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0016 GENERAL PATTON DRIVE
�� �, _,� �� , ' �� � � a .� Town of Barnstable ' Approved Plans Must be Retained on Job and Building this Card Must be Kept it rnx.�itrn , , �PostThis Card So That it is Visible From the Street- pp pt MAF& 'Posted Until Final Inspection Has BeenMade. r �y. �� 059 A� 1 Where a Certificate of Occupancy is Required,such Building shall Notbe Occupied until a Final Inspection has been made Permit NO. B-19-789 Applicant Name: Wojciech Piwowarczyk Approvals Date Issued: 03/15/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 09/15/2019 Foundation: Location: 16 GENERAL PATTON DRIVE, HYANNIS Map/Lot.: 292-128 Zoning District: RB Sheathing: Owner on Record: BARNSTABLE HOUSING AUTHORITY Contractor Name: _WOJCIECH J PIWOWARCZYK Framing: 1 Address: 146 SOUTH STREET Contractor License: CS-076146 2 HYANNIS, MA 02601 d Est. Project Cost: $ 15,500.00 . Chimney: Description: Roof replacement at Scattered sites Permit Fee: $79.05 Insulation: I Fee Paid: $79.05 Project Review Req: Date. 3/15/2019 Final: Plumbing/Gas r-- Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months aftee issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street orroad.and shall be maintained open for public inspection 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 thispermit. Minimum of Five Call Inspections Required for All Construction Work:; Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 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 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: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department Final': All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �`� Town of Barnstable Buildin PostTh�s Card So That�t isVisibletFrom the Street Approved Plans Must be Retained on,Job andthis Card Must be Ke t .`• Bnit'A`f3ewBL6. s ` Posted Until'Final IrspectnHas Been Made 'i' a a +.a Where�a Certificate of Oecu anc":his Re aired,such Bwld�ri sFiall Not be Occu ied:unt�l`a�Final,lns ectiori has been:made ., ei mit Permit No. B-18-4082 Applicant Name: WILLIAM J. FOGARTY III Approvals Date Issued: 01/04/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 07/04/2019 Foundation: Residential Map/Lot 292-128 W Zoning District: RB Sheathing: Location: 16 GENERAL PATTON DRIVE, HYANNIS , Contractor;Name: ;WILLIAM J. FOGARTY III Framing: 1 ��.. Owner on Record: BARNSTABLE HOUSING AUTHORITY Contractor;L►cense 179717 Address: 146 SOUTH STREET r 2 ' Est ProJest Cost: $20,000.00 Chimney: HYANNIS, MA 02601 �, Permit Fee: $ 152.00 Description: remodel existing bath & up date fixtures, repair rotten studs where Insulation: b * �. Fee Paid = $ 152.00 needed. No movement of fixtures. remove window to n tall Final: fiberglass tub unit. reinsulate outside wall&cellmg,�new walls,trim 1/4/2019 flooring b ; Plumbing/Gas Project Review Req: £ � Rough Plumbing: �:' xE Building Official Final Plumbing: b x Rough Gas: I. �. AllFinal Gas: This permit shall be deemed abandoned and invalid unless the work authorized bythis,.pe,rmit is commenced within six'Aonths after,issuance. Electrical All work authorized by this permit shall conform to the approved application and the-approved_construction'documents'for,whic#i ihis 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. Service: This permit shall be displayed in a location clearly visible from access street or toad and shailibe rnaintamedopen for publicjmspection for the entire duration of the work until the completion of the same. ,> Rough: The Certificate of occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Final: Minimum of Five Call Inspections Required for All Construction Work: Low Voltage Rough: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage 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 Health 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Final: 7.Final Inspection before Occupancy Fire Department Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Perso Tr ith unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). ~O Application Number..... ..... .... .... ............. '* BABNSPASLE. � , NAM g Permit Fee.......................................Other Fee........................ 1639. FO Mfg 6 Total Fee Paid.... ........................................ ...... TOWN OF BARNSTABLE Permit Approval by...... .........On.A�!1.OT... BUILDING PERNUT Map............ ./... ......Parcel...........lc�r................... APPLICATION Section I — Owner's Information and Project Location Project Address jqt„ 1� Village ,S err Owners Name Y1� D��o� ' r kC ° Owners Legal Address� �Nnr„_ 14 2018 .... City. �'-I)/�(1��e� State Zip oc�@ OFFIce 4 Owners Cell#,., 508 - 7 71 - `72 a A E-mail I br�� — �i �V V I(i r .1MD Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ® Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ` ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description e PA Ix IznyYff0i S,Tv Cs WrA re,Rr WJV�flEfa mC�U►EM�� o� �`XTv�' _ )Ub C�Nj► Last updated 11/152018 Application Number.................................................... Section 5—Detail Cost of Proposed Construction D0,006 Square Footage of ProjectZ7 Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design 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: . I amusing a crane ❑ Yes ® No Section 7—Flood Zone Flood Zone Designation { Within or adjacent to a wetland, coastal bank? Yes ❑ No a 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: 11/15/2018 Commonwealth of Massachusetts ® Division of Professional Licensure Board of Building Regulations and Standards Construction l Ma me 1 & 2 Family GSFA-064245 i��ires 10/28/2020 Spa '0r WILLIAM J FQ�CaAR3, if y u 46 VERMEERET fi OSTERVILLE M/ OZ k5 • �3 �ao. r�14;ti".ISO, Commissioner �:e rPaoranio?eweu�l/e a�C��,aagcr�u�e%�t Office of Consumer Affairs&Business Regulation { ` HOME IMPROVEMENT CONTRACTOR ? R-eg-isttation valid.for individual use only TYP alndividual before the expiration date. If found-re#urn to e i r Expiration Office of Consumer Affairs and Bus, ess Regulation 17 17 09/01/2020 i 1000 Washington Street-Suite 7i6"' WILLIAM J.FOGA•F3d#la' E Boston,MA 02118 W ILLIAM J.FOGAFII'YJ 46 VERMEER CT 5 ' OSTERVILLE MA 026 5 of Undersecretary valid without signature , A u,+04 n � 5 a ' 9CJ(VIdIH 9 - 9 r JV, J © a KtT CA55 46�I-) CD 09 Ban-IS -nv D- d7c)=-J'�-j I A i I I i C C W o o Io �® C8 f R\ �'�:'y �4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganinWon/Individual): W 1 L C,t A m 7 Fe as w i y es Address: VEZY)ECE-a 4 Co v R City/State/Zip: �t c,t_� I� Phone#: -50 4 _6)1 y� Are you an employer?Check the appropriate box: Type of project(required) L❑ 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.X I am a sole proprietor or partner- listed on the attached sheet. 7. Z Remodeling ship and have no employees These sub-contractors have g. ElDemolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.: required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.El officers have exercised their I am a homeowner doing all work 11.El Plumbing repairs or additions myself[No workers right of exemption per MGL comp. p p 12.❑Roof repairs insurance required]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also M out the section below showing their workers'compensation policy information. t Homeowner;who submit this affidavit indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of tare sub-rontractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify Jc the pains and penalties of perjury that the information provided above is true and correct. Si afore: Date: IaZ-61_020/e Phone#: JDST- S�r2�'�6ya2- C'E« 503 - 737/ 9// 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.EIectrical 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 situation and,if necessary,supply sub-contractor(s)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 for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/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 In&stciai Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4400 ext 406 or 1-877-MASSAM Fax#617-727-7749 Revised 4-24-07 www.maw.gov/dia Application Number........................................... Section 9- Construction Supervisor Name W 1 LL-w A rn 7, �oc,,A P-y -" Telephone Number 50,3- (-IoZ B-0617 2 Address L)6 omprz T City EAU�-trv- State Zip 0126,515 License Number CSFp-06L1 a�1,5 License Type Expiration Date /O R0a0 Contractors Email C) 7 FQ A i A-) , Corn Cell# 5b,9- 737- > 6// 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 b CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor Name f.,t,i u,IA M Fc9 Q P 2-N-Y Telephone Number,f oV-y,�S,!j6`y- Address E ton F CT City TESV► L LE State 1)1(1 Zip 6�6 55 Registration Number )7 9 71 7 Expiration Date 9 J- 1200126 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 re tMR d the Town of Barnstable.Attach a copy of your H.I.C... Signature Date �kC; Z/" o?Gs/F Section 11 —Home Owners License Exemption u Home Owners Name: p,_ �, �or_��,►�r� �:sz rZ Telephone Number c08 - 771 - 79,ag, 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 Date APPLICANT SIGNATURE Signature Date Print Name Z4 Lirk/" A06 ? Telephone Number 226- ���J'���•2 E-mail permit to: Ly m o Co m Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ 1 Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ , Conservation ❑ r fi r• a For commercial work,please take your plans directly to the fire department for approvab j r - i Section 13—Owner's Authorization I, Lai` j 061 Y (VIP as Owner of the subject property hereby authorize to act on my behalf, in all matters relativ to work tho ed by this building permit application for: a �( WA bM { (Address of job) *ie f Owner date rz 1 11011/1) La I Print Name i f i i Last updated 11/152018 Pic Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 2/3/14 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits �4 >a i Dear Mr. Perry, This affidavit is to certify that all work completed for 16 General Patton Drive,Hyannis has been inspected by a certified Building Performance Institute(BPI) Inspector. Ceiling: R-30 cellulose& R-19 fiberglass blanket Walls: R-13 dense pack cellulose All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map &J a. Parcel l a. S Application # Health Division Date Issued ee— Conservation Division Application Fee �f Planning Dept. Permit Fee iA- Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street Address Genec g� Q aJ o a r 1i y ej Village YOUTA,r ^ II Owner �ar�s+a�Ie t6%Ai _ A1AA0f,i Address 146 So,-A St . 1i Y [nn1S Telephone 508 �� th `` Permit Request aA 0 eeh.1o5e oA 'k- 9 ► ctilass ' -e tie. a-VVI1c . 'Pe AM, eacy waN WIX 1�' I ccNkkose. R"c Seal �}�.e. Pn,' 1 c P `a(+� i�li� �°Xua �QQ -"Gm. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 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 I'9 4 5 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) e7 Q o Number of Baths: Full: existing new Half: existing new' Number of Bedrooms: existing _new i Total Room Count (not including baths): existing new First Floor Roo- : Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other 06ntral Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:_W 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 IllruRl GCl tAs�.Q Ca 1 Telephone Number SOB 39 8 03 92 Address 7 - D 6u(Xin�Pr y'e, License # �0�, :F6 5uA'k 1' a'G Home Improvement Contractor# 3 0 Email Worker's Compensation # -T UJ C 3 3 5 3 9 b g ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO )(0.f MtlAA" SIGNATURE DATE V. FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE ` OWNER . DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING •J DATE CLOSED OUT ASSOCIATION PLAN NO. a ,f r' r l-- jam i s 460 West Main Street Housing ®� �� Hyannis, MA 02601-3698 F � Tel: (508)771-5400 Fax(508)775-7434) Assistance Corporation TTY on all lines Cap cod Free Weatherization ! Your tenant has requested and is eligible for weatherization of your rental home through government funding. This will be provided at no cost to you. Program regulations permit us to spend around $2,500- $7,500 'in materials and labor per dwelling unit. Program regulations require us to weather-strip and caulk doors and windows; insulate attics, sidewalls and floors. All work is professionally done by established private contractors. We will conduct a final inspection to make sure that all work is completed to specifications. If you request, you will be informed of the estimated measures before they are done and provided with a list of the actual measures and costs following the completion of the work. We also need proof that you own the property. A copy of a CURRENT TAX BILL OR DEED listing you as the owner will satisfy this requirement. Please fill in all blank areas of the enclosed agreement and return with the proof of ownership as soon as possible. If we do not receive the enclosed form within two weeks, we will do a basic energy audit of the home, but no weatherization work can be recommended or done. If you have any questions please call Suzanne Smith at 508-771-5400, ext. 123 or email her @ ssmith@haconcaaecod.org LANDLORD: 100 TENANT: l �6 OUP email: Set TZ ejee-DeyyV(A ha. h.('"jn,C'jL(,I e ems email: phone:(home) —71I'7c2Q5.. phone:(home) (cell) (cell) I a TENANT/PROPERTY OWNERIAGENCY WEATHERIZATION AGREEMENT 1. The Part' to this &rreemeQj are th following: e� (hereafter known as Tenant), (print your tenant's name) , sa,n c i�iG� (e— (hereafter known as Property Owner) (print your name) and Housing Assistance Corporation (hereafter known as Agency). In consideration of the mutual promises hereafter stated,the Parties agree as follows: 2. The date of Agency's signature will be the effective date of this Agreement. 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at(street, town) � 1_ n VA l S , unit# =, and currently leased or rented to the Tenant: a) Enter the premises for the purpose of performing a Weatherization inspection. b) Enter the premises to perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection of the property and in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas of the building for the purpose of accomplishing the Weatherization work. The Agency and representatives of the Commonwealth of Massachusetts, Department of Housing & Community Development (DHCD) may further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The Weatherization work will be performed in accordance with the Property Owner's consent as further specified below: *** INITIAL ONLY ONE OF THE FOLLOWING*** I consent to performance by the Agency and its contractors of any Weatherization work determined necessary and appropriate by the Agency as a result of its inspection of the property. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of work. I will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's inspection report and a statement of the estimated work and associated value. This additional consent will be sent under separate cover as Attachment A. I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of the work. 4. The Property Owner understands and agrees that any and all work, including related repairs for which the Property may also be eligible, will be performed at the Agency's discretion. The Agency estimated completion of the Weatherization work by the end of 5. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency,the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where the Property Owner receives a written extension from the Agency,time is of the essence in the performance of repairs by the Property Owner. 6. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel supplier/utility supplier as to the quantity of fuel/utilities used at the above address in each of the past three years and the future three years. The information is to be used only to determine the cost effectiveness of the Weatherization Improvements. 7. The Property Owner agrees that the rent for the dwelling unit will not be raised because of any increase in the value thereof due solely to the Weatherization work performed. 8. In consideration of the Weatherization work hereunder, the Property Owner further agrees that upon the effective f date of this Agreement and during a period extending through ,approximately one year from the time the work is completed, a) The present rent $ 4 'G7 _ per month will not be raised for any reason. (The rent amount must be filled in). Heat included in rent?Yes._ No f However,this Paragraph (8a)will be waived by the Agency in writing if,and only if,the premises are leased under a state or federal rent subsidy program, in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. Please state which Housing Subsidy program your tenant is on and through which Agency: Fam(L I Uhtf C',4AS na b) The Property Owner will not institute any summary process action for possession except in the case of non-payment of rent or other good cause related to the Tenant(or any successor Tenant). c) In the event the Property Owner decides to sell the premises, Property Owner shall comply with one of the two requirements below: --The Property Owner shall not sell the premises unless the buyer agrees(with a copy forwarded to the Agency) in writing prior to sale to assume all obligations of the Property Owner set out in this Agreement; or --The Property Owner shall pay the Agency an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed in the premises as of the date of sale. Said amount shall be paid to the Agency immediately upon sale. 9. (Applicable only if Tenant's heat is included in rental payment and blanks are filled in) At the end of the period set forth in Paragraph 8 above,.the rent shall not be raised more than % per for an additional period of one year, and the provisions of 8b and 8c above shall continue in effect for such period. However, the rent provisions of this Paragraph 9 may be waived by the Agency in writing if, and only if, the premises are leased under a state or federal rent subsidy program, in which case the actual rent charged by the Owner shall conform to the standards of the rent subsidy program. 10. The Parties agree that the terms of this Agreement are incorporated into any other lease or agreement between the Property Owner and the Tenant, and between the Property Owner and any successor Tenant, and if there is any conflict between the provisions of this Agreement and the provisions of such other lease or agreement, the provisions of this Agreement shall govern. However, If such other lease or agreement, including without limitation a lease or agreement under state or federal rent subsidy program, contains stronger protections for the Tenant, such stronger protections shall apply. i 11. For breach of this Agreement by the Property Owner, the Property Owner shall reimburse the Agency in an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed on the premises, as well as attorneys fee and court costs. The Property Owner may also be liable for damages to the Tenant in accordance with applicable law; in such instance, the Property Owner shall reimburse the Tenant for attomeys fees and court costs. Without limiting the foregoing, the Agency may at its option terminate this Agreement, by providing written notice to the Property Owner and Tenant, in the event of breach by the Property Owner or Tenant. 12. Performance of the Weatherization work hereunder by the Agency is contingent upon the availability of funds to the Agency from the commonwealth of Massachusetts and the federal government, as well as the eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written notice to the Property Owner and Tenant, if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. 13. The Parties acknowledge that this Agreement is under seal. It is intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a right of enforcement. Property Owner's Signature: ` Date 1,.-26 2013 Phone: J�C�c-- 7W- 1 a oZr�. Address: BARNSTABLE HOUSING AUTHORITY WANNIS,MA OW Tenant Signature,�z v 81 Agency Approved Weatherization Company C, e- All Cape Energy / A7./Cape ncorporated / Alternative Weatherization / Building Performance Contracting Cape Cod Insulationav / Conservision / Frontier Energy Solutions / Lohr& Sons Inc. Resolution Energy Agency Signature Date } The Commonwealth of Massachusetts _ Department of Industrial Accidents 1 ..,..� q:—;1;t Office of Investigations r Jar I Congress Street, Suite 100 Boston,MA 02114-2017 2.r � www.mass.gov/dia 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 box: Type of project(required): am a genera contractor 1.❑ I am a employer with.�� 4. ❑ I l t t and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1.am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity..ca employees and have workers' 9. Building g addition Y ❑ [No workers' comp. insurance comp. insurance.- required.] 5. We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their I I. Plumbing repairs or additions �.❑ I am a homeowner doing all work � p myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑✓ Other Insulation comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. -Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Technology Insurance Company Policy#or Self-ins. Lic.#: TWC3353968 Expiration'Date: 04/09/2014 1 p � Job Site Address. GGnem 1 \ ,Cw rN t` e City/Stat(/Z', ItNOr Attach a copy of the workers' compensation policy declaration page(showing the policy numbe 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of er' ,that the in oruiation provided above is true and correct. Sisnature: ::]Date l Phone#: 508-398-0398 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#: DATE(MMIDDIYYYY) ACCWE0 CERTIFICATE OF LIABILITY INSURANCE 10/22/2013 _ This CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WANED, 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 endorsements). PRODUCER CO Colleen Crowley NAME: Risk Strategies Company PHONE . (781)986-4400 FAC No:(7e1)963-4420 15 Pacella Park Drive E Suite 240 INSURER(S)AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURER A:Selective Ins. of America INSURED INSURERB:Safety Insurance Company 3618 Cape Save, Inc INSURER C:Technology Insurance Company 7 D Huntington Ave INSURERD: INSURER E South Yarmouth M 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL13102268490 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I DDLSUBR TYPE OF INSURANCE POLICY NUMBER POLICY MIDO E POLICY EXP LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE100 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea o cunence $ � A CLAIMS-MADE ❑X OCCUR S1994480 0/16/2013 0/16/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY X PRO- X LOC $ AUTOMOBILE LIABILITY Ea accident SINGLENED LIMIT 1 000 000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 208200 1/6/2013 1/6/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS Peracadent $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS41ADE AGGREGATE $ 1,000,000 DED RETENTION$ Nil 1994480 0/16/2013 0/16/2019 LIM C WORKERS COMPENSATION officers Included for X WCSTATTS OER TH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YINCoverage E.L.EACH ACCIDENT $ 500 000 OFFICER/MEMBER EXCLUDED? NIA /9/2013 /9/2014 (Mandatory In NH) 3353968 E.L DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMrr $ 500 00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Weatherization Specialists GL: Blnkt AI, Blnkt PNC, Blnkt WOS, Per Proj Agg, Per Loc Agg / GL Exclusions: Snow & Ice Removal/OCIP/Wrap Ups CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE chael Christian/CLC � ACORD 25(2010105) Q 1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD " Public Safety low Nlassachuset<s -Department of ding Regulations and Standards Board of Bull Construction Super'i.ur SPcciattv ,tense: CSSL-102776 1 WjLLIAM J MC CLUSIC Ygg 37 NAUSET ROAD West yarmouth MA 02673 i' �x 81 1 06/28/2015 commissioner _0 Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 R = Type: Corporation Tr# 222184 Expiration: 3/14/2014 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 _ Update Address and return card.Mark reason for change. -•- 1 Address Renewal Employment Lost Card DPS-CAI Co 5WA-04104-G101216 ✓le TOonrvnza�ttan¢u�a c '✓l�a%aa�l� License or registration valid for individul use only Office of Consumer affairs&R smess Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR t - e Registration: - 171380 Type: Office of Consumer Affairs and Business Regulation Expiration: 3114J2014 Corporation 10 Park Plaza-Suite 5170 _ Boston,MA 02116 CAPE SAVE INC.77.1.-;.._:,=._,..._ WILLIAM McCLUSKEY: 7-D HUNTINGTON AVENUE.. SOUTH YARMOUTH-MA:,02664 Undersecretary Not valid wit o signs ,4 i Assessor's Office(1st floor) Map 9 Lot / Permit# (� Conservation Office 4th floor Y ( ) ��—�1 � � `�;.J`' `� Date Issued 1 6 'ze Board of Health(3rd floor)(8:30-9:30/1:00-2:00) All Fee Engineering Dept.(3rd floor) House#if /%J.S, f 0�° Planning Dept.(1st floor/School Admin. Bldg.) 4- •'y _as� BARNSTABLE. Definitive PI ,pp ed by Planning Board ` ' 19 "� d�� e i TOWN OF:BARNSTABL .® Building Permit Application Project St et Address J Q, &,,a[F kjq L PA, 61&7 y OfL, (n" Ea, 03t Village H yB NN►.- Owner G&tip sTwbi a Avow ti..'t�� AddressIt Telephone S p F 7`) 1 -?X. L2— Permit Request To Aoo sN V K 4. A 0QaT1dQ T'v Te ldZ 1j?1 J fT)•✓c sleQC 1/rt���ter R n't Total 1 Story Area(include 1 story,garages&decks) y$ square feet Total 2 Story Area(total of 1st&2nd stories) c{ square feet Estimated Project Cost $ X UU0 Zoning District n 6 Flood Plain Water Protection Lot Size Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type Single Family Two Family Multi-Family Age of Existing Structure ErT. 4o a Lir Basement Type: Finished Historic House Unfinished C&,-jc n,tfte SLe..6 Old King's Highway Number of Baths i No. of Bedrooms o� Total Room Count(not including baths) �� First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other uilder Information Name Tele hone N ber w\'? 72 o y �jg-63 Address rV1 QcNtJZq-L (20N CTp2.SI' Liocen s" �® 3 6 4" — �# t s50 0,3 �o e,,� me Improvement Contractor A( +4 4�2e?teA4 Po k`T' AkA- 6a.�4Lker's Compensation#!-3ta- a��4054NEW CONSTRUCTION OR ADDITIONS REQUIRE AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Jzct•y NsTcvbl a SIGNATURE A Ae4,.i1 DATE �v�D 1 9� BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) r FOR OFFICIAL USE ONLY - PERMIT NO. . 9140 - DATE ISSUED '7/2 0/9 5 MAP/PARCEL NO. 292 128 ADDRESS 16 General Patton Drive VILLAGE -Hyannis . _Barnstable Housing r OWNER DATE OF INSPECTION: , FOUNDATION _ FRAME INSULATIO . FI$EPACE ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL 1 • GAS: ROUGH ' FINAL - FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. A 1 .YJ � O NMr rn j D = O O• C I o x ... r.,_ c _ O i 1 , The Town of Barnstable mum �e Department of Health Safety and Environmental Services Building Division 367 Main Strut,Hyannis MA 02601 Offrce: Sob 790-6227 Ralph Crosses Fax: 508775-33" Building Commission For office use only Permit no. Date AFFIDAVIT HOME MoROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reoonstrmction,alterations;renovation,repair,modernization,conversion, improvement,.removal, demolition_ or eonstrucdon of an addition to any pit-e dsting owner 00=00d building containing at least one but not more than four dwelling units or to strnc=es which are adjacent to such residence or building be done by registered contractors,with cutain caceptions, along with other Type of Work: W 60 )CA V 4� t 7`ia Est.Cost. FB o-V Address of Work: V &F Ime r 1 J a T; — O%mcr.Name: T / lna4 j ' Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner-0ocupied Owner,pulling own permit Notice is hereby gi%=that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WrM iJNREGIST D CONiIt ACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE .ACCESS TO ME ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL a 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owmer. B Date Contractor name tion No. OR (N er's name f +` The Commonwealth of?Itassachusetts • •=-• _ 1� Department of Industrial Accidents 0llfceel/ayestlgatloas ;_.` its._•-y•;a 6(1(1 if uslti»g-tun Street Boston.Mass. (12111 Workers Compensation Insurance Afl:davit ,Qj�nlic-e*�tnrn,afinn:_. .. PlCstse PRiN'T'`le�Iy• .. , --•,— name locations �`� SlS �1,IJ 9 r; sin, I wov i e4 fe,(T- II' 0.-) nhnnc{! 1 am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity 1 am an emplover providing workers' compensation for my employees working on this job. rem L , address, Ey _nhnnc#: q C/OV— LIP 0 insurance co. nolicv# Gi G Zr. 7. I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comnany name: address: city: nhone#:Co.nsurance nolicv# � - -.•__T--•- --.. ,s,.•:.:..s..::srvs-=-•ter`--•r-,-as-ryr-RF:u:r•,�,..s •-�!ira_+:re�••ra?�i;•�+`;f�R47rz�h-�•.._..-•7.-.•+.R,-+,+�-•---st comnan•name: address- city: phone#: insurance—co, nolicv# :Attach additional-sheet if nee aZ►ld -.2 IZI N �i.••. a� •�: — Failure to secure coverage as required under Section 25A of h1GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or une%cars'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of5100.00 a day against me. 1 understand that a cop}•of this statement may be forwarded to the Ofrtce of Investigations of the DIA for en-erage verification. I do hereby cerrifj-under t pair and pe allies of peJyart•that the information prm►7ded above is true and correct Si_nature ate Print name „��/�}�/ 14" <S'- 1✓l Phone# r_ official use only do not write in this area to be completed by city or town official city or town: permit/license# riBuilding Department C31rcensing Board ' C)check if immediate response is required [3Seleetmen's OMce (3liealtb Department contact person: phone#; nOther -� r IM-ised 1•95 PJA) 11/02•194 1 :02 $8177277122 DEFT IND ACCI Conukwiuveallli o Maddachu4edi .. ..Uopa�tineat o�,>" raL.�1 600 W"k-jton. I-d .Jan=I Campbeff &Ion, 9r/aaaadmu& 02f 11 CcmmissiWff Workems Compensation IBsnraace Affidavit 1, ZA►tur%AQi.g Nour1&35 A,,-c�.o,n,�'t ( mil with Xvrin ' lace of business at: ri � (Gtjr/StanfZioj do hereby certify. un r the pains and penalties of pedw.- that I am an employer Wing workers, compensation coverage for tay employees worknm this lob. plASI tJRMfLo WonAr..ErX rap Is"V, in,ysi Uj 1 03 O a3 S✓ Insurance Company Potty Number O l am a sole proprietor and bav no one working for me in any capacity. () I am a sole proprietor, general co aor or homeowner (drde one) and have hired th cons actors listed below who have following workeW oa ensadon policies: Contractor Insaranoe.CompanylPoGty Plum Contractor lessurauee CompanylPoIIcy Nu l Contractor Insurance Company/Policy Nunn O I am a homeowner performing ail the work myself.. I uzdtrsand t.=a co7f of dais srte:nent wil be f*v2rded to d..e OMm of imresdpdons of cite 0TA for a overagevac=ion and that bue v cm er:Fe:s retired under Sccdon ZSA of MGL I SZ cua lead to du imposition of atei nisei pemitiss of a tine of up to SI'S00.00 a'. yeas'impriternent is well as civil pernides in the fom:of s STOP WORK ORDER:nd a fine 100.00 a day apina,Me. Signed this i �! rk day of _ �� , 19 b Ucensee/Permittee A cse--,t o c" 9-►1-A . Building Deparanene UNow it*n , Board Selecnnens Office Health Depument ` Iut:naMATtnw rAi f.t A17-727-4900 X403, 404, 405, 409� 37 I' ,MASSA CHUSF77S MAHRO NC RS' COMPE`1SATiCN P.O. Box 8C3 O UP TRUST 1 West Spring;eic, Mi-,- 1090 Phone 1413 733-4141H Sers•ing �!)ar I= ce.heeds (800} �3Z 3" } FAX (41;. �31,7 CERTIFICATE OF SELF-INSURANCE MEMBER: Barnstable Housing Authority POLICY NUMBER: W1030235 POLICY TERM: 0-01-94 to 10-01-95 j . I i Massachusetts NAHRO Workers' Co Vensation Group Trust Retention i Coverage A: Workers'Co\nnInsurance - 53h .accident I $3ase - Policy Limit $3ease - Each Employee Coverage B: Employers'Lur ce - St0.000 S f Retention for security juards Reliance National Indemnity Company ' Specific Excess Insurance Coverage A: Workers'Compensation Insurance - Statutory - I i Coverage B: Emplovers'Liability Insurance - j $1,000,000 Each Accident $1,000,000 Disease - Policy Limit I 51,000,000 Disease - Each Employee - Policy 9 NXC 0109319-01 Effective 06/01/94 to 06/01/95 This Certificate of Self-Insurance has been issued to said a1fember pursuant to the Terms and Conditr ns of the Participation Agreement,,and has been executed on behalf'of the Massachusetts NAHRO Workers' Compensation Group Trust by the Administrator, Mass West Financiai Group, Inc. J Thomas K. Randall, Vice President MassWest Financial Group. Inc. The Town of Barnstable � a g Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ofr= 508-790-6227 Ralph Cons= ftc- SOVnS 3344 Budding Cbmml office use only no.__,___ Date AFFMAVrr HOME McROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c 142A that the"teaonstrncaon,altlemtions renovation tour+modernization,wmr won, Imp , tertto� demolition. or aonsauction of an addition to any p owner ooLvpied building containing at one but not more than d four daiiGng,utrits or to sues w asz�lacent to such residence or bail ' g be done by regrste:zd cona2gms.with gamin®00epdoM along with other Type of work: Ujvop T'1 Gwo t)n eJ Est.Cost 10 v d Address of Work. C7ENri. L PR rtd.0 r-i V Owner.Nar= InS 1AIL At ,siw c Date of Permit Application: I hereby= fy that: Registration is not required for the following s): w . Eby law_ Jab SI,000 C r gownpetmit Notice is hereby gh=that: OWNERS PULLING TIiEIR OWN PERMIT OR DEALING WI'Ili GiSIEItED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NO HAVE ACCESS M THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c 1ZA SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor name No. OR ' Date Owner's name 7MENT OF PUBLIC SAFETY ® '! OEPAR PLACE. � ` r ONE ASHBORTON I s. co OF SOSTON,MA 02108 CAUTI MASSACHUSETTS r�� � c�R FOR PR CTION AGAINST LIC-NO. TH PUT RIGHT THUMB EXPIRATION DATE I EFFECTIVE DATE RINT IN APPROPRIATE 12l'Z61144 I•;r/311/ 1 :d`')-'� 1.i BOX ON LICENSE. RESTRICTIONS i2 I �� 1�Cl 4 ; N 1) �.�}� BLASTING OPERATORS �> c p �i h AI) p 2 MUST,INCLUDE PHOTO. 126 5S 030-36--47 F, i�fz �'�i5TF.R Y LICENSEE AND OFFICIALLY NOl E. VALID UNl'll.SIGN TFIE COMMISSIONER �$TING UPR OIJLYI FE ,NATURE OF - SMP TAED.OR- . HEIGHT �I DOB. SIGN NAME IN FULL ABOVE SIGNATURE LINE t ',1 �' L�4 NJ`GV�. SIGNATURE OF LICE1• }� ��i.'• 1 DOCUMENT MUST BE �y. THIS DO MIS CAPRIEDON7HEPFFlSONO i N it THE HOLDER WHE f. OC A ON GAGED INTHISTI �R V . +Ik r \,'.. c JI � ` 4 i 7 9 7� // 4 .�Z 9) 39 / { y I .9 • I �• 19 �. ,.� h.. I. • r 7,(6 'h r f ` 41' / i + / 2. 44 292 ..__.._ r jr���• ," l %�=,may-�s�- 4 � `' L• �_ 10 C6 77 u� \/ 44.1 1 I l . . c:/barn/base292.dgn Jul. 17, 1995 12:21:03 Barnstable GIS portion of maps 292, 310 1"=100, NEW ROOF y ' EXISTING ROOF NEW SIDING To MATCH EXISTING 51 DING I , EXISTI NO SIDING FOR S►DI NG AND ROOF � TYPE REFER TO NOTES 18 24 ( PL-AN 5) i i ALI ,�E TYPICAL - FRONT ELEVATION y ►.. C-a u r� jz i f .TI-7 7" r. ..s G DE E' =VA-710N o �4A -4,000 PIS [ wi Now/ ;1 4 J 1 �1 7 NM P`• APPROXI!-•lAT6 LOCAT1pnj GAS iI 8Y &A5 COMPANY CONTRACTOR TO ?IPE 6AS Tp �-/DT AIR HEATER ANp NpT I bVATE T HE✓ rC-,e !N A CCORD,gNC j ! t.!!TH HAZSAC;WU.5E77S {! \I f•I ...i j : I i j I PLL//yfBlNEr CO=E 77 HOr wgr�R NEW HEAT r?E R001.1 j I I HEA-rF_R I i CHANGE 'TO CODE RA'-E� i 7Q PANEL BOARD i � B`F colvMAC70P APPROXIMATE LOCAT/ON F/RE RATED DOOR i' ' -fa RELpGATE!> �LEC7R/CAL I I E TER j I ' fl j I PeLOCATED ELECTRICAL i �XISTtNe; WALL i, I PANEL I I -ram PANEL 'CONrRACTeR ro IW-57A L AAD F��+ B OA R p 77/4— !N DRYE,� AIVO �BY Lt Nrfi,. C ALL A NAlVC,6S, I VCLC1G71,VG (/ENT .4n/p CONNECT iO mil'/ST!/V& g /?i4/N CONNECT/ON /N AC,-:oROtyv/ —. _. -,--• -- W!r!d MASS. oLUNIB/NG GOL�c ` I I MEW WALL -TO 13E TIED. i i TO EX1STlNG WALL u ; RELOCATEp � wVASHE,Z 7V WALL FOUNDATION -TO g_ 1 AND JRYER I f TIED TO EXIST;NG �UN11ON I i MACHINES i 5 To PAVEJ- ' i 3o.A B y y ; I Co/vrRACTOR I I SPECIAL PU,'?POSE Q(JTLET is I � FOR 220 V D RYE R j 5 1N T{-{►CIS COKCR=-Te SLA3 ; i ;O 5E PL,\CED ON Mt N G' i ' � - � 60 WATT FLUSH I a � I i I - -� MOUNTED 8 .N COMPACTED GRA\IEL. .I -� coo PSI CO�ICR�T✓� I'j I WCAiYDE5CEN-r I i LAMP F/XTURE i REINFORCED W t?'H [; 1 i FOR DUT'DoofZ t ! LAYER WELDErJ WtRE F I i us:✓ �AI3RtC 6K6-W2.9x2.9 = PLACED 21N $ Low -- TOP. SURFACE / E N C7 30, 0 M A'7I AN 3 5 I g r> i P`UMr3l 1�/'G cc . I , r o r4Cr WATER HEATER I i 5 H C)-r AIR HEAT-ER r0 PANEL 80 ACDR BY CONFRAC7 APPROXIMATE LOCATION 'OM OF RELOCATED ELECT-RICAL � METEf� i F/1?E RATED I / EXISTING WALL i RELOCATE o 70 plqNE4. 1 CONTRACTOR TO 11v s7- \LL q N0 T/E-//V t aoAR r.) I IAND DRYER ANC ALL A PPe/RTEn69Nc6:s ^ ELECTRICAL PA N e_ �V COdTA'AC1TGiQ�t I I VENT ANp CONNEC7 TU EX/STING �r r,\ I C01V"r- 'riU/V 11V AGCOR�.gNCF w/r, �- r"fA55.y CNUSETTS PLU.�/a/it'6 CODE NEW WALL - TO BE TIED i RELOCATED TO EXIST►NG WALL WALL FOUNDATION -70 BE i AND DRYER i TIED TO EXtSTiNG ;-:OUN-r'ATION �� i P-fAGNrr.IES i t Bo.4RpEBy SPECIAL PURPOSE ouT-E7 cOnnR,gCTOR � FOR 220 v DRYER NOOk-UP i i I i 5 IN THIC-1 WNLCRETE SLAB 70 5 F— PLACED ON 11"11 N _ 60 WA.Tr F"L(SYt' j L _ MOUNTED k: i 8 IN COMPACTED GRAVEL. - iNCAh'DESCEKT I 000 PSI C.ONCRET^ LartP �rxTURE 1REINe--ORCErD W tTH i FOR O//rpooR E I LAYER WELDED WIRE USE PABRtC 6KG-W2.9x2.9 PLACED 2iN BELOW T! TO P SU R PA C E � # 16 I I I I I � EPLAN . I IN J -4 COLLAR BEAM TPE JOISTS ARE I SECURELY FACE --NAILED .7:e -1-0 THE RAFTERS ELEV.. 7 ' -6" 2"X6" JO l5 T \\ BEAM BEAM EXISTINe � 411 x g "I- I FRANf E COLUMN 2.y9 STUDS ELEV. O -p" \ SILL I, I OWN". N O W"% I O'% A I f4L ■ R...�� ____ -- - - - f I I � I I I I I f � i � I I I i TYP91CAL CROSS SECTION )' 7177 SECTION 07200 BUILDING INSULATION PART ONE - GENERAL 1. 1 DESCRIPTION 1. 1. 1 Work included: Provide all building insulation required for this Work including, but not limited to: 1. Exterior walls; 2 . Roofs . 1. 2 PRODUCT HANDLING 1. 2 . 1 Protection: Use all means necessary to protect the materials of this Section before, during and after installation and to protect the work and materials of all r I other trades. 1. 2 . 2 Delivery and storage: Deliver materials to the job site, and store in a safe dry place with all labels intact and legible at time of installation. 1. 2-. 3 Replacements: In the event of damage, immediately make all repairs and replacements necessary to the approval of the Engineer and at no additional cost to the Owner. PART TWO - PRODUCTS 2 . 1 INSULATION MATERIALS 2 . 1. 1 General: All insulation material shall be the product of Owens/Corning Fiberglas, or an equal approved in advanced by the Engineer. 2 . 1. 2 L. Exterior wallinsulationv At all exterior walls where so indicated on the Drawings, provide foil-f.aced glass fiber batts having a thermal resistance 1_11R"_value of R-19 for insulation only. 2 . 1. 3 & ofs.- JAt all roofs where so indicated on the ri Drawings, provide foil-faced glass fiber batts having a thermal resistance ' R" value of R-431 for insulation only. Building Insulation 1 S '.l 'N Contractor shall low NOW g r r screws and bolt: a4 7 � IVAA � wood in direct cc rpressure treated. `tom of posts shalt s new siding in but .1ar shingles and mi -- _ ceding #33 the new iched with existinc xsently has Harvey ling) . ± heating room door y 9N1 t-f11y3NS arior walls in nee, P x gypsum wallboa s � tun wallboard shal section is provide b a d`dd 9N7 C V n,; sheathingshall NO1.1.`d 7r1SNI I ' ling in the new he , Psun wallboard. Ii roof shall be asp - I a warm air furnac stopping shall b !: ! luct work shall b S1NI_-j ?:iCt bS.LNI lation. loritractor must c( illation of gas 1: Louse at a locatic I Ings. T i - 0 � 4 I 5 ANDAR0 MA NUFAC7' ! o AND FOO , i N 6 FA S TE�I E R I! O . I POST AND FO'OTING I i i-ASTEMER N.T. 5 I II I DATE REVISIONS No BARNSTABLE HOUSING AUTHORITY TYPICAL DETAILS, NOTES ENGINEERING CIOMPANY INC. f CONSULTING kNGINLERS ! IiA F 112 ki ;DESIGNED BY : R. A. V. P! AN N0. ' ---�� - ---- 'DRAW!' BY TE 2/8/9S CHECKED 9Y • v. ` i i __ I j Lj IJ ji I ' I I; I I SLOPED TO SHED WATER !i � I .� iI Ili li II II j „ �jl II III i 4" MAX. I'I SALUST`R _ tj I I• RA„S I, I a t� c� All� � G A' BAL' ' 7=R� r E � ^ k. r• f!