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Home My WebLink About0041 SHELL LANE y � �� I� f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION pp Ma ()I Parcel I A lication # P -q Health Division BULDING DEFT Date Issued Conservation Division Application Fee T Planning Dept. RP 2 0 2017 Permit Fee v Date Definitive Plan Approved by Planning Board MAIN!07=PAL! !cTABLE Historic - OKH _ Preservation/ Hyannis P mt-Stre`et-Address, y 5�-{ L(� �-��-2_ vrth�age� Co I-CA I -T' Per_, V5,,A tc� A'►- 1� < wd-P�C`� G� �� ddress Z(VE�-e(Y 1 C��G<<?, ►�.d.yak�/ �C-7�SL G2li3 L Tete�ph� remit-.bequest ��(�1'�-Q- � � ►S►�1�q � t� Square feet: 1 st floor: existing ro osed 2nd floor: existing ro osed Total new, q 9—proposed 9—proposed , Zoning District Flood Plain Groundwater Overlay Pr-aject'Valuati AA n 'Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/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 INF IO (BUILDER O HOMEOWNER) Name, �'r�`� C . �� (II/ � Telephone-Number _ (D- y - �VXS� License # -ef-jt-� �,1-e- G 3 Home Improvement Contractor# 6.CuU CO NIC�SL h� Erx%a�� e Worker's Compensation # AL-6z:e(ERSTR_ 1C�1 -DEBRIS-R S JLTING FROM Tt 1S'PRO;IECT WI-EL B•E-TAKEN TOE SIG TAN TAN URE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. -,r ADDRESS VILLAGE y� 4 OWNER DATE OF INSPECTION: FOUNDATION t FRAM E INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. DECKS ❑ If located in OKH or Hyannis Historic.District- Certificate of Appropriateness is needed ❑ Map/parcel number. Sign-offs from: - ❑ Health ❑ Conservation _ � , �� - � • 3. 2� �I •3 ❑ Tax Collector ✓ / O ❑ Treasurer Owner's name & address �-t u1e4 v. 2Co3 2- Deck Dimensions 10 \t< Z a<�gat s vts ❑ Estimated Cost C/vU c ❑ Complete dwelling information for the Assessor's dept.- i�rGL L/✓ CB�N. ` ❑ Applicant's telephone number c f ❑ Signature ❑ Plot Plan ItOA� P ❑ Two sets of plans with cross section . ❑ Workman's Comp. form. Copy of Insurance Compliance Certificate must be on file. ❑ Construction Super's License AND Home Improvement Specialist's License ` OR ❑ Homeowner's License Exemption form. ❑ Check expiration.date on-license(s) ❑ Application fee ❑ Permit fee ❑ Property Owner must sign Property Owner Letter of Permission. q-forms:permits] rev.010208 r Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner 200]Main Street, Hyannis,MA 02601 BAYMsrr►ms. MAW www.town.barnstable.ma.us 639 �1 Mtld Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION G Please Print CDATr E• / JOS-U ATIONs, . S H ELL (;N _C 0 7-14 ►fi number street village ' "HO,hMOWNER,*� &vIk(t VIA Cy wV 711 1 A-.wry s?j-g- ?(o Y• Z Ito name home phone# work phone# J C-IJRRII�i'P MAII:ING ADDRESS: T -D . V�!/� �� Z- city/towa state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildingpermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures req a that he/she'will comply with said procedures and requirements. Si0Mw-e.of.Homeowner— Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner on 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 this issue is a form currently used by several towns. You may.care to amend and adopt such a form/certification for use in your community. Q.XWPFHM\FORMSIbuilding pemut fonns\MRESS.doc 09/16/17 Town of Barnstable Building Department Services • R•RM j • Brian Florence,C130 596 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 Usi=A Builder I, ,as Owner of the subject property hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for. (Address of Job) ' **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNMPERMISSIONPOOLS Rev:0&/16/17 The Commomwealth o,f- assachusetts Deparbumt erfrndrrstrial Accidents Q fflraa ofInvestigations 600 Washurgton, `t eet Bosnia,MA0211I nwn mamgov/dia Workers' Camlpensation Insurance Affidavit:BiuildersiCantractorsMecfri;cianslPlumbers Applicant Information r Please Print Legibly Cl atrxe-Bi>�essflo ganizatian�Indit dual) VL.t{Lk_ W t(�14- A,3tre :-s 2 �P ��C7n/ C'cXC(-e !)-O, /,O! c 4Q-ity/Statet ip---a C (.t. 611+ 02,0L.Phone 5-,rf' `(—.2 Yo'7 Are you an empl-j r?Check the appropriate box: Type of project(required). 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full atldlor part-time)-*' have hued the sub-contractors 6: �Idew construction I.rcQ 1 e 4 2_.❑ I am a sole pmpzietarr orpartaer- listed on the attached sheet 'I- ❑Remodeling 4 These sub-contractors have ship and Have no.employees -- 8.-[Demolition ylpuculrQ D,4 w°fi far me in any capacity. employees and have workers' g y q. E]Building a 'floe. ramma 'camp.insunnce comp-insurant�l 5. ❑ We are a corporation and its 1O.❑Electricalrepairscradditions 3. ovner doing all work officers have exercised their 1L❑Plumbing repairs or additionswoirlaees'damp. right of exemption per MGL 121❑Itoofr , and we have no insurance required_]a c.152 §14( �employees-[No workers' 13.❑Other cowp.insurance regtnred_j ;Any ankant:Btat cbedisbas#1 tarst also fill out that sectionbeLow shoo inn their waaes'compensationpolicy information. Homeowners who submit Ehis offidmit ingffcxtmg they are doing all weak sa4 then hire outside contractors mast wtmit anew affidavit indicating sa,ch. =connacturs that checit this boat must attached an additional sheet showing the name of the sub-contrza;ns and state whether ar not these entities have employees.If the sub-caatnutctshave employee%ft-y=zTpmuidetheir workeas'-comp.policpnumber. I am an employer that-is prodding workers'compensation inmarattce•for afty enrpiay ees Eetoiv is the pa cy arm job site n formadton. Insurance Company Nam: Policy 9 or Self--ins.Lic.9: Expiration Date: Job Site Address: CitylStatelr: 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 cw 157 can lead to the imposition of criminal peaa16es of a . fine up to$1,50D-00 andtor one-year imprisonmerd,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$25U.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 as epains and that the i►tformadoatprimidedabate is true and correct tSature `13ate:� - O•f vial use only. Do not twite in this area,to be completed by city or toirn o f ebi City or Fawn: PermitlLicense# Issuing Authority(circle one): 1.Board of Healt€r 2.Building Department 3.C ityl Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions hf ccaGh=eis Geheaal Laws chapter 152 regpes all employers to provide workers'compensation for their employees. pmrsuantto this statute,an.mtplayee is defined as."".every person in the service of another under any contract of hu e, express or implied,oral or write" An Mayer is defined as"an individnal,part ammbip,association,corporation or other legal entity,or any two or more of the foregoing engaged m a Joint enterprise,and includes the legal representatives of a deceased employer,or the receiver or trustee of an mdividnal,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who insides therein,or the occupant of the - dwelling house of another who employs persons to do ma�ance,cons'ftuction or repair work on such dweEi g house or on-the grounds or building appur ant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also sees that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings is the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.covearage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor airy of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the inSul2n ce._ re TIdi Pmnients of this chapter have Been presented to the contracting auihozity." Applicants Please fill oB± the wolk='compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of innaranc0. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not requited to carry workers' compensation insarance. If an LLC or LLP does have employees, a policy is required. Be advised that this a3dayk maybe snbm_it_d to the Department of Industrial Accidents for confirmation of in�n ce coverage_ Also be sure to sign and date the affidavit. The affidavit should be retained to the city or town that the application for the pennit or license is being requested,not the Department of ha r ism al Accidents. Should you have any questions regardmg the law or if you are requited to obtam a workers' compensation policy,please call the Department at the number listed below. Self-msuired companies should enter their self-in sum ce license number on the appropriate Iine. City or Town Officials t _ 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 is the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill is the permit/license number which will be used as a reference number. In addition,an applicant that must submit mulliple pennit/hcense applications m any given year,need only submit one affidavit indicating current policy infbnnation(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 Ate city or town may be provided to the ' applicant as proof that a valid affidavit is on fle 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 (Le- a dog license or permit to bum leaves etc.)said person is NOT ruj»aed 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 CommawmIth of Massachnsetts ' IIepaitc aent of lidustial Accidenta 600 wash 031 S Boston�MA O1 I I I T(,-1,4 617 727-4900 cot 406 or I-a77-MASSAFF, Fax 9 617-727 7749 Revised 4-24--07 ww .masa goo/dia z x lb Uo i s4- ,7 i L A� s/yX6" FT D t:�(N6 !: 2XfC7o � ST"S -- i t j TR i PLE ZYid �c�T Zo - S•T X�t i.MPSant A9 v y (�, CvER�° �o CST -TO GIRT Y f x� P -T'P, PLE' Zx tD Gr R`t® ate....-a A 6Z Pso STIR A FI n c z x ie RiM 7o t s4- shy X 6�� 'T pEC�I\J C�- / ' • r� o 2x10 �ToAST-S Jo►-s�2Y T®s7r r c � P r i PLE ZKio C�cfLT .® Zo AGO y �Z CV-RY Fo®-� ►u N , C L i h S 417T,'4 c 'o s-r To GIRT � l " ► PLC Z1C lD Gt FKr 2�2 'PT I 2® (1A vtMPSoN. � �o - t t, g 1 ►H PSDN q s" O ML-o w C-RA®r riO T: 781-871-8252 F: 781-857-1977 u July 1, 2015 J Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 RE: INSULATION PERMITS : BRUCE& KIlVIBERLY WILLIAMS Dear Mr. Perry, This affidavit is to certify that all work completed for insulation work at 41 SHELL LANE, COTUIT MA has been inspected by a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds Federal & State requirement. Sincerely, Victor Cimino limb 267 N. Quincy Street • Abington, MA 02351 www.insul-proinc.com TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 019 Parcel 1 1`7 lication # t Health Division Date Issued 3 IS Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis s�Project Street Address Village (127-li)t 02 60.5 s - Owner V 1110^ .Address �/ e�� CGty;t , �s Telephone ;�! 7 — / Z C�s 25? Permit Request -/—z (P 10 t-cl c/4.,/ J��rc �j rn j l �� d n C/'� �-/ �lovl'r f� �`�// 2`'��-/� f�►el•�-�� '�i c�w�/ h�yZ� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation r -3 -5r. Construction Type = ; "Lot Size Grandfathered: ❑Yes 0 No If yes, attach s`D porting ddcurfapntation. �d Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway_�Yet ❑ No Basement Type: ❑ Full O'Crawl ❑Walkout ❑ Other a_ 'J Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/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) — G Name �,'1.f�� G�2� C11V?f /Telephone Number �l— 4 1142-5�Z Address 267 ��Iz 1 b�i_s4in License# M k? A, d2,3 S / Home Improvement Contractor# Email V[CTor Worker's Compensation #VY9662.6 M 2_01 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATUR DATE 15 FOR OFFICIAL USE ONLY 'a - i APPLICATION# -DATE-ISSUED MAR/PARCEL NO. a >.s C} ADDRESS VILLAGE s OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE s T r ELECTRICAL: ROUGH FINAL f. ` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL E' FINAL BUILDING DATE-CLOSED OUT, ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations i 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumberi Applicant Information Please Print Legibly Narne(Business/organuation/Indmdual): -T n-f y l - �,/-O Address: . z 6 7 �� •��,: c/ J r /} %�-�f`� City/state/Zip: 4�2 in f�� /f2 5 0)-1Sl Phone#: 7 l l-7/-PS. Are g a am I van am a employer With an employer?Check the appropriate box.: 1. I T3°pe of project(regained): general contractor and I l� 4. ❑ employees(full and/or part-time).* ham hired the sub-contractors G. [3 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working, for me in any capacity. employees and have workers' 9. ❑Building addition [No Avorkers'comp. insurance comp.insurance.+ required.) 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all i ork officers have exercised their 11.❑Plumbing repairs or additions myself o«-orkers'com . right of exemption per MGL [N p 12.❑Ro f repairs insurance required.]t c. 152, S1(4),and we have no . employees. [No w-orkers' 13. Other �a2 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 ant an employer that is providing workers'compensation insurance for»ry employee& Below n the poficy and job site information. _ Insurance Company Name: I rr ye l elf Policy#or Self-ins.Lic.#: k .V/3 C,62 (o Y 3 5 L 1LI Expiration Date: z/ Job Site Address: . f e% City/State/Zip: CG t v f fi', ^S 02 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 herebi under the ains and enaldes o er' n,that the inor cation prm� ided above is true and correct Si ature: _ IDatell/P_//4r, Phone#: ��l'' 7� 2- Official use only. Do not write in this area,to be completed by city or toKw 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#: I AC40ROCERTIFICATE OF LIABILITY INSURANCE D °D 2/13/2015 13/ 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. j IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy((es)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 endorsemengs). PRODUCER CONTACT Denise Butcher NAME: Strategic Insurance Solutions, Inc. PHONE (617)555-7100 x122 FAX (A Not..(781)459-8282 2000 Commonwealth Avenue EMAILADDRESS.db@strategicinsure.com INSU S AFFORDING COVERAGE NAIC# Newton ' MA 02466. INSURERA:Scottsdale Insurance Company INSURED INSURERB:Commerce Insurance Company 4754 Insul-Pro Insulation Co. , Inc. INSURERC:Torus National Insurance Cc 267 N. Quincy St INSURER D.Travelers Casualty & Sure Co INSURER E Abington MA 02351 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1521303201 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 LTR TYPE OF INSURANCE POLICY NUMBER MPS Y EFF POLICY EXP UMRs GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY AGE REN E PREMISE Ea occurrence) $ 50,000 A CLAIMS-MADE aOCCUR BiING ISSUED /13/2015 /13/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JFcT PRO_ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X71 SCHEDULED VA563 /5/2014 /5/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LU1B X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE S 5,000,000 RDED I X I RETENTION$ o 9425FI41ALI /5/2014 /5/2015 $ D WORKERS COMPENSATION X WC STATU- DTH AND EMPLOYERS'LIABILITY Y i NTORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) 6626Y35214 /6/2014 /6/2015 E.L.DISEASE-FA EMPLOYE $ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace is required) Thielsch Engineering is listed as Additional Insured when required by written and executed contract for general liability. 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. AUTHORIZED REPRESENTATIVE Denise Butcher/DMB ACORD 25(2010105) ©1488-2010 ACORD CORPORATION. All rights reserved. INS025 r9(rinnsi m Tho Ar`npn n2mm end Inn^2ro rnnietnenrl m2rlre of Ar2nRr1 I • Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor l License: CS-089969 VICTOR CH MIN '- 267 N.QUINCY 5f Y ABINGTON a-' if 1 , Expiration Commissioner 05h 1/2016 i �ea�irAita•»weeil//n, -� Office of Consumer ��Ulj•::«�trre/fJ�� ' ___ Affairs&Business -~— OME IMPROVEMENT CON Regulation —.-..__•__. e ' - TRACTOR License or registration valid for individul use only 9►stration: .1-49123 before the expiration xpfration TYPe: Office of P ration date. If found return 11�8/201.5 Consumer Affairs and Business to: INSUL-PRO,INC. Pmafe Corpora0orr IO Park Plaza_Suite 5170 Regulation egulation ,MA 02116 VICTOR CIMINO - 267 N.QUINCY STREET ABINGTON,MA 02351 _ A Undersecretary — -;' Not valid without signature i xr . , OWNER AUTHORIZATION FORMA LCC C, �<<� atA (Owner's Name) .owner of the property located at - (Property Address) (Property Address) Frereby authorize (.Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to dbtaim a building permit and to perform work;on my property. \;ti�i(Ct,�--�� Owner's. Signature Date Federal ID t1:054405629 1tISE Efiginccr ng RI contractor Reg linen No 81861 MA Contractor Reglstiatlon No 120979 A division of'lhielsch Eogineering C7 Contractor ttonlstratlon No tt2d120 3 l liipont Avenue,SoatG Yntvtoulk AU 02664 CONTRACT. WA68-1926_X=6613 FAX S084G8-1933 Pago � ;7 TNUIcONIRACTIBENTEREDINToserm&EN.RitE }� I+��t (�) i_It(�� ENCRIEERING AND TIIF CU370MEO FOR YIORKA3 Ei kCWRER1NG` - DESCRIBED BEIOW.. CUSTOMER PIIONC DATE CUENT"0 WORKQRDEA Tim Rates (774)4974599 12/01/.2014 15,314Q; swca STItLEf BRI:INO STREET 41 Sliell Lane 41 ShellLn eERvtCE ci Y,STATE;7.IP: BULINO C=j8TATE,2)P Cottdt,MA 026315 C'c�tuit;m1 a 020,35 JOB DE,scmPTION N11ASh I'WO-Proposal foc'natycat's wcatucrization projeci.-2015 CRA�VLSPACi .!'r�ividc,taborRnd;TnRtcriat3to.instill (322)snu1rotectofMQ1igd: hectyvc insulation tothemawlspace perimeter will up to the sill and ogaiust ttte band juist. ProAde li hor and nmtcdals to install;(374)squirL,Itct of'6 U polyethylene over open ground in drsigoWd ernwla-pucrleurthrn tiaseiuenfareas. $2US& ►+rovtdc"Isbor:tnd matcnals to Insulate(1) buckotmlduos ith m `bwf p wrlde rcE,end seul;fhe cdKaof the hatch. Willi wealllcrslripping: $42.50 ltfSk Engiucering will apply all applicable Cligibh incv niiv�v tD this cuntrect, Yott ti ill'bc billed bhiy the Nct:amount: Clrrcntly,, under the l andlord Incentive,tot eligible measures;the Cape Light Compact otTeis loftincentivrsut tu.exceeti$4,000 per ealell Atyeae Ott d un.incrntivc of 100%f r the Air;$caling nicasures 1'o:p trticip ito in the Laudlo►d'iment►vo,,please ye.t a copy of this. signed.Wbaif the landioni and ahe tcount,its well Ds u ctlpy oPfhc:year-rpund rcnft l Agreement: For ihesafety and hcvlthof your hoindaindoorRir.gtlahty wcwlltbosoildnchnRati:blo�crdoordiagtiosttcoi'thcavat29Ule:airttow.iu your Ironic both wrwb the vrotk is begu)n and tller the weaihenatlion Hank tN cilmPlClc..1V�w111 Blsn sonif a fills tl5$GS9mcnt of lhC tvimhu�tiun sRfc}y:0fyounc�atingsystcntand watcr.Gcatcc.lLis has a value:uf$90 and'is ntno.eost to;you. $9000 rca Ile I , Total', $1753.56 f Uc 1 0 4014 I I}; , , ,l: Program Incentive: $1',753 56 I 'I% CustomerTotalt $0:00 WE ACREE HEREBY TO FURNISH SERVICES•COMPUTE M ACCORDANCE WITH ABOVE IPECIFiCATIONO.FORTNE;BUM'OF "*00/Dollars $0.00 UPON M&INSPECTION AND APPROVAL BY RISE EAOINEERINO.CUSTOMER AOREE8 TO R.ENITAMOUNT:OVA IN FW,INTEREST OF 1%VAIL BB CRARGeD.MONTILLYORANY UNPAID.BAtANCE AFTER 30 DAYS.BEE REVERSE,FOR.IMPORTANT"INFORMATION ON OUARARMIS;PWITS OF REdSION.SCNEOULINC,AND�CONTRACTOR RE018TRATIDN: Dt?NOT SIGN THIS CONTRACT1FTHEREARE,ANYALANK SPACES ' AUr110RaEO SIGNATDRE•'RISE ENGINEERING. CUSTOMER ACCEPTANCE Ycie TInB CONTRACT MAY OF VATHDttAWN OY US IP NOY iXECtrrEO NnrtUN. Lf cA7E OF"AccEPiANCE ( � AcOPTANCU OF CORtRACT.,THE AOOVEPRICES,SPECIFICATIONS AND CONDITIONS ARE smuwAcToRY Tows Amp ARE NENEBY Accwma..Yov AIM AWHQR—TO Do7Ns"WORK DAYS. AS SPECIFIED.PAYMENT WIK OF MADF,AS OUTLINED ABOVE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION TQ1wk, op Rhn 1 (3p3 Map Parcel r ication # Pk Health Division ll: =5 Date Issued AJ It Conservation Division Application Fee Planning Dept. g :S ' Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address f fhc J� Village t v/ r` /u 0 Z(e 3 f Owner Address Ll/ 54e</ 02CU Telephone 7 79 - qJ1` yS lqp Permit Request R1 rJe,/ cii-7'k 1 [n��l/ 3'0(-29 //l f ty// c pn)i R Iy G� c/�-�/ f/a-.^,AI +�"/��1 C-C�l�lcJL (�"/y)i i'7t J'fi�►�� p�� !/'z�r� iT� l,�t�fier ��,�.� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new ZOY' 9�1i i Flood Plain Groundwater Overlay Provct Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use_ _Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Vic c-r C/� %� G I-Ti7jil /v Telephone Number Address 2�� cy f /Tyi S License # �r� �� G Z3,S'/ Home Improvement Contractor# l 619 /Z3 13 Ehiail R Worker's Compensation # )(A 013 6026 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ch-7 T1c,7 Ci� SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED t. MAP/PARCEL NO. F ADDRESS VILLAGE OWNER DATE OF INSPECTION: r . z' vtFOUNDATI.ON.iR.-.�.a�A :_�;rEv ��-3:t FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING` _E DATE CLOSED OUT ASSOCIATION PLAN NO. I The Commonwealth of iVassachitsetts ' Department of Industrial Accidents Office of In vesil ations ' 600 Washington Street Boston, MA 02111 www.mass.;ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly j� Name (Business/Oreanization/IndiNidual): l Af U — fro Address: . Z 7 /l/ (Y a /1 Gy f—, City/State/Zip:/4 bl�/7 2J`o/t)/f or 0Z3S/ Phone y: 7 t1- f 7/ �0'2 S Z Are an employer? Check the appropriate bos: Type of project(required): 1.YI am a employer with 1 b 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet: 7. EJ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. worker' comp.insurance. 9. ❑Buildin;addition [No workers' comp.insurance 5. ❑ We are a corporation and its t required.] officer have exercised thew 10.❑Electrical repairs or additions 3•❑ I am a homeowner doing all work right of exemption per 14GL 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance requited.]1 employees. [No workers' comp.insurance required.] li ©Other i n✓�%��/1 *Any applicant than checks box#1 rust also RU out the section below showing their worker'cotnpensatior_policy information. Homeowners who submit this an&vit indicatine they are doing all work and then hie outside contactor must submit a new affidavit indicating such. ,Conti ctors that check this box must attached an additional sheet showins the name of'the su3-contractors and their worker'conic.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ Tl',ve ler1 C, ffv/e fx Co Policy n or Self ins. Lic.r: x AU S 662 6 l 3 S 2- 11 Expiration Date: 5/611V Job Site Address: l fdlc�l L� City;%State/Zip:Co AO- /1S' 02 U_f Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can'lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eerti under the pains and penalties of perjury that the information provided above is trice and correct Signature:X Date: C Cve CI Phone r: �0 l�—f -7/—0 Z S 2 Official use only. Do not write in this area, to be completed by city or town offcciaL City or Torn: Permit/License n Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other { i Contact.Person: Phone f-: i DATE a. CERTIFICATE OF LIABILITY INSURANCEF3/6/2(MMJDDNYYY) � 014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CON"AMTA T Denise Butcher Strategic Insurance Solutions, Inc. PHONE (617)558-7100 X122 FAXAIC (781)459-82e2 2000 Commonwealth Avenue ILADDRESS.db@strategicinsure.com .INSURERS AFFORDING COVERAGE NAIC 9 Newton MA 02466 INSURERA:Scottsdale Insurance Company INSURED INSURERB:COmmerce Insurance Company 4754 . Insul-Pro Insulation Co. , Inc. INSURERC:Torus National Insurance Co 267 N. Quincy St INSURERD:Travelers Casualty & Suretv Co INSURER E: ,Abington MA 02351 1 INSURERF: COVERAGES CERTIFICATE NUMBER:CL143602804 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 I TYPE OF INSURANCE ADDL BR POLICY EFF POLICY EXP LTRPOLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE 1 E 1,000,000 X COMMERCIAL GENERAL LIABILITY DDA A O R T D E 50,000 A CLAIMS-MADE FX OCCUR CPS1914781. /13/2014 /13/2015 MED EXP(Any one person) E 10,000 PERSONAL 8 ADV INJURY. E 1,000,000 GENERAL AGGREGATE- E 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG E 2,000,000 T POLICY PRO LOC E AUTOMOBILE LIABILITY COMBINED a e(SINGLE LIMIT _ 1 000 000 B ANY AUTO BODILY INJURY(Per person) E ALL OWNED M SCHEDULED LS563 /5/2013 /5/2014 BODILY INJURY(Per E AUTOS AUTOS ( ) X HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident E E X UMBRELLA LIAB X OCCUR Renewal of 79425FI30ALI EACH OCCURRENCE E 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE E 5,000,000 DED1 RETENTION /5/2014 /5/2015 E D WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOWPARTNER/EXECUTIVE E.L.EACH ACCIDENT E 1,000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) UB6626Y35213 /6/2013 /6/2014 If describe under E.L.DISEASE-EA EMPLOYE E 1,000,000 yes, DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT E 1 000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101.Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Denise Butcher/DMB ACORD 25(2010/05) C 1988-2010 ACORD CORPORATION. All rights reserved. INS025 r9ntnnRt nt Tha Af oPn name anri Innn arc ranictarart mar4c of A(non I ' � C/Ly C^}.C� '.ht!�{�iCZ'U K•�'�CST�`r.F4i�.^ [..F��v.`d.�Y �� C5489%9 . VICTORCIMINO 267 N.QUINCY ST ABINGTON MA 02351, 1' 05/11/2014 Otlice of Consumer ME IMPROVEMENT &Business Regulation ki—plelgistration. ENT CONTRACTOR License or registration valid for individul use only j49123 before the expiration date plration 11/28/.2015 Type' Office of Consumer 1f found return to. Private Corporatior, 10 Park Plaza_ affairs and Business Regulation INSUL-PRO INC { Suite 5170 `. Boston,MA 02116 VICTOR CIMINO _ 267 N.QUINCY STREET z- ABINGTON,MA 02351 Undersecretary Not valid without signature I ;2Ja` — •?lad RISE ENGINEERING Federar,ID41 os-u4oss2s r�' r RI Contractor Reg=ation No:8186 A division of Thielsch Engineering MA Contractor Registration No..!20979 i CT Contractor Registration No:620120 1341 Elmwood avenue,Cranston,.R103010 CO. Tp RAPT' (401)784-37U0 EAk(401):784-3710 C N R/'1�.►1 R *■ n Page 1 i S E . PROGRAM THIS CONTRACT IS.ENTERED INTO BETWEEN RISE CLC-RCS. ENGINEERING AND THE CUSTOMER FOR�WORK AS' ENGINEERING DESCRIBED BELOW CUSTOMER PHONE: 'DATE. Chant:# Tim Bates (7.74)487459.9 L2/23f.20.13 1,53140 ,SERVICE:STREET - BILLING.STREET- 41.Shell Lane �'� GX_ �7�. -SERVICE CITY,,STATE,ZIP - BILLING CITY,STATE,ZIP Cotuit;MA:02635 Cotutt,Ma U2635 JOB DESCRIPTION $0:00 PHASE TW:O-Proposal for next calendar.year:If the first piiase-occurred over 6 months agog we I igl tneed tb5khedule another Pre-Test of your home to check the.health:and safetyo,(your heating system: $0:00`. Provide labor and materials to install(322)squaze feet of R 2I:closed cell:spray.foam insulation to the,crawlspace perimeter\vall; sill;and band joists and;hasementsill and band joists: Then install a spray applied ignition harrier over all exposed foam. Any crawlspace Access within the perimeter wall will be wcatherstripNA andansulatetl to., 20. Any present crawlspace vents will.be pemianently:sealed. $1.,711`.00 Provide labor;and materials to install(374)square:;feet:of G:ml polyethylene over open;ground in designated crawlspace/earthen. basement areas: $287.98. Provide labor and materials to insulate( j back ofthe crawlspace door Vith3"rigid Therinax board,and seal ihe:edge of the hate*h with::\\eathcrstrippi ng.. $42 50: RISE Engineering will applyall applicable;eligible incentives to this contract. You will be-billed only the.NetainounL Currently,. under the Landlord Incentive,for eligible measures,the Cape Gight.Cotti Facet offers 1 m%incentive not to exceed$4,000 per calendar year and an.incentive of_100a/torthe Air Sealing measures. punei—pi q in the L75-diord',,chive,please return'a copy Gthis cvn Tact si>ned by of _thc.landLor and the tenant ate\\ell as acei of fhc yc a�roundaxntal ag>eenTant d t Total: $2,101..48 Program Incentive: $2,101.48 Customer Total: $000 WEAGREE HEREBY TO FURNISH:SERVICES_-COMPLETE IN ACCORDANCE V.RH ABOVE SPECIFICATION$..FOR,THE BUM OF **"001 Dollars- $6.00 :UPON FINALINSPECTION AND APPROVAL-SY RISE ENGINEERING.CUSTOMER AGREES 70 REMITAMOUNTDUE IN PULL..INTEREST-OF i%WILL-.BE CHARGEOMONTHLY ON;ANY UNPAID.BALANCE�AFTER;SO DAYS.SEE REVERSE l O6A IMPORTANT:INFORMATION ON:GUARANTEES;RIGHTS OF RECISION;SCHEDULING,AND;CONTRACTOR REGISTRATION., DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACE$ :AUTHORIZED/NATURE- NGINEERING: - - CUSTOMER ACCEPTANCE - t I NOTE:THIS.CONMCT:MAY'BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF.ACCEPTANCE. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES SPECIFICATIONS AND CONDITIONSARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO.`THE WORK' aDAYS. AS SPECIFIED:.PAYMENT.WILL BE.MADE AS OUTLINED ABOVE: 4 } }i} t RISE ENGINEERING FederalID#05-W5629 RI Contractor Registration No 8186 A division of Thietsch a neineering MA Contractor Registration No 120978 GT Contractor Registration No 620120 1341 Elmwood_Avenue;Cranston,Rl 029t (401).784-3100 FAX(40t)784-3710 CONTRACT Page T PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CLC'-RCS'. ENGINEERING.AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER- PHONE: DATE CIieM 9- Tim Bates (774)4874599 12/23/20.13 1:53140 SERVICE STREET -..�- BILLING STREET 41 Shell'Lane Pd �oX J j 7G SERVICE CITY,STATE;DP BILLING CITY.STATE;ZIP. ^ Cotuit,MA..02635 Cotuit .Ma;02635 JOB DESCRIPTION PHASE ONE-Proposaffor this calendar year. $0.00 Provide laborand materials to seal areas of yourhonie against;wasteful;excess airacakage: This work:will be'performed"in concert with the use of special tools and diagnostic.tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to-be used to scal:yourhome can include caulks,foams;weatherstripping and other products. Primary areas forsealing inctude air leakage to.attics,basements,:attached garages and other unheated areas:(windows are not generally addressed.) (15)workinghours.. At the completion of the wcatherization work,and at no additional cost to the tioroeawtier a final blower doorand/or combustion _ . safety analysis will be conducted.by the:sub-contractor to ensure the safet}ofthe indoor air quality. 155.00 Provide labor and materials`to install.-a 14'layer o.f.R-44 Class,] Cellulose added to(973)sgoare feet of open attic space:; $1 a08.15 Provide labor and materials to make(2) temporary access to ari attic area thr6ugh:06 roof `fhe opening will be,closed with materials:similar to those existing.Roofing will:be sealed properly when insulation work is.complete. �18484 Provide labor and materials to install;ventilat on chutes.in(0.)rafter bays to maintain airflow. ;$226:85. Provide laborand.materials to install:blown in Class l:C.ellulose;to(1078)square feet of exferior walls with:via siding. RISE Engineenng .will apply all applicable,eligible incentives:to thiscontmct Y66 will be trilled only the Net:ainount.:Currently, under the Landlord Incentive,for eligible measures,:the Cape Light Compact ofrers I , A incentive not to exceed$4,000(?er. calendar year and an incentive of 100%for the Air Sealing measures. ,o ticira a riiths f andlord in" ccnuve,please wtv a coPS- of this ton ract�signed-by b ii the t nnddlo3 nd t e ie`na`af 7—Ue i as 8 cm of the)tar-round rental_agrement. � $0.00 YdN Uorl i AN I i I 4 RISE ENGINEERING Federal I0#05-0405629 RI Contractor Registration No 8186 A division oiThieisch Engineering_ MA Contractor Registration No 1209,79 11 CT Contractor Registration No 620120. 1341 Elmwood revenue,Cranston,Rt Q29:10 (401)784-3700 FAX.(401) P-3710, C O N T i' ACT Page 2 S E PROGRAM THIS CONTRACT:IS ENTERED INTO BETWEEN-RISE CLC-RCS- ENGINEERINo AND THE cusroAAEri FOR waRH As .. . E ENGINEERING. DESCRIBED 6LOW CUSTOMER- PHONE DATE Cliem># Tim Bates (774)4874599 12/23/2013 153940 :SERVICE STREET BILLING�BTREET 41 Shell Lane'. 41 Shell Ln SERVICE CtTY,.STATE,LP —�� BR,LfNO CITY;STATE;LP - - Cotuit MA_02635 , r Cotuit,Ma 026a5, JOB DESCRIPTION Total:: $4961.34 Program Incentive: $41961.3.4 Custo er WE AGREE HEREBY TO FURNISH SERVICE ._COMPLETE IN ACCOROANCE WITH',ASOVE SPECIFICATIONS..FORnTHE SUM'OF Total: $O.00 S ***001 Dollars $000. UPON FINAL INSPECTION:AND APPROVAL BY RISE.ENGINEERING:CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST'OF 1%MALL BE CHARGED:MONTHLY_ON ANY UNPAID BALANCE.AFTER 30 DAYS.SEE REVERSE.FOR IMPORTANT INFORMATION ON GUARANTEES,;RIGHTS OF RECISION,SCHEDUUNG;AND CONTRACTOR REGISTRATION:. W DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES, AUTHORIZED SIO -RISE-ENGINEERING - - - ,. -✓ CUSTOMER ACCEPTANCE. NOTE:THIS CONTRACT MAYBE.INITHDRAWN BY'US'IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDMONS ARE'. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOUARE AUTHORIZED TO 00THE WORM' ,.._...s.....,.,..Y DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS ABOVE Cape Uf3h . tOnnpact - - GENERAL:RE,LEASE OF LIABILITY AND WAIVER OF CLAIMS This is.a.general release of liability. Please read.carefally before signing. Customer,listed lie.low,hereby executes#his General Release and Liability and Waiver of Claims (the"Release")voluntarily in,order to participaiOn programs,events oractivities offered,sponsored by adm nistered::by the Cape Light Compact(the"Corripact")and:RIS.E Engineering,a division ofThielsch ,.Engineerng In consideration of such participation,Customer agrees.to as follows: 16. Customer;,forhitiAersel'fand l sther personal representatives,.heirs,and next of kin,releases,waives, discharges and covenants not to sue the Compact,.its members,its contractors(includi;ng'RISE Engineering)and each of their officers;directors,employees;.representatives.,agents and volunteers; (hereinafter referred_to as"Compact Parties");:from all.liabilityto Customer,his/her personal representatives,assigns;heirs,next of kin,for all loss or'damage,and any claim demand;action or right of action,of whatsoever kind or"nature;either in law or.i,n equity arising from or by reason of any bodily injury orpersonal injuries.known.or un.knoN'vn,death ancl%or property damage which mayoccur a ;a result of participation in.any Compact program,regardless of wF ether:such injuries are caused`by negligence of the..Compact Partiesor.otherwise: 2i Customer;agrees that this Release is intended to be as:broad And:inclusive as permitted by the laws of. the:Commonwealth of Massachusettsand that if any portion of this Release is held invalid,it is agreed that the remainder will continue:in full legal for4e and effect: 3. This Release contains the entire.agreement between the parties:.and Customer isnot.relying on,any oral, or written.representation or statements made.:by any of the Compact Parties.. 4.. Customer'hereby.declares thathe/she is of legal age and is competent to sign this Release. By.signing this,Release,;.Customer acknowledges.that he/she has:carefully read.this Release; understands it,.agrees.'.to,.be bound by it,:and signs it on;his/hOr own freewill: Customer's executing this Release in.connect�on with his/her panc�apation with;the follov n Compact . . program: Customer has requested.installation of spray.foam m"sulation in;l islher'home. Customer understands that there are risks and.hazards associated with spray foam and specifically ackn'owledges:receipt of written materials safety data sheet.(MSDS)explaining such:risks and.hazards. Customer:acknowledge-s:that the.:Compact specifically recommended`use of traditional cellulose:and/or fiberglass:.insulation.Based upon Customer's request,the Compact has:agreed to incentivize the installation ofspray foam insulation::thatmatch the traditional k insulation.recommendat ons:in Customer's Nome Action Plan. Customer understands that his/her home's incentive of thespray foam costs will be equiv„aleirt to the total incentive allowable attl the trad t onal insulation cost. Customer acknowledges that he/she shall.:assume any defects in,materials,manufacture;design,or installation of spray foam.insulation. 41 Signature of.Customer: •°G�h Date; Print Name and Address of Customer.-7?4L�C :C' 1/U�r(ji/}K.S i 0 VI&c SSI IF t rhy d K.tt(GZIe3`t diudS '. �fi Sf46L- �CcS'i u.r T'' tM f ` f f 7. k , r i t OWNER AUTHORIZATION FORM (Owner's:Name) owner of the property Located at l (Property Address) (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's -.Si (�2.L{ 'I bate f i f , i t s f j 5 f F S 4$ 4 r t t E r i E 1�r Town of Barnstable ci21�' THE E Regulatory Services m"o K * » Thomas F.Geiler,Director 57/ » * i ■ARNMBLE. * Building Division � 1639. ArEo �a` Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 , , ^ 0'j www.town.barnstable.ma.us �/�/� v Office: 508-862-4038 Fax: 508-790-6230 PERMITM��)6 (::6 -((-e FEE: $ s�- SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less CUT-iA 1 �� Location of shed(address) Village t�✓�."vice L� ►l,(,\ S Cl - Zoos Property owner's name Telephone number 8 x iz r) (gj 1 � Size of Shed Map/Parcel# Signature Date b—f c C Hyannis Main Street Waterfront Historic District? l-3 b Old King's Highway Historic District Commission jurisdiction? 00 1 —� If over 120 square feet,you must file with Old King's Highway cv 4-- r-n Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:052813 school St G 4 APN 19-130-001 Clf 93.00 93K 66.00' BAY :25 STK TgK4 94.03 / APN 19-127 M 0.33 Ac.f " +92.28 - ore . i Shell Lane °f APN 34-002 LOCUS-119• _ 23' 93.07 LOCUS MAP I RESET T NOT TO SCALE - I V� }I- / - - I -3 I �7P�i j N 94.55 ' --98-- EXISTING CONTOUR 09 11y� _AREA 93.01 I x . Cb =.se EXISTING SPOT GRADE , \ 1 '-`�23 I :' 102 PROPOSED CONTOUR ._PR _•--�- 22' -W- EXISTING WATER SERVICE �� +�:. OP, S•AS.... ,53.52 -O:H:W.-OVERHEAD WIRES 0 TEST PT 0 BENCHMARK PROPOSED SEPTIC TANK ' }_�21' LEGEND 0 a /r , ` G BENCHMARK SET \_ ° 95+2�� , APN 19-09.3 OUTSIDE CORNER OF N " 9 .74 i' v CONCRETE SHOWER PAD +( EL.=97.91 (ASSUMED DATUM) � N +97.72 v y.----- 97.35 0 (,,Z. N� I� '.97.83 UD PROPOSED SEWER CONNECTION +96. 8 TIE IN AT, OR ABOVE, INV. 93.0 _ -_I - (INSTALL CLEANOUT) - I 9� +9 .10 t 7,91 1 r , i EXISTING CESSPOOLS 11,.97.96 Y9 .67 I '--0+ib (FROM RECORD AS-BUILT) - .t_ I� j +9 .7 980 CONTRACTOR SHALL LOCATE, - PUMP AND FILL WITH SAND APN 34-001T 1Ac - 6.9 9 .07 DECK + 9 .16 IP FND PROPOSED SEWER CONNECTION 100.03 x, EXISTING + /1 TIE IN AT, OR ABOVE, INV,=93.0 - 9 � + HOUSE(# /41 TO.F.=102.34t PLAN REFERENCES: /j 100.48 LAND COURT PLAN 15287 A �t 10 .51+ PLAN BK 38' PG 117 DRT 10@. G 63. 04 I PLAN BK 140 - PG 37 - M DRIVE _ 'PLAN BK 169 - P 3 210 0 _ PLAN BK 563 - PG 50 - - C6, 1OG02 BR/CK�WALK t DIRT - - FOUNDATION CERTIFICATION - // 100.34 I DRIVE O� 1159 MAIN STREET, 9/23/05 - ' PLOT PLAN OF 45 SHELL LANE- SENNETT.ENGINEERING, 3/11/09 / 28.54� 3 100. CB/dh 33.-------"100.0ui9-___ ttP FN77 _ 99.60 9 97 300 -< 10 .64" 100.00 99.72 99.80 edge of povement ? 9965 GENERAL NOTES: 99.62 . 99.55 i.ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SyELL LANE BOARD OF HEALTH HIS THE DESIGN ENGINEER. 2.ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE,TIR E V.AND ANY APPLICABLE - - LOCAL RULES AND REGULATIONS. 3.THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKnLLED PRIOR - TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. _ � OF <.ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN o PETER T. ✓„ - ENGINEER BEFORE CONSTRUCTION CONTINUES. - MCENTEE " 5.ALL ELEVATIONS BASED ON ASSUMED. o CIVIL " 6.THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF o. 35109 OWNER OF RECORD .THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF p -_ Diane Roper HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 'QECI$1E ' 7.WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. f' I 53 Cedar Pond Drive 8.THERE ARE NO WELLS WITHIN 150'OF THE PROPOSED SAS. I Walpole, MA 02081 - 9.ALL AREAS CLEARED FOR'CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. PROPOSED SEPTIC SYSTEM UPGRADE PLAN 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY - THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO-BEGINNING 41 SHELL LANE, COTUIT, MA 11.WHERE REQUIRED,CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS Prepared for: D.A. Brown, Inc., P.O. BOX 145, Centerville, MA 02632 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE SAS.AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). Engineering by. �T�r� y_ SCALE DRAWN JOB. N0. 12.AREAS REQUIRING SRDEPAR OF UNSUITABLE MATERIALS SHALL BE Englneenng Works,Inc. 1"=20' P.T•M• 127-10 INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFlLL - 13.THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND - 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. (508) 477-5313 3/26/10 P.T.M. 1 Of 2 ' Town of Barnstable �p THE Tp� Regulatory Services Richard V. Scali, Director Building Division BARNSTABI,E FhPNSTABLE•CSMER4?LL[•COTJR•IIYANIi15 MASS. �9 �i5i0N5!'I:5• 1EFYILLE•WKfMP45TA8LF� i639. `�V Thomas Perry, CBO 1639.2014 ArF01"0sA Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 July 17, 2014 Victor Cimino 267 N Quincy St. Abington, MA. 02351 RE: Insulation Permit Applications Dear Mr. Cimino, This letter is in response to applications numbers 201403977 and 201403981 submitted to do various weatherization works. Unfortunately, the permits can not be approved at this time because compliance with 780 CMR 408.3 and 316.5.4 are not demonstrated. Details demonstrating compliance is needed before a permit will be issued. Thank you for your attention in this matter and please do not hesitate to contact this office with any. questions. Respectfully, r L. Lauzon Local Inspector Jeffrey.luzongtown.barnstable.ma.us s (508) 862-4034 FRMIT PAYMENT, RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT, 200 MAIN STREET RANNIS, MA 02601 DATE ` 06/17/14 TIME: .09:47 ----.------=----TOTALS--------`--= --= PERMIT $ PAID 50.00 AMT TENDERED: 50.00 AMT APPLIED:- 50.00 CHANGE: .00 APPLICATION NUMBER: 201403981 PAYMENT METH: CHECK PAYMENT REF: 29600 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a Map 1A Parcel Ppploication #'e Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address / S�►e// Village ltCo Owner Py cL t 414 tic�pl.� tV 61/ty.^�l Address I p .O b a K 1 3 76 Telephone 7 7 V 7- � Permit Request I AJ 14 3� I kese-c R�/ 4 gr, w✓m 1`!Alton lx/��r oit Gl �. t/bGn`}`)�H�7�11 ��rY� �� `lu� ' lrh r.JtA/-- NJA� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation — Construction Type d Lot Size Grandfathered: ❑Yes ❑ No If yes, attach su porting doDumentation. - _ Dwelling Type: Single Family CY Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway:LU Yes"s❑ No j Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other c'fyy £'T9 WJ Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage•,❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name -��"P/w //-,i/fG)�%e— a Telephone Number 7tf— oPL JL Address 2 7 /1/, License # oh �;6O f /t�6 jt:12 O 2-3J) Home Improvement Contractor# c S 12- Email VtC1VV-(!5? 1"Ajd/!Lo the Cos^7 Worker's Compensation 0A W 6 Y35 2/� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOCi - CCri rrt ✓/! o� ✓�h /�'l. SIGNATURE�C` a _ DATE FOR OFFICIAL USE ONLY APPLICATION# i DATE ISSUED MAP,/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING DATE-:CLOSED OUT ASOCIATION_PLAN NO. - 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel pplication # Health Division Date Issued ' Conservation Division Application Fee �" Planning Dept. �._ Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address �f S e// L� Village Owner `611�rlp4 L,l I I;'lh� r Address �0, b a x 3 7� Telephone 77 Ll - (I4 7- C�.rq t sj Permit Request 1,1J 7 'ill 3 (1 r-21)(.1ose e--11 w.ay� l Ste,Tin ,//o/ c� c%. ✓/ w�lJi, �l � �w 6-1 ((� /a�/�G�f/ S P� �fitl� t l2q4,-1 , �/TC,II f 9 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation )661 �Z Construction Type =' B Lot Size Grandfathered: '❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0-' Two Family ❑ Multi-Family (# units) "A Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway:-U Yes-) ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other jri Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing , new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric 0 Other Central Air: ❑Yes ❑ No Fireplaces: Existing (. New Existing wood/coal stove: ❑Yes ❑ No Detached gal ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garag4- ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name n��/_ (G /�1/;C fig/ �' /,0 G Telephone Number Address vupl ly 'License #Z07 5 � 14 S 0 Z 3f Home Improvement Contractor# 1`'l 5 /Z 3 Email V iC 1(11'� r n f1/_15tU %11C Worker's Compensation #)A/96 6 2 6 t 3S Z/� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO (_`7 C�rkl O!,-7 C�i`y SIGNATURE --- DATE is F FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED J MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. RISE;ENGINEERING federal ID4 06-0405629 RI Contractor Registration No 8186 A division of ThiIelsch Engineering IWA Contractor Registration No.1209 0 CT Contractor Registration No,620120 11341 Elmwood Avenue,;CranSton,R102910. CONTRACT �! (461p784-3700 FAX(401)184-37'1 Page 1 I T E: PROGRAIvt .. THIS CONTRACT IS, INTO BETWEENRISE CLC-RCS ENGINEERING:AND THE CUSTOMER FOR WORK AS' E'N�t�� 'N.G - OESCRIBEDBELOW 'CUSTOMER PHONE DATE. :Cllnttt0 Tim Bates (774)487-4.599 12/23/2013 11 3140 SERVICE STREET aiLuNG-[STREET 41.Shell L.atie Q.; —W- )3 Z6 SERVICE CITY;STATE,LP - BILLING CITY,STATE,ZIP ` Cofutt,MA.02635 Cotutt,Ma 02635 JOB DESCRIPTION $0:00 PRASE TWO-Proposal:for nett calendar year.If tfie.'first phase,occurred over 6 months agog we might need fosehedule-another Pre-Test of your home to check the:health and safety of your heating system: Provide labor and materials to install(3,22)squaze feet of R-2'I,:closed`cell spray foam insulation to the_crawlspace perimeter wall., sill and band joists and basement.sill and band joists. Then install a spray.apphed ignition barrier.overall exposed foam. Any craWlspace access withiilahe perimeter wall:will be weatherstripped and insulated to;R=20.. Any present craw, lspace yenis will:be pernizinentlysealed. $i,771.00 Provide laborand;materials to iostall.(374)square-feet:of 6 ml:polyethylene over!open,groun8 in designated:.crawlspace(eartheq basement areas; $387:98-, Provide laborand materials to insulate(i) backof the craw,spIce door wiih3"rigid Thermax:board-,and seal he:edge ofthe.hateh wit It�1 eatherstripping.. $42 50 RISE Engineering will_apply all applicable;eligible mcenti�cs to 1his contract. Ymr. ill be.billed only the Net amount. Currently,. under the Landlord incentive for ehglble measures,the Ct*Light Com.p act o,5 10.0%incentive not to exceed:$4 000 per calendar vear and an incentive of I OOY forthe Air Sealing measures pep trtrclp r e:in'the l andtc Ord uiccntne please rety ,'a copy a , '. =contract sl�ned ut ttte.larullnrd and the tenant. yell a }of tlTc yeas and ruTtal-agreement— 3 j Total: $2,1"01.48 Program Incentwe: $2,10148 Customer Total: $0:00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE Itd ACCORDANCE WITH ABOVE SPECIRCATIONS.:FOR THE SUM.OF ***00/Dollars` $0.00 . UPON FINAL INSPECTION AND:APPROVAL:BY.RISE ENGINEERING.-CUSTOMER AGREES TO�.REMIT AMOUNT DUE IN FULL.:INTEREST OF 1%WILLBE CHARGEO.MONTHLY ON ANY UNPAID.BALANCEAFTER 0DAYS:SEEREVERSEFOR'IMPORTANT.INFORMATION ON:GUARANTEES RIGHTS':OF=RECISION.SCHEDULING AND,CONTRACTOp REGISTRATION. DO NOT SIGN THIS CONTRACT 1F THERE ARE ANY BLANK SPACE$.I�- ,tleP4 AUTHORIZED .,NATURE'-RISE:ENGINEERINGi - CUSTOMERACCEPTANCE ...-... 2 NOTE:THIS'CONTRA CTMAY BEWITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF:ACCEPTANCE: J i ACCEPTANCE OF CONTRACT-THE:ABOVE PRICES,SPECIFICATIONS AND CONQnTON3 ARE (/ SATISFACTORY TO US�AND ARE HEREBY ACCEPTED.YOU ARE AUTHDRIZED TO-DO:THE WORK <OAYS: AS SPEORED.PAYMENT WILL BE MADE AS OUTLINED ABOVE: 1 i 3 1 RISE ENGINEERING Federal ID#as-oaos629 RI Contractor Registration No 8188 A division:of.Thielsch.Engineering MA Contractor Registration No 120979 CT Contractor Registration Nd 626126 1341 Elmwood:avenue;Cranston,R102910 CONTRACT (401):784-3700 FAX(401).184-3710 S }E Pang , B PROGRAM TNISCONTRACT IS£NTERED WTO BETWEBMFUSE CLC,RCS'. EwOINEinh ANO Twit CUSTOMia mil wORKAs E,i' G1.N'MING DESCRIBEd BELOW 'CUSTOMER PHONE. GATE CIems Tim.Bates (774)187-4599 12/23./2013 1:53 l40 SERVICESTREET - BIWNG STREET - 4.1 Shell Lane pd 61V,1( 13 SERVICE CITY,:STATE.ZIP BILUNO CITY;STAM ZIP0. Cotutt,MA.02635 Cotutt,Ma;0263'S JOB DESCRIPTION.. PHASE ONE-ProposaMr thiscalendaryear; $0:00 Provide labor and materials to seal areas of your home against'wasteful,excess air leakage. This Work:will be.performed:in concert with.thc use ofspecial tools and diagnostic tests to ass urc Ihat your home will be leftwith'aHealthfut level of airexchange and indoor air quality.Materials to be:used-to seal your home can include caulls,foams;weatherstripping and otherproducts. Primary areas for sealing include:air leakage to attics,.basements,attached garages and other unheated:areas(%vindows owe not generally addressed) (15)working Hours. At the completion of the catheriiatidn;work,and at ho additional cost to he Homeowner.a final blower doorand/or combustion safety analysis will be conducted by thesub=contractor to ensure the safety of the:indoor.airquality.. $1,155<t)0 Provide labor and materials to install a.a4".layer o.f.R 49 Class l Ccllutose.added to,(973)square feet of open attic spade:: I508.:15 Provide labor.and materials to,make(2) temporary access to an attic area through.'the roof..The opening will he closed with materials similar to those existing.Roofing will be sealed properly when insulation work,iscomplete, $184 84 .:Provide labor and materials to.install.ventHat on:chutes in(65)rafter bays',to maintain.airflow. $226,95 Provide laborand,materials to.insiall blown in Class:l:Cellulose.to(1078)'squarc feet of extee or.walls with vinyl;siding. RISE Engineering ,will apply all applicable;eligible incentives;to this contract. You well be billed oniY the Net:amount. Currently;, under the Landlord Incentive,for eligible,measures;the Cape Light Compact offers 1006Y6 incentive not to exceed S4,Op6 er calendar year and an incentive of 100%for the Air Sealing measur o j acIpa t,in the f anc€lord mcenpve phase return a copy of this this to tied b� ih t e l"andJ a d e1 i"trnanT:as well as a copy of the year-round,rental agf�ement _. I - S0.00 4Lr 5; i 1 i c r — RISE ENGINEERING Federal ID#os-o40s6ss RI Contractor Registration No 8186 A division of T.hielsch Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood.;tvenue.,.Cranston.,Rt 029,11) �+ (401)`784-3700 FAA(401)784-3710. C O N T RAC T :1 g■ Page 2 RI S E PROGRAM THIS'CONTRACT:I§EIJTEREU INTO BETYkEN RISE Nlil<:1�1EEA;If� CLC-RCS' ENGINRIBED BELOWEERING:aNO THE:GusTOb1ER FOR WORIi:As DESC CUSTOMER - PHONE DATE CUentA Tiln Bates (174)4874500 1MN2013 153140 :SERVICE STREET BILLING STREET II 41 Shell Lane. 41 She Ln SERVICE CRY,STATE,ZIP BILLING CTY,STATE;ZIP - Cotuit,MA,02635 , Cotult7 Ma,02635,:. .,, g M JOB DESCRIPTION Total: $4961.34 Program ncentive: $41961.34 Customer Total: $0.00 WE AGREE NERE$YTO FURNISH SERVICES-:COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS:FOR THE SUM'.OF *"*001 Dollars $0 00. UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING:,CUSTOMERAGREES:TO'REMn'AMOUNT DUE IN FULL INTEREST:OF 1%WILL BE CHARGED:MONTHLYDN-ANY UNPAR)BALANCE:AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AMP CONTRACTOR REGISTRATION. D0 NOT SIGN THIS CONTRACT IF THERE ARE ANY SLANk SPACES< AU 0,R4EDSIG URE-RISEENGINEERING - �✓ CUSTOMER ACCEPTANCE. - NOTE:THISTHIS CONTRACT MAY BE WITHDRAWN BY USIF NOT EXECUTED WITHIN DATE'OF ACCEPTANCE. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE. SATISFACTORY TO US AND ARE HEREBY.ACCEPTED.YOU ARE AUTHORIZED TO DOTIE RlORM_- _..--._. :DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS:OUTLINED ABOVE t Catpe��- Co»pract r i. GENERAL RELEASE OF LIABILITY AND WAIVER OF CLAIMS This is a:general.release of liabil ity. Please read carefully before signing. Customer.,listed`be.locv,here-by:executes'this General Release acid Liability and Waiver of Claimt (the"Release")voluntarily in:order to participate in programs;events or activities offered,sponso"red: by administere&by the Cape Light Compact(the"Compact")and RISE Engineering,.a division of,Tl ielsch Engineering In consideration of such participation,Customer,agrees-to as`follows 1:. Customer;for him/herself.and and personalrepresentatives,..heirs;and next of k hjel.eases,waives,. discharges and covenants not to sue the Compact,its members;its contractors(including RISE Engineering)and each.of their officers;.directors,employees,.representatives,.agents and volunteers; (hereinafter referred to as"Compact Parties"),:from.all liability to Customer,his/her personal representatives,assigns,heirs,next of kin;for al loss or'damage,and any claim demand;action or right of action,of whatsoever kind or nature;either iri law or in equity arising;from or,by rea on of any bodily injury or personal injuries known or unknown;death and/or property damage which may-occur as,a Tesult of participation in,any Compact prograrn,regardless of whether such injuries:are caused by negligence of the:.Compact Partiesor otherwise: 2. Customer:agrees that this Release is intended to be as:broad and inclusive as permitted by the.laws of the Commonwealth of Massachusetts and;that if any portion of this Release is held invalid, it is agreed that the.reinainder will continue in full legal force and`effect: I. This Release contains the>entire:agreement between the parties:and Customer;is;not relying on,any oral or written.representation or statements:ma:&by.any of the Compact Parties. 4.. Customer herebydeclares that he/she is of legal age and:is competent to:sign this Release. By.signing.thisRelease,Customer acknowledges that.he/she has:carefully read.this Release; understands it,agre-es:to:be bound.by it,,:and signs it 60.his/her own freewill: S Customer's executing this Release in connectionw�th his/her artici ation w�ththe followm Com P p: g p ro m: Customer has requested:installation of spray-foam insulation in his/her home. Customer understands that there are:risks and hazards associated with spray foam and specifically a ckn'owledgesxeceipt of written materials safety data'sheet:WSOS)explaining such risks and hazards. Customer.acknowledges.that the.Compact Specifically recommended'use of:traditional cellulose:and/or fibergiass insulation..Based upon Customer's: request,the Compact has agreed to ineenti.vize the installation of..spray foam insulation;that match the traditional. insulation.recorrimendatiom in Customer's.Home.Action Plan. Customer understands that his/her home's incentive.of the spray foam costs will be equivalent to the total.incentive.allowable at the traditional insulation cost. Customer:acknowledges that he/she shall.:assume any defects in matdia.ls.manufacture,.design,or { installation of spray foam insulation. Signature of Customer: 5 �• V� �^" a>--�! Rate: Print Name and Address!of Customer: Ra.�Cq ':C'. `W�,��i/hs , P O t S'l c,¢;�Tagil at111 GL3 2 - T _ ... $ i OWNER AUTHORIZATION FORM JL (Owner's Narne) � — i owner of the property located;of 4e (Property Address) (Property Address) hereby authonze , (Suticontractor) } an authorized subcontractorfor°RISE Engineering, to act on thy:behalf to obtain"a building permit and to perforrn work on my property: � e Owner's Signature Date t f i i ' I r i } i i s I he Uommonwealth of Massachusetts Department of Industrial Accidents ,. V I Office of Investigations Ii 1 Congress Street, Suite 100 l Boston, MA 02114-2017 www mass.gov/dta Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 4,f y DrO Address: //� K r City/State/Zip: �l In �� /f'l S 0�)S� Phone k 7,A/ Are y an employer?Check the appropriate box: T��re of project(required): 4. I am a general contractor and I 1. I am a emplo}%er with ❑ 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [] Remodeling ship and ha-a 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 are a corporation and its 10.❑ Electrical repairs or additions q ] 3. work officers have exerc El their 11. Plumbing repairs or additions❑ I am a homeowner doing all myself. ' right of exemption per MGL �o workers comp. 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no f employees. [No workers' 13.UKOther! 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. 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. I an:an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Il, tie1cif t�, (O Policy#or Self-ins.Lic. #: k A V B � 6 L (o Y 3 S L 1 L/ Expiration Date: Job Site Address: W f 4?l� �n City/State/Zip:60 tv/ A y GZ(�1f 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 ceg0,under the pains and Eenalties c 'ur 7 that the in/brmation provided above is true and correct Si store: -.- Cjc y ,p� _ _. _ Date:_ __ _ _.. Phone#: �t/ U 4JL Official use only. Do not rite 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#: f ACOR& DATE(MM/DD/YY" CERTIFICATE OF LIABILITY INSURANCE 5/6/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Denise Butcher NAME: Strategic Insurance Solutions, Inc. PHONE (617(A/C No )$5B-710O x122 FAC o.(781)459-8282 2000 Commonwealth Avenue .ADDRESS:IL db@strategicinsure.com INSURERS AFFORDING COVERAGE NAIC# Newton NIA 02466 INSURERA:Scottsdale Insurance Company INSURED INSURERB:Commerce Insurance Company 4754 Insul-Pro Insulation Co. , Inc. INSURERC:TOT3 National Insurance Co 267 N. Quincy St L1 INSURER D:Travelers CasuWlty & Surety Co INSURER E: Abington MA 02351 INSURER F: COVERAGES CERTIFICATE NUMBERCL145602872 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUOR LTR TYPE OF INSURANCE POLICY EFF POLICY EXPO' POLICY NUMBER MWDD/YYYYI (MWDDfYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE To RENTEG PREMISES Ea occurrence) $ 50,000 A CLAIMS-MADE Fx_1 OCCUR CPS1914781 /13/2014 /13/2015 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY J'CPRO- LOC $ AUTOMOBILE LIABILITY EO aBBIINED)SINGLE LIMIT 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED M SCHEDULED S563 /5/2014 /5/2015 AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAB m OCCUR EACH OCCURRENCE $ 5,000,000 C X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTIONS 0 79425F141ALI /5/2014 /5/2015 D WORKERS COMPENSATION OTH- $ X WC STA LIMTUS AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? El N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) XAtM6626Y35214 /6/2014 /6/2015 If yes,describe under E.L.DISEASE-EA EMPLOYE9$ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attech.ACORD 101,Additional Remarks Schedule.H more mar Is reaulred) 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. AUTHORIZED REPRESENTATIVE Denise Butcher/D11B ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025r7ninnsi nt Tho Af_npn n2mo and Inn^moo roniefororl mar4e of AtInRn Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor r F; License: CS-089969 VICTORCHVHNO;` r 267 N.QUINCY ST ABINGTON Expiration J 05111/2016 Commissioner I Off, ce of Consumer Affairs&Busin�s 'Ire crc�r`3elf ME IMPROVEMENT C Regulation License or registration valid for individul use`onl V ~R gistration: 149123 ONTRACTOR before the expiration d s XpImtr°° 11/28/2015 Type' Office of Consumer Affairs and Business ss Regate. If found return Y e = Private Corporatior, 10 Park Plaza_ Regulation INSUL-PRO,INC s Suite 5170 Boston,MA 02116 VICTOR CIMINO - 267 N.QUINCY STREET ABINGTON, MA 02351 Undersecretary Not valid without signature School St APN 19-130-001 ! N __94 C07W 93,00 S93 25K 66.00' > STK TK a ; / 94.03 �o `t z / p. / =� APN 19-127 (b oC - Zo 0.33 Ac.f ; a M e + 92.28 i Ocean f APN 34-002 Shell Lane / v / LOCUS Lo 1g, 23_-�I{ 93.07 / LOCUS MAP 0 RESER l /�/ NOT TO SCALE N / 94,55 t 9 09 ' AREA 93.01 M n/ -- 98 -- EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE -��_ 2_3' Lv � 22, 102 PROPOSED CONTOUR S.q.$ l j 7Pr2 -W EXISTING WATER SERVICE `� rj P. i•J /h.52 / -O.H.-W.-OVERHEAD WIRES936 TEST PIT $ BENCHMARK PROPOSED SEPTIC TANK J_ -21' LEGEND x 094.79 0 00 / o; ° / 95.87 24 BENCHMARK SET APN 19-093 OUTSIDE CORNER OF N�� 9 .74 �'� d CONCRETE SHOWER PAD ^ F +f + 97,72 Na.w EL.=97.91 (ASSUMED DATUM) _ / 97.35 08 cv /97.83 PROPOSED SEWER CONNECTION 1- 96, 8 TIE IN AT, OR ABOVE, INV.=93.0 (INSTALL CLEANOUT) ± " Eck + 9 ,10 + 7 5~ 6 - i EXISTING CESSPOOLS \� 97,96 r 7 66 c) .67 ---'6 (FROM RECORD AS-BUILT) 9 .7 98.0 CONTRACTOR SHALL LOCATE, { PUMP AND FILL WI TH SAND s:..s.,..-.., APN 34=001 8.9 + ,07 DECK 9116 IP FNEI F f` PROPOSED SEWER CONNECTION 100.03 x TIE IN AT, OR ABOVE, INV.=93.0 -, 99,60 F EXISTING + HOUSE(#41) T.O.F.=102.34f - -- ---100 100.48 PLAN REFERENCES: ! .� 10 .51 LAND COURT PLAN 15287 A + PLAN BK 38 - PG 117 DIRT 10Q04 -~--- PLAN BK 140 - PG 37 /Y�:_�� 1 PLAN BK 169 - PG 63 DRIVE 0 0.. rn PLAN BK 563 - PG 50 / BR/CA'_WALK -I S� DIRT M 100..02 ��` 1 DRIVE CERTIFICATION / 100.34 Op 1159 MAIN STREET, 9/23/05 / PLOT PLAN OF 45 SHELL LANE / 5 28 BENNETT ENGINEERING, 3/11/09 �� 3 100. 5 33•F _____771, ;l`__ N CB/dh 100.09 0 .69D - 99 97 � 99.60 -100.00 99.72 99.80 edge of pavement = 99.65 GENERAL NOTES: 99.62 99,55 a 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED,BY THE LOCAL SHELL LANE BOARD OF HEALTH AND THE DESIGN ENGINEER. - 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS V OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE Y LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR. TO INSPECTION AND APPROVAL BY .THE BOARD OF HEALTH AND THE' DESIGN ENGINEER. MgSs9� 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO,THE DESIGN o PETER T. s ENGINEER BEFORE CONSTRUCTION CONTINUES. g f McENTEE 5. ALL ELEVATIONS BASED ON ASSUMED. o CIVIL 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF a, 35109 OWNER OF RECORD THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF Diane Roper HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. o RfG/S1ER� 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. OFFS / EG 53 Cedar Pond Drive 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. f( / Walpole, MA 02081 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS �� It AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE p /� DIRECTED BY THE APPROVING AUTHORITIES. f PROPOSED SEPTIC SYSTEM STEM UPGRADE PLAN 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR-TO VERIFY THE LOCATION OF ALL UNDERGROUND,UTILITIES, PRIOR TO BEGINNING 41 ( SHELL LANE COTUIT MA CONSTRUCTION. f 1 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS Prepared for: D.A. Brown, Inc., P.O. BOX 145, Centerville, MA 02632 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). Engineering by: SCALE DRAWN JOB. NO. 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE Engineering Works Inc. 1"=20' P.T.M. 127-10 INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. s 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. (508) 477-5313 3/26/10 P.T.M. 1 of 2 4 ^