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0317 MAIN STREET (CENT.)
��� ��s�u ��'� �. _. . _ .. ., y �. .�: o o .z o Town of Barnstable *Perm 1 -2q)R ' Regulatory Services Free!`n MA'S. Richard V.Scali,Director 1659. Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.to%m.barnstablc.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION, - RESIDENTIAL ONLY 0 j/�S/ Not Valid althorn Red X-PressImpiYnt Map/parcel Nwnber / Property Address _ �._ S� �Q���✓dilf� fed �� 3 z [R(Residential Value of Work$ bl Uo 0' ad :Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address YT41 &jt) 6,er/.4 B.41%?I) 3 Jy HA-111j JIL ��i Yt✓y�7/e iY.a 6 G 3 M — Contractor's Name �7C)h�JT J-t1(V j 11_1 Telephone Number ('Al i v2� 14Uff� i1pi✓ode �1�,� t-`Znr� Home Improvement Contractor License#(if applicable) /Bn 1 V11 Email:JAC e rfl�r LZl G/UMe.CUM 7Con truction Supervisor's License#(if applicable)_C_ S 0 b q j'J i Workman's Compensation Insurance Check one: ,o � arc MI am a sole proprietor am the Homeowner have Worker's Compensation Insurance NOV 13 2017 Insurance Company Name A M 6-u4 r0 A1J dr2A,Jre C a ft - Workman's Comp.Policy# ^ �3 2 7 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 F-1 Re-roof(hurricane nailed)(not stripping. Going over _ existing layers of roof) Va-side Replacement Windows/doors/sliders. U-Value U a 4 (maximum.32)#of windows D U Ot3/G 4,YAJ 6 #of doors:---*Where required: Issuance of'this permit does not exempt compliance with other tot%n 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 z' SIGNATURE: 0 14,j C:!Users:decollik'AppData%LocahMicrosorGWutdo%WINetCache',Content.0utlooLtL7U69LH2 EXPRESS(2).doc O1/25/17 199 'W(Ail'tA xcz-r A I F-- r 001 (p� Capizzi Home Improvement a 1645 Santuit Newtown Road, Cotuit, MA 02635 P: (508)428-9518 Toll Free: (800) 262-5060 o F: (508) 428-1547 H..: FID # 80-0014011 CSL # 7454 HIC # 100740 www.capizzihome.com Date: /4 PROPOSAL Name:_;.__ _.__ _. _�.__._. __. ...a �. _-- Job Address: Address Ci Town: City/Town i J i 7Gdik -� Home Phone_ ; - - - --- -State: ---Cell Phone IL: �- zIP: i Cell Phone 2. E-Mail 1: Estimator: _-- E_Mail2: __—_-___ _ . U�C�J lob Number: We hereby submit specifications and estimates to furnish and install-7--solid vinyl white replacement windows with 7/8"insulated glass,half screens,using the Harvey Sigttattw&welded sash window. c"k ell -Sid" I ihC 6-64Y5 �' E Type: ---- Qty Type: -- --+--------fie------- ------ -------------- ._....._.1 Double Hung 3r--------- — - ! 2-hke-ftzfer Singh-ant Picture-Unitant Triple-C-os�nent Double-Eaqemt-nt Lab $ A..�Ac,mo� �hn� .„t, Tthni�� aaoiciniyl I B• OR same as above except using the 7/8"Thermopane _-�� Slimline replacement window_ , �Z, �`:�g S_fG,�' La (or&Materials: $ Location of Window_— A-11, C.sH_._ '4Lc Ott 0Pf1&NS- A. - -B. Low E&Ar C. TiTffl-Coverage4m"effm-Ext"--F-S�� - D. Grid Type_._.__+..a_ Grids between glass b. Int' - ii- $ - OPTION. Painting_of Window jambs and Trims: 'f ------------.. — .---J--- ------_._. Z_ ---------- ---_ -'---- ----- — - — --- Interior Color: i Exterior Color peIGC �(ii.c �vv J 1+0 �v��'j0 "al5 a-k �ti'c; ��r% ✓ ACCEPTANCE OF PRO OSAL The above prices,s cifications,and conditions are hereby accepted. Capizzi Home Impro men,t is tho ized.to do e work s specified. Date of Acceptance: /U Signature: P��L, _ a` ' �/tr. �ci�rntn�ta�rrl�a�ta.11mutrc� . i, massachusetts Department Of Public Safety_ ceofCOmmerAffairs&2uduenRegulatloi Board-of Building Regulations and Standards ` ' OME IMPROVEMENT CONTRACTOR License: CS-0648 i7 '_' Regiafttion: 100740 . Typ Construction Supervisor "° E iratlon; n � xN 6/2312018 Suppiemen JOHN T STRUMSKI _ CAPJZ7J HOME IMPROVEMENT,,INC. 18 ALDEN AVE r = BUZZARDS BAY MA 02832 JOHN STRUMSKI 1645 Namdon Rd. COW,MA 02635 Undersecretary �,•,� CA,_:, Expiration: Commissioner 06/1812018. - - Ind-Bwldl of MW me Broup wMa wg=35,000r cubic 9W(99W)of fie• . sass a curreneadium cfths iVtesroctwew 5 we 14 ewas for wowlon of this Uoense. figYnforrnatlonUislt: vt91�J8ov/TIPS Cleanse or Ws"tionyalld$ar individual an only before the eg1ration date N found return to: Offtce of0metunerAffh1a and Buslam Regulation 10 ParkPiazg-Sufte5170 Boston,BU 02116 Not valid oat sigaatnre 4 t l ® DATE(MM/DD/YYYY) A�v CERTIFICATE OF LIABILITY INSURANCE 12/30/2016 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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CoMEACT Rogers and GrayProcessing ROGERS&GRAY INSURANCE AGENCY INC PHONEExth (508)398-7980 FnC No: E-MAIL mail ro ers ra com ADDRESS: � 9 Y• 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER B: CAPIZZI HOME IMPROVEMENT INC INSURERC: INSURER D: 1645 NEWTOWN ROAD INSURERE: COTUIT MA 02635 INSURERF: COVERAGES CERTIFICATE NUMBER: 114654 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any oneperson) $ NIA PERSONALS ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY❑PRO LOC PRODUCTS-COMPIOPAGG $ JECT OTHER:I $ AUTOMOBILE LIABILITY COEaMBIN cadene'r,q LE LIMIT $ a ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED P accident) DAMAGE $ HIREDAUTOS AUTOS $ UMBRELLA LAB HOCCUR EACH OCCURRENCE' $ EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I STATUTE I I ERH AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED7 I NIA WA NIA R2WC775326 12/25/2016 12/25/2017(Mandatory 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 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensationrinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of BamStable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 " t Daniel M.Croyey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. .ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD c ,�« dMO th ON Olul : 508400 s t, Ise NVWMWM ROM l sm awl►...----- . �' bib �. anew sauWsbeet Rambft Z. I as 1 sbNMvodftg S. D S. Is a eflv wda"pdnpw s 12. NAO(UP 06 M u advpab�eao . O&W bloomed.�t Leo(° ' raodee�' a 0ion t�ac#1eatw ,aL�eattdea �mea�a� l�e OWN ANt4Ul�RD tNRA i 1817 } ►#ace sdpb&Imo#: Ce=Now kfetac 48TOFW� a�dafl�e 0 *Ion r� �►ar�r�nre� z 4. ''� f Town of Barnstable 4 Building ; Post.fhis OF So Thai itisVisrble From the Street Approvetl,Plans Must be:Retauied on Job{and this Card Must be-Kept ., a . - • r M Posted Until Final Inspection�Has Been Made ,. •�s� �� p yam i63¢ _ " :' i el lllll �o : Where a Cert�ficatehof Occupancy rs Requ red;such Bu ldmglll* lNotxbe Occupied until a Frnalsln pectron has been made K Permit No. B-17-3571 Applicant Name: ROLAND LANGEVIN Approvals Date Issued: 10/27/2017 Current Use: Structure Permit Type: Building-Insulation Residential Expiration Date: 04/27/2018 Foundation: Location: 317 MAIN STREET(CENT.),CENTERVILLEYw _ Map/Lot 208-115 Zoning District: RC Sheathing: Owner on Record: BAIRD,RALPH FJR&BETH DELISI ; Contractor Name INSULATE 2 SAVE, INC. Framing: 1 i Contractor License 80747 Address: 317 MAIN ST 1 2 CENTERVILLE,MA 02632 Est Project Cost: $2,730.18 Chimney: Description: INSUALTION/WEATHERIZATION ? Perrtt t�F e: $85.00 Insulation: Fee Paid=� $85.00 Project Review Req: ) = Final: Date f 10/27/2017 Plumbing/Gas Rough Plumbing: x � ,,,Building Official final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorzed by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and thexapproved construction documents for whic'h '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 and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. " - Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building aril Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 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 contracting 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 I` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0 Parcel 1 , �J► Application # Health Division 20,c: '01 Date Issued /O a?A ZAW Conservation Division 9� � � �®e Application Fe Planning Dept. �98 Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH. _ Preservation/ Hyannis Project Street Address .717 Mk Sf Cn,,,.kjn2'I,, MA o LA?3 2- Village ca..Jilo' e.. Owner (Za(n/i Address 30 Mr,1, s+- C� �'1(A i`1%4 Q&32 Telephone .TDB 7 RQ-L(7Q5 Permit Request 'r4� Oar k,-fz t ht, ±,ar, 0-2 3-T f6 b 6 21 is, R--37 G th-losc 6- a f—k4 T'20 zc��� r Te �cea�r, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValuatioP All 3 I& Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Jk Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing. ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number sM- 6-1./7-6'706 Address q to C9 a e St License # L©"3 8-& A q-a7 Home Improvement Contractor# Email ���so�� ►�sv��a�e 2sa�.e_.�u-(- Worker's Compensation # S 0197f/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ALL �ev ✓c�c to to kriarf ",. `FBI( R:y-y- hk SIGNATURE /G� �- DATE (O 0 Y FOR OFFICIAL USE ONLY "APPLICATION # DATE ISSUED Y MAP/ PARCEL NO. ADDRESS VILLAGE k OWNER r DATE OF INSPECTION: FOUNDATION FRAME y INSULATION z. FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL a FINAL BUILDING y V DATE CLOSED OUT ASSOCIATION PLAN NO. DEBRIS FARM In accordance with the provisions of MGL c.40,s.54,a:conditlon*of Building Permit.Number is that the debris resulting from this work-shall be disposed of in a properly,licensed . solid waste disposal facility as defined by VIGL c, 111,s. 150A, This Debris will be disposed of in: Republic Services Dum ster: 1080 Airport Rd Fall River, MA 02720 (LOCATION OF FACILITY) kz� Signature of Permit Applicant tlohn r�j Date IF DUMPSTER IS USED IN EXCESS OF SIB 6 CUBIC YARDS A PERMIT-FROM THE FIRE DEPARTMENT 1S REQUIRES FOR COMMERCIAL, INDUSTRIAL,INSTITUTIONAL AND MULTI-FAMILY RESIDENTIAL OVER 20 UNITS DEMO, RENOVATIONS OR ALTERATIONS OF THE EXISTING BUILDING: CIRCLE ONE ** HAVE YOU.sUSM1TTED THE AQ06 NOTIFICATION TO THE MASSACNUSE7TS DEP? YES NO The Commonwealth of Massachusetts Department of Industrial Accidents a 1 Congress Street, Suite.100 Boston,MA 02114-2017 www mass.gov/ilia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE Fi'L'ED WITH THE PERMITTING AUTHORiTY. Applicant Information Please Print Legibly Name (Business/Organization/individual): Insulate2Saye Inc. ' Address: 410 Grove Street City/State/Zip: Fall River MA 02720 Phone M 508-567-6706 Are you an employer?Check the appropriate'box: Type of project(required): l,.Ex i am a employer with 20 employees(full and/or part-time).* �, New construction 2.❑I ant a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.(No workers'comp.insurance required.) 9. ❑Demolition 3.E 1 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 that all contractors either have workers'compensation insurance or are sole 1 I.[]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.a am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.'. 13.oRoof repairs 6.Q we are a corporation and its officers have exercised their right of exemption per MGL c. 14.MOther Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that cheeks box r:I must also fill oui the section below showing their workers'compensation policy information. p t-lomeowners who submit this affidavit indicating,they are doing all work and then hire outside contractors mustsubmit 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 entitieshove employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. 7 am att employer that is providing workers'cornpettsatiott insurance for my entployees. .Below is the policy and job site information. Insurance Company Name: Liberty Mutual Insurance — Policy#or Self.-ins.Lie.#: XWS 56418741 Expiration Date; 12/10/2017 p Job Site Address: �17 I'12���5�" City/State/Zip: &ke-o lk hA ®3-Ca 12 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL 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 violator.A copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. I do hereby certify under the tr' s art en ties of perjury that the information provided above is trite and correct. Signature: �"" Date: Phone#• 508-567-6706 Of fcial arse 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#: I ' Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Ma: husetts 02116 Home Improvem tractor Registration Type: Corporation. Registration: 180747 INSULATE 2 SAVE , INC. r Expiration: 1.2/28/2018 410 Grove St Fallriver, MA 02720 ° W Update Address and return card. Mark reason for change. 3CA 1 0 20M-05111 E,,,_,.tnploy_ ent. 0 Lost Card . �,, �e tyrrrirrzt��cuncr,�(la cr�G���z�f.7s.�uae�rrt. ..._. Off Ice of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only rTYPE:Corporation before the expiration date. If found return to: ran Jation Expiration Office of Consumer Affairs and Business Regulation Figgt 80797 12/28/2018 10 Park Plaza-Suite 5170 f Boston,MA 02116 INSULATE 2 SAS ,'�NC Roland Lange\A'.., 410 Grove St F '� cc--� '�! Fallriver,MA 02720t., "- � Undersecretary Not valid without signature ' Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constr -! sNb4jrvisor CS-103a6 ,, F ires 08124I20ig d € x u ROLAND LANGEVIN; 56'HIGH GREST',ROAD FALL RIVER MA�02T20 Commissioner I ' CERTIFICATE OF LIABILITY INSURANCE 7 (MMTE /1D2YYYY)16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Anthony F. Cordeiro Insurance PH ONE FAX 171 Pleasant Street E-JIAIL 508) 677-0407 A/ Ne; (508) 677-0409 ADDRESS: hsouza@cordeiroinsurance.com Fall River, MA 02721 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance INSURED INSURER B: Insulate 2 Save, Inc. INSURERC: 410 Grove St. INSURER D: Fall River, 14A 02720 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSIR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY Y Y $KS 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 1,000,000 X COM MERCIAL GENERAL LIABILITY DAMAGE TO RENTED g $ 300 OOO CLAIMS-MADE a OCCUR MED EXP(Anyone person) $ 5 000 PREMISES(Ea PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY Y Y BAA 56418741 12/10/16 12/10/17 EOMBINED'dent)INGLELIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident $ A _?X0 UMBRELLALAB X OCCUR Y Y USO 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000 DED RETENTION$ $ A WORKERS COMPENSATION XWS 56418741 12/10/16 12/10/17 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENi $ 500,000 OFFICE RIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yyes,describe under DESCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is requi red) "For Insurance Purposes Only" 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Fin S F P - 7 2017 1JJ , 114 f RISE Engineering RISE 5 Dupont Ave,South Varmouth,MA 02664 CONTRACT ENGINEERING 508-568-1926 FAX 509-568-1933. Page 1 PROGRAM THIS CONTRACT IS.ENTERED INTO BETWEEN RISE- NGCC-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE, CLIENT WORK ORDER Ralph F Baird (508)7904725 05/05/201,7 232123 03402 SERVICE STREET BILLING.STREET 317 Main Street 317 Main Street. SERVICE CRY.STATE.ZIP BILLING CRY,STATE,ZIP Centerville,MA 02632 Centerville,MA 0202 JOB DESCRIPTION AIR SEALING`.Provide labor and materials to seal areas of your home against wasteful;cxccsti:air leakage This work will be performed S800:00 in concert with the Use of spcciad tools and diagnostic tests to assure that your horn will be lc flwith'a.heAthhful level of stir exchange and indoor air quality.Materials to be used to seal your home can include caulks,iaams;wcathcrstripping and other products. primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas.(windows are not generally addressed.) (10)working hours. A reduction in cubic feet per minute(cfm)ofair infiltration_will occur,but the.actual number of cfm is not guaranteed. Alit SEALING:Provide labor and Inatcnals to install Q-tun weathcrstripping,and'a doorswccp to(4)door(s)to restrict air Ic.IkRgc. $320.00 t/ .� ATTIC FLAT:Provide labor and materials to install a 12"layer of R738 unfaced fiberglass-baits to(60)square fat of attic Space. S 147.60 /f ATTIC:FLAT:Provide laborand materials to install a 10''laycr of R-37 Class 1 Cellulos e to(240)squart feet ofopen attic space. S374.40 I/ ATTIC ACCESS;Provide labor and materials to insulate the back of the attic door with rigid board at R-10 or greater with the required $1 10.00 fire rating and scal the duties edge with weatherstripping to restrict air leakage.; ATTIC ACCESS:Provide labor and materials to make(2)temporary access to art anic area. Thaopening will be closed with a Si 84.84 pemianent.roof vent:- VENTILATION:Provide labor and materials to install ventilation chutes in(36)'rafter bays to maintain airflow. S125.64 `-/ COMMON WALLS:Provide labor and matcrials to install 2"rigid board with the required_fire rating to(102),squarefcct ofcommun 5392.70 wall area. BASEMENT DOOR:Provide labor and materials to'insulate the back of the basement door leading to.the bulkhead with rigid board.ai R- $110,00 IA or greater with the required fire_rating that mcels the sections R-3I6.5.4 and 316.6 requirements of building code. Se:d all cdgLs,and scams with FSK;tape. RISE Engineering. IS E 5 Dupont Ave,South Yarmouth,MA 02664 CONTRACT ENGINEERING` 508-56R-.7926` FAX 508-568-1933. Page 2 PROGRAM TNIS CONTRACT IS ENTERED INTO BETWEEN WE NGCC- ES- ENGINEERINO AND THE CUSTOMER FOR WORKAS - ' DESCRIBEDDELOW _ CUSTOMER PHOKE DATE CLIENT# WORK ORDER Ralph F Baird (508)790-4725 05/05/2,017 232123 03402. SERVICE STREET BILLING STREET 317 Main Street 317 Main Street. SERVICE CITY.STATE^ZIP 0141 Ni CITY,STATE;ZIP Centerville,MA 02632 Centerville;MA 02632 JOB DESCRIPTION INCENTIVE:RISE Engineering will apply,all applicable,eligible incentives to this contract. You will be billed only the Net amount. S165.00 Currently,for eligible measures,National Grid offers 75%incentive,not to exceed$2,000 per calerfdi r y(1r,and anrincentive of 100°% for the Air Scaling measures.. For the safety and health of your holies indoor air quality,we might be conducting;a'blower door diagnostic of the available air flow in your home both before the work is begun,and alter thewcatheri»tion work is complete(not to be conducted if asbestos is present).We will also conduct a diagnostic assessment of the combustion Fumes in the exhaust flue of your heating system and water heater.T11is has a value of S90 and is at no cost to you, The Permit will be secured by the insulation contractor.This has a value of$75 and is at no cost to you. Total: $2,730.18 Program Incentive: $2 368.89 Customer Total: $361.30 WE AGREE HEREBY TO FURNISH SERVICES--COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Three Hundred Sixty-One&30/100 Dollars $361.30 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT .1NTEREST OF 1%MILL BE CHARGED 110NTHLY ON UNPAID BALANCE AFTER]a DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.RION FR IB10K,SCHEDUL ,.AND CONTRISCTOR REGIS7RATI AUTHORIZED SIGNATURE•RISC 12.91 169 OMER ACCEPTANCE` NOTE.THIS"CONTRACT.MAY BE WITHDRAWN BY US IF NOT.ExECUrED wmBN OATE:OF"ACCEPTANCE. /- ACCEPTANCt OF CONTRACT.-TEIE ASOVL ICES,SPECIFICATIONS AND CONDTIIONSARE 30 DAYS, SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK . .. AS SPECIFIED,PAYMENT IMLL BE MADE A$OUTLINED ABOVE J DocuSign Envelope ID:A058BD74-9012-4OB6-8384-OA55B22C8B32 Town of Barnstable Regulatory Services RwuMAJIM Richard V. Sca6, Director s43� Building Division �d Nay' 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 I Ralph Baird as Owner of the subject property > J p p Y Insulate 2 Save hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for: 317 Main St, Centerville, MA 02632 (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. O�ocuSigned by: u ed — ,xir . Sig;m,�wev&Owner Signature of Applicant Ralph Baird Print Name Print Name 10/3/2017 1 12:10 PM EDT Date Q:EMS:CWMERPERESSIMPOOIS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �� Parcel J l S Application # ad ( 3 0 3 4 IT Health Division Date Issued & <�' Conservation Division Application Fee Planning Dept. :` Permit Feel. Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address �S i l ►y-VA>I 0 Village E0Ty Owner Oafa: Address er Telephone 5j® ZZ Atj� Permit Request '�e,fto DM, ,"I on-C 71 114 �D- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tq:Wl'neat' Zoning District Flood Plain Groundwater Overlay VE Project Valuation Construction Type . yp Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup; orting docume tation. Dwelling Type: Single Family Two Family 0 _ Multi-Family (# units) co Age of Existing Structure 2 Historic House: ❑Yes No On Old King's ighway: Ye ❑ No Basement Type: ❑ Full i,(Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z 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 J_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 I No r If yes, site plan review # Current Use, - _Proposed Use - - - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name J�T1.<Z Sr, P6wt Telephone Number Address 41 License # 0 1 ��4 BAPs r l3LL� Home Improvement Contractor# oo C��J Worker's Compensation # r—' ALL CONSTRUCTION DEBRIS RESULTING FROM HIS PROJECT WILL BE TAKEN TO _ad SIGNATURE DATE /9 13 i` FOR OFFICIAL USE ONLY ' r I'» APPLICATION# DATE ISSUED ' MAP/PARCEL NO. i5 II`? ADDRESS VILLAGE OWNER DATE OF INSPECTION: :.:,•FOUNDATION,-: . FRAME _ t i INSULATION E_ FIREPLACE ELECTRICAL: ROUGH FINAL Se� PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT '€ ASSOCIATION PLAN NO. r— = The Commonwealth of Massachusetts Department of IndustrialfAcci Office of Investigations 600 Washington Street Boston,KA 02111 www.mass_gov1i is Workers' Compensation Insurance Affidavit: Bud.ders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizatimVIndividual): � �. alas Address: ' S City/State/Zip:-. I' !� Phone k 5 o S' ` ° Are you an employer? Check the appropriate beg: Type of project(required): 1.0 I am a employer with 4. I am a general contractor and I employees (fall and/or part-time). * have hired the sub-contractors 6. New construction 2 I am a sole proprietor or partner- listed on the attached sheet, 7. ❑ Remodeling ship and have no employees These sub-contractors have g. Demolition working for me m any capacity. employees and have workers' [No workers' comp. insr„-once comp.insurance. # 9.. 0 Building addition required.] S. F-1 We are a corporation and its .10.❑Electrical.repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself: [No workers' comp, right of exemption per MGL 12.❑Roof repairs insM¢ance required.]t c. 152, §1(4),and we have no : . employees. [No workers' 13.❑ Other . comp.insurance required.] *Amy applicant that checks box P-must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.. I am an employer that is provi ' g workers'compensation insurance for my employees. Below is the policy and joh srte information. Insurance Company Name: Wr Policy#or Self-ins.Lic.#: / Expiration Date: Job Site Address:,® /rlN ��' _� 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 tc the imposition of criminal penalties of a fine up to$1,50.0.00 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 latof dvised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ' coy ation. I do hnnby.certify u e p es of p ry that the information provided above is true and correct -Si ature - Date: L �� JI Phone Official use only. Do not write in this area, to he completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Euilding Department 3. City/Town Clerk 4.Electrical Inspector 5..Plumbing Inspector 6..Other. Contact Person: .w. Phone#: ..S Information and Instructions Massachusetts General Laws chapter 152 requires an employers to provide workers' compensation for their employees, pursuaut-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."- . i MGL chapter.152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or - renewal of a ficense 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()states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirement of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking-the boxes that apply to your-situation and, if. necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no-ernployees 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 tie 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 enterthei.r 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 fhe 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 perxpit/homse number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all localions in (city,or. ' town)."A copy of the-affidavit that has.been officially stamped or marked by the city or town may be provided to the' . applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must:be filled.out each year. Where a home owner or citizen is obtaining a-liceme or permit not related to any business or commercial venture . . (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit" The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions; please do not hesitate to give us a call, d fax number; The Departments address telephone an , F eP .. The Commonwealth of Massachusetts : - Department of Industrial Accidents ' Office of Investigations 600 Washington street Boston, MA Q2111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 .evised 4-24-07 www.mess.gov/dia . Mass�icbusetts- De pr - -4"ment of Public Safetj Board,of Buildiny.Re-ulatiorts anal Standards Construction Supervisor; License°` '. License: Cs 14501 STURGIS.STPETE'R , ., . PO BOX 372 BA RNSTAB L E,,MA 02630 x� ate. Eipiratiorr. .8/23/201.3 ('ummi�tiiiiner' Tr#.: 20698 ✓fie.Panv�zQ �raaltl - Uffice of Consumer Affairs.&BUsMess Re License or registration va if for mdiv�dn use onP - HOME IMPROVEMENT CONTRACTOR befgre the egpiration date: If found refurri.fo . 'Registration: 100390 ' Type office:of Consumer Affairs and Business Regulation j Expiration: 6f16/2014 Individual 1 10:Park Plaza.-Suite 51,70. S GIS ST:PETl=R Bost on, 02116 a Sturgis;St. Peter 1 , a y 65 Cindy Lane/P O Box372 p 'y Barnstable,.MA 02630 - Under§ecretar .= of va id without signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION d00CP9 Niap Parcel s 1,n11 Health Division Date Issued 1 lag _ Conservation Division Fee Tax Collector Application Fee - Treasurer �� Planning Dept. Checked in By Date Definitive =111rreservation/Hyannis nning Board Approved By Historic-OKH �6 Project Street Addre A �°- Village V/�l l Owner h 'Beth 2aJ Address _-3,7 r / )0J i� c Telephone c�U�-" 116 T— Permit Request 1/owL yn cSQ Vu Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new Valuation#qq 5ml. Zoning District Flood Plain Groundwater Overlay Construction Type tj)CD06 Lot Size ��� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 6- qrs Historic House: ❑Yes ❑ No On Old King's Highway: Cl Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing CPI new Half:existing new Number of Bedrooms: existing 2-) new Total Room Count(not including baths): existing new First Floor Room Count. Heat Type and Fuel: s ❑Oil ❑ Electric ❑Other Central Air: ❑Yes replaces: Existing New Existing wo4c7toal stove ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barm.(lexisting p new- size Attached garage:d'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 BUILDER INFORMATION Name ` Telephone Number i1 '!V77 4 Address 1!5 TdblSS�et U License# Y'hQShAXk, t&k Home Improvement Contractor# / (o 3!Fann !-It �.� Worker's Compensation# (P ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN Xrr SIGNATURE DATE Cry j 0 FOR OFFICIAL USE ONLY, PERMIT NO. i DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE 1 OWNER ' 1 r DATE OF INSPECTION: h FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1 ne L.ummonweairn oI massacnusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/P'lumbers Applicant Information Please Print Legibly 4 Name (Business/orp3izationamnvidual)• 1 rYl&+fiLA 2ukac*1)31 Address: City/State/Zip: Cls ,� _ 1�-t P Phone#: Are you an employer? Check the ropriate box:. Type of project(required): 1.0am a employer with _ . 4• ❑ I am a general contractor and I employees(fulland/or part-time).* have hired the sub-contractors 6` ❑ Newconstruction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition Working for me in any capacity. workers' comp. insurance. - g, Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10. Electrical required.] officers have exercised their repairs or.additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.[I ofrepairs n insurance required.] t employees. [No workers, 13. Other (! comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information �a t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check ibis 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 information. Insurance Company Name: tt:_V&f1 (4e Policy#or Self-ins.Lia #: Expiration Date: v� Job i s: Site Addres 7 . i C �. Ty stat�ir: 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 maybe forwarded to the Office of Investigations of the DiA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information prov• d above is true and correct: Si afar . Date: Phone#: Official use only. Do not write in this area,to be completed by city,or town official. City or Town: Permit/License# Issuing Authority(circle ones 1.Board of Health 2.Building Department 6.Other 3.City/Town Clerk 4..Electrical Inspector 5.Plumbing Inspector - . Contact Person• Phone#• 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"a4 Wdual pie hip,: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. How. ...ever:tlte 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 shall not because of such employment be deemed to be an employer." or on the grounds or building appurtenant thereto MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or a business or to construct buildings in the commonwealth for any renewal of a license or permit to operate applicant who has not produced acceptable evidence-of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 permitlicense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in _ (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that-a valid affidavit is onfile for:future permits or licenses..A new affidavit must be filled out-each citizen is obtaining a license or permit not related to any business or commercial venture year.Where a home owner or (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts . . . .. „ . Department of Industrial.Accidents Office of Juvestigattons . r. 600 Washington Street . Boston,MA 02111r Tel.#617-727-4900 ext 406 or l-877-MASSAFE Fax#617-7274749 Revised 5-26-05 www,mass.gov/dia SET Town of Barnstable Regulatory Services 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 Permit no. P - Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW w SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,_ _-- improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied. - building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: U` V!=1111:�,—Estimated-Cost ... -- - _ Address of Work: -7 /' /0j>l r Owner's Name: Date of Application: ri — 0(,o I hereby certify that: Registration is not requiredfor the following reason(s): OWork excluded by law ❑Job Under$1,000 ElBuilding not owner-occupied []Owner pulling own permit Notice is hereby given that: u OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY, I hereby apply for a permit as the agent of;he owner: D to Contractor 446 f Registration No. _ OR Date'- Owner's Name Q:forms:homeaffidav FROM :Timothy Gray Building Remodeli FAX NO. :5085393714 Aug. 04 2006 01:04PM P1 NE Town of Barnstable W r Regulatory Services Tbumas P.Geller,1%rcetor, 01 Building Division Tom Perry, Building Commissioner 200 Main street, Hyamis,MA 02601 W vvw.towu.barnstable.mta.iis Office: 508-862-403 8 Pax: 508-790-6230 Property tamer Must Complete and Sign This Section If Using A Builder "QcLlnh f QCa 11-0 as Owner of the subject property hereby authorize r//-y7OWW to act on my behalf, in all xpaffers relative to work authorized by this building permit application for. (Address of job) Signature of Owaer Date Print Name Q:F01tM8,0WNE PEFJQS[ON -: i .'r �& ✓lte LRJI74fdCYItUJ@��/L C1�i%!/Lf1.wf{i� `��'`s� . SOARD OF BUILDING REGULATIONS, I License CONSTRUCTION SUPERUISOF _ + Number:.CS O46234 ' airthdate t41/30J1$59 . ` Exprnes 1'1-3012006 Tr no:` 8312 0 Restricted 1G f TIMOTHY GRAY � 15 TOBISSET ST a MASHPEE, i Commissioner V✓/�' lations and Standards Board,of Building Regu r p - HOME IMPROVEMENT CONTRACTOR Registration: 102634 Expiration: 7I212006 - Type: Private Corporation s TIMOTHY GRAY BUILDING''&REMODELING w .Timothy Gray i 15Tobisset St .e { Mashpee,MA 02649 Administrator aR JUL-28-2006 09:15 From:MARK S'TLQI; INS 5084209227 To:5.085393714 P.1%2 . oATatIe;NAaorrwl ACORA. CERTIFICATE OF LIABILITY INSURANCE � 07128=08 PRpm:apR 508 428.0440 j THIB CERTIFICATE IS I8OUED AS A MATT R OF INFORMATION MARK SYLVIA INSURANCE AGENCY t ONLY AND CONFERS NO RIOHTB UPC "THE CERTIFICATE 988 MAIN STREET HOLDER. THIS CERTIFICATE DOES NOT:AMEND, EXTEND OR ALTER 71416 COVERAGE A.FLORD D BY NE:ROL 6 LOW. a66 MAIN STREET OSTERVILLE,MA 02055 INSURERS AFFORDING COVERAGE w NAIL Y - .... wauapq INSUuReRA'FARM FAWLY CASLA,L Y INySURANC� - 3020 TIMOTHY GRAY BUILCINC&,REMODELING INC 2005 j INauarao t ISTOSISS6TSTREET 'MASHPEE,MA 02848 `weuaeraD i. j 'Iuauaese r. AGE3 , rierv.—,�moiau.r THE POLICIES OF INSURANCE LISTED BELOW WAVE BEEN ISSUED TO THH ftiSURED NAMED ABOVE FOR TIE FOUCY PERIOD INDICATIO NOTWITHSTANDING ANY.RCCUIR9M'NT,TERM OR vONCITION OF ANY CONTRACTOR OTI+fER OOCUAAGY`WITm R@9PECT TO WHICH THIS CZRTIFICAY6 MAYBE ISSU60 OR j MAY PERTAIN,THE INSURANCE AFFORDED EY TRE POLICIES 0E6CRi8ED Hskaim 13 SUEJECT TO ALL THE T 6AMS,EXCLUSIONS AND CQND'TIONS Cl:SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PA10 CLAIMS jINWA66-1 ._-PO vohGYdilinlicrivU ►bIICYaYNIR4 N 9 LIGYNUfaOeR e I l�AtTe aRNgRAL LfAA1LRv 'G�cr OCcuRaer�e i 1,000,000 A ! ' X coNA+ERCIAI cEr.ERALLIneIIJrt '2001Xti640 02/264006 020/2007 i o�TOReNrtD � t.. Ak_ Ls lea0aurenpel I. _ 1 CLAIMISMADE i X OCCUR 5,000 f� I ;I�RSONAL&ADViNJURY j S 4PNERA.AGGRGQATC IS 2,000,000 ' i OakLACO4OCATELIMITAPPIIWO9009 ! - -FRODUCTSsPOtdp!DAAGG. 5 2,ROW POLSY I j......1 _ PRo, Lim — I.. I AL bOB�As.MO'IJtY f COiJ01NCOGINGLCLtMIT ;a I ANY AUTO iP®atalMrl; I I ALI QtYNEOAl+T4$ ImolLY)NI a, i 1 i BOOINJURY i SCH1!DUL0CAt1T09 rt:RCDAUT06 j 89011YINJURY - I. NON,OWN.3 AUTOS i ;IP4,"i mi) _ j PPdPCpYY DAIAAGD ' i ;tParec4ls»nq `i i i t CANA111L1A0�IM _ i ?AUTO ONLY,LAACdR�GNT ,f jANYAUTd ;AUT�RTWAN ACC. i .. I j I ! ONLY •O3�0 21IC9M96RpLI.ALIARILITY ,w OCCUR) NCE I ;OCCUR j C.AIMO MACE ;AGGREQAT9 i � � ,aI:DUCTIDIs:• j i I i ,i 77 a WORKaRACOMPINBATIONAND ... j n I.. , I .;L UMI 8 I ffts., Ra! A 9mpi.QY4 'uAwTY 2001We340 i 10i15k005 ,01161200E .i'���ehActlDeNr s 1,OCIA, OD ONYPR9PRIpTORiPARTNCAiaXf':aURrvp - r QP r,t,p1AlP_L&e,'ACMPLOYGE�Ii �,000,000 PIC6RA9LMaGR f•XCLti0E0P uyea aaa0rm&(I ` PF.LtIAI.B�oVIeiQYBM�v� I rm.01119A5e,POLICY LWI_T ;i A11330 0T3140 i 6@9CRlPTIONOPOP)iR�ATi0A1p�;.UCATI0ti8+Ya�lq6Gl3ipsG!.ii8sON8NI�ARgG!iBkDORpaMaNT;IPaCt,ILPRObI11DN4 .. .. j CARPENTRY I { cEaTIFICAT NOI.DER C HC LLATiON - - SHOULOAHYOP TiI®AGOVII 04501998 POLIO IN noCAMCB"dt IM'POAa THA W RAY14N t' OATS`TN0940,ThC igGumO INSUNR WIL.GNOGAYOR TO MAL_DAYS WRIYT61i { TOWN OF BARNSTABLE MOTICk TO TIP CARIVICATO HOLIZA NANOD TO TNa LBPT;lUY PAILURI TO DO OA ShALL ArrN; -4/ nw.ri/ OtP089"*paLIpA7ow OR LIAO Op I UPOR Trig IN6YI�R ITS A6$N1!Op t FAX TO iNSUREC.5W 53M71'I NaPFTFIAawTA�IVQ$. _ T j LMFI , AUYHORf3CC+TAPROaSNTATiYa \ AC09D25(2068 j RPORATION 163a j,I i jii� I I 04,112/2006 13:49 FAQ �iJU2iG05 t, MICHELE C. TUDOR, PS Consulting Structural Engineer 123 Cottonwood Lane•Centerville,Massachusetts 02632-1y79-(5 jg) ?71-76C i -,Fax(SOS)771-716, mctudor a>.cortcast.not March 13,2006 Beth Baird 3l7 Main St_ Centerville,MA 02632 RE: . � DRT Progr of Repair 317 Main Street,Centerville,MA Dear W.Baird, At your prior request,i went to the abai-ee captioned r!sidEnce on 1dmiil"A,2f)-M, r tl IT pwix=of addrussng 6e structural integrity of the residential strucft=,is particular as rebate-1 tc the o�-rvz�fb mdation wall mortar joint cracks and warping of wood famed floors,w preparation of a Secas:d P-ovr.lath R„r-odelir s projz^t. The purpose of this report is to list the structural issl=of cancer;t n:ah t-:ga d.to be ooserNed co ditFons. Other rues are not covered herein. 1.0 BggkgM1pd. The existing residential stricture was ccnstrustcd a ppro:drttateIN'l 3 ,Is mi the ational Raggister of Historiz Places. The original structure is a one-and two—story wood framed.tn_ji�ng on borl a fan a,d dra,vi space stone foundation. Toward the rear,there is a tine-stop addition,an all ate wbzd Pali and cn-i v'_;pace fo-wida ion.The Si'le is relatively flat,and slopes somewhat away from tLe buikbug. You iafarmed me that yan had recently purchased the paoperty,p—o:ded;ome rnain,aadwrciild like to be informed as to the ramifications of the observed issues,especiall;, aggir�g Er floor at.tL:5r r to ther.ad;ao,r in light of the Send Roos Bath Remodeling Project. .0 R tton 2 ASP The existing approximately 2'height foundation galls are o-tgae,wit.l.2 jeej_eyA% he_&of cenerete cover&d soil berm,visible on the inside face. There is a slab-on-grade floor. 1•itsr.)5-*r joists bear over the stone wails. wbluch earn-the exterior stud walls,second floor and roof.The crawl{pra;,e ip the(root section ix-as not access- as enhance Fasaat�rovi is an aces io the basecn t via an uz:enor stair w a a toward the right side rear. The stone wail has numerous mortar joint cracks,which Ymie rep&)re.3,azd niaY Mom-r tin ment Ye re-� :�to P molsan penetration,and farther opening up the joints Lathe free x:%th41w wafter C is le. Note that the--acnor. grade,approximately l'below the top ofwall,indicates badc&ll are lou.avd the berm desigm within the footprint is an acceptable means of buttressing the foundation walls agaima bacUil soil pros urs.. Where at-grade landscaping touches the wood ftamia;,wood rot t;Ticall is<a ts. Themore;re-,grading For positive pitch and re-point*may be required, 9 /2006-S0 04/121,2006 13:51 FA3 4j4VU.) uk'a r STRUCTURAL.REPORT 317 Main Street,Centerville,MA Page 2 3.0 ftor Timber FrarWnz Floors exhibit open joints m the plank flooring and sags at strategic lowuns is the footphni. Conditions above first-fiwr fi-ammg gerarally remain-Hidden,ecept whe a-visible at tip accm Viel in the ceiling below the - - Badnwm. Where framing members are sagged,under-sizing is anticipated in tLc timber framing. 1' suw--va=ai problems appear due to renovations,i.e.,improper ccnsamcfio:of mains. Generally,it is a maintenance item to replace am deteriorated tarrbe,,tl roug eut the bfc c±the strircturc. 7bg. solid timber guts have locations whew they are split m two,and it is r==-ended to use laminated verse r Iumbei (LVL)ganged to the existing member,in order to keep:he profile the sarsre. the s 3bt3oonng or plant&-F is theta toenail wrewcd from andernPath to the new Some elevation discontinuity of fruiting was obse,-,vd at t`z first f1wr leycL i"floor joists and ai-As ar+:fhazied over telescopic steel columns. T'o correct this condition,provide pertnavent:,o"wuns at consistent elevations,or shim with solid wood pressure treated 2x stock,•tint wedge shaped piths. Where floor framing requires sistermg and replacing deteriorated gaming;use=angle pig of LVL. lac,rain beam was sistered with 2-2xg,which requires leveling,a,-id attnchmi-nt to the main girt. Alternative z gang ;) 1.75"x 5.5"laminated veneer lumber to the existing k6 beam,o-ne s ima railed to m&face.Entrance to eht second floor via the sb&vasc,was sloped. Farther my stigatior below the stair ax the first floor framing level reveals the longitudinal girt spautnrng 5'between telescopic columns. A level L"VT bemn ganged to the e>asbm_g girt is required to stabilize this condition. INx SKS-1,following Ow xrq ort. , All new second floor framing repair work is best done from n�above.by rer ing the pink scab-floorng,obscmr.E J 4/ \the Hidden framing,ganging LVL to it,and refastening plank flooring from abm!e. The roof framing was not owed. 4.0 EzUnor Buildhne Facade Exterior trim and deteriorated timbers setgwm rernovai and mplace ew as part of the ongoing main enance to the structure, 12006-50 I 04/12'20a6 13:52 FAX (0004/005 o , STRUCTURAL REPORT g Main Sbvd,CenteriMe,MA Page 3 5.0 0onehusii90 and Ret —nW-AD This residence is suitable for impairs to maintain and provide safe hatiitation. Repeals are requil-W to tte fiairunP conditions. Repair to localized bearing and additional concrete foundation footings an requtrr;;. Re-grading for positive pitch and M12l ment ofdeteaiorated siding i`regwr d as on-p na�ntenance Provide-sne gradin for positire pitc^all around the foundation,toward required Also,the above information provides you with the minimum requires enis for wwiterarce of the sz�5uar inte", of the above captioned residential wood-framed supers ni-•tttre,uamet ad:irrg�o tie hamin.- CORTU3c with a licensed general oDritractor,smh as onz you may fund in tit--Bluj ,^gI cf B'•idjns and('o,strticuc,a. is recommended to perform the scope of svork to repair t1se fr MM' Timt�tir:C,-.Niashpee;NI-A, ,s oae contractor(508-477-3364). Further estimates for the Bath Remodeling Project:say be ob maed f* m Cr ug Bor don;Perr-P.urden jzc.. Chatham,IAA, (508)432-1627. I tru t the contents of this report meet your needs ai this time. should yv-o have any questions on ary of the abc.€; please do not hesitate to will. ,Fhcby, C.'Tudor, E. elel t2OO6.50 OFC. TUDOR 140.34774 STRUCTURAL lSTE atvAt. e J006.50 04/121'2006 13:53 FAX 6?005/005 71 VUH i I I I i �31' �Z'49�i�� i MICHE� i c Tuo()" &U5'( JS s i'uc-u ONPL YL I Tv 8• o i cA? To t8 c 0 D'? FTr'- y7-A;L.:@ GIla. FAAgfzj . PROP�Q,�S� MDDIF'IC�TIol�' CHELE C. TUTKO P.E. 9 �calG�� 7�� s . Conguitinq Structural irnglneer 123 or ormWd Lone, Cent.!Mle, Uosomhuse C2632 BAIRD RESMENCE awn sY �cr aot®: 03/07/te Drawing 317 MAIN STREET 6Qle: 4+7'l'o Rev. a CENT'ERVILLE, da Namw-am project No.2006-50 � ►� w I �G+Jc or' GLt�•�f � . FROM :Timothy Gray Building Remodeli FAX NO. :5oe5393714 Aug. 21 2006 09:13AM P1 j .. Board of Building Regula 'ons and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Nome Improvement Contractor Registration Regi"Ion: 102634 Type; private Corporation Expiration; 7=008 TIMOTHY GRAY BUILDING& RBMODELIN Timothy Gray 15 TObisset St MaShpee, MA 0264.9 � Update Address and rehire card,Mark reason for change. s-cAi S 50M-0"6-Pc9490 n Address ❑ Rawwal F7 Vmployment Lost Card Board of>guild.........,,._.. ....,„...._....,..,-. ....... ........ ✓�e�a�nasoriouuenl�a ay°.ra' rs . mg Regulations and Standards License or r4stration valid for indlividul use only HOME IMPROVEMd NT CONTRACTOR before the expiration daft. If found return to: ' Roglstrat M 102634 Board of Building Regulatloas and Standards fIora;i®ret. :7/212008 One Ashburton Piave Rm 1301 Type: Private Corporation Boston,Ma.0210$ 11MOTHY GRAY BUILDING b REMODELING r Timothy Gray 15.7abisset St Mashpee,MA 026Q Deputy Administrator No ld without signature r er�,�e-rVI-1f-Q. , n PQO 3LEr(�\ L E.