HomeMy WebLinkAbout0110 CONTENT LANE Rio � A
-
f
Town of Barnstable *Permit#
Expires nths jrom isss date
p Regulatory Services F
x� S annxszes� , f
1 Thomas F.Geiler,Director
N10n�
Building Division o1c �136�13
�S�A Tom Perry,CBO, Building Commissioner
-eO N �F gA� 200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDIENTUL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number O j b
Property Address //D �on den f Gin e. � i � 0.26OF,177
U]Residential Value of Work$ 174 . Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address /014 A Z'45ew"'a
//U �LOi9 l e',1 IC
Contractor's Name ILt Q n LpyS / t Telephone Number SO S_ ,SD IF J.—rlolv9
Home Improvement Contractor License#(if applicable) ( 7 p06 Email:6C/trj/f/ii� 11.2 a LV cj6r4-Ap-cee"
Construction Supervisor's License#(if applicable) d 72 3
❑Workman's Compensation Insurance
Check one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
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)
❑ Re-side
Replacement Windows/doors/sliders.U-Value • (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
'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
quired.
ze
SIGNATURE:
C:\Users\decollik\AppData\Local\Microsoft\Windows\Te ary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc
Revised 061313
I
The Conunornvealdt of Massachusetts
Deparhnent of Luhrstrial Accidents
Office of Investigations
VJ_ 600 Washington Street
Boston,MA 02111
nnvty etas&gov/dia
Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leidbly
Name(Busioess/0iganization&dividnal): i.0-V t�yS�Lr
Address: /vlror!e L,q
City/State/Zip: &Z Phone 1k _-fOY ,SD y
Are you an employer?Check the appropriate box: T ' r
3'Pe of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).: have hired the sub-contractors
2. ] I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
` ship and have no employees These sub-contractors have S. ❑Demolition
w for me in any capacity. employees and have workers'
°fig i�' 9. ❑Building addition
[No workers'comp.insurance comp.insurance.a
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
employees.(No workers' 11.0 Other f(
comp.insurance required.] AV14,ee/yr�izt
•Any applicant that checks boa#1 rttttst also fill out the section below showing their wotkers'compensation policy information.
T Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating mcb_
(Contractors that check this box mast coached an additional sheet showing the name of the sub-conaactms and state whether or not those entities have
employees. If the sub-contractors have employees,they mast provide their workers'comp.policy number.
I am an empkyer that is providing workers'compensation insrtrarrce for my enrplayem Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Uc.#: 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under thepains and p allies ofpednry that the information provided above is bare and correct
Si tire: Date:
Phone M SD it SO 2 �Gto
Official rise only. Do not write in this area,to be completed by city or lotvn ofi'ciaL
City or?own: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
- - 6
r
i
• snxxsTnsu.
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8624038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, :rr M et S GAY b,4 r ,as Owner of the subject property
hereby authorize �L�'iss.� �as��i>, to act on my behalf,
in all matters relative to work authorized by this building permit application for:
lld l_�h Xell 7" ZQi!r-
(Address of Job)
Of- Pa la
Signature ofVwner Date
ZJ�IF»�4T �ACTCAlbAr
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\8R76BDVA\EXPRESS.doc
Revised 061313
i
17
Massachusetts -Department of Public Safety
Board of Building Regulations and'Standards
Construction Supervisor
License: CS-072354 .
�.`.
BRIAN P COUGIU�IN
82 PRUDENCE IN
Cotuit MA 02635�
r �.
`.i,. -. -01-44 ,. "' Expiration
Commissioner 06/14/2014
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/_ _J� 2nan�2iyur���o a� JJo a:,gJO
d
i
Town of Barnstable *Permits�ad�3��
F 'Er-
Regulatory Services Fees OCt
�MASS. Thomas F.Geiler,Director
a6S9 ♦�
D 11AA�a
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 0 q 0 0,30
Property Address 110 C014 c v,-
(Residential Value of Work_-:F2r/a Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address �� a L-aS C,44a r
1 10 60 n4C.-w-E 1,40,e 6,94-1 + 1AA Q kG 3S
Contractor's Name •_:j r%!.c v. `G Telephone Number SO g `i 2 O 1170
Home Improvement Contractor License#(if applicable) / 2 7 GOB
Construction Supervisor's License#(if applicable) pp�� �/�
❑Workman's Compensation Insurance X-PRESS
RESS PERMIT
Check one:
[D�I am a sole proprietor BAN 2 0 2�12
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name TOWN N OF RaRNSTABLE
Workman's Comp.Policy#
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)
�] Re-side
#of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum .3.5)#of windows
*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
required.
,SIGNATURE:
C:\Users\decollik\AppData\Local\Ivlicrosoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc
Revised 072110
OFF �
BARNSTMIX
139. Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Building Division
Thomas Perry,CBO
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
as Owner of the subject property
hereby authorize r i ti,k coo i►1 to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
a/2-
Signature o wner Date
Zrm-,? 4-yq sCOlt 6,4r
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exem� tForm on the
reverse side.
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.OUtlook\DDV87AAZ\EXPRESS.doe
Revised 072110
The Commonwealth of Massadiuseas
Department.of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
►vwrv.nras&gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lestibly
Name(Business/organizatiowh&vidoal): i
Address: ��- • ,Vlew;; G.�
City/State/Zip: 1�o7/yi f A6 44,0S` Phone#: S2P -a�o, 7 7e
Are you an employer?Check the appropriate box: T project am a general contractor and I Yl�of p Iect(r��-4.
1.❑ 1 am a employer with ❑ I g 6. ❑New construction
employees(full and/or part-time).: have hired the sub-contractors
2.M'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
w for me in an ci employees and have workers'
offing Y capacity. I 9. ❑Building addition
[No workers'comp.insurance comp.insurance.
required] 5. ❑ We are a corporation and its ME]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
employees.[No workers' 13.❑Other
comp.insurance required]
*Any applicant that checks boa#1 must also fill out the section below showing their workers'compensation policy information.
T Homeowners who submit this affidi tnt indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such_
(Contractors that check this bwc 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.
lam an employer that is providing workers'compensation insurance for my employem Below is the policy and job 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(shoving 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains penalties of perjury drat the information provided above is true and correct
Si tore: Date:
Phone M .S"ok Z/- ,;Lv y 70
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#:
6
O1'sce f&MVM'iff di es g9dW License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 127006 Type: i Office of Consumer Affairs and Business Regulation
Expiration: `8%19/2012 DBA 10 Park Plaza-Suite 5170
Boston,MA 02116
C E; LIN PROPE,---WWAINTENA.NCE
J r.
AIJR-
BRIAN COUGHLIN��.=_
82 PRUDENCE LE
COTU IT, MA 026351` ,,�=
.h Undersecretar
• �.._y— y Not valid without si ure
n'IaSSflChUSettS- Department or Public Saret
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 72354
Restricted.to: 00
BRIAN P COUGHLIN
.82 PRUDENCE LN
COTUIT, MA 02635
Expiration: 6/14/2012
('ununissiuncr Tr#: 27017
C>"! 3�
�01-1HE rO�ti Town of Barnstable *Permit#
Expires 6 monthsfrom issue date
Regulatory Services Fee
BARNMBLE,
v MASS. $ Thomas F. Geiler,Director
Building Division X-PRESS PERMIT
Tom Perry, CBO, Building Commissioner MAY' 2010
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us TOWN OF BARNSTAS.,E
Office: 508-862-4038 Fax: 508-790-
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ��-
Not Valid without Red X-Press Imprint
Map/parcel Number /��
Property Address �)(, (n o .t e-vi t L o at -'-
a
[►Residential Value of Work Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address v>'►G� L�- IS C_a I Ys�C
Contractor's Name d yylrt �r9eJ�1 r�—/ Telephone Number ,�0�5 -Sroa_94'�fo
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License# (if applicable) r>ry )
[/Jorkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
VI
am the Homeowner
have Worker's Compensation Insurance
Insurance Company Name je-- [) S iq
Workman's Comp.Policy# ('¢S R7)Q)0
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
T-1 Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
#of doors
R(Replacement Windows/doors/sliders.U-Value .,_3q (maximum .44)# of windows_
*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
required.
SIGNATURE:
Office of Consumer Affairs and usiness Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement:Contractor Registration
Registration: 164591
Type: Corporation
Expiration: 10/28/2011 Tr# 289959
THE REMODELING AND MAINTtKANC,E C'
THOMAS .DOWNEY
17 SPARROW WAY
SOUTH YARMOUTH, MA 02664
Update Address and return card.Mark reason for change.
[] Address [] Renewal Employment Lost Card
DPSCAI 0 SOM-04104-0101216
�/ce 'Pom�rno�uaeald�o�.�aaQac�
License or registration valid for individul use only
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
Registration:;,,_r184591 10 Park Plaza-Suite 5170
Expiratiant=_°:'1U(16/2011 Tr# 289959 Boston,MA 02116
TypQ', otporatlon-'
THE REMODEL�NGND MAINTENANCE CORP
THOMAS DOWNF�Y-Va- '
17 SPARROWOnJ IN )
SOUTH YARMOUTFi*I—.02fi64 Undersecretary Not valid without signature
i
I
BOaL 01�IIilUltlg, ttORS a't�t0 >�f 5�
�! riOlR�fitdd ..Sup FNISOTI.IEsnS6t
671
:Ex ft ion 3I9120{` Z ,c9488
';�ott t10
ttd
TH
1.7 SPARRQW WAY
•S YRR��Ui�i MA 02664':�� `om>bcsstwt�r�`,:_..::.. ..
�FZHEJp� Town of Barnstable
Regulatory Services
SA"Sr"BLF, ' Thomas F. Geiler,Director
Building Division
Tom Perry,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 Usina A Builder
1, 7�ry'm 2!SS'Q i as Owner of the subject property
hereby authorize 77�I!n wig e to act on my behalf,
in all matters relative to work authorized by this building permit application for:
go ec>yl f e-Y1 L c.-4\ e
-' (Address of Job)
$= 2 � �0
ignature of r Date
1,�w►a- LaSCa► �
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the.reverse side.
Q:FORJAS:OWNERPERMISSION
Town of Barnstable
o Regulatory Services
' Thomas F. Geiler,Director
BARNSTABLE,
MASS.
1639. `0� Building Division
plfD �n Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street .village
"HOMEOWNER":
name home phone# work phone#1
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 as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsipilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:\WPFLLES\FO RM S\homeex empt.DOC
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 Legibly
Name(Business/Organization/Individual):7-r�_e, 2 e vi cy
Address:
City/State/Zip: Phone#: 5OR
Are v u an employer?Check the appropriate box: Type of project(required):
1.[ Ioatn a employer with �5-_ ' 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
shipand have no employees ees These sub-contractors have
P Y 8. ❑ Demolition
working for me in any capacity. employees and have workers'
9. ❑ Building addition
[No workers' cotitp. 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.] c. 152, j 1(4),and we have no
employees. [No workers' 13.[✓ iOtlier�eo�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 and job site
information.
Insurance Company Name: �C 11_S l4
Policy#or Self-ins. Lic.#: )d)D Expiration Date: 1/-/8-ZDjQ
Job Site Address: ))0 C0Yn i'r_Y1 i- ' �n City/State/Zip:[_n+-t,
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 under the pains andpenalties ofperjury that the information provided above is true and correct.
Signattne: 1 Date:
Phone ' —
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#:
L-M LC. lr I=,LVNJ 11111C. 1< ..JI n l III; JlU - .-1J✓J0J_r1'aco L-1 Gr_J
A(Z-ORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMMiWt)
12/021 2009
PRD]ACER 413.534.7355 FAX 413.536.9286 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION j
Coss & McLain Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
47a Appleton eton Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
p ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P 0 Box 1128 1
Holyoke, 14A 01041-1128 _ INSURERS AFFORDING COVERAGE _ ! NA,IC it
INSURED The Remodeling & Maintenance CorpF T—— —1
p r-:=, rational Grange Mutual � 129939 _
12 Sparrow Way ;.;;r_� ACE USA - — --
South Yarmouth, MA 02664-1655
COVERAGES
THE POLICIES OF iNSUP,A,NCE LISTED BELOW HAVE BEEN i!SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOT61THSTANMNG
ANY REQUIREMENT.1'=nt.S OR CONCITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO'AHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTN,THE:1,1SURANC7 AFFORDED BY THE POLICI S DESCRIBEC HEREIN IS SUBJECT TO ALL THE"TERMS EXCLUSIONS AND CONDITIONS OF SUCY:
POLICIES.AGGREGI TE L IVITS SHOWN MAY HAVE BEEN RECUCED BY PAID CLAIMS.
II' 11 TIPE?F!JSUR4NCE ------! •---'-- ----Y- •T?OLb"/^PFECTI�'E ;PJ ICf EXP62ATI0"":—'— ----
LT ,tJSP,D ^,- POL!CYNUMBER I DATE M1MlDDMWI CATS(MMIDDNY:'Y1 �— LIMITS-
I GENERAL LIAsILI Y MPS5904R' 11 18 '2009 i 11/18/2010 1 1,000,000
X -.•I, _ ,'•.. ! �vl_E={_,cc':u"rr:::- rs 5_D0,00
—! ' Dc !-X ! _.. I �^I=.%.)n-i si<..i.' -- 10,00
1.000,00
I------- i i'.al._-:nt�•::,Re::-t 2 000 00
2,000,00
i AUTOIa051_E:LABILITY TBD; 12,,01/2009 i 12/01 2010 i
1,000,00
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EX:ESS!UMBRELLXLLAB:UTY
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r 'MORKERSCOMPENSATION --�— C45871010: 11/18/2009 11%18/2010 —
I AND EV (Wr:RS LIABIL-Ty Y
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS AUDEC SY ENDORSEMENTI SPECIAL PROVISQNS
I
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF T.4=-ABDV-c DESCRIBED PCLICIES BE CAVCO LEO 3EFCRE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR 70 IAAiL _10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.PUT FAILURE TO DO$O SHALL
1
IMPOSE NO OBLIGA'ION OR LIABILITY OF ANY MAID U?CN TIE INSURER.ITS AGENTS:R
I The Remodeling & Maintenance Corporation REPRESENTATIVES. -T-_
12 Sparrow Way AUTHORIZEDREPRE$ENTATI✓E
South Yarmouth, NA 02664 Cynthia Squires
ACORD 25(2009101) FAX: 508.398.7866 01986-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
i
Town of Barnstable *Permit#
Expires 6 months from issue date
Regulatory Services Fee ��
X-PRESS PERMIT Thomas F.Geiler,Director
S E P 2 5 2007 Building Division
Tom Perry,CBO, Building Commissioner
TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601
www.town.barmtable.ma.us -
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number_0�4 O 0 C�
Property Address j Q 'r' L-!-\ cjj! y Vr
LN'ffesidential Value of Work Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address -r R ww'N., LTA S.C-A T-Y6( KM .
L'tA Co TN)AT-
yt yk
Contractor's Name %Q6 It S Telephone Number, 5&d- 110 -,SE 141
Home Improvement Contractor License#(if applicable) I ZS 3 IQ
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Che one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
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)
0;1�e-side
❑ Replacement Windows/doors/sliders. 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.
py of the Home Improvement Contractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise061306
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 Legibly
Name (Business/Organization/Individual): . 6o,,K
Address: \-m, LmAczk_� `ax>
City/State/Zip: • V"pv-rt"I5 N4 Oz-l06N Phone.#:_ _Sob . 711E) - SZ311onp
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
have hired the sub-contractors 6. ❑New construction .
loyees(full and/or part-time). �
2 am a'sole proprietor or partner- listed on the'attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors-have g• ❑Demolition
working for me in any capacity. 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.❑ officers have exercised their I am a homeowner doing all work 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
employees. [No workers' 13 -dther g\�lttwt{�l.t�
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 subrnit 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 ornot those entities have
employees. If the sub-contractors have employees,they must pravidt:their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees Below isthe'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 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 insuranceof the for insuuance coverage verification.
I do hereby certify- der the pains-and penalties ofperjury that the information provided above is true and correct.
Signature: Date: 'Z. - b'7
Phone#:
Official use only. Do not write in this area,'tb 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 CIerk 4.Electrical Inspector S.Plumbing Inspector
6. Other
Contact Person: Phone M
' �pp1HETp��
'down of Barnstable. _
Regulatory Services
BnxNsr Thomas F.Geller,Director
s
rKasS.s $
nt Building Division
Tom Perry, 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 ABuilder
L As CuA ZQR_ , as Owner of the subject property
hereby authorize. (.;pjgN Wn% to act on my behalf,
in all matters relative to.work authorized by this building permit application for: .
• L 1 b CAwra,��:� �`,r�
(Address of rob) ;
Signature of `er Date
' 5-7
X ftytJP L a (&*Ar—
Punt Name
�Pq4-
QTORMS:OWNERPEWISSION
1
✓7 -(/JO'IYVI77,p'ILCIIP�LCIL 6L �f�/ ,._ / _iy
.._.Board.of Building,BegulaGons and.Standards__.--
HOME IMPROVEMENT CONTRACTOR
Registration 132117
Expiration -11/20/2008 Trl1 125369
f Typet Individual
i
GARY R.STUBBINS''.'
' GARY STUBBINS
126 LINCOLN RD.
HYANNIS,MA-of
601
Administrator,
1
I
Lien OA O/��BU, �y -
Nury►berc S STRVCT/O/y�s'p U�AtIpNs
Birtha f 077307 RV/SOR
EX 6j212��,966
r plr
'06%2 p!71
+1 GARyR 3T Rest�cteq��t ' 1/=108 Tr.
126 ll/yCO VBg/NS nO' 2520 HYgNNI 0
' Com�lssion
1r o 0
J p u
�9
l.� o
I
°ll
a for individul
�r use ut rrgistration valid nd retUr Use only
^the expiration date. (f fold Stapd U t0:
L4 dC, lldin Re ulatious a ap
„bird ojl3u 1; g ds
0 Ashburton Place Rm 1301
oaou,Ala.02108
✓— -- pre ��___
'Ydt valid without signat .
f
Le S
r _
becens
fore the registration:valid-for-individul•use.only._._
j before the expiration date. If found return to: fi+
:Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston,Ma.02108 '
I !�
valid without signature
Town of Barnstable "Permit#
v��vs9�
' E,4*es 6 nwxdrs from issue date
Regulatory Services Fee
Thomas F.Geller,Director
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8624038 Fax:508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLYv Y
Not Valid without Red X-Press Imprint
Map/parcel Number D qj—636
i rr��
Property Address /1 V C./?
U 17 je l7- L Q l7 ('�
,❑Residential Value of Workf t 3 b mot" Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address Yl ct r e-S
La e- Co r IWA, oa(93
Contractor's Nam Telephone Number, q35' J50 ;� G
Home Improvement Contractor License#.(if applicable) H b x
Construction Supervisor's License#(if applicable) a_
[3Wo-rkman's Compensation Insurance
Check one:
❑ I am a sole proprietor vi. — :;
❑ jjw-the Homeowner
4---D have Worker's Compensation Instuance `- v
Insurance Company Name ce A m e � C -e—
Workman's Comp.Policy# kOLPCZ44340260 45XIOi U/ 7
Copy of Insurance Compliance Certificate must be on.file.
Permit K(check bo
ep� c v � �f 7aor, w emov e S
❑ Re-roof(stripping old shingles) All construction debris will be taken to -rk)Pi
rt J
❑Re-roof(not stripping, Going over existing layers of roof)
❑ Re-side ®PRESS PERMIT
❑ Replacement Windows. U-Value (maximum.44) F E B 0 1 2007
•Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
T(,WIN 0 rsARNSTABLE
"Note: Property Owner must sign Property Owner Letter of Permission.
Ho a Improvem t Contractors License is required.
SIGNATURE: a Ste' A &P44f)
QTorms:expmtrg
Revise071405
1111111 Job# W/9-7Yr
Sears Home Improvement Products,Inc. IMAM
Location: Bof
License No.COC 01253e Phone# 791- Y71-2971
P.O.Boxi522290♦Longwood,FL 32752-2290 °®Doors
rs
ry
Name: C'a..IeS La S L4.6sr
Address: j rn_e4 44--f- m a : . A tr SL: WA ZIP:
Me.the owner of the premises described below,hereinafter referred to as"Purchaser"offer to contract with Sears Home Improvement
Products,Inc.hereinafter referredto as"Contractor",to furnish,deliver,and arrange for installation of all materials necessary to improve
the premises located at: 110 ,,1,4_9.++_ 4.44- 6D '}'t.i 4- y 04 & -_o a 43 i—
(Street) (City) (State) (zip)
Entry Door 1 Loc._aa, Entry Door 2 Loc. Loc. Loc.
Style: it cl e _dZ_ Style: BIDELTTES: STORM DOORS:
)iWull Jamb O L Frame O Double ❑Full Jamb ❑L Fame ❑Double Model Number: Model Number:
OCC Stainade PtC Snrooth OLMT Smooth OCC Stainable OCC Smooth❑LUT Smooth OCC Stal:mble OOC SM ❑One/Ttso O Deluxe ❑DuraGuard
Exterior Colors Exterior Colors Exterior Calore odor
Interior Coors Interior Colors Interior C0IMS ❑Tinted GlassO Bronze O Gray
OrkMind Color GrINBlind Color Grid/Blind Color ❑Alurnima n Screen Wire
it Glass Style C-Lawe ❑Glass We ❑Glass Style O Storm Door Standard Hardware
IV Hardware Flnish OBB 10AB OSN ❑ Hardware Finish OBB DAB ❑SN ❑ Brass Threshold ❑Black M White
PWStardard Hardware PKG ❑Standard Hardware PKG ❑ 39 ❑2%Colonial Casing Specially Hardware
10 Decorative Trim Handle ❑ Decorative Ttlm Handle M 29 Modem Casing Color:
❑ Magazine Slot ❑ Magazine Slot O Jamb Color
O Door Knacker and View ❑ Door Knocker and View O Standard ❑Extended Jamb ❑Wrdkem M ❑BB ❑AS ❑SN
❑ Door Knocker O Door Knocker Additional Options
❑ Kick Plate ❑ IGdk Plate TRANSOMS: SECURITY DOOR:
Additional COMB Additional Options Model Number: Model Number:
❑ CC Stainable OCCSM ❑Single Door Double Door
Exterior colors O Sldel tes ❑One ❑Two
ring Outswtng Inswing outawlrrg Interior Cobra Color
�rtwa aomNend unwo wmanw Wrm won c kenwq went a O Glass Style El Standard Hardware(Bright Brass)
name �d d'�m.dr ��,n� ❑314 ❑2%CdanialCasing Hardware Options
❑2%Modem Casing Color:
O Brass Threshold ❑ Brass Threshold O Jamb COW
U 3k PF 29 Colonial Casing ❑3%❑a Colonial Casing O Standard ❑Extended Jamb O Magazine Slot
O 2%Modern Casing Color: ❑2%Modern Casing Color Additional Options O So"Storing Glass
❑ Door Cumown ❑ Door Cutdown
Jamb Cladding Color Jamb Cladding Color
I?Standard Jamb O Extended Jamb O Standard Jamb❑Extended Jamb
Patio Door Screen Color Patio Door Screen Color
Do Not Do: !� (+ i y /� Purchaser Initials:
Special instructions: Clad Ord' &Aog e � De stet G. t(e� jM 4&V lor C4 C'N"
Contractor Is not liable for condition or operation of rehuntp storm doors l b Ile. %+a t K e d C.Q.-
IF
Clean up job related debris and provide necessary permits and insurance.
A low approximately 3-6 weeks for installation.Warranty will be mailed upon satisfactory completion.
NOTE-THE WARRANTY PROVISIONS AS STATED ONTHE REVERSE HAVE BEEN EXPLAINED AND UWE UNDERSTAND THEM FULLY.
ADDRIONAL PWASIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND AREA PART OF THIS CONTRACT x
Please read the following bold type and initial oomespondrig line. 40,
Verbal urnffirstendings and agreements with representative shall not be bktdingg.All understandings end agreements must
be set forth In writing In this Contract. Due to climatic conditions,Interior co;%neadon may occur. Purchaser Inkials:
king on storm chore may Doom.
Total Items
Terms: Credit 51 (SAW to the approval of the Credit Department) $ .00
Cash ❑ (Final Payment payable to installer upon completion) Initial Visit Discount $ X&3 .00
State Sales Tax(_%)
Funded (It applicable) - D —
by Bank Phone# Total Contract Price
City State Acct# Depot S
Balance Due $ 1-
10%Preferred Customer Discount(PCD)awarded for any future Seers Hohe hnprovemorrt Products purchases.current pricing avatlab a for one(1)year.
0 this Is a credlt transaction,the agreement for credit is contained in a separate document which is Incorporated herein by reference and made a part hereof.Uwe the
undersigned are hereby aut ominng Sears Home Improvement Products,Inc,to verify and review mylour credit record with an independent credit reporting agency and
release them from all liability Incurred from Inadvertent omissions or enom. �.+�v"�
IN WITNESS WHEREOF Purahaser(s)have hereunto signed their names)tine - day at -LA _ 2007 and acknowledge
receipt of a true copy of this Contract and unless otherwise specified,it is understood that the owner Is ready for w6lk to begin.
You the Purchaser(s)may cancel this transaction any time prior to midnight of the Bird business day after the date of this transaction.See
accompanying notice of cancellation form for an eWanation of this dgltt
Slpnanxe ebad_bOmAW w,4sipt khaki of reGoIrliAmrste xarrcdteton brm&
S D BY.Reprea DatePW Date
f'
ACCEPTED BY:eea Improvement Prodixts,bo. Date p
IX 1LX
G2-SO Rev.OWN
-rjwl iw;%
Board of Building Regulations and Standards
--
HOME IMPROVEMENT CONTRACTOR
o m;g Registration: 148607
g
Gxpi i aiton: 10/11/2007
Type: Public Corporation
SEARS HOME IMPROVEMENT PRODUCTS INC.
ALFRED NYMAN JR.
---4-024-F-L-OR-6
LONGWOOD, FL 32750 Administrator
Board of Building Regulations and Standards
- One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 148607
Type: Supplement Card
Expiration: 10/11/2007
SEARS HOME IMPROVEMENT PRODUCT
LUBOS SVEC
1024 FLORIDA CENTRAL PKWY
LONGWOOD, FL 32750 Update Address and return card.Mark reason for change.
DPS-CAI 0 50M-0510r-PC8490 1:1 Address E] Renewal ❑ Employment [:] Lost Card
. Q .J�t6 L�00)LI� O�✓ �LCCdC�d
\_ 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: 148607 One Ashburton Place Rm 1301
Expiration: 10/11/2007 Boston,Ma.02108
Type: Supplement Card
SEARS HOME IMPROVEMENT PR'
LUBOS SVEC .✓
1024 FLORIDA CENTRAL PKWY _
LONGWOOD,FL 32750 Administrator Not al'd witho xt Signature
y
DRIVER LIGEME 0 86395907, �a
t38 M31.1963 F,r 18-3+.-2M7
Cbss:2M Restr.B axkws'NONE
Sm:M V:6-02 Eyes:HAZ hnmd-.08-26-2003 t .~
SVEC
t L.V8OS .
827 THOMPSO
4 IHOMPSbN CST 0627
410 .Ari�aj9 `
-50 a 6
4 9
11/17/2006 13:42 407-767-8536 LICENCE PERMITS SUBS PAGE 01
ACORD. CERTIFICATE OF LIABILITY INSURANCE o4/oinow 03/10/200
zooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
LOCKTON COMPANIES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
525 W.Monroe,Suite 600 HOLDER.THIS CE111iT1FICATE DOES NOT AMEND, EXTEND OR
CHICAGO IL60661 -K Cj0—VERAG-E 9EEM,I;D�YT 01.lC S�B
(312)669.6900 INSURERS AFFORDING COVERAGE
MURED INSURERA erica
062183 Iris m
Sears Holdings Corporation
d/bla Sears Home Improvement Products,Inc. INSURER O,of No erica
Attn:Risk Management 85477E
3333 Beverly Rd. INSURER Q
Hartman Estates,IL 60179
:OVERAGES SEAH004 C7
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWRHSTANDING
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.
ISR POLICY POLICY EXPIRATION
TYPE Of INSURANCE POLICY NUMBER DATE MIOD LIMITS
GENERAL LIABILITY EACH OCCURRENC 5 000.000
A X COMMERaiAL GENERAL Loa4rrY HDO G21.729383 04/01/2006 04/01/2007 FIRE DAMAGE A onofire Ewhided
CLAIMS MADE EXI OCCUR D EJ(P one S Excluded
PERSONAL&AM INJURY 9 5,000,000
GENERAL_ REGATE 0 5.000 000
GEML AGGREGATE LIMIT APPLIES PER; PRODUCTS^CDIdP10P AGG 9 5,000.000
P -
J LOCI
AUTONOWLE LIABILITY
COMBINED SINGLE LIMIT a 5,000,000
A X ANY AUTO ISAH08219953 04/01/2D06 04/01/2007 (PJ,°rsmw)
ALL OWNED Amos
BODILY INJURY a XXXXXXX
SCHEDULED AUTOS (Par pew)
HIRED AUTOS BODILY I111URY
NON-OWNED AUTOS (Per nxldurd) I XXXXXXX
PROPERTY DAMAGE S XXXXXXX
(Per eocldent)
IGARAGELJAB4tTY AUTO ONLY-EA ACCIDENT 9 XXXXXXX
A ANY AUTO S.I.R.$5,000,000 04/01/2006 04/01/2007 OTHERTHAN EAACC * XXXXXXX
AUTO ONLY; AGG $ XXXXXXX
EXCESS LIABILITY EACH OCCURRENCE 9 XXXXXXX
OCCUR ❑CLAIM8 MADE NOT APPLICABLE AGGREGATE a XXXX7UCX
❑uLIR a
e XXXXXXX
DEDUCTIBLE FORM 8 XXXXXXX
RETENTION + 9 XXXXX X
A WORKERS COMPENSATION AND WLRC44340860(CA)(T)ED.) 04/01/2006 04/01/2007 }( WG STA OTH.
A PMPLOYEW LIABILITY SCFC44340872(WI)(RETRO) 04/01/2006 04/01/2007 E.L.EACH ACCIDENT a 1.000,000
B WLRC44340959 04101/2006 04/01/2007 G.L.DISEASE•EA EMPLOYEE t: 1000 000
B ALL OTHER STATES E.L.DISEASE-POLICY LIMIT a 1,000,000
A OTHER S.L&$5.000.000 04/01/2006 04/0I/2007 S.I.R.$9,000,000
Garapkeepers Liability
DESCRIPTION OF OPERATIOWLOCAIIONL"EHICr, BWCLUSIONS ADDED BY P.HDORSPMENTISPECIAL PROVISIONS
Alfred W.Nyman,Je.,License#CGC012538 located(a)1024 Florida Central Parkway,Longwood,FI,32750 and Alfrcd W.Nyman,Jr..License#CMCI249510
Incatcd @a 1024 Florida Central Parkway,Longwood,FL 32750
CERTIFICATE HOLDr=R AnonmNAL INSURED.,INSURER LETTER: —,CANCELLATION
2268082 SrtOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Sears Home Improvement Products DATE THEREOF,TIE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
1024 Florida Central Parkway
Longwood FL 32750 NOTICE To THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
NPOSE NO OBLIGATION OR LIABILITY OF ANY IONO UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES,
AUTHORED REPRESENTATIVE
ACOFRIO25-S(7197) For quanftmma■ralepenlncerftft,cmgectOwnumterUmdIn the ProducveFoConnbwn-mdopwMpMoclbrttm$q'SDXF4, ACORD CORPORATION 1968
Received on 11/17/2006 1 :37:25 PM
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ADDITIONAL PERFORMANCE RATINGS
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Mmuft urw sftla es blot areas 11*11 n oordam I I apalceW WK PDCW rea far d@W MkV%dole p w Wl peftffwm WM
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IRS
.... _. , ......._,..._._.__. __r.._..____�....._.._..�.�..._�._...._.._ . q dos
S� I
OF1METpN, Town of Barnstable F—rptres nonthsjrorn lssrreda(e
re
o�N��$�. ]�Zegulalo>t•y Services
MASS. .� Tl►on►as IF,.Geller,Director 1639• X®PRES PERMIT
�
'°rfo yA Buildi119 Divisi011
•Ion►Perry, Building Com►niss►once MAY. 18 2005
200 Main Street, I Iyan►us,MA 02601
Office: 509-962-4038 TOWN OF BARNSTABLE
Pax: 508-790-6230
)CYI'RTTS5 PLIUVIINot Vn1�l��►o��ed0,�Press 1�SIDLN'TIAL ONLY
Map/parcel Number
n y0�o �Tl�
Property Address
Value of Work l ?
[Residential
Owner's Name&Address
qA-
Telephone Number �_�
Contractor's Name
Horne Improvement Contractor License#(if applicable)
Construction Supervisor's License 11(if applicable)_ �.
❑Workman's Compensation Insurance �?
Check one:
❑ I am a sole proprietor ►a
❑ I yn the Homeowner .
►ave Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Perntit Request(check box)
❑ Re-roof(stripping old shingles)
❑Re-roof(not stripping. Gouig over existing layers of roof)
❑ Re-side
Replacement Windows. U-Value (maxinu►ui.44)
❑ Other(specify)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.llistoric,Conservation,etc.
Signature M nZLI
Q:Forms:expmtrg
L�rsc�ia�,�
CAPIZZI HOME IMPROVEMENT INC . // •�
SPECIFICATIONS ANV ESTIMATES PAGE 6 OF 6
STATE- OF MASSACHUSETTS
LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT
I Ire ( IDS „( �('l� �✓�✓
OWN THE PROPERTY LOCATED AT IIo c6 l n U Lm
IN � ' I ) MASSACHUSETTS.
I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT
TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,
THE MASSACHUSETTS STATE BUILDING CODE'.
I GIVE MY PERMISSION TO
LESSEE TO APPLY FOR A BUILDING PERMIT IW ACCORDANCE WITH 780 CMR, THE
MASSACHUSETTS STATE BUILDING CODE.
SIGNATURE OF OWNER:
OWNER'S ADDRESS:
OWNER'S TELEPHONE:
LESSEE'S SIGNATURE:
LESSEE'S ADDRESS:
LESSEE'S TELEPHONE:
APLLICANT'S SIGNATURE: )(Af R
APPLICANT'S ADDRESS: 1645 NEWTOWN RD. , COTUIT, MA 02635
APPLICANT'S TELEPHONE: 5081428-9518
RESPONSIBLE OFFICER:
RESPONSIBLE OFFICER ADDRESS:
RESPONSIBLE OFFICER TELEPHONE:
ACCEPTED BY DATE
THIS PAGE S T ND N ON MAN E WITH PROPOSAL #
r6-GE 03:5?pR Fr Um-A16 4�9 810-69U3 1-IZ4 I'.UUL/UU[ 1--lit
77-77,
lid
iT SIJ. I� L';., .ilk Il •I; , ;
, ':r,' 'U1�0
PRODUCER —_ —_ ,_:•� _L�L,.+ :'. r _���t_�
'I HIS CERTIFICATE 1S ISSUED AS A MATTCR Of- IN[-C)P yfATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Employee Ins Gtoul)Inc HOLDER.THIS CERTIFICATE DOFS NOTAMENU, EXTEND OR
201 Main St ARt,suite j11 ALl CR THE COVERAGE AFFORDED BY l HE POLICIES BELOW
Fitchburg, MA 01,120
COMPANIES AFFORDING INsURANcF
INSURED
COMPANY A GRANITE STATE INSURANCE COMPANY
Resoume Managements Inc
201 Main Stteel,SLltte#5
Ffthburg, MA 01420
THIS IS To CERTIf1 THAT THE POLICIES OF INSURANCE USTED®FLOW HAVE BEEN 1S5UED TO THE INSURED NAMNQ'
THE POLICY PERIOD INDICATED NOT WITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OP ANY CONTRACT OR TH OTHER
DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE
POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN
MAY HAVE BEEN REDUCE-BY PAID CLAIMS.
DTZ�'IN m a' POLICYNUM6EZL PDucy0TFCTrTDATL 1`OttCYt9CPiFiAT10HDATb - .A COMPEtt&1Ti01�
ND rl-PL0YQ3B LIA9ILITY
Ht;nTTOPRl�OTv LIMITS
ARTI`HTS't7(FnyE
PF
wcL o ExcL to
C Group 1225/2004 12/25/2005 ITATUTOM LIMrM
»trrt 0477192 1��' ;rl "�• ' !>d;
8�App4n to MA Oprmoun'$Ody.
CH ACCIDENT S 100,O
19CASC POUCY LlM S sm'000
E CR1P710N OF 0PI-RA710 HIQLI IS/sm-cl L I7La 5 $ 100.0
RE:COVERS THE EMPLOYF-ES OF THE NAMED INSURED LEASED TO CAPIM HOME IMPROVEMENTS INC,1645 NEWTON ROAQ,
OT UIT MA OZ535.
CFRTIF)CATE HOJ I)FR CANCELLATION
CAPIZZI HOME IMPROVEMENTS INC SHO'D ANY OFTHEADOVEDIMCRIDILDPOLICISSKCANMLLS'OD6PORt "M
1645 NEWTON ROAD D)?IRAATION DATE nietEOF•THE t3WING COMPANYWILL ENDEAVOR TO MAIL3R
COTUFT, MA 0263B DAYS-RI TEN NOYrCE TO THE C5ZfTT-rCATE HOLDM NAM®TO THE Lr=T.BUT
FAILURE TO MAIL SUCH NOTICE SHALL IMPOSL No omjGKT1ON OR L"lLrTy OF
ANY KIND UPON THG ODMPANY,ITS AGENTS OR REPRESENTATNES,
AUTHORIZED REPRL-SENT'ATIVE
���7T
1i �rd3 Jac tu.la�c)
Standards
One Ashbul on Place - ]:oom 1301
130st.031_ Masachuselas 02] Ub
1 ome I.mprovempit �;o tr°actor Iz.e ;istrai.ion
Repistralion: 100740
Iype: Privaie Corporation
Expiration: 6/23/2006
CAPIZZI HOME IMPROVEMENT, INC.
Thomas Capizzi, jr.
1645 NeMon Rd.
Cotuit, MA 02635
Updatc Address and return card.A1ark reason for change
Ej Address Renewal R Employment ❑ Lost Ca
✓�c Z(inmrmr.o�r�ue2l�. o�,/J�nacr�uae.��
Itoard of Building Regulations and Standards
:J I3° "jrn License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration dale. If found return to:
Registration: 100740 Board of Building Regulations and Standards
>' Expiration: 6/23/2D06 One Ashburton Place Rm 1301
Type: Private Corporation Boston,A42.02108
CAPIZZI HOME IMPROVEMENT, I
YI' Omas Capizzi,jr.
1645 IJewlon Rd.
COtuit, MA 02635
Administrator )tof valid without tar
/ .I�nv:rar�u�veCla
.y.0 BOARD OF BUILDING REGULATIONS
.a License: CONSTRUCTION SUPERVISOR
Number: CS 057032
Birthdate: 09/26/1963
Expires: 09/26/2005 Tr. no: 7171.0
Restricted: 00
THOMAS X CAPIZZI JR
1645 NEWTOWN RD
COTUIT, MA 02635 Administrator
{ 1/I f' C01"n em ilveti1//r O, (I,S'.Sfl('II II,S('/IS
"
crjhidusb-in//J(c'id(nLs
��4 =• 0/lice nt/n�esUgal/ons
1 600 13'(ishingfalr ,S'/rye/
1t 0.WOIJ, Masi'. 02111
Workers, Compensation Insurance Affidavit
1 ,
natu�:_ 1 i
❑ I am a homeowner performing all wor},mysclC nhonc fl
❑ j;om a sole proprietor and have no one working in any capacity V�
1 am an employer providing workers' tom ensation for my employees working on this jo .
i�
t
MAUM
❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed bel
the following workers'•compensation polices: ow who fis,.
;ads•
iim
Um Daily Da car.*
nhonc#f
.:.:..:.:.:.... ......
rite:
nhonc d
itisa rtl ncc tLb
nQicy#!
lFall urc to secure coverage as required under Scction 25A of l%IGL 152 can Iced to the imposition of criminal penalties of a fine up to S1,500.00 and or
one years'imprisonment As well as civil pcnaltics in the form of a STOP\PORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement may be farlvardcd to the Off'"of Investigations of the VIA for coverage verification.
I do hcr�by ccrrij),under file
pains and pcnaltics of perjury that rile inforntntion provided above is true and correct
Signature-AM V .
{� Date
Print snit ��I.1 > (�
hone 11 )I l 1� L, 4 ') I x
Ccheck
nly do not write in this nrea to be completed by city or ION'n official
Or
permitAiccnsc 11 —Building Department }r.,
mmediate responsc is required DLieensing BoardOSdeetmcn's Office
n: C)Heallh I)cpnrtmcnt
phone tY; Other
t�6cd rtvs PtAt
27
Harvey Industries
A Proud ENERGY STAR Partner
Harvey vinyl windows are ENERGY STAR qualified throughout the U.S. with Low-E/Al gon glazing.
ENERGY STAR qualified windows are 40% more efficient than windows that meet most national
building codes. If all products in the U.S. were ENERGY STAR qualified, we'd save $100 billion in
energy costs over the next 15 years. ENERGY STAR windows are good for the environment, using
less fossil fuels which cause air pollution, smog, and global warming.
Source: U.S. Deperament of Energy.Must use Low-E/Argon to achieve ENERGY STAR rating.
U and R Values
U-Value: A measure of heat transmission.The lower the U-Value, the less heat loss.
R-Value: A measure of a winclow's resistance to heat conduction.The higher the R-Value, the better a window is able to insulate.
U-values in accordance with M'RC-loo,imsal on whole windokv v:,�ucs. Clear Insulating Low-E .Low ElArg'on*3 Air Infiltration
VINYL.WINDOWS U-Value R-Value U-Value R-Value U-Value R-Value cfm/ft'
Classic Double Hung(N/lechanical) 0.50 2.00 0.37 2.70 0.34 2.94 .05
Classic Double Hung(Welded Sash&Frame) 0.49 2.04 0.38 2.63 0.34 2.94 .10
Classic Acoustical Double Hung STC40 0.33 3.03 0.25 4.00 0.24 4.17 .09
Signature Double Hung(techanic>[) 0.50 2.00 0.37 2.70 0.34 2.94 .04'
Slimline Double Hung(Welded Sash&Frame) 0.50 2.00 0.37 2.70 0.33 3.03 .09
Slimline Single Hung(Welded Sash&Frame) 0.50 2.00 0.37 2.70 0.33 3.03 .08
mkV-inyl1Casc-me/iAwnin7 0.47 2.13 0.36 2.78 j%0-BA=w3 03w .01
Vinyl Casement/Awning&Thermal Panel 0.32 3.13 0.26 3.85 0.25 1I.00 .01
Vinyl Designer Shapes 0.49 2.04 0.34 2.94 0.30 3.33 ----
Vinyl Hopper 0.47 2.13 0.35 2.86 0.32 3.13 .08
Vinyl Picture Winclow 0.46 2.17 0.31 3.23. 0.28 3.57 .01
Vinyl Roller-2 Lite&3 Lite 0.50 2.00 0.38 2.63 0.35 2.86 .09
VINYL NEW CONSTRUCTION WINDOWS
(Z-hir:)
Vicon Double Hung(Wcicled Sash&frame) 0.50 2.00 0.37 2.70 0.33 3.03 .10
Vicon Single Hung(Welded Sash&frame) 0.50 2.00 0.37 2.70 0.33 3.03 .10
Vicon Classic Double Flung(WCl(lccl Sash&frame) 0.49 2.04 0.36 2.78 0.33 3.03 .10
Vicon Casement/Awning 0.11.7 2.13 0.34 2.94 0.31 3.23 .01
Vicon Picture Winclow 0.11.7 2.13 0.32 3.13 0.28 3.57 .01
Vicon Designer Shapes 0.48 2.08 0.32 3.13 0.29 3.45 .01
Low-E/Argon`'` Low-E/KryptoW"* Air Infiltration
WOOD WINDOWS U-Value R-Value U-Value R-V:due ctn,/ft
Ma.tjCsty Double Flung N/A N/A 0.35 2.86 .13
M:,ycsty hixccl Casement(PbV) 0.36 2.78 N/A N/A .04
Majesty Catic nicrit/Awning 0.41 2+1• N/A N/A .02
Majesty PiCWI-C Winclow(DFI) 0.34 2.94 NIA N/A .10
Tempered Tempered 'lem)erect Dbl.'Iemp. Air Infiltration
Clear Low-E, LowlUArg Low-E/Arg cfn,/ft'
PATIO DOOR U-Value R-Value U-Value RNI lue U-V:due RNAtie t NAtle R-Value
H:uvey Solid Vinyl Patio n Door 0.49 2.04 0.40 2.50 0.37 2.70 0.35 2.116 .09
All vinyl windows with Low-E/Argun qualify for the ENERGY STAR progr:un throughout the U.S.
vise of winperecl I env-I?11ass may clli:ct 1"NFRGY STAR qualilic:diun in your rcoion. U-,uid It-V,,lovs;u'r suhjccl to change wilhoot notice.
L
t ap and lot numg. �. ...
` ... ......... �/�'•
C�THE t0
ewage Permit num er .....................1.7L� SWM SYSTEM MUS
. ............................ � �'tALL�01N COMP
House number ... ......
L.� 1A�NM�E•5 9BneaLE, so
J.
AL,CODE pY JW-
TOWN OF 'BARN,SZ ' "noes
r .
BUILDING 1HSPECTOR
APPLICATION FOR PERMIT TO �1...s. .....ZW!Tff......... ...
���X S� �
TYPEOF CONSTRUCTION ..1 ......��C.'�l.W..E................................................................................................
(�l�/!�........�..1..........19k.
. . ......... .... ..
r TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
CO iU I�VItT I..14 N� ,
Location ' :1,.......� ........�� ��1'�t <i '�C, ..... ..........Q.lU.tT.... 1/ l�LIQ!(�5........... ....j'.CJI./c..�.� ..._......
Proposed Use .....St..k&g-.......T�7m:.7........k.)� . 1: .-&)6.........................................................................................
Zoning District .... .. . ..............................................................Fire District
•
Name of Owner.�.�.jQfw.l1V.......1� �'-��8.{?� .....Address �7...4 ►trT� /rr.. � /.f ..1�5! /U•..M
Name of Builder 1 ..... 1/E l•7 ..........................Address .... ........OR... may./U....de4°1�... ....
Nameof Architect ..................................................................Address ........................................................................:...........
Number of Rooms ........S.�.X....... ..............................Foundation ...1�.....AO ....... ! 1 .............
Exterior ..... lfZ�l.1 .........///...................................Roofing ..........���I GT.......-5f1144-L,69.................
Floors} ,......... .....GUr9, C.....................................Interior ......�� � .....................................................
Heating .........Plumbing' ��............. ....................::............................................
Fireplace ..:. .......(...C?/ ..../ ll/!/!'>!�'.. !K. ........Approximate Cost �. 000
\ ................................. ..............
Definitive Plan Approved by Planning Board -----------_______-----------19 . Area .:... .....�...... ..............
Diagram of Lot and Building with Dimensions Fee �'��
f '
SUBJECT TO APPROVAL OF BOARD OF HEALTH
04° �
�o
°
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name � ........................................................
1
'CAIBAR, a-,JOAQUIN
,JOAQUIN
f for 9 .
�F�2
U.T5.... Permit for .......9 gle...Zamily
P
...............
Location ..JLjot..17-- -Q...CarLten.t...Lane
.................cotult..............................................
Owner ....q.1...Joaquin Lascaibar
.........................................
Type of Construction ....Frame
.............................. .......
...............................................................................
Plot ........................... Lot.................................
Permit Granted ........May...5......... .........19 80
Date of Inspection ....................................19
Date Completed ............... 19—,
PERMIT REFUSED
...... ..... ....................................... 19
..... ...... .. . . ... . .......
M. .. . . ... ....... .. . ..........
A
. ................................
< M
CU
.................................... 19
...............................................................................
. ........................................................... ...................
- TOWN-OF BARNSTABLE Permit" No. --4173 s
i _Building Inspector - N
C j
ash. � I
°`p.► '` OCCUPANCY PE RMIT Bond ' ' {
c + No building_nor structure shall be-erected .and no
''land, building or structure shall be
used for-a new, different, .changed, or enlarged .use without a Building. Permit therefor
first having been obtained from the Building Inspector. No'building shall be occupied until a
certificate. of occupancy has been issued by the Building Inspector."
issued to J. C,•IaSCaibar 'Address
7.nt 17 11:0 Cki tent Tine.. 06txl7 t
Wiring Inspector i , . --: 4 Inspection date
Plumbing Inspector ' �' J y Inspection date
Inspection date Gas Inspector �" �C f �'y ` • . F'f�l uan
' J
Engineering Department Inspection date-
:THIS PERMIT WILL NOT"BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED, UNTIL
SIGNED BY THE BUILDING INSPECTOR ,UPON 'SATISFACTORY COMPLIANCE, WITH TOWN
REQUIREMENTS..
. ...... ... .., 9............ ..............................Buildmg..Inspector..... Y
s
• Y
t
' 1
. r 150•ce
w ,
• 33.6 •
1
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44
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y .fir
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C 61Z T l F Y T"AT T N E. t-W pt>jt T(oi j s F c rzr--�lI C.a
WV-ZGot4 COAAPL%�{S WIT" TWG SlrrE.LI► C
AWt> SET$AC- - REQVI�ZEAAE: 4% OF TNP L I1
S A.X u TG IZ. 4. Y _ I%,-!G.
REGISrCIZi=D t... wc> 6uev`YovLs
THIS VLAW IS UOT BA'SEID v►J AW DSTE�VILLG o MASS.
6-�T BG used 10 r.>erc-v- %JL for Llwe V/1
Assessor's map and lot numbers ....`?' . ...,. .. ...... ' THE T
gL-P?d �o o�
'. Sewa a Permit number .... ... d�Q ♦�
............. ..
Z BARBSTSDLB, i
' r
House number ..... 90 rhea
p t639. \e0
�0 MAY y.
i
TOWN OF BARNSTABLE
f
B U IL�D I N G, INSPECTOR
APPLICATION FOR PERMIT TO y..X- a/l{rfi� 10 T�
....................... ....................................
TYPEOF CONSTRUCTION ...... .<...............................................................................................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following. information:
C'oiU TV.IT ►.A ili�_
Location. �Y IKc-ate r� .:....... t GiU-.......... U/1... �° .;:. .
�t tc�.6-�. rR 1r� !r,,� ,r 1��- ..............Proposed Use A 4'
Zoning District ; �U 1�
........................................................................Fire District ......./.�.....................................................................
Name of OwnerQ! . AC�I)1.to....... •A�:CA\,�c.ite2.....Address :��.�7...t..�rl. .S% �fli/l9r�i(�f�••/U�/i/� %?Ji`��•
Name of Builder 2VI4,L ... r1C�'t Nu
ice!' � �/�1j�i/ �T
...........................Address X .......'......';1 ....
Nameof Architect ............-....................................................Address .....................'...............................................................
Number of Rooms .......:; AAA.......1 ....................:.................Foundation / �[� C)itJe�F 7�
�d.........DU...... ........................�.........:..............
Exlerior ...../ + /�e� ..........��IlS��/ �'......................................................
. ......... ...................................Roofing ........... }
. / T�
Floors .L• .�, �;
.(I .L. .........:? �>f??..... {:.f......................•................Interior ...... p
Heating �"!`...-.� F,.?T l(' .....r�� ;..j''` �`.........Rlurnbing ....r„ ........................:...:.........................:........... -
i
Fireplace s ✓�O t ::....d�t.i/� 'r. � Y.1! (.,1........Approximate Cost .............:�•�,.07 P...................................
Definitive Plan Approved by Planning Board -----------_-------------------19________. Area .................................:........
s
Diagram of Lot and Building with Dimensions Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I
I
r i
�u I
n
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .... ........ .... ...................................
LASCAIBAR,,_ C.. JOAQUIN
A= 0-3, 0...
No 22-1.7.5.... Permit for ,-....le
............. ..
Family Dwellinq and Garaqe
. .............. ..........................................................
Location ..Lo.t...1.7...#.11.0...Content. ...La.ne
..... .. .. .. .. .... .. .. ....... ....... ..... ...
.................0..Q.t-q it..............................................
Owner ....Q.....iTQAC1.1J.i1T).. .........
Type of Construction .Frame............................
...............................................................................
Plot ............................. Lot ................
................
May 5 80
Permit Granted ................ ..............19
Date of Inspection ....................................19
Date Completed/......................................19
PERMIT REFUSED
.................................... ........................... 19
.;,/................
� /
...................
o.
........................... ..... ............................................
............................... ...............................................
.......................... .. .................................................
Approved„ I.................................... 19
...............................................................................
............... ........................................ ...................