HomeMy WebLinkAbout0196 POPONESSETT ROAD / . .__
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P,Op(HE,pw4 The Town of Barnstable
BARNSTABLE. Department of Health Safety and Environmental Services
MASS. a
9Q s639. �00
opjEO MPyA Building Division
367 Main Street,Hyannis, MA 02601 µt
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice
Type of Inspection )
Location q (0 '�'OQ6M PA*"RA Permit Number ` 1 ,,s tz
Owner Builder '1 A)rj-;kAG
One notice to remain on job site, one notice on file in Building Department.
The following items need correcting:
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Please call: 508-862-4038 for re-inspection.
Inspected by
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Date i
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` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
tV7 .v
Map Parcel Permit#
XHealth Division �/�l— 011 /�M-/T C7� Date Issued
71
Conservation Division QIA Feei ���
Tax Collector Pof ' I�b� v - ,
�.,. d pr o i U iT BE
Treasurer /U/107TU INSTALLED IN COMPLIANCE
a
Planning Dept. ENYIRQ
A An
Date Definitive Plan Approved by Planning Board '
Historic-OKH Preservation/Hyannis w .
Project Street Address
Village i
Owner o el-- Address
Telephone
a
Permit Request 12 Z 7 el / roe al
Square feet: 1 st floor: existing proposed� 2nd floor:existing 163D proposed Total new
Estimated Project Cost 00 a Zoning District '��� Flood Plain G Groundwater Overlay
Construction Type 1'✓e0A 'Cr."y P �.
Lot Size 2�5:/ Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family , Two'Family ❑' Multi-Family(#units)
Age of Existing Structure `SZ ���Historic House: ❑Yes JA No On Old King's Highway: ❑Yes ,&No
Basement Type: /0 Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.)—d Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing Z new Half: existing O new 42?
Number of Bedrooms:- existing 3 new r�
Total Room Count(not including baths): existing new 2 First Floor Room Count
•
Heat Type and Fuel: /k1l Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes )No Fireplaces: Existing �'o New 6*s Existing wood/coal stove: .❑Yes Flo
Detached garage:0 existing Cl new size "4 Pool:❑existing ❑new size �� Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use'
-BUILDER INFORMATION
Name //, �Cri�f' �� Telephone Number
Address _5— 4�wt 's ,�'� License# O 2 Z s 2 2
<62zeef 4G 4' u y Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t-JS eg 4/%5 f�
�✓ir
SIGNATURE_ DATE _ D�
FOR OFFICIAL USE ONLY -
PE -MIT NO. 4415 ..
>;• TE ISSUED
MAP/PARCEL NO. ,
ADDRESS' VILLAGE
OWNER
DATE OF INSPECTIOIN:
FOUNDATION 2,-2- 00 � �� ✓� ,
FRAME V
INSULATION -
R •
FIREPLACE
ELECTRICAL: ROUGH FINAL t
PLUMBING: ROUGH In FINAL
.r p
GAS: ROUGIt FINAL s
s
FINAL BUILDING rnn Wit - f }
DATE CLOSED OUT
ASSOCIATION PLAN NO.
m
I
MAScheck COMPLIANCE REPORT I_ I
Massachusetts Energy Code I Permit # I
MAScheck Software Version 2.01 Release 3 I I
I
I Checked by/Date I
I
TITLE: FARRINGTON BLDG. AND REMODEL.
CITY: Barnstable
STATE: Massachusetts
HDD: 6137
CONSTRUCTION TYPE: l or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non-Electric Resistance)
DATE: 6-5-2000
DATE OF PLANS: 6/5/2000
PROJECT INFORMATION: .
196 POPONESSETT
COTUIT R
COMPANY INFORMATION:
M.A.P. INSULATION CO.
COMPLIANCE: Passes
Maximum UA = 165
Your Home = 165
Area or Cavity Cont. Glazing/Door
i Perimeter R-Value R-Value U-Value UA
---------------
CEILINGS 650 30.0 0.0 23
WALLS: Wood Frame, 16" O.C. 800 13 .0 0.0 66
GLAZING: Windows or Doors 83 0.500 42
GLAZING: Skylights 8 0.500 4
DOORS 32 0.350 11
FLOORS: Over Unconditioned Space 400 19.0 0.0 19
HVAC EQUIPMENT: Furnace, 85.0 AFUE
-------------------------------------------------------------------------------
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 requirements of the Massachusetts Energy Code.
The heating load for this building, and the cooling load if appropriate,
has been determined using the applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat or cool the building
shall be no greater than 125% of the design load as specified in
Sections 780CMR 1310 and J4.4.
Builder/Designer Date
iw
TITLE: FARRINGTON BLDG. AND REMODEL.
MAScheck INSPECTION CHECKLIST
Massachusetts Energy Code
MAScheck Software Version 2.01 Release 3
DATE: 6-5-2000
Bldg. 1
Dept. 1
Use I
I
CEILINGS:
[ l I 1. R-30
Comments/Location
I WALLS:
[ ] I 1. Wood Frame, 16" O.C. , R-13
Comments/Location
I
I 'WINDOWS AND GLASS DOORS:
[ l I 1. U-value: 0.5
I For windows without labeled U-values, describe features:
I # Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments/Location
I SKYLIGHTS:
[ ] I 1. U-value: 0.5
I For skylights without labeled U-values, describe features:
I # Panes Frame Type Thermal Break? [ ] Yes [ ] No
I
Comments/Location
I DOORS:
[ ) I 1. U-value: 0.35
Comments/Location
I FLOORS:
[ ] I 1. Over Unconditioned Space, R-19
Comments/Location
I HVAC EQUIPMENT:
[ ] I 1. Furnace, 85.0 AFUE or higher
I Make and Model Number
I
I AIR LEAKAGE:
[ ] I Joints, penetrations, and all other such openings in the building
I envelope that are sources of air leakage must be sealed. When
I installed in the building envelope, recessed lighting fixtures
I shall meet one of the following requirements:
I 1. Type IC rated, manufactured with no penetrations between the
I inside of the recessed fixture and ceiling cavity and sealed or
I gasketed to prevent air leakage into the unconditioned space.
I 2. Type IC rated, in accordance with Standard ASTM E 283, with no
I more than 2.0 cfm (0.944 L/s) air movement from the the
I conditioned space to the ceiling cavity. The lighting fixture.
I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure
I difference and shall be labeled.
I
I VAPOR RETARDER:
[ ] I Required on the warm-in-winter side of all non-vented framed
I ceilings, walls, and floors.
ti
,r
I MATERIALS IDENTIFICATION:
[ ] I Materials and equipment must be identified so that compliance can
I be determined. Manufacturer manuals for all installed heating
I and cooling equipment and service water heating equipment must be
I provided. Insulation R-values, glazing U-values, and heating.
I equipment efficiency must be clearly marked on the building plans
I or specifications.
I DUCT INSULATION:
[ ) I Ducts shall be insulated per ,Table J4.4.7.1.
DUCT CONSTRUCTION:
[ ) I All accessible joints, seams, and connections of supply and return
I ductwork located outside conditioned space, including stud bays or
I joist cavities/spaces used to transport air, shall be sealed
I using mastic and fibrous backing tape installed according to the
I manufacturer's installation instructions. Mesh tape may be
I omitted where gaps are less than 1/8 inch. Duct tape is not
I permitted. The HVAC system must provide a means for balancing
I air and water systems.
I TEMPERATURE CONTROLS:
[ ] I Thermostats are required for each separate HVAC system. A manual
I or automatic means to partially restrict or shut off the heating
I and/or cooling input to each zone or floor shall be provided.
I HVAC EQUIPMENT SIZING:
[ ] I Rated output capacity of the heating/cooling system is
I not greater than 125% of the design load as specified
I in Sections 780CMR 1310 and J4.4.
I SWIMMING POOLS:
[ ) I All heated swimming pools must have an on/off heater switch and
I require a cover unless over 20% of the heating energy is from
I non-depletable sources. Pool pumps require a time clock.
I
I HVAC PIPING INSULATION:
[ ] I HVAC piping conveying fluids above 120 F or chilled fluids
I below 55 F must be insulated to the following levels (in. ) :
PIPE SIZES (in. )
I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4"
Low pressure/temp. 201-250 1.0 1.5 1.5 2.0
I Low temperature 120-200 0.5 1.0 1.0 1.5
I Steam condensate any 1.0 1.0 1.5 2.0
I COOLING SYSTEMS:
I Chilled water or 40-55 0.5 0.5 0.75 1.0
I refrigerant below 40 1.0 1.0 1.5 1.5
I CIRCULATING HOT WATER SYSTEMS:
[ ] I Insulate circulating hot water pipes to the following levels (in. ) :
PIPE SIZES (in. )
1 NON-CIRCULATING • I CIRCULATING MAINS & RUNOUTS
HEATED WATER TEMP (F) : RUNOUTS 0-l" 1 0-1.25" 1.5-2.0" 2.0+"
170-180 0.5 1 1.0 1.5 2.0
I 140-160 0.5 1 0.5 1.0 1.5
100-130 0.5 1 0.5 0.5 1.0
----NOTES TO FIELD (Building Department Use Only) -------------------------
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oFTME� .
The Town of Barnstable
t� Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 t rl �( Ralph Crossen
Fax: 508-790-6230 ��~� � J—' Building Commissioner
PLAN REVIEW
Owner: �� Map/Parcel: 019
Project Address: o(o p6bon-f�s-e.Tj'
Builder: W, FA4?qJ
fR
The following items were noted on reviewing:
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Please call 508 862-4038 for re-inspection.
Inspected by:
Date: v'" `�'
q:building:fonns:review
`pptHElp� The Town of Barnstable
BAR ASS. C' P. • Department of Health Safety and Environmental Services
MASS.
plE M10 Building Division -
367 Main Street,Hyannis,MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Inspection Correction Notice
( !
Type of Inspection C)
Location 1.9 6 ��PPa 0
Permit Number x'
Owner Builder 1 k(2P 1pj ODIC
One notice to remain on job site, one notice on file in Building Department.
The following items need correcting:
r� l
Eve -�-- ;
CC
l
Please call: 508-862-4038 for re-inspection.
Inspected by ���
Date b ' Z dZ)
The Commonwealth of Massachusetts
Q�,'' Department o Industrial Accidents
A : _-� OJ�ce of/�restigations
._ 600 Washington Street
Boston,Mass. 02111
Workers' Compensation Insurance davit
name: /ors r
location ��{ To'✓/� ®�
city " hone#
❑ I am a hofneowner performing all work myself.
I am a sole proorietor and have no one woridng in auv acity
for my
1
working on this ob
workers ensauon g
rov1 oy� J
em Iover �P
I am an �P
company name. ,� ` :;..cf ..
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ad dress
cites try
►asurance co. -sue` "` go
WN
❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who
have
the followingworkers' compensation polices:
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address � ;:.:;.;::• :<>•:>::;::.::><;<:>;>:
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city r-�
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a v name•
c n amp
address "r '
phone#:
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Fanare to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.Q0 and/or
one year,,imprisonment as well as dvil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the 01fice of Investigations of the DIA for coverage verification.
1 do hereby certify the parrs end penalties of perjury than the information provided above is true correct
Signat�e Date 1-e:v
Print name q Phone#
o
fficialnly. do not write in this area to be completed by city or town otHcial
town: permit/llcense# ❑Building Department
❑Licensing Board
mmediate response is required ❑Selectmen's Ofte❑Health Departmenton• phone#; - ❑Other.
(mvued 9/95 P1A)
Tab1eJS22b(
- Prpa ipd v P2ckz s for dae and Two-Faady Raatde mW Baildtap AesW with Fond Fndn
MAXIMUM ME NIMUM
�8 Q1 CeiUm Wall HOW g� z1b H�ias�Cooiiag
Anal(K) Uwalutr Rwaiusl B-Who, Revalue! WaII Pa* 'r F3na=cy'
�� Revalrte� &valra:r
5"1 to 6500 HeadmR Drum Dais'
Q IZ". 0.40. 1 31 13 19 10 6 No=si
R 12!S 0.32 30 19 19 1 10 6 No ai
S 1IZ!S 0 o 31 13 19 10 6 13 AFUE
T 13% 436 31 13 2S WA WA Normal
U 15% OA6 31 19 19 10 6 Normai i
1/ YG44 j �s 1: ivA MIA 25 AFUE I
W 13X 4SZ 30 19 1 19 10 6 iSAFUE 1
X IVle 1 432 1 31 13 25 WA WA Normal
Y IS*/. 1 (L42----F 31 (I 19 Zt WA WA Normai
Z IVI- 0.42 31 13 19 10 6 90AFUE I
AA ISOK 0.10 30 19 19 10 6 90 AFUE
1. ADDRESS OF PROPERTY. d
Z SQUARE FOOTAGE OF ALL IDCTERIOR WALLS:
3. SQUARE FOOTAGE OF ALL GLAZING.
c
4. %GLAZING ARE.4,(#3 DIVIDED BY#2):
S. SELECT PACKAGE(Q —AA-set:4chart above):
NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS
ARE AVAILABLE. ASK US FOR THIS INFORMATION.
BUILDING INSPECTOR APPROVAL:
YES: NO:
q-Corms-090303a
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°F VE A
• '11, The Town of Barnstable
BAMSTABa Department of Health Safety and Environmental Services
rEc r�'t Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no.
Date r
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building.be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: %T�d 4z�
Estimated Cost �d
Address of Work:
Owner's Name: Xo�e f
Date of Application: ®�
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded bylaw .
❑Job Under$1,000
❑Building not owner-occupied
[]Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
ate Contractor Name Registration No.
OR
a
Date Owner's Name
q:forms:Affidav
r
ESTIMATED PROJECT.COST WORKSHEET
Value
LIVING SPACE 4 square feet X $55/sq. foot
GARAGE (UNFINISHED) square feet X $25/sq. foot=
PORCH /00 square feet X $20/sq. foot= 00
DECK /lam Z square feet X $15/sq. foot= 3110
OTHER square feet X $??/sq. foot=
Total Estimated Project Cost D
g990915b
_ _.�� �anvnw�uura�i d�-�aavac�uaetta
_ BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number CS 061665
a
_.
tr Expires 07/01/2001 Tr.no: 929
- Restricted To: 00
WILLIAM E FARRINGTON
54 JONAS DR (•'�•»°
MASHPEE, MA 02649 Administrator
0 �io��naruuealda a�✓�aaaac%uaella
HOME IMPROVEMENT CONTRACTOR
<Registration 115356
Type - _D8A .
Expiration 02/10/00
WILLIAM FARRINGTON BUILDING I
WILLIAM E. FARRINGTON
4(t°'"ao & �ILANN RD
an�niNisnTOR :MASHPEE MA 02649
° ri
Engineering Dept. (3rd floor) Map &19 - Parcel Permit# S
House# 9 JS Date Issued -2
Board of Health'(3rd floor)(8:15 -9:30/1:00-4:30) - Fee _ 0?
Conservation Office(4th floor)(8:30-9:30/1:00-2:00) G�
Planning Dept. (1st floor/School Admin. Bldg.) INE
Definitiv5ress
ming Board 19 ;
KARMA ARLE.
059.
TOWN OF'BARNSTABLE
wilding Permit Application
Project S �. (D-caftZ �a
,
Village '
� a C
Owner ' Address , � '
Telephone
;Permit Request �p �. �� Z k
.First Floor square feet Second Floor 7 square feet
Construction Type
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No. of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
Na Telephone Number
Addre s Q License#
Home Improvement Contractor
#
Worker's Compensation : Gr. l 70a(� o�
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATUR DATE
BUILDING PERMIT DENIED #OR THE FOLLOWING REASON(S)
Ghaz_
` I � Q
. FOR OFFICIAL USE ONLY
At-
PERMIT NO. 3 � 3 15 E. G
DATE ISSUEDy —
MAP/PARCEL NO. �` {
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• ,. ' ♦. .. r 5 •. ♦ < -' '' L r .. t `.' S S yam'♦.:��
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n
ADDRESS' 4 _ i VILLAGE-',"
e
OWNER
DATE OF INSPECTION: T
FOUNDATION
FRAME
INSULATION
FIREPLACE
E LECTRICAL: . ROUGH '—♦
FINAL , c
PLUMBING: ROUGH 4 I r FINAL
GAS: ROUGH i FINAL
£ P f
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO. 5 5
The Town of Barnstable
K. P Department of Health Safety and Environmental ernces
°'g' ,e Building Division
367 Main Street,Hyannis MA 02601
Office: 508 790-6227 Ralph Ctossrn
Faac 508 775-3344 Building Commission
For office use only '
permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c 142A inquires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,temo%mL demolition. or construction of an addition to any pre-existing owner occupied
building containing at least one but not more than four dwelling units or to saztcm=which are adjacent
to such residence or building be done by registered contractors,with certain cwcptions, along with other
requirements-
Type of Work: Cost
Address of Work: Old
O%mer.Name- n .
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):-
Work colluded by law
Job under SI,000
Building not owner-occupied
ownerpullingownpam#
1
Notice is hereby given that: COrTTRACMRS
OWNERS PULLING THEIR OWN PERMIT OR DEALING WiTHt7NREGI3'1'�
FOR APPLICABLE HOME WROVENOgT WORK DO NOT HAVE -ACCESS TO THE
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply fora permit as the agent of the owner: �p
Contractor ream' Registration No.
Date
OR
acoRa CERTIFICATE OF LIABILITY INSURANCECSR DR DATE(MMIDDIVY)
CSIR DR
09/29/98
PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Drake,Swan & Crocker Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
14 Lot's Hollow Rd. ,PO Box 429
COMPANIES AFFORDING COVERAGE
Orleans MA 02653-0429
COMPANY
David D Rust A Assurance Co. of America
Phone llo. 508-255-3212 Fax_No:_--, ---_--- ----
R1. UI�ED COMPANY- -
B Credit General Insurance Co.
- COMPANY
C
Paul J. Cazeault & Sons, Inc. __—_ _____.----_---------- ---------------- -
P O Box 930 COMPANY
Marstons Mills MA 02648 D
COVERAGES
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 -------__
_-..-...
POLICY EFFECTIVE POLICY EXPIRATION LIMITS
C.0 TYPE OF INSURANCE POLICY NUMBER: DATE(MMIDDlYY) DATE(MMIDDlYY)
LTR
GENERAL AGGREGATE $ 1000000-
I GENERAL LIABILITY --'-----
05/O1/98 05/01/99 PRODUCTS-COMP/OPAGG $ 1000000
A i X I COMMERCIAL GENERAL LIABILITY CFP25552812 � --- - - — -
CLAIMS MADE }( OCCUR
PERSONAL&ADV INJURY $ 500000
EACH OCCURRENCE $ 500000
OWNER'S&CONTRACTOR'S PROT --=---- --' -----_ ---
FIRE DAMAGE(Any one fire) $ 300--00
• MED EXP(Any one person) $ 10000
1 I
I I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO
j ILY
ALL OWNED AUTOS - � - - Per personURY $
SCHEDULED AUTOS ------
i FUREU AUTOS (Per accident)BODILY INJURY $
I
i NON-OWNED AUTOS ---_.- ------------------------- --
� PROPERTY DAMAGE $
I{ 1
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
` ANY AUTO - OTHER THAN AUTO ONLY_ - -_
I I EACH ACCIDENT $
AGGREGATE $
I i •
EACH OCCURRENCE $
EXCESSLIABILITV ..._._. _. .._. ..
AGGREGATE $
UMBRELLA FORM _—
S
I OTHER THAN UMBRELLA FORM Y W S C TATU: OTH-
tt MIIS,_1------ _------._--..------
i WORKERS COMPENSA6014/\NU -tR.
I _.. .-_-
I EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100000
-
- -
} $ THEPROPRIETGR/ }{I-INCL SWC17005902 08/09/98 ' 08/09/99 EL DISEASE-POLICY LIMIT $ 5000
PARTNERSIEXECUTIVE -- EL DISEASE-EA EMPLOYEE $ 100000
OFFICERS ARE: EXCL
OTHER r
I
I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
Roofing. Corporation active 10/l/98.
1
{ TI CERFICATE HOLDER CANCELLATION
PFACO(1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
I EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
I
j10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY 5KEOMPANY%,ITS AGENTS OR R PRESENTATIVES.
AUTHORIZEVE M
�V
! - "tA
ACORD CORPORATION 198
ACC
` � �`�°''�' ✓fie Ur o�;�ea� o��,��a�eG�
HOME IMPROVEMENT CONTRACTORS REGISTRATION
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston , Massachusetts 02108
HOME IMPROVEMENT CONTRACTOR ----------------------------------------
Registration 103714 Expiration 07/09/00
Type PARTNERSHIP i OL
HOME IMPROVEMENT CONTRACTOR
Registration 103114
PAUL J . CAZEAULT & SONS ROOFING Type - PARTNERSHI.
Paul J . Cazeault i a Expiration 07/09/00
22 Giddialt Rd . P .O . Box 2781 �
Orleans MA 02653 PAUL J. CAZEAULT & SONS ROOFII
Paul J. Cazeault
I G� �� e iddialt Rd. P.O. Box 278",
ADMINISTRATOR Orleans MA 02653
IK.PARTMFNT OF PUBLIC SAFETY 136726
ONF ASI-IRURTON PLACE, RM 1301
ROSTOI A 02108 -1618
CONSTRUCTION SUPERVISOR L.CCE_NSE
Number: Expires: Ya
CS 026325 1 0/20/1.999
Restricted To: � y/7/�l. .
1.n
11 } Y y
116-- ....'. 1 .r
PAUL J CAZFAULT
Y t •._ .. __... ..........
._».. _. ......_.._..._........._.....__..
1585 MAIN ST
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OS TERVI L I-E, MA 02655 _,_.-...�-,• ;
Keep top for receipt and change
bf address notification.
Al
DEPARTMENT OF PUBLIC SAFETY
1 CONSTRUE-TION SUPERVISOR LICENSE j
Mulkii... '- Expires:
�..
. Restricted to: 11
J -CAZEAULT
1585 MAIN ST
OSTERVIL1E, NA 12655
f
The Commonwealth of Massachusetts
--•z' Department of Industrial Accidents
office 01fosesg oo foos
" 600 Washington Street
Boston,Mass. 02111
Workers' Com ensation Insurance Afridavit
name: LILA
location: I e 6
city Y, hone#
❑ I am a homeowner performing all work myself.
❑ I am a sole p rietor and have no one working in am►ca achy
❑ I am an employer providing workers' compensation for my employees working on this job.
comannv name: D A TT
address:
city: ___ .,..pQ&BSTr)Dj mILT cz phone#: 4 7 R-1 1 7 7
insurance co. 2011m#
303/707/7-77/77711,
❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who
have
the following workers' compensation polices:
comvanv name•
address.
..........
dhr
phone#• .... �.
.........
Insurance ce W.
elicv#
companv name- : ;. : :......, X.: ::. —X.::.. ..;
address:
dfv
phone
..... ..........
oitev# :..:>.::;:;. ;:><:>;:: ::_>:::' :. °
Fanure to secure eovera;e as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the ORice of Investigations of the DU for coverage vetiffcatlon.
I do hereby certi&,inder the p ' and penalties of erjury that the information provided above is&w.and correct
r 1 �,9
Siplature�" --•�, � mate � -
I
Print name PAUL CAZEAU ,T Phone# A-)A-1 1 -7-7
oifldal use only do not write in this area to be completed by city or town official
city or town: pennit/llcense 0 ❑Building Department
QLiceuaing Board
❑check if immediate response is required ❑selectmen's Omce
C3Hmlth Department
contact person: phone#., C]Othu
(w4sed 9/95 P1A)
Information and Instructions
-Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the-:
employees. As quoted from the "law",an employee is defined as every person in the service of another under any cow
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 c:
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rece:�•e:
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
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renev
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h:
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work uanl
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting-
authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and,
supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if roL
are required to obtain a workers' compensation policy,please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of th
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be rct ued io
the Department by mail or FAX unless other arraagemeats have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Inesugations Y
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone #: (617) 7274900 eat. 406, 409 or 375
. r
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LOT 45 f
r 93.15 corurr.
_ C�� ` SCHOOL ST
ciz182. 68 q� BAY
(F O N86 50'40"E
/ LOCUS e
11' 1 o3
SEPTIC PERMIT
# 99,297 � P4CESSPOOL
LOCUS MAP
LOT
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_ IO' NaM LOT 72
ASSESSORS MAP 19
PLAN REF. 19/143
RES. ZONE. ,.R�,..
HOUSE_--- �,�a 4 Z 2'
UPOLE FLOOD ZONE. "C"
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cHie�Nsr A DI j . LOT
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ASSES�LOT ORS �• �a 2� 4 PLOT PLAN- OF LAND
72
AREA=44,251f SQ. FT.
i^ e, PROPOSED%
C B. , GARAGE I� 16. 0' PROJEC T L OCA TION
(fnd) �` _�` - HOUSE , 196 POPONESSETT
UPOLE h 1 ( COTUIT) BARNSTABLE, MA.
APPLICANT.-ROBERT SILK
IV
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lb 11 YANKEE SUR VEY CONSUL TAN TS
�� , �. ► 5 � P. O. BOX 265
UNIT 5, 40B INDUSTRY ROAD
MARSTONS MILLS, MA. 02648
G B. PH.(508)428—0055 — FA X(508)420—5553
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y�� L_140�9' ti cr SCALE. 1 "=30 FT. DA TE. 1/7/00
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