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0057 PHILLIPS ROAD
'55`7 h l I l t s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map3747 I Parcel ® Z ... # Za 16 U�1?0 Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address P+�11_l❑�� -� Village Owner CY9-rRiA 444-u,4 Address : 7 tPWLL P S fl Telephone 5D8 . `775- > M Permit Request o�,j RosE Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay �Rroject Valuation 26 f3 /o ` 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 vNumber 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 135*6 of Appeals Authorization ❑ Appeal # Recorded ❑ =" Commercial ❑Yes ❑ No If yes, site plan review # , Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name M V G&LQ��C��_I ' Auki, q�,5L /1 �Yl2S'�� Telephone Number Address K ,4_ce) _Pr License # ere.L,4tr OA o a,1,63 J Home Improvement Contractor# IODO(, Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOr SIGNATURE DATE 3 FOR OFFICIAL USE ONLY f APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS Yr VILLAGE OWNER . 'G DATE OF INSPECTION: ' FOUNDATION FRAME 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 Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le;~ibl'p Name (Business/Organization/Individual): , C. Address: City/State/Zip: SrLvi Phone#: �3-� I6s0 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑ Building addition [No workers' comp.insurance comp. insurance.$ 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 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no C� � employees. [No workers' 13.0 Other Sb�,r 1 V 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. tContractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie;#: 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 rider t e pains and penalties"of perjury that the information provided above is true and correct. Sip-nature: Date: Phone#: so �'-2,3 l ^ 7/h Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3: City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other , Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity,or any two or more or the joint enterprise, and including the legal representatives of a deceased employer, of the foregoing engaged m a poi rp g g p 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 bum leaves etc.) said person is NOT required to complete this affidavit. 'The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions; please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 - Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.Rov/dia . Board of Building,Regula on5 and Standards One Ashburton Places, Room 130.1 k Boston.Massachusetts 02108 r Home Improvemet&.0 tractor Registration Registration; 1.63006; 4 Type. Private Corporation P ExpirBtiom 6/4/1011 Tr# 283199 MY:GENERATION ENERGY, INC14 LUKE HINKLE ie! r ; 1= - _..—._- 326 YANKEE DRIVE E BREWSTER, MA.02631' �,, — r -- — - Update Address'and return card:;Mark,:reason forchangc Address Renewal Cs Employment .Lost Card PS•CAI O 40M-0B108;D8SUF0RRMCAi68v2008 Board of Baildiog Rtgolations and•Smadards License or.registrshon valid for individul use only HOME IMPROVEMENT CONTRACTOR before the'e:piration date., If found return;to: Regiatrationi ,16390g Board of BuildingsRegulptions and Standards Expiration: 5/4I2011 Trl1 283729 One As66urton'PLace Rm.,l30I t ' q,. Boston,Ma. 2108' Type:, Pmvate CoMoration. ` MY GENERATION ENERGY;INC:. LUKE HINKLE 326 YANKEE Miv BREWSTER MA:Q2631 Admiaictrator w Not valid,without,signature i i 4 1 l s CONTRACT My Generation Energy; Inc.. HIC# 163006 FID#26-4343622 326 Yankee Drive Brewster,MA 02631 508-237-4650 CONTRACTOR:My Generation Energy,.Inc. OWNER: CYNTHIA_HAUN LEGAL ADDRESS: 57 Phillips Road;Hyannis,MA,02601 DATE: April 19,2010 PROJECT:.Design,provision,and installation of a renewable energy system.The system is a roof- mounted,grid-interconnected electrical solar photovoltaic array with-3.290 kW(DC STC)rated capacity,The system will comply.with all Commonwealth Solar It requirements as stated in Program Manual Solicitation 2010-CSII-Version 2.This contract and performance of the CONTRACTOR to order equipment or proceed with the installation is:contingent on confirmation of the Commonwealth Solar base rebate.award.The entire contract.will be rendered void and any deposit amounts will.be returned to the OWNER in the case where the Commonwealth Solar Rebate is rejected for any reason regardless of fault. Major equipment and components will include: Modules:Sharp NU-U235 F 1 (14 each) Inverters:Enphase M 190-240(14 each) Mounting Hardware:Unirac Solarmount SCOPE OF WORK: My Generation Energy proposes to furnish a turnkey system including design services;project management,recommendations,installation,labor and materials in accordance with the plans;specifications and requirements as approved by the owner as in the February 18,2010 revised proposal. This.service includes responsibility for:obtaining necessary buildingpermits;application for electrical service interconnection;scheduling and participating in inspections;conducting user training and orientation,and providing warranty services as required. Owner is responsible for: providing information as necessary and in a.timely fashion,to support the submittal of Commonwealth Solar Rebate.applications and supporting materials;NSTAR interconnection applications;permit applications;allow access as necessary for the installation at agreed scheduled times. TIME SCHELDULE:Order to commence on Maw28,201.0. Installation to commence on.June 25, 2010 or to be determined by,June 11,2010(subject to permitting,delivery and availability of components).Project completion.is estimated to be July 16,2010(subject to.inspection,utility;and forms processing schedules).No work shall begin prior to the signing of this contract and transmittal to, the owner,of a copy of this signed contract. PRICE AND PAYMENT.SCHEDULE: The total system price is$26,846.40. Payment will be made in three installments;deposit,order,and completion: Deposit allowance is'$2000.001 due at signing of this contract. - Initial payment shall be one half of total system amount,$13,423.20,due at the time of order. Final payment shall be the remainder of the total system amount,$11,423.20,due at time of completion(passed relevant inspections,.submitted utility interconnection completion form,and project.completion form). CONDITIONS: It is understood and agreed that My Generation Energy shall not be held liable for any loss;damage or delays occasioned by fire,strikes or material stolen after delivery upon premises, lockouts,'acts-of God or the public-enemy,accidents,boycotts,material shortages;disturbed labor conditions,delayed delivery of sellers suppliers,force majeure,inclement weather;floods,.freight embargoes,causes beyond his control. Prices quoted in this contract and subsequent submissions are- based upon current prices and upon the condition that the proposal and/or submissions will be accepted within thirty(30)days and under standard:conditions for.specialty contractors in the construction industry. PERMIT NOTICE: For any and all necessary.construction-related permits,it shall be the obligation of the contractorrto obtain such permits as the owner's agent.If the owner(s)secure their own construction-related permits or deal with unregistered contractors,they shall be excluded from access to the Guarantee Fund. INSTALLER WARRANTY:My Generation Energy warrants the system installation for.a period of five;(5)years on defective workmanship,PV project or component breakdown(except for the lesser . intervals noted in Manufacturers'Warranty Summary),or degradation in electrical output of more than fifteen percent(15.%)from their originally rated electrical output.This warranty covers materials and associated labor.Parts.may be repaired or replaced at the discretion of My Generation Energy.in addition;all manufacturer warranties apply.Renewable energy systems are,by nature,load driven and dependent.Owner assumes responsibility for proper maintenance.and use of the system, MANUFACTURERS'WARRANTY,SUMMARY:.(See manufacturers'literature for details). Sharp PV Modules: Five(5)year limited on materials and workmanship,twenty five(25)year limited . on power output.Enphase Micro-Inverters:Fifteen(15)year limited on materials and workmanship. UniRack Components:Ten(10)year limited on materials and workmanship,five(5)year limited on anodized finish. TERMS: The entire outstanding amount of the contract to be paid upon completion. A 1.5%service. charge per month will be,made on all past:due accounts. OTHER CONSIDERATIONS:All home improvement contractors and subcontractors shall be registered.Any inquiries about a contractor or subcontractor relating to a.registration should be directed to: Registration Division,Program Coordinator One.Ashburton:Place:Room 1301. Boston,Ma 02108' Tel:(617)727-3200 ext.25239 2 You may cancel this agreement if it has.been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided:you notify the seller in writing at his main office or branch.by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third,business day following the signing of this agreement.'Attachment A. THIS PROPOSAL IS SUBMITTED IN DUPLICATE. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. SUBMITTED: My Generation Energy,Inc. ACCEPTED: Owner(s) f SIGNED: NAME: L uk,✓ i lc, C! �(/ IFFL A A, DATE: Oy 12.Z2-v1�'. G a� i 3 . Attachment A NOTICE OF CANCELLATION ContractDate 1�210 You may cancel this transaction,without any penalty or obligation,within three business days from the above date. If you cancel,any property traded in,any payments made by you under the agreement,and any negotiable instrument executed by you will be returned within ten business days following_receipt by the seller of your cancellation notice,and any security interest arising out of the transaction will be cancelled: If you cancel;you must make available to the seller at your residence,in substantially as.good. condition as when received,any goods delivered to.you under,this agreement;or you may if you wish, comply with the..instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty. days of the.date of your notice of cancellation,you may retain.or dispose of the goods without any. . further obligation.if you fail to make the goods available to the seller,or if you agree.to return the goods to the seller and fail to do so,then you remain liable for performance of all obligations under the contract. To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other written notice,or send a telegram to My Generation Ener>ay,Inc. at 326 Yankee Drive,Brewster,MA 02631_not later than midnight of OZ' w i hereby cancel this transaction. (Date) (Buyer's signature) 4 Attachment B ARBITRATION The contractor and the homeowner hereby mutually agree in.advance that in the event that the contractor has a dispute concerning this contract,the contractor may submit such dispute to aprivate arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and'the consumer shall be required to submit to such arbitration as provided in MGL c 142A. Owner: C�10C cam. 7 -------------------- Contractor: a9 � NOTICE: The signatures of the parties above apply.only to the agreement of the parties to alternate dispute.resolution.initiated by.the contractor. The owner:may initiate alternative dispute resolution even where this section,is not signed separately by the.parties. .5 ' r TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION Map ` Parcel _1k- Application # l �� Health Division Z�,��Z' �� Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 1 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address �7 P QfD Village Hy"m l Owner �' Y AULAI Address ? Pf/C�'% s r �c t] YY A0JJ JS Telephone d ' 7'lS— 9(66 Permit Request i--iY-g-6W ti4yc) (Cif '.'WaS S d,+- P er,5' fhy \� �z ���.4.Vti �Nr.. li'vU' l JYS t��. _ ..C. �� . r pop-A Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio �� 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 5 Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other cs Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woodeoal stoveA:�❑Yew ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑'existing knew �gize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: m ;Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ a &v rn Commercial ❑Yes ❑ No If yes, site plan review# V Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name if II)IM v Telephone Number �3 � Address [3 License c),CQ T M �Sr` Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO cU/Y ,b 0? SIGNATURE DATE rv://Wo FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. p 4 ADDRESS VILLAGE OWNER DATE OF INSPECTION: r FOUNDATION c+ FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT p: ASSOCIATION PLAN NO. 4s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I� 600 Washington Street c� AV Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plum bers Applicant Information Please Print Legibly Name (Business/Organization/Indivi dual): 80et ' i COO , ,UC,?-/o�.,) Address: U� City/State/Zip: ' �S f i 0,160/ Phone#: �_S�0 o�7yy , Are you an employer?theck the appropriate box: Type of project(required): 1.❑ I am a er with employer 4. F] I am a general contractor and I p y * have hired the sub-contractors 6 ❑ New construction employees (full and/or part-time). 2. I am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodelin g These sub-contractors have g• [] Demolition ship and have no employees 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 addition 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or addition 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 comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy 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 ftt 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. 1 do hereby certify under the pains nd penalties of perjury that the information provided above is true and correct. Cz� Date: tall �9 Si nature: l Phone.#: r 7 y 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 S. Plumbing Inspector 6. Other Contact Person: Phone#: s Information and Instructions chapter 152 requires all employers to provide workers' compensation for their employees. Massachusetts General Lawsp P P q 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 Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7 749 Revised 4-24-07 www.mass.gov/ldia 1 . Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only before the expiration date. If found return to: t Registpration 161124 Board of Building Regulations and Standards I Ex I,tion -425/2010 Tr# 275548 F One Ashburton Place Rm 1301 i l I T r z; t �' l'tType LL�C Boston,Ma.02108 BELCAPE CONSTRUCTION LLC,4 t � DZMLTRY LABKOVICH' 29 WOODBURYAVE —_--- HYANNIS,MA 02601 Administrator Not valid with t signature 1 1 Massachusetts- Department of Public Safet) Board of Buildima Re"ulations and Standards Construction Supervisor License License: CS 102600 Restricted.to:.00 DZMITRY LABKOVICH 13 ATHENS WAY WEST YARMOUTH, MA 02673 Expiration. 3127/2013 Tr#: 102600 s • 1 �- S BEL CAPE. CONSTRUCTION, LL C CONSTRUCTION Proposal REIEFIPE 29 Woodbury ave Hyannis MA, 02601 508-685-9720(Dennis) 508-360-2749 (Dmitry) Fax 508-534-9730 Website:www.belcape.com e-mail:belc'apeconstruction@yahoo.com HIC REG#161124 ; LIC # 102600 Job Address: SAME Name: Synthia Haun Town: Address: 57 Phillips Rd Job Phone: 508-775-3846 -City: Hyannis Other Phone: State: MA ZIP• 02601 Estimator: Dmitry Labkovich Job Number: 12/17/09 We hereby submit specifications and estimates for the following work: 1. Apply for permit. 2. Install two new knee-walls in order to support rafters inside the attic on the left side of the porch roof. 3. Install one new brace to support roof overhang. Labor and materials:.$860.00 �y S+e ►-� `'� ` �� ` / �' y 1 2 - Damages that may occur during construction to landscaping or any finish ground work, plantings asphalt or stone driveway, etc., are.not the responsibility of the BELCAPE CONSTRUCTION, LLC. Flowers and shrubs against building may need to be repaired or replaced by Owner. - Contractor not responsible or liable for damage to asphalt or cement driveways walks or yards resulting from supplier, subcontractor or BELCAPE CONSTRUCTION, LLC vehicles. -No.tree removal, finish landscaping, retaining walls,walkways, driveways or shrub relocation. - Relocation of underground utilities or sprinklers. -Professional interior cleaning. BELCAPE CONSTRUCTION, LLC will provide cleanup on a continuing basis, utilize magneto minimize exposure to property or personal damage from nails left behind. Any work above and beyond specifications outlined in this proposal will be priced on request. All additional work will be subject to extra charge. Payment will be made as such: 1/2 Deposit 1/2 upon completion This Contract not valid unless signed by Corporate Officer: . J Date: De .d Signatures: wa- c ---- j � 4 i � j i i � �., f i � � ► { � I � } .I � � I. t � � � I � � E I I ' lip I , � � � � � i ► i � _i i � � I I � � i f � � C � � � j f � � I I � I � j � 1 I � i i I I f � j i f ! I I � � � ' I � i � I I i ` i � � � ► ! ' � 11 � i i f f � i � - - I I ( � � ► _ __ � f � - ; , � , 1, �tr j I � --t------ , � , : ; , , � ► ► � G ► ; I I : i � .� I � � _ _...,,- I __..__' _A. T� �, _ I � f � ► , I � �-�---,- � , i .�. ��1 f t � . _►� � , f � ! I� � � � �� �� I � I �' � � I f � i � � I i i � ----_"__"� ' i � � � I I � I� I � � � � i I �� _�---- i , j{ i r � a 1 I �� i � ' I _.___ ----- I � r i i t .f 4 � f I r I , I � i � + � r' , J I � i i j l j � �, •r`� ► � I ► � I f i � � I ` i f i t - ' ' t i t � i I � I i � � ► I � � I � � � � ' I � � I I � I. i� 1 � � I � I 1 � � I i I i I i i I + ! f I i � � �// I i �� I I I r � i .�. I � �} � , f' i ---� iil 'p I ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- Parcel e Application # Health Division 1 � - Date Issued l ?, U Conservation Division Application Fee S7 V Planning Dept. Permit Feed Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address P141 LL l PS Village W /ANN1 S Owner �`r/l f l 114 ALI A/ Address rh r-W' Telephone &O J 7 7�— 3 e j .6 Permit Request n/ 3jt1rMrrti/ C /dA/99 L385 M�vr P�(��N►���rt 4 L-,! i i4) A!® LGCS2 P(.(Qa/ OR 5 y/U* roOZA-C C&.4&4&S Square feet: 1 st floor: existing 77 I'proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Projecf Valuation 1 -/0J.30 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a/ Two Family ❑ Multi-Family (# units) Age of Existing Structure 75- 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 ®'atOil ❑ 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 # t Current Use Proposed Use ,o N rn V APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number C.Y d1 270 - a i'ddress 13 �j License # CAD L/4^ Y �eA�✓S"�G�v , L OoL CD Home Improvement Contractor# l O 77 7 Worker's Compensation # t✓C 711 -T Z4�-01 c/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - - DATE / a a ` FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. 1 ADDRESS VILLAGE OwmER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE'CLOSED OUT ASSOCIATION PLAN NO. E The Commonwealth of Massach usetts Department of Industrial Accidents 1` li Office of Investigations 600 Washington Street wi Boston, MA 02111 z tsy� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LejZibly Name (Business/Organization/Indivi dual): (Sa- &A/CUVAkle(/1< Address: t s 9 5b4 4j a n d > CI4 City/State/Zip: '(f eo ow Q ct l 0 Phone #: �y©/ 7 R9-37® 0 Are on an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑Lwemodeling construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 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.$ �• ❑ 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 1 I.❑ Plumbing repairs or additions 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' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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: T pS (Oe✓ L /Lj T Policy#or Self-ins, Lic.#:_tXJC�.' Z./)—�.��8`7�t►-o/9 Expiration Date: A I ho Job Site Address: 57 Pwalps ao City/State/Zip: 14YU4,1_5, _A4 e0-0 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 cert' it er t pai and penalties of perjury that the information provided above is rue nd correct. Si nature: Date: / Phone#: ZC, Olt ) 7M( - 370 0 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#: i ' CORD CERTIFICATE OF LMBILff OP ID 31 DATE(MM/DDlYYYY) INSURANCE THIE31 04 06 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Preston Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 150 Division Rd Suite 303 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR J Box 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Greenwich RI 02818-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Underwriters Ins, Co INSURER B: Hartford Casualty Insurance Co Thielsch Engineering, Inc INSURERC: Liberty Mutual Insurance Group 195 Frances Avenue INSURER Di North American Ca acity 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. POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE DATE MMIDD/YY DATE MMIDDIYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000tu A X COMMERCIAL GENERAL LIABILITY 02UUNTD5678 04/01/09 04/01/10 PREMISES(Ea,,..,ence) $ 300,000 CLAIMS MADE K OCCUR MED EXP(Any one person) $ 10, 000 PERSONAL&ADV INJURY $.1,0 00,0 0 0 r GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 JECT POLICY X PRO LOC Emp Ben. 1,000,000 " AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000,000 B X ANY AUTO 02UENTD4850 04/01/09 04/01/10 (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ - +HIREDAUTOS 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 $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 10, 000,000 $ X OCCUR CLAIMS MADE 02XHUUF6573 04/01/09 04/01/10 AGGREGATE $ 10, 000,000 $ DEDUCTIBLE $ }( RETENTION $10,0 0 0 $ WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE WC2-Z11-259874-019 04/01/09 04/01/10 E.L EACH ACCIDENT $ SOO,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 I1 yes,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 Eqp 02UUNTD5678 04/01/09 04/01/10 Equipment 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS (*Except 10 days for non payment of premium) CERTIFICATE HOLDER CANCELLATION TWNBARN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0* 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 IF EPRES ACORD 25(2001/08) ©ACORD CORPORATION 1988 i RISE ENGINEERI1�1G Federal ID#05-04o662s RI Contractor Registration No 8186 A division of Thielsch Engineering, MA Contractor Registration No 120979 CT Contractor Registration No 620120 �,lc 1341 Elmwood Avenue,Cranston,RI,02910 r W._.t W i .9 0 (401)784-3700 FAX(401)7$4=3710 ;CONTRACT r Page 1 I E ':THIS CONTRACT IS ENTERED INTO BETWEEN RISE ................. _.. .-.., ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERINGDESCRIBED BELOW CUSTOMER - PHONE DATE Client# Cynthia Haun (508)775-3846 09/03/2009 103858 SERVICE STREET BILLING STREET 57 Phillips Road 57 Phillips Road SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Hyannis,MA 02601 Hyannis,'MA 02601 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 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. 7 man hours. $462.00 RISE Engineering will provide labor and materials to seal heating and/or cooling ducts within designated unheated areas. This work will be performed at the rate of$75 per man per hour,which includes materials. 2 man hours. $150.00 RISE Engineering will provide labor and materials to install a 8"layer of R-30 Class 1 Cellulose added to 291 square feet of open attic space. $320.10 RISE Engineering will provide labor and materials to install all"layer of R-38 Class 1 Cellulose added to 291 square feet of open attic space. $349.20 RISE Engineering will provide labor and materials to install 110 square feet of R-19 faced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $121.00 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. - $1,051.73.. WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Three Hundred Fifty&57/100 Dollars $350.57 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. s w DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZED SIGNATURE-RISE ENGINEERING CUSTOM RACCEPTANCE _ ,• .e NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE —! — ACCEPTANCE OF CONTRACT-THE ABOVE PRIC S,SPECIFICATIONS AND CONDITIONS ARC' ' SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADEAS OUTLINED ABOVE ' �icensee Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 100459 Restriction WS,IC Name Erik Nerstheimer City,State,Zip North Scituate, RI,02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Beck To Search G lie.Ui om�no7uuea�� a���ccc�iuGel7a ��r -- ,- Board of Building Regulations and Standailgi License or registration valid for indiyidul use only HOME IMPROVEMENT CONTRACTOR �:_ before the expiration date: If found return to: Registrat�om 120979 Board of Building Regulations and Standards - 1 Expiration3/25/2010 One Ashburton Place Rm 1301 Apsfoif, Ia.021.08 Type Supplement Card THIELSCH ENGINE,ERING� >t- ERIK NERSTHEIM'�6":I 1341 ELMWOOD AVENi CRANSTON RI 02910u ' — --- ---- i Admfiistr%itor Not valid without signal.}re http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=CSL100459 9/24/2009 —E T�E•RGY CONSERVATION APPLICATION FORAY,[FOR ENERGY EFFICICIENCY FOR ONE; AND TWO-FATYIILY DETACHED RESIDENTTAL'CONSTRUCTION (780 CMR 61.00) Applicant Name: L=21K /10�2`S'UTP!�V/C Site Address: 57 P)/CC/PS Pe print Town: YOA/, //5_ Applicant Phone: 00 Applicant Signature: - Date of Application: /0 ®. NEW CONSTRUCTION: choose ONE of the following two'o tions 790 CMR TABLE 6107.1 PRESCRIPTIVE EN-`�rELOPE COMPONET';T CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MA�QMulv1 •MINIMUM ' Ceiling or Slab Option 1: Fenestration exposed Wall Floor Basement perimeter Wall AFUE HSPF SEE1 U-factor floors R Value R-Value R-Value R-Value R-Value and Depth National Applianoc.Encrgy 3 5 R-3 8 R-19 R=19 R-10 R-10' Cons r-mtioh Act(NAECA)of 4 ft. 1997 as amcndcd,minimums or calm as applicablc Note: This form is not required if you choose either of the two versions ofREScheck as listed below. ❑ Option 2: REScheck Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 �I REScheck--Web which can be accessed at http•//www.tntrgycodts.goy/rescheck/ ADDITSOIVS;b R A T�"TZOI�S.TO EXISTING$TJLLD I S.O R 5 YEARS OX,D *buildings under S years old must use option#1 or#2 in New Construction section above• Complete the following formula to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 ,(b _ a) SF 100 x - — % of glazing (b) Glazing area equals SF b a If'lazing j.s<- 0%.49e the chart beloW, If glatimg is > 40 % rgce6d to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMP ONENT CRITERIA ADDITIONS TO EXISTING LOVE'-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling and Slab Perimeter Fenestration � •Wall Floor Basement Wall R_Value U-factor Exposed floors R-Value R-value R-Value R-Value and Depth .39 R-37 a R-13 . R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e, not cons ressed over exterior walls, and including any access openings). ' SUNROOM—An addition or alteration to an existing building/dwelling unit where the total E] glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Forth found in A2Pendix 120.P �• 7 _ _ .b ------------ -- n _ _ _ _ _ _ ------------ rX -_ ____ _ rr r ... ___ _--___._._.... .. _... ..__.. ... _ _ ._-• 4 ,