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0095 OXFORD DRIVE
�95 C�XFo�� ���ve, / \ °`a,'•, TOWN OF BARNSTABLE Permit No. ------------------------ »2TAU Building Inspector Cash ------------------------ �0 YPY�\ OCCUPANCY PERMIT Bond ----__------- No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ............................................... I9...».__ ........................................................ .............»...................».......».....».» Building Inspector Assessor's map and lot number / .... 4 SEPTIC SYSTEM MUST BE INSTALLED 1N COMPLIANCE Sewage Permit number WITH TITLE 6 yo�TB E roe♦; OWN OF ' - A R N StVAL CODE AND ULATIONS 1, BA"STADLE, "6 DUILDING "INSPECTOR 1 YFY APPLICATION FOR PERMIT TO .... ..5 4` .: C ..... ......... ..... ...............:................................ TYPE OF CONSTRUCTION .W. `c�zw?L.... 1,: . �! ?✓ ................:...... ......... ................ C ..:.......... .............I S� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..1........ a' �� Im...... ............G .................:................................................... ProposedUse ....S C:.. .......... ........... ..................................... ........... ........................ ...................... Zoning District QQ � ,.... ..1.4 t.� l C..`. ...........Fire District .. ej ................................................. Name of Owner V�. .c9z. ... � ......V:5................Address .. �... ........ ,� � .......................... Name of Builder . .. .. � ••.. ...�... C.... . . ..............Address ogG Nameof Architect ..................................................................Address ....................................................:............................... II Number of Rooms ....G...........................................................Foundation .PQ4�� .. ................................ Exterior `!u �?...��' .... 4� ..�esa �!.....:..................Roofing ..... �. `?t� ........................................................ . Floors .... ��!�...4sp��,... ':...C� ( ..........................:Interior .. `f. . .1 .�.................... Heating ^w..l ".` ^..... .V�,r..... ....................Plumbing ..`��� ` ` ...N�ms- ace ... ... ...Firepl "�..` Approximate Cost ....................... ........... Definitive Plan Approved by Planning Board ________________________________19________. Area .....:...............v... ............... Diagram of Lot and Building with Dimensions Fee v ' SUBJECT TO APPROVAL OF BOARD OF HEALTH (3 r� f A l' II IU 5fl( 1 hereby agree to conform to all the Rules and Regulations of the .n sta I r g rding the above construction. Nam .. .. ........ . ... ...:... ,..:....... ,.........:............:... Mycock & Allen R E. 21996 1 112 story ............... Permit for ..................................... frame dwelling & garage . ............................................................................... Location .........95...Oxford Drive.......................... ........ . .. .... . .... . ........................Cot uit ....................................................... Owner Mycock & Allen R. E. .................................................................. frame Type of,Construction .......................................... ............................................................................... ; Plot ............................ Lot ............#72.................... February 19 80 Yermit Granted ........................................19 'Date of Inspection ..................:..... ............19 -Date Completed ...... 19 aio R ....... . . .F/� PERMIT REFUSED ................................................................... 19 . ................................. .. ... . ............. .. .................. ? . ... ......... .. ............. in IN ..... .... .. ..... . .. .. ....... ................. rn, 45 .. . ........................... Appt ................................ 19 0 rn .................................................... Assessor's map and lot number .::' ................................... Sewage Permit number � '._,r ............. ......................................... +� F1ET�� ���vlF Jr �!� TOWN OF BARNSTABLE i . i MAR114ABLE, i IL "6 c w °'• BUILDING INSPECTOR . ar APPLICATION FOR PERMIT TO ..................`.:.. .:ar. �.. ?-+"..... ...\•........CL.#.. .............................................. I' TYPE OF CONSTRUCTION ..........: ....^. `'`;......... l...t'...;•`............c✓I ........j................................................ ........1 .................. :.............19?C .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit `according to the following information: Location :.....:...........� ..............f.....:�,�.C'11......... .....`..!...-'................ t's... •............................................................................ ProposedUse ........: •. `F...e:............................................................................................................................................. Zoning District E .n.�: .. ..c Ga..:t'�+ ... ! C(7 � •••,,,. _ .................�...................... ...........Fire District ....................................................................... Name of Owner C r......c......:... .......�....:--'.................Address S......^ .........+'.. ....... •.:...............^............... . Name of Builder z 1e. r,vc_ \�•,-Alm+`. Address \.... ...-.�^�t....... 1�4•....;..}"...........I 2C.a..... . ... Nameof Architect .............. .... ......... .............. ..............Address ................... ......... ............................... .....!........... Numberof Rooms ...f!i................\..........................................Foundation ...,.....:,.......:.........,................................................. Exierior : �r, c �� ,...C.: �m l �1 Roofing 4 ��•� ��.............................................................. �...Floors .....i.........\ . ....�..,...... �......l! '..,��'• ......................Interior ll t qt.....�...a.1..?.....t..~......t...i..I...........................�, �Heating ............................ . ........ ................................Plumbing ............................................................. Fireplace ... � ,� - .1 t`� '3 _ 1_ C -�C� �U ............. .................. .... ., ..... APProximate Cost .............. ..... ............................................ Definitive Plan Approved by Planning Board -------------------------------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ,4 it �;l ..� ._ .—"• --- �` I hereby agree to conform to all the Rules and Regulations of the'Town'of-Barnstable regarding the above construction. ;X, *. Name :.'� ; ....!......': `:...... .............................. ` 21998 l I/2 story No ................. Permit for .................................... � frame dwelling & garage -----------^--------'------' 05 Orford Drive Location -------------.—.------.. cotuit .............. ....,................................. & Al "== ^ Type of Construction � Februtry 19 80 rennv Gnum=" InspectionDate of ' Date Completed «^ w PERMIT- REFUSED ` _,_.. lA ............. —'—'^~^'^—'—'`' 6 —^—'—'f��~ +'`^ —^^~^'—~—~^--' V / . ............................................. ................................ � -------.~—.--..—..,---......--..- \ \ Approved ................................................. lg i '--------^----^—~^^'--~'^^^---'' / ^ � -----------.-------......--.... ` � | | | � ] s..�..+.t �s..a..:,s�:�ti»•;ivrt i..-....._..«.Ai. ... x .._.. � i ,� ° �a t - �. ✓ t .._ 'f••''m$?�. �t 4 �.: �. `p Lo� -� 0,0 s of 0. �G R- O )< dR � RJ\j ATION OF TOP OF FOUNDATION o i CERTIFY THAT THE FOUNDATION 0WN DOES NOT VIOLATE ANY !STING ZONING REGULATION OF 1E TOWN OF EAW ST--A-g;lx _ low rJ c V- BARQcs7rAbLt Co-r u cr dr• �p V ►.�D.��-i.o N �`R�r t GA•T't✓o rJ N O V4 NERS WALTER may. P. OLDHAM v 1123207 �(�p�.(L �� R eA L-:T � 9EClSTi�`��p� T�DV`�'C.�S S U R�F'� i Q s ENG, iZ A-56oc , rj(-. R4`/ )t�4� Sc l✓�r"_3of 9; 980 FRIEDLINE & CARTER ADJUSTMENT, INC. 436 Main Street , P . O. Box 338 Hyannis , Massachusetts 02601 Tel . ( 508 ) 771-3232 Fax . (508 ) 790-2344 TO: Building Commissioner or Inspector of Buildings ( ) Board of Health or Board of Selectman ( ) Fire Department, Town of Barnstable Town Hall Hyannis, MA RE: Insured : AHLIN. Jack T. Property Address : , ' ' 95 Oxford Dr . Cotuit . MA Policy Number . 560226613" 4' M Loss of : Water 12./2.7/2000 File or Claim # . 90185 ';M�t a Claim has been made involving loss ; damage or destruction of the above-captioned property , which may either exceed $ 1 , 000. 00 or cause Mass . Gen . Laws , Chapter 143 , Section 6 to be applicable . If any notice under Mass . Gen. Laws , Ch. 139 , Sec . 3B is appro- priate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number , date of loss" and claim or file number . On this date , I caused copies. of this ' notice to be sent to the persons named above at the addresses indicated .above by first class mail . „$ Ad j,u s t,e r Date :* oFZHE, Town of Barnstable *Permit# P� Expires 6 months.from' e Regulatory Services Fee >UxsTABLE, v� MASS Richard V.Scali,Director p i639. Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 568-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not valid without Red X-Press Imprint E Map/parcel Number O�2/ 6 S/ r _Dr n Property Address O K c d1 D r t:v _ `-o/v i r Residential Value of Work OVD Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address s9 Gil tI n Contractor's Name ��y h" Telephone Number Home Improvement Contractor License#(if applicable) )f --0 6�—� Email: Construction Supervisor's License#(if applicabley - d ❑Workman's Compensation Insurance FEB 1�15 Checi,one: �I am a sole proprietor TOWN OF BARNST 8LE ❑ I am the Homeowner �`1[7 C ❑ I have Worker's Compensation Insurance Insurance Company Name `3Jorkman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ' ❑ Re-side [Replacement Windows/doors/sliders.U-Value a_3 V (maximum.35)#of windows C #of doors: / ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must ' Property Owner Letter of Permission. A copy of the H e I provement Contractors License& Construction Supervisors License is quir d. SIGNATURE: QAWPFILESTCOR S\building permit forms\EXPRESS.doe Revised 0.61313 - - - The Conimonfiveaith of aassachnsetts Depcarttnewt of Industrial Accide nts Office ofrnvestigations t'Yy-v 600 Washington Street Boston,JU4 02111 ` wivinmass.gov/di a MForkeis' Compensation Insuranr 4ffidavit: BuEiItiersiContt-acturs,1[L-I a1 ns/Phunhers Applkant Information - Please Print Legibly Name(Bits-=s,Orgariizationiin&-, duai): Address: o _ 1 � - CityJState/Z Phone#: Are you sit employer:'Check the appropriate box.- Type of:project r wire 4. I am a general contractor and 1 e d : 1.❑ I atn a ger�#1� ❑ 6- ❑New casi�tau+ctiou. yees Mull andFor part-time).* have Hired the sub-contractors ? am a sole proprietor orpastuex- listed on the attached sheet. y- ❑Remodeling slip and have no employees These sob-contractors haze g- ❑Demolition -vorkmg forme man} capacity- en ployees and have workers' 4 Fa 9_ ❑Building-addition. [No woilmrs' comp.ina-uranee comp.insuran e.X required-] 5. ❑ tote are a corporation and its 14_❑Electrical repairs or additions 3_❑ I am a homeowner doing all work affi".have exercised'their 11.0 Plumbing repairs or additions inTself [No workers'comp, rig�it ofexemption per NIGL - 12❑Roof repairs insurance required.]^ c.1.52,§1(4),andwe have no employees.[No workers' 13.0 other comp_insurance required-] 'rnyapplicam 4hatchecksbox#1n=also fillourthesectionbelowshowingtheywotkea''compensationpolicyinfo€madon_ F=onx-owners who submit this af[ida%*indicating they are doing all wuA,and the¢hse outs;ida contractors mast submit a nets affidavit indicating such_ C'o:cL=tors dmx%check this box must attached au additional sheet showing then of the sun-conttactm and state whether o€not those entities Dave employees. If the sub-coatracioas have eniployees,They rmsrpmvide thear workm'romp.policy number. lam an employer that is prowdfrig rvorlters'compensation inmra ace for rrry erniployees. Below is the policy*artdiab sffe inforruation Insurance Gotnpany tame: Policy 74 or Self-ins �: E�-piration Date: Job Site Address:Ak � - f2 CitylS.-sip: 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 25 A of NfGL c_ 152 can lead to the imposition of criminal penalties of a. fine up to 51,500.00 andor one-year impi sonment,as vuell as civil penalties in the fotm of a STOP WORK ORDER and.a.fine of up to S250_00 a day against the violator. Be advised that a copy of this statement maybe foiwuded to the Office of Irrvestigatims of the DIA for insurance coy ae verification_ I do hereby certafjr er the 'ns lid, s ofP- art,thattlre infornzadarr pro-Med above is trice and correct -Signature: Date: 1-6 Phone II: Official use only. Do not ivrite in this area;to be czrnpieterl by city or tolvil official City-or Tmvn: PermitUcense 9 Issuing Authority(circle one): 1.Board of Health ?.Budding Department 3.Ctyllown Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone a. 6 * BARNSrABLE, 9� "�: ,0 Town of Barnstable ArEo�,t a Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:, 508-790-6230 Property Owner Must Complete and Sign This Section If Using A: Builder as Owner of the subject property hereby authorize ✓-ee le to act on my behalf, in all matters relative to work authorized by this building pen-nit application for: r �k d U►�l V� (Address of Job) WC1— 2,1 / 7 /S Si ature of Owner ate S�k IGx,k CA h LI w Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWHILESTORMS\building permit forms\EXPRESS.doc Revised 061313 Town of Barnstable Regulatory Services ' " oFSHe ro Richard V.Scali,Director Building Division * tABNSTABLE. ' Tom Perry,Building Commissioner MASS, 9Q� 1639• ��� 200 Main Street, Hyannis,MA 02601 ATFD �s www.town.barnstable.ma.us Office: 508-862 038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: !�JOB LOCATION: ✓ �x(7J/Lf it/V CO Jv I number street village "HOMEOWNER": --JA �'FIX il . name home phone# work phone# CURRENT MAILING ADDRESS: / city/town state zip code ,The current exemption for"homeowners"was exten d to include ner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does of posses a license,provided that the owner acts as su ep rvisor. DEF 'ITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resi o intends to reside, on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory t uch use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home n . Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be r onsi e for all such work performed under the buildin ermit. (Section '09.1.1) - . - The undersigned"homeowner"assumes responsibi ty for compiianc with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that /she understands the Town Barnstable Building Department minimum inspection procedures and requirements and that he/sh will comply with said procedur and requirements. Signature of Homeowner Approval of Building Official Note: Three-family ellings containing 35,000 cubic feet or larger will be req ' ed to comply with the State Building Code Section 127.0 Construction ontrol. HOMEOWNER'S EXEMPTION The Code state that: "Any homeowner performing work for which a building ' rmit is required shall be exempt from the provisions of is section (Section 109.1.1-Licensing of construction Supervisors provided that if the homeowner engages a person(s) r hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our.Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 JIM Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor ' ` r.i . License: CS-009013 GREGORY M CAAE 33A BAXTER A1Y W YARMOUTH CIA Ex pi ration Commissioner. 05/11/2016 �/ze ioanvnzomurea`l� o�./�/�iaooac/zuael�'6 � 4 —� - Office of Consumer Affairs&Business Regulation. License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 173822 Type: Office of Consumer Affairs and Business Regulation Expiration: 11/1-9/2016 Individual 10 Park Plaza-Suite 5170 v Boston,MA 02116 GREGORY M. GREGORY CAULEk=� r� 1 , /-7 33A BARTER AVE W.YARMOUTH, MA 02673 Undersecretary Not valid without signature Town of Barnstable Building , ',' ,:. ,i.' Y�; � `., ��,'""` .. �,_ ,. ��`,.':'.'�b,a '< �� '.:.,� OSt..TI11S Card,So That rt is;Vl-ibl rom h,e Streelq` <An,Yfroyed Plans:Must:be Retained on Job and this Cartl Must be Ke t 1ARSi57CABLE,.. -�. b 5,. -i",m ;t` - Pp a?" ys 4 r?»:.F.h �y �: ,,, p M PostedUntil Final Inspection Has Been IVlade . .., ,. ... ,. ,�., �� :;„; p rrn +R Whe're a-Certificate of Occu ands Required,such Bulldmg''shall,Not,be Occupied untal a F-,,inal Inspection has been made F 1 �1 ijjlt A Permit No. B-16-1582 Applicant Name: Emmanuel Mello III Map/Lot: 021-051 Date Issued: 07/12/2016 Current Use: Zoning District: RF Permit Type: Solar Panel-Residential Expiration Date: 01/12/2017 Contractor Name: EMMANUEL T MELLO Location: 95OXFORD DRIVE,COTUIT Est Project Cost: $8,008.00 Contractor License: CS-065607' Owner on Record: AHLIN,JACK T Permit Feed $90.84 Address: 95 OXFORD DR Fee Paid $0.00 y .._.. .. COTUIT, MA 02635 Date- Description: install roof mount photovoltaic solar p system with 1A-panels and 3.64 kW Y" please be advised that this is to replace the incorrect permitting of TB-16-1535 whichhas'already been paid for in they 7 =- r. (,J o amount of$90.84 - - Project Review Req : install roof mount photovoltaic solar system with T4 panels and 3 64 kW < please be advised that this is to replace.the incorrect permitt ng of TB 16 1535 which has already been paid for in the amount of$90.844 d Building Official o - S a6 This permit shall be deemed abandoned and invalid unless the work a'uthonzecJ by tis permit is commenced within six months after issuance. All work authorized by this permit shall conform.to the approved application and the approved construction documents for whicth-is permit has been granted. All construction,alterations and changes of use of any building and strudtures sMII be incompliance with the local zon g by laws and codes. This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open foryp(iblic inspection for the entire duration of the work until the completion of the same. r � � The Certificate of Occupancy will not be issued until all applicable signatures by_the Bu Id ng$and Fire Officials are provided on thi permit. Minimum of Five Call Inspections Required for All Construction Work' 1.Foundation or Footing t ' R 2.Sheathing Inspection r �. _ - 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed r<a. 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy 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. N �I£ "Persons contracting with unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). 64T— Building.plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 4y�GF � 1'O Application Number.............. .......... ..........:.......... y ass.MASS. � Permit Fee........ ... �.. cr Fee........................ 1639• ♦0 TotalFee Paid..........................................:.................... ...... TOWN OF BARNSTABLE F Permit Approval by...... ... ..D......... BUILDING PERMIT . �} Map.......... :. ..............Parcel....... APPLICATION Section 1 —Owner's Information and Project Location Proj ect Address Village C o -}- Owners Name -- -M a T G. BUILDING DEPT. Owners Legal Address r� TOWN OF BARNS,TABLE city_C, State Zip a Owners Cell# I� E-mail YY1 ���� ` a®a (nl,J l C Section 2— Structural Use �ingle/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3 -Type of Permit ❑ New Construction ❑ Move%Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System F]VRe'novation. Adition _....__.. __.W.._._ . ❑._._Retauung wall - .---❑ ._Solar------ ❑ Pool ❑ Insulation Other-Specify Section 4 - Work Description F c Z Si Ano . Y c`Czt� i C 6i /ut}w A-)A-3 VAS l i(c S TD l l.c--JT i vOT P A /2�� (A.) UN Ck A x) t= k a l"s o I N G L c��c`S /� S iV�[.c�4-r�W y nJ `(-, sr t . TactnnAateA• 17/)R/)(117 Application Number...................................................... s Section 5—Detail Cost of Proposed Construction 37 77.E D Square Footage of Project Age of Structure l 9 o Dig Safe Number l fl Total# Of Bedrooms (proposed) #Of Bedrooms Existing (P p ) 11-0-MPH_—W--indZone_Compliance Method I-1 MA Checklist ❑ WFCM Checklist ❑ Design _/L__/M - j- i Section 6— Project Specifics I . Wiring ❑ Oil Tank Storage ❑ Smoke Detectors Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Suppler Public El Private - Disposal ❑ Municipal On Site Sewage p . Historic District ❑ Hyannis Historic District, ❑ Old Kings Highway Debris Disposal Facility: P!NR �1 5 PAS '� i— I am using a crane ❑ Yes�No Section 7—Flood Zone Flood Zone Designation ,1U6 Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8— Zoning Information Zoning District ProposedUse Lot Area Sq. Ft. �� A C.&% Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed f from the Zoning Board in the past? El Yes No Has this property had retie $ �r I ST t,�G k-A IED . 60 . y t v � -- 36 x-34 4A LL W" CCU I) ` 'E.r✓ineered Home Solutions, Inc. s� ; 4 Wolf Hill 4 E. Sandwich, MA 02537 508-274-7553 jsuomala@comcast.net ESTIMATE ADDRESS ESTIMATE# 1070 Marian Godwin DATE 01/25/2018 95 Oxford Dr Cotuit, MA 917-697-4346 PROJECT DESCRIPTION: k KITCHEN UPGRADE ACTIVITY ACTIVITY h 03 KITCHEN RENOVATION ($9,072) 01.2 Building Permits Building Permits * Building permit application and all inspections to be completed by contractor. Permit fees ar NOT included in proposal and are to be paid by customer upon final invoicing. MASK HARDWOOD Installation of rhino hard cardboard floor protection over newly finished pine flooring as well as stairs to second floor bath. Tearout Kitchen Faucet, Sink,Cap Tearout and dispose of kitchen sink,faucet and cap water lines arid waste line Lines Services Relocate stove to living room for duration of project Services Break-up and remove granite countertops below upper cabinets as well as island,and clean adhesive from top of cabinets Tearout Drywall With Tile Cut and remove drywall with tile along backsplash between upper and lower cabinets. Drywall Installation of new 1/2"drywall on walls between upper and lower cabinets Services Fabricate and install new quartz countertops using Ceassaestone"London Sky"including one (1)single bowl undermount stainless steel sink#1823 ($2800 allow) Services Fabricate and install custom brushed stainless steel countertop with wooden core on island cabinets ($1400 allow) Services Tiling of backsplash using customer supplied stainless steel the and grout (32sf) .l Kitchen Sink&Faucet Basic labor and materials to connect dishwasher, sink, and install customer supplied faucet. Connect supply lines between existing shut off valves and faucet. Leak and flow test. Price does NOT include new supply shut-off valves Services Reinstallation of stove upon completion DEBRIS Removal of all debris from job site upon completion.($500) ITY ACTIVITY., FIRST FLOOR BATHROOM RENOVATIONS ($ 905) NOTE: WIRING ADDITIONS AND/OR MODIFICATIONS BY OTHERS AND IS NOT INCLUDED IN THIS PROPOSAL. REGLAZING OF TUB TO BE DONE BY OTHERS UPON COMPLETION OF THIS PROJECT AND IS NOT INCLUDED IN THIS PROPOSAL. Toilet Tearout Tearout and discard toilet Services Remove/discard wall mirror Tearout Formica Countertops Tearout and dispose of Formica countertops and sink. Cap water supplies and drain Tearout Vanity Tearout 60"vanity and discard . Remove Base Trim Removal of base trim around perimeter of room as well as baseboard heat covers Services Remove doors from hinges and save. Tear-out and dispose of door trim inside of room Services . Remove window trim. Tear-out of all drywall on window wall as well as surrounding fiberglass tub unit Services Remove shower valve trim and drain. Cut-up and remove fiberglass . tub/shower down to framing of structure Tear-out vinyl floor Cut and remove vinyl flooring and underlayment down to original subflooring of structure Installation Of 5/8"Plywood Cut and install 5/8" ULC plywood underlayment over entire floor, nailed every Underlayment 4"using ring nails,cutting to fit as needed (sf) Sterling 4pc Tub&Surround Purchase and installation of Sterling 4pc tub/surround ($700 allowance), including reconfiguration of drains, new overflow kit, leveling and mounting to walls Drywall Installation of new 1/2"moisture resistant drywall on window wall and around new tub as needed to blend . Painting by others. Install 60"vanity of choice Purchase and installation of one(1) 60"Dura-Supreme vanity of choice ($1200 allow). Contractor to install knobs and pulls provided by customer. ,granite Fabricate and install custom granite 60"countertop for vanity($1100 allow) Installation Of Ceramic Tile Labor and materials to install ceramic the flooring over entire floor surface(52 Flooring sf),color and style of choice. ($300 material all Replace baseboard heat with new Labor and materials to tear-out existing heat register covers, and install new Slant-fin heat register covers Toilet Purchase and installation of 2pc high boy toilet,elongated bowl,soft-close seat ($330 material allowance). Pricing does not include new shut-off supply valve. Tub/Shower Valve Purchase and installation of Symmons tub/shower valve with standard shower 'head, chrome ($200 allowance). Costs to reconfigure supply lines in wall not included Vanity Sink& Faucet Plumbing and installation of new vessel sink($350 allow)and faucet($350 allow) of choice: Includes new stop valves and drain. Does NOT include relocation of services in wall cavity Interior Door Casing Cut and install primed 2-1/2"Colonial door casings on inside of both doors in room. Filling of nail holes'and painting by others. Base Trim(primed 3-1/2"Primed) Cut an_d install primed 3-1/2"primed Colonial base trim around perimeter of room. Two nails per stud, and all inside corners coped to fit. Filling of nail holes and painting by others 05 SECOND FLOOR BATHROOM RENOVATIONS($16,273) VIT qC IVITY Y NOTE: WIRING ADDITIONS AND/OR MODIFICATIONS BY OTHERS AND IS NOT INCLUDED IN THIS PROPOSAL. Toilet Tearout Tearout and discard toilet Services Remove and discard wall mirror Tearout Formica Countertops Tearout and dispose of Formica countertop. Cap water supplies and drain Tearout Vanity Tearout 60"vanity and discard Services Remove window trim and save for re-use Remove Base Trim Removal of base trim around perimeter of room as well as heat register covers Services Cut and remove drywall behind vanity as needed to expose plumbing to convert to double sinks. Cut and remove drywall on entire window wall to enable new tub/shower installation. Services Remove door from hinges and save. Tear-out and dispose of door trim inside of room Tearout Tub(fiberglass With Cut and remove drywall around perimeter of tub. Remove shower valve trim Surround) and drain.• Cut-up and remove fiberglass tub down to framing of structure. Tear-out vinyl floor Cut and remove vinyl flooring and underlayment down to original subflooring of structure Installation Of 5/8" Plywood Cut and install 5/8" ULC, nailed every 4" using ring nails, cutting to fit as Underlayment needed Services Reconfigure supply and drain plumbing in wall for twin vessel sinks Services Purchase and installation of new shower/tub valve of choice ($350 allow) Sterling 4pc Tub&Surround Purchase and installation of Sterling 4pc tub/surround ($700 allowance), including reconfiguration of drains, new overflow kit, leveling and mounting to walls Drywall Installation of new 1/2"moisture resistant drywall as needed to blend. Painting by others. Install 60"vanity of choice Purchase and installation of one (1) 60" Dura-Supreme floating vanity of choice ($1500 allow). Contractor to install knobs and pulls provided by customer. -Granite Countertop 60" Fabricate and install custom granite 60"countertop for vanity, drilled for twin vessel sinks ($1200 allow) Installation Of Ceramic Tile Labor and materials to install ceramic the flooring over entire floor surface (54 Flooring sf), color and style of choice. ($300 material allowance) Replace baseboard heat with new Labor and materials to tear--out existing heat register covers,and install new Slant-fin heat register covers Toilet Purchase and installation of 2pc high boy toilet,elongated bowl, soft-close seat ($330 material allowance). Pricing does not include new shut-off supply valve or hose Vanity Sink& Faucet Purchase and installation of two (2) vessel.sinks ($700 allow) and two (2) lav faucets ($700 allow) of choice. Includes new stop valves and drain connection. Interior Door Casing Labor and materials to trim-out one side of interior door using primed 2-1/2" Colonial casing. Filling of nail holes and painting by others. Services Re-installation of existing window trim Base Trim (primed 3-1/2" Primed) Cut and install primed 3-1/2" primed Colonial base trim around perimeter of room. Two nails per stud, and all inside corners coped to fit. Filling of nail holes and painting by others Services Installation of customer supplied wall mirror, and towel bar accessories• 'TES: TOTAL $37,750.00 j Contract does not include costs to repair unforseen decay or poor workmanship l 2)Contract does not include permit fees,wiring costs,paint prep,or painting upon completion 3)Project timeline:4-5 weeks 4)Payment schedule:1/3 at acceptance,1/3 after drywall,balance upon completion. 5)Debris container to remain on-site throughout project Accepted By Accepted Date cam; f tSffice of ConsumeMX r Affairs&Business RegulafrF HOME:IMPROVEMENT CONTRACTOR " %} Registration T60825 ` Expiration '8l26/2018 TYhe Y ' p nvate'Corporal : ENGINEERED HOMESOLUTIONS INC. rJOHN SUONWLq 4 WOLF WILL E SANDWICH,MA 02537 _ Undersecretary-7777777774 License or registration valid for individual use only.':A before the expiration date: If found return,to: Office of Consumer Affairs and Business Regulation ` $h 10;,P,ark Plaza.Suite_.5170 Boston,MA 02116 gp of valid rtho t signatures 9 Massachusetts Department of Public Safety B. oar&of Building.Regufations and Standards .`t License: CS-082T12:;' a Construction Supervisor e 4 JOHN E SUOMALA 4 WOLF HILL EAST SANDWICH MAk 0253i' Expiration. M • Commissioner _. � 0921/2 . The Commonwealth of Massachusetts Department of IndustrialAccidents MW Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insuranee Affidavit:Builders/Contractors/Electrieians/PImnbers Applicant Information PIea.se Print Legibly Name(Bugness/organization4ndmdud): A- 8-ICJr �t`z�Lt=� yh� caC-cam 1 c 'S c. - Address: City/Sta#e/Zip: 5.A C.l-L Are you an employer?Check the appropriate box: Type of project re e am a to ea with 4. 0 I am a general contractor and I Y have hired the sib-contractors 6. ❑Now constrr�ction employees(full and/or part-time).* 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, 0 Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp.insurance comp.insurance.: 5. [] We are a corporation and its 10.0 Electrical repairs or additions regTutied]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 *Airy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy inormation. t Homeowners who submit this affidavit indicating they are doing all work and them hire outside contractors must submit a new affidavit indicating such xContractors that check this box must attached an additional sbeet showing the name of the sub-contractors and state vybcther 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 the polfcy and job site information: hisu aace Company Name: l9 &Z Cyr 4112D i,�jLNNO t, t L Policy#or Self-ins.Lic. AViraiion Date: Job Site Address: � k Pou n2_ City/StaWZip: C uy-L)e r- /t-t4 CJ� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required Tinder Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one-year imprisomnent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$150.00 a day against the violator. Be advised that a copy of this statement may be forwarded to time Office of Investigations.of the DIA for insurance covcAe verification. I do hereby certify under p ' and p of perjury that the information provided above is true and torrent Si atrre: Date. zv Phone#: 'v 02r7S' Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: Application Number........................................... Section 9- Construction Supervisor Name TUNS S L)OI`*L-0 Telephone Number -� 74`- T? S 2 Address -�f G�zx� }1it.c.. City 6• SAS-. jeQ-i State MA Zip OAS 3� un12N sT�Grp License Number License Type Expiration Date L, 1 aO( P Contractors Email 4 VO L Q- 02H G4S� —Cell# _5-Z;'-9��9� ��s I understand my responsibilities under the rule d regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Co understand the construction inspection procedures;specific inspections and documentation required by 0 CMR and own of Barnstable.Attach a copy of your license. Signature Date ,4511C P Section 10-Home Improvement Contractor Name -TOl j,`J Telephone Number _)-74�, 7 Address C,.)Otr- City 36�_6 L_)(Cl, State Zip OAS-3`? Registration Number(o 0 a-5-- Expiration Date G 8 I understand my responsibilities under the rules and ulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I der and the construction inspection procedures,specific inspections and documentation required by 780 and the T of Barnstable.Attach a copy of your H.I.C... Signature Date 1/z2 f, Section 11 -Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLI NT SIGNATURE Signature Date o2 / Print Name �"dh y �v0 l-j A [ A Telephone Number �u&—a27,i_ ?5 s E-mail permit to: __-T- S L)om A Cam-- C®M CA-S%• A287— Last updated: 12/28/2017 1 Section 12—Department Sign-Offs K� Health Department ❑ Zoning Board(if required) El 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 I G®d w�� as Owner of the subject roe hereby (��.� '> J property rtY Y authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: 95— O X F o _01�_ CoT U i T— MA (Address of job) Signature of Owner date Print Name { T.ast undated: 12/29/2017 r� t � Application number. Fee .................................................. ..... .... .. BARMAMYLL Building Inspectors Initials........... ... ....... ........... SEP 2 0 2018 date Issued................. .. . .�.. .... ...................... TMA 0� bARNSIMLEMap/Parcel... ... . �—../................. TOWN OF BARNSTABLE 5• EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: Opx, o�� ER STREET VILLAGE Owner's Name: V 7> Phone Number ci 1- — 9 5t — q 3 qL Email Address: Cell Phone Number Project cost$ '�, 5 6 Check one Residential �Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize f to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ED Siding Q Windows( change)no header # E-1 Insulation/Weatherization � DD ors (no header change)# Commercial Doors require an inspector's review E Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# 1 57 15 , (attach copy) Construction Supervisor's License# °� �� (attach copy) Email of Contractor ZAP �j-5 3 Phone number a s�' • L 2 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER `t *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X , X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date Oj' 21) All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts G9 Department of IndustrialAccidents Wr Office of Investigations 600 Washington Street Boston,MA 02111 -' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): w1 /`+ Address: _ .. City/State/Zip: �'�-v7tit z Phone#: o 5> Are you an employer?Check the appropriate box: Type of project(required): 1I am a employer with 4. ❑ I am a general contractor.and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 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'many capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance. # required.] 5.❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL ' 12. 00f repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' . 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all.work and then hire outside contractors must submit a new affidavit indicating such. #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: Ndt,�7 r Policy#or Self-ins.Lic.#: 1Q w C y via :10 -Z 5!� Z y -ZO 1? Expiration Date: � =� 3 ���j► Job Site Address: �'�� City/State/Zip: C �O ?w i Z Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). . Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: �Z '� —P Date: Phone#: S Z Z L� f Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state-or locallicensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings'inthe commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall _ enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone.and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations 600 Washington.Street Boston,MA 42111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 vrww.mass.gov/dia ROOFING PROPOSAL Hamel Roofing R.J..,Hamel PO Box 543 Cataumet, MA 02534 (508)'563-6092 CS SL 98778 HIC 115971 t i Marian Godwin 917-697-4346 19/20/2018 95 Oxford Dr Cotuit, MA In response to inspection report We hereby submit specifications and estimates for: Front of house only Strip approximately 750 square feet of roofing and apply ice &water barrier along first three feet of bare roof deck and under all flashing. Remove and replace two skylight flashing kits.Apply roofing underlayment to rest of bare roof deck.Apply 8" white drip edge along rake boards. Remove and replace vent flange on back. Roof, using GAF Timberline lifetime warranty, algae resistant roof shingles. Install ridge vent. Remove all debris from job site. J ' We Propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: Five Thousand Five Hundred Dollars ($5,500) . Payment to be made as follows: $2,750 in advance, and $2,750 upon completion All material is guaranteed to be as specified.All work to be completed in a workmanlike _ manner according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra �— charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry necessary insurance.Our workers are fatty covered by Workman's Compensation Insurance. Authorized Signature Acceptance of Proposal—The above prices,specifications Note:This proposal may be withdrawn by us if not accepted within and conditions are satisfactory and are hereby accepted.You are authorized to do the S work as specified.Payment will be made as outlined above. - 90 days. �✓ Date of Acceptance: Signature Signature _� DATE(MMIDD/YYYY) ACcwZ CERTIFICATE OF LIABILITY INSURANCE 05/08/2018' THISCRTIFICATE 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 PO LICIES 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). CONTACT Rosemarie Gillard PRODUCER NAME: EASTERN INSURANCE GROUP LLC -ACC N Exti' (78.1)261-2023 Fnc No): E?dAIL ADDRESS;, g111ard@easlerriinsurance.com 233 WEST CENTRAL ST INSURER(S)AFFORDING COVERAGE NAIC# NATICK MA 01760 INSURERA: AIM MUTUAL INS CO 33758 INSURED} INSURERB: -- -• ROBERT HAMEL INSURER.C: HAMEL ROOFING INSURERD: -- P 0 BOX 543 74 DEPOT ROAD CATALIMET MA 02534 IN.sU.RERF: COVERAGES CERTIFICATE NUMBER: 266596 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 ADOL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE I POLICY NUMBER MMIDDIYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I$ _ DAMAGET�RENTED ..CLAIMS-MADE D OCCUR PREMISES(Ea occurrence)_ $ .----._..._. MED EXP(Any one person) $ NIA PERSONAL 8 ADV INJURY $ w- GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER POLICY❑JPLRGOT LOC PRODUCTS-COMP/OP AGG S O'rHEt;: CCMBINEGSINGLE.LIMIT $ AUTOMOBILE LIABILITY E.acids.1 -.._...�, BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED 1P'E:accidenll' ( - HIRED AUTOS AUTOS fl , UMBRELLA LIAB OCCUR EACH OCCURRENCE._._ $ __ i EXCESS CLAIMS-MADE NIA AGGREGATE 1 DED -- t RETENTION$ �/ I$ WORKERS COMPENSATION /�I STA UTE I ERH AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ 500,000 ANYPROPRIETOR/PARTNER/EXECLMVE NIA WA NIA AWC40070259242018A 05/1312018 05/13/2019 - A OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE_$ 500,000 (Mandatory In NH) � If yes,describe under E.L.DISEASE-POLICY LIMIT s 500,000 DESCRIPTION OF OPERATIONS below - N/A Additional Remarks Schedule,maybe attached If more space Is required) DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the Issue date of this certificate of insurance), The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov4wd/workers-compensation/investigations/ Sole proprietor has not elected coverage. CERTIFICATE HOLDER. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable Building Dept 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02061 Daniel M.Crow)ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD achusetts,Department of Public Safety. ® Board of Build ng Regulations and Standards L iceffse""'CSS -098778 Construction Supdryisor Specialty i ROBERT J HA EL 74 DEPOT ROAD BOX 543� CATAUMET MA 02534 Expiration: Commissioher 05/06/2019 .��e �o�nnaofuurretc 1 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR T�1 Ealndividual e ist lot— Expi�n 1 05/03/2020 l - �ntlr ROBERT HAM i y D/B/A HAMEL U. G 1 4r ROBERT J.HAMEL - �retarV74 bEPOT RD CATAUMET,MA 02534 Undersec �4 _ l � construction Supervisor Specialty --� Restricted to: CSSL-RF-Roofing CSSL-WS-Windows and Siding ` Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. h DPS Licensing information visit: WWW.MASS.GOV/DPS Registration valid for individual use ON. before the expiration date. If found return o; Office of Consumer Affairs and Business Regulation �,•.:. One Ashburton Place-Suite 1301 S BOSt0`n,MA.02108 I Not valid Without 6119nature - l