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0014 FIDDLERS CIRCLE
�y -����a c�� j � - - — _ � Town of Barnstable Building r ,:� c�� `. � ...,,•.���v i.".".� � .u.� ,"",:e� �'�; 'may. � '�� �,'�' � �q `..,; � .;:.� '.,"a" `•��, y;.• a;`. '�. IPost This Card So That�tais:UisiblezFrom the Street-Approved,wPlans Must bevRetamed on lob andth�s Card#Must be Kept Y ?, Posted Until"F nal inspection?Has Been Made s '' l P a ° ,Where a'Certificate::of Occupancy,is Requ�red,,such Buildmg3shyall Not'be Occupied u;ntII a Final Inspection has been made rmit F � _ Permit No. B-19-2620 Applicant Name: jose Tavares Approvals Date Issued: 09/18/2019 Current Use: Structure Permit Type: Building-Addition/Alteration- Residential Expiration Date: 03/18/2020 Foundation: Location: 14 FIDDLERS CIRCLE,HYANNIS Map/Lot: 288-161 Zoning District: RB Sheathing: Owner on Record: TAVARES,JOSE E Contractor Name:; Framing: 1 Address: 14 FIDDLERS CIRCLE Contractor License 2 HYANNIS, MA 02601 Est Project Cost: $ 10,000.00 Chimney: Description: add bathroom to back of house off the master bedrooms Permit Fete: $ 101.00 �. Insulation: :a Fee Paid:: $ 101.00 Project Review Req: _ Final: Pat 9/18/2019 r Plumbing/Gas Rough Plumbing: a: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six�months after;issuance. r v d construction documerits for which-this permit has been ranted. All work authorized by this permit shall conform to the approved application and the app o e P g Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by ws and codes. This permit shall be displayed in a location clearly.visible from access street or roa& nd shall be maintained open for pul he'inspectibh for the entire duration of the Final Gas: work until the completion of the same. Electrical 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:i a i Service: 1.Foundation or Footing : 2.Sheathing Inspection ,' Rough: 3. l Fireplaces must b 4.Wiring&Plumbing Inspections to be completed prior to ltoF a me Inspection n's installed :. Final: 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: " ersons cont ting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). k,r Building plans are to be available on site Fire Department �-� Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT d pf Mckechnie, Robert From: Mckechnie, Robert Sent: Wednesday, September 18, 2019 10:20 AM To: 'krmtav@comcast.net' Subject: Building Permit B-19-2620 Good Morning, Thank you for submitting the final information required for this permit. I have just issued it and you should have received it by email by now. If you don't see it in your inbox please check yourjunk/spam mail folder and look for an email from NoReply@viewpointcloud.com as that is it! Just a note: 1.) The code requires that any window within 60" of the water's edge in the tub have tempered glazing in both sashes. I don't believe the existing window will work. Thank you Robert McKechnie Local Inspector Building Department Town of Barnstable 200 Main Street Hyannis, MA 02601 508-862-4033 1 , ° . Town of Barnstable 11Clin d BARIMA Post This Card So,That it.,is Visible From the Street p r Apoved Plans:M,ust be Retaine on Job and-;this=Card Must bye Kept Postec! Until Final Ins ect�on Has Been Made Permit 7■�t■yy�■ ea,r, a vWhere a Certificate of Occupancy isRequred,suchNBu�Iding shall Not bye Occyp ed until a Final In�spectlon Chas been made Permit No. B-18-3487 Applicant Name: jose Tavares Ap provals Date issued: 10/29/2018 Current Use: Structure Permit Type: Building-Sidi ng/Windows/Roof/Doors Expiration Date: 04/29/2019 Foundation: Location: 14 FIDDLERS CIRCLE, HYANNIS Map/Lot: 288-161 Zoning District: RB Sheathing: Owner on Record: Jose tavares Contractor Narne:"':x Framing: 1 Address: 14 FIDDLERS CIRCLE ;` =- Contractor License: �. 2 ` ' HYANNIS, MA 02601 3 Esil Project Cost: $3,000.00 Chimney: Description: Vinyl Siding Permit Fee: $35.00 Insulation: Fee Paid $35.00 Project Review Req: Date 10/29/2018 Final: - Plumbing/Gas Gas g/ is g Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work author¢ed'by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the-approved construction documents for whichjthi's permit has been granted. All construction,alterations and changes of use of any building and structures shall{tie in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or'road and shall be maintained open for public inspectign for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Budding and Fire Officials are proVid6d-66,this°permit. Service: Minimum of Five Call Inspections Required for All Construction Work: - 1.Foundation or Footing n �r Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 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 c� Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 12/29/14 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Cnn Hyannis,MA 02601 zy m rn RE: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for 14 Fiddlers Court,Hyannis (201406647) has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey NIALL HOPKINS BUILDERS 14 FIDLERS CIRCLE HYANNISPORT MA January 30, 2012 Town of Barnstable Thomas Perry, CBO 200 Main Street Hyannis, Ma 02601 RE: 14 Fidlers Circle Hyannisport Dear Mr. Perry, This affidavit is to certify that all work completed at Fidlers Circle Hyannis Ma has been inspected by a certified Building Performance Institute (BPI) inspector.R-49 class 1 cellulose was added to the exterior walls and R-19 faced fiberglass was applied to the basement ceiling. All work performed meets or exceeds Federal and State Requirements. Sincerely, Hopkins Builders Inc. zz : TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ODD Parcel ` Application # c20 I fZ l Health Division Date Issued /6 Y P� Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address y V a ea C 4 rvlb Village 11 1 -,- Owner �a.vl d Fe c k ja Address sotm e Telephone R oroa R 6=1: Permit Request rA Irma jilaq to 1- Crawl s, Da q° Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new, Zoning District Flood Plain Groundwater Overlay Project Valuation 13 OD 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 ANo If yes, site plan review # T p_ ? tJ 1-jo Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 6 Name I S %,t Telephone Number g (1 a 33 R 69 R Address T-� � License# 3 C (.Q �� cc II jjI c�Q tk4, YawADJ1 d�V 9 Home Improvement Contractor# Worker's Compensation # W C3 0 85W ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO [LIM SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. a { ADDRESS VILLAGE OWNER DATE OF INSPECTION: `t FRAME n,INSULATIONL Aa--. �- FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL c GAS: ROUGH FINAL ' ' FINAL BUILDING— DATE CLOSED OUT _ ASSOCIATION PLAN'NO. k A i I T1 he Commonwealth of Massachusetts Department of Industrial Accidents FZ Office of Investigations 1 Congress Street, Suite 100 ' Boston,MA 02114 201 7', www.mass.gov/diu Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly,- Name(Business/Organization/Individual) Cape Save Inc. Address: 7D Huntington Ave City/State/Zip: South Yarmouth, MA 02664 Phone`#: 508-398-0398 Are you an employer?Check the appropriate boz: Type of project(required): 1.M I am a employer with 4. 0 1 am a general contractor and,l ❑ employees(full and/or part-time), have hired the sub-contractors 6- New construction' or partner- ship listed on the attached sheet. Z. ❑Remodeling 2.❑ 1 am a sole proprietor -and have no employees These sub-contractors have 8. 0 Demolition workingforme in an capacity., employees and have'workers' y 9. [�:Building addition [No workers'comp.insurance. comp.insurance fi required'.]. 5. ❑ We are a corporation and its 10.M Electrical repairs or additions: 3.❑ 1.am a homeowner doing all work officers have exercised their 1 LE] Plumbing repairs or additions myself. [No workers' comp-. right of exemption per MGL 12.❑ Roof repairs insurance required;]fi C. 152, §1(4) and we have no employees. [No workers' 13.0✓ Other insulafiorr. comp.insurance required], *Any applicant thatchecks box#,I must also Fill out-the section below shoat°ing their x.iorkers'compensation.policy information. t.Homeowners who submit this affidavit indicating.they are doing all work and then.hire outside contract9m.mustsubmit a new affidavit indicating such;. -0Contractors that-check:this box-must attached an additional sitieet show'ng the name ofthe sub-conft=tors Arid>state whether .or iiot chose entities have employees: if the sub-contractors have:empioyees,they must provide their.workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the:poliev and iob site infortrtation. .Insurance Company-Name: Wesco Insurance Company Policy.#or`Self-ins.Lic.#: WWC3085633 _ . Expiration'Date: 04/09/2015 C1 . Job.Site Address: �� 1 rJj fi _C �GI City/State/Zip:_ cCL 1/ 15 Attach a copy of the workers'compensation policy declaration page(showing the policynumberland 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'S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form.of a STOP WORK ORDER acid afine of up to$250.00 a-day against the violator. Be advised that a copy of-this statement;may be forwarded to the Office of Investigations of'the D1A for insurance coverage veriticafton: I do hereby certi under the pains and penalties of er' that the information provided above is true and correct Sienature: _. _ Date Phone#: 50'$=39$-0398- Ofcial use only. Do not write in this`area,to be completed by city or town nffcial: 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#: DATE(MMmDIYYYY) .4COR'l7° CERTIFICATE OF LIABILITY INSURANCE 4/14/2.014 THIS CERTIFICATE IS ISSUED AS AMA TTER;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(les)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: Colleen. Crowley Risk Strategies Company PHONE (781)986-4400 AG No:(781)963-4420 15 Pacer a Park Drive AnDRSS-z. Suite 240 INSURER(S) FFORDINGCOVERAGE NAICi .. Randolph MIL 02368 . P INsuRER:A:Selective Ins.., oE' AmericaINSURED . INSURERR.:Safety Insurance. C an 3618, Cape Save Inc _ INSURER C-.Wesco Insurance Company 7 D Huntington,Ave INsuRERD: INSURER E: _ South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1441475243 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 18 SUBJECT TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS OF SUCH.:POLICIES.LIMBS SHOWN MAY HAVE'BEEN REDUCED BY PAID CLAIMS. �TR TYPE OF INSURANCE INRR POLICY.NUMBER. POLIO EFF MPOMI�-EXP -YYYJ LIMITS GENERAL:LIABiIny EACHOCCURRENCE $ 1,006,000 DAMAGE TO REM= X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A 4 LAIM5Iv1ADE FX OCCUR 1994480 0%16f2013 0/16/2014 Mp(MY one person} $ 10,006 PERSONAL&ADV INJURY' $ 1,000,000 GENERAL AGGREGATE $ 2,.000,00.0 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICE rXjPRO- X, LOC AUTOMOBILE LIABILITY .... . ._..._. ... ._... . ..... ........ ,. . ,.I I I,.. Ea accident 1,000,000 B .IR ANYAUTO BODILY INJURY.(Per person) $ ALL OWNED ;.X SCHEDULED 208200 1./6/2013 1/6)'M14 AUTOS AUTOS BODILY INJURY(Per aocident)NOWOWNED $ HIRED.AUTQS X AUTOS Pe�a�CandentAGE . X UMBRELLA LIAB X .... _.. ._.._ OCCUR EACH OCCURRENCE $ 1,OOO.,O00 A EXCESS LIAB :CL4IMSMADE` AGGREGATE. $_. 1,000„000 I 1994480 O/16/2013 0/16/2014 DED fiETENTiON I C WORKERSCOMPENSATION. ff cars Included For X VCSTR7U TH- AND EMPLOYERS'LIABILITY YIN. - ` TORY LIMITC R ANY PROPRIETOR/PARTNER/EXECUTIVE overage E.L.EACH ACCIDENT $_ 500,000 OFFICER/MEMBER EXCLUDED? �NH) : NIA 3085633 /9/2014 /:9/2015 (Mandatory describe and E,L DISEASE-EAEMPLOYE -$ 500,000 If s;describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT.'$ 500 0aO DESCRIPTION.OF-OPERATIONS[LOCATIONS I VEHICLES(AttachACORD 101,Addttional RemarksSchadute,If.more spaceasrequlred) Issued as evidence of .insurance. Issued as evidence of insurance:. T,hielsch ;Engineering, Inc.: is listed as additional insured as respects General Liability as required by written contract... CERTIFICATE HOLDER CANCELLATION / a ISO110CApelightcompact.Org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE<POLICY PROVISIONS.. Cape Light Compact Attn: Margaret Song PO BOX 427/SOH AUTHORIZEDREPRESENTATIVE 3195 Main Street Barnstable,,:.:MA:...0263:0 chael Christian/CLC - -�" = ACQRD 25(2010105) 019.88-2010 ACORD CORPORATION: All,rights reserved: INS025(zoloos.o? The;ACORD;name and logo are regi§tared marks of ACORD 77 Office of Consumer Affairs and Business Regulation r` 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement . bntntrrktor Registration ma . ..� Regis4ra ton: 171380 { � Type: Corporation: Expiration. 3%14/2016 Tr#. 249649 CAPE SAVE INC. WILLIAM MCCLUSKEY 7-D HUNTINGTON AVENUE ' 3 SOUTH YARMOUTH MA 02664 xx Update Address and return card.Mark reason for change. Address scA 1 c, zone-o5n ❑' ❑;Renewal ❑ Employment ❑Lost Card _______ 'Vlie�anvinaarturetc�a�C�/llab;tcujuaeGta •_ �� Office of Consumer Affairs&Business Regulation-: License or registration valid for individul use only" x before the ex iration date. If found returnto: OME°IMPROVEMENT CONTRACTOR. '` <x � P , egistration: 171380 Type:' Office of Consumer Affairs and Business Regulation ' -- Expiration 3/1 /4 2010 ' Corporation ; 10 ParkPlaza" Suite 5170 Boston,MA 02116 IT CAPE SAVE INC. �r r l a ga WILLIAM MXLUS EY �� a 4 r 7-D HUNTINGTON AVENUE m` SOUTH YARMOUTH,MA 02664 Undersecretary" " Not vali tthout signature. s I— - Massachusetts-Department of Public Safety" Board of Building Regulations and Standards Construction Supervisor Specialh License: CSSL402776` WILLIAM J MC CLUSI[�']' - 37 NAUSET ROAD s West YarmouthlAA 0267� r ' ,A Expi"ration " Commissioner 06/28/2615 I , F E I _ �v q Building Permit Authorization I, David Formato , as owner hereby give my permission to Cape Save, Inc. 7-1)Huntington Avenue South Yarmouth,MA 02664 Office:508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 14 Fiddlers Circle Hyannis, MA 02601 Signed Date 9/28/2014 Town of Barnstable Regulatory Services Richard V. Scali,Director • t Building Division BMWSeABLFE + 9 MAM Tom Perry,Building Commissioner s639. iOTEo 3,t s 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 48,-790-6230 Approved:_,efi- �J Fee: Permit#: c,? D 1 `-f D 6 ff3 � HOME OCCUPATION REGISTRATION - -j -� - ---- --.. - - - - - - - Date: 10 Name; N y)n e— l a+Q a V16 Phone#: Address: F--i ( d 1-e rs C tY c Le Village: H-L/,,-�r)n I.S Name of Business: QV-6 Vl 12M� 1AJ 1j V 1 —Ar rl 1 -C Type of Business: BSI U(Go i) IMap/hot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van.or one - pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. ® No sign shall be displayed indicating the Customary Home Occupation: a If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit I;the undersigned,have read andagree with the above restrictions for my home occupation I am registering. Applicant (�lYl/L�' /Y ' Date: HnmenrAor.. Rev.10R11 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St.,.Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: I I a v 1 Fill in please: t " APPLICANT'S YOUR NAME/S: �--e- C a �� 2 rev WEN 16���T.Y N4�jG ly� �.��YI �� BUSINESS YOUR HOME ADDRESS: 1-d E(J d Iers C iYC e _ " �r f TELEPHONE # Home Telephone Number •w w�teA,rfut.d`L�Nfr�''ox-lao7p-. � .. ,.—+w, r-�+++M..;.. NAME OF CORPORATION NAME OF NEW BUSIN ESS � ��z�t 1%U�1 ra r1 i ° TYPE OF BUSINESS P SSA 0 �� I ��O r IS THIS`ia HOME OCCUPATIONS `YES �'� ADDRESS OF.B,USINESS � ' . C:I'� � hl MAP/PARCELNU.MBER . � � (A�i es kiY��x q� it I�+ When starting a new business there are several things you must`do in order to be in compliance with the rules and regulations of the'. t)f Barnstable. This-form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make scare you have the appropriate permits and licenses required to legally operate your business in this town. O 9. BUILDING COMIyIISSID ER'S OFFICE This individual ha!s a infor ' d oaa p mit requir ments that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION =MULES AND REGULATIONS. FAILURE TO Aut f;d n ** 17;CIAPLY MAY RESULT IN FINES. OMMENT • I' . 2. BOARD O HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* I+ COMMENTS: �✓ 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* p� COMMENTS: U t ' l,. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION o It ZY6 Map Parcel TOVIl 0 c fat j application # Health Division Date Issued l a} 101 10 ' ? Conservation Division application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board I x 14, ;y Historic - OKH _ Preservation / Hyannis Project Street Address 14 F 1' M Gro°ddW Village Y Owner Q, ���, d Address Ilk Telephone Permit Request CO& Square feet: 1 st floor: existing propose 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio f�b`OD Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name fl \ Telephone Number Address 2, t License # °alb I Home Improvement Contractor# aVOY Worker's Compensation # ALL CONSTRUCTION DEB I RES LTING F O Tj nIIS�,PROJECT WILL BE TAKEN TO SIGNATURE DATE �� ` FOR OFFICIAL USE ONLY T l (APPLICATION# t DATE ISSUED t MAP/PARCEL NO. r. ADDRESS VILLAGE C • OWNER 1 4 i ; i - DATE OF INSPECTION: i . r FOUNDATION L . t FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. � rrr The Commonwealth of Massachusetts ^i Department of Industrial Accidents Office of Investigations rHLIL }� 600 Washington Street {' Boston MA 02111 c www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information a 1 0 11 A A A Please Print Le 'b! Name(Business/Organization/Individual): N14 V&K )a Address: City/State/Zip: S, 9"WDA Phone #: sa Are ou an employer?Check the appropriate box: Type of project(required): 1.'( I am a employer with �/ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full.and/or part-time).* have.hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.[:1 Electrical repairs or additions required.] officers have exercised their. 3.❑ 1 am a homeowner doing all work 'right of exemption per MGL 1].❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t.. employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#I 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. fi�i� Insurance Company Name: Policy#or Self-ins.Lic.#: �1J111 64 Expiration Date: 2 Job Site Address: City/State/Zip: ' 0164 Attach a copy of the workers' compensation pol y 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$1,500Aday or one-year imprim sonent, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00ainst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations offor insurance coverage verification. I do hereby certi n r the pains and penalties of perjury that the information provided ov is true and correct Signature: Date: 1110 luI2� Phone#: D �(�� ®L Jn 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#: Information. and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,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 employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an.employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license 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 commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situati on and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit foryou to fill out in the event the Office of Investigations has to contact you'regarding the applicant. Please be sore to fill in the permit/license number which will be used as a reference number: In addition,an applicant that must submit multiple pefmit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write`.`all locations.in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like 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: The.Commonwealth of Massachusetts.' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 Qr 1-877-MASSAFB Fax# 617-727-7749 Revised 5-26-05 www.mass..gov/dia ,aco CERTIFICATE OF LIABILITY INSURANCE DAT9/09/2011 Y) 09/09/2011 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: Mark Sylvia Insurance Agency PHONE FAX 771 Main Street Alc No E:t: 508 428-0440 Alc No: 508 420 9227 ADDRESS:mark marks Iviainsurance.com OSterv)Ile,MA 02655 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Farm Family Casualty Insurance INSURED INSURER B Niall Hopkins Builders,Inc. 118 Lakefield Road INSURER C PO Box 231 INSURER D: South Yarmouth,MA 02664 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. ILICY EXP �TR TYPE OF INSURANCE NSR WVD SUBR POLICY NUMBER MMIDDY/YEYri MM/DD/YYYY LIMITS A GENERAL LIABILITY 20011-6275 10/30/2010 10/30/2011 EACH OCCURRENCE $ 1,000,000 TO X COMMERCIAL GENERAL LIABILITY DAMAGES(RENTED PREMISES Ea occurrence) $ 100,000 CLAIMS-MADE FOOCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000 Cj X POLICY PRO JE LOC $ A AUTOMOBILE LIABILITY 2001 C53575A 6/25/2011 6/25/2012 EO a811NdED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ 1,000,000 ALL OWNED SCHEDULED BODILY INJURY(Peraccident) $ 1,000,000 AUTOS x AUTOS NON-OWNED PROPERTY DAMAGE $ 1,000,000 HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION 2001 W6459 9/8/2011 9/8/2012 WC STATU- I X OTRH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED?. N N/A (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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Carpentry,Electrical CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD a Al �. OWNER AUTHORIZATION FORM , (Owner's Name) owner of the property located at 1 E G S Cl 0-c(% , (Property Address) 2(.01 (Property Address) hereby authorize 1 Gt NO:,,. )C- ?J �1 W (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my.property. Owner�f'Signature Date r _:� .. 11:f�.acl�a�sctt� - Utrp vinaent j I'tiblu _ BOMA of Bttiltlin�-Rc,uiatimis stnzl�t widar'th Construction S€, r ttsar t_ir +tse: Lice;se: CS 84916 l NIALL J HOPKINS BOX 231 SOr YARMOUTH;MA 02664 Expi�atio rl: 41212013 Try: 14504 r. . .. // oarrr r un�i r,a /J��,eac�uf�eli Office ofi or�ume � airs`�B inc� egivatIon License or regiitratlon Valid for mdiv idul use only ( 1 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return Registration 161773 Type.: Office-of Consumer Affairs and Business Regulation �4 r t / E�cpiratlon: 1,1120/2012 Private Corporatiotr l0 Park Plaza-Suite 5170 .r Boston;;V1A 021 6 i Nlpl L HOPKINS BUILDERS,INC. MALL HO.PKINS. 21 G FRUEAN AVE SOUTH YARMOUTH:MA 02664' __ Ondersecreta'ry Not gal' without Signature i i i i t 110a29 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma v v Parcel Application # 70 L& 0�� p pp Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 2 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 14 Fiddlers Circle Village Hyannisport Owner Brent Stephens Address same Telephone 774-487-4800 Permit Request air sealing, insiOntp open artir (E-49) , weatherstrip the attic arrPGG hatch and install polyethylene over open ground in basement Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2200 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: d6xisting 0 new,. size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: _T Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ = ; Commercial ❑Yes ❑ No If yes, site plan review# nr" Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RISE Engineering Telephone Number 401-784-3700 Address 1341 Elmwood Ave. Cranston. RI 02910 License # 100459 Home Improvement Contractor# 120979 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE IL Erik Nerstheimer for RISE Engineering y FOR OFFICIAL USE ONLY t APPLICATION# DATE ISSUED MAP/PARCEL NO. 1 ADDRESS VILLAGE E OWNER a T DATE OF INSPECTION: FOUNDATION:'_ fi E FRAME INSULATION, FIREPLACE :a ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL .z GAS: - ,F_T ROUGH . " FINAL IFINAL BUILDING rt ¢t_ 'f. 4 DATE CLOSED OUT s - ASSOCIATION PLAN NO. ; r , � r w _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600.Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Dame(Business/Organization/Individual): RISE Engineering a division of Thie1sch.Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone#: (401)784-3700 or 1-800-422-5365 Are you an employer? Check the appropriate box: Type of project(required): 1.N I am an employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance. $ 9. ❑Building addition required] 5.0 We are a corporation and its 10. ❑Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL 11. ❑Plumbing repairs or additions insurance required] t c. 152, § 1(4),and we have no 12. ❑Roof repairs employees. [no workers' 13. T& Other Insulate comp.insurance required.) *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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: The Preston Agency Policy#or Self-ins.Lich.#: 3373�0J961-00 Expiration Date: 1/1/11 Job Site Address: �T ,r I�(/� d 1 J G City/State/zip:_N an✓i I J 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 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 $250.00 a.day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certi and the ins �_enalties ofperjury that the information provided above is true and.correct. D Signature �- Date: Print Name: Eri_k_Nerstheimer Phone#(401)784-3700 or 1 800 422 5365 PxtI13 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): LBoard of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: I ACoxD CERTIFICATE OF LIABILITY INSURANCE OPID 4-7OATE(MMlDDrYY(Y) —Y PRODUCER TH IEL-1 09/13/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Preston Agency, InC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 13SO Division Rd Suite 303 HOLDER'.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Greenwich RI 02818-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE INSURED NAIC INSURER,A: Zurich-American Ins Co. Thielsch Engineering, Inc INSURER B Ll.bll ty A..r.lc.n cusrant.•Thielsch Group Inc- INSURER North American Capacity Hi Tech Realty Inc. `------- 195 Fran(tes Avenue INSURER Hartford In51]SanCe Company Cranston RI: 02910 INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN)ICATED.NOTV✓I'fHSTAI`IDING ANY RECUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCL"&TTl VITH RESPECTTO WHICH THIS CERTIFICATE WAY 8E ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY POLICIES DESCRIBED HEREIN IS SUBJECT'TO ALL THE TERMS,EXCLUSL0 AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . MbN j4UU . LTR INSRC TYPE OF INSURANCE PODGY NUMBER PATE TFFE T DATE f m - LIMITS TX GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 COMMERCIAL GENERAL LIABILITY 3730962-00 04/01/10 01/01/11 PREMISES(Ea cwncal .4300,000 CLAIMS MADE D OCCUR' MEO EXP(Any.one person) b 1 0,000 PERSONAL&ACV INJURY S 1,000,00o GENERAL AGGREGATE s 2,0 0 0,0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X .jE 4 LOC PRODUCTS-COMP/OP AGG $ 2,0 O 0 ,O O 0 - Emp Ben. 1,000,000 AUTOMOBILE LIABILITY � - A. X ANY AUTO COMBINED SINGLE LIMIT 3730963-00 04/01/10 01/01/11 (Ea accident) y2,000,000 ALL OWNED AUTOS -- S. SCHEDULED AUTOS BODILY.INJURY per on) on) HIRED AUTOS NON-01 — BODILY INJURY NNEG AlJTOS (Per accidant), PROPERTY DAMAGE S ?Per acciaenq GARAGE LIABILITY AUTO ONLY-EA ACCIDENT g ANY AUTO OTHER THAN C-AACC $ AUTO-ONLY' AGG EXCESS(VMBRELLA LIABILITY EACH OCCURRENCE S 10,000,000 B X OCCUR �CLAIMSMADE UMB 9263637-00 04/01/10 01/01/11 -AGGREGATE 510,000,000 DEDUCTIBLE g X RETENTION S 1D,0 0 0 4 -- WORRIERS COMPENSATION AND I,- EMPLOYERS'11ABILITY X I TORY LIMITS EF, A VNYPROPRIETOR/PARTNER/EXECUTIV= 3730961-00 04/01/10 01./01/11. F.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-.EA EMPLOYEE 3 1,000,0 0 0 If yedescribe under � _ _ SPECIAL PROV151 ONS below E.L.DISEA.S"E-POLICY LIMIT S 1,000,000 OTHER c Professional L'iab DVL000026800 04/01/10 04/01/11 Prof Liab 2,000,000 D � Leased/Rented EqD 02UUNTD5678 04/01/10 04/01/11 Equipment 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESE V ACORD 25(2001/08) @ACORD CORPORATION 1988 -- �iOTEP�[� Also for RISE Engineering, a division of Thielsch Engineering,. Inc. Gaskell Associates.; a division of Thielsch Engineering, .Inc. $AL Laboratory; .a division of Thielsch Engineering, Inc. ESS Laboratory, a division of Thielsch Engineering, Inc. ALCO Engineering, a division of Thielsch Engineering, Inc. Water Management Services, a divison' of Thielsch Engineering, Inc. 91te O ice o nsumerKnqa4nuWs1n4esse0gu1a*tion 10 Park Plaza- Suite 5170 Boston, l�qssachusetts 02116 Home lmprove� ontractor Registration - Registration: 120979 Type: Supplement Card z w Expiration.: 3/25/2012 THIELSCH ENGINEERING M ERIK NERSTHEIMER M > 1341 ELMWOOD AVE. CRANSTON, RI 02910 Update Address and return card.Mark reason for change. ❑ Address Renewal Employment R Lost Card DPS-CAI 0 50M-04/04-GIO1216 ,tom ✓fie C�ary�mo�i�ea ay✓aGaaaac�ucae�d Office of Consumer Affairs&Bu iness Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration, b�g79 Type: 10 Park Plaza-Suite 5170, Expira —^'12 Supplement Card Boston,MA 02116 THIELSCH ENGQ '=i i4i -- —_ JA ERIK NERSTH 1341 ELMWOOD - A' g CRANSTON; Ri 029 Undersecretary Not valid without signature 1 ra6e10I1 The Official Website of the Executive Office of Public Safety and Security (FOPS) Mass.Gov Home Public Safety Department Of Public Safety Licensee Complaints License Type Construction Supervisor License# 100459 Restriction WS,IC Name Erik Nerstheimer City, State, Zip North Scituate, RI, 02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Back To Search 1:.:..� ..:. Board of Building Regulations and Standaiq License or registration varW'for individ.ul use only HOME IMPROVEMENT CONTRACTOR �' i i before the expiration date. If found return to: RegistratiP-hi t 120979 Board of Building Regulations and Standards -P .25/2010 3 1 ''. ,. One Ashburton Place Rm 1301 T ? ^ a. 02l08ype'Sp :P- i. IELSCH ENGIJVE-E_f-.*i. �V•`- -~ IK NERSTHEIM11 R-- 11 ELMWOODE` = ANSTON, RI 02910 �=� i(... Administi::uor - ---- Not valid without signztire http://db.state-.ina.us/dps/llcdetalls.asp?tXtSearchLN=CSL1 00459 ` n 1 u � fuyY Cn 4�t} it J Ida 5 fi i d � k i' T 1•w_ I , RISE ENGINEERING Federal 10 05.0405629 in Contractor Registration we Sim A division of'Thielsch Engineering NIA Contractor Registration No 120970 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,RI 02%0 �! (40,1)7843700 FAX t401)7t143710 CONTRACT R S E Fie .. Tr1IS COM'RACT IS ENTERED Ieaa BETWEEN RISE - ENGIN13MING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER -------- PHONE --i_—.�.—DATE - C11"t Brent Stephens (774)487-4800 11/08/2010 110129 SERVICE STREET MUJNG STREET 14 Fiddlers Circle 14 Fiddlers Ci SERVICE CITY,STATE,AP — --�..—.— --� Ba.LING CRY,3TATE,Zr HyanNisport,MA 02647 Hyanisport,MA 02647 JOB DESCRIrrroN RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage, This work.will be performed in conceit with the use of special tools and diagnostic tests to assure that your.home will be left with a healthful level of air exchange and indoor air quality..Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows ace not generally addressed.) This work will be performed at the Tate of$66 per man per hour,which includes materials and testing. 13 man hours. $858.00 RIBE Engineering will provide labor and materials to:install a 14"layer of R-49 Class I C.elh dose added to 1092 square feet of open attic space. $1,528.80 RISE Engineering will provide labor and materials to install insulation and weatherstripping to f attic access hatch(es). $25.00 RISE Engineering will provide labor and materials to install 589 squares feet of 6 nil polyethylene over open ground in designated crawlspaee%ardien basement auras. $176.40 RISE Engineering will apply all applicable,eligible incentive&to this contract. You will.be billed only the Net amount. Currently,for air sealing measures,the Cape light Compact offers a 100%incentive. �1158.00 RISE Engineering will apply all applicable,eligible incentives to this Contract. You will be billed only the Net amount+ Currently,under the landlord program,for eligible measures,the Cape Ight Compact offers a 100%incentive,not to exceed$2,.000 percalander year. -$1,730.20 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE Bi ACCORMANCE WITH ABOVESPECIFICATIONS.FOR THE SUM OF ***00/Dollars $0 00 UPON FINAL OMECTKWAW APPROVAL BY RISE EHa1POWW G•CUSTOMER AGrXESTO M3W MMW W-M iNFUe!_N"MMT OF#%WILL SE CNAR M WWHLY Olt ANY UNPAID BALANCE AFTER 90 DAYS.BEER-4MSE FOR IMPORTANrVW*RgAnoN ON GUARANTEES,RKWTS OF ROCISION,SCHEDULING,NO CONTRACTOR REGISTRATION. -- DO NOT SIGN THIS CONTRACT IF THERE ARE ANY ALAW SPACES AUTitOR�osIONATURB-RISE eIaDrssR,NG ACCEPT NOTE:THIS CONTRACTMAY SE WITHDRAWN BY US IF NOT ErECUFED WrrmN DATEOF ACGEPrANCE. �BIVI ACC�TAt�E OF l Ot1iRACT• S.SMCSTCAMM Alp CONDO ARE DAYS. - SATiSFACTORYTO US AND ARE HEREBYACCEPTED.YOU ARE AUTHOPAMD TO D0 THE WORK AS SPEC!nED.PAYM M WILL BE MADE AS OUTLINED ABOVE . <.; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a T 1LMap �.� Pa e �Ce^( Permit# 37 G r s_ Health Division Date Issued Conservation Division Fee o2Sr c0 &4,L Tax Collec r-�. Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis c _. i • Project Street Address Village PdS/ Owner a L - Address � lloerui� «6 ree -L ;d Telephone _ Permit Request /J Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay 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 On Old King's Highway. ❑Yes :;5,1 o 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 BUILDER INFORMATION Name �,�IGI,��L,� Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE FOR OFFICIAL USE-ONLY� y PERMITi DATE ISSUED 'r MAP PARCEL NO. % •_' 71 v. ADDRESS � s s"i VILLAGE OWNER DATE OF INSPECTIOI _k • Pr _ FOUNDATION 4 _ , FRAME — INSULATION FIREPLACE f r ELECTRICAL: ROUGH 4 FINAL r , PLUMBING: ROUGH FINAL f - GAS: ROUGH FINAL FINAL BUILDING }DATE CLOSED-OUT ' 442 -3 10-D ASSOCIATION PLAN NO. +' i' r V e Town of Barnstable Department of Health Safety and Environmental Services r' Fo ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Cresm Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ; T e of Work: ����r Estimated 6721:90,yp Cost � i Address of Work: Owner's Name: Date of Application: �f / I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied ,Kwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR Date er's Nam q:forms:Affidav --- --- The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnaestigatiaes 600 Washington Street �r Boston Mass. 02111 Workers' Comiensation Insurance Affidavit ffranriltt{nrnralxtxu; name: location: 7, city hone I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. comnnny name: address: city: phone#- insurance co. policv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the follo«ing workers' compensation polices: company name: address: city: Phone* insurance ca. /////////////// / camnanv name: .::.:.:... address- cih- ... phoneM imurance co. :..:,;.;:. ,;::..;.>. olicv# Ell I Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Me up to S1.500.00 and/or one vears'imptisottment as well as civil penalties in the form of a STOP WORK ORDER and a tine of 3100.00 a day against me. I understand that* copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage vetiIIcation. 1 do hereby certify uA&P the pains and penaltiu ojpe ' at the information provided above is truce and coned Signature �j Date 1 _ Print name /1 Fai C � �� Gff 1/ Phone tl 7 79--��7� SIR official use only do not write in this area to be completed by city or town official city or town: permit/Rcense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's OMce ❑Health Department contact person: phone#; ❑Other (mvuw 9,95 PIA) Information and Instructions , Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under anv coax-.:" of hire, express or implied, oral or written. An employer is defined as an individual partnership, association, corporation or other legal entity, r ore P P� � rp g lily, o any two or m or the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive: trustee of an individual,partnership, association or other legal entity, employing employees., However the owner of a e use dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. - MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews: of a license 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,neither the . commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of inz,rance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the'law"or if you are required to obtain a workers' compensation policy,please call the Department at the munber listed below. City or Towns 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 fill out in the event the Office of Investigations has to contact you regarding the applicant. PIease be sure to fill in the permidUcense number which will be used as a ice number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have bees made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Departmeat's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of lavesduatlons 600 Washington street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 e Town of Barnstable °FVE Department of Health Safety and Environmental Services r a Building Division a � 9B&AMSTABIMEg" 367 Main Street,Hyannis MA 02601 1639• ArFG MA'I A Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION C� Please Print DATE: � / � / 9 JOB LOCATION: / r num r street CC village "HOMEOWNER": �2 � —Oe- 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 building permit. (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 mmimu inspection procedures and requirements and that he/she will comply with said procedures and req ' e 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPT