEST YARMOUTH; MA 02673 Update Address and return card.Mark reason for change. ?sCA I I 20an-o5111 0Address n:Renewal Q Employment F-1 Lost Card .. �foMIirrarrurefrlll, Iw�r'attar�u�elf Office of Consumer Affairs&Business Regulation: License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR ::; before the expiration date. If found return to: p,Registration: 17929g Type:, office of Consumer Affairs and Business Regulation Expiration 7/15/2018 Indvdual 10. k Plaza-Suite 517.0. Par - Boston,MA,0.2116 DANIEL J.MCGRATH DANIEL MCGRATH 312 CAMP STREET j. WESTYARMOIITH MA 02673 Uoderseeretary Not valid wit ignature ; s: q Ta'.n=. III .. l�l --rFz*c 4-r ceuc cv�K+van Np ci I I I Ia- -! ���..� �i � � , ✓ '� - 1,..q 1. _}- I � Pam' I �', <: _I3 > J ' _ I I ! I T`r9cP.�co L,Fww•.'y I 1 U� i 1 � -� c.e Ur !� - f�xGG�VAT7 1 I � I I (.!4�.n G oV s p. I \ I :• 1=-L,eri,S ny� I ' Ut-FGxc�ua,T�D III( FeWr,C. Sl-AKi(s'CrO Yl I fllrJ'� ✓ con- 7er!e � w,r-w,Ta �„rnl, to 4n�nc.4 o�cr, 3 � r_ � � W,w,F.o✓Vr,Vn�, • 1 1 _1 �I (3eoe !^n v)'TW+ 4- 7 yp t 1 E t• ;� s ^m: 'IL J - �GONT. O"X Ivi. 3 } ZccrJc. 1 fJr a�'n'..__.'./ j It -1_'-^} 'I I I ... I _��� — lz — 74, ! I 3 1 i I � I • I: � - �.o G�j� � y� I I, i , I ' !2 '6^ N17i1�1 .1F-oul-lrDL\—, 10H f LLCM— TWO P�I✓Df-OEM. UNI I 1�ull,�� N� -- ►wo�eo� -REYIS�O►FS: r.T�r 8•2?' t� Ul D1NG #1 #2 - : 1!/ t ii]'"a L'�i Ito: N_4>;� asucCT-ENSINEERB 'i ` .(�1�.J-..L.1. a wewta n .. A n 4. DW-'Q MA SRO / t1tI�o1Nb:..., - GC�zvt till+- 106.MAM.*rRMST. i ALO t7D.C'G�yR p@C1T �s- . s'rowea+►M."uwenuser'rs.os+e$ &75 6 Z. ............. ............. 1 `f1.G!r ADE�V��:� j .. S•o' �� :•fL6 Kw7 Mt-r Lk- 3 SLIDER - IKITGF1GNi9 c ( i LlM irrr n,r:!'2 I _ f 4'�,.. M! a r3caa ta'f•-_� I '�I I; II IZITc_.t•�P_N ._..._ ! r a_,,° . - i :4'. LlV ihihf f71NIN!> _� �'�-�r !-•'' r -J Ii +' �. ._� I� r i.11Al of?'i;K-'�'-Z � I I!: LA. M pf I L — ! sidle li4 j,v6 c P i•� na. 2nnm✓o--1 � I � � I �'r_ow .t / O —_ � �_ ._� - .., GA Is is 1"-TLI Is `� �S _ n ! �• � , (»TI.{ol w r!.c.u6Ft !P 07 �� i I 1 6S 63 p 7 >F 069 c j 068 -41 N ' � a — �t 2va. ��t '-- I J.4or�zJ✓m, _! �' Y P'�s +. i - - I IP 1 12 Fr _ Is �C7t-c H : 1 P-om Is 1 1 _ _. A I !'o' _ rl�s ff FLAN _TWC �1�=;�� `'{ UI`i !�- I5UI'1�IlH t3 Up PROJECT, _ 'pEY1S10 NS: � � �-Z7i•1 0 .T oe�aer.Tmw o PE?ER.F DIMEO • BU_iLDI_N,G.�1_.�#2 ��Ti�17�t�.T�.� r��si6�.�s _ A88bC1A7'tlQ8TINC.. _7 .X '�17tt�?{N G 91 IriL TP r, s�?3�!7rF�13.- low r�K T".111sa�NE No es o`s o .. � .. u ER9 16 1 �,L4— LOW S70NEMAN,WAs1RCNYsITTt.01160 Th.T'61 106 �2.Q1-�.-.N.DIZ"�F� .�I�.I.CN1..c�.):1-i}�•-' � f:R:i�l�T��T�� j i Z E 12 I � ! h� • 1`----- t t'-4,, t _ 7 3 �-d -�`-5--._ G-3" 7'• 12'-4" � , I I : all url R I 14 • � �t E � —.._ �,._..._—�.. — � �� Ji 1/ — . II .I; `mil _1 5%4'xV 0faccs-w rosr E , i -7- N I I O I R! !i r lV l t74T L j -P F_ 71 c -y tl 4G- _ 5 WIDE O ENIN a-I 't I 1! _�. _ ._ ✓ i -.. 1 NO DOOR - G?5N wOov t I•G.�09T { i— — ' ____. _ ♦-rnH .�,,: - .. G`.o .P�Ersr,OaM�G - E I I I 7VC1 l I !- E'r 1+ 4k' 4- ram' �`✓� 5'� WIDE OdENING T NO DOOR I . �! �. ✓L__. _. .__._.,...\j;._.—_. _P r �I. � E i V�:S{`-^ mil,1 'r�I �L1 V G i 1 _ I -- --, �� F \ 1. r..r-t�• I I ! it i .tip--'�'�.�y._•—^„ y •- '>l.� a'. I .. .l i I ' A I '-o2�•I' svC01Nr FL OC)f'� r'L/SN - Two 3GI:-)r-o0� —1 UI`I:I.T r�UIL��i�l:� r'2.p Lt lz.fsy5 �IN; 6•15-I0 I$ ►eOJ[CTr ... �. ... t BUILDING #1 #2 _. T��: R ,o. ,r � .. -c_a L Z.`�N _ 1ff 2C CEO ew need MT O A�dC1ATE$,MC ; - ARCHITECT8-8N01NHER8 'u�o �• �4tt�r)T 'rT T;' av17,►nth^. ,es.MAIMAT"MT. � t A162 -R-JAY JtEGI_1..LC sroreswr.rwsewcnus[rTe 0:160 «�. f'. .4 w� fiR-ice•�✓•0 R.4R .. `F '."'COTUIT CENTE R. *.ES1- - NC 67.1 , . STREET, CO BUILDING #3. ' ..• ... _ _ .. .1. Contractor Contractor shall obtain ands-: GENERAL NOTES .GENERAL, POINT. LLC J1. All construction and procedures can for all royalpermities a,faes.lf p reuse¢, royalties and tBAY axes, >shall mee! the requirement of - rqulred f or'construction anf the Massachasett .Late build!'ng occupancy. - code; the local ocj or juriedletion of the� CODES, �j . 297 NORTH STREET ether applicable items shlone. I. All material° and items shall be� 1. Contractor ahail perform all in°L°lled or plied as par the vork and provide all material^ . - - •, ;manufacture. instruction.,d lrec- in compliance vith all ap)111- -. tions and recosmegdations and ... cable codes ane juri.diction an pei'the beat practise of the - including the latest issue HYAN N�S,• MASSA H U S ETTS trade. - of The g Codehuaetts State 3. Any reference to "Contractor' In.. Building Code these dravinge and notes shall re - fer to the contractor, his employees, Contractor shall perform all his sub-contractors or their sub- work end Install or••A"ly all - aubeontractoze, his suppliers and items and materials ae per man- , - --any other.individgal. or companies -ofacturar•s laatruction¢.and r _ - ' .. - under contract to him for this pro_ '. y. commend atlone'and as per praccii • - r .. _ • Jact ae:the case bar apply-' of the trades: - 4. Cc tractor shs,11 provide all nee- - easary labor,material,equipment, ' TEMPORARY SERVICES: . i tome tools and supervision.as re- quired to perform end complete the 1.. Contractor shall provide, instal - work a° shown or in by the and pay for any and ail tem- . dravingo. per a ry services as required for construction including xa ter.. - SAFTEY,.,•" electricity and telephone,and. " y 4 hest. � �/�, ! ����� * • -1 Contractor shall carry out pro- {R� V181dn. of The taanual of AGcidenE STORAGE, F rave.sl In Con.trecL l on", pub- lished by The Associated General .1. Temporary storage of materials Coh1ea.Cora o[ America,Inc. and•any debris and .:seas materials � � T� � A _ e ec earacy applicable a s- nail Do alloyed on the pro-. - •!r jV' quir°d by any applicable jurisdictions feet site only in n location including OSHA,and manufacturer•a previously approved byovner aafety recommendation. for equijiment �- to or materials. Also .ee;.,.0$HA TEMPORARY SANITARY PACZLITIES: _s����� �a�� w w����� - Safety and Health Standards ti.n . s - - 8`�L17 ,r`ea V -G!R icable930)'or latest edition nn 1. Contractor shall provide tem- - applicable. sanitary facilities in eon- d+d 1Do MAIN STREET forml with all state and !o- ` SHORING SHEETYNG AND RRACINGx cal laay.e. a ��1t E�H�M�l `,A�S��-C^J 3. Contractor shallSCAFOLDING: LIOf.'US /�1 _j '�7T�G,MH!s IYIf!�7a7f►Vhl�s Provide,inst,.t ". l.� R �1011 - ) and rearove and pay for.any sheet a_. 1. Contractor shall rbvide,erecL O2 IW ah'ring and bracing as required P Q by any portions of the construction' °nd aIdmen tIs any and all inter •' proce.e. - ^ioz nd exterior scafolding Gad regoi red for conetr_ -- J �� � 1. Contractor shall cheek,verify , ayl uction and incompliance with - and coordinate all measurements apply cable laxs,ordinnnoea dimensions and report any-discre- coees.°afety rules (including . - � • - panclee directly to the Architect OSHA) and other applicable jur- LOCUS MAP.. Immediately.. i.dictions. scut t'- soar al _ g,23,10 1 i - -- ���� d Tyr, P TYrl I I Arxve. "P/UL14LtLLtiD i I 6M 3 I I f —__ I — � , I . — _ 12 II s�rr - - L.-q--+ UrIIGxe A V ATN D f(P nL ebL,FeoTq o I -T ! 1 ' I �--•2 f"X24"�c 42.coN � � _. I• I _ 4 •' � 4PFhG, over, � ! pYti (au3a.�:,�� r " -i^.I-r!cnu4��uc I I. 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