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HomeMy WebLinkAbout0127 CLIFTON LANE ' i :-''.... ., �.'... ., .-,,.. :. _. ,, ... :.. ,.. ... .. .... .. .. ,,,r1 �!*. ir�Y� �c�yti<s 3 °'`0.s1� ri��, {i �•,ias ir,�l„6t��•. '�.i"., � . u...,'. i: {, r; n4 .. `^'".e � �r rF• � rc -i' ;� -; .emu ^...- ' r. ,�. - ,-s.,: ; y.•. Y •' . -° .. .�'� ,',. �••. a" Ya�1. � rs .a. �. ,a "s" 'i€3C r ;tx.�i�,.i.1 'e h. J � tr`� it y' 9 n a n ... , a i n a c � n - r 41 P e .is ��� " �\ '�w'31''� -7'1S � � Sdg (5� DIME TOWN OF BARNSTABLE :`RU s din g 201104736 Permit BARNSTABLE, Issue Date: 11/18/11 9 MASS. �Ar16 3 a�� Applicant: SERRIELLO,MICHAEL Permit Number: B 20112551 Proposed Use: SINGLE FAMILY HOME Expiration Date: 05/17/1.2 Location 127 CLIFTON LANE. Zoning District RB Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 247122 Permit Fee$ 35.00 Contractor SERRIELLO,MICHAEL Village CENTERVILLE App Fee$ 50.00 License Num 13478 Est Construction Cost$ 4,500 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND SHEET METAL-WHOLE HOUSE THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: PAROJINOG,RICHARD G&PATRICIA BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 127 CLIFTON LANE INSPECTION HAS BEEN MADE. CENTERVILLE,MA 02632 Application Entered by: JL Building Permit Issued B KOW THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,.ALLEY OR SIDEWALK OR ANY PART THEREOF,EI RILY 0 E` NTW ENCROACHMENTS,ON PUBLIC PROPERTY,NO. SPECIFICALLY PERMITTED UNDER THE BUILDING CODE;MUST BE APPROVED BY THEJURISDICTION. ST AL Y:GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE - OBTAINED FROM THE DEPARTMENT OF.PUBLIC WORKS-THE ISSUANCE OF THIS PERMIT DOES NOT RELEAS PPLICANT FROM THECONDITIONS OEANY APPLICABLE SUBDIVISION. RESTRICTIONS, MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONST I WORK: Q 1.FOUNDATION FOOTINGS.FO DA O OR UN 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEN FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETE RAMS INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY O L 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERM S ARE REQ RED FO ECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL T INSPECTOR AS AP OV THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL D I STRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED N ED ?O PERSONS CONTRACTING WITH UNRE IST, D CO -,RACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel` �Z Application # u o I. Health Division Date issued l Conservation Division Application Fee Planning Dept. Permit Fee F Date Definitive Plan Approved by Planning Board 1017111 Historic - OKH _Preservation / Hyannis C:=Pr_cject Street�Address '� �.� F iO rNj Owner a-� �:�B- Address 1 `1 Telephone- Permit Request- Av-e-I' ante--y, . ty �C 9z, v SC__ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay cl?roject Val ua� tion+ YS'CO 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 U YbE❑ No E-«.s Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other 6 £ Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing_ new Half: existing r@`V Number of Bedrooms: existing _new ' c 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`1 \" l`�,��e� 5��► �� ,��la Telephone Number S�� 77�P Addresses.:- �- C-Q.- o 2 -License#-�,� I'3 4 77 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO s / SI& El -, CIDATE,* ..... 6 f ,,. f FOR OFFICIAL USE ONLY } 'WIPPLICATION# DATE ISSUED r, - '' MAP/PARCEL NO. f ADDRESS VILLAGE OWNER p DATE OF INSPECTION: ` K I. FOUNDATION b r` FRAME ,INSULATIONS r, FIREPLACE s ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL tFi.NAL BUILDING' , DATE CLOSED OUT. ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): lV l;L,i.1 n.c_` Sc.e..g,_ �L �' Address: : ;,,C C, ?-L City/State/Zip: ,�sf tin_ U c_ 3Z Phone #: S;O F X) -� d?_,�_ Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I 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 2.19 1 am a sole proprietor or partner- listed on the attached sheet. 7. KRemodeling ship and have no employees These 8. Demolition working for me in any capacity. employees have ❑ loyees and have workers' 9. ❑Building addition [No workers' comp. insurance comp, insurance. $ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LF]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' 13.0 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the Rains and penalties of perjury that the information provided above is true and correct Si attire: Date: F C� Phone#: e o 6- 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#: S ` �IKE>n Town of Barnstable Regulatory Services MASS, Thomas F.Geiler,Director i63g�. A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section , If Using A Builder MI, C� LIC-►'� , as Owner of the subject property hereby authorizeAlt ` �P ��1 P to act on my behalf, in all matters relative to work authorized by this building permit I'l,�r I 4V"46�b+ (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be 4gnae nal inspections are performed and acc r atur� pplicant C ` o� ICY M W i (J Print Name Tint Name Date Q:FORM&OWNERPERMIS SIONPOOLS t)F THE Town of Barnstable Regulatory Services BARNSTABLE, : Thomas F.Geiler,Director 7 MASS. �A i6s9• ,• Building Division lEc Ira+" Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 -------------- HOMEOWNER LICENSE EXEMPTION Q Please Print DATE: JOB LOCATION: le ne (lS c number street village "HOMEOWNER": ORA I K �0 V name home phone# work phone# CURRENT MAILING ADDRESS: t6AAmS 02 city/town s to 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 building permit (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" eowner"c ies that he/she understands the Town of Barnstable Building Department minimum i ection pr ures and requirements and that he/she will comply with said procedures and uirem ts. a re f eowner 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 exbmpt 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 hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt r. COMMONWEALTH OF MASSACHU:SEW-S _ SHEET METAL WORKERS A,S A MASTER UNRESTRICTED t ISSUESTHE ABOVE LICENSE to"..." Ni ..f MICHAEL R SERRIELLO _ C/�� I 9 PINE C'.BEST; RD=. '. CENTERVILLEMA 02632 3765 �# 13478° 01/28/13 � 1 i y ' Commonwealth of Massachusetts Sheet Metal Permit Date: 12,v 11 Permit# Estimated Job Cost: $ Y5,0 0 Permit Fee: $ Plans Submitted: YES NO e Plans Reviewed: YES NO e< Business License# Applicant License# Business Information: Property Owner/Job Location Information: Name: �,c�Ati &-44-V.-MU Name: f f Wl f W Street: e( - 06, Street: City/Town: �� 1 �,�w`�'e-�Lu. � City/Town: Telephone: -�y b`T7 0 6"16'' Telephone: 5� Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Inidal J-1/M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family X Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. it. over 10,000 sq.ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: 1 / 0-AAjc-Z C-Is; ` Nc' .ems �,�a.AI ...��V INSURANCE COVERAGE: 1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes❑ Now If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSU ANCI WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachus General ws,fthiatg ature-on rmit pplication waives this requirement rCheck One Only Owner [ Agent ❑gnature of Owner ent By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑Master Title ❑Master-Restricted City/Town ❑Joumeyperson- Signature of Licensee Permit# ' ❑Joumeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.govidol Inspector Signature of Permit Approval TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel-.- Ic2cD, -' Application Health Division Date Issued 1 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address el Village T;e, Owner &L4A e_ —Address2C_X.,� I �yr � a o 107,2, Telephone� �� Permit Request 4LM o 6c- o aug 5 ect f 6 ` L. 1 I N i C�a air► , / 1I rs �.�_�c7 l[ � AW% .. ,ts,— - Square feet: 1 st floor: existing proposed b. 2nd floor: existing O proposed Total new Zoning District Flood Plain fbne Groundwater Overlay Project Valuation Construction Type rengcxA 1 Lot Size c I flL Grandfathered: AYes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Jai Two Family ❑ Multi-Family (# units) Age of Existing Structure 19(,p3 Historic House: ❑Yes i(No On Old King's Highway: ❑Yes allo Basement Type: ❑ Full CgDCrawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) o Number of Baths: Full: existing new o Half: existing new Number of Bedrooms: existing 0 new , Total Room Count (not including baths): existing new 0 First Floor Room Court Heat Type and Fuel: XGas ❑ Oil ❑ Electric ❑ Other Central Air: , -Yes ❑ No Fireplaces: Existing 0 New ® Existing wood/coal she: Yes O[No V --1 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ® existine❑ rteyv _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 Telephone Number Address License# .��to lQ L� "\ AU , PO 0, 0 Home Improvement Contractor# 14 1 L9 ,�� :. Worker's Compensation # ALL CONSTRUCTION-DEBRIS- SU f ING FROM THIS PROJECT WILL BE TAKEN TO IV4� [ 1 NAT� G IIJRE DATE FOR OFFICIAL USE ONLY APPLICATION# .x ' DATE ISSUED -,r -- t MAP/PARCEL NO - ' "ADDRESS VILLAGE ` i OWNER t DATE OF INSPECTION: I Jl .�>FOUNDATION FRAME I A U INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH `1 _- FINAL 4 FINAL B-UiLDIN.G 1 1.0 c DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ( Department of Industrial Accidents L to Office of Investigations 1 t�dri� ++ J. 600 Washington Street Boston, MA 02111 c www.mass go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name{Business/Organization/Individual): � 1 Address: i City/State/Zip:- Vl `k'f✓,` M W(Phone #: 1 (o Are you an employer?Check the appropriate box: Type of project(required): 1•Egq'am a employer with 4. ❑ I am a general'contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.ElI am a sole proprietor or partner- listed on the attached sheet t . 7. K emodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity.. workers' comp. insurance. 9 ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work -right of exemption per MGL 1 l:❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t. employees. [No workers' comp. insurance required.] 13.❑ Other ;Any applicant that checks box#I 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site irtformadon. Insurance Company Name: o Vq Policy#or Self-ins. Lic. #: / cZ - 5"—:s� 7 7t9- Expiration Dater 7 Job Site Address: �I' City/State/Zip: �� ' Attach a copy of the workers' compensation policy declaration page(showing the policy rum ber and expiration date). Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and n of erjury that the information provided a ove is true and correct Signature: Date: Phone#: F only. Do not write in this area,to be completed by city or town officialn: Permit/License# ority(circle one): Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector on: Phone#; r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "..,every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner,of a dwelling house having not more than three apartments and who 'resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or 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 info 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-contractors) name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured-companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the.permit/Iicense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/licease 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 proofthat 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 Iicense or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would Irke to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The-Commonwealth of Massachusetts Department of Industrial Accidents Office of Investiptions 600 Washington Street B.ostoa,MA 02111 Tel. # 617-727-4900 ext 406 w 1-977.-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass..gov/dia 6/13/2011 5:51:09 AM PST (GMT-8) FROM: insurancevisions.com-TO: 15U8/ /Sbbbb Lrage: .z oT in ® DATE(MM/DD/YYYY) aco�z� CERTIFICATE OF LIABILITY INSURANCE 6/13/2011 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 terns 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 endorsements . PRODUCER FRANK L HORGAN INS AGENCY INC CONTACT NAME: 44 BARNSTABLE ROAD PHONE A/c o Exl: 508 775-5830 FAX Alc No): 508 775-6688 HYANN IS, MA 02601 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC it wsURERA: LIBERTY MUTUAL GROUP INSURED CAPE & ISLANDS CONSTRUCTION COMPANY INC INSURERB: PO BOX 210 INSURERC: CENTERVILLE MA 02632 INSURER D INSURER INSURERF: - COVERAGES CERTIFICATE NUMBER: 10385984 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.LIMPf'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE IN wVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY GENERAL LIABILITY - - EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR - - MED EXP(Any one person) $- - PERSONAL S ADV INJURY $GENERAL AGGREGATE $ - GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ POLICY PRO- L 0 C GG $ AUTOMOBILE LIABILITY (E�aoadeDISINGLE LIMIT $ _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PR08ERde ID $ HIRED AUTOS AUTOS $ r UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATEH $ - - DED RETENTION$ $ $ A WORKERS COMPENSATION WC2-31 S-377540-011 5/7/2011 5[7/2012 / ORY uMITs AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE F-N-] N/A _ E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under - E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Workers Compensation Insurance: Part One of the policy applies only to the.Workers Compensation Law of the State of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN c+ STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE _ Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD :ERT NO.: 10385984 Anne Chandler 6/13/2011 5:46:22 AM Pagel of 1 - This certificate cancels and supercedes ALL previously issued certificates. a Town of Barnstable Re guiatory Services s s F LltTf6TASL� s . Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA:02601 www-town.barnstable ma.us Office: 508-862-4038 Fax: 508-790-6230 . Property I P nY Owner Mus t Complete and Sign This Section If Usn' A Builder as owner of tb.e s. ubject,ptoperty hereby authorize O to act on my behalf, in all matters relative to work authorized by tbis buz7d permit app cation for. (Address of Job) 5 o R CIO 11 Date Print Name If Pro ga owner is appjymg for permit Lease complete the Homeowners License Exemption Form on the reverse side.. Q:FORMS:OWNERPERMLSSION I �OFTHE rti Town of Barnstable yam. Regulatory Services stixrrsrwsre Thomas F. Geiler,Director �b„r l6S9� •� Building Division FD MA't k Tom Perry, Building Commissioner 200 Main.Slreet,_Ayann' ,MA_02601 www.to wn.b arnstab l e.rna.-us Office: 508-862-403 8 Fax: 508-790-6230 HOAMO"ER LIMISL EXG1rIP O Please Print DATE. JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: ertyhown statz ap code The current exemption for"homeowners"was extended to include_owner-occupied dwellings of six units or Iess and to allow homeowners to engage an individual for hire who does not possess a-license,provided that the owner acts as supervisor. - ' DEP'17 MON OF HOMMOWN'ER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intmviad tu- be, a one or two-family dwrllin& attached or detached structures accessory to such use and/or farm structures. A person who constmcts 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 a l such work performed under the building permit. (Section I09.1.1) Tl�e undcrsigncd"homeowners'assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The imdersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department r,,=i1rn inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings contar"ring 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION -Tire Code states that: "Any homeowner perfomang work for which a building permit is rcqufird shall be exempt from the provisions of thir section.(Seetion ID9.1.1-Lining of constvetion Supcmrisor);provided that if the homeowner argagos a persons)for hire to do such work,that such Homeowner shall act as supervisor." Any homeowners who use this exemption art unawm-c that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Rtgvlations for Licensing C=stuetim Supervisor,Section 2.15) This lack of awareness bft=results in serious problems,particularly when the homeowner hires unlicensed persons. In.this ease,our Board cannot proceed against the unlicensed person as it wrould with a licerued Supervisor. Thehorireo,%m ar acting as Supervisor,isultimat0yresponsible, To ensurt that the homeowner is fully¢wan:of his/her respmmbilities,many communities mqua•e,as part of the permit application, that the homeowner ccr*that Wshe understands the resp=bilitics of a Supervisor. On the last page of this issue is a form currently used by several towns. You may can t amend and adopt such a forn•Jcertification for use in your community. Q:forms:homacxcmpt License or registration valid for individul use only ,{ �anv7io�z�uva ✓�ju uo:_. before the expiration date. If found return to: l � O.'fce of Consumer Affair Biisiness Regulavon Office of Consumer Affairs and Business Regulation HO CIE IMPROVEMENT.r1G- aTRACTOR 10 Park Plaza-Suite 5170 Regitration: .;-165936 Type: Boston,MA 02116 Expiration: 491 12 Private Corporatjo CA &ISLAND CG�tSTRIJ�'3tggeU0.1,,C 1r jr)SHUA KOURI o signature a I I l-HYANNIS, MA 02601 de secretary. .. - •- INlassachusett - Department of Public'SafetN Board of Buildin!- Regulations and Standards Construction Supervisor License License: CS 74660 JOSHUA X KOURI PO BOX 210 } CENTERVILLE, MAS02632r Expiration: 2/12/2013 Commissioner Trn': 12106 f Home Energy Raters.LLC BTorrey@EnergyCodexeap.com Box 989,E.Sandwich,Ma 02537 ,,, .888-503-2233 Duct Leakage Test Address: 127 Clifton Lane Centerville,=Ma 02632 'Date- Nov 10, 2011 " LL Test Type — Post Construction,Total Leakage to outside. Conditioned floor area =950 Sq FT.: To comply with Section 403.2.2 Of,the 2009 IECC.Code in.this-home the Maximum duct leakage CFM 76 CFM •(950/100 x 8 76) Duct leakage tested = 64 CFM Post Construction Test Combined Duct Blaster and Blower door This Home complies with-Section 403.2.2 Of the 2009 IECC Code Date of Test: Nov. 10,2011 Technician: C.Maaola Test File: Clifton Lane 127 Mike Customer: Samuel Traywidc Building Address: - 127 Clifton Lane` P O Box 216 Centerville , Ma 02632 W. Hyannispoit, M.a 02672 Phone:508.776.3174 Fax: 508-771.5336. Test Results 1. Measured Duct Leakage: 64.0 OM l'12.1 sq. in, (+J-.0,0%) 2. Duct Leakage as a Percent of System Airflow:'r 3. Duct Leakage as a Percent of Building Floor Afea:. 6 7 4. Leakage Split: Supply Side; Return Side:: 5. Duct Leakage Curve: Flow Coefficient(C) �9 3 �,. 600 (Assumed) 6 Test Settings: Test'M6de-S ;Pressurization Test Pressure: 26.0 Pa Equipment Series B Minneapolis Duct Blaster -Test,Type:,w Outside Leakage MU .. CD (Combined Duct Blaster and Blower'Door Test) Building and System Parameters: Floor Area: 950 sq.ft. ,. Average Supply Operating Pressure:t Pa System Airflow: Average_ Return Operating Pressure: Pa Supply Leakage Split: % _ Supply Leakage Penalty: Return Leakage Split: 46 _ Return Leakage,Penalty: Percentage of Measured Leakage Connected to Outside: ' 100%(64.0 GFM) Contact our office with any questions, Bruce Torrey, Certified HERS Rater Home Energy Raters LLC �+ ,. n: ..� � � � ��„"� r .d `'_, � '`a - �.�,a=,+ � ,.,�.- .� v►� `''°". ice- �.. y• x itet t '� a MY tc,1� + .. .9, a �.� Y •,r� �.#�'' .[.'w�7'��� it I._ ` m .w_ s i �r� r .. _ ♦. 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