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HomeMy WebLinkAbout0005 JIB WAY r��- _- -�-".. :r,��, � 1 I i i I I i I I �I � A � J�� _' f �- I E7) I r4hlF OF 5ARjy'S;A, R I S E 213 Pry Y AN Division of Thielsch Engineering,Inc. 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02910 May 1, 2013 Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Re: Insulation permits Dear Mr. Perry, This affidavit is to certify that all insulation work completed for 5 Jib Way has been inspected by a Building Performance Institute (BPI) certified Professional. All work performed meets or exceeds Federal and State requirement. Sincerely, Erik Nerstheimer Supervisor of Installations, BPI certified Building Analyst Professional and Envelope Professional, RISE Engineering, a division of Thielsch Engineering, Inc. 1341 Elmwood Avenue Cranston, RI 02910 401-784-3700 •800-422-5365 •Fax 401-784-3710 Town of Barnstable *Permit'so, Expires 6 r n&s from' e date .Regulatory Services Fee o� saBtasxnst.e, v� Mass Thomas F.Geiler,Director �^ s639 ♦0 CEO MA't A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.maus Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY y Not Valid without Red X Press Imprint Map/parcel Number R Ltj �a Property Address J 10 W4 q 4PJNiJ /L14 0 Residential . Value of Work 161000 t �d Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address J 0 b y -r P4 4 ri d l�V 1610V 1)11n44 Ali#li!/? je f Contractor's Name �Jy�� :1 /�l?ld lei fel�i 1 llfl&e- :fir Telephone Number f yg,/94—/l Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 007Y Q y ❑Workman's Compensation Insurance �T�- R Check one: ❑ I am a sole proprietor OCT T 2 8 2011 ❑ I am the Homeowner [ I have Worker's Compensation Insurance rowli ar RARNSTA Insurance Company Name h Ce, ����i't'� S�f�J�/�L L���J �/✓� Workman's Comp.Policy# 4/U) CC �4S-dr- Y G� Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) dl s' y��9aZ/�4lliU�vL4Y 13 J C(zl�i�liN�te'� �/'.itl /efirt�Z 1tf�dtl/� Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to n t�� ''1�i PS!✓� 4 i . ❑Re-roof(hurricane nailed)(not stripping. Going.over existing layers of roof) 1YRe-side GtK�f1i�a1 it'd SC�f/U Uird / S f�lfyc (iu*t idgin y a-f �l �� tl kb-e f Ql'1 Y / #of doors Rep6e�G'tffdMmtbor f/slider U-Value (maximum.35)#of windows N/R 60011 r *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.lEstoric,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. copy of the Home provement tractors License&Construction Supervisors License is e9 7 SIGNATURE: C:\Users\decellik\A ta\I ocal\NGcrosoftlWindows\Temporary Internet Files\Content.0utlook\DDV87AAZ\EXPRESS.doc Revised 072110 I Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, a�1�� �w ��OWN THE PROPERTY LOCATED AT IN aon t MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: r/#1 , -f-- �� OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: . hwt/ /( 2 " llenle RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: f Client#:47298 CAPIHOM ACORD. CERTIFICATE OF LIABILITY INSURANCE FD TE(MM0,�) 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 NEE^c Karen Walther Rogers&Gray Ins.-So.Dennis PHONE 508-760-4630 F 5 A/C No Ext: A/C,No: 08-258-2230 434 Route 60 ADDRESS: waltherka@rogersgray.com P.O.BOX 1601 PRODUCER South Dennis,MA 02660-1601 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:National Grange Insurance Co. Capizzi Home Improvement,Inc. INSURER B:ACE Property&Casualty Ins.Co Capizzi Enterprises,Inc. 1645 Newtown Road INSURER.0: COtuit,MA 02635 INSURER D: INSURER E: INSURER F: - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LT R TYPE OF INSURANCE DDL UBR - POLICY EFF POLICY EXP LTR NS D -POLICY NUMBER MMIDD MMIDD LIMITS A GENERAL LIABILITY MPB1075H 06/08/2011 06/08/2012 EACH OCCURRENCE $1 DAMAGE TO RENTED 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence' s500 OOO CLAIMS-MADE F x1 OCCUR MED EXP(Any one person) $10,000 ' PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:. - PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC. $ A AUTOMOBILE LIABILITY M1 M28044 06/08/2011 06108/2012 COMBINED SINGLE LIMIT .R,� $ (Ea accident) ANY AUTO OO OOO ALL OWNED AUTOS BODILY INJURY(Per person) $ _X SCHEDULED AUTOS BODILY INJURY(Per accident) $ ' PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ iNON-OWNED AUTOS - $ Drive Other Car $ A UMBRELLA LIAB X OCCUR - CUB1076H 06/08/2611 06/N/2012 EACH OCCURRENCE s5,000,000 EXCESS LIAB- CLAIMS-MADE AGGREGATE s5,000,000 . DEDUCTIBLE $ X RETENTION 10000. $ B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X WcsTATu- oTH- AND.EMPLOYERS'-LIABILITY. YIN' To ANY PROPRIETOR/PARTNERIEXECUTIVE� OFFICER/MEMBER EXCLUD NIA- E.L.EACH ACCIDENT $1,000,000 ED?. (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1,000,000 _T _ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional insured status is provided under the general liability when required by a written contract with the certificate holder CERTIFICATE HOLDER CANCELLATION 10 Da Vs for Non-Payment I f SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 0198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD. #S67537/M67480 MEE The Commonwealth ofAfassachuseifs Department of Industrial Accidents 4 _ Z Office of fnvesdgations 600 Washington Street - Bastort,MA 02111 www massgovldia Warkers' Compensation Insurance Affidavit: Buiflders/Contratctoralectricians/Plumbers APPHcant Information J Please Print Legibly -Name(&usineWorganizatiomgadividuai): Address: SA 149 uSsct+�-� 1� City/State/Zi : C o4-vi+ ; .Mq 'hone##: I Az a you an employer?Check the appropriate liars L Type of project(required): am a eaipinyer with .'f 0 'i" 4. Q I am a general contractor and I employees(full aadlor part-tune).* have hired the sub-contractors Q New constructiort 2.Q T.ar r a sole proprietor,or partner- listed on the attached sheet 7 C1 Remodeling sIup,and have no employees These sub-contractors have g; Q Demolition working for iue.in any capacity. employees and have workers' [No workers'comp.insuuance comp.insurance.x 4. Q Building addition required.] 5. Q We are a corporation and its 10.0 Electrical repairs or additions 3.Q I airs a hotneowne.r doing all work ofEicers have exercised their . Plum 11 b• f mg repairs or.additions, mysel�No workers'camp. right of exemption per MGL Insurance required.]t c. 152,¢I(4),and we have ad 12.�,,�/not repairs, employees.[No workers' 13�1._l Othet ✓%l�/�1 yC �. -. wrap.insurance required 6 •rttiy appaiicant tint checks box f€1 must aiso lilt oat tilt sccdoa below shah ing their we mars•+ompLsation policy infoi�arioii� ' °s t Ffomeawtiets wlta sufimit this afHdav#indicating tiny are doing Ali work and then kite owside contiactors must stibnnta new adiiiiavit indicating such '�Coatractotst6i chbck this boj tpast a=zhad an additional sheet showing the naive ofthesub-conttacfois and itata whether or;abt Hsose entities have:emli[oyccg [f the sub cen�ctots have employees ifiey artist pmvi3c..their workcis'comp.policy mcmbec I ain arc eafplayer that is pravtdzxg workers:'coiicpensatiort insurance for my employees. Eelaw is the policy and job site utfarrrtatran: . Insurance company Name: v t3 lip Y Policy#or Self-ihs.Lie.# l tt Ott C C- ` 5 8 3 11 piratiou Date �. M� Job Site Address: ��: f��7 Q!�!1%t/ t� jj Cityl.Sta&Zip: Attach tach a copy of the workers'compeusitioni po€i'cy declaration page(showing the policy irunrlter and eagia atitrn date): Failure to secirre coveruke.as required.under Section 25AA of MGL c. 1.52 can lead to the imposition of criminal penalties of a fine up to$i,500.00 and/or..ne year 4aprisonmeat;as well as civil penalties in the form of a,STQP WORK,ORDEIR and a fine of ttp:tra S80.00 a day arams.the violator. Be advisee!that a copy Qr this statament may be forwarded to the Office of Ingesttgattans of the DIA for insurance coverage verificatio>i: Ido hereby'` -under thepains atsd penalt! f perjury that the information provided abope is true add correct �- SiQuahrrei Date: /G . OQurat use only. Do not write in Phis area,to be carttpleted by city or town octal City'ar Towns Permit/License# IssuingAttthority(circle oae); I.Bagrd of Health Z•Bttiidiva Department I City/Towa Cleric 4.Electrical Inspector S.Plumbing Inspector Contact Person: Pignut • tHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:V Office of Consumer Affairs and-Business Regulation Registration:4":100740 Type: b Yp 10 Park Plaza-Suite 5170 Ex iration`-'--���- P,.._. __612312012 Supplement Card Boston,MA 02116 CAPIZZI HOME-IMPROVEMENT'INC. JACK STRUNSKI 1645 Newton Rd. _-_` 17 Cotuit, MA 02635 = ' Undersecretary Not valid without signature Massachusetts- Oelaartment of Public Saferr Board of Building Re�,Ma#ions aid Standards cozTstruetieri Supervisor License License: C5' 64817 .r Fir:'i,. . • _:JOHN T RGUMSKI`,a= - • "Po BOX 8661'1 BUZZA3 RDS BAYn}MA 02532 8x0Ati0n: 611 W2012 " Tr-1: 10573 - 1 I ' i ~ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map -2q Parcel I�(� Application # 90� (o(p Health'Division Date Issued Conservation Division Application Fee `> y Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address,, Village Owner DQYIY1r1 P� Address :5 J 1b VW as) Telephone 50 9 — -1ci d 5-7```� Permit Request - � j 1�16 Yl 9`5S ip 1244 6 a.- Ff LOW i b C -i- P 1 Q i o3 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation }� 1U.0Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U/ 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 ` :a new y CD Number of Bedrooms: existing _new co Total Room Count (not including baths): existing new First Floor Room C unt P Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other q9 <n ca Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: LFYes "]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) � �5 � lY7e� i'�)f1 Cu �iVi51t3Y) pjG j, r Name 1 4 Telephone Number Address �! t'}2��11 � QJ/1 U.L License # • C� V 2J / b Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO F)hlX,l )SLC d e.S DUr JL s an J�)Jjyjsbm, C 291 SIGNATURE DATE Y FOR OFFICIAL USE ONLY y `E APPLICATION# DATE ISSUED MAP/PARCEL NO. .w ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ` FRAME a INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING j DATE CLOSED OUT ASSOCIATION PLAN NO. s . rF The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RISE Engineering; A Division of Thielsch 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.[9 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 required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs ��n insurance required.] t employees. [No workers' . 13.© Other P n1�7/11' 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 their workers'comp.policy infonnation. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ The Preston Agency Policy#or Self-ins.Lic. #: ��c 2 [ �. -� l `�1 1 Expiration Date: 04/01/ 10_ _ City/State/Zip: Job Site Address: I M 14�, C7�1D� Attach a copy of the workers' compensaticU 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. �_Ido hereby certi un r the ins an,penalties of perjury that the information provided above is true and correct ature: Date: f (� Erik Nerstheimer for RISE Engineering Phone#: 401-784-3700 or 1-800-422-5365 Ext. 133 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#: f RISE ENGINE ER1'iG Federal ID#05.0405629 RI Contractor Registration No 8186 A division of Thielseh Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,R1029.10 (401)784-3700-)�@ 11 EAX(401)784-3710 CONTRACT Page 1 THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS E N G I N E E R I N G DESCRIBED BELOW CUSTOMER PHONE DATE Client# Donna Patriquin (508)790-1574 10/26/2009 104591 SERVICE STREET BILLING STREET i - '- "'R 5 Jib Way --- -- ---- -------- 5 Jib Wayim SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP F �� West Hyannisport,MA 02672 Hyannis,MA 02601 JOB DESCRIPTION LL' h RISE Engineering will provide labor and materials to seal area,of your home against wasteful,excess air leakage. performed in concert 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 nclude caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing. 12 man hours. $792.00 RISE Engineering will provide labor and materials to install a 11"layer of R-38 Class I Cellulose added to 1244 square feet ofopen attic space. $1,492.80 RISE Engineering will provide labor and materials to install insulation and weatherstripping to 1 attic access hatch(es). $25.00 RISE Engineering will provide labor and materials to install 10/4" X 16"rectangular aluminum soffit vents to increase ventilation in attic areas. $170.00 RISE Engineering will provide labor and materials to install 148 square feet of R-19 faced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $162.80 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$2,000 per calander year. $1,981.95 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Six Hundred Sixty&65/100 Dollars $660.65 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID.BALANCE AFTER.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. -- DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPA AUTHORIZED SI TURE-RISE ENGINEERING CUSTOMER ACCEPTANCE NOTE:THIS CONTRA T MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE _ ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE . C14 SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE k /SEF Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security (EOPS) Mass.Gov Home Pubitc 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 r Board of Building Regulations and Standar'1'' i License or registration vaf d'for individul use only I I HOME IMPROVEMENT CONTRACTOR �. before the expiration date. If found return to: Registrati:on:, 120979 Board of Building Regulations and Standards Exprcatton 3125/2010 One Ashburton Place Rm 1301 k Type a? SU:p " ston,hda.021,08 plement Card -HIELSCH ENGI1`IEE 7&G -RIK NERSTHEIMER 341 ELMWOOD AVE'` ;RANSTON,RI 02910-- Administritlor Not valid without s;gnab!,re a Y http://db.state.ma.us/dps/liedetails.asp?txtSearchLN=CSL100459 9/24/2009 A 100463 RestTicted Co: WS,IC A- STEPHEN HINFS 222 NARRAG% ETT AVENUE JAMESTOWN, 02835 i rn-ic,rc, 6/23/2012 100463 fi of ipuhijc License: CS 102935 00 STEPHEN HINES 222 NARRAGANSETT AVENUE JAMESTOWN, RI 02835 6/23/2013 102935 s ACORD CERT CATE OF UABU Y INSURANCE OP ID MIC DATE(MMIDD/YYYY) THIEL-1 ll 05 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO The Preston Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303 BOLDER.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 Faxs401-885-1700 INSURERS AFFORDING COVERAGE NAIC� INSURED INSURER A: Hartford Underwriters Ins. Cc Thielsch Engineering, Inc INSURER B: Hartford Casualty Insurance Co Thielsch Group Inc.Hi Tech Realty Inc. INSURERC: Liberty Mutual Insurance Group 195 Frances Avenue INSURERD: North American Capacity Cranston RI 02910 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MNMDD TIVE DATE MM/�D�N LIMITS GENERAL UABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 02UUkTTD5678 04/01/09 04/01/10 PREMISES(Eaoccurence $ 300,000 CLAIMS MADE 1 OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PEC m LOC E Ben, 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 B X ANY AUTO 02UE=4850 04/01/09 04/01/10 (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000 $ X OCCUR CLAIMSMADE 02XHLMF6573 04/01/09 04/01/10 AGGREGATE $ 10,000,000 DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND X TORY LIMITS ER C EMPLOYERS'LIABILITY WW2-Zll-259874-019 04/01/09 04/01/10 E.L.EACHACCIDENT $ 500,000 ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 If yyes,describe under ' SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER .D Professional Liab DVL000025902 04/13/09 04/01/10 Prof Liab 2,000,000 A Leased/Rented Egg 02UUNTD5678 04/01/09 04/01/10 Equipment 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TOWN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town Of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Building Division IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 Main Street Hyannis MA 02601 REPRESENTATIVES. AUTHORIZED EPRES ACORD 25(2001/08) ©ACORD CORPORATION 1 ,kEngingering Dept.(3rd floor) Map '_ _ Parcel, House# Date Issued /6 u.,,, ; rr�,., _. io.,c _o•�n i i• n Fee THE BARNSTABLE MA p TOWN OF BARNSTABLE 0. Building Permit Application ; I LF 0 0 Ttrege et Address ` n' !J 5 P" D Owner � t-0. ��// �Address Telephone 190 — '-5 y" Permit Request ,i First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ , Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family p 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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number Address nc� / License# l /&6 6 �`�/ - y �n�-0.. • d�"fO Ss Home Improvement Contractor# 1 d Worker's Compensation# " 3 K '.,;L 516 43?— U/ NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE40_1�t� DATE b -�%Q ro BUILDING PERMIT DENIED FOR THE OLLOWING REASON(S) 1 $ FOR OFFICIAL USE ONLY t PERMIT NO. 1 11 ljN310 a +' DAT&ISS`ED MAP/PARCEL NO. � SS ADDR , VILLAGE OWN DATE' F IN D SPIECTION: FOUNDATION 4 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH �j FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t °F SHE?�n ; . � The Town of Barnstable aAMSTABIX. • `►9 � Department of Health Safety and Environmental Services iOTEo nog" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. //& D(v T Date p" �11 q 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. 7 Type of Work: OW ' /L V) Est.Cost . Address of Work: Owner's Name Date of Permit Application: 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 Owner 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 Owner's Name Z > a i a o a —+ o < ti m Z -0 -0 3 m rn v x —4 m = m: a a--> z ►. s i x o z m of v r o-� o c-> cn C� zco f I. a 0 j r. ` The Commonwealth of Massachusett Department of Industrial Accidents ;�; Offft 8l10=11ga11oas 'i4A 6(l(1 fl'ashin;;ton Street _.., Boston, Afa.v& (12111 Workers' Compensation Insurance Affidavit itilicani information• "��' rr: Please PRINT leibl�Q"�7z s_ .... • _ name loci i 1 am omeowner'performing all work myself. 0 I am a sole proprietor and have no one working in any capacity _ t t5.: ;,�e�.����yys?-.•�spa..^`� y :'r.39ff9"r!XAm+pr<r. i4T.s,!*"RPRa�r'; , +6^P...: +1e4+�fi�onYT`�r ar*•s. r- ,u,•..4+ ❑ .I am an employer providing workers' compensation for my employees working on this job. company name: address: city: phone#• insurance co policy# �, .. <•. ' �. . .. .—> -..,a.; +--���� ..,� ..w...+<+.••r+..+w.rs..«w.,•�Fn>w'�s _ ems' """""""'"."t�....y. .w,-....s........ 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: company name- address: city phone#• insurance co policy# ._....�. ,. ...,, ..., tn:Fi�«:.;•:....?1'.m.'a•^ter^: �l'•'Y t;-x- - .r'^c.^•,zrc. �.'...-^,•��Fa'r�,,A'."�.8'C}�::.r s *�'+kr..z 'i;:'.?2aa����''...."._-'s �...+a_.....,...._. �....:..._...-...Jra• _s_ -"" .:.a.(.i►aaW.,4f"a6:.�...-'.v.C:ii.r::3H _,_._._ .. _.. ..,....:.~.:_Q�°.E�_�:., ''w,':i�3'mn> .. .LL�3.iGG. company name: address- city: phone#• insurance co policy# 'Attach®dditional sheet if necessary, f ;y 4>"R +s Failure to secure coverage as required under Section 25A of 111GL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Officc of Investigations of the DIA for coverage verification. 1 do hereht certift under the pains and penalties of perjur}•that the information provided above is true and correct. Sienature Date `6 Print name /e ���� \��✓ � Phone# official use use only do not write in this area to be completed by city or town official city or town: permit/license# MBuilding Department C]Licensing Board O check if immediate response is required [3Selectmen's Office [311ealth Department contact person: phone#; I•(Other (re"sed 3195 P1A) 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 earphoi,ee is defined as every person in the service of another undeir'any contract of hire, express or implied, oral or written. An etnphover is dcf fined 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 d%vellino 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 reneival 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. -77 V 3� J= ,y ,.; 8 tAd.,•,,.- ^rr.,b T ' '�"C" 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 as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tile 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. .-;�•• -.3�. ,,.e+?•.:-.:-^'r+v'.. ..,...:.,.•sn. •,r:-rmi+.++iF' •s„^' 7-7:-7'9nrr Cite 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. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. Tile Office of Investi_ations 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. . r^+'Tsuv..�... .^..rr _.-s.A'Tm,...-rw :,r.cw,- .G.�-sa.. ....++s�•�.{+Te.,.*,�as_.,s=rnarm.,,:, w+�..n+�.m.+1,Zw-.-n..-c:ennwws.s.�i^ .r+'r7'"-7=•tar.wrm.-+•.aw• 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 .. fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375