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0134 HUCKINS NECK ROAD
" 't , kb d[f �A'�'aA '�'i°tt ✓ iVri , AR `yy2'as4� axr�9 T✓ N VI-;,�,°���n ,y.da n � 4 n'r i � p r,'4� N Yr r' 'lqb �':,t ��{_ .. t• .�, 1' y s..{. .. r '4A,f s.,, �}. ';. {, % J n 'IRR'�+L- iL..s } f �r p P. .'aiei.,tn. n, r St,�....,. ,.5:,d-•.c ,a,t 4[ 1^'. 4 o-i -_...i a...:�5' ..�! .• .�!G h n}', }�''r '. '� y {' �{ t ' *4 ''res p r ,: '_� fi rur o'F ,mf.a., �� rr,J 4 f u U[Ir'' .�'° •°,.® F9 +t -{4 v F,.r� ,`,� �. �' ,kt4. l�' ty on 4 ISM 0, Ali 1 TOO .A r e'� 1' r �i ..i'. o d i �'• �„� r� fib,. 5 ":F,•:. .. i -.,.�.. � + :.:E:. ,r' .,}%, WON j. k 5 t yy S k a b t •i,' r d;r now Im t r r 4 n r , t a .. .E �M a d s"r n ,Y 1 i :j 1 , r , Tom }Rum s a k... e,...b .. t him ,, ... �.,:r.. ,.,....1 - # :� ...v ,Y ., �..f..... � , ..- a ..,MAIMS,.. ... .t,:. �.,,_.. ., ,..,.,,., ,.t, .. .. .. .. ;., ,. ,�.. .•e... . rs...-.,t ai ,r � S19 �..,.. :;�,.. •., .- ,.. -.. r � s. .r. .t ;..�: � i A: fin: �;>;Pt.i S 14�iti5l ( .1 I, t •4:. IIY i � s 1. �., ... R ..... ,. ,..:., ,. :..::� - �::• , .: ". - J t i \rfN t 1 i 2' `J t. i y � 1 .�f d' S -.f•. t•. ,r 11 ,9�'. F� �F ar SWIM i' ¢ I w' f 2 it 5 1 f f .ti t Y ,., ...r.. ,.,, ,.�.t,x.....f ,.:, .. .,:.," ,.. .... , .,.... ,�„ r ,.,._t .' _,ti.;; • ..,._,,. a ..�.; t..:.; a -v' 'r .rye' E rt. i x„ ,_ _. ,. �..,, : �:< "� t, ; .,. ,. to u`x.. F•� ! ,.r,: q ..i�N 1 y .r 1. s. ,7: .S �,,:./,i. r ..,; ,, ." t �...i..`i ..r:.F , ,. :.,:3 Ai ...:_.,:• .',�.. 1L ..t ii 1 t.. / 5 N M t i i ORY-TOMAIl Kong �} F ➢fA r J It 4 d ,y f 1Y .car" �,l i r �, a try ,ti 'i1 y" •ti n J. P !i � 1} •1, �J` J 'I tlAl .y1� L u,:,' Ot. \ 4.•. a c rt tce�r Application number(b.....q.... Date Issued.......1�.1.. �1.� b STABL&MAM b a �� Building Inspectors Initials..... ............................. a� Map/Parcel.. .................................. TOWN F BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: ( 3,4 0 vc.K;n s de,-(( NUMBER STREET VILLAGE Owner's Name: -Phone Number Q f(-7 7 s g-i Z v Email Address:; e ae,ca s-.n e Cell Phone Number Project cost$ 3 2 7 3 — Check one Residential Commercial OWNER'S.AUTHORIZATION 0 K ' z C:) W O G q ! As owner of the above property I hereby authorize T' to make application for a building permit in accordance with 780 CMR N Owner Signature: See 4\4act,4 corn fimc--� Date: vo TYPE OF WOE Siding ZWindows(no header change)# Z 0 Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to (/JOL 5�e Ma.�-a.�.en CONTRACTOWS INFORMATION Contractor's name� S'FQe(e - GPI�i��,J L or (rot �bo51dn Home Improvement Contractors Registration(if applicable) (attach copy) Construction Supervisor's License# O,7 2 7 7 Z- (attach copy) Email of Contractor /k,5weR49,iT-oimtJ,C4rp Phone number 7 h/ ALL PROPERTIES THAT HAVE STRUCTURES ER 75 YEARS OLD OR/F THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE,A PERMIT CAN BE ISSUED. APPLICATION NUMBER. ............................................................ *For Tents Only' Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X_ X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a:for profit non-profit event Check one: Food served Yes I No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMTTION Homeowner's Name: Telephone Number Cell or Work number I understand any responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CNM the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date LICANT S SIGNATURE Signature _ Date All perms a 'ons are subject to a building official's approval prior to issuance Illtidaiiv:Wor'�d'af�.6stofi :MA[ttctriogiati9tian Ott�ce6&$hbNtrOf3f1IB....... ... .... Nugiyor: r f?3IACltmsllhg@P.er1t t�28B01dbgk'Si�ei USOOQgasSon7Gmp�Co: '168oz8 tJ�'" ` Wpfiiim:lAA;9t9d1: t'amljrokor.M14(1F34f1,: Stir•• tsuiS NfA'uf�4$° •.:4tal if}:R ed (lBSj'92 A9pfi �18fj 828 826i' ;{ pril(68i$ ez be9942 :.wwmvwadaw,w4iltfote'dw, iircgjij Curtoinorp:- .:f/�isil fl�lti, ����;�. 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G61St�a 14.,1ra.{R,n�ii�rNoc§dtl.- uarorpajrittiif oraenioOt�WIdA'eArlr�et�lgt fnQd.fiaftst. 41-06(GjwfNpB ' AM1�t�(?N➢ff{oriti0ltta.EEthpealddptROnhBeW�4�i�lrpo'fOpa� 'gfdt141. f:i11�p1'�io�A(,yd.aiWiie{tlaiiiF►I��ah�9lp-tD'11-.. .: .W9eladta; d ioN( PN'M.11.1 � �nuhmafew>,Fl�.. 1af�on!4muA trt9edBudahl 14. p"T t'1N(CPI M. •_BijpMafil►403t1BPlmno::f6]7 Yt3-0100 Npigpki5jp_' HJBflQ..!�ab4trofltil.eaWei.0. dltltkaakgrriik ofiwpf�vofrxU. a A t9aumvF. 1.lita laia62A poaalptrihfib rrirooaauprnrur�a�trAgroirfosraupuurofp. �wiuiwor 9aitpairuflnctwqutl Iid; yaroAptRtti'.: , dii@�gpprq@ ci r pni!�h'idlwediw kF,wuwemfmmti �s Met .rrtr;,P BEII n� W) i.. ettYdl vi0d n@fetAr. f!6 QduNlgl�llrtl ro me o!e L>�16 epl�i dfaM�tLie�k t �` yee trnerQ+wl� ` t >,auiae�emaoatanantna � uUncktGslus�► a�aea "Aaaktr4'ara:. 9aAgmQ►1hniW 4fl Aflh480 )S' IngYlfuyFlaE f r irptala►. . 8 oa Aii1 n 6tl�iololiflGitanmui(betnWftU�!':ifpfe�lcg Aat :llien ddlYSlo tlioto}(oivlify.iblyd.bgdnoeideK. ►'� !R ' rude" a wat`I R+: xun r+u.. 'f8 UditYWiiWatJ _ - t' ... . ' ;•�lw..l�uii�F;,,w;t+u>a4a:•- ;irtp BdPa ,.Ab: 'npna Ole'�y�voyptinA ..".pet6 -'"O+nmrtq MWanui[gitrreannr44bikMiesk ijMi. l IWn4rlf ' iMeluCd�p!''WIUYuA :.f9r16MH497H'S.Fpu "reait.iiw fSWuvuF •.. . Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervfsor CS-072772 Expires: 04/07/2020 JEFF C STEEI E 24 SHERWOOD AVE DANVERS MA 01923 CCommissioner 7�n >(rur�nnirrilFrr�/f el, log�r[ nda/f.: Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Reoisbration ExpimU 168a25 04/11/2020 WINDOW WORLD OFBOSTON,LLC. JEFF C,STEELE -- 15A CUMMINGS PARK WOBURN,MA 01801 UrlderSl a tAry The Commonwer hli of Hassacliusefts Department ofIndustrdnl< ccade;�ts 1 Con-'ess Street, Suite_190 Boston, IbL4 02111-29.17 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/ElectriciansiPlumbers. TO BE FILED WITH THE PERMyfITTT V4G AUTHORITY. Applicant Information Please Print Le--ibi Name(Business/Orgaaization/Individual):,[-/1-7� S/on GJP/ ��r - �giq' r✓ii�aa t✓W dam/& Address: 1 5 Ci )rn rn City/State/Zip: W MA D Phone#: 7,? Z-I f,?Q :ire yoy an employer?Check the appropriate box: Type of project(required): 1. II am a employer with_employees(full and/or part-time).* 7. New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.lido workers'comp.insurance required.] 9. ❑Demolition 3.[]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t - 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure hat all contractors either have workers'compensation insurance or are sole I L Q Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 3.71[am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.+` �,/ � � o.❑We are a corporation and its officers have exercised heir right of exemption per;VIGL a. 14.1�0Hier w i%1 d-i� t32,§1(4),and we have no employees.[No workers'comp.insurance required.] /-ef—Jq>ce ►t v� *Any applicant that checks box.41 must also fill out he section below showing their workers'compensation policy information. '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 ofthe 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: A Ssnc; 0-4e of u�/Pr 3 Policy#or Self-ins.Lic.#: W a C. -5 00- 5 o O ci- Z O l Expiration Date: L/ Z O Job Site Address: / .31V /f&C 42-) S Alecle / City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expira 'on date). Failure to secure coverage as required under IVIGL c. 152, §25A is a criminal violation punishable by 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 Aolator.A co o this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verific 'on. I do hereby certi and he pa' a enalties of perjury that the information provided above is true and correct Si afore: Date: Phone Official use o not write in this area,to be completed by city or imm 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#: �®� DATE(MM/DOIYYYY) A CC) CERTIFICATE OF LIABILITY INSURANCE 03/26/19 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 have ADDITIONAL INSURED provisions or 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 NAME: amy roberts M.P.Roberts Insurance Agency Inc. PHONE o Ext: 978-683-8073 A/c No: 978-683�147 1060 Osgood StreetE-MAIL North Andover, MA 01845 ADDRESS: amy@mprobertsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: WESTERN WORLD INS COMPANY INSURED INSURER B: MERCHANTS INS COMPANY L&P BOSTON OPERATING,INC INSURERC: ASSOCIATED EMPLOYERS DBA WINDOW WORLD OF BOSTON INSURERD: 15A CUMMINGS PARK WOBURN,MA01801 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INS. WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES a occurrence $ 100,000 MED EXP one person) $ 5,000 A NPP8525379 04/05/19 04/05/20 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ 1,000;000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED MCA1002569 04/05/19 04/05/20 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-0WNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIas CLAIMS-MADE AN065362 04/05/19 04/05/20 AGGREGATE $ 1,000,000 DED I I RETENTION$ r $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 C OFFICERIMEMBEREXCLUDED9 NN N/A WCC-506-5018609-2019A 04I05119 04105/20 (Mandatary In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it 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 EVIDENCE OF INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED;7*TATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and-logo are registered marks of ACORD . Town of Barnstable Buildin _ �`,�...,�� '�:�°� .s`��5 "� �. ..:�a� 'h'3,. :' ..-'» ��.��, � ia 'aewy+ �2" � :-2�� s �.. s: .,�� �"...; a°" ';:'���- ::� ��- •�e '4�`' ,�j `;,i.. : . .. eA g Po'stThis Card•So`That rt�s Vis�ble`From theStreet-Aft roved Plans Muss"beRetamed on Jo•b antl th�s.Card-Mustbe;Ke t _ ♦ �AttNt3eA6LB, • `' +. $ ..- d.. >,' �. .:; R M" Posted Until°Final InspectionHas Been Made \ ` ` \ RWhere a"Cert�Rcate of Occupa€ncy.es Requiredsuch Bu�itlmg shall Not;be Occupied;unt>l,a-Final"inspect�on,has beenmade Permit Permit No. B-18-1640 Applicant Name: HENRY E CASSIDY Approvals Date Issued: 06/13/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 12/13/2018 Foundation: Location: 134 HUCKINS NECK ROAD,CENTERVILLE Map/Lot 252-030 Zoning District: RD-1 Sheathing: F Owner on Record: ROWELL, BARBARA H TR ' Contractor"Name:;_CAPE COD INSULATION, INC Framing: 1 Address: 134 HUCKINS NECK ROAD Contractor�License 153567 2 CENTERVILLE, MA 02632 ,;; Est Project Cost: $2,300.00 Chimney: Y: Description: 9" Layer R30 VM Faced Fiberglass Batts to 48sq Ft Attic Space. Permit Fee: $85.00 Insulation: Fee Pala $85.00 Project Review Req: Final: Date 6/13/2018 Plumbing/Gas F 4' Rough Plumbing: .:_• ' Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorize mo d by this permit is commenced within six nths after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for�which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road a.nd shall be maintained open forpublic inspection for the entire duration of the work until the completion of the same. - Electrical 26 x Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Bwldmg and,Fire Officials areprovided on this"permit. Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing µ ,.,_ � Rough: 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons acting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel O Application — Health Division Date Issued 6 /3 iV � • Conservation Division Application Fee ' Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic- OKH _ Preservation/ Hyannis Project Street Address _•s' 4Z eC,e 42<✓ Village 1' , 7;eW ei, Owner ,! & Address Telephone rF' � Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project 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'sHighways❑Y� ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other y� ZE =-) Basement Finished Area (sq.ft.) Basement Unfinished Area(sgft) N-' t Number of Baths: Full: existing new Half: existing f new cry Number of Bedrooms: existing _new 3-1 Total Room Count (not including baths): existing new First Floor Room Count r' 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 -r - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name L-l��� e /,�f�1 �r� Telephone Number 'e ZZ S /7/`/- Address T l�<��2�a License# /,-I ` Home Improvement Contractor# / G Email r Worker's Compensation # /�,c",� /Qz ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ,s:fZ /l� FOR OFFICIAL USE ONLY APPLICATION # 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 ASSOCIATION PLAN NO. DocuSign Envelope ID:7483576C-8CD6-462A-971A-741162770B80 of ,He ro Town of Barnstable �114 `1y Regulatory Services IiAxvsrnBLE, •` Richard V. Scali,Director MASS. o 9�p 1639. . Building Division .orEo MA Paul Roma 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 I, BARBARA H ROWELL as Owner of the subject property hereby authorize . �'o� ��0_(�.� to act on my behalf, in all matters relative to work authorized by this building permit application for: 134 Huckins Neck Road Centerville, MA 02632 (Address of Job) DocuSigned by: - f�AY�GUra 5/14/2018 1 9:12 PM EDT ED74721 F F44E. Signature o�° wner Date Barbara H Rowell Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form. C:\Users\decollik\AppData\Local\Microsoft\Windows\1NetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 The Commonwealth of Massach usetts t Department of XndustrlalAccldents I Congress Street, Sulte 100 Boston, MA 02114-2017 www,mass,gov/dla Workers, Compensation Insurance AftldavIti Bull ders/Contractors/Electri eta ns/Plumbers, TO BE FILED WITH THE PERMITTING AUTHORITY, Applicant Informadon Please-Print Leeibly Name (Business/organization/Indivldual); Cape Cod Insulation, F� Address; 18 Reardon Circle City/State/Zlp; South Yarmouth,MA 02664 Phone#; 508-775-1214 Are you an employer?Check the appropriate boxt Type of project(required); I Q l am a employer with 48 employees(full and/or parw•time),* 7, ❑ Now construction 2,❑1 am a oleproprietor or partne ip and have no employees working forme In 8, ❑ Remodeling an capacity.(No workers'comp,insuranoe required,) 3,❑I am a homeowner doing all work myself,-[No workers'comp,Insurance required,)t 9, ❑ Demolition 4,❑1 am a homeowner and will be hiring contractors to conduct all work on my property, l will 10 ❑ Building addition ensure that ail contractors either have workers'compensation Insurance or are solo ,❑ Electrical repairs or additions proprietors with no employees, 11 5,❑1 am a general oontmotor and I have hired the sub•contracton listed on the attached sheet, 12,❑plumbing repairs or additions Theca sub-contraetors have omployees and have workers'comp,Insuranee,t 13,[]Roof repairs 6,❑We are a corporation and Its of'fiosm have exercised than right of exemption per MOL o, 14, ✓[�Other Weatherization 152,11(4),and we hive no employees,[No workers'oomp.Insurance required,) $Any applicant that cheeks box N! must also fill out the section below showing their workers'oompensaufon policy Information, t Homeowners who eubmlt`iRialtffidavit indlcating they are doing all work and then hire outside contractors must submit a new afAdavit indicating such, ;Contractors that check Us box must ettaehed an additional sheet showing the name of the sub•contreotor$and state whether or not those enttles have employees, if the sub-contraotors lava employees,they must provide their workers'oomp,policy number, !am an employer that is providing workers'compensation Insurance for my employees, Below Is the policy and fob site inform.adon. Insuranoe Company Name; Atlantic Charter Polioy#or Self-ins,Llo,#; WCE004 31902 Upiration Date, 06/30/2018 _ Job Site Address;lY,� /�.cy�� � �',oQ l&= lty/State/Zip; 6 Attach a copy of the workers' eo>nperisation policy declaration page(showing the policy number and explration date), Failure to secure ooverage as required under MOL o, 152, §25A Is a or(minal violation punishable by a fine up to$1,500,00 and/or one-year Imprisonment, as well as civil penalties In the form of a STOP WORK ORDLR and a fine of up to$250,00 a day against the violator,A copy of this statement may be forwarded to the Offtoe of Investigations of the DIA for Insurance coverage Yerlfloatlon, 1 do hereby cer un r t - ns and penalties of perjury that the information provided above is true and correct, rz 508.775.1214 Date! 0111c1al use only, Do not write in flits area, to be completed by city or town o,/yiclal, City or Towni Permlt/License# Issuing Authority(circle one); 1,Board of Health 2, Building Department 3, Clty/Town Clerk 4, Electrical Inspector•.5► Plumbing Inspector 6,Other Contact Personi Phone#; w i r' Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Ma11 u_setts 02116 Home improveMj,= tractor Registration tration -Type: Corporation Cape Cod Insulation - Reg(stratbrtr 153567 Inc �, �1,� Expiration; 12/14/2018 18 Reardon Circle • • 6° - So, Yarmouth, MA 02664 SCA 1 45 20M-05/tt —� Update Address and return card, Mark reason for change, ._. ....... ._.__. �s�oa��aconsusalC<c a '—'----......._.___•--�—Ac{rizest�_.1;,'',.L',snt�.Lvt�l_�,,..�cxolayn7ant..�1•.i„nS±,.r,a.r� �C3�aaaao/icoetd• Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for IndlVidual use only ei Corporation before the expiration date, If foun urn to; csu<%%t egis.t:ratlon Expiration Office of Consumer Affairs and J81 as Regulation 10 Park Plaza• e 8170 :� 12/14/2018 11 x •••••. t`:';{` x, Boston,MA Cape Cod Insul`rl'`F Henry Cassidy 18 Reardon Ciro So,Yarmouth, Undersecretary t al hout si at 1 \ z' Commonwealth of Massachusetts Division of Professlon'al Llcensure .Board of Building Re� gqulallons and Standards 1 Cons�,� fii�,N(trvisor CS•100988 11/11/201.9 HENRY E CA D 8 SHED ROWI Y', WEST YARMOtjfiJ'�41, i7t Commissioner ' CAPECOD-27 KDOYLE CERTIFICATE OF LIABILITY INSURANCE D 0TE 403/20 103120Y8 18 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 have ADDITIONAL INSURED provisions or 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 endorsements, PRODUCER C ACT Rogers&Gray Insurance Agency,Inc. PHONE 434 Rte 134 ac No Ext: ac,No:(877)816-2166 South Dennis,MA 02660 AS.mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company 24198 INSURED INSURER 8:Safe!yIndemnily Insurance Company 33618 Cape Cod Insulation,Inc. INSURER C;Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Company44326 South Yarmouth,MA 02664 INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE [X]OCCUR BKW53328281 04/01/2018 04/0112018 DAMAGE TO RESIEaENTED 100,000 RE MSMED EXP(Any oneperson) 5,000 PERSONAL&ADV INJURY 110000000 GEN'L AGGREGATE LIMIT APPLIES PER:jP GENERAL AGGREGATE 2,000,000 X POLICY &- LOC -PRODUCTS•COMP/OP AGG 2,000,000 OTHER: B AUTOMOBILE LIABILITY m CO_tEaMBINEaccIdeD nt,SINGLE LIMIT 1,000,000 ANY AUTO 6232707 04/01/2018 04/01/2019 BODILY INJURY Per person) $ AUTOS ONLY X AUUTNOSSWUL�EEDp 1,000,000 X AUTOS ONLY X AUTOS ONLY BODILY INJURY Per accident PROPER Y AMAGE Fer accijent C UMBRELLA LIAB X OCCUR EACH OCCURRENCE 2,000,000 X EXCESS LIAB CLAIMS-MADE R/0 EXCI0006635002 04/01/2018 04/01/2019 AGGREGATE DED RETENTION$ Aggregate 2,000,000 D WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY X OTH• ANYPROPRIIETgOERR/PARTNER/EXECUTIVE YIN WCE00431903 06/30/2017 06/30I2018 9atoryendR/MIEn NH)EXCLUDED? � N/A E.L.EACH ACCIDENT 1,000,000 If yes,describe under E.L.DISEASE•EA EMPLOYEE 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 10luAddltlonal Remarks Schedule,may be attached It more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. 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 ACORD 25(2016103) ©1988.2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD a<"W3of T Town of Barnstable , *Perm / Expires 6 mo ssu e Regulatory Services Fee • sMatvsTABLE. 9� z Richard V.Scali,Director PIED MA'S A — — ui ><-n- Y-Vst -on— Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS ERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 3 y vc „✓5 �GCfc ��i� ���✓j�7z t/«� �t'`�i as Zesidential Value of Work$ 3,,200 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address A.) 3Ll 1¢r,ctc�.�� �/L c« ,7 L! .z�zy,�� x/1 Contractor's Name €k Telephone Number O8 Home Improvement Contractor License#(if applicable) 9 7 b 6 Email: D RW4�t3 Construction Supervisor's License#(if applicable) U, [�1 ❑Workman's Compensation Insurance X-If RESS B HIMEN ll Check one:®'I am a sole proprietor SEP 0 8 2014 ❑ lam the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) 9--Ke-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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&Construction Supervisors License is SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 _ ,il KERS,�COMPENSATOON<SAND EMPLOYERS LIA'�1L11"Y iI�SUR�NCEfPOLOCY ' Mg Bnfor�nataon Pagery. � ,.. x. ., � .,.. _ .. __.. .. ..•. , _ .._ _,. _ WC A Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number: WCV01168000 1. INSURED: Prior Policy Number: New Robert F. Tyndall . Producer: ' 80 Brigantine Avenue O'Briens Centerville Insurance Osterville, MA 02655 Federal ID Number:174560293 Agency, Inc. Risk ID Number: PO Box 610 Centerville, MA 02632 Business Type: Individual SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured: See WCE106. Other Work Places: See WCE107 2. POLICY PERIOD: The Policy Period Is From: 7/11/2014 To 7/11/20,15 12:01 A.M. Standard Time at The Insured Mailing Address 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are-. Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20'03 06B D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates & Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $500 Interim Adjustment: Annually Servicing Office: Estimated Premium (Minimum Premium) $500 25 New Chardon Street Boston, MA 02114-4721 Issue Date 07/01/2014 Countersigned By: �l.0 Coovright 1987 National Council on Compensation Insurance F r,,;• Inn.,,,, k� ��ti<m•a`rxa�ttf�FetrJ'th o��assrFel�trt�� -- � e c' 7t��ior�s • Deparhnent of huhv3&kd Accidents -Pm-ii�.rrimmgoVdia _ workers' campensafion insurance .davit:Builders/Cantraactors/E,ectriciansMurnbers Applicant Infe rmation Please Priaf LcTibly Name(Busiue Oiyani zatioa(10 naq_ hl c vv�33 ' A�Iress U ds6 - City/SfatefZip:6• )K+C- /VL,4 6,:5L5 3(, Phonfa 4 '` Are ya-aan,employer: Check the appropriate T . of oiect (r t �-_ Li�'���ge�al confracEor and'i 3'� � l (required): 1_❑ I am a emp foyer with 6- ❑Ntw oonstn�ioa employees(fall an&osgart-fme)-* have hired the suli-confradDrs. 2_❑ I azn a sole piapaetor or partner- listed on the attached sheet 7- ❑Remodeling ship and have no employees 17hese sab-contractors have S_ Demolifiou -,�,ro> J-br rein in any aP`a c cibr_ emplm} s and have workers' 9_ E]Building addition 6 Workers' couap:rn.�e comp-insurance 1 . 3_ We are a corgoraticnand its 1{l_.❑E��ical repairs or additions 3_❑ I and a homeuvmer doing all work officers have exercised their I I_E]Plambing repairs cr additiomis nrysalf [No tvofj-M'=33p- right of e2zemptionper MGL 17.0 RDofregai.s in c,x e—required-]t e-152,§1(4),and we ham na employees [Na wmicers' 13_.❑other comp_insurance required.j '��ny apptxxslrf;nat sheds boa rI burst also fill o-�rt tha sr�rion hcloG�t:��R i'eir�odrets'cvu�e�ss�oa poiicg� � t 3nmecwn�s�s'so�bmit dais.ai5dxvif i�r�v they ate tiding zIT zr>Qic a;�Bien hire p�ridz co�t=actms mmrsi sa�mit a��€�dsvit;�,�;--r_='n,�sarli =cbmaciors ih. cf_sk this box mast sttacb2d as 33diaons sweet shaking the naax of die mb-omirseto�-md state whets ucbnt tImse evities have awpja ts- If-the sale-co�toictars have empIoyees,they must provide th—._r policy nwnbez I agi are e:npLoyer That is prmddiNg ItIorleers'compemr ion imairarace f`or my employ ecu Helow e thepoUcy and job alto irtfctmalio;� Ins�raince Compatr=�I�Iame: _' • Poll-Y 41 or Self in€Lic-1k Expiration Date: Job Site kddsess: Cit�'/Stat z p: Attzdx a copy of the workers'compensation polity declaration page(showing the policy-ntwher xnd expiation date). Failure to secure caVrrage n reTtiredunder Sectioa 25 AL of MGL c. 152 can lead to the imposition ofcritn rat penalties of a f=up to$1,5 DD_QQ and/or one-year imlttirmmxrneuiy as well as civff pm ualties in the.fora of a STOP WORK ORDER and a fine of up.to$250-010 a day against the violator_ Be advised that a copy of this statement maybe forwarded in the Office-of Im-eg6gadons of the DIA far fimn-a ce coverage verfication I da hereby e nnd--r tit peaks andpenadiiss p�uiy thatthe infornzat&a prcn ded abave is tnza and corrsct Sianatvre: Ojjzcial use only, Ela not writ&in this area,to be cnuapleted by chty at town offic&L Cif v-or Town: Peruri#ILicense# Fccar—AcLthari-ty(drde one)- 1.Board of Hezlth 2.Bmidin„Department I Git0rown Clerk 4_Electrical Inspector S.Plumbing Iuspector 6.Other Cnsct Person: Phone 9- 6 Information and Instructions Massachusetts Cenral Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 de fined as"an individual,partnership,association,corporation or oilier 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 individua%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 appu�tenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to oper-ate a business or to construct buildings in the commonwealth for ala; applicant who has not produced acceptable evidence of compliance vvZt_li the insurance-coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its snail enter into any contract for the perfo_Tmance of public work until acceptable evidence of compliance,vi'L the in-sur-aace requirements of this chapter have been presented to the contacting authority." Applicants — _— Please,fill out the workers' compensation affidavit completely,by chec;iirg the boxes that apply to your sitzatien and,if necessary,supply sub-contractors)naine(s),address(es)and phone nrin-be.r(s)along with their ceri:nc;lc(s) Of insurance. Limited Liability Compr�ies(I LC)or Limited Liability Pa,-uex;} ps(LLP)vi�no e?rinlryees other liar nit members or partners,are not rt,-p_ed to carry workers' compensation i siLrance_ If an LL.0 or LL?does have employees, a policy is requirecL fie advised hat dis affidavit may be s bmitted to he Department of indu_inial Accidents for confirmation of inset—ance r-oYc age. Also be sure to sign 2--ad date the affidavit_ 'I1ie aida,,6t sbo lld be returned to the city or town that the application for the permit or liczsse is being requestmd,not the Dcpartment of Industrial Accidents_ Should you have any questions regarding the lava or if you are requiifed to obi-i a workers' compensation policy,please call h Department of the number listtd below. Sal;-in_nared companies should enter their self-insurnce license number on he appropriate line. City or Town Officials Please be sure that the w 5i davit is cemplete and printed legibly. The DepartT eat has provZded a slue:at the bottom of the affidavit for you to at out�the event the Office of Investigations has to contact you it-ding the applicant Please be sure to fill in the permiJlicease number which will be used as a reference number, in additic;z au applicant that must submit multiple perm, itllicense applications in any given year,need only submit one a Eleavit indica fig current policy information(ifnecessary) and under"Job Site Address"the applicant should vmite"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 provZded to the applicant as proof that a valid affi:ltvit is oa 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 affadwrit The Office of Investigations would like to thank you in advance for your coopei-ation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and hx number: ' .1!-CoDamaaw-,alth of Massachuseiis Depar�ent of ladust ual Aocidr.fits OM14-e of f avestiptiam . 6QO Wasungtal,Sit Briton,MA 02111 Ttl, 617 727-49-Q0 W 406 or I-Rr?NL,SSA^FE Revised 4-24--07 Fx 0 617-727 l`t( Www.maS,,govrd a �1HE rti Town of Barnstable Regulatory Services NAM $, -Richard V.Scali,Interim Director �ED39. �►,� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete.and Sign This Section If Using A Builder z aC-��'-��/�� ,as Owner of the subject property.. hereby authorizes to act on my behalf, in all matters relative to work authorized bythis building permit a (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. i�tur of Owner Signature of Applicant Pant Name Print Name Date Town of Barnstable - Regulatory Services optHE rok� Richard V.Scali,Interim Director Building.Division t mxxsraBc E Tom Perry,Building Commissioner MASS. 163.. �$� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6250 HOMEOWNER LICENSE EXEMPTION Please Print DATE: = JOB.LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityltown 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 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"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Appioval 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 1091.1-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. e �porrvrnoracueccl�o� c��a�cvreCl. ,� -- _, Office.of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOP, ; before the expiration date: If found return to: p egistration &19766 Type: Office of Consumer Affairs and Business Regulation: Expiration: 8/28/2'115 DBA o I 10.Park Plaza-Suite 5170 IeGN J1iE j. ..Boston)NA 021,1E BB CRAFT DES � DAVID WEBB �� � 1 25 MEADOW VIEW _ EAST FALMOUTH MA G2 �+ ��a 536 Undersecretary I u t � Not valid without signature • 1 M as s F ach. _ .u sett s Dep artment of Public Safety Board of Building Regulations and Standards .Construction Supervisor •.. License: CS46189 _ , . �:. . •. DAVIDH WEBB i 24 MEADOW VIEW DR E FALMOUTH MA 02536 � i Expiration Commissioner 10/29/2014 •4 , ' > >nns4•= TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel l J A lication # y ���0 2— I? pp Health Division Date Issued t U ti Conservation Division 4„ Application Fee Planning Dept. Permit Fee _ Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address 134 Huckins Neck Road Village Centerville Owner Barbara' Rowell Address same Telephone 508-775-5120 Permit Request air sealigng, insulate exterior walls, basement ceiling at house sill, insulate crawlspace, add polyethylene Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2099 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: D:existing d'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 RISE Engineering Telephone Number 401-784-3700 Address 1341 Elmwood Ave, Cranston, RI 02910 License# 100459 Home Improvement Contractor# 120979 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE `2 —24,_t C) Erik Nerstheimer for RISE Eng. FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: t FOUNDATION t FRAME INSULATION 9 o Q #&LS hTaT DuSE r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): RISE Engineering a division of'Thielsch' Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone#: (401)784-13700 or 1-800-422-5365 Are you an employer? Check the appropriate boi: a Type of project(required): 1. 0 Lam an employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors '7. ❑Remodeling 2. ❑ I am a sole proprietor or partner listed on the attached sheet. 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. 1 9. ❑Building addition 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 11. ❑Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no 12. ❑Roof repairs employees. [no workers' 13. N Other Insulate comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContactors that check this box must attach an additional sheet showing the name of the sub-contractors and state wbether 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 thepolicy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins.Lic.#: 3730961-00 Expiration Date: l°/1/11 Job Site Address: -54 ffiAa•il/1C' City/State/Zip: uA 2V [ -P 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 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 $250.00 a.day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coVeravze'verification. .I do herby certi and the ins enalties of perjury that the information provided above ris true and correct. Sign ture: K Date: Print Name:` Erik Nersthe mer Phone#: 401)• 84t�L/.00 or 1-800-422-5365 ext133 Official use only -Do not write an this area to be completed by eity,or town official City or Town: Pefmit/license#: IssuingAuthority(circle one): 1.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other f Contact person: Phone#: 41 r • m - .. AAC®ftD. CERTIFICATE CF LIABILITY INSURANCE' 47 =(MMjD()ryy(y) THIEL-1 PRooucER THIS CERTIFICATE IS ISSUED AS A N9ATTER OF INFORMATION The Preston Agency In'C. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303 HOLDER'..THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 81'0 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ East Greenwich RI 02818-0810 Phone: 401-886-8000 'Fax:4.01-88571700. INSURERS AFFORDING COVERAGE NAIC INSURED - INSURER A' _ ;ZuLich-Ame=scan Ins' Co. I Thielsch EngineeringINSURER*, IncIRC NSURE Amor.lcan tua Tanta a Ltabl l'i ty Thielsch CBroup Inc. INSURER North American Capacity Ni Tech Realty Inc. -_ I95 ranston RI: 02910 Frances Avenue -Cranston INSURER 0: Hartford Insurance Company INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAvE BEEN ISSUED r0 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING � ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'NITH.RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR - WAY 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. IFISF?"fIuuT LTR INSR .TYPE OF INSURANCE POLICY NUMBER. PO DATE(MMlDDIY1') _DATE nMM p LIMITS GENERAL LIABILITY EACH OCCURRENCE' �� .' :{ 1,00 0,0 0 0 . A , X COMMERCIAL GENERAL LIABILITY 3730962-00 :040 /110 01 01/il / /. 5300,000 PREh11SES(Eaoccwenda)_" CLAIMS MADE T.00CUR. ME EXP(Any,one person) A.10,0 0 0 - - PERSONAL 4 ADV IN.;URY ;1,0 0 0,0 0 0 - GENERAL.AGGREGATE ; 2,0 0 0,0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMP/OP nGf $Z,0 0 0,0 0 0 POLICY X JET LOC - - '— Emp Ben. 1,000,000 AUTOMOBILE LIABILITY - h X ANY AUTO 37.30963-00 04/01/10 O1/01/11 c(Ea cdida accideni)0'SwGLEuM1T 2,000,000 ALL OWNED AUTOS - --- . BODILY INJURY - SCH000LED AUTOS - - (Per person) •- HIRED AUTOS BODILY INJURY WON OYJNED AUTOS - v - (Per acc�d@NI . :PROPERTY DAMAGE - - - 1Per ac6ibanl) -, GARAGE LIABIEtr7 - _ Y AUTO ONLY-EA ACCIDENT ; - ANY AUTO - . OTHERTPAI EA,ACC $ A.UTO.GNLY: AGG_ ; `---- EXCESS(UMBRELLALIABILFTY. -- - EACH OCCURRENCE ; lO,OOO_,OOO B X OCCUR CLAIMS MADE UMB. 9263637--00- •04/01/10 OT/O1/:1 'AGGREGATE s10,000,000 DEDUCTIBLE — X. RETENTION -;10,0 0 0 I WORKERS COMPENSATION AND X TORY{_IMIT`- EP. EMPLOYERS'LIABILITY " A 3730961r00 04/OS/10 01./01,/11, E.LEACHACCIDENT ; 1,000',000 W1'FROFRIETGR/PARTNEP./EY.ECUTIVE - OFFICERWEMBEREXCLUDED7 A E.L.OISEASE-E EMPLOYEE 51,000,000 If yes.describe under - '-- — SPECIAL PROVISIONS belay - E.L.DISEASE-POLICY CIrA1T :f 1,000,000 - OTHER C professional Liab " DVL000026800 04/01/10 04/01/11 Prof, Liab 2,000,000 D � Leased/Rented Eqp 02UUNTD5678 04/01/10 04/01/11 Equipment 100,000 DESCRIPTION OF:OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/.SPECIAL PROVISIONS - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ,. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 0_YS WRITTEN - NOT!CE TO THE CERTIFICATE.HOLDER NAMED TO THE LEFT BUT F.gILURE TO 00 SO SHALL - - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON rHE Im SURER,ITS AGENTS OR - REPRESENTATNES. - AUTf/N/O�RfIZ�EDREPRESE Vf ACORO 25(2001/08) r _)ACORD CORPORATION 1988 * ' . y --� !1 fe i'b _i(lii, - - S{t9lt rj'i`THIEL'�. H 1'' PAGE 2 ® Q¢�� ,'®` . rrt ` -E � rt� 'r4, rff{ ks.' °r ��1Y�i l'it a"'f=.�rUf l+ftfi','I.�C3 �ik�LS�jjiit��ti; + �;,�< ��'�3jEi.r. . _ _ i 1,. •E 5 71V +}�l' ��N�UREDRS#1�AME aTh''i81�c,�►e+L�n�:inee�; ag�,��n �-r tttUr ff11>!��y r,��,�OPi 10 27jk9 i :rj , DA7`E'�04/12/X.0 ts' +il # 4];±. rIL.,. rfli ic.,.ii..._ -.• I ..,_r Sal ni 11 s a`tif.$.a3„ _•.hstll?;i .. aii'u,c .�?,'Yi. 15. ! ,. _.. ,. ... ..I l+: ... Also for RISE Engineering, a division .of Thielsch Engineering,. Inc. E Gaskell Associates,; a division of 'Thielsch Engineering, Inc. BAL Laboratory, a division of Thielsch Engineering,, Inc. ESS Laboratory, a division of Thielsch Engineering,, Inc. ALCO Engineering, a division of Thielsch Engineering,' Inc. Water Management" Services, a division of Thielsch Engineering, Inc 4 O ice o nsumer ai an usines+se u ation og 10 Park Plaza- Suite 5170 ° Boston, �sachusetts 02116 " + a Home Improveontractor Registration ; - Registration: 120979 M Type: Supplement Card Expiration: 3/25/2012 THIELSCH ENGINEERING s. - ER1K NERSTHEIMER ..w .1341 ELMWOOD AVE: - tRANSTON, R1 02910 : `F Update Address and return card.Mark reason for change _ t µ Fr y Address Renewal Employment Lost Card , DPS-CA1 0 5OM-04/04-G101216 Tk Office of Consumer Affairs&Bu iness Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - ; Office of Consumer Affairs and Business Regulation ° Registration �g79 Type: 10 Park Plaza-Suite 5170 Expira "`—= 12 Supplement Card Boston,MA 02116 THIELSCH EN&t a , ERIK NERSTHE 3 '/1 1341 ELMWOOD ( — CRANSTON, RI 029f _r Undersecretary Not valid without signature —--- -- f ra?t; i OI 1 The Offtcial VVebsite of the Executive Office of Public Safety and Security (FOPS) ` Mass.Gov Home ~ :r Public Safety i Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 100459 Restriction WS,IC Name Erik Nerstheimer City, State, Zip North Scituate,RI, 02857 Expiration Date 3/28/2012 Status Current " No complaints found for this Licensee. Back To Search ��ie.Ur ozn�r,:cynu�ecz� a��4Qax:�cc�eLrb _ • I. � _.- ... .. Board of Biiildino Regulations and Sta"ndaritg� ' I Li.Cense or registration valtd for individul use only i HOME IMPROVEMENT CONTRACTOR i before the expiration date, If found return to:. Registration,:. 120979 Board of Building Regulations and Standards , Expiration _3�.25/2010 , One Ashburton Place Rm 1301 -YPe:-Si pplemeni Card rrt?stc�l 1s1a. 021-08 E L S C H ENGINEERING-`` K NERSTHEIMER=_:--- 1 ELMWOOD.A"E \NSTON, RI 02910 Admmisti-:uor Not valid without sign ." � N lid ---- - 'ni-tp://db.state.m.L--LIS/dps/licdetails.asp?txtScarchLN C5 1111 f _ Gt 4\ n ryfi m 3 �T t NAT-24531 - 1 w . _ o r -. I RISE ENGINEERING " ' Federal ID#05-0405629 RI Contractor Registration No 8186 A division of Thielsch Engineering AAA Contractor Registration No 120979 - CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,R102910 CONTRACT ®/�r4 1 (401)784-3700 FAX(401)784-3710 COl�TRAC 1 Page _ THIS CONTRACT IS ENTERED INTO BETWEEN RISE - ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE - DATE Client 6 Barbara H Rowell (508)775-5120 05/10/2010 110054 SERVICE STREET - BILLING STREET - - 134 Huckins-neck Road 134 Huckins-neck Rd SERVICE CITY,STATE,LP - BILLING CITY,STATE,ZIP Centerville,MA 02632 Centerville,MA 02632 JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. 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 seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing. 2 man hours. $132.00 RISE Engineering will provide labor and materials to install blown in Class 1 Cellulose to 920 square feet of exterior walls with wood or vinyl siding.Touch-up painting,if needed,will be the customer's responsibility. Invoicing will occur upon completion of installation. Subsequent to your payment,as an added service,RISE Engineering will return when weather permits to check for any voids with an infrared scanner. Any major voids that may be found will be filled at no additional cost. $1,334.00 RISE Engineering will provide labor and materials to install 137 square feet of R-19 faced fibers sirr cowi basement ceiling at the house sill. F 'yp� — 4 (��Q $150.70 L�V IV RISE Engineering will provide labor and materials to install 123 square feet of R-10 rigid fiberg 1Ilation board.to the crawlspace i perimeter wall,and R-19 Kraft faced fiberglass to the band joist and house sill. $332.10 RISE Engineering will remove 153 square feet of batt style insulation from the crawl space area irteecntibemeligible-)—-- $99.45 RISE Engineering will provide labor and materials to install 153 square feet of 6 ml polyethylene over open ground in designated crawlspace/earthen basement areas. $45.90 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$2,000 per calander year. $1,504.16 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred Eighty-Nine&991100 Dollars $689.99 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER AO DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES G. /of " _ AUTHORIZE StGNA RE•RIS NGINEERING .CUSTOMER ACCEPTANCE - NOTE:THIS CONTRACT MAY BE WITHDRAWN BY U3 IF NOT EXECUTED WITHIN, DATE Of ACCEPTANCE �`•tti.P� t 30 ACCEPTANCE OF CONTRACT- HE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK. DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE Town .of Barnstable *Permit# � � � F Zt1E Tp��o Expires 6 months from issue date . OU M� sr�BM Regulatory Services Fee ` v KAS& g Thomas F. Geller,Director m Building Division Elbert C'Ulshoeffer,Jr. Building Commis 367 Main Street, Hyannis,MA 02601w i�" Office: 508-862-4038 JUN 9 _ 2005 Fax: 508-790-6230 EXPRESS PERMIT APPLICA'[tDQDI 1 OF BARNSTABLE Not Valid without Red X-Press Imprint Map/parcel Number 25 o 3 O 1plk Property Address t3 WelldT AlCac p 0 C " 2'Zesidential OR ❑ Commercial Value of Work /J d Owner's Name&Address w��L _ 13y Hu ck llrs Nick Telephone Number Contractor's Name t t�►��2:T � Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Orkman's Compensation Insurance . Check one: I am a sole proprietor Lam the Homeowner I have Worker's Compensation Insurance Insurance Company Name C 12 Workman's Comp.Policy# C y3a� 6 Permit Request(check box) . ❑ Re-roof(stripping old shingles) - ❑Re-roof(not stripping. Going over existing layers of roof) . Re-side ❑ Replacement Windows. U-Valtie _ (maximum.44) Other(specify) r *Where required: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic.Conservation.etc. r_ _, •. is W.. W-. ,..r.w -.rwrx' e a .r :... ....., ..,,.. ,...w.,a..„R. .-rows .u- -aa*�.• yry.�.,,�...,. r.` ;i,.r_ — 'Signature expmtrs u TYNDALL ROOFING #3 7 Briar Patch.Road ropos�. t 0.Sterville, MA 02655 (508) 420-4456 Page No. of Pages PROPOSAL SUBMITTED TO PHONE DATE An L C ( `? STREET JOB NAME: 13"h Alf R- l -OL.)r C C CITY,STATE AND ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE Ctfk(7-�' 2 We hereby submit specific4,tions and estimates for: r t- ���- Sl11r[C�C �— l �t►t K ©024.f E�2 GJt,E�K � r.. a rf iusi�cC AlFw Ile S t..rcYeFs C,e�e -- T'rvg� - noo I(All7b C1+rMw ra �ti CFI to 0r%f . rtiu It ,� n tom' _ 4 Af IF �o.dollars ($ v C ) Payment-1 a made as follows: All work to be completed in a sub- stantial workmanlike manner according to All submitteo,.per standard Authorized Practices. Any alteration or deviation!from above specifications involving extra Signature costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or Note:This proposal may be delays,beyohd•our.control.Owner to carry fire, tornado and other necessary in- surance.Our workers are fully covered by Workmen's'Compensation Insurance. withdrawn by us if not accepted within days., ACCEPTANCE OF PROPOSAL The above prices,specifications and condi- tions are satisfactory and are hereby accepted.You are authorized to do the work as specified..Payment will be made as outline above. Signature Date of Acceptance: Signature j 4 .a.. ..^ -.o.,...,.-..-•�.fae+w.. �w .. ..-........+..s: .» e+.. r!.. ...^i.+'.••.!".^�i,YY�/+�.+:r...rw+M.M.s_�.w-M.i�nwi sww:i+'w,u*+aw....«.......-r �. .•.. ..,«.«., .• b .r.awJ..:Wai td. .-__� s_.a�..�:1.1�k.. .._..-......+�:.•....+......%_«..ui:caseau�+i.2r•�.^.�v'hr4 w_.^n ,wlsna�'.�:w�e�:-- - -. - _ - ... � ay..w...•:.T._.•-„..•.....,�.,«.w».".•=a.,,.,.a+Y-.-a4,v..ww•.w+..s+',:,=+tT-w:M..Vi..«.a....,..+,r-u...."s�r.» - ...-....-_. ., w ,.� w r a«... _- u-..mow.». ..•.,. .... -« .e,�,:.,w.. .. ...,... -. _ .- . ' ✓�TOO7I7//IL408(IM.ClI[/L O�✓[�UlGdClCi/.s[orccq.' .. ., :. Board of Building Regulations.and Standirds HOME IMP OVEMENT CONTRACTOR Regist 116064 15/2006 TYNDA4 R00 = , ROBER TYNDA � /< «y 37 SMA: PATGki..: OSTER�d LLE,'MA 026M Administrat r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street. 7`�Floor Boston,Mass. 02111 Workers' CoIn ensation Insurance.Affidavit:Building/Plumbing/Electrical Contractors. name: /7l9'g6+-R.0 �0 L1/ iLL address: Y 14 CIcI/YS jt&C& �® city fIN Ts state: zin phone# 77� work site location(full address): ❑ I am a homeowner perfornung all work myself. Project Type: ❑New Construction❑Remodel I amq a sole proprietor and have no one w}or�Idpg in an capacity. Building Addaiyt�ion �^��'i�$t�'.�'S i:•,�.ci�ti,:� 'SY F'«[.�'�''� 3: •Fi•:)..�3+,'.S" �'�s�e�{.'t�d•;�a:.�:xy<�'-' ti.��".�•'ivi"�'x`�'n`,� 5h".>y�,?`,!'Y�Y A�a���h,U'��••A•i.{tq{b.��;F9 -. r. I am,an employer-providing workers' compensation for my employees working on this job. M company name: address: "�� t!✓ � �`U_� r} .c �r— city: /7 04A S7 0 LVS A i/ t& phone#• ` /y-oI� ^�� insurance co. i�' r (r� polfcv# iN 00(0 4130 o iR--d •1•,3La"cIS S'X.Mfi .dtdacl4G:3:3'. IGtfa: kz'i.'o:,,b;vi$id+i.3•t.F't.,�dt �• '.iE' i`•. :%:i5r 'iV '':.. 3:3:4::'''§..l:?:/:•Cs'°aril% .•'sr}':iif:�:'Z: -:'a,z:ic `''�.9"'•. :fe::a"`'':� '6t. ❑ I am a sole proprietor,general contractor;or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name, address city: phone#: insurance co, olic # ,lMt;-:f."f '%. ';' .t 4t'i_i�r y a••+ .> gpvr+ A �'•a>q, �•• :g"). •oa y^1•,r y'�r'., ,; tk"�'•i'�tt:ra. . '.�x"�',k`v6^+,.s c> .. . . �nas3:�r'''".i.'�t�4`�'�i�;1ii; .Yu, y 'rye:. ``r 7•�A �r y ,•.., y.,, r t 77•� . ,r w en::a. �:'7'•L,'151:9:'.•rf'*'.�''. 'si.r.•�•.:';i-' '4Fr.E$rlrs.»K{a':.•�' ' Sdt��.r.+t.�7'',••k'_Fr`.i'di.....^F.:�•'Y� _. COmpanY name: address: city: phone#: insurance co. polig# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a fine up to SI;500.00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER ind a fine of 5100.00 a day against me. I understand that a• copy of this statement maybe forwarded to the Office of investigations of the DIA for coverage verification. ' I do hereby certify under the pains and penalties of per'ty that the' oration provided above is true and correct Signature � �� Date Print name K 0 official use only do not write in this area to be completed by city or town official L permit/license# ❑Building Department ' mediate response is required ❑Licensing Board ❑Selectmen's Office : phone#; ❑Health Department ❑Other r Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all-employers to provide workers' compensation for their . employees. As quoted from the"law", an employee is defined as every person in the service of another under.any contract of hire,express or implied;oral or writteg. 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law" or if you are required to obtain a workers' compensation policy,please call the Department at the number listed.below. t , �, •`e �. r- �i1 Shy, �';•s..• • r'i..7.°�. .rJ..'•�u'�..Kf.!.u. n�,Xr•. .•I,SSe'ai�.R City or Towns 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/license number which will be used as a reference.number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for.you cooperation and should you have any questions, please do not hesitate to give us a call. AM w- r ` •rAk t W , sqc,,. H, q yc• is,a�t -�, '�.:.. 9 ..r !�n , '' ? f at` t+°E'.'.i��tj`� ` ' '! �• .-r`,� rx,:f*�� *,'.°'- ';4 .y%•.s!•:'' " rr�p e.2k ;+ 4.. !•: :a. :r�'3' '•wdir152 :fib'• n`:t._±A. } .ail r�E7 : as+.+,rS'k`a: ,'S,t, k:.k ` , r The Department's address,telephone and fax number: The Commonwealth Of Massachusetts- Department of Industrial Accidents Office of Investigations 600 Washington Street,7t'Floor Boston,Ma. 02111 fax#:(617)727-7749 P � � hone#: 61 727-4900 ext.406 . . WE TOWN OF BARNSTABLE Permi # MASSACHUSETTS `����� Date: pr * BARNSTABM * d 1 MASS 9�'OTEp 39. a SOLID FUEL STOVE PERMIT Feel-2 6-,� Mo► J � Owner: Phone: Address: ZO-4 Village: Approved by: - Date: Stove A. New sed B. Type/Radiant Circulating C. Manufacturer Lab No. D. Model No. t� Chimney r� A. New Existing/if yes, date of last cleaning _ B. Flue Size C. Are other appliances attached to flue? 't) o D. Pre-Fab type and Manufacturer E. Masonry/lined Unlined Hearth A. Materials ;�� B. Sub Floor construction Installer Address Phone Location of Installation 'Polaroid Photo Necessary This consd'tutes xi official stove permit dierinspection and approval byBuildmgInspector ' R Assessor's map and lot number _.. ... .Q....... . b�*THE j0 Sewage Permit, number E� �O"WPLiq *- R T� Z BASHSTODLE, i House number `........ .. `. „.,� a i Ri�r� r'® _ "6 a er, ................ ..................................... .. � t D MP`(Or• TOWN OF BARN-STA.RLE BUILDING INSPECT0R �D APPLICATIONFOR PERMIT TO ............................................. ..................:..................................................:........ �� � .. TYPE OF CONSTRUCTION ..................�.....�....�..............................................:............................................ U.. L. ................19/.0.:. TO THE INSPECTOR OF BUILDINGS:_. . The undersigned hereby applies for a permit according to the following information: Location ....... t/C� l Al ��t-l� /2d•.. .... .............:........:... ..................... ,r: y....... ....... ..... .................................... ProposedUse ........ .... `.;. .... .� M..................................... ........................... .................................... ot!/ !l C C Zoning District ...................................:............................:.......Fire District ... ...��.......... Name of Owner ../'� ... �/.2. /... ®-......Address ...........�5!ftor; ..................................................... Name of Builder ..h.6mjw.... ress ,�. r !!!�?ll ' l.�tO! d....................... Name of Architect ....Address ...............n.......................................... Number of Rooms .. .....( // ..........................Foundation ......� L Exlerior ... ?r.L 19K...s4 -6.e-s'....:...................Roofing ....... .............................................. • Floors ..........................................................Interior .......... Heating ..u?. .. -...:...............................Plumbing ../.'L.® ................................................................ Fireplace "-- ..........................Approximate Cost �" ....-..`.......................... ...... Definitive Plan Approved by Planning Board ________________________________19________. Area d . ...................... Diagram of Lot and Building with Dimensions Fee — . .............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH u . 1 EX,. _uU ws e 190 17, I . rl I U I hereby agree to conform to all the Rules and Regulations of*T16o.wn Barnstable regarding the above construction. . Name .... .... . ... .. .s.�"S)....... ^=~ p"s, Harry l No _2U 4l._ Permit for ......�d..to..dwelling � � ^ . ^ . --''~-f--^'`----^^-'---^---^^^~' 134 Neck Road - ^"`"..'� ---..-.------.-.'---- .......... . , Centerville -.------..:�: ����.��------.-----.. ~ . Owner ����% ^="���� � ^~ 'H ~,..^. -.-.-.-.~---.----.------- Type of Construction -.---.'L�����-'---- -�-.--~--.~'...�-------------^-.. Plot ............................ Lot ................................ ' | / � October 24 ' 78 | Permit Granted -----------./-]q ,~ Date of Inspection . =- [�� -..'.l9 Dote Como��a6 -���./-^.�-�.,�--..�lq � . ^ PERMIT REFUSED _ `—.--.--' ---..-..-.--'----.. lV | ''---'~^--^~'----^'-'----^-----�' ` ,.._.....�.....-.-.--.—...----..~..:.- ' ` ................................. ............................................. . .......... ..^..--_....-.-...-.- ......................... . � tj . .'`�.�_.______-`-----. lA ' - . . . ^ ' ^ � /, ----.-.--.---.,...--~------. � �_ . - ^ . ----_ .............................................................. . . ' | • Assessor's map and lot number .....: ypi THE p0 - Q Sewage Permit number ...........................................:........... ' • Z BAH39TLELE, i House number .......................................................................... 9♦ Mae& � p 1639. \00 o MAY a' -- TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO .........! .. ......................................................................................................... TYPE OF CONSTRUCTION .... .L t' f .�,P/0 6''"- - } .... ...................................................................................................... ......./0...:r...z .l I.................19 2 F- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Hsi r k t-a t&- Location ............................... ............................................................................................. Proposed Use ..................... le& Zoning District .....................................................Fire District....( •,,./,;!�•�•ir/;�;%�;l/r.L;..�..�........................... `............................................................ .. .. ........................... Name of Owner h►fr,� f�t�/Z / �/ / .....'ICU S •..„Address .�. � �".......�1.... .................................................... Name of Builder ../.r'n�r�:.:.....�1? 1R? ./v� {. -�sT. /. t!Address ��? .- A, •`t/���i(/d...1�4 (�....................... Nameof Architect ............:.....................................................Address .................................................................................... •� _ Number of Rooms ...: ..... /�!i!<!f`............................Foundation ......r'�.:.... .. ......................................... Exterior ...! �..E:..�,�3A/ Cat,/,✓G l,-" ...Roofing f�� 'G���l /.r ................................................ ............... ................................. ....... Floors ` �� ...................Interior � �- ...........................:...................................... Heating !....:..!........ .... ............ .......................................Plumbing .. �!? ........................................................ Fireplace ..................................................................................Approximate Cost ........................................................................................................ Definitive Plan Approved by Planning Board ---------------_---------------19_______. Area ........ . ............................. ... .. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH . t I ,V X I E4,— I hereby agree to conform to all the Rules and Regulations of the Town/of Barnstable regarding the above construction. 1 r Name .. .�4.1.,:):: �. .C,,.... ..� .. `3 .............. .................................. ....... Terpos, Harry A=252730 . 20741 add to dwelling No ................. Pe for .................................... .......................................................... . :................ Location 134 Huckins Neck oad ............................................................... Centerville ............................................................................... Owner Harry Terpos .................................................................. Type of Construction .........frame ................................. ' ............................................................................... Plot ............................ Lot ................................ Oct ber 24 78 Permit Granted ........................................19 Date of Inspection ............ .......................19 Date Complete......................19 PERMIT REFUSED ................................\............................ 19 .. . ... . ............... ..... ! .r.. . ..� ..................... .. ... .. ........... .. . . .................................. ........................................... ............................................................................... 1 Approved ................................................ 19 ............................................................................... ............................................................................... } i Nb x f !`J C: 'r 7 Lac Cf 7 /1 6.4 � r3 iJ �.iF i• ..r }, tit r . Lk r_ gip- f M1 1 ( 9 ! a if - - - - - co _ - FAf