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HomeMy WebLinkAbout0143 FAWCETT LANE _` I r" 1'� ' p'�i`wlV� r 11 ''mv\p � `�i � , 4 -IA Town of Barnstable Building y, �. .� y S� ti� �S 1639, Post This Card So That it is,Uisible From the Street Approved,,Plans Must be=Retained on lob and this Cartl Must be Kept , xq=y �,�:,,.', ,,: h s'»-r ;� rxa - s n r • Posted Unt�l�Fina1`Ins ection Has Been Made ;., �` :_ < u �� �, � ���`� +° s `�` � � � � �' 4 ° Where a-Cert�ficate.of Octu anc":sRe u�red;such Buildm ashall�Notbe,Occu led,until a Final Inspection;has been made h Pe rml Permit No. B-17-4354 Applicant Name: Jonathan Whipple Approvals Date Issued: 12/22/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 06/22/2018 Foundation: Location: 143 FAWCETT LANE, HYANNIS Map/Lot: 269-082 Zoning District: RB Sheathing: Owner on Record: Rebecca Anastasia A, ' Contractor Name ;',J0NATHAN N WHIPPLT Framing: 1 '� •" e R Yp :.. Address: 143 FAWCETT LANE Contractor License CS-078683 2 HYANNIS, MA 02601 •:? Est Protect Cost: $4,686.00 Chimney: Description: Insulation.Air Sealing. Insulate attic.Add ventilation chutes. ,' Permit Fete- $85.00 Insulation: Project Review Req: Fee Paid: $85.00 Date Final: 12/22/2017 F Plumbing/Gas r _ Rough Plumbing: g Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work auth�onzed`by this permit is commenced within six months S' er'issuance. Rough Gas: V ;>. All work authorized by this permit shall conform to the approved applicatio and the;approved construction documentsfor�,whic nh this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws�and codes. 11 Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public h'spectibn for the entire duration of the work until the completion of the same. s Electrical I� � r Service: The Certificate of Occupancy will not be issued until all applicable signatures*,,t a Budding and Fire Officals are,provided on this permit. Minimum of Five Call Inspections Required for All Construction Work Rough:, 1.Foundation or Footing -. 2.Sheathing Inspection final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department = Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT i 150"*SL. S£� �Ile, Town of Barnstable *Permit °* Building Department Services Expires 6mo f efrom issue date anarrsresrE. : Brian Florence,CBO tKnss s63p. Building Commissioner J V lJ®� 200 Main Street,Hyannis,MA 02601 � R1 www.town.barnstable.ma.us '�� Office: 508-862-4038 roo19 Fax: 6 6230 EXPRESS PERMIT APPLICATION - RESIDENTIAt4-Any _ Not Valid without Red X-Press Imprint Map/parcel Number / Property Address J Ae (lam' J/f� �� .���/ �_ e o2G—YU ❑Residential Value of Work$ °7 Odld / Minimum fee of$35.00 for work under$6000.00 J Owner's Name&Address L'ad(f'G� �J, 4�:2Z 14 G Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Chec ne: a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to�� T ❑ roof(hurricane nailed)(not stripping. Going over existing layers of roof) ERe-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: � .� Q:\WPFILES\FORMS\building permit forms\EXPRESS.doe 08/16/17 0 IV The Co mm'omweaM o;f Ma-wadjmsetts Deparkireut cr,frndhrlrid Accidvd 9 OfTwe a,f rm-Tstigatiam 600 Washfiwtaw&reet Bastin,CIA 0Z11F ivrviumass gapldia Workers' Cumpensaff-an I ce,dffr*Imi-Bugdex-JC=ractarsMectdcians(Phm3bers �AppHcznt lufmxnaf�n Please Print Le 1V a=BUSPFL�SS '�F� 3�14II DL�mErTna = O/1.�sl /�`L/� �t e� Are you an employer?Checkthe appropriate bay ' T of project r L❑ I our a 1 � •4.-❑'I am a general confractor and I .[: e I ( wired}: employees(full anan&or part-time * . 'have hiredlhe Sdb-cc atMCtos 6. ❑New consiruciiaiz 2.❑I am a sole propaietcw orpartuer- listed onthe.attached sheet ?. ❑RPmodeliatg ship and have no employees Theme sib-cautractors hava . S.,❑Demalififla woaidag for in au capacity. employs aadhare wadzers' 9. ❑Building additia IND S$o&Mrs! comp,iusun ire comp-ksurarne l required-] 3_ ❑ We are a noapoaatiim and ifs 10❑Eleorical.repair,or ad&fious 3.❑ I am a bemeomner do img aU work officers have exerdsed their 1 L❑Plumbiagrepairs or additions.. € o wofkers't' riglrl:of exemption per MGL y i ssetu reclaired j l c.152,§1(4k and we have no 1.y❑Rflafrepairs employees.[gowoA=e 13_❑other cam-ihsurence Mgnired_) .g_nyappfic=tHsatcheftboajl—alsofficmttheswdonbelowsbaiaagdie7mwmierecompmot; upnIicyinfn n5mL #�a7EoatIleiS Wd7D soU�it ilR]S affida�ii they are r1m'aIE�VtCr3C sad tfieahiie oat ide contoictarsnmst 5aImiit a neW affida�t mdicabeo sacb- rCc=Bctum ezt dhect*is box must aitadn as additional sheet sboazng tbenme of @me sib-�m and sFmie whedm ornot ftse eatidwhn�a employees.lfthesni)tontICt=Haveemployees,fiLeyamsI pan'i&their tvadea'tamp"policyaumbet I ain an elspIger Mat it prauidrirg warkets'compe-walion ik=ra=fbr my emprgwar. Below is MerpaM7 toad jab sate information. Insurance Company.Name: Po-ficy 41 or Self-ms.IC. i psEatroaDafe: Job Site Address lyGve k�� '✓tea P1 X c-�G�t �ze r citpJstafer, p: 3 Attach a copy of the workers'compensation.policydedarat mr page(showing the policy number and expiration date). Failure to secure coverage as required under Section 2.5A of MGL,rd 15-7 can lead to the imposition of cairnhyal penalties of a fi=up to$UDD.OU andtor one-year impdso-- t,as well as civil peata16 u the fog of a STOP WORK ORDERand a fine of up to$2f0.00 a damp against the violafur. Be advised tiiat a copy of this statement maybe forwarded to the Office of InuesEsgataons of the DIA for iisumce coverage y�ica ica. I do herby cenf 5,raarder tbAppains and penaUes of perlW7 tatthir infornuWmrprovhW a5ow h bare avid correct hate: Phone a,,�ciid use ar�,� Ua nit esrite in flr�area trr b�crr�Mpleted lip clip Qrtan-ri av,�`reiat Cit y or'To-= PernAVTJ,eeuse:9 Issuing Authority(m cle one): L Board of yeah i IWIding Department 3.CiiylTawa Clerk 4.Electrical Inspector S.Phunbmg Inspector 6.Other Contact Person: Phone#: --- 6 Information a)E'td Instructions M�_carh mfL4 Gebmzl Laws char M regaII=all e�IoyeM Yn provide 'comPe o far theta ofho e;s. f, Pnrs'aant�•this ,an av&7=is dealed as":�vedYpeason m e semvi ce of an other undo an7Y contact fli�e, express or implied;oral or wriftm." An MTIayM-is defined as`pan individual,pm-jnCr3E6p,assoChiion,corporation or otber legal may,or amY tWD or more of file foregoing engage•is a3oint ,andmch uTmg the Legal=2=mta&=of a deceased employer,or ih.e receiver or trastee of an bTN dual,per,assccsaizan or otherIegal Canty,toying=[3Ploy=S- However the owner of a dweIImghonsehavmgnotmoref3ian free crime andwho resides therein,arihe oc ofths- dweIIing house of anot�r who employs pegsans to do C,r.,r,ckuctim or repair wow cn such dwe]Img house iiiemeb shallnotbecanse ofsach emplapmentbe deemedfn be an employer-" or on the grounds or bm�appurEena� • MGL chapter 152,§25C(6)also sues that"evmy.sfztm ar Iocal Hcensnag agency shall wif -hold•lie issuance or renewal of a licease or permitto operate a h>rSiCLess nr to construct bm7db:Lgs k the commoawealth for= applicantvYho bms not produced acceptable evideu=of cumpfiance wrdL the msur=ae cove mge regmh: Additionally.ly.M ff-rhapt=152,§25dM sfafs-Teitb=the c nor goy of its Political subavisions shaIL e r into any contmd for the pm once ofpnblic;WDI cvnI a�fable evidence of corapli�cc f3�e;,,�n�nce. req�en7e�s 0ffiais ch2ptCr &Vr beenpresentE dt o the canftactmg.anfhozity: Applicants •, Please flI out ae, 'compeasafion affidavit completDly,by cog then boxes ffiBt apply to your siinafion cad,if nece<ss�Y, PI3'sob�onfraatnr(s)namets), es)and phonemnnber(s)alongwiththmr certCac�e(s)of Companies cr L bited Liability pmt==shigs(LI P)`gym°�l°Y=other than tb e . insarance_ Limif�dLiav�7.dY t`-�-P �� . members or partners,are not to cagy wnzkets'comPensaiion insorance If an LLC or LLP does have employees,apolicyisre . Beadvisedtbatthi.saffiidayit maybe sabmhtedtothr.Depaitmentof rn&sftial Accidents for conformation of ins x.m=coverage. Also be sure to sign and date;e of davit The affidavit should be-retumed to$e city or towntiat the applicafim for the permit or license is being mquesEed,not the Depaz{menf of Ldn strial AcdAm m- Mauldyou have any gnestions regmtrmg the law or ifyo a am required in obtain.a W0330ers' conipensationpofiay,please can fbeDepatnez±at Self-inscT =°®pmiesshovldea,Xrflieir s elf-i �n ce license mmlbm on the appropriate line City or Town.Offfdals r Please be sate tb.at the afdavit is complete andprfiited legibly- The Deparimenthas provided a space at tTie bottom o fthe.affidavit for you to fib out in the event the Office ofInvestiIons has to con actyouregardtagtbe applicant Please be sure to f olinthe peaami (sense mrnbes which wM be used as arafe rence n=bcr. In addition,an aPphc=t that must sabmit n�ubiple pm mitllicen sse appIibafi=in any green year,need only submit one affidavit indicet<ag cadent policy infazraafiaa (if accessary)and ceder`lob 5�e Q s"the applicant should write eau lacafions in (dty or gown):'A copy of the affidavittiiathas bey officially s mVed cr madced bythe criy tnvra may be provided in�e applicant as pmofthat a valid affidavit is on file for fritare-penaiis or Ijc:=� Anew affidavit rmrst be fMcd o'ut ea r-h a license or emit nct related ib any busincss or comm.=631 vie year.�1he5e a home ownea or can is obiamm g P - �this affidavit ' (ie. a dog license or permit to bum es leav etc.)said pmsc n is NOT req�d to CampThe Office ofTnTCSdgqfi=wouldlzlce to tl=k you m.advance for your coopexafim and shouldyou have any qumfionst, please do notb Bmtr,to gam=a=- the Deparimers ad&=r.,telephone and fax - ' CG=10aTmIft Of Masmchusets Degazim�of Ind�a1 Ar�i3t.�1� • . • �4 man Sirt� -Ted.4C1'-' -49W*xt4.06or1477MA&GAF Fax#617 727 7M 1Zevised 424-07 - ��rn a e��•�z��. . Town of Barnstable Building Department Services IMMETABM XAS& ` Brian Florence,CBO ►`� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section - If Using A Builder I f ,as Owner of the subject property hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for. xp�- (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. t� Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:0&/16/17 Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: I�/�9 �l Please Print JOB LOCATION: el- e fIZ 41Zo , 2,9 3� number -� street "HOMEOWNER"lY�Y Ji] /// J. 4%c�yt�2' yt=a 77/ name 0 home phone# work phone# CURRENT MAILING ADDRESS: /! Vzo- LR2 z K 4l zaz-zp— city/tMM 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- f tinily 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 building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, tylaws,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 comply with said procedures and requirements. ignature of Homeo 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFMES\FORMS\building permit fotms\EXPRESS.doc 09/16/17 r0 Z _ c I � fl � d , r 0 _` ice' r 1 t �+ i I i f .� a- r :i' ,.� I. } Town of Barnstable Building r �"Yw��^ ""�^.,�e � r• ,s a '� .< s r" `.fir r y . e �-\ate.r, .� ,:� w h. ,Post This Card So That it is Visible FromNthe Streets Approved'_Plans Must be Retained on-Job and this Card Must be Kept M" �Z* sted Until'Final Inspection Has'Bee 1•Mdde�; a y� i t Y, c�; R here a Certificate of Occupancy is Regmredsuch Building shall Not be Occupied until a Final Inspection has beenAmade Permit Permit No. B-17-4362 Applicant Name: INSULATE 2 SAVE, INC. Approvals Date Issued: 12/22/2017 Current Use: Structure Permit Type: Building-Insulation Residential Expiration Date: 06/22/2018 Foundation: Location: 99 GEORGE STREET, BARNSTABLE Map/Lot 319-0S3 Zoning District: RB Sheathing: Owner on Record: ST ONGE,STEPHEN R&HOGAN, MICHELLE S Contractor Name` INSULATE 2 SAVE,INC. Framing: 1 Address: 1166 BURT STREET Contractor license 180747 2 TAUNTON,MA 02780 Est Project Cost: $3,684.00 Chimney: Per Description: Weatherization mit Fee:\ $85.00 Insulation: Fee Project Review Req: Paid:: $85.00 Date 12/22/2017 Final: �k Plumbing/Gas f Rough Plumbing: N s tiBuilding Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: s , All work authorized by this permit shall conform to the approved application and the;approved construction documents'for which this permit has been granted. \ Final Gas: All construction,alterations and changes of use of any building and structures 0all be in cornpliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street&of road and shall be maintained open for public mspectio for the entire duration of the work until the completion of the same. ; Electrical V 4� s Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT OF THE Tilly �A lication Number .........174S �T Qi► pp y........................... * BARNSTABLE, + Permit Fee.......................................Other Fee........................ y MA$S. s639. 'eTEb MA'S A TotalFee Paid............................................................... ...... TOWN OF BARNSTABLE Permit Approval by..Of/&c .......� fOn?��1�,��. (7 BUILDING PERMIT APPLICATIONMap........................................Parcel........EC..1.-4-2--1. .............. 0"OF EARS Section 1 - Owners Information and Project Location ProjectAddressO9 4eol, PYL Earn fig ble,wf4 Da. (e-� O Village Owners Name aeoAelli -q, D d15 C- Owners Legal Address 99 4eo rSe -P4 City Ra t ref 4a.�o`@ State. t. Zip Owners Cell # 50?- ad F- &mail � �t h oo-rg g4-tiz apt. lit e-)4- Section 2 - Structural Use Single/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3 -Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Pool ❑ Fire Alarm Rebuild ❑ Deck ' ❑ Solar El Sprinkler System 0 Addition ❑ Retaining wall Insulation ❑. Renovation Other-Specify Section 4-Detail Cost of Proposed Construction _�(7' S 5l - Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total # Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method .❑ MA Checklist ❑ WFCM Checklist ❑ Design Last updated: 10/31/2017 Section 5 - Work Description e_& 1/0 ql"- -pea. r/`S r`a'_ Boa vc?'t r i-a.et-)Ii-Po-P / 4 S Q (12 X-2, dt O e v, Section 6- Project Specifics ❑ Wiring ❑ Oil-Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: &)a s V-e I�Lxy sV e i` I am using a crane C Yes ❑ No Section 7- Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8- Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 10/31/1017 Section 9— Construction Supervisor Name /7 04,9' Za wj ec,1ryr Telephone Number Address Wo _ I- City Tu.Cf 116`lell State �kd Zip od 9I d License Number/0 3 6 / License Type U Expiration Date �1d�/f Contractors Email && ,6WI A.rY.1 k -,? S Q.0 e,, c° f Cell # 7'3J& 4o Ya I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and x� documentation required by 780 CMR and the Town:6f Barnstable.Attach a copy of your license. Signature Date Section 10 — Dome.-Improvement Contractor Name A 4�A d (/7 Telephone Number 560 5'6 9—( -2 0 � Address L& 6 r o v e 1 , City State Zip 0,3 a v Registration Number /id '1 Y7 Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature l� C ji -- Date /2 Y117 Section 11 Home Owners License Exemption Home Owners Name: Telephone Number 'f'4 — 4' ' q4 2 9'Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature See, a Y-Yu � C"/_ Date APPLICANT SIGNATURE Signature r l� Date Print Name /0O Imo . Za.-A S P y in Telephone Number 6 e) 7 6 f7 E-mail permit to: Vie r4,1 sq e/ -,P? Last updated: 10/31/2017 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board (if required) Historic District ❑ Site Plan Review(if required) 0 Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval. Section 13 = Owner's Authorization L e.19� 4 S-Z b as Owner of the subject property hereby authorize .��_r�r �� � � s � .� <f to act on my behalf, in all matters relative to work a thorized by this building permit application for: a63 (Address of job) Signature of Owner date a /e n O Print Name Last updated: 10/31/2017 Page 1 of 1 Customer Name:Stephen St.Onge CONTRACT Email:beachhouse99@verizon.net Phone:508-208-4079 Premise Address:99 George St,Barnstable,MA 02630 Project ID:3333408 RISE. Date:Dec.1,2017 ENGINE€ N6 >:�xensyEnergaed. RISE Engineering 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Job Description CRAWLSPACE:10 MIL GROUND COVER 912 SF $884.64 $0.00 AIR SEALING 6 hr $480.00 $0.00 CRAWLSPACE WALL R10 RIGID BOARD 558 SF $2,259.90 $564.98 CRAWLSPACE:INSULATE DOOR 1 each $60.00 $15.00 Total: $3,684.54 Program Incentive: -$3,104.56 Customer Total: $579.98 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "*`Five Hundred And Seventy-Nine And 98/100 Dollars $579.98 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THER ARE ANY BLANK SPAj4 CES f,,,� — '--V7(;,e o RISE Re sentative Customer Signature / ` 7 Sign Date NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT ACCEPTANCE OF CONTRACT-THE ABOVE PRICES, EXECUTED WITHIN 30 DAYS SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE Prmit AVorizatQn i�Orm Site ©; 3312717 Custorrter owner #the property located at ([Tamer's Name;'pr nw) 99 George St Barnstable, MA 02630 (PrOP"4rM Addrm) (curl hereby a tltiarize tie Tula `Save Home Energy cervices rogram.4ssigned Participating Contractpr.listed' below to act.on my behalf':and obtain a'buitdin9 permit to.pedormintulatiorn and/or"Atheriza ion work on my property.. ChNner's.ftui tiurez Dates We have assigned the following Maw Save Fame Energy Ser.vi'm Ptr.tic "Con#ractor to t e above referenced pr*xt. Participatnng-Cantrado or Date Name: RISE Engineering Phone: 401-784-3700 Email: Rev.102015 4 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Ma usetts 02116 Home Improvem - 0Atractor Registration `rye: corporation FA At, Registration: 180747 INSULATE 2 SAVE , INC. Expiration: ° 12/28/2018' 410 Grove St �� � Fallriver, MA 02720 GV Update Address and return card. (dark reason for change. 3CA 1 +"a 2OM-05117 _......._....___,....._. _._.._......_....._...__._ ___..__....._.__.__..___... ...;...___...___...:.._................ _. _................. il1,f>-.(,i`fY1��fJ/YI,LfA���fi�.�/LI.I.t/✓,N21�L1!/�4:�t'-- Office of Consumer Aftrs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporabon before dte axpira on date; Iffound return 20: Office of Consmer Affairs and Business Regulation 10 Park Plaza-'Suite 5170 12128/2018 Boston;,MA 02116 INSULATE 2 S{ IEq Roland!arty ' , 41 O Grave S1 e <� FaW]kh r,itiAA 0272Q Undersecretary Not Valid witthout Slgnature Coftnanweaft Of M satbustt C?tvt n t4 l+roiassir�t t.i ire BOarfA of quiijitfiog alons and Standards ; 1 }r 8t" A i CS-10,U61 :. POLAND FA1.RIVE �� The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 < Boston 11?A 02114-2017 3 wwtt muss.govIdirt NA'orkers'Compensation Insurance Affidavits BuilderslContractflrs/Electricians/Plumbers. TORE FILED WITH THE PERMITTING AUTHORITY. A nlp icant Information Please Print Legibly Name(Business!Organization4ndividual): Insulate2Saye.Inc. .. .. Address:410 Grove Street City/State/Zip: Fall River MA 02720 Phone#: 508-567-6706. Are you an employer"Check the appropriate box: Type of project(required): l.Ex f am n employer with 20 employees(full and/or part-time).*' 7; ❑New construction 2.r J 1 am a sole proprietor or partnership and have no employees working forme in $, Remodeling any capacity.(No workers'comp.insurance required.) 9: [l Demolition 3.01:am a homeowner doing all work myself(No workers'comp,insurance required.)t 10❑Building addition 4.0 1.am a homeowner and will be hiring contractors to conduct all work.on my property. t will, ensure that all contractors citircr have workers'compensation insurance or arc sole 1 Ln,Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5 1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insuranoe,4 13.❑Roof repairs b.Q we are a corporation and its officers have exercised their right of exemption.per MGL c. 14.L WJ Other Insulation 02,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state,whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp:policy number, I am an employer that is providing workers'compensation insurance for my employees. Below.is the.policy and job site information - Insurance Company Name: Liberty Mutual Insurance Policy#or Self-ins.Lic.#: XWS 56418741 Expiration Date: 12/10/201$ Job Site Address: 9 6�5-0 t^S L City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy numnber and'expiration date).. Failure to secure coverage as required under M.GL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under`the sari a ties ref perjury that the information provided above as true and correct. Signature: Date: //yA 7 . Phone#; 508-567-6706:' 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 C►:other Contact Person: Phone#: ' DATE(MM/DIYYYYY) AC-49R CERTIFICATE OF LIABILITY INSURANCE THISCERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.1 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 policyVes),must b6.:endorse.& ItSUBRO ATIONIS WAIVED,subject t a 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. .Morsemengs, _. PRODUCER CONTACT Anthony F. Cordeiro Insurance PHONE "` (FAx::::.:. ......__. ..__._ 171 Pleasant Street 508 67.7-0407 N (508) 677-0409 Fall River, MA 02721s= hsouta@cordeiroinsurance.com lNSURER(S),AEFORDING COVERAGE NAIC#_ INSURER A..Liberty Mutual Insurance INSURED _— INSU RER B:__ __._______---- -.r__.......__._..___..,_,. Insulate 2 Save, Inc. INSURERC ..... __ W 410 Grove St. UR'INSERDr Fall River, MA 02720 ----- INSURER E: INSURER F: _ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. b,.µ ......,, .._ ., ._..... . tNggR AODLjSUiBif":,,", ( POLICY EKE`, POLICY'E%P (( LTR TYPEOFINSURANCE POLICY NUMBER ). M14DIY.YYY MMIDDIYYYY I LIMITS A ;' ERALLIABILITY Y Y BKS 56418741 1 12/10/17 12/10/18 EACHOCCURRENCE $ 000�00©_. XI COMMERCIAL GENERALLIABILITY DAMAGE TO RENTED: $ Y13LtkItSE;iS '�i�s) .... ... 300,.:000_.: CLAIMS-MADE,....,,,,.! occuR M DE:w(AnyonePersa,) $ ` 5;,_000 ;.",,,, .._..........__._._.....................__."_......., PERSONAL&ADV INJURY $, _1 r 000,, _ .. i GENERAL AGGREGATE $ 2.,-O00s,,O00 GEN'L AGGREGATE LIMITAPP LIES PER i PRODUCTS fAMPlOPAGG $ 2,000,¢QQ .X 1,POLICY _ PRO•, $ AAUTOMOBILEunelurr Y Y' BAA 56418741 12/10/17 12/118jacIN arQ�_N GLELHUi $_ , _.._.......0.....0_00/ _....._ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAO£ $ X HIRED AUTOS X-',AUTOSPnreadent)„_ A X, UMBRELLALIAB iX OCCUR Y Y. USO 56418741 12/10/17 12/10/18 EaCHOCCURRENCE $ 2 000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE _- $ 10,000 DED RETEN ION$ I $ A WORKERS COMPENSATION l WC STATU OTH- )XWS 56418741 12/10/17 12/l0/16 }{ AND EMPLOYERS'LIABILITY Y 1 N � � TORY LlctllTS �."E& ANY PROPRIETOR/PARTNER/EXECUTIVE F"LFACHA+CIt NT $ 500 OOO OFFICERIMEMBER EXCLUDED? N/A --- (Mandatory inNH) EL,DISEASE""EAEMPLOYEE)�.,,,__ SO�a_OOO _. if yes describe under i I.DESORIPTION OF OPERATIONS below ]] E.L.DISEASE-POLICY LIMIT' $ 500: 000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Taunton ACCORDANCE WITH THE POLICY PROVISIONS. 141 Oak St Taunton, MA 02780 AUTHORIZEOREPRESENTATIVE " �✓� ._ ©1988 2010 ACORD CORPORATION: Ail'rights`reserved, ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD eM 7 .. _�� : Building ep� Report Complaint/Inquiry `a 2 C Date: �6v Rec'd by: Assessor's No.: _�— t011 Complaint !Name• 1 Location Address: V i WP � k Originator Name• ---� `� tv� M Street: Q o. Stag zip' Wage: Teiephone:D/E Q r b Complaint Description: Inquiry Description: For 09ce Use Only Inspector's a j ector. Action/Comments Date: �� Insps Follow-up Action Additional Info. Attached cop),Disaibutron: White-Department File Yellow-Inspector pink-Inspector(Return to OlTce Manager) ♦\ •r �. ,�L r 1 � H �. 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