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0221 LONGVIEW DRIVE
Is�J�� . r ofsr rA►�. Town of Barnstable *Permit#lUpp - n — 31g Building Department ices ='rer6mo ee romisfedate��� BAMSTARIX Brian Florence,CB ` z Building Commissioner iOrFor 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us SEP 15 2W Office: 508-862-4038 TOWN OF LINHNS f Agrr 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY S `S - Not Valid without Red X-Press Imprint Map/parcel Number � � Property Address \_ f R sidential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address C: Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: ACP�C*� Construction Supervisor's License#(if applicable) Cl 6:Z3'3�- <' MIA/torkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I,=the Homeowner have Worker's Compensation Insurance Insurance Company Name "C:— S. Workman's Comp.Policy# V�C_V O`L(` odd U Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ side [ eplacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\E.NPRESS.doc 08/16/17 r - y • The Commorrtreakit aifMassadtusetts . .�Epr�sfinent cr,f'�ndrfstri�tl�ccide�"s - Owe af ligations 600'Washhwton J eet Boston,AIA 02112 t-crivi tmasmgovldia W1 arlmrs' Campensaficm Insurance Af iwrL$wldexs/CianfractursMectacmus(Pb hers Applk-mt T33fdTII fi= Please•Print 1V SIIIB Bncir�PiffII9tB�I ��� cityfSfa Phan Are} an employer?Check appropriate bo= ' Tppe of project(regaked): I_ I am a emplayff witTi I mn a general contractor and I ❑ emon ployees(full andfor part-limed* Ise fired ate soft-cons 6. ein r i 2.❑ I am a sole propzietor orpa�ar- Usted aathe.attached sheet. I- ElRemodeli>rg These sub-co�ractors have s4zFp and hav8 so etaplcyees. � >i`,❑Demolition wodring fbr is any rapacity: euaplayees andhave xvor3 ss' 9. ❑Building addition jNuza�.ts.' camp,r���e � Comp.iM .��.# required—]_ ❑ lWe are a cmporafiza and ifs M❑Electrical repairs or addifioas 3.❑ I ama homeowner doing atl woda offcen have exercised limit 1L❑Plumbiagrepaiss or addititms. seli_ a Rto�TrPrs' ugh of exemption per MGL 7 ���re�vEed]7 - c.152,§I(4k aadwe have no L❑ afregairs p employees.[No vmrk-a ' UEOther V.►�v��e�C C0mp-mmumm reed-] ;Any WHumtfatcbedsboxinamstOmfiIloattheswdonb9v sbamdugttiekwmkeecvmpeasat; upeIigYiafamsrsaa- ffbnvff;sets wbo sabm3k d9s Ada«mgBrstmg tb.-y axe+g muvrc c mcl t5mlffm outadecmtmcmrs— mmmit anew saidatft iadieadao smeh rCon2tacios$s21ebe<Ytbisboxmastatt Ch ffiaddifianal shed sIiousag the n9neofthe s and statewhether air notftseendtksbave employee;.Ifthesabtaat ictu chive mnptoyw-%flLe}`mnstgm4•idetheir zearkes'camp.paHU uumben lam an entpLqvr duzc is prai idir>,,-.warkets'compertsadmt fizuirmwofor my eatphUear. Mow is thopoUcy and joh seta in f ormatiam InsuranceCompanyName: Policy,411L to Self-imlic-&__k4�e3�_a �a FgpiFatiouDate: /O -7 lob Site Addre= �` ` V�` � cify/StatelZtg: A02ch 2 copy of the workers°corapmsationpolrcy-dedaration page(showing the policy,number and expiration date). Faiinm to seemti coverage as.requiredvades Section 25A of MGL r-137'can lead to the impos lion of csminal penalties of a f ma ap to$l,5Oa Oa and/or one-year impsisoua-tA as w6H as ciO penalties in the form of a STOP WDRF ORDERand a fine of up to$25100 a dap against the violator. Be adtised gat a copy of this sfatemennt.my be f 17nded to the Office of IsmesEigatians of the DIA for M" ' MOR a coverage vedficatiam Ida kereby ced#Y archer din pains 4WdpvuMn<rperjary fhatffis fqt;for matkraprmuWa€am�s b&"and arrrert Sitnaature Date- phone ii� ` 7 7`-( - �3,fj i d use anly. Ua uat eFrfta ftt flFi�areQ,#�r be crrtttglete�d�iy cafy Qriatrri n jrczat City or Town: Permitlf icense: Bsuing Authority(carte one): I..Board of Health r.BuTTng Department 3.Cityt£owa Clerk 4.Electrical Inspector S.Phxm.bing Faspecter 6.Other Conact Person: Phow 9: — -- - -- - 6 laformation and Instructions 1 Geri Laws r M rDq=m-a=1PIoye to Provide worl=s'=33p far their employees- Paisv�tt�o this sue,an evqrIoyw is damned as¢.sveay peason in.f a service of another unader a¢y confract ofbire, " express ar implied,'oral or written.." AILeurpkyer is defined as`pan indivi ffiA paxinesmbip,asso�on,�P�on or o1heS legal may,CT any t�vo or more m a pint andincbjdmg the legal sepmsehtives of a deceased employer,or fiie of the foregoing � J Vie• to However fits rDCzTMor ttastee of an baVi&A per.aasociaiinn or other legal wgjy,mgL)yng� Y�- owner of a dvmMoghonse having not more�three apaLtmeats andwho resides,��e ocrcgr�ofthe- dweaing house of another who m3plaps pesons to do ce,c n•skucc an or repay work cn sash dwelling house or on the grounds or bmying app—te:ttiieretn shannotbmanse of surds employmedbe deemed to be an employer-" MGL cbzpter 152,§25C(6)also sues that"every sfatL-or local H=xdng agency shRR withhold•6ae issuance or renewal of a license or permit to operafe a blames or to construct buffidiii -3 in the commonwealth for any applicautwho has notprnduced acceptable evidence of cumpfrance`.vifh the iasuiznceeo4eragerdg vison shall Additionally;MGL�t�152,§25C(7)states aN6iBner the comman.�Yeala nor�yy,of its political subdivisions ear into any cantcad{or the performance 0fpublio work umtl acceptable evidence of compliance:vllfii file insoi'ance. re�e�s of this chap�a have been P�°�An fine co�ractm-g.a�Tiotaty." . AFPIicaicts Please ffiI o-c± the WOIIC='compe asatOu affidavit completely.by chec1cmg the boars that apply fin your sitnaiion and,if necessary,S70PPIY snb�a s)name(s), addresses)and Phone mmzber(s)along will.their=tlflc8±e(s)of fiisnzancce Limi6ed LiabfiifY Companies(LLC)or Limits d.LiabEity Partnexahips(LLP)'wrfhno�L �Y other than the members or partaeTS,are not rbqab:ed fn caay workes'compensafion;ncrlrm= If an.LLC or LLP does have licyisre ' BeadYisedthatthisaffdaykmaybesnbmiffedtathe;Departmentoflndusfiia rmpIoyees,apo .I Accide�for confimzal on of insurance coverage Also her sin a to sig�x and date .e afddavif TYie affidavit shouzId b 5ret=acd to lhe city or town that the application for the permit or license is being rmpmstA not the D ep arty enf of Ism A oci d=tL Shouldyouz have any questions regardmg the Iaw or dyou are rcga=a d to obtain a workers' compensation policy,please call the Deparimeot at the mmLea list:d below: Self-insured companies should eater their self-;,,sar m license number on the im appriafn line. City or Town.Officials - Pleas a be sore that the aidavit is cnmplete and pridd.legibly. The Depad:me:ut has provided a space at the bottom of the affidavit for your to fll out in the event the Office oflnvmti has to-dactyouregardmgthe applicant P lease be snre to fll in the pe Clicense number which wM be used as a rues amber. In addition,an agplic:anf tl3at must s¢bmit multiple pe»st/I-cease apglic�ons in any gtve�yen,need only sabmit one affidavit indicating cusent policy information[if nwzssmy)and under"lob S'te Qom"tie applicant should WIite-all locations in (c'tY or tDwn)"A copy of the affidavitthat has be=officially sued or mazke .by.A3Le cRY or town may be.provided to the applicant as proof t7gt a valid affidavit is on file:for fafm:e'p=xifs or licenses Anew aff davkt� be filled oil earl year.Wheae ahome owner or citizen is obtaining a.Romse or permitnotreIated:D any business or commercial veMbre e or pexmit to bum leaves eta.)said person is NOT=Titre .to-complete tits affidavit (ie.a dig lccxns The Office oflnvesfigstionswovldll Mtathankyouinadvace for YOM co0pera1=and shoo Uyonhave'myg eslions. please do nothesiiste to give us a caz Zhe De:RaI =Lfs address,telephone and fax nlzmbCr CGnna0aWeaj&of Massachnmtbl T01.4 617-727-4 Q%t 406 or 1477-MAgRAFE Fax#617 727 7749 xevised¢24-07 J 1 �WE Town of Barnstable Building Department Services ` MASK �,` Brian Florence,CBO 61 k Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section.If Using A Builder I, L' -, Vo U V',, ,as Owner of the subject property hereby authorize L � � g=c i to act on.my behalf in all matters relative to work authorized by this building permit application for. (Address o ob) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. r ignature of Owner Signature of Applicant Dal o-AfM Print Name Print Name Date Q:FORMS:M4MERMISSIONPOOLS Rev:09/16/17 Town of Barnstable Building Department Services Brian Florence,CBO ' Building Commissioner 200 Main Street, Hyannis,MA 02601 �� MAM www.town.barnstable.ma.us 1639. Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village i "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/tOwn state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the 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 minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act"-,supervisor." . Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q.\W R ESWORMSIbuilding pemut forms\EXPRESS.doc 08/16/17 07/7/2017 12:09 PM PDT TO: 15087597177 FROM:6174886501 Page: 3 AC40RP CERTIFICATE OF LIABILITY INSURANCE °Ao/07 /2017 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 pollcy(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 00978-002 cT David Dunn GH Dunn Insurance Agency,Inc. M Eg: (508)759-3132 , . ,; (508)T59-7177 PO Box 330 Buzzards Bay,MA 02632 ...-buzzardsbaY@9hdunn.com......__._............__....._......._..._....._......._...__........................_......._....._........._....._.... ....................................................... 5.tl.REIt4S)..AFFQRitR .SX1Y..tsilAAE........._..._..................................._.._'.........._._NAIG.IE.............. . Atlanti ............................................................................................................. RrS.I!RERA.:.. c Charter insurance Company. VDAC 44326 INSUREDURi _B_:......_....._.........._....................................._. Stuart&Co.,LLC _. ...__..._.....---._.._._.._.. t75 TeatNccet Highway,Unit 13 .INSURER Q:................................................... ...... ....................................... ............................. Teaticket,MA 02536 .........-...........................-............................-........-...--....._..._..----.--...---...__...__... ... ........._........ .__..._. 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. ....................-................................................................................................... - . ... ...... ....... Lam _LT,R._.................._.....TYPE OF INSURANCE............................ ......_....._._POLICY.NIMBER............._....._..._'._( Q __I0YYY1_.._..._... .._.__.__..... - -....................---------------------------------- - .. GENERAL LIABILITY EACH OCCURRENCE $ - --- ------._.._..._.....__ .................... QAMAGE TO RENTEbCOMMERCiALGENERALLABILITY $ PREMISES.(Eaoacurrenca) ..;....._ ................................ CLAIMS MADE OCCUR MED EXP(Any one person) $ ............................-.........._.......__......._..._...................._....._......._..................._....._...... PERSONAL&ADV INJURY $ .............................._..................._................................_.................., ......._.........................................................................................._.........._....._............_.............._ ...........................I.............................. ; GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ -- PRO- w_ ._POLICY... - -e1EwGT. ._L..--L ._..... -- _......._...._.....__..__..._._ - .__._..__... - - _._...................._... --......................... - - - ... ------------------------- a. -------------- AUTOMOBILE LIABILITY € i COMBINED!)k�LE LIMIT �$ (Fa axident).............................t......................................... ANY AUTO BODILY INJURY(Per person) $ ...... ALL OWNED SCHEDULED _..._......._................._.._.........._.............._....._., ............j AUTOS ............j AUTOS BODILY INJURY(Per accident) $ S HIRED AUTOS ;NON-OWNED ; ; (..PROPERTY DAMAGE......._......... AUTOS .(Per.rAdant).............................$....................................... UMBRELLA LIAB OCCUR EACH OCCURRENCE $_........__....._.............._.....--.--..._.. .........._.; ............._........................ ._..... EXCESS UAB CLAIMS MADE AGGREGATE $ .......................................... ..................... DED i ?RETENTION$ S .......................__...:........__...................................................._...............;..........._...._....._......................................................................................._..._................... ;............................. ._..__:.__... - . -..__... i sr YIN is. ....... _....° ..._.....................-........._......... A 6I�I�t ffi %MR%WECUTNE ......... N/A i WCV01041204 10/6/2016 ' 10/6/2017 'E.L.EACH ACCIDENT $ ...... m.'.000.00 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500 000.00 Policy Coverage State: MA .............................................I........._...........;................- .......... D � PERATIONS blow E.L.DISEASE-POLICY LIMIT €$ 500,000.00 .......... ..............._..._............................................................._.................__..............................;._..................................._:....................._..._....._.._....:......_....._.................-........._......._..._.....................: ....................................... Brian Stuart Is not covered by the workers compensation policy. .................:......................... .............................................................:............................ .............................................. ......................................... DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarke Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION ErIce Donaldson SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 221 Longview BEFORE THE EXPIRATION DATE THEREOF THE ISSUING COMPANY Centerville,MA 02632 WILL ENDEAVOR TO MAR NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY r -l _� Iva�Daa.!'ruacu�;;,JcFJaPU ilCflt SJI rUU11G Jdl Cly. Board of Building Regulations and Standards -% ��Xe Ifcniaeoi�.rnen�C�c�r"'•!'ln::.;ac�[t.;e/l1 License: CS-023320 �'�� office of Consumer Affairs&Business Regulation Construction Supervisor HOME IMPROVEMENT CONTRACTOR TYPE:LLC KENNETH I STUART Registration Expiration 63 HANDY RD ' 53684. 01/02/2019 PocAssET MA 0265s` STUART&Co.LLG - KENNETH STUART 63 Handy Rd. Pocasset,MA 02559 .` . CAI— Expiration: rs7retary. Commissioner 06H812018.. f✓~'� J Constru ction Su Restricted to Pe►vlsor Unrestricted- I ess than 35,000uildings of an - enclosed s cubic feet Y use group which co pace. (991 cubic contain I Registration valid for individual use only Meters)of before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation I 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to State posses 1 Buildin s a current ed" IPS Lice 9 Code is cause for�1pn Of the Il4 oaf Ssachusetts i Not valid without signature j ;! nsing inforrnatio evocation = w •MAS . OV license. - �� Cape Save Inca 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 12/1/15 Thomas Perry CBO Q Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 201504684 Dear Mr. Perry This affidavit is to certify that no work was completed for 221 Longview Drive,C-entery Sincerely, William McCluskey r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 3 T 7111' 01 Ap. lr tion # Health Division � , �-, � ;Date Issued Conservation Division Application Fee O co Planning Dept. Permit Fee 33s-Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street A- _ + ddres-s `, L o v' D orel Village CeNe �V1�I Owner F=ri r a ll5hal s o n Address a.m Telephone r)0 8 3 6 0 9 6 19 Permit Request Add R,- a1 ce�1A1 Ave- +a '�'.�e � +C-• i t Sea ( 4 e 641 r, A e-, WI"Vh °l,2 i 01. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0 0 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 1 (No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name V��� I Ye T c, Telephone Number !�2- 8 gg 0393 Address D n�c�n c�o n Av6- License#_ —.tC, 7 _:5. )a.rma44 I,fA n k -I Home Improvement Contractor# 1 �l 38 0 Email Worker's Compensation # W V C 13 6 �� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 1 arm a V 'L SIGNATURE DATE 3 5 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION FRAME S INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT �. ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents _d 1 Congress Stree4 Suite 100 Boston,MA 02114-2017 Q' www mass.gov/dia «'orkers'Compensation:Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information _ . . Please Print Legibly Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth.,MA 02664 Phone#:508-398-0398 71 Are you.an employer?Check the appropriate box: Type of project(required): 1:✓ I am a employer with 20 employees(ful)and/orpart-time):° ❑ 7. 0 New.construction 2. I am a sole.proprietor or partnership and have no employees working for in. ❑ 8: E]Remodeling any capacity.[No workers'comp.insurance required.] 9. ,❑Demolition In I am a homeowner doing all work myself.[No workers'comp.insurance required],t 4;M I am.a homeowner and will be hiring contractors to conduct all work on.my property. 1 will 10 Building addition ensure that all contractors either have workers'compensation:insurance or are sole I L[]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the Attached sheet. 13.rROOf repairs These sub-contractors have employees and have workers'comp.insuranceit 6;❑We are acorporat ion.and its officers have exercisedtheir right of exemption.per MGL.c, 14.E]Other insulation 152,§1(4),and we have no,employees:[No workers'comp.insurance required.] 'Any applicant.that checks box!f l 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:Wesco Insurance Company Policy#or Self-ins.Lic.#:WWC3136274 Expiration Date:04/091201`6 Job Site Address: 221 Longview Drive City/State/Zip: Centerville Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a.fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the-form of a STOP WORK ORDER and a fine of up to$250:00 a day against the violator_A:copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. j I do hereby certify under th pains andpenalties of perjury that the information provided above is true and.correca± Signature: Date: 7 23/2015 Phone#:508-398-0398 0 ial use only. Do-not write.in this area,to be completed by city or town official. City or Town; Permit/License# Issuing Authority(circle one). 1.Board of Health 2.Building Department 3.City/Town.Clerk 4.Electrical Inspector 5..Plumbing Inspector 6.Other Contact Person: Phone#: ACORI[7� DATE(MMIDDlYYYY): CERTIFICATE OF LIABILITY. #NSURANCE 3/24/2015 THIS CERTIFICATE 1S ISSUED AS A.MATTER OF INF,ORMATION ONLY AND;CONFERS NO RIGHTS UPON THE ctitnfICATE'HOLDER. THIS ; CERTIFICATE DOES: NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE:AFFORDED'SY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES:NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUfNG INSURERS) AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE BOLDER; !1!IlPORTANT: wthe cef if(caaeholder:Is an ADDITIONAL INSURED,the polley(les)mtast be BndOrsed. 'If SUI3ROGATIi7N IS WR411iEf1; Subject to the terms and conditions of the policy,certain policies may require an endors®inept. 'A statement on this certificate does not.confer rights to the certificate holder in lieu of.such endorsemen s. PRODucER NAME: Colleen Crowley Risk strategies Company PHONE (781)986-4400 FAX (781)963-4420 IC o: 15 Paeella Park Drive ccrowley@risk-strategies.00m Suite 240 ... . INSURER(S)AFFORDING COVERAGE NAIC Randolph" MA 0 ;3$S INSURERA:SeleCdtive Ins. 61p America INSURED INSURERRA11merica FinaAczal -lance0212 Cape Save., Sac INSURERC wesco' Insurance COMA 7 D Huntingtoa Ave - :. �f },t .: I1 }A INSURER South Y'a �Lll` � aG�9Y INSURERF: COVERAGES CERTIFICATE NUMBER:CL1532491501 REVISION NUMBER. [NR' is IS TO ERT{1 Y T#ArT THf• f31tCIES Of iNSt f2AlBCE tiS�ED BELOW HAVE 8£EN ISSUED'To THE'(NSURIFIJ�lA'hAED'A'BOVE ft�R"t1 tE'POLICYPEaJOD` INDICATED. N07WJ)"HSTANDIRJG ANY REQUtftEMENT,TERM OR CONDYt70N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECfTO WHICH THIS ERTIFICATE MAYBE ISSUED.OR MAY:PERTAIN; THE INSURANCE:AFFORDED BY,THE POLICIES DESCRIBED HEREIN i8 SUBJECT TO-ALL THE TERM$, XCLusioNs:AND CONDITIONS OF'SUdFt POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID:CL4IMS., _ TYPE OF INSURANCE POLICY NUMBER MOIDID :EFF PO�ICYEXP LIMITS. GENERAL LIABILITY a EACH OCCURRENCE $' 1 r 000,000 X COMMERCIALGENERALLIHSILITY N PREMISES Ea occurrence $ 100,00 A CLAIMS MADE 1�OCCUR 1994490 0/16/2614 0/16/2015 MED EXP(Any one person) $ 10,W0 • 't`-' PERSONAL:&ADV IN VRY J S 1,0-00,daa GENERAL AGGREGATE $ 2 000;000 GEN'L AGGREGATE LIMIT APPLIES PER,'.. PRODUCTS-COMPIOP:AGG -$ 2,000,000 POLICY X X LOC. $ Auromo LE`LIABILITY 1,000,000 B ANY AUiO BODILY WJURY(Per person) $ AUTOS SCHEDULED ' P9.660o 1/.6/2014 1/6/2015 AUTOS >? AUTOS BODILY INJURY(Per accident) $ :. X `HIREDAUTOS X ANOAQ Vai!EEI} FROPERTY;DAMFGE Per® n£ $ X UMBRELLA UAB }Z OCCUR EACH OCCURRENCE $` •1,000„000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,001 0' DEo RETENTION �a 299448() o/is/4o4 0/16/2Q35 C WORKM. CQMPENSATION ffie�r"� Ietclucied for X v�srAru oTH AND EMPLOYERS'LIASB,I7Y Y/N ANY PROPRIE 6R0APTNER/EXEGJTIVE average R 0FRCE tNEMBER EXCLLX)ED7 N NIA E.;L.EACH ACCIDENT $ 500,000 (Mandatory in;NH) 1 $ /9/'2OT5 /'9/'ms E.L:DISrA$E- EMFLOY $ 5d0 }QQ I(-yy88s,describe under I• J DESCRIPTION OF OPERATIONS bet6w E;L.DISEASE-POLICY LIMIT $ 500,000 r b _ DESCRIPTION OF OPERATIONS:!LOCATIONS!VEHICES(AtlacPrACORD 909,Add(tlorrel Remarks;`Schadule,.if.more space fe roquired) Issued, as evj:dence of.snsurance.... Thielseh E'riginee ng, Inc. is ,listed as additional i sured;as respects=General Liability: as :requiread .by wsitt tract. CERTIFICATE IOLDER - CANCELLATION ghtcoMact"Org SHOULD A94Y Of THE A6OVEDESCRIBED`POUCit:$-ag CAFtCHLLED BEFORE THE EXPIRATION DSTE THEREOF, NOTICE WILL. 9E :DELIVERED IN Cape Light Ccupact ACCORDANCE WITH THE POLICY.PROVISIONS. Attn: Margaret S.oag. rO BOX 427/kIl. AUTHOWEDREPRESENranve 319h Main 3tx�et • Barnstable, P� D2630 chael. Christian/CLC. c'_!!' _�r ACOM z (20tolOs� o k98R,21.10 AC D CQaaPORA All TFCJhQS reserYgd. tNS025(zo(oos).a9,. The ACORD name and'Iogo are register6tf marks of ACORD Building Permit Authorization I, Erica Donalson (Rocheteau) , as owner - hereby give my permission to Cape Save, Inc. 7-1)Huntington Avenue South Yarmouth, MA 02664 Office:S08-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 221 Longview Drive , Centerville, MA 02632 Signed A' Aid, P'�•� Date 7//Vi 7JZ>°" 0 ?2��I'Ceff Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. WILLIAM MCCLUSKEY --- 7-D HUNTINGTON AVENUE ' SOUTH YARMOUTH, MA 02664 ---- --- - ----- Update Address and return card.Mark reason for change. 0 Address Renewal Employment Lost Card SCA 1 0 20M-05/11 ✓feF trr,rieauiuueaL ri �if[tiJurlellrtue - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 171380 Type: Office of Consumer Affairs and Business Regulation Vxpiration zg--3/1,4/2016: Corporation 10 Park Plaza-Suite 5170 N Boston,MA 02116 CAPE SAVE INC. V- WILLIAM MCCLUSKEY�, 7-D HUNTINGTON AVENUE SOUTH YARMOUTH,MA 02664 Undersecretary Not vali '` rthout signature Massachusetts:-Department of Public Safety Board.of.Building Regulations and Standards C-1/tIsUUCt'son.SunervAor Sneclafiq License: CSSL-102776 KIN c, r-I:ti ,� a '• w1u]AM J MC C'�U 37 NAUSET ROAD West Yarmouth RA Expiration Commissioner 06/28/2017 TOWN OF BARNISTABLE 7013 MAY 10 AN !1: 19 RI S E Division of Thielsch Engineering,Inc. 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02910 DIVISION 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 221 Longview Drive 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 11 1.373 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ".Application #Z10 t O Health Division Date Issued Conservation Division Application Fee _ J Planning Dept. Permit Fee; Q ?9 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis 15 LJ Project Street Address 221 Longview Drive u UI Village -`--.. RYANATT S By Owner Erica Rocheteau Address same Telephone 508-771-8124 Permit Request air sealing, insulate attic and kneewall areas, install 1 new attic access and 3 new kneewall access hatches, install 6 soffit vents and insulate basement ceiling at house sill Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4281 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 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 Erik Nerstheimer for RISE Eng. 1 ' ' FOR OFFICIAL USE ONLY 'APPLICATION# DATE ISSUED MAP/PARCEL NO. f I � ADDRESS VILLAGE f OWNER r t i t DATE OF INSPECTION: :f`,FOUNDATION) ' FRAME !.f INSULATION. , FIREPLACE t � t ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL GAS: ROUGH: + _; FINAL =•FINAL B:UILDING�"-: 4WI A E.:= DATE CLOSED OUT • ASSOCIATION PLAN NO. i , Lid ,- I RISE ENGINEERING Fedetll to#05-0405629 R1 Contractor Registration No 8186 A division orThiclsch Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,RI 02910 (401)784-3700 FAX(401)784-3710 CONTRACT J� I� Page 1 y THIS CONTRACT IS ENTERED INTO BETWEEN FUSE I ENGINEERING AND THE CUSTOMER FOR WORK AS ENC I NE E RING ENGINEERING I CUSTOMER I PHONE DATE CII.nt0 Erica L Rocheteau (508)771-8124 08/09/2010 111373 SERVICE STREET ( NLUNO STREET 221 Longview Drive 221 Longview Dr I' SERVICE CITY,STATE,LP - BILUNO CITY.STATE.ZIP 1 Centerville,MQ 02632 Centerville,MA 02632 III JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be 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 include 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. 20 man hours.This measure is available for!00% rebate from the Cape Light Compact. i $1,320.00 RISE Engineering i ill provide labor and materials to install a 4"layer of R-19 Class I Cellulose added to 302 square feet of floored attic I space. $302.00 RISE Engineering 1 ill provide labor and materials to install 3.5"R-13 faced fiberglass batt insulation to 8 square feet of missing knecwall area abutting the bedroom next to the garage. $8.80 RISE Engineering will provide labor and materials to install 3.5"R-l3 faced fiberglass batt insulation to 8 square feet of missing knecwall area. I $8.80 RISE Engineering ill provide labor and materials to insulate the backs of 4 sct(s)bf knecwall drawers and seal the drawers against air leakage. j $400.00 RISE Engineering will provide labor and materials to install 2.25"R-10 semi-rigid fiberglass board insulation to 252 square feet of knecwall area. j $680.40 RISE Engineering wilt provide labor and materials to install 2.25"R-10 semi-rigid fiberglass board insulation to 156 square feet ofcxposed floor in the rear addition. $421.20 RISE Engineering I ill provide labor and materials to install a I I"layer of R-38 Class 1 Cellulose added to 480 square feet of open attic space. $576.00 I i I , 1 I - I I I I` r I RISE ENGINEERING Federal ID#05-0405629 RI Contractor Registration No 8186 A division of Thlclsch Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,R102910 (401)784-3700 FAUX(401)784-3710 CONTRACT Page 2 I S E THIS CONTRACT 9 ENTERED INTO BETWEEN RISE e II ENGINEERING AND THE CUSTOMER FOR WORK AS ENGI DINES iRi11'�7G DESCRIBED BELOW I CUSTOMER I PHONE DATE ciwd0 Erica L Rocheteau (508)771-8124 08/09/2010 111373 I SERVICE STREET I - BILLING STREET 221 Longview Drive 221 Longview Dr i SERVICE crrY sTATE,ZO. BILLING CITY,STATE,ZIP Centerville,MA102632 Centerville,MA 02632 i 1 JOB DESCRIPTION I RISE Engineering will provide labor and materials to install a new,finished plywood,attic overhead space access hatch.The hatch will be insulated,wcatheipped and held closed by eye hooks. (Wood surfaces will be unfinished. Prime coat and/or paint is not included.) $100.00 RISE Engineering will provide labor and materials to install 3 new,finished plywood,kneewall space access hatches.Each hatch will be insulated,weathe.rstriIpped and bcld closed by eye hooks. (Wood surfaces will be unfinished. Prime coat and/or paint is not included.) 1 $300.00 RISE Engineering will provide labor and materials to install 6/4"X 16"rectangular aluminum soffit vents to increase ventilation in attic areas, l+ $102.00 RISE Engineering will provide labor and materials to install 56 square feet of R-I 9 faced fiberglass insulation to the perimeter of the basement ceiling at the house sill. j $61.60 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 colander year(excluding air leakage scaling.) $3,320.00 I i I k II 11 i 1, ! WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF I 1 i I j ***Nine Hundred Sixty&80/100 Dollars $960.80 t I UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MO NTHLY ON ANY 1 i UNPAID BALANCE AFTER 70 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCFEDULING,IWD CON TR R ED REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES I. AUTHORIZED SIGNATURE.RISE ENGINEERING tO.M 4ACCEPTANCE {� i NOTE:THIS CONTRACT I Y BE WRHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE — 1 V j / I ACCEPTANCE OF CONTRACT-THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO DO THE WORK I AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE II it j ( l I 4 The Commonwealth of Massachusetts Department of Industrial Accidents IV Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Flame(Business/organization/Individual): RISE Engineering a division of Thiel ch Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone#: (401)784-3700 or 1-800-422-5365 Are you an employer?Check the appropriate box: Type of project(required): 1. I am an employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part time),.* have hired the sub-contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.$ 9. ❑Building addition required] 5.❑ 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 I I- ❑Plumbing repairs or additions insurance required] t c. 152, § 1(4),and we have no 12. ❑Roof repairs employees..[no workers' 13. l& 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.Lie.#: 3730961-00 Expiration Date: 1/1/11 Job Site Address:p;�i LQr'jo�V 1eAA-3 D 6 V e_ City/State/Zip: C e_Vl,-[�r V I I I f 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 eins enalties ofperjury that the information provided above is true and.correct. Si nature: Print Name: Erik Nerstheimer Phone#-(401)784-3700 or l 800 422 '165 x i '13 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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: ; --------- ACORD' CERTIFICATE OF LIABILITY INSURANCE aP ID 47 OATE(MM/OOrYrN) PRODUCER THIEL-1 04/13/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The' Preston Agency, InC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303 HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 810 ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. East Greenwich RI. 02818-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE INSURED NAIC 4 INSURERA: Zurich—American Ins Co. Thielsch Engineering, Inc INSURER B:. Ue•r.lun tu>ran t•• y Ll.bll ty Thielsch t3roup Inc. INSURER North American Capacity Hi Tech Realty Inc. -- 195 Frances Avenue INSURERD: Hartford Insurance 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 INDICATED.NOTVJI'niS'rA),IDING ANY RECUIR9,4ENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS A.ND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ir4bH j4OO . LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(� LIMITS _ GENERAL LIABILITY EACH OCCURRENCE $ 1,0 0 0,0 0 0 A X COMMERCIAL GENERAL LIABILITY 3730962-00 04/01/10 01/01/11 PREMISES(Ea occurence) T300,000 CLAIMS MADE .a OCCUR MED EXP An.one arson 1, v person) $ 10,000 --------. PERSONAL&ADV IN.;URY s 1,000,000 GENERAL AGGREGATE s 2,0 0 0,0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMP/OP AGG $ 2,0 0 0,0 0 0 POLICY X JET LOG Emp Ben. 1,000,000 AUTOMOBILE LIABILITY , COMBINED SINGLE LIMIT g e. X ANY AUTO 3730963-00 04/01/10 O1/Oi/11 (Ea accident) 2,000,000 ' ALL OWNED AUTOS SCHEDULED A BODILY INJURY AUTOS BODILY person) HIRED AUTOS — BODILY INJURY NON•OV/IdED AUTOS BODILY acc-da_nt.) PROPERTY DAMAGE ; ?Per acciDent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT s ANY AUTO 07AERTHAN EA ACC $ - AUTO ONLY: AGG $ EXCESS/UMBRELLALIABILTTY EACH OCCURRENCE s 10,000,000 B X occuR O CLAIMS MADE UM 9 2 6 3 6 3 7-0 0 0 4/01/10 O T O 1/11 AGGREGATE / $10,000,000 DEDUCTIBLE- - '- 3 X RETENTION 410,0 0 0 S WORKERS COMPENSATION AND X TVYC sT LIMITS EP. A EMPLOYERS'LIABILITY 3*730961-00 04/01/10 01., -,NY PROPRIETOR/PARTNER/EXECUTIVE 01/11. E.L.EACH ACCIDENT s 1,000,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE T1,000,000 If yes.describe under _ SPECIAL PROVISIONSbolow OTHER E.L.DISEASE-PO LICYLIMIT ,11,000,000 C i ProfessioTlal Liab DVL%O026800 04/01/10 04/01/11 Prof Liab 2,000,000 D Leased/Rented Eqp 02UUNTD5678 04/01/10 04/01/11 Equipment 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I 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 KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESE V ACORD 25(2001108) kDACORD CORPORATION 1988 - c �.;,cc -rs -, <~ f e�' � :.;, •.�,�}!��i a #."'at�PI'I�y{Pi #t1 ' � ;�l1 �r�r•THIET� � a i i x.. AGE 2 .k ; 1� . lkl,� �'�'�tiwrr�t!il��?�.�i�'��:�,,.�;�. �Yi�::� }�,r,. ..�'i:• ,a �j��'l�C� '�?fuy9lit�".�ijylzt}i �},��x�,�i�..xls�. i+,,__.. 7 ; ��:,-1 t N�T�PA�Q,� ! �T��U�E �SrN'AMEw afih"i�el`�� ��1' � �neile•�r�,a J�� n , �[;�i���'��; DA�f Q4 f l2/10 s'a�..__,?�t_fi:,���t r tl�r,�..G:!)9.tc.,,�'"7r .. - Is,v: ;s;5:1.KI'i�!��rtr�.,::Pt,�7rt ..,.., t,�S61U t.�,'�.� �� �,kk�.�3't�1� i15E�-f!OP ID '1._7it� l I to l p SS _ i•�. _. i - Also for RISE Engineering, a division of Thielsch Engineering, Inc. Gaskell Associates.; a division of Thielsch Engineering, Inc. BAL 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 division of Thielsch Engineering, Inc. Off e o onsumer aft an usin4seoguelaotion 10 Park Plaza - Suite 5170 M Boston, ssachusetts 02116 Home Improve ontractor Registration Reqistration: 120979 Type: Supplement Card z w Expiration: 3/25/2012 THIELSCH ENGINEERING ERIK NERSTHEIMER rn 1341 ELMWOOD AVE. CRANSTON, RI 02910 ty �a Update Address and return card.Mark reason for change. Address Renewal 0 Employment ❑ Lost Card DPS-CA1 0 5OM-04/04-G101216 ✓�ze -Pianvmanusea./� o�./�aaoac`uraella • Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: i Office of Consumer Affairs and Business Regulation Registration 7g _ Type: 10 Park Plaza-Suite 5170 r Expira 12 Supplement Card Boston,MA 02116 THIELSCH EN4 Y ER IK NERSTH 1341 ELMWOOD _ CRANSTON; RI 029 Undersecretary Not valid without signature I 1 arc i Ui 1 rf' The-Official•Website of the Executive Office of Public Safety and Security (FOPS) Wss.Gov,Home rublic 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 Board of Building Regulations and Standards i License or registration vartd"for individol use only � HOME IMPROVEMENT CONTRACTOR f before the expiration date. If found return to: Registration,:, 120979 Board of Building Regulations and Standards Ez"pi"Tat+i'o:n:=:3 25/2010 I One Ashburton Place Rm 1301 TYRe"_S�uP'PlemenlCard _ P�tstc�t l�.ta. 027.0$ IELSCH ENGINE=ER'I.N IK NERSTHEI'Mf=R�= •`-= 1 ELMWOOD ANSTON, RI 02910 --" - Admbi.ist:ator , Not va d with out signitrre - ---- , t http://db-state-rna.us/dps/llcdetalls.asp?txtScarchLN=CSL100459 �/fin 0nn L i c i a N � ,^ a V , } n � Nw / III V ' Town-Of Barnstable,* N? p Expires 6 months from4ssue date. - Regulatory Services Fee.. c� 9� s ;q 6 9. 0� Thomas F.Geiler,Director p Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 JUG 2��4 EXPRESS PERMIT APPLICATION - RESIDENTIATr&2gA, BARNSTABL s� Not Valid without Red X-Press Imprint Map/parcel Number S) Ir Property Address CP - esidential Value of Work ( �l,� TWner's.Name&.Address l 1M C-4`)i'' Contractor's.Name e Telephone.Number�S&_� 1�22 Z Home Improvement Contractor License#(if applicable) JJ/ Construction Supervisor's..License.#(if applicable) orkman's.Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance. Insurance Company Name Worlanan's Comp.Policy# 144 Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) f -side !�❑_Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home rovement Contractors License is required. Signature Q:Forms:expmtrg Revised121901 "ak David Sawyer Construction 318 Meiggs Backus Road Sandwich, MA 02563 (508)-539-1992 Proposal Submitted To: Work Place: Date j'-'7 V 6 "it?� Locgm t te 01 Cc C� , Strip, Remove, and Haul Away all old c.' ( ' SUPPLY&INSTALL: 4 Pc ( Yfflzj dyv CLEAN&REMOVE ALL DEBRIS FROM WORK PLACE AFTER JOB IS COMPLETED. ALL DEBRIS TO LANDFILL. TOTAL INVESTMENT FOR MATERIAL&LABOR$ All material is guaranteed to be as specified, and the above work to be performed in accordance with the specifications submitted for the above work and completed ' a substantial workmanlike manner. Payments to be made as follows lu Any alteration or deviation from the work specifications involving extra costs will be executed only upon written order,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. 10YEAR LABOR WARRANTY/PLUS MANUFACTURES SHINGLE WARRANTY. NOTE-This proposal may be withdrawn by us if not accepted with days. Respectfully submitted ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payments will be made as outlined above. Dat 5©2718 Signatur Board of Building Regula(ions and Standards ' e On e Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 134313 Type: DBA Expiration: 10/24/2005 DAVID SAWYER CONSTRUCTION DAVID SAWYER 318 MEIGGS BACKUS RD. SANDWICH, MA 02563 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card - - 71. �om�mzonureolU a�J aoa�lucaella ijo Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 134313 One Ashburton Place Rm 1301 Expiration: 10/24/2005 Boston,Ma.02108 Type: DBA DAVID SAWYER CONSTRUCTION DAVID SAWYER 318 MEIGGS BACKUS RD. �,, SANDWICH,MA 02563 Administrator Not 4dift wi out signature