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HomeMy WebLinkAbout0137 SHORT BEACH ROAD � ` r k';'i f ' ti+. ,:..z^' �.,� �.,.•w .�x �...,, �, ,., �, ''�w �r - r� .. n '.".y"e.,. ,:F..c -e �` e. r ;•i'� �- r-> � ,�p t�� 11 =-�, �j�` l'!�. _..fir Y. L,�'... .q,y� S"x Gx. :.. �.� n -.v!�..n L� ,.±4y� x t�,,•, y.:,�} ,..' K 3.r "�,:m. •z:{,,„V-... ,a. r. .., ,•+ d.,.:� ..x,'� L:.-�.. �'.:b _.,{; � � .4.. -� -iu �. .,. _.�,� .r, a< £�• ."�Y. r„„�'�a t:C{, �-- z 'a.. - �'�'. Y 3` Ai i-�. .;y" 'i ..� e:kt.. .f F'p, .�.t�f',: ..� �t', ..' .rt' 't.. -"t`i.�cl� t� YiTs=� e'n' AA 4P«�Y,:y, 'yfy, :� �• Za• u+ i:. ..,,,.y - '�{ s. .�. :7. .cv,�. �tri ,.t'� `ta' as J?' fir' ,:es. {aey!'��tc'�k ',•a. �rF,�: - ho x �'++ 4a,.0"s'�tY,.f � }f� '{j`�`T���'s,�' •fY�f,`�d� L `�� `, A - > y �M.r:As441 •�.,kr� 4a� ,e� �7•T �{� o� tv '7.� y t • I 3` l d CAPE 0,00 TOM, INS U L A T�I O N 9 ? - {_i : : )�# kP E 0 1 7014 ts! iR 5 s PIYEY YLASS 3[AY1L[55 fYYA1 FYAM 9YSP[NDED - [AR5 3UR[YS INSYIA[IDN CLIlINOS - 1-800-696-6611 DIVI .1� , Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 0260:1 3/3 i Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. I Property Owner Property Address Village , Lc)vipv,-- 131 Sh��� cLC� � Cep► ,fie v, 1��: (-fanne s !fir 5 ih s - veto a on�r (,OvIM � s P�eJ a� Insulation ff stalled: Fiberglass Cellulose R-Value Restricted Unrestricted � 1, , Ceilings ( ) ( X) ( 7 5,) Slope 6 . Floors ( ) ( ) ( ) ( ) ( ) Walls I - s 4 Sincerely w �- �i He ry E Cas y Tr,.Presid'ent C., e Cod I IFulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �0(0` Parcel OW7 Application # o?Ol yak of Health Division Date Issued 1 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Stre3a,,Address 3� Village lC/ Owner 0141 RIOV Address Telephone �$ 67 Permit Request fUo 4b�kl ' " CX OI/ /(. 41 Square feet: 1 st floor: existing proposed 2nd floor.: existing proposed Total new Zoning District Flood Plain v1 Groundwater Overlay Project Valuation Construction Type '1, �af Nam-- y orting do:�umetation. Lot Size Grandfathered: ❑Yes ❑ No If es, attach s7mb / 1--a01) Pt 1 Dwelling Type: Single Family CX Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: _CJ Yeses❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) I IUJ rn 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 UO If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION 5 w _ .(BUILDER OR HOMEOWNER) Nam Telephone Number U ?7S e�vdo� 1 9 Address � License # Vy Home Improvement Contractor# A5;�S'6 7 Worker's Compensation # (.,vCa oo52 5`�1(� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL 13E TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# .._DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FRAME .-INSULATION..I.. FIREPLACE ELECTRICAL,- ROUGH FINAL I' PLUMBING: ROUGH FINAL GAS: _ ROUGH FINAL FINAL BUILDING n.. DATE CLOSED OUT } ASSOCIATION PLAN NO. f _ OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at } 1 3-z 51w1 (Property Address) C o 3�- (Property Address) hereby authorize �� (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building - permit and to perform work on my property. Own r ignatu 4. li�a- Date Massachusetts -Department of Public Safety \' t Board of Building Regulations and Standards Construction Supervisor License: CS-100988 HENRY E CASS110 8 SHED ROW s WEST YARMOIFIH) f2' 1, lit Expiration Commissioner 11IM/2015 IJ I f r. , ' '•- i; C f)1;U m er Atllairs uid Bus111e3S 1\',C.gt:1lat `0n 10 Park plaza - tai e �S t _ 17O BOst'011, Massaclwsetts 02116 . H.0ITI Improvemeni Cotltrutor Registratioll Registration: 153567 ,,Type: Private C ort:iura boii Expiration: . 12/1 5/2b 14 1 rN 23JI33I �.,`%PF OD INSULATION. INC III:_NRY CASSIDY lti I\FAI-\001\1 CIRCLE t . YARMOUTH, MA 02664 Upiliac A(klress and ret'uru Curti. IYlur k rcusun Iol dli ngr• l.• Address L 112eucw 111?ntt.itu}'llivili I I l•usl l:;trtl vu, „I t un uu,tt �(Gtit, 13usrness Itcguletiu„ License or regls[rdtiulty Ilul loritidivillul use unly ( f}1 �(tUmtr IMHKOVEMt N t CON rKALTOh bclu,c the c.�pira[iun(late. It'found relut n to:I� ugnUuUu,,: IS,j!�177 Type: OPliceut(:unsumer Affairs lull Business Regnti luun A:I1 ulUu: 12/15/2014 1='ovateCorpora4cll 101':uI l'laz,t-Suite 517U Itustun,MA 02116 Iludc.rsucrclury of s;tl' witho t ual 'i'c iDie Comnnorrwealth of Massachusetts i Department of Industrial Accidents 0Jf1ce of Investigations 600 Washington Street Boston,MA 02111 www.inass.gov/dia Workers' Coelrtpe:nsatioul Insurance Affidavit: Builders/Contractors/lEle ctriciansiPlu inters i o1_ica nt �alforx�:�tiota Please Print L(', ilil INallic (Bu�incss/Orbauizatiot>/Individual): �"y�C' / v ticiclrl;ss: /�- � .- /� j�-- C'ity/Stale%Zi Phone #: 2. :1J'c youatn eurploy�r? C hecic tine appropriate box: I J&I:ura a l:tnployer with. I� 4. [] I afn a general contractor and I Type of pTo]ect (retluJred): I _ �ttaployctes (fiill ancV ►`part-driie).* have hired the sub-contractors 6. C] New constz-uction -'.U I:Ina a solo proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have $ (� Demolitiorn working for Inc in any capacity. employees and have:workers' Building n addition jNo wortcat�s' comp. insurance comp. insurance.t ❑ 6 ; required_] 5. [] We are a corporation and its 10.❑ Electrical repairs or additions I ,i.❑ 1 an a homeowner doing; all work officers have exercised their -1,,E Plumbing repairs or additions myself. [No workers' comp. .right of exemption per MGL tr>surancC required.] - 12.[] Roof repairs q ] t c. 152, §1(4),and we have no 3a.❑ 1 am a homeowner acting as a employees. [No workers' 13.13'Other�._� general contractor(refer to #4) comp.insuruce required 'Any applicant that chocks box*1 roust also fill alit the sOcnon below showing their worker'coolpensatiodt olicy intonuation. r HUU1e1)W=3 who submit this affidavit indicating they are doing all work and then biro owide contractors must submit a now affidavit indicating such. :Cu11ua.:to-3 that check this box roust attached an additional sheet showing the nanw of the sub-coumictorn and scat,whether or not those enlitic3 have curptoyccv. if the sub-cona-Mccora have crnployecs,they must provide their worker'comp.policy number. 1 um an employer that is providing workers compensation insurance for my employees. Velow is the policy and job site ;nfurmtatturr. ,,✓ f lnsurancc Company Name: Policy ti or Self-ins. Lic. #' Expiration Date; Job Silt:Address:_ t 37�j�f Y ►Ln�/,Q�, to � City/statt/Zip_C_&!W t A11a4:t1 a Copy of the workers' corupensatiou pollcy declaration page(showing the polley utimber and xe plrutlon date). Failure to sccurc.covcrcugc as required under Section 25A of MGL e. 152 can lead to the imposition of crirni,nal penalties of a [Inc up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK OR-DER Iand a tine of up to$250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office of Investigations of the DIA for inairance coverage verification. !do hereby certify, nder the nd penalties of perjury that the information provided above is tree arnctC correct. Dat -2 UJ cal u e only. Do not write in this area, to be completed by city or town official City or Towu. Permit/License# Issuing Authority (circle 0aea): L_liuxrd of Health 2. Buildiug Department 3. Cityao;wu Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other cumact Person: Phone#: CAPECOD-27 MYOUNG CERTIFICATE r�. �y DAl'E(hIM10DlYYYY) ""�-• . . .. ERTIFI(CATE OF LIABILITY INSURANCE 71812013 _ �_ 7FIIS CER1lFICA'1 E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON Th1E CERTIFICATE HOLDER.THIS CERTIFICA- E DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 8ELOW. 1"HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If khe cartificaka holder is an ADDITIONAL INSURED,thu poIicy(ies)must be endorsed. If SUE3ROUA1'IQN IS WAIVED,subjtict to ithu terms and conditions of the policy,certain policies may require an endorsement. A statenlont on this certificate does not confer rights to the Curlillcate holder in lieu of such endorsements . �w i j r,r„ruc�R'Lice IIse l6 PC 514062 CONTACT Margaret Young Noun n s&Gray Insurance Agency,Inc. PHONE_Mar FAX 434 RLu 134 (AIC.No.Exn:�Suulli Dennis,NIA 02660 EMAIL _.� ADORess:nl oun t ro eras ra corn _ _.�_y..- _. .. ... - . INSURERPOt10D NG COVL=RAGE NAIC A .1SAF ^— __.. �—.—_.___. ....__._..___..........._.__.._._........_.. j --:...... INSURER A:PEERLESS INSURANCE COMPANY _ INSURER B:COMMERCE INSURANCE COMPANY i.ape Cod Insulation, Inc. INSU;ICRC:Evanston Insurance Corn anY _ -...__ ..._......... .._...,.___ - - -- _ --- -� - 10 Reardon Circlo INSURER r :ATLANTIC CHARTER INSURANCE GROUP j South Y'airnouth, MA 0266.4 wsuRERE: INSURER F: COVERAGES CkR61:ICATE NUMBER: REVISION NUIVIBER Ttn IS 10 GERI-IFY '1 HAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAIEU. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT''10 WHICH THIS Ct li I IF'ICA'I E MAY 'bE ISM UED OR MAY PERTAIN, THE INSURANCE AFFORDED-,BY THE POLICIES DESCRIBED HEREIN IS'SUBJECT TO ALL THE TERMS, 1:XCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IINCR . ....--...._........__._...�..._._ -- XppC SpBR'—. -- R5LIC_V_EF POI.ICYEkP LIMITS I,fR TYPE OF INSURANCE' POLICY NUMBER IMMIDPlynyl uAm.loo./yYyy-1 - Q01: AL LIAWLITY - EACH OCCURRENCE $ _1,000;D00 i CON41NERCtAL GENERALLIABILJI'Y CBP8263063 411/2013 411/20.14 PREMIS-TO"RENTE[)' '- -- A X - '100,000 „„ PREMISES Ea ncuurancaL n CLAIMS MADE (.X.J UCl UR MEL7 EXP(Any una L,orsan) -- —5,000 .... .. - PERSONAL d,ADV INJURY 3 1,000 000 j GCNERAI.AGGREGATE T 3_ 2,000,000 GC N t A 6KEC Al E l IMIT APPL IE_S PER: PRODUC115•COMPIOP AGO $ 2,000,000 {.PRO. l I ULit Y l_ 1.1L•S�L..__L_.._�LOL .. ._..._ —_ __._ t3 fAuroMUUILe LIABILITY - COMBINk`D�INGCC LIMIT— 1,000,000 f Ea ANY ALIU 13MMBCKVMK 411/2013 41112014 BGOILY INJURY(Pei parson)ALL.OWNED _.__. SCHEDULED autos X BODILY INJURY(Per acGddnq 1 _ -----I Pf{OPE.Y1TJrCMAGE- .I NON-OWNED S X WRLD AUTOS X NON-OAUTOSACCIDENI")_.[ ' X .UMaI<cLIA l_IAl9 X UCWt2 EACH OCCURRENCE $ -1 000,0 00 _._._. LIAp XONJ453512 4//12013 411120.14 AGGREGATE 1,000,000 �. Lxccss I X I _` CLAIMS-MADE UELI l .l kkiENl-ION$-.T^ 10,1700 I WORhtR>COMPENSATION �- 1AK,STA _07( OTI+ - AND entPLUYERs LIABILnY - M1T�L.: _ 1,000,000 YIN D AN Pn l Rir1OHIPAHTNER/EXECUTIvE WCA00525904 6130/2013 613012014 E.L.EACH ACCIDENT $ _ Urtli:r R hIEMpER EXCLUDE-O9 NIA (Mandatary In NH) E.L.DISEASE-EA EMPLOYEE 8__T-. _.......i._ If YV>,Q.sQJU.Undor SE LICY..LIM T_ $ 1,000,000 IltS RIPI ION Oh ONERA IILlIV3 below E.L DISEASE-POLICY LIMIT 5— _i In51�RIV PION OF uPEtaA PIONS I-LOCATIONS I VEHICLES (Altaell ACORD 101,Addllianai Remarks Schedule,It moro space Is requirod)� IWorkers Compensation includes Officers or Proprietors. Addtiunal Insured status is provided under the General Liability when required by written contract or agreement with the Certificate Holder. I I , i - I , I CERI'IFICATE.HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES GE CANCELLED BEFORE L:a e Cod Insulation, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN N ACCORDANCE WITH THE POLICY PROVISIONS. I AUTtIORIZED REPRESENTA11vE T i l./ (1�� 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201 U/05) The ACORD name and logo are registered[narks of ACORD _.ii►-i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map2_06,1041 Parcel 20 60LO Application Health Division Date Issued Conservation Division_ Application Fee Planning Dept. GIV Permit Fee 3 Date Definitive Plan Approved by Planning Board - Historic OK _ Preservation / Hyannis Project Street Address 13�1 Shl �s Village wry Owner t AddressA Alba Imt Rd. �(,•�IC�Zs Telephone a I / Q O Permit Request S' e , ce 37 goo L' e&o-A'el I S qce Misc. rAA\ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District / Flood Plain Groundwater Overlay �Rroject Valuatioi`p 2hC 6�'D-G� Construction Type wm Lot Size + �� `�tC�� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of•�xisting Structure Historic House: ❑Yes ❑ No On Old KR s Highv is ❑des ❑ No Basemet Type: ❑ Full Crawl ❑Walkout ❑ Other n Q T.a Basement Finished Area (sq.ft.) Basement Unfinished AreaI'(.'s( ft) Number of Baths: Full: existing � new Half: existing _mow Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor Room Comet 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 c I IBC` Imce L� Telephone Number O� v�� �' 3 ✓`� " �-x (J p Address ? �yrr?C� r�rx License # C, 10&-- D � V WA Home Improvement Contractor# �o aYVIti .� rYIc��1M�� r ell IWorker's Compensation # &)CC—`5�p—bOlall3—%ls��y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ` TEoi 09'-- C-o 6 tr- C SIGNATURE DATE 9 AT FOR OFFICIAL USE ONLY t r ! APPLICATION# _DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: X<FOUNDATI.O:M=Dtitii?' FRAME ±-INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING .6_60E)XIAA4 DATE CLOSED OUT M i iO ASSOCIATION PLAN NO. ,,,. { 77ze Commonwealth of Massachusetts Department of Industrial Accidai& . ...___ Office of Investigations 600 Washington Street Boston,MA 02111 w n�x�.rrrtss�go s�'dia Workers' Compensation Insurance Affidavit:Builders/Contractors Ek&ctriciansMumbers Applicant Information Please Print Legibly Name(&==V0rga on&&mdnal): A 'I • Address:Aib 7dl J� City/Sta&7-jp: hnAxykvU► Phone 4 3 L� Are you an employer?Check the appropriate box: Type of project �. am a general contractor and I (r���: 1. I am a employer with ❑ I g 6. New construction employees(fi d 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' 9- ❑Building addition [No workers'comp.insurance Comp.insurance. 10-[J Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 1 LE]Plumbing repairs or additions myself.[No workers' - right of exemption per MGL 12.❑Roof insurance required.]1 c.152, §1(4),and we have no repairs employees.[No workers' 13.0 Other comp.insurance required.], *Any applic=that checks boa#I wise also fill out the section below showing then wo%kets'eompemation policy informatiML i Homeowners who submit this affidavit indicating tfiey axe doing all won k and then him outside contractors most submit a new afdnk indicating such_ rCantmct ors that check this boa must attached an additional sheet showing the name of tha sub-ca ntrwU cs and state whether or not those entities has e employees. If the sub-contractors have employees,they mmrst pmvide their workers'comp.policy umober. I ain an employer iliat is providing ttwrke.rs'compensugun insurance far nzy employees BeTon is live paticy Rmd}ob site informadom / �? Insurance Company Name: Eta 4(a�` Policy#or Self-ins.Lie.#:WCC" 0D`019,11 -2013 W Fxpiratian Date: ho /q Job Site Address: w s 6t(LacV 1 1 S 1,e n ftrV`I(C. 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 ORDERand a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for' ce coverage verification. - I do hereby r under the s andpenai es ofpetjury tliat the inforirtatian provided a e is and correct Si tare Phone#: �.�5 3---L) I Offi ial use Drift Do not write in this area,to be completed by city or town alJrcwl City or Town PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylFown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 n® CERTIFICATE OF LIABILITY INSURANCEF5/m2l/2013 DA (MM/DDIYYYY) �� 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 ND E T Margaret Viera Morse Insurance Agency, Inc. S PHONE • (50B)74B-9577 FAXIAIC-No IAIC No);(508)748-9579 354 Front Street E-MAILS maggxevxera@morseins.com ADDR Suite 4 INSURE S AFFORDING COVERAGE NAIC# Marion MA 027.38 (NSURERA:Selective Insurance Group, Inc. INSURED INSURER B-Associated Employers Ins. MLP Carpentry & Building LLC INSURERC: 207 Turner Road INSURERD: INSURER E: East Falmouth MA 02536 1 INSURERF: COVERAGES CERTIFICATE NUMBER:2013 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. IL SR TYPE OF INSURANCE D POLICY NUMBER M POLICY EFF MWDDf EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE ❑X OCCUR s 2067979 /20/2013 /20/2014 MED EXP(Any one person) $ 51000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ' PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JrCT PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED & 9091134 /20/2013 /20/2014 AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Peraccident) 0 tional bodily injury $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEO I I RETENTION$ $ B WORKERS COMPENSATION WC STATU- X OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) �C_ 500-5012113-2013A /20/2013 /20/2014 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Michael Palmer is included for coverage on the workers compenation policy. The General liablity policy includes blanket additional insured for ongoing operations, blanket waiver of subrogation, primary and non contributory wording if required by written contract. CERTIFICATE HOLDER CANCELLATION rthowmaninc@aol.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN R.T. Bowman LLC ACCORDANCE WITH THE POLICY PROVISIONS. � PO Box 201 West Falmouth, MA 02574 AUTHORIZED REPRESENTATIVE Margaret Viera/MMV a.a� L)(A,. ACORD 25(2010/05)° ©1988-2010 ACORD CORPORATION. All rights reserved. IN9025roMnnsmi Tho AnnRn name onri Innn aro roniefororf marka of ARnRl1 e , r Massachusetts -Department of Public Safety Board of Building.Regulations and WStandards Construction Supervisor License: CS-102901 'PALMER L MICIWL 207 TURNER EAST FALMOUTH Nh►'0 Expiration - .. . Commissioner 08/25/2014 Office of Consumer Affairs and Business Regulation 10 Park Plaza -. Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration y Registration: 1.64275 I Type: Individual Expiration: 9/28/2015 Tr# 243824 MICHAEL L. PALMER. .. 'r j 1u k MICHAEL PALMER 207 TURNER RD �� E. FALMOUTH, MA 02536 Update Address and return card.Mark reason for change. cn 1 C 20M-0en i ~t '" Address ❑ Renewal Employment ❑ Lost Card i moo, ��e�porrUrrw�useccCC�d�C/�/lay�acliccaeCG,t i Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: ;114275 Type: Office of Consumer Affairs and Business Regulation Expiration` 9/28[201n5i Individual 10 Park Plaza-Suite 5170 Boston,MA 0 116 QICHAEL L.PALMER t z 11CHAEL PALMER � 07 TURNER RD <== - FALMOUTH,MA 02536 Undersecretary ' Not valid without signature i o�TME Town of Barnstable Regulatory Services MAM Thomas F.Geiler,.Director °r� ►. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax; 5.08-790-6230 Property Owner Must ---Complete and Sign This Section If Using A Builder :as Owner of the subject property hereby authorize vG�` %l. ,I�.V l�tiCa c6kx!��to act on my behalf, in all matters relative to work authorized by this building pertnit. (Address of Job) *Pool fencers and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is inst, ed and all final inspections are performed and accepted. ture'of er. ature k Applicant Print Name j Pant Name Dat I QTORMS:OWNERPERMISSIONPOOLS 6/2012 CAPE COD INSULATION 'PIBBR GLASS 59 MLE53 SPRAT FOAM SGSPBNBBG BARS GVRBRS INSBLA5IGN C5ILINGS 1-800-696-6611 Town of Barnstable Regulatory Services , Building Division 200 Main St Hyannis, MA 02601 P Date: q/j l Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the-building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village ?rlap4- m 1 Ladner Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted P Ceilings Slopes ( ) ( ) ( ) ( ) ( ) Floors Walls ( ) (?C ) ( 13 ) ( X) ( ) Sincerely He y E7, ulation, Jr, President C e C Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map kAV Parcel Application # Health Division Date Issued 41 F-;)- Conservation Division Application Fee Planning Dept. Permit Fee flb S/ Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis / Project Street Address Village Owner —Address Address Telephone zal 9 7/C.5-7 Permit Request) Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 o4o, 4Q Construction Type/�,:��/VP7�4 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s orting 4�5,_tum4tation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) =' Age of Existing Structure Historic House: ❑Yes 9 No On Old Kings=�ighway:,Iip Yes WNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft Number of Baths: Full: existing new Half: existing nevi 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 ,r Address ��� ���/�4a�D �L% License # 10 z', 2�. Home Improvement Contractor# /v'�JG1-7 Worker's Compensation ��w5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO !� SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED y MAP/PARCEL NO. ADDRESS VILLAGE OWNER y r DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT. ASSOCIATION PLAN NO. I ��';�,;,•, �,Irtssuc•lutsc•ttx - I)clt:u•fritcrtl of Puhli� lafclt l3uart) of IiatiP�lin Re ulatiun.. and Standards Gonstru)ction Supervisor License Licen��-"--CS 100988 r >� HENRY CASSIDY 8 SHED ROW WEST IJARMOUTH, MA 02673 Expiration: 11/11/2013 l niuuis�ivucc Tri;:'7620 C /h, .a.lcalI`l i Office.. of Consumer Affairs and Business Regulation >' 10 Park Plaza -.Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor`Kegistration Registration: '153567 Type: Private Corporation Expiration: 12/15/92'b14 Tr# 23383i GAIT= COD INSULATION, INC IIENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address attd return card. Mark reason for change. l� Address L_I Renewal _I.Employinent I.. I bust lard `in• �(' /rriru r�rre�rr�C/c c��;'�la�:irrr.'/rcr.ie���' , :w\ tlliirr ,t( ousumer All,urs & Kusuress Rtl ulatiou License or registratiun valid for individul use unity i I1IOMF IMPROVEMENT CONTRACTOR before the expiration date. If found return I.(): Neyislration: 153567 Type: Office of Consumer Affairs and Business Regulation vt ' .;Expiration: 1 21 1 5/2 0 14 Private Cor otagcit 10 Park Plaza-Suite 5170 R p v Boston,MA 02116 C01)1WiL)LA-rI0N„INC': 'Iti RI:Ai Dt.)NL;IR;LRF: ,;0 1`AR OU fhl, MA 02664 Uuticrsrcrcl rr}' of vat witho 7. M, CAPECOD-27 MYOUNG CERTIFICATE OF LIABILITY INSURANCE DATE /8/2 DIYYYY) 7/8/2013 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 License#PC-5514062 CONTACTNAME: Margaret Young Rogers&Gray Insurance Agency,Inc. PHONE FAx 434 Rte 134 A/c o t: Alc No): South Dennis,MA 02660 ADRess:myoung@rogersgray.com INSURERS AFFORDING COVERAGE NAIC 0 —_.___--------------- INSURERA:PEERLESS INSURANCE COMPANY INSURED - INSURERB,COMMERCE INSURANCE COMPANY Cape Cod Insulation,Inc. INSURER C:Evanston Insurance Company 18 Reardon Circle INSURERD:ATLANTIC CHARTER INSURANCE.GROUP South Yarmouth,MA 02664 wsuRERE: 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 A STJ99 POLICY EFF POLICY EXP - - LTR TYPE OF INSURANCE INSRPOLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CBP8263063 4/1/2013 4/1/2014 PREMISES Ea occurrence) $ 100,000 CLAIMS-MADE I A J OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ `2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000 000 Ea acddent $ , B ANY AUTO 13MMBCKVMK 4/1/2013 4/1/2014 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NOTOSWNED PROPERTY ACCIDENT)DAMAGE $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-MADE XONJ453512 4/1/2013 4/1/2014 AGGREGATE $ �1,000,000 OED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- , AND EMPLOYERS'LIABILITY O LIMI S - D ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCA00525904 - W30/2013 6/30/2014 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED' ❑ N/A . (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes•describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Workers Compensation includes Officers or Proprietors. r Addtional Insured status is provided under the General Liability when required by written contract or agreement with the Certificate Holder., CERTIFICATE HOLDER CANCELLATION , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE •THEREOF, NOTICE WILL BE DELIVERED IN Cape Cod Insulation,Inc 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 .� The Commonwealth of Massachusetts Department of Industrial Accidents ° Office of Investigations a 600 Washington Street' Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance'A,ffidavit: Builders/Contractors/Electricians/]Plumbers Aliplicant Information ]Please Print L eItbly Nome (Business/Organization/Individual): /�j�,;p � Address: ty Ci /Slate/Zi Ozk tphone .Are you an employer? Check the appropriate box: L❑ 1 am a employer with, `4. ❑ lam a general contractor and I Type of project(required): employees (fill] an&or part-time).* have hired the sub-contractors 6. ❑ New construction i 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 in any capacity, employees and have workers'` [No workers' comp. insurance comp. msurance.t 9• ❑ Building addition required:] - 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing'all work officers have exercised their l l.❑ 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 3a.❑ I am a homeowner acting as a employees. [No workers' , 13•❑ Other general contractor(refer to#4) comp.insurance required.] ' 'may applicant that checks box#1 must also fill out the section below showing their workus'compcnsatiod�olicy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contracton.must submit a new affidavit indicating such. tconauctors that check this box must attached an additional sheet showing the name of the sub-conttacton and state whether or not those eatities have employees. If the sub-conttuctors have employees,they must provide their workers'co mp.policy number. I rt an employer that is providing workers' information. compensation insurance for my employees. Below is the policy and job site . Insurance Company Name: Policy#or Self-inns. Lic. Expiration Date: , Job Site Address:���5 �� , ' �,/�.G� �� �' ! /, /State/Zi ty p: 0 z G. Jr Z . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. -Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. , I do hereby certify under pains and penalties of perjury that the information provided above is true and correct t Dat (7ciad use only, xDo not write.in.thu area, to be completed by city or town officiaL 411 b- City or Towtr: Permit/LIcense Issuing Authority(circle one).-, _ # ' J.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other... , Contact.Person. ,` 4; Phone#• r• OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at f3-7 5 L {- 6e-e� .2` 1<o 4 , (Property Address) CrP..rl k-1 v,1 le 44; L�9,�3.2-- (P operty Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Own r ignatu Date