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2971 MAIN STREET
1 (4:------;--4.4"iy [Y Town of Barnstable Building and So That mAtisible From ahe Street�A covetl Plans`Must be Retained on<Job antl this Card=Must be Ke ,t " Post This C Pp p * �/IRN$fABLL, ' r ^-r ;' r .fir< xz '` >.a '-, �' rr ?,W •.eii & Itd1V & eri111�d; il a F�nallnecioh,�: -<�„��., , n� ,. .�.' Permit No. B-18-2159 Applicant Name: Russell Cazeault Approvals Date Issued: 07/06/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/06/2019 Foundation: Location: 2971 MAIN ST./RTE 6A(BARN.), BARNSTABLE Map/Lot 279 045 Zoning District: RF-2 Sheathing: A _ PAUL J. CAZEAULT&SONS, INC. Framing: 1 Owner on Record: MATHEWSON FAMILY.LLC ''''''''''''''''''''''''',.'; ,''-,=,'kt-f'.'":.' ''''''''*." '''',-,,,:'.,-.-I:- Con�tractorName '' t � Contractor License 103714 2 Address: PO BOX 614 BARNSTABLE, MA 02630 Est Project Cost: $8,125.00 Chimney: Description: Remove existing shingle roof. Replace with new architectural , Permit Fe: $41.44 shingle roofing system. "'_ Insulation: Fee Paid $41.44 Project Review Req: Y. Dane 7/6/2018 Final: h ;;;.. Plumbing/Gas Rough Plumbing: '€: -• ",, �r "; �, ,-Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sixmonths after issuance. All work authorized by this permit shall conform to the approved application andithe=approved construction documents for whichthis permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zone g y laws and codes. This permit shall be displayed in a location clearly visible from access street oVr road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. il Electrical The Certificate of Occupancy will not be issued until all applicable signatures'by the Building and rrei0ff ials are p,,,,, ed on this.permit. s Service: Minimum of Five Call Inspections Required for All Construction Work ; t N 1.Foundation or Footing 2.Sheathing Inspection " ..., " Rough: - 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 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 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 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: „ , /' , Town of Barnstable RECO:PTA S cc. ' 200 Main Street, Hyannis MA 02601 508-862-4038 *11:,...,:t .' ,V4:76;9.0 ig ,...,) Application for Building Permit6 Application No: TB-18-2159 Date Recieved: 7/5/2018 1( (D( 1 b Job Location: 2971 MAIN ST./RTE 6A(BARN.),BARNSTABLE Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: PAUL J. CAZEAULT &SONS, INC. State Lic. No: 103714 ;�t , 0 Address: 1031 MAIN ST, OSTERVILLE, MA 02658 Applicant Phone: a j �8)428-14;7 (Home)Owner's Name: MATHEWSON FAMILY LLC Phone: (774)994 1585 v c)— co (Home)Owner's Address: P.O BOX 614, BARNSTABLE,MA 02630 70 Work Description: Remove existing shingle roof.Replace with new architectural shingle roofing ystem. ' S �O ro 1 vt rrn v Total Value Of Work To Be Performed: $8,125.00 Structure Size: 0.00 0.00 0.00 Width Depth 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). I 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: Russell Cazeault 7/5/2018 (508)428-1177 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $8,125.00 Date Paid i Amount Paid 1 Check#or CC# Pay Type Total Permit Fee: $41.44 7/5/2018 1 $41.44 j XXXX-XXXX XXXX-, Credit Card i I 0985 Total Permit Fee Paid: $41.44 s TTI ISM OTZA ERMIT 0 x� - ' -, b.�`- .� .-'-,: 40'.'+ � .¢ ,a” 5 , `-,a As? s, i ?` - .,,,44, t Town of Barnstable *Permit# ,3 .1 ? � � .�s Regulatory Servicesties 6 ",,,hs from is ue date ��'� g � �ee t�•' * BARNSTABLE. * ID \ Richard V.Scali,Director \� �� Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 2-��1 � , Prop riy Address LL [Residential Value of Work$ Minimum fee of 5 00 for wo rk$3 . o wo k under$6000.00 Owner's Name&Address 1--le. - MA-nuk�5 ) 2-en RAW Q3AaNr—A•AAPIti ikAA- Contractor's Name £l QOQc ulk)6- Telephone Number S r) no( 4(0 Home Improvement Contractor License#(if applicable) [2 (261 Email: V 1a.�.t -a r OP ( COC.0q/ Construction Supervisor's License#(if applicable) ' � L L`, l o* "' Workman's Compensation Insurance 'ttmceri 40tA14ini . Check one: T 12cc o ❑ I am a sole proprietor I p z® ❑ I am the Homeowner �1�/�.f p 1, ❑ I have Worker's Compensation Insurance liktu5 f b� Insurance Company Name Acei\mb--,Ao.1� [7 Workman's Comp.Policy# (A 25 40 '3 g Copy of Insurance Compliance Certificate must accompany ch permit. Permit RegyeSt(check box) ,� ( Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 4 Jl t Z 9. 4_Ai -c'p ❑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: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Co tors License&Construction Supervisors License is qu I` SIGNATURE: OW ' , ,,-.Q0 C:\Users\decollik\AppData\Local\Microsoft\Windows\INetC che\Content.Outlook\I7U69LF2\EXPRESS(2).doc ✓ ''// � 01/25/17 .lDO1fi 1 • /*. "1 ' wuvsrns h ' Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Paul Roma Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder �6:5bty ,as Owner of the subject property hereby authorize CU J9 lF et )J to act on my behalf, in all matters relative to work authorized by this building permit application for: Zan Pc4ttiv P ,A.240c-w8Lg- (Address of Job) i Y11,1, 17 • Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. CAUsers\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.0utlookE7U69LF2\EXPRESS(2).doc 01/25/17 • _ - ' . aka Co nve ds ofiefassirchusetts _M=.: - - Department �Ac �ij„ 't1 - .srintesigadcns.. - - u'kers'' P TIISu_t ease Name � . i , ;.... Addresw‘ C6 ( "!F yr }� - . .... , ,Z1,1,tAl&!,',33':..,.::.-. :',. ' �S �tb Are al !er?Checktheappra r- �uV�T L Iaaeaemplcg� I 4❑Ia a l andI rplteafgrnl {re p} c � ethe p � • ig.I am a sole arp aria •` L iie a - • 7. ❑Roder rs 1I s }t---- have as empl es _ have x�asigrs 8.:❑Demalisort ,•ir_..ii wag£ors m any y �P g" Rtn't , arEdrs • • -1 • 5❑ We are a cozporafioa.aad its - • ! ❑;Eledracai-nrpa rs oral s 3_0 lama doingalIvorlc `:_ a�cets.lrave sed IL❑ rePais-mad s. [Nowokro s'camp,. . g , � • ms segmire&]T C. m§i{4),andwebasea31} „O, , m 4 f?ffier - • • `kys Pmt ixia-tlmastekQs aeirw ' se s' 3csiii trialibiia aoidetootmeasmiiiigEaa*sit. s. ;3.ss i,aau their wade&comp'p membe fLPSiErDi9 s : _''�_''SS�_''-- OTiZ:tSrttdlic8 @ a r . BZ4�i8 gip�Cr3S7t'8 fild.4 •" F - 4i ' . . •P 4orS ls• : O•. 6 • t, •:--- •••••••:•.:.:-.- :-,•-.-:-:..-wi:,:.,..; ,"?9-7( -• 6,14) • • - A campeasa oap�cyd cbra4 on'•pa• �o-t policy andes�fiationdat . -ate as du s 25A-Ofi c]2 a lead to The forposit4a of Cdothaal penalties ofa is 3 LDa tf ane-gearim es eeflas ci llgeaa ffi the fano are SlQP Vire8X OBDF.Raarl a - w b S2 LOO a day agamstale,*1ak. Be ad aco gof a me may.be rdedisffieOffiCe of . saffheniA :e0era0 'Matter , • rr!j, Niif. . .. � •e°�dsda=• , :�bare I�, correct • . :::::-:.'': . . - OC .-- 5. iri- 7 .. -.bet- • 44-''''. • . ..-t''..•• .:'•:..::':.'r.": ' ,......-„.. .' • Official:rag Da not write in this ,to ha completed-by dip nrio l - yorTowa: - PeredfaTiceizsaf ;,_;; - Lssaiag Azdhazity(circTeese). • - • ;L?B of aD C tyff Clerk d.I3er tical r g r tether- . . . • Person: . - . Phone* ?a 6 ®ACGRU CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYY) , `+•...----- 11/13/2017 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(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: Christine Davies DOWLING&O'NEIL INSURANCE AGENCY WC.NE_Ext); (508)775-1620 A No): E-MAIL ADDRESS: CdaVies@doins.Com 973 IYANNOUGH RD INSURER(S)AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: KELLY ROOFING INC INSURER C: INSURER D: 8 RHINE RD INSURER E: YARMOUTHPORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 212146 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYYI UMITS COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ (Ea accident) _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE _ AUTOS (Per accident) $ . $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE PER ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? WA WA WA 6S62UB8H08580917 05/10/2017 05/10/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensation/investigations/. , CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Douglas Desmarais ACCORDANCE WITH THE POLICY PROVISIONS. 20 Jerusha Lane AUTHORIZED REPRESENTATIVE Yarmouth MA 02673 'Q C„))c Daniel M.Cro _y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD C Clite C67 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improveme.IT ontractor Registration1 I Type Individual v i .. / , Registration: 128957 eg OLIVER KELLY ,, 'tr Expiration: 06/13/2019 8 RHINE RD 1 � YARMOUTHPORT,MA 02675 rPrl( = -` �` ?_ qr .�.f ,.r'�.` ff P-h V�c .Update Address and return card. Mark reason for change. SCA 1 0 20M-05/11 — .Address r71 P0newai n cn nIQ mpnt 0 Lest Card _,..—_: e(eamemiovztoecdt/o/Q faraac/utetli Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 'k.289s7 06/13/2019 10 Park Plaza-Suite 5170 , KEILYa;T — (511A 02116 ._,, „ r.. 1 ��OUVER M_KIEL€Y 'e°L ' 8 RHINE RD- YARMOUTHPORT,MA 02675 " Not valid without signature 1. Undersecrete Commonwealth of Massachusetts • Division of Professional Licensure 1 Board of Building Regulations and Standards 1 Constructio4 S r Specialty • rI CSSL-099167 E Tres• 09/28/2019 OLIVER M KELLY , may, -, 8 RHINE ROADS `� YARMOUTH PORT MA`02675 "` ��s � 1 Commissioner V"" ,'a � 1 l Mass. Corporations, external master page Page 1 of 2 . 4 r y 11Viliam Francis Galvin " � �' - • ' Secretary of the Commonwealth of Massachusetts " Corporations Division Business Entity Summary ID Number: 465643639 Request certificate I i New search I Summary for: KELLY ROOFING, INC The exact name of the Domestic Profit Corporation: KELLY ROOFING, INC Entity type: Domestic Profit Corporation Identification Number: 465643639 Date of Organization in Massachusetts: 05-13-2014 Last date certain: Current Fiscal Month/Day: 12/31 The location of the Principal Office: Address: 8 RHINE RD City or town, State, Zip code, YARMOUTH PORT, MA 02675 USA Country: The name and address of the Registered Agent: Name: OLIVER M KELLY Address: 8 RHINE RD City or town, State, Zip code, YARMOUTH PORT, MA 02675 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT OLIVER M KELLY 8 RHINE RD YARMOUTH PORT, MA 02675 USA TREASURER OLIVER M KELLY 8 RHINE RD YARMOUTH PORT, MA 02675 USA SECRETARY OLIVER M KELLY 8 RHINE RD YARMOUTH PORT, MA 02675 USA DIRECTOR OLIVER M KELLY 8 RHINE RD YARMOUTH PORT, MA 02675 USA DIRECTOR MAIREAD M KELLY 8 RHINE RD YARMOUTH PORT, MA 02675 USA Business entity stock is publicly traded: ❑ http://corp.sec.state.ma.us/Corp Web/Corp Search/Corp Summary.aspx?FEIN=465643639&... 12/7/2017 Mass. Corporations, external master page Page 2 of 2 The total number of shares and the par value, if any, of each class of stock which this business entity is authorized to issue: Total Authorized Total issued and Class of Stock Par value per share outstanding No. of shares Total par No. of shares value CNP $ 0.00 20,000 $ 0.00 0 El ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Administrative Dissolution Annual Report • Application For Revival Articles of Amendment v; View filings I Comments or notes associated with this business entity: I V New search http://corp.sec.state.ma.us/CorpWeb/Corp Search/CorpSummary.aspx?FEIN=465643639&... 12/7/2017 " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 9gole Map �� Parcel 0 `�' pplication # \ Health Division Date Issued 11""''`'i-4 3 Conservation Division Application Fee Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Stre Address 21?1 /14GG,G2�- Villaa �W5 to 61 d 26 3O 9 f Owner .i- 'ht"-i �,(/ Address Telephone 1-14--4V-16 V-1 Permit Request d fVlfAA/ta*I !4/ 1VeiM1tw%%hn'—' p cl VIA 7 ( �`4dc'i 1 1 e" i i a6,` 4, or l`oli b4( ...5i11e & ��®� �/ Cle7t) ( � 4% - , 'aLgem)-vrc4 t *W, ira V --YaQ/J ' 4r Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain � Groundwater Overlay Project Valuation 606-0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: 0 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 o F a Total Room Count (not including baths): existing new First Floor Room Count. Heat Type and Fuel: ❑ Gas ❑ Oil 0 Electric 0 Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woodcoal sto ❑ s ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ne40 size_ c7o Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: N rY 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 L, 8 /O�/��ii 7I Telephone Number L6� .7)i7l Address ✓02l240/1� l'f// License # /11. 1-4Home Improvement Contractor# 75 G7 Worker's Compensation e ;, 2J ilk/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY -APPLICATION# DATE ISSUED MAP/PARCEL NO. - ADDRESS VILLAGE OWNER DATE OF INSPECTION: Li EOUNDATLOJy E1 T«Aiti-r:w,on,=. ,,N.. r FRAME rr ._INSULATION ._• FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE.CLOSED OUT .. +.64i It bjA 5' I ASSOCIATION PLAN NO. +�t� f?'_ ENSt".2iV E i r•-----~ \Ia.ssacltuwll� - Department ul Pul)lic lafct\ ))'''',...,1' '' Uu;trtl of liuittlitt_ 1 42,ulatrur . ;incl ,Lanka'h (;onstru r✓tion Supervisor License a do 1 Lice u ':' C-S. '100988 ,�zt`' c 1S ) t t. HL:NkY CASSIDY 1 t "'' � I�' , 1 SHED ROW • 4vsk ) ;',ti WL:Sic `tiARMOUTN, MA 02673 , �+�?p 1 1!r ,.� ._. ... _. _.........%'`.._.._ pirauon: 11/11/2013 .. . l ,...uui,nl..ucr . .. Tug: 7620 u . •� ' .'(Iiit-))l-Olt(('( (T/A 0/ / rJJ1fJt/J t,�k \. 0.t-fice: of Consumer Affairs and Business Regulation r,t .i.., 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 • Home Improvement Contractor Registration Registration: '153567 Type: Puivate CorporationExpiration: 12/15/21)14 TO 233031 i:;AI E= COD INSULATION INC HENRY CASSIDY 18REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card. 11'larlt reason for change. 1 1.7 Address L_I Renewal L__) Employment I I Lest lard 'ir `l!'{'rrrrrtr:rrrne:rrl(/'e ( C;F'(rr,l.l rr t'frc6.l e;C(J uu et I (mauler/\flails , Business ttegulaliou License or registration valid for individul use only shlUMt_IMPKOVEMENT CONTRACTOR before the expiration date. If found return to: 1,t 4, ,uyitruuun: 153507 Typo: Office of Consumer Affairs and Business Regulation -s I¢ .1 10 Park Plaza-Suite 5170 y rf.�utraui>�): t2/f5/2014 Private. Corporation `t. tfr:. Boston,MA 02116 -,. :'IN .i it AWN,`INCC 1:;iaar1.)(IN1.:1i�t:1.F: ...__ Undersecretary 01 vat ),vtfho 1 nat re ,1f I - The Commonwealth of Massachusetts —_ -- , Department of Industrial Accidents __,` '=` Office of Investigations ' `--- .. 600 Washington Street Boston,MA 02111 - ivww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Lesibly Name (Business/Organization/Individual): ��/4el a i /1,0'6)./v9�/J,j Address: /F City/State/Zip: ,G z GG�- ryGI�1l a�� /)i i Phone #: .� 72J 12 / Are you an employ r? Check the appropriate box: I.re. 1 am a employer with_ 01,) 4. El am a general contractor and I Type of project(required): employees(full and,/gr-part-time).* have hired the sub-contractors 6 ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet, 7. 0 Remodeling ship and have no employees These sub-contractors have working for mein any capacity. • employees and have workers' 8. ❑ Demolition [No workers' comp. insurance comp. insurance.] 9• ❑ Building addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions I 3.❑ I am a homeowner doing all work "officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required,] t c. 152, §I(4),and we have no 12.0 Roof repairs 3a.❑ 1 am a homeowner acting as a employees. [No workers' 13. Others 'J,i / �� general contractor(refer to#4) 1 comp.insurance required.] •Amy applicant that checks box#1 must also fill out the section below showing their workers'compensadod olicy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I on:an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information, /� � Insurance Company Name: /-{'��,tiG �dadi2 ikel , Policy#or Self-ins. Lic.#: kG,1/..9(),j-c2 - ,�/ Expiration Date: 7'f' '///4 Job Site Address: ? ' ( City/State/Zip: ,V0/6 6 1 t" O2 3 ) 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 S250.00 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 nder the nd penalties of perjury that the information provided a ove is true and correct Signature: Date: V V' "1 I ! 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#: • CAPECOD-27 • MYOUNG _ CERTIFICATE OF LIABILITY INSURANCE I ((( DATE(MM/DU/YYYY) -ATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS d. DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED -SENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. JRTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to— ne 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 Ileu of such endorsernent(s). PRODUCER License#PC-514062 Rogers&Gray Insurance Agency,Inc. NAME: Margaret Margaret Young 434 Rte 134 PHONE Fax — South Dennis,MA 02660 E-MAILNo.EztY. (AIC No E-M C Noti_ — _ ADDRESS:myoung@rogersgray.com INSURER(S)AFFORDING COVERAGE T NAIC a — lrlsuRERA:PEERLESS INSURANCE COMPANY INJUFtED "'----- INSURER :COMMERCE INSURANCE COMPANY IN SURER Insurance Company Cape Cod Insulation,Inc. 18 Reardon Circle INSURER O:ATLANTIC CHARTER INSURANCE GROUP i South Yarmouth,MA 02664 INSURER E: . _... ..._....._'--_...._____—.._.__...— INSURER F COVERAGES "----- —"- -- -- ___ .__ CERTIFICATE NUMBER: REVISION NUMBER: IRIS 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-tri SDB}i__ _ TYPE OF INSURANCE POLICY EFF POLICY EXP' -------- INSR WVD POLICY NUMBER (MM/DDfYYYY)JMM/UD/YYYYI LIMITS GENERAL LIABILITY A X CO_MMERCt4L GENERAL LIABILITY CBP8263063 EACH OCCURRENCE $ 1,000,000 4/1/2013 4/1/2014 PREMIDAmASES(Ea MED EXP(Any one person)) $ 5,000 J CLAIMS-MADE (X] OCCUR PREMISES(Ea occurrence' $ — 100 000 PERSONAL&ADV INJURY $ 1,000,000 i - ____ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: — PRO- PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY1-1 jEci --� AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT— l B arvYAUIo 13MMBCKVMK BODILY $ 1,000,000 ALL OWNED X 4/1/2013 4/1/2014 BODILYINJURY(Perperson) $ SCHEDULED AUTOS BODILY,INJURY(Per acddenl) $ X FIIREu AUTOS X .AUTOS ED PROPERTY DAMAGE — _�_--- .PER ACCIDENT) $ X UMBRELLA LIAR X OCCUR $ „ C M6RE LtA ~— EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE XONJ453512 4/1/2013 4/1t2014 AGGREGATE $ 1,000,000 —_OLD TX RETENTION$ 10 000 -- — _ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WC STATU- I OThI- D ANY PROPRIETOR/PARTNER/EXECUTIVE EXECUTIVE Y/NI WCA00526904 6/30/2013 6/30/2014TORY LIMITS I ER OFFICER/MEMBER EXCLUDED? I N I A — E.L.EEACH ACCIDENT $ 1,000,000 (Mandatory In NH) _ .__ It yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below --- E.L.DISEASE-POLICY LIMIT $ 1,000,000 L_. _ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Workers Compensation includes Officers or Proprietors- 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 Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE — I - ACORD 25(2010/05) 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DUO-WS-o/uW OWNER AUTHORIZATION FORM (Owners Name) owner of the property boated at ,2q 71 t27c . (rsPedY Address) ckwAtA-ca I ,fr (Property Address)/ hereby authorize l 11 U\. , 00 91441.104C- en authorized subcontractor fo RISE E►gineering,to act on my behalf to obtain a buBding permit and to perform work on my property. C I‘eA.A 12o7l2-- 4-AAA ea7tA,Loscl,•-- Owner's Signature /a/ /Date .3 F - /Z _/5"--/3 f IA 'S TO INSULATION MINI -== 1 PH 2: 15 a /IYSAOLASS SIAMLSSS SPRATAOAM SUSPSNASO SATTS OUTTUS$ INSULATION CNLINOS 1-800-696.-6611 Town of Barnstable Regulatory 'Services Building Division 200 Main St Hyannis, MA 02601 „r N Date: f �d/j3 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 / ri4 A emsor', ;47/ � S� /��,�,� r-�-- Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( . ) ( • ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) 6/1/. �Q re.� C�Lt / , 2/ Sincerely He ry E Cas y Jr, President C e Cod I ulation, Inc. • I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION • Map a 7 Parcel 0 Application # 0 Health Division Date Issued 4 I Conservation Division Application Fee `3341 Planning Dept. Permit Fee ) S Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 41797/ 01,4li1 JV Village 1g AJ s T94 73(. Owner / �A 'l Address .277/ / OWE je Aege,a5 1ff/� Telephone 7741 9 944 //5'0Vc" Permit Request 6' 12/f C/g'$ / 4J1 `�,�� / j # 2/ ' 75, 7S nJ5/ /wIv/, ,e4�� :7z4 -,e&A// ;,, ,�n r,/l am ei4e'Z PizL 1 v/ poi/ell/Ave /wild ir,9z6 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatior94 14,, Construction Type/4'd'€ /1-7TD4.0 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a 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 LI Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woodcoal stow: ❑ s ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: 0: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) 9 Name eif/e. Co , � �, ;/A77Neitelephone Number Address 3"J /'/1/ 27 Y1 i**/LJ License # /6D ��f Home Improvement Contractor#/53 �L 7 Worker's Compensation #/G.1D,0 '.2 59 '/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO • SIGNATURE DATE 05//ir 4 r • FOR OFFICIAL USE ONLY . AP?LICATION# . .. DATE ISSUED — 1 .• .... . . , t • ;,./ . , i MAP/PARCEL NO. • , L. . t . . , . i l •. . ADDRESS • VILLAGE ,-- , . OWNER I ,,,7 , , 1 , . DATE OF INSPECTION: .•. , . . i ,- FOUNDATION . • •, ., •,..7 '_..„, FRAME INSULATION ‘ •,s: -'1 • . _ .., — , FIREPLACE . k. ELECTRICAL: ROUGH FINAL • i • PLUMBING: ROUGH FINAL -GAS: -,,,r ROUGHt-; -- •- n.•, FINAL . . • ,.= ;',..FINAL BUILD.ING* r••;..,74,1 • - , - - . . -,-- ,... . . ., DATE CLOSED 01)T - r f ' i i . , • ASSOCIATION PLAN NO. ri:7 ,i . I ' '' '` The Commonwealth of Massachusetts =gar-. Department of Industrial Accidents -� Office of Investigations _ =• 600 Washington Street • —1 F. • Boston, MA 02111 yy wWW.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): CA to. Co r _ N .Sv Co f )tJ'71_ _tA) Address: y,'.r Xilie -u fd City/State/Zip: f t f � Phone #: S0 7 7 - I /9 . Are you an employer?•Check thXppropriate box: Type of project(required): 1.531 I am a employer with '10 4. ❑ I am a general contractor and I have hired the sub contractors 6. El New construction • employees(full and/of Dart-time). - -. _ ___.____..__.... ........_ . . listed on the attached sheet. 7. El Remodeling 2.E I am a sole proprietor.or partner- ship and have no employees These sub contractors have _ 8. ❑Demolition working for me in any capacity. employees and have workers' 9. 111 Building addition [No workers' comp. insurance comp, insurance.$ g required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a bomeowner.doing all work officers have exercised their 1 1.❑ 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 0'04v/at i py`• • comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy'number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Af CR,Tr( Gy aA /ASVVt1l7Ce CO Policy#or Self-ins, Lie.#: kx.,A oU' ,rZ,s6f Q( Expiration Date: (p 13O /� Job Site Address: • City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1„500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of . Investigations of the DIA for insurance coverage verification. I.do hereby certify u e pa' and penalties of perjury that the information provided above is true and correct. • sx Signature: ' Date:' . • Phone#: 0 d 7 7S - y — — 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#: xogers & Gray ins. rage: Qua Client*:4597 CCINSUL ACORITM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/01/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIS 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 Rogers&Gray Ins.-So.Dennis NAME: Margaret Young PHONE 508-760-4602 434 Route 134 Lb"O ) is,No): • 508-258-2102 P.O.Box 1601 ADOREss: youngma@rogersgray.com NHWUCtk South Dennis,MA 02660-1601 CUSTOMER IO#: INSURER(S)AFFORDING COVERAGE NAIL g INSURED Cape Cod Insulation Inc INSURER AI Peerless Insurance 18333 455 Yarmouth Road INSURER B:Ohio Casualty Insurance Company Hyannis,MA 02601 INSURER C:Atlantic Charter Insurance INSURER D:Commerce Insurance Company 34754 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 I 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. TNSk -ADDLSUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/ODIYYYY) (MMIDO/YYYY) LIMITS A GENERAL LIABILITY CBP8263063 04/01/2011 04/01/201 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE RENTED PREMISESS(RENTED occurrence) $100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $5,000 d PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 7 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY n. T LOC COMBINED SINGLE LIMIT D AUTOMOBILE LIABILITY 11MMBCKVMK 04/01/2011 D4/01/2012� $ ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS I BODILY INJURY(Per person) $ X SCHEDULED AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS PROPERTY DAMAGE $ (Per accident) X NON-OWNED AUTOS $ I $ B UMBRELLA LU18 X OCCUR UU01254514645 04/01/2011 04/01/201 EACH OCCURRENCE - EXCESS LIAR CLAIMS-MADE ����'��� AGGREGATE $1,000,000 DEDUCTIBLE X RETENTION $ 10000 $ C WORKERS COMPENSATION WCA00525902 06/3 2011 D6/30/201 X $ AND EMPLOYERS'LIABILITY C STATU• OTH- ANY PROPRIETOR/PARTNER/EXECUTNEY!N ACH LIMBS I IER OFFICERIMEMBER EXCLUDED? C WA . .EACH ACCIDENT $500,00Q (Mandatory in NH) f yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors (See Attached Descriptions) CERTIFICATE HOLDER _ CANCELLATION 10 Days for Non-Payment 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 r / -..._. ^' , • ACORD 25(2009/09) 01988-2009 ACORD CORPORATION.All rights reserved. 1 of 2 The ACORD name and logo are registered marks of ACORD #568575/M68179 MEY t°7-415fiCaVagfaiVitelifiaticl = i= 10 Park Plaza- Suite 5170 =1_( Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. HYANNIS, MA 02601 ---- .:„Update Address and return card.Mark reason for change. Address ❑ Renewal (`i Employment [J Lost Card 1 - •,-cm is 50M-04/o4-G101216p fuiAffairs e o m� us'ne Regul non er License or registration valid for ir.3ividu!use only before the expiration date. Iffound return to: Registration: Type: Office of Consumer Affairs and Business Regulation Expiration: 15/2012 Private Corporation 10 Park Plaza-Suite 5170 12/ Boston,MA 02116 HENRY CASSID`r"',` `,` a ` :`j'"1 455 YARMOUTH :' HYANNIS,MA 0260A':? Undersecretary alid ith t si ture • '•-•;•: Ntassachvsilts- Dcpartnlcnt ut'Public Saft.:th Board of Building Reg iatiun. and ltantlard. Construction Su rvisor License License: CS 10098 Restricted to: 00 s;24- `:'�,' „7g • HENRY CASSIDY 4.7611ED ROW {, F WitT • ' YARMOUTH, MA 02673 rVzMf, s'' • '' kilit Expir ion: 1i/11/2011 - 4„uIiui.auncr• 10 1207 12- OWNER AUTHORIZATION FORM 1, i4Z rz-& ttr- 1A4 bil (Owner's Name) owner of the property located at c61-71 eitAnA-44-7AQ 'Mk -i-1)34) (Property Address) (Property Address) herebyQ ,19€ C TTY� k authonze1��0?�(Subcontrtor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature q/t/4 Date d!c 6 -►3 -(-3 pia CAPE COD TOWN c. ft,RNSTELE INSULATION , f , in: f WO III kW EMIR GLASS SEAMLESS SPRAT FOAM SUSPENDED EATTS GUTTERS INSULATION CEILINGS 1-800-696-6611 CI-MS Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: /0//c7/// 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 / 'g>Se2 ' o1/'7/ ,9-i4/ /i' 41i4- Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) /.ti J'‘-'Ji9 77-YE.,/ 4l/d/j/Z Sincerely ,/ Henry E assidy J , President Cape Cod Insulation, Inc.