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0490 MAIN STREET (CENT.)
49D �� w Town of Barnstable � $ Building Department Services' Brian Florence,CBO BARMAs, Building Commissioner N MA 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fart: 508-790-6230 PERMIT# S fed �2�" FEE: $35.00 SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less Ce-n�c E �� Location of shed(address) Village Property owner's name Telephone number o X 14 ao l Dq C,.j, Size of Shed Map/Parcel# i F Mail KA-1-f)5 u�C� PL3 tiOe C_ 3\11a0ay S' re U Date Hyannis Main Street Waterfront Historic District? 6 Old King's Highway Historic District Commission jurisdiction? You must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:08/6117 Z� as BAX TER NYE rt;GINFhI:ISU a SURVFFh1ti BAXTER NYE ENGINEERING& SURVEYING a6gL.d tnoymriw and Lwd mwrwa 78 Nor h SVW-2d R— HrTemh,U.—t—NA OSSOt L00P!MMMOT105CLE INme- W!))771-1502 Fax- !WS)'77r-7L22 xw.adlN-R7P.Bm I GENERAL NOTES 6TA11V �\ I. 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A6 ".�"ffini�6% ^ ` _ ��' .art Bas wrARW roeereAY[IWo emus NEA MNARma Centerville,MA 02032 \� as d oraiOL � Lan.ud" PNw met,.. w.N",�x.0 _��-' .scam Eur ARcw m a mw A mu AVFomm mE A awAnwax Y x0a N�.�,» T eoa NlSi`P/Q to ALOVAQ Rrorzcaw AAtA ur Im T AwesTBR xM Bn,,oT ao-am _—- N \ - aRNAMS U M AIaE6wN wVOaroASO TRmmmMr Fl AO6TA a[aBN t¢NAFAA A A OaNNI IN07 FIRaw¢P!-1m SEEK dnF AT - eANN7A9E xeuw®Mode 1 \ S _ V��Lk aN80T TITLE PIPT�Bx iYLITBY T1U1T ro 1M®r O YY IMaemB[1ME Onnm waM NeaCR rs ouTm w P¢Amx ro uc wnrxOArs aww Net s xm Laarm wow A wmAt CortMed 5 RaOa xAu m AREA TRa PAN a.R//wjLw rooamm xa s/R ro se met ro LsrAAual vaBPtRx IBaa Plot P1811 $Hdky NO . A1OIIIwFB wa�W w9 RaaYd-8A NR oYlamO a aNaYNO OArr w+eo pr v r . O 01 MILT 14,met m 0 m w u LE W FEES TIC AL 8:Y_2a r• �f Town of Barnstable Building ...ram,.-..•Nwawu. MAnxs�wa�. ; (Post This.Card So That it is RVisible"From the Street Approved Plans Must b6 Retained on Job and this Card Must be Kept MA59. y • /..: Posted'Untif Final In Has Been Made ro s Permit f63p �a b � �•; 1 `1 iWhere a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made g Permit No. B-17-3936 Applicant Name: ROLAND LANGEVIN Approvals Date Issued: 12/26/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 06/26/2018 Foundation: Location: 490 MAIN STREET(CENT.),CENTERVILLE Map/Lot 207-046 Zoning District: RD-1 Sheathing: Owner on Record: KERNS,JOHN J IV&NADINE r Contractor Name; INSULATE 2 SAVE, INC. Framing: 1 w Address: 23 OLD STAGE COACH ROAD , - Contractor License: 180747 2 WESTON,CT 06883 �"� � Est. Project Cost: $2,964.00 Chimney: Description: INSULATION/WEATHERIZATION 4Permit Fee: $85.00 Insulation: Project Review Req: # Fee Paid: $85.00 Date: . 12/26/2017 Final: t '_ �1^ vy('t✓ Plumbing/Gas � f Rough Plumbing: - .. Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized 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 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 o'r road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. a . � ..k Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building andyFire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: : 1.Foundation or Footing - mm Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to CoveringStructural Members Frame Inspection) ( P ) 6.Insulatio n 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcelg�/ Application # lVv Health Division k�/NG. Date Issued Conservation Division T NOV 13 2 Application Fee Planning Dept. Q��NOI�&AID 1,,7 Permit Fee Date Definitive Plan Approved by Planning Board !N"�' �� Historic - OKH _ Preservation/ Hyannis Project Street Address of 4Q Ma,k 'Sk Village Cao4Cf✓►(�- Owner Nary Ke^ Address k,2,k 3�- (p,, e-ivA_ Mk 02639.7- Telephone Permit Request !1.r Seel, d [ �� a.� s� ,c.� a,..o/ ej.,V-s,,& n, Cie t lose f---P76arca l a Mr, T� r2-uy C�11A-e. k !2�0i R- qq ���`` (��,� ��c� Ca a�'kic �2'Ff�i �6ra�.s� /�.61.� a.• ���/.o �`P.H�- �6 �a.k� �a., P�Pavc.,-1.5 �� fa 1fnc�c,�:h.l Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuati 2-9 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing' new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name � Telephone Number SV&- 1-G706 Address �&o aM e S�- License# �Z I Q Qa a o Home Improvement Contractor# Email 0,14 Cd a k-9-s a.�e • ,e+ Worker's Compensation # 1��✓S-���!/�7 �{ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SQ•,"'CRQ, SIGNATURE DATE r 1 I-LOIL2 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAM E INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL I' GAS ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Coininonwe'alth of Mttssachusetts Department of Industrial Accidents 0 1 Congress Street, Suite 10f1 Boston, M4 02114-2017 s` l vww.rnass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pldmbers. 1,073EFU ED WITHTH E PERMIT`rIR'G Al7THORiTY, - AniDlicant Information Please Print Legibly Name(Business/0rganizatiortilndividull): Insulate2Saye Inc. Address: 410 Grove Street City/State/Zip: Fall River MA 02720 Phone ;'508-567-6706 Are you an employer?Check the appropriate box: Type of project(required): 1.Fx-J I am a employer with 20 employees(full and/or part-time). 7. New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8, Q Remodeling any capacity.[No workers'comp.insurance required] 9. []Demolition 3.Q 1 um a homeowner doing all work myself,(:No workers'comp.,insurance required.]_I n trill 10❑Building addition 4. I am a homeowner and will be hiring contractors to conduct all work on riay property. a 1 Electrical repairs or addthons ensure that all contractors either have workers'compensation insurance.ar are sale 1.❑ p proprietors with no employees. 12.o Plumbing repairs or additions 5. I am a general contractor and I have}aired the rub-contractors listed on the attached sheer. ❑ � 13.DRoof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.�We are a corporation arid its officers have exercised their right of.exemption per MGL C. 14. Other Insulation 152,t1 and we no employees. No workers'cone .insurance required.] a { }, p [ P pl *Any y applicant that checks box 91 must also fill out the section below showing their workers'compensationpolicy 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 tine name of the-sub-contractors acid state whether or not those entities have. employees. If the sub-contractors have employees,they must provide their workers'coanp.policy number. /'aar art employer that is providing workers'competisa.tion insurance for my errtp[oyees._Belo w is the policy andjob site iraformatiort. Insurance Company Name: Liberty Mutual Insurance — Policy#or Self-ins. Lic.#: XWS 5641.8741 Expiration Date: 12/10/2017 s JobSiteAddress: ` o /` ."k �k 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 M,GL c. 152,§5`25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-yeas imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a free of up to$250.00 a day against the violator. A copy of this statementmay be forwarded to the Office of Investigations of the:DlA..for-insurance coverage verification. I do hereby certify under t/ a sate pen ties of perjtu)a that the inf6rniation provided above is-trite and correct. Siqnat:ure: / Date: Phone 4: 508-567-6706 (.1l/ieitd trse only. .Do not write in this area, to be corupleted by city or town official: -. City or Town: Permit/License# issuing Authority(circle one): 1..Board of Health 2. Building Department 3. City/Town Clerk 4..Glectrical inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ._..� Office of Consumer Affairs and Business Regulation -- 10 Park Plaza - Suite 5170 Boston, Mas�shchhusetts 02116 Nome Improvement Cora�tractor Registration o- Type: Corporation Registration: 180747 INSULATE 2 SAVE , INC. - ' Expiration: 12/28/2018 410 Grove St Fallriver, MA 02720 Update Address and return card. Mark reason for change: 3CA 1 Co 20M•05/11 Emploment 1:1 Lost Gard , t�✓ate T�r.�ninv,�x:7t�rrra rr�i:���r�acao�ir�lr:�l _ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only 1 TYPE:Corporation before the expiration date. If found return to: :. Office of Consumer Affairs and Business Regulation 01s.�%(mrRij,� ation Ex iru anon - 12/28/2018 10 Park Plaza-Suite 5i70 4Boston,MA 0 2116 INSULATE 2 S';`VE I Roland LangevAm,' 410 Grove St Fallriver,MA 02720 �. Undersecretary Not valid without Signature - CommonWealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cortsirttaial ' ' rvisc�r . /2019 CS-103861 E ires. 08124-- T ROLAND LANGEVIN 56HIGHCREST ROADr FALL RIVER MA02720 �� P 41 -�f$ Commissioner A4C"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `...� 12/8/16 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 _ PHONE FAX 171 Pleasant Street E-MAIL ' (508) 677-0407 A/ No: (508) 677-0409 ADDRESS: hsouza@cordeiroinsurance.com Fall River, MA 02721 INSURE S AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance INSURED INSURER B: Insulate 2 Save, Inc. INSURERC: 410 Grove St. INSURERD: Fall River, MA 02720 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 ADDL SUBR POLICY EFF POUCY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/Y MM/DD/YYYY LIMITS A GENERAL LIABILITY Y Y 13KS 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERALLIABILITY DAMAGE TO RENTED PREMISES Ea occu a ce $ 300,000 CLAIMS-MADE �OCCUR ME EXP(Anyone person) $ 5,000 PER SO NA L&ADV I NJU RY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENTAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY JE LOC 7 $ A AUTOMOBILE LIABILITY Y Y BAA 56418741 12/10/16 12/10/17 EOMBc ntSINGLELIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY nDAMAGE $ X HIRED AUTOS X AUTOS $ A X UMBRELLA LIAB 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 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N )IyANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACGDENT $ 500,000 OFF ICERIMEMBER EXCLUDED? N/A - (Mar datory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under ES6describDESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regui 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 i ©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: RISE Engineering RIS:E 5 Dupont Ave,South Yarmouth,MA 02664 508-568-1926 FAX(401)784-3710 CONTRACT- Page 2 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 Nadine C Kerns (203)610-0226 08/21/2017 238799 26102 SERVICE STREET BILLING STREET 490 Main Street 24^T r.STA.Gr;eeA1=4t@AD 1- tiv Mgin St. SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP' Centerville,MA 02632 Gev1 evvi ee. /vI n oL fo 3 2- JOB DESCRIPTION LIMITED TIME SPECIAL INCENTIVES: For a limited time,National Grid will waive the cap on their Insulation Incentive. RISE will reduce your cost by 75%on all the weatherization work outlined in this proposal.This special summer incentive is available to homeowners who sign their weatherization proposal before September 15,2017 and submitted to RISE by October 8,2017.All work must be installed by November 15,2017. National Grid will also offer an additional$100 incentive towards the weatherization work outlined in this proposal,amount not to exceed the dollar value of your co-pay.This special summer incentive is available to homeowners who sign their weatherization proposal before August 31,2017 and submit to RISE by September 8,20.17.All work must be installed by November 3,2017. Total: $2,963.81 Program Incentive: 42,64186 Customer Total: $320.95.. WE AGREE HEREBY TO.FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF 'Thre.e::Hundred Twenty&95/100.Dollars $320:95 UPON FINAL INSPEC AND—, AL-BY RISE ENGINEERING.C TOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY .UNPAID BALANC ER 30 DAYS!'E ERSE FOR IMPORTW INF RMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. .. - RI E SENTATI CUSTOMER SIGNATURE - - NOTE:-THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT.EXECUTED WITHIN DATE OF ACCEPTANCE - SIGN 0 TE 30 DAYS. - ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE . SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO:THE WORK AS SPECIFIED..PAYMENT WILL BE,MADE AS OUTLINED ABOVE - - i Town of Barnstable S- ���� 'fir M�� j � • i Regulatory Services 471, Richard V. Scali,Director Building Division ., Paul Roma Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403.8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section I, Nadine C Kerns as.Owner of the subject property hereby authorize Insulate'2 Save to act on my behalf, in all matters relative to work authorized by this building permit application for: 490 Main Street Centerville,MA 02632 (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners.License Exemption.Form. C\Users\decollik\AppPata\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01M/1.17 . . f Commonwealth of Massachusetts Sheet Metal Permit Date: v ® �., Permit# Estimated Job Cost: $ ��+�, Permit Fee: $ U Plans Submitted. YES � 1�14 i ; Plans Reviewed: YES NO Business License# 1413 � �plicant License# 12—Z Business Information: `` II Property Owner/Job Location Information: Name: 1 'an c-e-c` H\rAC I Y)c . Name: . e)1(\ Street: Street: City/Town: City/Town: Telephone: 5 O LI- 0 Telephone: Photo I.D. required/Copy of Photo T.D. attached: YES ✓ NO Staff initial J-1 M-1-unrestricted license J-2/M-2-restricted to dwell s 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: `-7- i c13l 2o , ,e!c Me Commomveah*of Massachusetts Department of1n&mtrW Accida* Office of,Investtgations 600 WashhTton Street Boston,MA 02111 www.mass.gov/dia Workers, Compensation Insurance Affidavit: Builders/Contra-ctors/Blectrick=/Plumbers Applicant Information Please Print Legibly Name(Business/organiaabion/ladivi&4: sm n Cee-e. NV IR C Address: City/State/Zip: Phone 4n 077 Y Are,you an employer?Check the appropriate bog: . .Type of pcojec (required) S 1.Ltd'I am a employer with 5 •4. � I am a general contractor and i . employees(faIl and/or part:time).'`. have hired the sub-contractors 6. ❑Ne co ling lion . 2.❑ I am a'sole piropriettsr or partner- listed an the•attached sheet. 7. deling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in:any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance camp.insurance.$ mq �] 5. We are a corporation and its 10.❑-Electrical repairs or additions .3.❑ I am a homeowner doing in work officers have exercised their M❑Phmi:)ing repairs or additions niysel£[No workers'comp. right of exemption per MGL 12.❑Roofrepairs insmaune )t F.152,§1(4),and we have no - employees.[No workers' C"= comp.insurance required] 'Any applicant that checks box 01 most also fill out the section below showing Oteii worker;'compensation policy information. t Homeowners who submit this affidavit indicating$hey are doing aII work and then hire outside contractors must submit anew affidavit indicating such. :Cowractors that check this box must attached an addifi®al sheet showing the name of the subcontractors and state wbether or not those catitics bave employees. If the subcontractors have employces,they most provide their worlosrs'comp.policy number. I am an employer that Is providing workers'aompensadon i'nsuranee for my employees. Below is thepoli y and job site information. Insurance Company Name: %rg Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: e-I FU , f l'1 A i r? S fit ` ' City/State/zip: r-,4 )i- 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 rip 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 statemerit may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. - I do hereby certtjy under the pains and penalties of is that the information provided above ,es t/rue aril correct. Stare: - Date: L.3/ Phone#: S U Ff^ `/2 Official use only. Do not write in this area,tb be completed by city or-town oficiaL City or Town: PermitlLicense# .Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i I, • I :+COMMONWEALTH OF MASSACHUSETT o . SHEET MTAt.WORKS. ISSUES THE FOLLOWING LICENSE w GVEASTE}2-UlVREST1iLTED j � a LINGQLN T STUBBS 1 gI.ANCED,HVAD#N124 C ' f" 15 JAN SA:BASTION DR 'S I J ,-SANDWICH,MA 02563 2354 1226 07t2812019 304921 � qt: .n•d' nt • • ..tgr)�ilYlr' . VLlq :.I0bI' _ Ch Along All PYrftroong COMMONWEALTH OF �- M+A ► US SHEEN'Mf=TAL WORKPRg. ISSUES THE FOLLOWING I_Ii=1dE BUSINES:S:::.;' LINCOLN T STUBBS � 3Ad:ANCgQ H1lA�r 15 JA !~ A> TIAN QRIuE SANDWICH,MA 02563 143 $Z/07/2018...... 207753 Jr-- _ - �ICENSE P.Elm i:�NUMBER _ 07.27.2015 NONE S56562730 ah E%P 07 a4.,2oao _ o.7�2a 4.s71 p rrrl NONE Ic go M In 80 T.,6 r00', n 18 JOHN EWER ROAD 'm-ztillTr SANDWICH,MA 02683 '•0007•tB•All Rev OT•Iit00B BALAHVA-01 LRUO CERTIFICATE OF LIABILITY INSURANCE DATE(M TE(M Zo ) 17 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 CONTACT NAME: Reid-Hofmann Insurance Agency PHONE 155 Howard Street IA/C,No,Ext):(508)583-4400 (A/c,No):(508)588-5148 West Bridgewater,MA 02379 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Commerce Insurance Company 34754 INSURED INSURER B: Balanced HVAC,Inc. INSURERC: 78 John Ewer Rd INSURER D: Sandwich,MA 02563 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 LTR rypE OF INSURANCE ANDp SUBR POLICY NUMBER OOLICY EFF POLICY EXPWVD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR BGSLQR 11/02/2016 11/02/2017 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE' $ 2,000,000 PRO- X POLICY JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-AWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE I IERH ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main St Hyannis,MA 02601 AUTHORIZED,REPRESENTATIVE WV: t ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACOf20' CERTIFICATE OF LIABILITY INSURANCE 08/0320"'„°""Y"' 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 endorsements. RODUCER CONTACT Paychex Insurance Agency Inc PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE PHONE 877_266 6850 FAX . 585 389,7426 ROCHESTER, NY 14620 E-MAIL Certs@paychex.com ADDRESS- INSURERS)AFFORDING COVERAGE NAIC# ISURED INSURER A: NorGUARD Insurance Company 31470 BALANCED HVAC INC. INSURER B: 15 JAN SEBASTIAN DRIVE,S SANDWICH,MA 02563 INSURER C: INSURER D: INSURER E: INSURER F: OVERAGES 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. ,R TYPE OF INSURANCE DDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS R INSR VD (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ =]CLAIMS-MADEE=�OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY =PROJECT=LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED SCHEDULED BODILY INJURY $ AUTOS AUppTNNOppS (Per person) HIRED AUTOS AUTOSWNED BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DIED RETENTION$ - $ WORKERS COMPENSATION AND X WC STATU- OTH- EMPLOYERS'LIABILm BAWC842777 03/01/2017 03/01/2018IT, E.L.EACH ACCIDENT $ 100,000.00 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? _ E.L.DISEASE-EA EMPLOYEE $ 100,000.00 (Mandatory in NH) N N/A E.L.DISEASE-POLICY LIMIT $ 500,000.00 If yes,describe under :SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) ;ERTIFICATE HOLDER CANCELLATION The Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 200 Main Street DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY Hyannis,MA 02601. PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - .CORD 25(2010/05) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Page 1 Residential Heat Loss and Heat Gain Calculation 8/3/2017 In accordance with ACCA Manual J Report Prepared By: Balanced HVAC Inc For: Avery 490 MAIN STREET CENTERVILLE, Ma Design Conditions: CENTERVILLE Indoor: Outdoor: Summer temperature: 70 Summer temperature: • 95 Winter temperature: 75 Winter temperature: 0 Relative humidity: 50 Summer grains of moisture: 93 Daily temperature range:Medium Building Component Sensible .Latent Total Total Gain Gain Heat Gain Heat Loss (BTUH) (BTUH) (BTUH) (BTUH) Duct 1,382 0 1,382 4,892 Floors 0 0 0 . 1,080 Walls 3,134 0 3,134 8,224 Ceilings 4,230 0 4,230 6,912 People 0 0 0 0 Fireplaces 0 0 0 0 Misc 0 0 0 0 Windows 14,930 0 14,930 8,549 Doors 0 0 0 0 Glassdoors 0 0 0 0 Skylights 0 0 0 0 Infiltration 5,330 5,008 10,338 24,143 Whole House 29,006 5,008 34,014 53,800 (3tons ) HVAC-Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-1101 Load calculations are estimates only,actual loads may vary due to weather and construction differences. Page 1 Residential Heat Loss and Heat Gain Calculation 8/3/2017 In accordance with ACCA Manual J Report Prepared By: " Balanced HVAC Inc For: avery 490 main street CENTERVILLE, Ma Design Conditions: Harwich Indoor: Outdoor: Summer temperature: 70 Summer temperature: 95 Winter temperature: 75 Winter temperature: 0 Relative humidity: 50 Summer grains of moisture: 93 Daily temperature range:Medium Building Component Sensible Latent Total Total Gain Gain Heat Gain Heat Loss (BTUH) (BTUH) (BTUH) (BTUH) Duct 0 0 0 0 Floors 0 0 0 0 Walls 1,806 0 1,806 4,736 Ceilings 2,820 0 2,820 4,444 People 0 0 0 0 Fireplaces 0 0 0 0 Misc 0 0 0 0 Windows 7,320 0 7,320 6,411 Doors 0 0 0 0 Glassdoors 0 0 0 0 Skylights 0 0 0 0 Infiltration 4,335 4,074 8,409 25,232 Whole House - 16,281 4,074 20,355 40,823 ( 1.5 tons ) HVAC-Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-1101 Load calculations are estimates only,actual loads may vary due to weather and construction differences. Page 1 Residential Heat Loss and Heat Gain Calculation 8/3/2017 In accordance with ACCA Manual J Report Prepared By: Balanced HVAC Inc 60 For: Avery 15 ' 490 Main Street Centerville, MA, Design Conditions: CENTERVILLE Indoor: Outdoor: Summer temperature: 70 Summer temperature 95 Winter temperature: 75 Winter temperature: 0 Relative humidity: 50 Summer grains of moisture: 93 Daily temperature range:Medium Building Component Sensible Latent Total Total Gain Gain Heat Gain Heat Loss (BTUH) (BTUH) (BTUH) (BTUH) Duct 1,515 0 1,515 7,399 Floors 1,013 0 1,013 5,008 Walls 2,501 0 2,501 6,564 Ceilings 0 0 0 0 People 600 460 1,060 0 Fireplaces 0 0 0 9,161 Misc 1,200 0 1,200 0 Windows 18,700 0 18,700 19,604 Doors 1,185 0 1,185 3,105 Glassdoors 0 0 0 0 Skylights 0 0 0 0 Infiltration 5,089 4,782 9,871 30,536 Whole House 31,803 5,242 37,045 81,377 ( 3tons ) HVAC-Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-1101 Load calculations are estimates only,actual loads may vary due to weather and construction differences. Page 1 Residential Heat Loss and Heat Gain Calculation 8/3/2017 In accordance with ACCA Manual J Report Prepared By: Balanced HVAC Inc For: Avery 490 Main Street Centerville, MA Total CFM: 1,200 Room Cooling CFM Heating CFM Both First Floor CFM: 500 Kitchen 311 245 311 Formal/Dining Co 189 255 255 First Floor/2nd Zone CFM: 500 ENTRY 165 209 209 Living Room 335 291 335 HVAC-Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-1101 Load calculations are estimates only,actual loads may vary due to weather and construction differences. r �.KE Tbwn of Barnstable Regulatory Services • A Thomas F.Geller,Director 39. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.nma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, I J&A �/ �`�✓� ,as Owner of the subject property hereby authorize ll f?eec; f!V1q 1V11 to act on my behalf, in all matters relative to work authorized by this building peamit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not_to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Ownerl Signature of Applicant � �a�.t til,Pi �.�P.vv�-S ���cry �� S�✓��S Print Name Print Name 3l Date Q:F0RMS:OWNERPERMISSI0NP00LS Town of Barnstable RAC IPT 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit t Application No: B-17-2431 Date Recieved: 8/2/2017 Job Location: 15 VISTA CIRCLE,CENTERVILLE . Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: STEPHEN T DICKINSON State Lic. No: CS-081843 Address: MERRIMAC, MA 01860- Applicant Phone: (508) 676-6820 (Home)Owner's Name: WOOLF,PAUL K,BETH G,JEREMY S& Phone: (914)261-3415 DAVID S CD (Home)Owner's Address: 85 FARM LAKE CRESENT, CHAPPAQUA,NY 10514 Work Description: Sliding Doors rD ICP �y 00 w ,NO r- M Total.Value Of Work To Be Performed: $8,268.00 Structure Size: 0.00 0.00 0.00 Width Deptli Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). 1 understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by . filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted_on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Stephen Dickinson 8/2/2017 (508)676-6820 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost: $8,268.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $42.17 8/2/2017 $42.17 XXXX XXXX-XXXX Credit card 7597 ...... ....... ......... . .... . .. ... ......... Total Permit Fee Paid: $42.17 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map AQ I Parcel D (_ Application # Health Division Date Issued �— Conservation Division Application Fee Planning Dept. Permit Fee r-)CP Y r S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis /t 01 Project Street Address ( O Village Owner I'l^' NPV7,r10Q Address `7Y0 �� ��• �a� Telephone Permit Request Square feet: 1 st floor: existing proposed �2nd floor: existing proposed t C—Total new Zoning District Flood Plain Groundwater Overl y S exc.:d e Project Valuation G�G10 Construction Type Lot Size An Grandfathered: ❑Yes 4&,N"o If yes, attach supporting documentation. Dwelling Type: Single Family AS' Two Family ❑ Multi-Family(# units) Age of Existing Structure 8b0 Historic House: ❑Yes 0 No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full awl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) 'O Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 3- 0, new 4-44k, Half: existing new Sly-lac Number of Bedrooms: existing _new Total Room Count (not including baths): existing new N First Floor Room Count Heat Type and Fuel:Ar<as ❑ Oil ❑ Electric ❑ Other Central Air: es ❑ No . Fireplaces: Existing New er-- Existing wood/coal stove: ❑Yes tfNo Detached garage exist'inJ�v❑ 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 ❑ /J ®�� Commercial ❑Yes *-No If yes, site plan review# 1J ZA- 'l�® 1 Current Use ;5x� r— Z-5 Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name + _ t i Telephone Number S�� g�U 7.?72 Address ?. o f 1 License # D� 7 71 Home Improvement Contractor# 7 9 8 I Email �'�AUlrets�I6 �b�i"L�ar;C % 'l Worker's Compensation # & A: ALL CONSTRUCTION DEBRIS ESULTING FROM THIS PROJECT WILL BE TAIEN TO J� SIGNATURE ATE / FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME )V II r -7 o =� INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 3 p FINAL BUILDING fF//lJ 9) DATE CLOSED OUT ASSOCIATION PLAN NO. r MAIVISTARM Town of Barnstable Regulatory Services Richard V.Sc*Director Building Division Paul Roma Building Commissioner 200;Main Street, Hyannis.MA 02601 www.town.barnstable mn.us Office; 508-8624038 Fax: 568-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner:of the subject property hereby authoriue J1 ilra_e+ �\.V •e-' to act on my behalf, in all matters relative to work authorized by this bulYding permit application for. /��J�'�I�� pp- �p,,-.,�/(Address of Job) X 66/1 57/271 2-0.k-7 SIture o wrier bate �i(n� �e,��nS • `�da� /fit✓�S Print Name It Property Otmer is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:tUsmldecollikMpiDodiLoc MinomflltVwdowsUNetCwbe%CootentOlniookV,7U69LP-\EXPRESS(4doc The Commonwealth of Massadiuselts Department of Industrial Accidents Office of Investigations ` 600 Washington Street Boston,MA 02111 wivrv.niass govIdia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibbr Name aksineworganiiation&dividual): Av [ / �-•_ Address: City/State/Zip. MR t'C l . phone#: ©, 9 �g 7 3 7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. [-I am a general contractor and I 6. ❑New construction employees(full and/or part-time).: \ have.hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insuranee.i 9. ❑Building addition required-] 5. ❑ We are a corporation and its 10_[3 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself[No workers'comp. right:of exemption per MGL 12.❑Roof repairs insurance required.]'t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] .Any applicant that checks box#1 emmat also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affida%*indicating they are doing all work and then hire outside contractors emu,submit a new affidavit indicating such. 'Contractors that check this box toast attached an additional sheet showing the name of the sub-contractors and state whether at not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is pro ift workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Dame: Policy#or Self-ins.Lic.4: Expiration Date: Job Site Address: City/State/zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi anJdhepa' s and penalties of perjury that the information pmided abov is brae nd correct Si tire: d Date: J5 3 4 (. Phone#: Official use only. Do not write in this area,to be.completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: - CERTIFICATE OF 'LIABILITY INSURANCE �"�'0/20' MM ft7 �� 3/3 /2017 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(tes)must be endorsed If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsemenL A statement on this certificate does not confer rights to the certificate holder in fieu of such endorsement(s� , PRODUCER CONTACT CT Gregory Bates Risk Strategies Company PHONE jAr (781)986-4400 Fax •(781)963-4420 15 Pacella Park Drive E-MAIL -ADDRESS: Suite 240 IN AFFORDING COVERAGE. NAICD Randolph HA 02368 INSURER A4;tlard Insurance Group INSURED INSURER B Baer Custom Carpentry, LLC INWRERC• 93 South Orleans Road INSURERD• INSURER E Brewster MA02631 INSURER F• COVERAGES CERTIFICATE NUMBER.CL1722128775 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 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 ADDL SUN POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR OAMA TO RENTED PREMISES Ea nmmence $ MED EXP(Any one person) $ PERSONAL BADVINJURY $ GEN1.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑jRa LOC PRODUCT'S-COMP/OP AGG S OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 02 $ acdd. ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILI(INJURY(Perastidem) $ HIRED AUTOS AUTOS ® PROPERTY DAMAGE $ (Per $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LILB CLAIMS-MADE AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION PER I OTH- AND EMPLOYERS'LIABILITY .,:YIN STATUTE I I ER ANY PROPRIETORIPARTNERIEXECUTIVE NIA EL EACH ACCIDENT $ 500,000 A OFFICERIMEMBER EXCLUDED? IMa►da"In NN) BMC849601 1/12/2017 1/12/2018 EL DISEASE-EA EMPLOY $ 500,000 If yes,desaihe under - . DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LAAIT $ 500,000 DESCRIPnON OF OPERATIONS/LOCATIONS/VEOCL ES(ACORD It",Additional Rmearl6 Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Fn BEFORE Cape Cod Remodeling, LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Po BOB 2416 ACCORDANCE WITH THE POLICY PROVISIONS. Mashpee, MA 02649 AUTHORIZED REPRESENTATIVE Michael Christian/GUC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 munn PR JS W. Parcel Details 00850022f W- rJiE0�5�©3 ^ 4454 Location `ti ?r Parcel: 207046 f ' , ' 1 t Address 490 MAIN STREET (CENT.) AV tg' �4 Village: CE , Acreage: 0.75 - � Full Property Info - Property Photo '' 20813t� �. ; 4; 1 i - �20r045001 , Owner&Mailing Address 2 07�0,4 Owner: KERNS,JOHN 1 IV& 540 NADINE "- Mail Address 23 OLD STAGE COACH ROAD WESTON CT -06883 J Assessed Value(FY17) ��S's• __—__.:._ - - _- Building Value: $364,400 - - 27043 Extra Features $15,000 524x Outbuildings $17,400, Land Value: $280,800 Total Value: $677,600 . Residential Exemption No exemption. Building Details Model: Residential Basemap . Hone Layers Parcel Details � 100ft p Massachusetts Department of Public Safety Board of Building Regulations and Standards License-- CS4384771 Construction Supervisor RICHARD T AVERY PO BOX 2416 MASHPEE MA 02649 /ir-�t :rsfi' I� � - Expiration: �Commissioher 01/16/2019 License or registration valid for individual use only /� �Pa�irTura��u err��lt a. before the expiration date. If found return to: f rt��r;rrc%�unita Office of Consumer Affairs and Business R �R' Office of Consumer Affairs&Business Regulation Regulation h�-�HOME IMPROVEMENT CONTRACTOR 10 Park Plaza-Suite 5170 =' Registration ;: Boston;MA 02116 a 178816 Type: _ Expiration 52212018 LLC. CAPE COD REMODELING LCC RICHARD AVERY of valid without gnatu 3 39 FOUNTAIN ST MASSHPEE,MA 02649 Undersecretary C'O L o� 1 � 9 1 I 3, �tz0 l S- A-c A- r-A.- 1 e� g�� L t AWE Town of Barnstable *Permit# 2- Expiresp Expires 6 months from issue date Regulatory Services Fee W s a%txZ g o PER ON 0 �63a �0 Richard V.Scali,Director . IF . Building Division , APR 2 5 2016 Tom Perry,CBO,Building Commissioner �R�n' �F BARNSTABLE 200 Main Street,Hyannis,MA 02601 TO]u 1 www.town barnstable.ma us Office: 508-862-4038 Fax:.508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprim Map/parcel Number. c�2Q 7 to Property Address V--u C, T- ['Residential Value of Work$ 12( to L9 J Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name_ t L �� C Telephone Number Home Improvement Contractor License#(if applicable)_ ��cZ 3 („ Email: Construction Supervisor's License#(if applicable) Q orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance J Insurance Company Name_ G ?✓ Lj L kt i I Workman's Comp.Policy# 1 j G — 3 7-7 Copy of Insurance Compliance Certificate-must accompany each permit.. Permit Request check box) �e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ✓ w,� 44 ❑Re-roof(hurricane nailed)(not'stripping. Going over existing layers of roof) . ❑ Re-side ' ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: s ❑ 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: py of the Home Improvement Contractors License&Construction Supervisors License is r it SIGNATURE: Q:\WPFILES\FORNIS\building 'nnit fonns\EXPRESS.doc Revised 040215 1'TFe Commonweah*off r*use&s Department aflud rshia!Accidearts O rice cfl ra kgati ns 600 Washington Street Boston,M4 02111 stwvm-masmgovldia Warimrs' Compensa tian Insurance Affidavit: BuildersdCantradursMe c&kianslPbunbers Applicant Please Prim Na= 1L C 9 Address-_�Il- CiigdState( U,�-� '" ��e- r Phone 2 ..�� e Are ya an employer?Check the appropriate bay type of project(reg�ed}: 1. am a employer v,rth 4 y 4- ❑I am a general coatmct�sr and I employees(ftall armor part-time)'* have hired the salt-coalactors G. New consaucfr� 2.❑ I am a sale proprietor orpastner- listed onthe attached sheet 7. [:]Remodeling ship and have no ernplayees . These sub-con_lractors have 9- ❑Demolition , worzing for in any rapacity. employee`s aadhave xgotkers', jNo waders comp-insurance comp. 9-.❑Building addition required-] 5_ ❑ We.are a cwporation and its 1OL❑Electrical repairs or additions 3.❑ I am a bomeoramer doing all work officers leave exercised their 1 LQ Plumbing repairs or additions mYse1€[No worlrers'camp- of eecenzpfim per MGL 1.❑Roof repairs insurance required_]T c.152,§1(4).andwe have no employees.[NO workers' 13-El'other t; cow.insurance required_] •�4ay appEicaatB�at cbedsbas�l rua;t aLa fa].outthe settioaheiowsisatdag theiriva¢xex�`comp�m++�+*�pol;cyiniiarmsao� T Hamemnm uho submit dn af5dast in1ffca±mg they ste d=.-sH wat mmi Brea him outade cant=f.„z �����..��� most submit a nem affida�t SaCIL fCa actos8zzIcheckthusb=oastattachedasadditinual sheet shoahgthenameofthasob-�smdstsba-whether arnatfhoseenfitieshave emPbYees.Ifthesnb-co-ntmao shm employees,dley=nTpmaide their trarkam,comp.polky numhea lain an Below is flee policy and jab site in,formation, / } p / _ Ins�ceCompany Nome: l� ( r �/Vi,Vi Y,*,q ' Policy 4"L or Self-ins.Lea_ (J e -Z - . AYO -0(c,s--pirafionBate: Job Sire Addle T`� C� F 4 1. 4 7— — CiVStaWZip: ` /Kit,-, C., - Attach a copy of the workers'compensationpolicy declaration page(shawing the poTcy number and expiration date). Failam to seam-,coverage as required.under Section 25A of MGL c. 1572 can lead to the imposition of criminal penalties of a fine up to$0-OD 00 andfor one yearimprism mm id as well as rival penalties im the fann.of a STOP WORK 01WEI€and a fine of up to$254-OtI a clay against the violator_ Be advised that a copy of this swement 2nay be forwarded to the Office of Investigations of the DIA.for insurance coverage verifiesion. fi .f tio Hereby cattfF�raider ills ' t dpsrr ' s ofpmrurp that file irafornra€wi proud ahmv i v and correct SiEnature Date: kW Phone . Ojg al use only. Da stat write in dds area,frr be completed by city or total Official City or Tovm: Pertmitlf;tense;g Lw ing A,vthor€ty(drde one): L Board of Health 1 2.RwIffing Department 3.Chyfrowa Clerk 4-Electrical Inspector S.Plumbing Inspector b.Other Co tact Person: Phone#- lbaformation and lastmctions ;` . Ma_tcsar�tttsetls Gceaeral LAWS dIapfea 152 retlunes aII M]ploy=to i ''"—� � eIISatlOn fQr tbelr f�plQyeeS- pm tto this sisfufe,an.=T&yee is defined as."_.every person in$ie service of another order any coact of hire, express or inplied,oral or " Au.emplaya is d�:ied as"an.individnal,parfneashap,association,c�por�ion or other legal a y,at airy t�vo or more of the foregoing engaged m a Joint e�apase,andincbidmg the legal represeaiaiives of a deceased employer,or r the receiver or tustes of an mRvidnA pm±ommhip,association or otherlegal 1 ,employing employees. However the owner of a dwelling hlDusD having not more;a than tbr=apartments and who "des therein,or the occ¢paat of the - dWPT house of 1 na er who=a ploys pemons to do make, on or repair work on such dweI3mg house or oathe grotinds orbm7dmg aIjrL nuar3tthereto OmHnotbecanse Of employmentbe deemed to be an employe-" MGL chapter 152,§25C( also states fhat"every state or IocaI agency shall withhold ffie issuance or renew-al of a license or permit to operate a business or to consiract uaffings is the co---wealth for any applicantwho has notprod[ Iced acceptable evidence of comp with tIm bi mmnce-covexage requirred Additionally,MGM chapter I �25COC7) us"Neither s fhe norany ofifs political subdivisions shall into any contract forthe po ofpublic warlcu� Ie evideace of compIiancewith�e;ncrrrance. requi emus of this chapter have be preseuted to the f APPlicarrts Please fill out the workers'comperzsati\o affidavit comple#EI, checl &e boxes ffiat apply to your situation and,if necessary,supply sub-contrautar(s)name(§), ad&=Ces)and'pho anumberCs)alongwiththeir c;mtfficzt*)of inscaance. T-h:, Liability Companies(LtC)or �Liab�fy Parineasbips(I.LF)With" e�Ioyees otitier than the members or partueas�,al a not mquired to carryS Tulk=s =L4-m fi=== If an L LC or LLP does have empLyee§,a policy is requhed. Be advised davit m�y be mbmuted to the Department of Industrial" Accidents for confirm ation of insurance coverage Ada be Smrye to sign and date $e affidavit The affidavit should be retied to i`he city or town that fhe application a petmlt or license is being requested,not the Department of Ld astrisI Acoi dm:L- M021CI you have any questions the the law or¢you are rcgair d to obtain a workers' compensation policy,please call tbe'Departmeo±at listed below: Self insured companies Should enter their self fi somata license number on the appmFdate City or Toven.Of6ccials t Please be sure that the affidavit is complete and I Iy. Tb Tzdmmthas provided a space at the bottom of the affidavit for you to fM otrt is the event Office o Inv has in coact you regarding the applicant Please beu=tb fM in the penn�c=se mmb which be used as feream number. Ia addition,zn applicant thzt must submit multiple pennitllic-=D appIi in given year,n only mbm-rt one affidavit mdicat g'cusent p olicy mrorrnatian(if necessary)and under`� b Site�+ "the applicant ould wute"all locations in ( 3'or town)!' .fficially ed�marked by city Or tuvm may be provided�the ' own):'A copy ofthe-affidavit fhat has he applicant as proofthat a vaT.id affidavit is on a fur ermi is or licenses ew a$davit must be filed out earJi A year.Where a home owner or CYLZ n is o a license or peffiit not related to business or commercial veattn� a dog license or permit to bUm leaves )said person is NOT reguiredt o compl this affidavit The Office of Investigations would at to. you in adv dce for your cooperation and uld you have any questions, please do not hesitate to give us a call- The Department's address,telephone and mmmbm: C0MMWWMJtEE of Ma ssarhnsf t - Deg meat of Indistial Apra dents Q+ffi=alitwe&tki atio= 6DawasbivQ11 Bcst=.,MA 0�11I Fay 9 617-'27-7M Revised4-24-Q7 ��f�a y - o AM PST (GMT-8) EROM:`100005-T0: 15087-756688 Page: 4 of 18 DATE(MMIDDIYYYI)(R�® CERTIFICATE�OF LIABILITY INSURANCE F1 5/8/2015 ,4IS 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 WANED,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 FRANK L HORGAN INSURANCE AGENCY INC° - ';` NAME:CONTACT - _ - - NAME: 44.BARNSTABLE ROAD . PHONE FAX PO BOX 250 c o A/c No): HYANNIS, MA02601 EMAIL ADDRESS:^ x, INSURERS)AFFORDINGCOVERAGE NAICS > e wsuRERA:-LM Insurance Co oration` _ `p 33600 INSURED t. _ CAPE& ISLANDS CONSTRUCTION COMPANY INC INsuRERB. PO BOX 210 " INSURER C: I' CENTERVILLE MA 02632 INSURERD: INSURER E: 1 ` ' r'?•. '� INSURER F: k COVERAGES CERTIFICATE NUMBER: 24610723 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 n - - - POLICY EFF POLICY EXP. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM1DD. -MM/OD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE DOCCURPREMISES DAMAGE t pR 1 S occurrence) $ y + MED EXP(Any one person) $ ' a J" e PERSONAL&ADV INJURY $ ' 1 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL'AGGREGATE $ PRO- ' ^� POLICY❑JECT LOC r s:� PRODUCTS-COMP/OPAGG $- OTHER a , $: AUTOMOBILE LIABILITY "'-". <� _ COMBINED SINGLE LIMIT $ - �, Ea accident _.. ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS r" '4 BODILY INJURY(Per accident) $ NON-OWNED > PROPERTY DAMAGE $ HIRED AUTOS AUTOS r Per accident $. UMBRELLA LIAB - - ' OCCUR - . �,. -� �� �- ,. "`' � EACH OCCURRENCE $g EXCESS LIAB CLAIMS-MADE - AGGREGATE $ DED RETENTION A WORKERS COMPENSATION - WCS-31S-377540-01.5 ;5/712015 5/7/2016 ,/ STATUTE 'ERH - AND EMPLOYERS'LIABILrfY YIN { - ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? �N N lA (Mandatory in NH) `. I E.L.DISEASE=EA EMPLOYEE $ 100000 If es,describe under " 500000 DESCRIPTION OF OPERATIONS below �= -"' - E.L.DISEASE-POLICY LIMIT $ ¢ � r DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) p ' Workers compensation insurance coverage applies only to the'workers compensation laws'of,the state of MA •" This certificate cancels and supersedes all previously,issued certificates only as they relate to workers compensation coverage ,CERTIFICATE HOLDER s '`,.�. - • �� :. ` '.` CANCELLATION' t TOWN OF BARNSTABLE 'SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN CELLED'BEFORE ZOO MAIN STREET THE'EXPIRATION DATE THEREOF;' NOTICE WILL BE DELIVERED IN HYANNIS MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. , l AUTHORIZED REPRESENTATIVE LM Insurance Corporation _ ©1988-2014 ACORD CORPORATION. All rights reserved., ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r CERT ND.:44610723 Anne+ChandLer. 5/8/2015 1:54:54 PM (EDT) Page 1 of 1 1. .. . . . . . . . . ""-.' :. 5• r . Estimate 11. 201: Date Apr f2,2016.; Cape Uslan€�s Construction Go l of ; ' Po Box 210 Terms11 Ceppntvrvil!e(�I��v1]jar 02632 J�Q. .�41V41 c 11 � 0 Sl- Via 3. r, k �, Ship Date '�x ..... Rob Massa 490 Main St: € Centerville;.Ma.02W2 . . ..... .. * o . CERTAINTEED Certainteed Single Roof 12>600.00 Strip.existing 2 layers:of shirgles from roof;:: Secure any loose sheathing. Install;Hicks`brand vented a!un!num;rrip edge; install-Wip brand Ice&waW..Shield to all eves;rakes,valleys and ail'protrusions: Install Rhino brand.Synthetic Felt Underlayrnent.. .. Install Certa'inteed Quick Start.starter,shingles to all rakes&eves. Insta!l'Certainteed LIFETIME Landmark architectural shingles: Storm.nail all.shingles:. -. (State buildIng.code.requires 4 nails,•we use 6):'' Re-flash all,vent piges:with,new boots:; InstallsRigid Vent II n,dge venting Remove and disposQ of all°jab related. ste. leave your pre perty b k!ng l!ke we were never-therel : Provide aq manufactures vvarranties;and, - .. LIFETIME warranty an our labor, if it ever falls due to our workrnapp... ,p we:. fix it,forever! 'It'sAThe.C3est'In The Business. . .. IIII Please HateIl:our w!nd warranty'.is also:the best: .And Iongest avaiiatale ANYWHERE! . . ` Total $12,6Q0.00 2ji dii )"'.'P a .. ,::. t '+ µ I.1. Y y 8. f ✓ .P 4 •.: `. .....i:. b R . :;v.1 q:� ,� N�"a :: ! f Y :��.. ` a Artisan Gutters, LLC rtisan Estimate 30.Molly. Rd' West Yarmouth, MA:02673-3645, A (508)364-6985 www.artisangutters.com'. AC1blSS S1tIP To Josh Kouri Josh Kouri Cape and Islands,. Cape and is!ands Construction Co,lnc -"- Construction Co:Inc; 490 and 508 Main.st:. P Centerville,, MA 16.62 'OVO!J2016 _.. > � k ¢ WORK-TO SE PERFORMS) b ' - ;L1N Fl k COSTS 508 MAIN ST: refasten downspout over front porch; replace 2 story (25 ft each " 585.001 totaling 50 ft) ownspouts on nght:side of main house, repair downspout orr rear of.right side of rnam house, refasten_downspout over rear-foof addltiori of main house, repair downspout near`.rear entrance a# main house, clean a!L { gutters on main house 508 MAIN ST REAR UNIT:"clean all gutters, check for proper pitch-arid 529:00, drainage, install drip edge;extension to eliminate leak behind 92 Ft,.install elbows and extensions on bottom of downspouts j 490 MAIN ST:replace 30 ft gutter and 30 ft,downspout over driveway; replace. 1 342:5Os plastic damaged downspou# on rear of main house with aluminum 35 ft, remove plastic;gutter on garage and install 25`ft of new aluminum gutter and 15 ft of now'aluminum downs 'out, remove rotten wood gutter and°rotten facia and replace with new facia andaluminum guttering downspout (wood is 1 x10x1$, gutter is 18'ft with 126ft of downspout), replace tlamaged gutter over porch on front right of main house gutter is 35 ft downspout is 17 ft and it'has 4;miters, refasten gutter and downspout over front porch, clean,all gutters on house Alt of our work is backed wdh a;:I O year warranty agajr st manufacturer TOTAL 2 V.�O ancJ install ition;defect if instalied to iii"lers:specifications:Ail specialty- - �. ... items require`a 500/6 deposit fo sche'd I'dg:Thank you for your inquiry we. look forward to exceeding your;:expectations Accepted By Accepted:Date s. !(� 1�41e, �- Mass. Corporations, external master page Page 1 of 2 y. Corporations Division Business Entity Summary ID Number: 000971839 I Request certificate I New search Summary for: TJLC, LLC The exact name of the Domestic Limited.Liability Company (LLC): TJLC, LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 000971839 Date of Organization in Massachusetts: 02-22-2008 Last date certain: , The location or address where the records are maintained (A PO box is not a valid location or address): Address: 508 MAIN STREET City or town, State, Zip code, CENTERVILLE, MA 02632 USA` Country: The name and address of the Resident Agent: Name: GILL, DEVINE & WHITE Address: 776 MAIN STREET City or town, State, Zip code, HYANNIS, MA 02632 USA Country: The name and business address of each Manager: Title Individual name I Address MANAGER REBECCA S HARVEY 562 MAIN ST BRANFORD, CT 06405 USA In addition to the manager(s), the name and business address of the person(s) ` authorized to execute documents to be filed with the Corporations Division: Title Individual name I Address SOC SIGNATORY MICHAEL J GILL 776 MAIN.STREET HYANNIS, MA 02601 USA SOC SIGNATORY CARLA MAZZA 1156 MIDDLE ROAD COLCHESTER, VT 05446 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=000971839&... -4/25/2016 Mass. Corporations, external master page Page 2 of 2 Title Individual name Address REAL PROPERTY CARLA MAZZA 1156 MIDDLE ROAD COLCHESTER, VT 05446 USA REAL PROPERTY JOHN MENZIES 1803 N.MOHAWK, UNIT B CHICAGO, IL 60614 USA ❑ ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Annual Report ^; Annual Report - Professional Articles of Entity Conversion l Certificate of Amendment v+ 'View filings Comments or notes associated with this business entity: I New search J http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=000971839&... 4/25/201.6 Massachusetts Department of Public Safety 3 Hoard of Building Regulations and Standards Constl UcIIUL Supervisor License: CS-074660 JOSHUA X KOUR PO BOX210 CENTERVEU E RA �.�..�� •'""'P Expiration Commissioner 02/12/2017 s of any use group which Unrestricted-Building - contain less than 35,000 cubic feet(991m3)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. i$ For DPS Licensing information visit: www.Mass.Gov/DPS - '= License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10_Paik'Plaza-Suite 5170 r Boston',MA 02116 of ah without signature ., Y_. ' � � �e�pomyraaraioea,�C�a�Cac�zuaeCts Office of Consumer Affairs&Business Regulation UWHOME IMPROVEMENT CONTRACTOR i Registration:! fi659W Type:. i �:. Expiration= 41912-d tf Private Corporation CAPE&ISLAND COf� Cgj3Al`e0 INC. JOSHUA-KOURI ` �W 1 =_r 55 ELM AVE, HYANNIS,MA 02601 Undersecretary NE OR Front Elevation &31 eft Elevation PI WOOD PRODUCTS SCALE: 1/'4 = 1_-0. _ CALE: 1/4 1'.-0" PINEHARBOR.COM _ . 1- -368-SHE 800 D ?59 Har�wich �Anne d MA 02645 ". . 0 1 %12.pitch: P:(50 e) 430-2 115 Architectural Shin des P n- barnsQ i eharbor com I ENGINEER'S STAMP s , _ kz PVC.Tr.irri . t Board and Batten .. Primed Clapboard r PROJECT t ` x .1.4 =Quivett Cape 10 14-0' . 0(�. - _ . e . h < �rw 1 .CL CLIENT { 'ADDRESS. r • Rear Elevation /' eVatl.on PHONE: 3 - : SCALE: 1/4"� 1:0'" E-MAIL. • ' ADDRESS OF PROPOSED WORK: Architectural Shingles - REVISION DATE-:,Board and Batten Board oa d and Batten : • DRAWN BY: Scale:. 1/4" = 1'-0° _ Unless otherwise noted Page A.1 i