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HomeMy WebLinkAbout0038 FAWCETT LANE Town of Barnstable *Perm/ Expires 6 months from issue date Regulatory Services Fee ��P 0 Y� M' 9 �' Richard V.Scali,Director X�� no HMaim MIT i639. 1 ��(j �D Mld A Building Division SEP 2 5 2015 Tom Perry,CBO,Building Commissio1wr 200 Main Street,Hyannis,MA 026011 OWN OF BA RNSTABLE www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY of Valid without Red X-Press Imprint Map/parcel Numbe /� Property Address T r-ALAkQA C,�. �\jann'JS MA Residential Value of Work S Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Off JjO Z QJ j— Telephone Number r 6 /S� Home Improvement Contractor License#(if applicable) `] /�o Email: ��,� jry/Q t Gf/PyhO✓� (�✓�G'/wVG='� Construction Supervisor's License#(if applicable) C's orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name I`1 `C.(n i t!'n. T n5 Workman's Comp.Policy# I�� Copy of Insurance Compliance Certificate must accompany each permit. Permit R�qu jst(check box) -roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to�U� it //❑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: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. • Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\DecollikWppData\L,ocal\Micro \Windows\ ary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 r ACCP® CERTIFICATE OF LIABILITY INSURANCE DATE 06/03/2O 5n 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 CONTAW Erica H O'Connor HART INSURANCE AGENCY,INC. NAME: 243 MAIN STREET PH0 N 508 759 7326 x205 ac No):508-759 7326 PO BOX 700 E-MAIL ADDRESS: BUZZARDS BAY,MA 025320700 INSURERS AFFORDING COVERAGE NAIC p INSURER A: PENN-AMERICA INS CO 32859 INSURED Scott Lohr dba Lohr Home Improvement INSURER B: ACADIA INSURANCE COMPANY 31325 23 Grand Oak Rd Forestdale,MA 02644 INSURER C: INSURER D: 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. LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY MM/DDmY LIMITS A GENERAL LIABILITY PAV0059201 05/15/2015 05/15/2016 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 50,000 PREMISES Ea oxunence $ CLAIMS-MADE ®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-COMP/OP AGG $ 1,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED id P BODILY INJURY(Per accent AUTOS AUTOS ( ) $ r $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ B WORKERS COMPENSATION WC202000555900 03/26/2015 03/26/2016 WC STATU- OTH- AND EMPLOYERS'LIABILITY y/N E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If es,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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PROOF OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standard Construction Si;pci-+'i.or License: C"53961 SCOTT A LOHR 23 GRAND OAK Forestdale MA 02 4" �� � .�r►+�+`� Expiration Commissioner 06/09/2017 ✓tie 766, ozraealC/ Once of Consumer Affairs&Bdsine�s�s Reg�a�n. License or registration valid for'individul us HOME IMPROVEMENT CONTRACTOR,. before the expiration date If f6und return se only — - Registration ,172172 Expiration: 6/31%2016 Type off Cc Rf,Cansumgr Affairs and B�isir css'Regutation DBA 10 Per%Playa,-3mte 5170. LO HOME IMP�2pVEMENT: Boston,MA 02116 SCOTT LOHR 23 GRAND OAK RD�t r� ` FOREST DALE,MA 02644 Undersecretary --- u No v:, id without signature TTie ComrHomareakh r�,f Vassachusetts Depraranent of rm1ustrial Accidents n lQ,face a,f Irt�WStigations. 600 Washington Street Boston:,M4 02111 y wavtn mass govIdia Workers' Campensatian Insurance Affidavit.Bmldei-srCantractur--JEIectricians/Plumbers Applicant Infarmatiaa. Please Print E.e:a Na=(Business,'7dr mimfionfln&idaaly_ j��4/t� lId11 Address J_ City/State Z4i; Phone Tire you an employer? ec1£.the appropriate box; Type of project(required): 1. am a to with 4 ❑I am a general contractor and I 6_ ❑New constructiuu employees(fish andfor p me).* have hired the sub-contractors 2.❑ I am a sale proprietor orpartner- listed on the attached sheet; 7. ❑Remodeling slip and have no employees These sub-contractars have 8. ❑Demolition working forme in any capacity- employees and have workers' 9. ❑Building addition [No❑norl rn' camp.insurance comp-insurance required-] 5. ❑ We are a corporation and its 1-6-❑Electrical repairs or additions 3.❑ I am a hameoumer doing all urork officers have exercised their 11-❑Plumbing repairs or additions myself_[No workers'comp- right of exemption per MGL 1?_❑Roofrepairs immmnce regsimd]1 c.152, §1(4h andwe have no employees-[No workers' 13_❑offier comp.insurance required-] *Any appUmatthat checks box 91 mast also fill outthe section beTawshowing theirwodcere compensationpolicy inf nnscticn. I Hamaawne m who submit phis sftidn ff inztsrating they are doing alk wzA and then hire outside coatnsctors mast submit a new affidavit indicating snrx ICont m=rs that check ibis bcm mast attarhea as addiiirm sheet shouting the n=a of the sub-comtrwbms and state whether.or not those entities have employees.Ifthesubtaatzrtoes hive employees,they mnisrpm%ddetheir workxs'tamp.palicpnunsber_ I ant am eitiployer that is pranztiing itrarkers'conapeatsat,iort imzarance far arty enrpL4,ees ffetow is the pa cy imd job site information. , Insurance Company Name: Policy or Self-ins-Lic_ - ExpirationDate: lob Site Addt:; `�� ha by(el —<41- city/state/Ev: / Adach a copy of the workers°compensationpolicy declaration page(showing the policy ntrm�d iration date). Po c3' � ) Failure to secure coverage as required.under Section 2 5A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$U0a 00 and+'or one-yiarimprisonment as well as civil penalties.n the faim of a STQP 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 Itrvestrgations of the DIA.for insurance-coverage tiwrification. I do h relry certify uptjErr thepauts jui rtaNties ofpeduty thatthe urformafiwj-prm irft d abmre is $and correct Sit>rtature: hate: Phan (� OBkial arse apily Do nat write in this area,to be ciampTeted by tatp artotcn offaciat City or Town: PerffitfUcense# Issuing Authority(drde one): L Board of Health 1 Buffding Department 3.Cityffoswn Clerk 4 Electrical Empector 5.Plumbing Inspector 6.Other Contact Person: Phone#: laformation and Instructions k ' Massachusetts General Laws chapter 152 requires all employers to provide wojJ='compensation for their employees_ �f-tD this sttufe,an errployre is defined as_"_.every person in the service of another under any contract ofhirt, express or implied oral or " An ezpkyCr is defined as"an mdividral,partnership,association;corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased empIoyer,or the receiver or trustee of an individual,partnership,association or oilier legal entity,employing employees. However the owner cif a,dwelling house having not more than three apartments and who resides therein,or the occupant of the, - dwelIing house of another who employs persons to do mahitman=,contraction or repair work.on such dwelling house or on the grounds or building appurEenant thereto shall not becauise of such emplcyinent be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing ageuicy shall withhold fIie issuance or renewal of a Incense or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commalwealth nor any of ifs political subdivisions shall enter into any contxa.et for the perlvmanee ofpnblic workumtrg acceptable evidence of compliance with the hMUr2nce. r ments of this chapter have been presented.to the contracting aufho�" equse . Applicants Please 911 out the workers'compensation affidavit completely,by checking the boxes that apply to your sifnation and,if necessary,supply sub-conb actnr(s)name(s), address(es)and phone numbers) along with their certificate(s)of in u ance. Lanited Liability Companies(LLC)or Limited Liabilityparinerships(LLP)withno employees other than tilt members or partners,are not mquired to cant'wolkers' compensation msurumce. If an LLC or LLP does have employees,a policy is regau-A Be advised that this affidavit maybe submitted to the Departmmt of lndnsfrial Accidents for confnmaii.on of in suran ce coverage. Also be sure to sign and date the affidavit The affidavit should be retumed to the city or town that the application for the peuuit or license is being regnest A not the Department of n T A_ccidenfs. Should you have any questions regarding the law or if-you are required to obtain a workers' compensation policy,please call the Department of the number listed below. Self-insured companies should enter their self-insurance license n=ber on the appropriate line. City or Town Officials t . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to f[l out in the event the Office of Investigations has to contact you regarding the applicant Please be sine to fJl in the pemm. Iicense number which will be used as a reference number. In addition,an applicant that must submit multiple penitllieense applitidans in any given year,need only submit one affidavit indicating current . policy information Cif necessary)and under`Tob Site AddrMs"the applicant Should write"all 10caiions' (c'ty or. town)."A copy of the-affidavit tat has be a officially stamped or marked by tie city or town may be provided to the applicant as proof that a valid affidavit is on fat for future permits or licenses. A new affidavit must be filled out each. year.',Tdl=a home owner or citizen is obtaining a license or permit not related to any business or commercial vent Im (in. a dog license or peumit to buns leaves etc.)said person is NOT required to complete this affidavit 'Ile Office of Tnves6gations would ae,to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call- The Department's address,telephone and fax number. e CGMMQaWaStbE of Massachusetts . Degadmeut cif Ii dustdak AccUeta (504 washm4an. t Bus MA 0�1ZF 4-06 car 1-977-MA SAS Fait 617'27 7749 Revised 4-24--07 I *THE t • sn8xsrABLr. Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Petry,CBO 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 Ly, te as Owner of the subject property hereby authorize Yn.l 1 to act on my behalf, in all matters relative to work authorized by this building permit application for: (S , (Address of Job) Signature of Owner D to T Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services THe rqf� Richard V.Scali,Director Building Division ' anrexsresr.E Tom Perry,Building Commissioner 039. ��� 200 Main Street, Hyannis,MA 02601 rED MA't www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# . CURRENT MAILING ADDRESS: - city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures.'A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildiagpermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109:1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that.the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map pp Fl o Parcel A lication # � U Health Division Date Issued P-e-? � P� Conservation Division Application Fee 7so Planning Dept. Permit Fee 2 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 942 cz-ow (,'_ei t-13 - Village tt / S Owner F C_A- AddressX F6U4JC61J�L L�1.- Telephone J ~ 771 5-1'9 Permit Request u 0 cif e lN. /7� GIJ 6X Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValuationL3L/Dy- Ir-u 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 INFORMATIONk, ,E (BUILDER OR HOMEOWNER) - Name 7:1—ithOY&I Telephone NumberLJ 07a� S®� Address lL60 6-tkAsnd License # /0-15�7 JV raff 6,9 7., Home Improvement Contractor# /7S lad_' 3 Email `Q-f'iti�Dg��2 ►�sj't ,Worker's Compensation # ALL CONSTRU ON DEBRIS RESULTING FROM T IS PROJECT WILL BETAKEN TO Gee S SIGNAT E DATE FOR OFFICIAL USE ONLY y , }' APPLICATION# i. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSQCIATION PLAN NO. The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston MA 02114-2017 .: www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION,INC. Address:1440 STAFFORD RD City/State/Zip:FALL RIVER, MA 02721 Phone #:508-567-4240 Are you an employer?Check the appropriate bog: Type of project(required): 1.0 I am a employer with 8 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.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 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4), and we have no INSULATION employees. [No workers' 13.0 Other 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 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 am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name:ACE AMERICAN INSURANCE CO. Policy#or Self-ins.Lic.OS62UB513918901 Expiration Date:4/5/15 Job Site Address: G.W C&1I C_y1 . City/State/Zip ',jam /14, Attach a copy of the workers' compensation policy declaration page(showing the policy nu ber 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cent unde 't ains a alti er' that the in ormation provided above is true and correct Si a7 Signature: Date d v Phone#:508-567-4240 Qifrcial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing.Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: A CERTIFICATE OF LIABILITY INSURANCE °0�.2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement($). PRODUCER CONTACT NAME: VIVEIROS INS AGENCY INC. PHONE FAX 375 AIRPORT RD we No Ext: A/C N : FALL RIVER,MA 02720 E-MAIL INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:ACE AMERICAN INSURANCE COMPANY INSURED INSURER B: ALTERNATIVE WEATHERIZATION INC INSURERC: 1446 STAFFORD RD FALL RIVER,MA 02721 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATENUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD SU POLICY EFF POLICY EXP LIMBS LTR INSR POLICY NUMBER MMIDD MM/D GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISE Ea occurrence) CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $ POLICY ECT LOC $ UTOMOSILE LIABILITY MBInt D BINDLE LIMIT $ a ac ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS NON-OWNED �29PERTY AMAGE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ IDED1 I RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY yyy M TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIV N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N 6S62UB 04-05-2014 04-05-2015 Mandatory In under L. It yea,describe under 5B918901 E. DISEASE-EA EMPLOYEE $500,000 DESCRIPTION OF OPERAT11ONSE.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE CANCELLATION NATIONAL GRID SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 40 WASHINGTON ST CANCELLED BEFORE THE EXPIRATION DATE THEREOF, WESTBOROUGH,MA 01581 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE. POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I JOHN J.LUPICA President 2010105 ©1988-2010 ACORD CORPORA A rights reserve ACORD 25 . ( ) The ACORD name and logo are registered marks of ACORD �•. 7 ;22 CQ��a2/'?�.��L�2�vG•l•��� t'1���%�'��i.�;l�`��id?iL�:1-G�G�• Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 1�1 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 175683 Type: Corporation Expiration: 5/29/2015 Tr# 241009 ALTERNATIVE WEATHERIZATION, INC. TIMOTHY CABRAL 1440 STAFFORD RD. FALL RIVER, MA 02721 _ Update Address and return card.Mark reason for change. sCA 1 0 2OM-05rn Address !; Renewal J Employment 7 Lost Card � �%�r`Fr.urirrr.•nmr•rr�f�r��'�lr��nr/a,'e// Office of Consumer Affairs&Business Regulation License or registration valid for individul use only "il BIOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: kRegistration: 175683 Type: Office of Consumer Affairs and Business Regulation rExpiration: 5/29/2015 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 ALTERNATIVE WEATHERIZATION,INC. TIMOTHY CABRAL 1440 STAFFORD RD. i ! FALL RIVER,MA 02721 Undersecretary N� t valid ithout signature =oa -r __.:c: _ ilcFrllCiiuq 1U11C1'S F�n� _ = ,-a: CS-906454 `•r TLM07HY CABRAL' 58 DICIKERINSoN ST Fall River MA 02*721 05/08/2015 ' 0 Hoysing Assisfancp Corporation Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. I hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation ( herein after referred as "Agency" ) cn •the property located at: f/�T The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures:. Weather-stripping & caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2 . The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is. completed. I,.have read the provisions of this agreement as listed and freely give frfiy consent. Home Owner: (Signature) _ ,�'/ �•> • G ` '_ Date. Agent: (signature.) Date': - Assessor's map and lot n umber, °.:. .:... .�G.'........ THE Fr Q — �o o�y Sewage Permit number ...../,1...G!....i�.:.✓....../.�uT`��� uM 1 Z BA"S'TODLE, i House number .................................: :.��... ......:.......... �o VAG& p 039. \e0 �a OR a' I TOWN OF BARNSTABLE BUILDING INSPECTOR �.�?.APPLICATION FOR PERMIT TO ........ ............................................................................................... �Z(R/ Q TYPE OF CONSTRUCTION .......�.nw...!7:�*:...:........................................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby a.gplies_for a permit according to,.the following information: Location ...... ..... . �. .!N... ............................. /....1/. ;iT//(J..5.......... ................................... ProposedUse ...... NYC',..... . . ....................................................... ....................................................... ZoningDistrict ..........�..................................`...............................Fire District ...............................................�............................... Name of Owner .....`)� c'�... c.X-`rn ......................Address ... .0?�... ..... Q ................... 32 Name of Builder �t^�-� Address r.............. ..................................... .................. . ` R............................... .......... .k Nameof Architect � ...Address .............................................................................. Numberof Rooms .................... .............................................Foundation .... ........, .................................................... C�1C�ppvJoru / W/Cr ,.�. Exterior V Roofing ........��......?e-.. .................................................. Floors ...1.,. ..�.............:. .Interior ......�r..Z rr........ ...................... ....G................................................... Heating G� .. ......................................................PI Plumbing :�.. ?.`.• ,...... .....r ............. umbi Fireplace .......k .................................................Approximate. Cost .........-S�...007U r ............................................. Definitive Plan Approved by Planning Board ________________________________19________ Area .......................................... Diagram of Lot and Building with Dimensions Fee. .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I. hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. #� Name . ....E....... �/�.M v �� �� �Construction Supervisor's License :..................� ............... DACD REALTY A:--290-11 00 No .26554..... Permit for Pn ..St9rY.............. jj.jgjQ:Family..]DW141, ATIO IV I -att",........ ....... ,Dwell ... ..... Location ...LQt;..4.4..... Lane . .........M............... ............. ....................... ...................................... ... Owner ..........DAM-RIML ................................ Type of Construction ..F.10M. ............................... ............................................. .................................. Plot ............................ Lot ................................ Permit Granted ...... ....................19 84 Date of Inspection ....................................19 Date Completed ......................................19 TOWN OF BARNSTABLE . :. .. Permit No. ___2_=� _5S__ Building,Inspector Cash'ep NASL ---------_---_____----- _____ eta YAY a` OCCUPANCY PERMIT Bond _X __________----- Issued toy Address zpatv Irt 44. 38 Fawcattt lam, RValnii.S Wiring Inspector Inspection date Plumbing Inspector.! r� Inspection date Gas Inspector ; t -� `i � .erur.d J Inspection date Engineering Department :'.ij err �.�r Inspection date ; 4-'/• u t Board of Health 4S �� ' V� Inspection date THIS PERMIT WILL NOT BE!VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0-OF THE MASSACHUSETTS STATE BUILDING CODE. ......u.......................................... ....^:. . ..........................._...._ Building Inspector t I r �{{ , € � a t • �FfFi �. .y. ,L O-T- 4 ,ti i7, � r3 1' }_ IA � Y'VILl1AM GJ' o- I .} d N C. H ' t` AFC/5Tt-�IV ,L O 6.4 T/O,,C/ '-A yA" C�e 7744 'y T,G/AT T/,�� �i�/(�- -5cA 1`_ f/Ol�/�h�E.2E0.�/ COMf�L yS W/TH L� =4G> s A,c/O SETBACk .E'EFE.e,E/(/C� �E4�/.2EME�c/Ts of 7-.41E �-oW.-V :.:. ,L O CA OA TS- �. BAXT�,E?E.VY /NC. 1 Ty/S [,4.v/S ,t/aT B-QSE" .</ Ate(/ .eEG/SrE.2E0 L /O S!/,eV6yP,r�I s /NST,2U�/.E.c/T Sve✓Ey� Tye QSrE,2✓/,�1�� M,4Ss. ; O.�FSETS,sya y✓y S,�v[ 1-107 B� A /E ZT a t . b i 6:. 4 im IIN 741 06 r �, cV �t orb- Assessor's map and•lot number ......:..........G. :. �i Sewage: Permit number .... ✓ -. ' ` ' • a + f s, Z BAB STeDLE, • 'House number. .. . ......... � � ........ w11t e` V ,.. so a i63q• ' ENVISO -TOWN- OF� R_ RNSTA j, Y �UIINDIHG 11SFEG•TOR `. ti ., ' APPLICATION FOR PERMIT TO � .:..:.:.. -_ C 4�- ..;` r`+ TYPE OF CONSTRUCTION .....: ...... .......................... 71 r ......................................... .....,9.:�? . TO THE INSPECTOR OF BUILDINGS: The undersigned here6 for a permit according to, the following-information: ' Location ...... .... :``]-'�; .... !'J!- s ....................... .�� /iJ l ................................................. ProposedUse ...... .... @.:. ................................................................ ..................................................... Zoning District :...................Fire`District '........................................................................: Name of Owner ... ` 1.1,-T Csa,. . c`. Address ... .C?X..... �R ,.....( !4 .... G. �� Name of Builder .Address .....�'� " .... Name of Architect :...:Address ..................... .... ........ ................................. .. i Number of Rooms ......... ........ ............ .................... .........Foundation. ... . ............ l..C.................................................... Exterior .5: ?..... � . .... l.� .... -� 4...........:Roofing .?!.. ................................................... Floors �. `�.... .. �...............:............:.......Interior ......................`. ..................................................... O r ' Heating .......:. :. . g Y.. . ..L".N.. ....a:?!CK...... - Plumbing �?:G���- .....` .:...� ............. v GYM , Fireplace ....... .. .... 'Approximate. Cost Do .. ...................'......................... i. .... r Definitive Plan' Approved by.-Planning Board __----------------_______ ___`1.9________. Area .... ................. ..,:......... Diagram'of Lot and Building with Dimensions Fee ............. _ ,`� SUBJECT TO APPROVAL OF BOARD OF HEALTH w �. _ 4 , OCCUPANCY PERMITS. REQUIRED-FOR NEW, DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable.regarding the above construction. F - Name ...... ... .. .....� .. . .... . QjSn Construction Supervisor's License"........ ....... .. ...... DACO REALTY .. y..a a y.- .:x. '� • •-... '�#No 2655 Permit for .. e..... ... " �! - iSin f le Fan l g, y Dwelling + ... �• I,ot 44�... . .... 38 Fawcett Lane _ Location ..... ...................................... Hyannis ........................................................... ............ (' ,Lp alp �,F .. _ i � •". `! � - .. - � � � � - - Owner DACO REALTY +� r TYpe,'of Construction; ...Frame..... .. i" rr...•- ' :. x ..... . . ...... ..... .... . ....... ..... Plot' s:......................... Lot ................. . `t f 1 'Permit Granted ..:June 6. ` .................19 84 �6 w'Date'f.Inspecty'e� :...711, .....i(W s + Date CompletediCv ``.19 i h v