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0220 VINEYARD ROAD
�� V, ��y��� �� ,� �� �pptXE►p��pw Town of Barnstable % BAE. Regulatory Services 9 MASS. 039. MP �0 Building Division prEO y a 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice i Type of Inspection E,^)A L Location Permit Number Owner Builder I One notice to remain on job site, one notice on file in Building Department. j The following items need correcting: ��uga7-,JG F:1;eFPL-1KE RAS GAS iz-,.)E t✓ { A, 21NZ L -TD 8/'H 5En F./+1T N6 r /3677-be N TAuoUS F:71ZOw— Pli)M--IeO Fwur2 t�f�o-r Cc7--F,V. PA i'J C.1.S N)157 PRE.->Kl. -2 N o AA RID A9-r- h--M4 4Db C�> b0orZ5 Not" h-L- , (,)oRkS-,JG PF-6fEgLy V -finQEtt*-.p GLAWtU N6r P 'f'&r* f W& Tug U,pia 5 be FbPnnn Artrc Please call: 508-862-4038 for re-inspection. Inspected by 1 �,,, , J Date I I2,y I3 i i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r Map � 0]i� Parcel �����/ o Application # � J Health Division Date Issued 1::4 44- ) n Conservation Division Application Fee Planning Dept. Permit Fee t CYD Date Definitive Plan Approved by Planning Board O(i, V" Historic - OKH _ Preservation/Hyannis Project Street Address oho& a V kVVC�A4 (?C C9)41zI Village Cyl� Owner (21&n a.ZQ gn 4/U45' Address YY Mm j� 5� &z 4l:K4 n . Telephone 6/2 6/7 0 Permit Request I Py4<A, vz c �2mS4 , _06-9 o u, o o Ae4 fv IgOOQ g4An p /L� �-. Gar► -h /a-n1 Square feet: 1 st floor: existing�roposed 2nd floor: existing proposed Total new 0 Zoning District Flood Plain Groundwater Overlay Project Valuation _')0240,0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 41 Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ;Q No On Old King's Highway: ❑Yes 2 No Basement Type: S Full I.Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) •-6 Basement Unfinished Area(sq.ft) Is-ocO 6L Number of Baths: Full: existing new 1 Half: existing ! new Number of Bedrooms: 5 existing 6 new Total Room Count (not including baths): existing _anew 0 First Floor Room Count Heat Type and Fuel: ❑ Gas ® Oil ❑ Electric ❑Other Central Air: ®Yes ❑ No Fireplaces: Existing f New Existing wood/coal stove: ❑Yes ® No Detached garage: 0 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 ❑ Q Commercial ❑Yes ❑ No If yes, site plan review # C) Current Use Proposed Use APPLICANT INFORMATION W (BUILDER OR HOMEOWNER) Name �2 e C��6G9'?r� Y Telephone Number +dress f P 60x l `l S License# C S 5'7661 Home Improvement Contractor# ilA�6 Worker's Compensation # C9 6 3 In Z6-0 9' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO DATE SIGNATUR FOR OFFICIAL USE ONLY APPLICATION# t . _ 4�1 DATE ISSUED r �. MAP/PARCEL NO. A ADDRESS VILLAGE OWNER t L DATE OF INSPECTION: FOUNDATION 11 ev FRAME Bk ro�6u f r /a ti'v iL�N�k/ E ti `INSULATION 4INS.sc 'FIREPLACE ELECTRICAL: ROUGH FINAL A?r r F �. "PLUMBING: ROUGH FINAL GAS: - �r: ROUGH FINAL 'FINAL BUILDING 6 2AIt .S1 DATE-CLOSED OUT ASSOCIATION PLAN NO. _ r ToWn of Barwta le Regulatory 5erwices Thomas F. Geiler,Director ,6s �,�� Building Division Thomas Perry, CB O,Building Coxnxnissioner 200 Main Street, Hy�s,Nam- 02601- YW W.town.barnstable.ma.us Fax: .508-790-6230 Office( 508-862-4038 P Al .a.o 10 `ol , 9 a M /Parcel: 0l6- Do, DO Owncr: �N vAJl P r �D . : Builder: project Address ZZD .y—IIVCY. The fallowing items were noted on reviewing: �Jj W: � c LA ZS s G-�ts Pt e2 S L N fo C-izE- ReY-iewed by: y Ira- Date: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street .' Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information t Please Print Legibly Name (Business/Organization/Individual): FA L LC_ Address: 1 City/State/Zip: C_4b u J 35 Phone #: 56 9 or)- 9o'Z Are you an employer?Check the appropriate box: Type of project(required): l ZJ am a employer with 2 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' y p �'• $ 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy 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 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: cl z�J Policy#or Self-ins. Lic. #: g ® �15:5 "09 raiiorla&- Job Site Address: O V10-A1 - RUB 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. I do hereby certi he nd pe ties ofperjury that the information provided above is true and correct. Signature: CC a Date: ab l0 Phone#: Cad�" Ya Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 141 E'jll 1.l'0.A liL-L O/ LO/ LV VJ J . JJ . LL. Al'l rc]4..r 1: L/ VVL I ".% U01 YOl ACORU. CERTIFICATE OF INSURANCE DATE(MM\DD\YY) 09-29-09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE WISE&QUINN INS AGCY IN HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 449 PLEASANT ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE BROCKTON,MA 02301 COMPANY 24WCB A HARTFORD GROUP INSURED COMPANY B FRASER CONSTRUCTION LLC COMPANY P.O.BOX 1845 C COTUIT,MA 02635 COMPANY D COVERAGE 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 19 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMMD\YY) DATE LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL PRODUCTS-COMP/OPAGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Anyone fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALLOWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE UABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-0341M556-09 09-26-09 09-26-10 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 500,000 PARTNERS/EXECUTIVE INCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: X EXCL DISEASE-EACH EMPLOYEE $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THUS REPLACES ANY PRIOR CERTUFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FRASER CONSTRU(:17ION LLC EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT PO BOX 1845 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE N0013UGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. COTUIT,MA 02635 AUTHORIZED REPRESENTATIVE ACORD 25-5(3193) Ramani Ayer ivo, 04 i J r, Z rug' r, TawU4 of B arnSta hle Regulatory Services auursr�8ur, Thomas R Gziler,Director c6.7 �a Sufidiug bivislou Tam Perry,Butluiag ColYlrAus!!Dv&r zqo:Mzit Street,Xy&=Ia,MA 0^6m )'rww•to'w it-b 3rns csble.m:e.'us Office: 508.862.4-038 Fax: 508-79( Property OvAier Must Complete and Sign This Section If Usk A Builder x, �T/Ve, ,as Oa=r of d-=sub}ect.property bambyauhoiize Z matters raker a to work-2.utl:orizad bytbar 6ZLMg permit application,for. aeo w A (.A,ddmss of O Sigra+i:re of Orc�nex ate Print I AI= If Pxopezt�'•�°?wwneris-applying for pern-i tplease complete the Hoincovmers License Exemption Forma on•the reverse side. TO 3E)Vd QWN 08669ZGLT9 9T:TT 0TOZ/80/b0 4eulaons ad�S a ard� i v Cb,'�tlgt�ct,�c,�1�S '�erv�'`,iso�r?�ii 'nfl �`� . )T.l. yR!,�:. Xl'` 'Atf�l0ll r. Y r Boo> ulld � ons and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: uly Regist q`ptt 112536 Board ofBuilding Regulations and Standards rr aW---4a3/2011 Tr# 281021 One Ashburton Place Rm 1301 Types D.•t� Boston,Ma.02108 FRASER CONSTRj 1QN Co. DEAN FRASER 3 I 104 TWINN VIEW ANE E FALMOUTH,MA 02536 y AdminisMator Not erem 13®ard o uzl e gu.l a ®n xe. ar s l . g s a One Ashburton Place m Room 1301 Boston. Massighusetts 02108 Hone Im-provement-Cbntractor Registration Registration: 112536 Type: DBA FRASER CONSTRUCTION CO. Expiration: 3/23/2011 Tr# 281021 DEAN FRASER P.0. BOX 1 845 COTUIT, MA 02635 Update Address and return card.Marls reason for change. Al Co 40M-08/08-DBSLJF0RMCA108212008 Address Renewal � EMP10yment [] Lost Card l z REScheck Software Version 4.3.1 Compliance Certificate Project Title: Renovation-to existing home Energy Code: 2007 IECC Location: Cotuit,Massachusetts Construction Type: Single Family Project Type: Addition/Alteration Heating Degree Days: 6137 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor: 220 Vineyard Road Elise Entine Dean Fraser Cotuit,MA 02635 44 Hunt Street Fraser Construction Company Watertown,MA 02472 31 Boden Road Mashpee,MA 02649 508-428-2292 Compliance: Compliance: Maximum UA:583 Your UA:583 Cont.Gross Cavity Assembly Area or R-Value R-Value or D•. Perimeter U-Factor Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 2000 38.0 0.0 52 Wall 1:Wood Frame,16"o.c. 946 15.0 0.0 60 Window 1:Vinyl Frame:Double Pane with Low-E 121 0.330 40 Door 1:Glass 40 0.320 13 - Wall 2:Wood Frame,16"o.c. 863 15.0 0.0 59 Window 2:Wood Frame:Double Pane with tow-E 7 0.300 2 Window 3:Vinyl Frame:Double Pane with Low-E 69 0.330 23 Door 2:Glass 20 0.320 6 Wall 3:Wood Frame,16"o.c. 946 15.0 0.0 43 Window 4:Vinyl Frame:Double Pane with Low-E 265 0.330 87 Door 3:Glass 120 0.320 38 Wall 4:Wood Frame, 16"o.c. 863 15.0 0.0 57 Window 5:Vinyl Frame:Double Pane with Low-E 82 0.330 27 Door 4:Glass 40 0.320 13 Ceiling 1:Flat Ceiling or Scissor Truss 1728 49.0 0.0 45 Ceiling 2:Cathedral Ceiling(no attic) 426 30.0 0.0 14 Skylight 1:Vinyl Frame:Double Pane with Low-E 9 0.440 4 Boiler 1:Other(Except Gas-Fired Steam)93.1 AFUE Air Conditioner 1:Electric Central Air 18 SEER. Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2007 IECC requirements in REScheck Version 4.3.1 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Notes: REScheck by Cape Cod Insulation,Inc. 455 Yarmouth Road Hyannis,Ma. 02601 1-800-696-6611 Project Title: Renovation to existing home Report date:04/16/10 Data filename:C:\Documents and Settings\Keith\My Documents\REScheck\#8354.rck Page 1 of 5 #8354 Project Title: Renovation to existing home r Report date:04/16/10 Data filename:CADocuments and Settings\Keith\My;Ddccuments\REScheck\#8354.rck Page 2 of 5 REScheck Software Version 4.3.1 Inspection Checklist Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-49.0 cavity insulation Comments: ❑ Ceiling 2:Cathedral Ceiling(no attic),R-30.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame, 16"o.c.,R-15.0 cavity insulation Comments: ❑ Wall 2:Wood Frame,16"o.c.,R-15.0 cavity insulation Comments: ❑ Wall 3:Wood Frame, 16"o.c.,R-15.0 cavity insulation Comments: ❑ Wall 4:Wood Frame,16"o.c.,R-15.0 cavity insulation Comments: Windows: ❑ Window 1:Vinyl Frame:Double Pane with Low-E,U-factor:0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 2:Wood Frame:Double Pane with Low-E,U-factor:0.300 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 3:Vinyl Frame:Double Pane with Low-E,U-factor:0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 4:Vinyl Frame:Double Pane with Low-E,U-factor:0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 5:Vinyl Frame:Double Pane with low-E,U-factor:0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: Note:Up to 15 sq.ft.of glazed fenestration per dwelling is exempt from U-factor and SHGC requirements. Skylights: ❑ Skylight 1:Vinyl Frame:Double Pane with Low-E,U-factor:0.440 #Panes Frame Type Thermal Break? Yes No Comments: Doors: Project Title: Renovation to existing home Report date: 04/16/10 Data filename:C:\Documents and Settings\Keith\My Documents\REScheck\#8354.rck Page 3 of 5 ❑ Door 1:Glass,U-factor:0.320 E Comments: ❑ Poor 2:Glass,U-factor:0.320 Comments: ❑ Door 3:Glass,U-factor:0.320 Comments: ❑ Door 4:Glass,U-factor:0.320 Comments: Floors: ❑ Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-38.0 cavity insulation Comments: Floor insulation is installed in permanent contact with the underside of the subfloor decking. Heating and Cooling Equipment: ❑ Boiler 1:Other(Except Gas-Fired Steam):93.1 AFUE or higher Make and Model Number: ❑ Air Conditioner 1:Electric Central Air:18 SEER or higher Make and Model Number. Air Leakage: ❑ Joints,attic access openings,and all other such openings in the building envelope that are sources of air leakage are sealed. ❑ Recessed lights in the building thermal envelope are 1)type IC rated and ASTM E283 labeled and 2)sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. ❑ Access doors separating conditioned from unconditioned space are weather-stripped and insulated(without insulation compression or damage)to at least the level of insulation on the surrounding surfaces.Where loose fill insulation exists,a baffle or retainer is installed to maintain insulation application. ❑ Wood-burning fireplaces have gasketed doors and outdoor combustion air. Sunrooms: ❑ Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U-factor of 0.50 and the maximum skylight U-factor of 0.75.New windows and door's separating the sunroom from conditioned space meet the building thermal envelope requirements. Vapor Retarder: ❑ A minimum of Class II(1.0 perm)vapor retarder is installed on the interior side of above-grade framed walls or it has been determined that moisture or its freezing will not damage the materials. Exceptions: Class 111(10 perm or less)vapor retarder is permitted for vented cladding over OSB,plywood,fiberboard,gypsum,or for sheathing over 2x4 framing having insulation of R-5 or better,or for sheathing over 2x6 framing having insulation of R-7.5 or better. Materials Identification and Installation: ❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions. ❑ Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R-value. Materials and equipment are identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. ❑ Insulation R-values,glazing U-factors,and heating and doling equipment efficiency are clearly marked on the building plans or specifications. Duct Insulation: ❑ Supply ducts in attics are insulated to a minimum of R-8.All other ducts in unconditioned spaces or outside the building envelope are insulated to at least R-6. Duct Construction: ❑ Air handlers,fitter boxes,and duct connections to flanges of air distribution system equipment or sheet metal fittings are sealed and mechanically fastened. ❑ All joints,seams,and connections are made substantially airtight with tapes,gasketing,mastics(adhesives)or other approved closure systems.Tapes and mastics are rated UL 181A or UL 181B. ❑ Building framing cavities are not used as supply ducts. Project Title: Renovation to existing home Report date:04/16/10 J 9 Data filename:C:\Documents and Settings\Keith\My Documents\REScheck\#8354.rck Page 4 of 5 6A Lj Automatic or gravity dampers are installed on all outdoor air intakes and exhausts. Additional requirements for tape sealing and metal duct crimping are included by an inspection for compliance with the International Mechanical Code. Temperature Controls: ❑ Thermostats exist for each separate HVAC system.A manual or automatic'means to partially restrict or shut off the heating and/or cooling input to each zone or floor is provided. Heating and Cooling Equipment Sizing: Additional requirements for equipment siting are included by an inspection for compliance with the International Residential Code. ❑ For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2006 IECC Commercial Building Mechanical and/or Service Water Heating(Sections 503 and 504). Circulating Service Hot Water Systems: ❑ Circulating service hot water pipes are insulated to R-2. Lj Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-2. Certificate: A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R-values;window U-factors;type and efficiency of space-conditioning and water heating equipment.The certificate does not cover or obstruct the visibility of the circuit directory label,service disconnect label or other required labels. NOTES TO FIELD:(Building Department Use Only) Project Title: Renovation to existing home Report date:04/16/10 Data filename:C:\Documents and Settings\Keith\My Documents\REScheck\#8354.rck Page 5 of 5 r 2007 IECC Energy , .Uf1*4 Efficiency Certificate 'Insulation . Ceiling/Roof 49.00 Wall 15.00 Floor/Foundation 38.00 Ductwork(unconditioned spaces): Glass&Door Rating U-Factor SHGC Window 0.33 0.35 Skylight 0.44 0.48 Door 0.32 0.34 CoolingHeating& Other Non-Gas-Fired Boiler 93.1 AFUE Electric Central Air Conditioner 18 SEER Water Heater: Name: Date: Comments: _ . . `oFINEr Town of Barnstable p ' Regulatory Services BARNSTABLE. 9 MASS. 0 �plFt639. 0 Building Division , 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 i Inspection Correction Notice Type of Inspection /3`ie& Z le Location Z ZO Ui��G r c�IU Permit Number L b b Owner 6—JU T/IV45 Builder T;�45-�'�-- One notice to remain on job site, one notice on file in Building Department. The following items need correcting: Aa<Zn/d-6� Ova !i'(:f i-r� blase o� � �oyz r 3 54) e`62 r Please call: �5'08--86n2-4ff3-�8-forrr rye-ins ection Inspected by Date a I ` . Town of Barnstable *Pernut ) C1�-� ?(o Expires 6 months front is a date ' ® Regulatory Services Fee - cl Thomas F.Geiler,Director T Sip Building Division Tom Perry,CBO, Building Commissioner V Qfi 4?0 V 200 Main Street,Hyannis,MA 02601 �9 www.town.barnstable.ma.us Office: 508-862-40 3S sO - Fax: 508-790-6230 EXPI2 S PERMIT APPLICATION - RESIDENTIAL, ONLY Not Valid without Red X-Press Imprint Map/parcel Number ProperlyAddress � d V X l �Lu.�/l. Y)L zT DA 6 a ' Residential Value of Work 73Ll. Q� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name F/r 6��a�- 1�7�/), l� L t--y,- Telephone Number Jed�- 9 c� Home Improvement Contractor License#(if applicable) ' 2 6 3 Construction Supervisor's License#(if applicable) C S [$Workman's Compensation Insurance Cheel one: ❑ I am a sole proprietor ❑ I am the Homeowner [3,I have Worker's Compensation Insurance Insurance Company Name T- ( �(n Workman's Comp.Policy Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) 9-Re-roof(stripping old shingles) All construction debris will be taken to 0 10,L)Z ` i ❑Re-roof(not stripping. Going over existing layers of roof) e-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission, A copy of the Home Improvement Contractors License is required. SIGNATURE: I . QTorms:expmtrg Revise061306 i The Commonwealth of Massachusetts Department of Industrial Accidents ` Office of Investigations -- s 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv Name (Business/Organization/individual): _FA 6L,� L LG Address: �p D City/State/Zip: Z oa63s Phone#: 569 9, Are you an employer?Check the appropriate box: l 2�,I.am a employer with 4. ElI am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp, insurance comp. insurance. 9• Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12.❑ Roof repairs employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: V Policy#or Self-ins. Lie.#: (J�(/j13 — 0 3 0 s,$6 — Q Expiration Date: Job Site Address: A 020 V e City/State/Zip: � d PZ a 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 certi the nd pe lties of perjury that the information provided above is true and correct Signature: Date: Phone#: Yoeg' a 012 F� Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing]Inspe]ctor 6. Other 1= Contact Person: Phone#• R.ightFax C2-2 10/1/2008 1 : 00:56 PM PAGE 2/002 Fax Server r.:: r:5 }:•{:'{:•{v'<{r.{:{riri}i r... ISSUE DATE ti-{i:•:r}'r:�;';:'}l tir:{ii'rlti:•:{Y•r.• i- .� f.•.•..:•••.{•.•.•r.:-.:i}•..m..�;ry�: ' .vriauu:.,:,M _ r}X{•:{-i..r.•.}�{{v:jx .r ••-.��.•X�•. ..-- .1. !��� >:f::::iYf{.}:::Y:r•ir} 1 /Ol/VO -::•:•:::::•c-r':•.v:•r:-Jrr:•%vr:vrr:•rii-:•::•-r'r-i•i r4:••}••:r••, r •r- •:•••.r=::' rr •r _ r - :•• •: _ THIS CERTIFICATE IS ISSUED AS A MATTER OF @)FORMATION ONLY PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.'TM CERTIFICATE DOES NOT AMEND;EXTEND OR ALTER THE COVERAGE, AFFORDED BY THE POLICIES BELLOW. WISE&QUINN INSURANCE AGENCY COMPANM AFFORDING COVERAGE 449 PLEASANT ST . BROCKI'ON MA 02301AR")F A HARTFORD UNDERWRITERS INSURANCE CO LETTE INSURED COMPANY . FRASER CONSTRUCTION LLC LUITER ANY PO BOX 1845 rLEETTTEER C COTUIT MA 02635 00mpmy D LETTER {hv:wr.•.vJi•:vrwrxn:vii::{:v ::v}.v•r:iutiw uu{iv• COMPANY �+ •::::::{{•: ::.r i ti•{s=: iff:{iiirti�}r.•.;y^}j+kti{}??irf{ti:•r ry iirri{�}'v} LETTER THIS IS TO CERTIFY THAT THE POLICIF3 OPRY3URANCB LISTED BELOW HAVE BEEN ISSUED TO=INSURED NAMED ABOVE FOR THE POLICY PERIOD . INDICATED NOTWITHSTANDING ANY REQUBRMWr.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BB ISSUED OR MAY PERTAIN,THE INSURANCE APIORDBD BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OP SUCH POLICIES.EndM SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CO TYPE OF INSURANCE POLICY N(MB ER POLICY POLICY LIMITS LTR EFFECTIVE DATE EXPIRATION DATE (MOD D WDD/YY) GENERAL LIABILITY GENORALAGORHGATE $ PRODUCT&COMWOPAGG. $ ❑COMMERCU+L GENERAL LIABILITY ❑ CLAIMS MADE ❑ OCCUR PERSONAL&ADV.INJURY $ EACH OCCURRENCE ❑OWNERS&CONTRACTOR'S PROT. $ DIRE DAMAGE(Any On;IIFe). $ MM 6)(PENSE(Anyompe on $. AUTOMOBILE LIABILITY CObI INPA SDIOLE LIMIT $ I ❑ ANY AUTO .. BODILY INJURY ❑ ALL OWNED AUTOS. - (Per Person) $ ❑ SCHEDULED AUTOS ❑ INJURY HIRED AUTOS - BODILY $ (Per Ardilcot) ❑ NON-OWNED AUTOS ❑ -GARAGE LIABILITY - PROPERTY DAMAGE $ EXCESS LIABILITY ❑ - - - EACH OCCURRENCE UMBRELLA FORM AGGREGATE $ ❑ OTHER.THAN UMBRELLA FORM . STATUTORY LMWS_ EACH ACCIDENT A ORIIER'3COMPFIWSAT[ON � 0 000. W $5 0. DISIASE•POLICY LOW /08 0 /26/0 $sooaoo AID Ul3- 09/26 9 9 OM IM556-08 EMPLOYEWS LMIEL TY DISHAS&EACHEfHPLOYBE $500,000 OTE[ERTBG _ PROPRLETORNARTNERSIE)MCUTIVE OFFICERS ARE INCLUDED DI"E'rIONOFOPB@ATWNWL .ATICMIVMInCLEWBPIC1ALrflM TIJB UOUHIMISI NL1 VVORWMCGffW8AMONFOLMCYANDTISUMMOUM&rATOWMMCBENDORSMMAUTHORIM TUE PAYM&Vr OFB"TrS FOR CLAHN9 MM911Y UM IN8l RMS MA EAH WYM W 8rATW OTMM 74LW MA.NO AUIHOREM11ON IN GrMTO PAYCLAIMB FOR DEPI)MTB IN ANY STATE OTHER THAN NIA IFTHE INSUREDDIRHB4ORHA MRU)yffdPLOYMOUMMOPAMA.TMPOLICYDOESNGTPROVMBCOYIIRAOEFORANYSTATEOTTRERTHANMA. W WREFIACESANYMMR(I<+A'I WATB9UMTOTHBCJIl2 MCAIEIR MMAFFWMGWORKMCOMPCOVERAGE :'rrJV1t S ' {1{Y:_ •: 1 -�� - 5}_1 1- • YY VL'3L{� R��: 1{1�y�5"1�LVYJY H Yf'•v t Xl •:.. . ...: . .......... .... ti{{•::•:CY..X:X.i::::$it:::}:X{::�::i°::s�}^CYJ:}{{{•�•,''-:�i�'i}� .vr. uu - vrxr _: _ FRASMEPi MKIERPROMLLC BHOUIDANYOFTMAROVRORSCREEDPOLICESSECANCUJADMFURETRIB PO Bm flse WIPUMWN DATB TfRBRHOF,7AE RUING COND'ANY VOU RIMEAVORTOMAN, CQIIXWMA02635 ID DAYS wuns±rtNOTCEToTwt3iRuwATI3mumNAMzDiroi m imT, BURFAIUIRBTOMAD.BUCHNOTDESNA1d.11IM SNOOBM &NOIROR IJAEU%(YOFANYMMUPONTIIECOMPANY PR9A($fcR180RR iPAWIVIB ABpR®VPA7IVP, - � I"Affm c4s7m.-t*Lm .... Y.:..::: :::::.Y ........ • Y V - :1'i•C•,�)G[-• � ' {�t .�.'r�: �JL11:.1�}:•JYJL{5M111Y 1� L 3�- •'•'•'{....... �1 02. Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 112536 Board of Building Regulations and Standards Expiration:-W23/2011 Tr# 281021 One Ashburton Place Rm 1301 Type: DMA Boston,Ma.02108 FRASER CONSTRUCTION C.O. ,f '- DEAN FRASER 104 TWINN VIEW LANE ' E FALMOUTH,MA 02536 Administrator Not re I Boar o uil in e ula4on g g s an tan�ars One Ashburton Place - Doom 1301 Boston, Massachusetts 02108 Dome Improvement Contractor Registration Registration: 112536 Type: DBA Expiration: 3/23/2011 Tr# 281021 FRASER CONSTRUCTION CO. DEAN FRASER P.O. BOX 1845 COTUIT, MA 02635 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card I 'Al is 40M-08/08-DBSLIFORMCA108212008 i .-I P gtc'L'+tense a itL�� P1�hakrMN 11• Teak a708 • OEM FMWM EAST FALMUT-H,-10 amass Oommmimaundr LJU9 4/PM No. 310 7 P. 7 J - Fraser C ' *CONTRUC r,ON onstruction, LLC lawmzclr P.O. Box 1845, Cottlit MA. 02635 • ,� Email: fraser construction,(7u.verizon.net {%vv.fraserrod_1w ow FAX 1-508-428-0123 50$-4Z$-�291 MCL#112536 CS#97668 WORK PROPOSAL DATE: June 30, 2009 (revised 7-28.9) PRONE: 617-926-1161 x6846 NAME: Dr. Gerald Entine FAX., 617-926-9980 CONTACT: Beverly Sky 617-308-9000 Mauro Ron 617-699-6]70 JOB ADDRESS: 220 Vineyard Rd Cotuit, MA 0236S FRASER CONSTRUCTION hereby proposes to perform the following ser\ices in a neat and professional like manner and its accordance with the maxzufacturer's specifications and local building code. -Remove and Haul away all of the old roofing material (2 layers) -Re-nail all plywood sheathing as needed. Supply and Install - CERTAINTEED LANDNLUM /WooDSCAPE AR 30: 30-Year Warranty, S year Sure Start ProreciiorL, CLASS A FIRE RATED, ALO-AR Resistant, Extra Heavy Weight, Self Sealing, Multi-Layered, Architectural Style, Fiberglass Based Asphalt Shingle with New England's, Exclusive COPPER/CERAMIC Stones with a Full 10 Year Warranty against ALGAE Containment. 6 year 110 mph wind- resistance warranty with six nails in common bond area, Fraser construction Includes sic nails in common bond area at NO additional cost. See actual warranty for specific details and limitations. Color: ` /-lOr+ PRICE- 1$14,325 House initial i/ 11t Color: BYO 2 PRICE- $1,675 porch Initial V/it v Porch section will have lee & 'Water on entire roof surface b6 1 � l §_u_Rp1_y Install- CertainTeed Winter--Guard: (ice 6 water shield) l Waterproof Underlayment System (3ft, on evts and %alleys, 18" on rakes, vbatls, and sltyliglits) Supply &Install- Roofer's Select Underlayment Paper (as recommended by C6rtainTeed) ttu-nDiy & Install -White 8" Aluminum Drip Edge ftppjyInstall-Aluminum & Neoprene Soil Pipe Flashing SURRI-Y & Install-Air Vent Ridge Vent (as mcomrnended by CertainTecd) Smart vent as needed TO 39Vd CM ] 08669ZGLT9 00:ZZ 600Z/60/60 co, zvv, ,adr'Tj No, '�J`1 F, 2 r C *4 Star Warranty Upgrade will be applied if proposal is signed and returned within 10 days, (see enclosed brochure) WHITE CEDAR SIDEWALL Supply and Install 16"WHITE CEDAR R&R CLEAR Shingles Supply and Install T'Y'VEK HOUSE WRAP Supply and Install GALVANIZED FASTENERS STAINLESS STEIG:L FACE NAILS AS tNl�EED Supple and Install NEW WINDOW only if entire house is being re-done Supply and Install NEW WINDOW SPINE AS NEEDED only it entire house is being re-done Sapp:and Install NEW FLASHING l6oz COPPER,STEP,WALE, (between asphalt end wood siding)only if entire house is being redone) 1. REMOVE& REPLACE WHITE CEDAR SIDEWALL ON ENTIRE HOUSE PRICE.S17X0 Ynitial7 j� 2. REMOVE & REPLACE WHITE CEDAR SIDEWALL ON CHEEKS REAR SOUTH FACING BACK WALL PRICE-S850 Initial (v0 3. REMOVE &REPLACE WHITE CEDAR SIDEWALL ON GABLE SOUTH FACING FROM ROOF LINE UP PRICE-S1,800 Initial . TM WORK: • Replace pine trim as needed on porch - any rotten areas a Replace rotten deck boards 1x5 fir • Rebuild front door trim, (new ldck boards as needed, PVC under doors) a Replace deck boards 1x5 fir as needed side entry • Note: trim over all looks to be in good shape with the exception of poach area and some upper trim L PRICE-$10750 hatial �J1 INFERIOR Sand and polyurethane (4) coats on pine flooring - aprox. 3,000 aq ft IP'RIC1E<-$5,930 Initial Clean & Remove - Debris from work area daily. Z0 39dd (MIN 08669ZGL19 00:ZZ 600Z/£0/60 10 , ZO, 1UVy 1 48FM 1 PAINTING QUO#rp, Paint all exterior trim Miguel'$ Painting quote plus 10% Initial Payment schedule: yv Down Y4 finish roof % sidewall Balance immediately upon completion Initial Painting contract will be separate and completed after roof& side wail Possible Extra-After the Shingles are removed from the root, we will lift one sheet of plywood to make sure that the insulataiolt is not up against the plywood sheathing Preventing ventilation from the eaves to the ridge, If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, till g the plywood over and then re-installing the he 1 rt�►'ood, If n as an extra at the rate of$6.00 per panel including needed, this would be changed for Panels per sheet of i p p g 8s Labor. There are 6 plywood. Possible ldra-Any rotted or otherwise deteriorated trim boards Plywood lead flashing, or other carpentry needing replacement will be done and charged four as an extra at the rate of$60.o0 per hour,plus 15% mark-tip materials FRASER CONSTRUCTION Warranties the labor for 12 years FRASER CONSTRUCTION Warranties the shingles.against Blow-Offs for 10 yeaxs. CERTAINTLED Warranties tho shingles and labor 100% through the Sure Start Warranty duration_ CERTAMTEED Warranties the shingles to be ALGAE resistant for the duration of the Sure Start Warranty depending on the shingle that was purchased. Any deviation or alteration from above specification will be executed upon written orders and will,become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fue, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION, LLC: Carries Worlrman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: Q omeowner Fray®r ion ruction, LLC 60 39Vd QWN 08669Z6L19 00:ZZ 600Z/60/60 L lcf TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION aD Map. 616 Parcel 005- 00l Application 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 t;Ia n Ur 61-W«� Village C04701n- - 11 1M G Owner —Address Wa$0i06n7 �►'�a9 Telephone 6/7 - 6" 6/-w Permit Request +d rw_w al IcGnsS Act& wlwd,,' L s-\�rn 1'l-,oc� w+ Square feet: 1 st floor: existing kroposed_1 2nd floor: existing proposed / M)Total new 7200 Zoning District Flood Plain Groundwater Overlay Project Valuation 76azw 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 A No On Old King's Highway: ❑Yes 0`No Basement Type: M Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) — Basement Unfinished Area (sq.ft) S � Number of Baths: Full: existing_ new —6 - Half: existing / new �--� Number of Bedrooms: S7 — existing o new Total Room Count (not including baths): existing _new First Floor Room Count Heat Type and Fuel: ❑ Gas XOil ❑ Electric ❑Other Central Air: %Yes ❑ No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes 2d 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 Z st&,...4,Jk Proposed Use s►�,n.Q F ' ' Lq APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name F2m42(;� C'cnnsi-rwc -tee-, Telephone Number SbSS yap a�9 a Address O 13 ox Ts Ns License # -7 66 2< Home Improvement Contractor# Worker's Compensation # wd- 0099 30 6 O 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO lSa,"C.wlL A SIGNATURE DATE ���a3 I t iL' , FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. „ ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' FOUNDATION ft frc FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL } PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Lq 113 DATE CLOSED OUT ASSOCIATION PLAN NO. n E a 1� r The Cotnrnonwealth of Massachusetts Depaitment of Industrial Accidents Office'of Investigations, 600 Washington Street + Boston,.MA 02111 www.mass.goy/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly. Name(Business/Organization/Individual): 614� ci.^5 r%_+ Address' (��• c1y 1�SY 5+ City/State/Zip: Qj 41,, M, Phone #: �&rAre you an employer? Check the appropriate box: Type of project(required): 1.5P am a employer;with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6: ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. 0 Demolition workingfor me in an. capacity. employees and have workers' Y P y 9: Building addition [No workers' comp. insurance comp:insurance. required.] 5.-0 We are a corporation and its' 10.❑ 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:D Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13:0 Other comp..insurance required.] ° *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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: lnnQi (J or-% Policy#or Self-ins. Lic. #: WC 000 6 6 0 1 Expiration,Date: p,E 1 , Job Site Address: �f�ill„ e�.��, /2 City/State/Zip: , r ,�, Attach a copy of the workers' compensathm 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 copy of this statement may be forwarded`to.the Office of Investigations of the DIA for insurance coverag ification. I do'hereby cer16 under' . atns d tes of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by'city or town official City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk I. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: r Information and_1nstruction.s. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs'persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation.of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the'permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A.copy of the affidavit that has been officially stamped or marked by the.city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a_home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do'not hesitate to give us a call. The Department's address, telephone and fax number: - r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel:##617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass,gov/dia t ACO p° FRASCON-01 MOSU oucER CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDryyYY) PRo 10/21/2010 Viveiros Insurance Agency,Inc. �5 )676-0309 THIS CERTIFICATE IS ISSUED AS A MA TTER 375 Ai ONLY AND CONFERS NO RIGHTS UPON TWE INFORMATION Airport Road HOLDER. THIS CERTIFICATE DOES NOT N THE Fall River,MA 02720 ALTER THE COVERAGE AFFORDED BY THE POUCIEEs B DOyy INSURED Fraser Construction LLC INSURERS AFFORDING COVERAGE P.O.Box 1845 INSURER A:*National Union Fire Insurance Compan NAIL# Cotult,MA 02635 INSURER B: INSURER 0. INSURER M COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TF(E 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IT POLICYNUMBER POLICY PO CY RATION GENERAL LIABILITY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE a OCCUR PREMISES Ea occurence $ MED EXP(Any one person) $ PERSONAL BADVINJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGR"GATE $ POLICY PRO LOC PRODUCTS-COMPIOPAGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS accident) SCHEDULED AUTOS (BODILY;INJURY $ HIRED AUTOS NON-OWN ED AUTOS _ BODILY INJURY ( accident) cd de $ PROPERTY DAMAGE GARAGE LIABILITY (Per acciderN $ ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN 'EA ACC $ $ EXCESS I UMBRELLA LIABILITYAUTO ONLY: AGG OCCUR CLAIMS MADE w EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORIQ:RS COMPENSATION .. $ . AND EMPLOYED'LIABILITY X WC STATU pT}� �► ANY PER/MEMBERIPATIN�oECuTWE Y� C009930601 9/26/2010 9(2&2011LIMLIS (Mandatory In H)IXCLUDED7 EL EACH ACCIDENT $ 500,00 (My�ensdatory In NH) ADDAL,des.—be ONSbelow E.L DISEASE-EgEMPLOY g 500,00 OTHER EL DISEASE-POLICY LIMIT $ $00,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVIffiONS CERTIFICATE HOLDER CANCELLATION SHOULDANYOF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Fraser Construction,LLC PO Box 1846 DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Cotult,INA 02635- NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO So SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORED REPRESENTATIVE ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORNS i' i I• ''- _ � 42/JtY1J7%gLryj LIL O iif� "-Fee". c Boand of Building Regulattona anjd Stand ids R s zF fl Construttion Supervisor LiaenseF:` License!.CS 97668 �irthdate S/7/1957 t I E°plration 8/7/,2011 tc : 1668 E Riestrlatio"ti 00 DEAN FRASER r 104 TWINN VIEW EAST FALMOUTH,MA 02536 Office of Consumer Affairs and Efusiness Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Cor�tr��tor Registration ----- -' Registration: 112536 r Type: DBA Co- Expiration: 3/23/2013 Tr# 209024 FRASER CONSTRUCTION CO. DEAN FRASER P.O. BOX 1845 COTUIT, MA 02635 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CAI 50M-04/04-GIO1Q216 � _,,� Office-f co90ume�a'irs�cc tsu'sines- s xegu a on License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Type: Office of Consumer Affairs and Business Regulation Registration: . ,�12513 DBA 10 Park Plaza-Suite 5170 Expiration: :313% 013 Boston,MA 02116 F R CONSTRV JONGO t DEAN FRASER >J 104 TWINN VIEW l!ANE:; _;; w . E FALMOUTH,MA OZ536' ==" :,. Undersecretary of vah wit ut si re i R LUI I Ii ;J/AM hD, 1821 F, 2' a�stvsrAea,� r twws Town of Barnstable A ReguJ$tory Services Thomas F Gaiter,Alreetor Building Division Thomas Perry,CB0 Snilaing Commissioner 200 Maio Street, Hyatenis,MA 102601 W w'W.rowa,b a rest®b1e,rn a,us Office: 508.862-403 s Fax: 508-790-6230 Property owner Must Complete and Szgn This Sectioti If UGing A Builder 6:i JL as Owner of ttte subject property hereby authorize`rrtt���IZ C'r,,���sr� ro act o-n my ba>zalf, raarters Uladvc to work authOrizcd by this building pern->j appbcanon for. (Address of Job) Sigr:aa:rc of Owner 2-1" J / Date Print Name If Property Owner is applying for permit,please complete the liomeOwurs License Exemption Form on the reverse Side. C,1UsersUeeoilik\gpppgrylC,�cj\MicmSOft\Window"CM?ocaty Internet FiletlCoeteni.0 apUookU)DV87 Revistd 072110 AAZ115JCPk55s.coa TO 39tid GM 08669ZGL19 T£:bT TTOZ,/TZ/£0. PROJECT NAME: i r . ADDRESS: v D 'PERMIT# l PERMIT DATE: M/P: LARGE ROLLED PL.A N,$ ARE. IN: . t BOA . SLOT Data-.entered in MAPS program.-on: � g i/ PROJECT 1 NAME: :k)0 C-VVq,� iccy" ct d ADDRESS: 00 PERMIT# 2© l0 Cal c1 a -7 PERMIT DATE: LARGE ROLLED PLANS.A IN: ° BOX SLOT Data entered in MAPS program on: 5-151 10 BY: _ a/wnfi les/archive 06/22/2012 17:52 5087785731 CAPE COD INSULATION PAGE- 01 Cape Cod I.nsulation Inc. Date 45 5 'Y. annouth Road Hyannis, Ma. 02601 1'11A-800-6 96-66 ). 1 Fax. 1.-508-778-5735 co TO: B l.[iId1Ilg Department De ent, Please accept this spW foam statement.. Job Location 2 2C Vine Builder Keith Presswood Vice President of Sales keithpresswood@verizon.net oAg ri balance Spray Foam Insulation Installed Insulation Statement Location of Insulation Thickness •Total R-value Approximate Sq.Ft Walls x.4.45 �p Z0 Attic -Floor or Roof Deck (circle one) x '4.45:= Cathedral Ceiling x 4.456= 5� C 71+ x 4.45 x 4.46 C/o 0 - R-value =4.45 peg inch Tensile Strength=3.87.psi Density 0,6 0.8.lb/fe Compressive Strength=1.86 psi DEMILEC Batch# 1Zd1 2.o3,01 Andek Batch# r., (i a�urcfi n) omp6my Name Phone Number bassAw nppllcalor Nfma Appl.tcr,igngluro Oak), 114E r, Town of Barnstable BARNSTABLE. Regulatory Services MASS. '639' Building Division plFO MAC 200 Main Street,Hyannis,MA 02601 r Office: 508-862-4038 ' i Fax: 508-790-6230 ! i Inspection Correction Notice Type of Inspection f 'Fie 9 , Location Z 2-0 �n/�--r'�� � 11.?' Permit Numbe-r-� 20 /a 0/7 ]' a Owner Builder One notice to remain on job site, one notice on file in Building Department. 4 The following items need correcting: �?-f c L AL v ti zz i3 7-�y iN w � C L " -7� q7-l4 A9NS aid. U5 I&-,eWikJ67-E /N /lV.6/fi/JCt19- ►��a Dckrc J5--7'5- JLA-OW 5s iV-) � Please call: 508-862-40ft for re-inspection. Inspected by Date