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HomeMy WebLinkAbout1481 SANTUIT-NEWTOWN ROAD 1��' ', i r vn law _Cana r /i ian t _ �,:_ -vt 11/14/14 Thomas Perry, CBO Town of Barnstable Building Division 200 Main St Hyannis, MA 02601 RE: Insulation Permits Hear Mr.Perry, This affidavit is to certify that all work completed for insulation work at 1481 Santuit-Newtown Road (application#201207893) has been inspected by a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, 0 Corror McInemey ConserVision Energy s8� EwJ �-•� 1 � p N i 3.`.1 376 ROUTE 130,SUITE C SANDWICH,MA 02563 508-833-8384 W W W.CONSERVfODAY.COM r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r Map US Parcel Oot/ Application # aO 3 D'a Health Division Date Issued 1 Conservation Division Application Fee Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board 51V13 d4d- Historic - OKH _ Preservation/Hyannis Project Street Address I��I SC�rI�-1,>�-� (yeti?�e�i_A�Y1 2C. Village C rA-uL-+ Owner Li 50 61ry-�a_u- Address ILIEJ Aun to Telephone Jam' 0'7KN -,5co 0 - 300 Z Permit Request LIMB StrQ hki_.on CL XA_AAn7. i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation cSX M. Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a-' Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Taal 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 Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ ing ❑ r ew sge_ , Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: CD Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use c� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Fclaryi I cyncV`,0 Telephone Number �� S�'T (D-70Cv Address !J I b ( O-v e �5+ License # I CZ&LI 1 12 Y>rE 1-M CD-7a-n Home Improvement Contractor# 1 oP3) Worker's Compensation # J'N W C A)103 I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Al lied wa,-Ae �-! e I I 1 r` -gA 2�V , SIGNATURE DATE LI 5))3 I'll . � `+ FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ,i ADDRESS VILLAGE _ OWNER Z1 t DATE OF INSPECTION: FOUNDATION r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL `i PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. = The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a e 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,,nn Please Print Legibly Name(Business/Organization/Individual): i I�1 )i C't 4e a 5�\j Q— Address: � — City/State/Zip: O'JA Phone #:� �• �� (.P 7Q(,g Are you an employer?Check the appropriate box: Type of project(required): 1.2/1 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 listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We area corporation and its I0.❑ 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 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.92/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-G i Ci I'd I a5UY7Y Al n Policy#or Self-ins.Lic.#: � C I .� Expiration Date: La 10�f Job Site Address: Ma 1 0ell City/State/Zip: �(-) 1 i 1:, �Or 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�thheefpainss anddpJenalties ofperjury that the information provided above is true and correct. Signature: Date: `4 S I 1 Phone#: 01 a-'COy7QC4 Official use only. Do not write in this area,to be completed by city or town offciaL . T , 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#: - W Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 "M Boston, Massackla efts 02116 Home Improvement Castor Registration Registration: 166311 t �} Type: DBA y . Expiration: 5/11/2014 Tr# 222532 INSULATE 2 SAVE ROLAND LANGEVIN � 410 GROVE STREET V^ � z � - - - - '� y�.r FALL RIVER, MA 02720 ' ` % Update Address and return card.Mark reason for change. ❑ Address Renewal Employment [].Lost Card DPS-CAI is 50M-04/04-G101216 ---------��-- ---------- - ------ ..---- g -------- --- -- ---- -_------------ - - - License or registration valid for individul use only Office o onsumer Affairs&B mess Re ulation g y TINTE HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:Registration: �•66311 Type: Office of Consumer Affairs and Business Regulation Expiration: .5k1;�.�20 10 Park Plaza-Suite 5170-14 .DBA Boston,MA 02116 2 SAVET, �T_ / ROLAND LAN GE�f�N 536 EASTERN AVEi FALL RIVER, MA 02723 ' ✓—.._�,_ ----- — Undersecretary Not valid without signature. a ° Massachusetts- Dcpartmcnt of Public SafetN Board of Buildim-, Re-evulatiuns and Standards Construction Supervisor License License: CS 103861 Restricted,;q 00 x ROLAND�tL'ANGEVIN 536 EASTERN AVE.- FALL RIVER; MA:02,723" � Expiration: 8/24121113 ('otittfll S1MCr Tr#: 103861 r i a - DATE (MUMWYYYY) A1540RV CERTIFICATE OF LIABILITY INSURANCE 1211/2012 TH RTIFICATE IS ISSUED AS A NATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER:THIS CERTIFICATE DOES NOT AFFIRMAT VELY 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 endomement(s). CONTACT PRODUCER NAME - ---- '--— ANTHONY F. CORDEIRO INS. 1,GCY. , INC. (A/C._N,,_Enr._(508) 677..... Fax No).(soa) eTT_odo9 — E.MAIL— --'—` '— - 171 Pleasant Street ADOREss: ---- - --- PR000CER - CUSTOMER Ip._0: .................... ................. -- Fall River, _- MA 02721=_.. iNSURER�S)AFFORDING COVERAGE .............._ .. NAIC M — -- INSURED INSURER A Atlantic Casualt}.y�� Ins. .._--......—_"S.. Insulate 2 Save Inc. INSURER a :Torus Specialty Ins. Co. 410 Grove St INSURER c :G .......... Ins... - —'-- INSURER D :Guard Insurance INSURER E Fall River MA 0.:720— INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLIdE!>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. .. _—._ADDl f>OBR-` .--.- . .•— POLICY EFF POLICY EXP LIMA .._.._...._ _ -_. (MR GENERAL LIABILITY Y Y M 081000174 TYPE OF INSURANCE INSR 'yyyp POLICY NUMBER "(MMIDDA-YYV) (MMIDDIVYYY) A - 6/12/2012 06/12/2013 �_EACH OCCURRENCE_ S 1,00.0-,0_00 / / / J 'ffANWG5 r-5-RENT D $ .100-.,00.0 X COMMERCIAL GENERAL LIABILITY �I PREMISES_(Ea ocwrrencei __...__ _ ._ .. ._. M_ED EXP(Any-a person)___ s 5,000 CLAIMS-MADE X..OCCUR -'- ---` - _ r..._._ PERSONAL&ADV INJURY $ 1,000,0100 _. _ — / / / / -- 2,000,000 ' f GENERAL AGGREGATE _-_ s _......... ........... -- - I / / / / GENE.AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPlOP AGG $ 2 00 + :0+OOO. X POLICY ---PRO- _ LOC � / / / - - - $ --- - AUTOMO&LE LIABILITY - ," - / / COMBINED SINGLE LIMB $ (Ea acciQentj _ --- ANY AUTO I / / / "/ BODILY INJURY(Per person)- $- _.-- ... ALL OVMEEO AUTOS / / / / - BODILY INJURY(Paraccident) $ _— . ..._. _.......... _. - SCHEDULED AUTOS (PROPERTY DAMAGE $ (Per a=iderd) -. HIRED AUTOS NOWONMEDAUTOS -- / $ }( UMBRELLA LIAB X OCCUR Y Y I78264D120ALI 06/12/2012 06/12/2013 EACH OCCURRENCE $ 2-00.0,000: B _----------- / AGGREGATE $_.._. 2,.000+000_ EXCESS LIAB CLAIMS-MADE: DEDUCTIBLE --- -- --... X RETENTION S 10,000 - - 2/10/2012 12/10/2013 WC STATU OTH D WORKERS COMPENSATION INWC311431 X TDRY;LIMIT$ .--- - — AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN ' / _E.L.EACH ACCIDENT -- 5,001000. 6FFiCERLTIEMBER EXCLUDED? C N!A E. DISEASE"-EA EMPLOYER s _.50_0.+000 (Mandatory in.NH) .. �. ......_...... - - If yes.describe under / / / / E.L.DISEASE-POLICY LIMIT .S 5:.0 000 DESCRIPTION.OF OPERATIONS below C Equipment Floater n4P 3759976 I SW Storage 75,3SQ b6/12/2012 06/12/2013 1 /• / / Vehicle Storage Limit 76,250 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Anach ACORD 101, Add%ond Remnts Sehaduie, N moro span is requimd) Proof of Insurance. Residential Insulation Contractor. CERTIFICATE HOLDER CANCELLATION ( ) ( ) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED;BEF.ORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable AUTHORIZED REPRESENTATIVE 200 Main St J- Hyannis Ma 02601- f / •. ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION: All nghts reserved. INS025(2009,09) The ACORD name and logo are registered marks of ACORD - RISE ENGINEERING Completion r A division of Thielsch Engineering,• r' y Certificate 1341 F.Icnivood Avenue,Cranston,RI 02910 PROGRAM ll; � S B saWHi€estNc ,(401)784-3700 FAX(401)784-3710 CLC-RCS CASE 13-9473 Page 1 CONTRACTOR 0050.Insulate 2 Save CONTRACT DATE START'DATE ADDRESS 11/5/2012 4/36/2013 CLIENT NAME Matthew Vasquez AUDITOR_ Darrin Duty ADDRESS 1481 Santuit Newtown Road ' Cotuit,MA'02635 CASE 135473 HOME (508)360-3008 WORK,p \- P.ROJECT NO CELL 508-477-5351 - PAX RIS-81-12-0035:1459 NOTE: Owner Dana Nardo 508-477-5351 Air:Sealing Completed Start:CFM50 End CFM50 70%OF BAS CFM50 Combustion Safety Testing Worst case depressurization number_____pascals CAZ limit pascals - Spillage failure: Yes or No Draft failure: Yes or No CO levels: pass or fail The following:areas were sealed,as directed by the RISE Engineering Energy.Specialist: Basement-Crawlspace Attics'-Kneewall Spaces Living Areas —Sill/Rim Joist Wahl Top Plates _Plumbing.Gaps . Plumbing Gaps Plumbing Gaps _Door Sweeps Wiring Gaps _Wiring Gaps Door Weather-strip' ' —Chimney Chase _Chimney Chase i Fireplace/Wall seam —.Basement Door _Attic Hatch _Duct.Register Gaps,. Crawlspace Ducts Joist Transitions _Air Con.Cover, Kneewall Hatch Attic Ducts Exterior Items Sealed: _ Other Items Sealed: Comments: t r , RISE ENGINEERING Completion # A division of Thielsch Engineering CeI't1Catfi' ) 1341 Elmwood Avenue,Cranston;R102910 PROGRAM (401)784-3700 f'AX(401)784-3710 CLC-RCS CASE �13547. g 3 Page 2 ENGNkEtfNC . F Perform(9)man-hours of air sealing to include all appropriate blower door tests,combustion safety tests and procedures. Energy Specialist's NOTES: 5 BASEMENT, I CRAWL,W/S 2'EXT DOOR.: Provide labor andmaterials to install(1)exhaust hose with wall mounted flapper vent to exhaust existing clothes dryer(s)through band joist or wall. - Install R-19 unfaced fiberglass blockers to the sills.(106)square feet. Install (318)square feet of R=l0 rigid board to the perimeter walls within the crawlspace. Insulate the:sill area with R- 19 fiberglass blockers. Install 620 square feet of 6 ml polyethylene over open ground in designated crawlspace/earthen basement areas: Lap the poly 6"up the side walls and seal with polyurethane caulk or equal. Seal poly seams with air barrier tape. ,r I confirm that the measures listed above have been completed to my satisfaction.I have received a copy of the Certificate of Completion and hereby authorize the release of any final payments to the Contractor.I understand that this Authorization of Completed Work does not in any manner void any warranties provided to me by the Contractor. i — ...._ _.........................---._,....._._. ------- Inspector', Signature -....__ _..__..........:_ ...—.....�__....._...._....... Customer Signature ' __...._ DATE 4142013:4:01:52 PM f - OWNER AUTHORIZATION FORM (Owner's Name) x owner of the;property located`at y ,(Properly.Address) (Property Address) ,. hereby authorize .(Subcontractor) an authorized subcontractor for.RISE Engineering; to act on mybehalf to obtain a building permit and to perform work on my property. ; ` Owner ignature Date 9 { TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Flot ee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner Address \AS\ Telephone Permit Request NAA (L,-5'0 �e\\v.\ose, 0a2 cr �t , Arc' se'o'\ OM\C WA. e no,54.medt. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation�1>S W e 1�10 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting doe tion. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Co s � .r Age of Existing Structure Historic House: ❑Yes ❑ No . On Old King's Highway: W'es , No _�>4 Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) ° Number of Baths: Full: existing new Half: existing Lnew ..a r Number of Bedrooms: existing _new i 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 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 2j� 'U J -L' Name Co c)or M L\c,ec(\" Telephone Number Address _V1 kcikkle2 \3o SLx:V_ C_ License # \0_;191T9 Home Improvement Contractor# Worker's Compensation # NN C rl o1 S h5 S'0\ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1 2,11`+)1 Z FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER z DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL + FINAL BUILDING r i r DATE CLOSED OUT ASSOCIATION PLAN NO.-.. f v► The Commonwed/th of Massachusetts Rrini!orrrt = Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite.id0 Boston,MA 02114-2017 www m ass.govfdia Workers' Compensation Insurance Affidavit: Builders/Conti-actors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):CONSERVE ENERGY INC. d.b,a'CONSERVISION ENERGY Address: 376 ROUTE 130, SUITE C City/State/Zip:SANDWICH, MA 02563 Phone#: 508-833-8384 Are you an employer?Check the appropriate box: Type of project(required): 1.91 1 am a employer with 6 4. ❑ 1 am a general .contractor and I have hired the sub-contractors 6. New construction employees(full and/or pans-time). , 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These stab-contractors have ship and have no employees 8, ❑Demolition ' working for me in any capacity, employees and have workers'. ❑ [No workers'camp. insurance. comp.insurance.* 9. Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all workofficers have exercised their I l.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL . 12 ❑hoof repairs insurance required.]t c. 152,§1(4),and wehave no employees:[No workers'- 13.El OtherWEATHERIZATION comp, insurance required,] Any applicant that checks box i#I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this aflidavir indicating they are doing all work and then hire outside contractors must submit a new an-idavit indicating such. tContractors 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. lain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: SELECTIVE INSURANCE COMPANY OF THE SOUTH Policy#or Self-ins.Lic.#:WC7956539 Expiration Date:3/15/13 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. IdoberebY certifyunder the pains and genalties o er'u that the information provided above is true and correct. Si nature: Date Phone#:508-833-8384 Official use only. Du not write in this area,to be completed by city or town official. City or Town: Permit/License t# Issuing Authority(circle one); 1.Board of)health 2.Building Department 3,City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone M , . .-.. . ... _ Client#:68880 CONSER ACORD. CERTIFICATE OF LIABILITY INSURANCE FIDATE(MMMDNYYY) 03/1512012 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 SUBROGATI6141S 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 andorsement(s). PRODUCER •CONTACT NAME: _ Rogers&Gray Insurance Agency,Inc. PMoNE - ---rFAX— �— � 508 398-7980T� LAIC NO Ext: v y(AIG No; 434 Route 134 E enaL South Dennis,MA 02660 AODREss: _�INSURER(S)AFFORDING COVERAGE NAIc S 508 398-7980 INSURER A:Selective Ins.Co.of the South - -- ...,- INSURED _.....—�- - 'INSURER B: Can-Serve Energy,Inc. _. ............: 376 Route 130.STE C INsuR@Rc: IN, SURER D_—� Sandwich,MA 02563 INSURER E: i 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 - "- -- POLICYEFF- POLICY EXP—T----*- LTR TYPE OFINSURANC@ AODLSUBR pOLICYNUMBER MMIDDMIYY) MM1DO rNSR j..._._.<VYY1_i`..;... LIMITS ------- A GENERAL LIABILITY - I`X S2011299 031141,2012 03/14/201 3�EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY I PREMISES�Ea oErrOence I$10O 000 •CLAIMS-MADE OCCUR i �. fIIIt MED EXP(Anyone petsm)_i$10 000 PERSO &ADV INJURY I S 1000 000 ]ii 'GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: -� DUCTS COMPIGP AGG $3 000 000 X POLICY PRO- LOC ,PRO I _ IMP $ - AUTOMOBILE LIABILITY i — - COMBINED SINGLE LIMITi(Ea accident) 1$ ANY AUTO ) {BODILY INJURY(Per parson) is ALL OWNED ,._ SCHEDULED AUTOS AUTOS �BODILV INJURY(Per accipeni)t$HIRED AUTOS AUTOS 111 - PROPERTY DAMAGE $ ! Per accldem �- 8 A UMBRELLA lae A OCCUR X S2011299 3/14/2012 03/14/201 EAcM occuRRENCEA�s3.000.000 000 X EXCESSUAB _ ' CLAIM&MADE; AGGREGATE DIED 1 X1 RETENTION$O I $ — ---— A WORKERS COMPENSATION WC7956539 --- 3l14/2012 03/14l2013 iwc sT"-nru• ?. AND EMPLOYERSLIABILITY -1 ' TORY LIMITS.• IERM... YIN ANY PROPRIETORIPARTNERIEXECUT .' J. t NE�� (- OFFiCERIMEMBER EXCLUDED? l T 1�NIA } �.L.EACH ACCIDENT 100.000 (Mandatory In NM) - E.L.DISEASE-EA EMPLOYEE $1 00 000 m yes,RIPTIONOFO .. . —�—�E.L.DISEASE-POLICY LIMIT S5O0;000 DESCRIPTION OF OPERATIONS I. I', I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Excluded officers under workers'comp-Conor and Courtney McInerney. Blanket additonal insured coverage applies under CGL. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering,Inc. SHOULD ANY QF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 Francis Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Cranston,RI 02910 AUTHORIZED REPRESENTATIVE 'r 0 198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S78899IM78899 DDR t Massachusetts -Department of PubPc Safety Board of Building Regulations and Standards Construction u�ci 'Lv,lr 4pi:u t�lt�` License;CSSL-102778 CONOR D;61CINERN EY r/ _ 39SIASCONSETDRIVE�'t SAGAMORE BEACFI MA 02562 Y'� ,M Expiration Canaytaissio i r 08/19/2014 ra �ruecc8c1Bifs ����.�,,,,«��,�.�j�� �. k :I Office o o sumer airs mes v,-2 tart"ina License or registration valid for individul use only MHOME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: Registration: 171251' Type: Office of Consumer Affairs and Business Regulation Expiration 3/1/2014 Partnership 10 Park Plaza Suite 5170 �,� a Boston,MA 0211,E C641' ERVE ENERGY ,w ' ' CONOR MCINERNEY '' 376 ROUTE 130 SUITE C" SANDWICH,MA 02563 R. ' Lluderseeretary �^ Not valid without signature ,OWNER AUTHORIZATION FORM t\moor (Owner's Name) owner of the property-located.at, _ (Property Address) (Property Address) hereby authorize = j F '�:;C (Subcontractor) an authorized subcontractor for RISE Engineering, to act on.mV behalf to obtain a building permit and to perform work on ray property. ` Owrjer' ignature 5ate � j r 1 n � 5fii Town of Barnstable *Permit#s 6 KVires 6 monas from issue UWaTAB Regulatory Services Fee Was. g ' 16;. ,ig Thomas F.Geiler,Director _ ,�^ 01 .M c 0 fD"""t► Building Division Elbert C Ulshoeffer,Jr. Building Commissioner X-P p C c S PERMIT R p�I T 367 Main Street, Hyannis,MA 02601w /� (SG.7 G 'M' Office: 508-862-4038 ,1 U L 1 8 2001 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION TOWN OF BARNSTABLE Not Valid without Red X-Press Imprint Map/parcel Number. 0dS-1o014 �- jvz4j-7,ad jeA Property Address�p CC)7{ 14 residential OR ❑Commercial Value of Work Owner's Name&Address Contractor's Name C 1 Z Z t. �Ih � �/�r 6 Telephone Number mot-K Home Improvement Contractor License#(if applicable) p U 7 q 0 Construction Supervisor's License#(if applicable) CS 0-7a 7 V ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name ZA-!r( G I'1'VVVu l cc n Workman's Comp.Policy# L 3 1 -7- `( (0 U Permit Request(check box) ❑ Re-roof(stripping old shingles) 7e- of(not stripping. Going over existing layers of r000 Re-side ❑ Replacement Windows. U-Value (maximum.44) Other(specify) -at Q n-N *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature expmtrg