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0086 STARLIGHT DRIVE
�C.o �i-c�1� �}- �'ive� �- � Q > � Town of Barnstable Building • snx�asrwBce, Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept MAS& Posted Until Final Inspection Has Been Made. Permit 16s9 p�� Myt Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-1950 Applicant Name: Craig Orn Approvals Date Issued: 07/02/2019 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 01/02/2020 Foundation: Location: 86 STARLIGHT DRIVE, MARSTONS MILLS Map/Lot: 100-048 Zoning District: RF Sheathing: Owner on Record: BARNATCHEZ,CHRISTOPHER F Contractor Name lxCRAIG M ORN Framing: 1 Address: 86 STARLIGHT DRIVE Contractor License: CS=080034 2 1. MARSTONS MILLS, MA 02648 Est. Project Cost: $ 22,358.00 Chimney: Description: Installation of an interconnected rooftop PV system with battery Permit Fee: $ 164.03 storage. 29 (360w) Panels 10.44 KW DC and 115kw Lithiumllon ; Insulation: Fee Paid: $ 164.03 Da Battery / Final te: 7/2/2019 Project Review Req: - �/ Plumbing/Gas Rough Plumbing: - `,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after`issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Ow/ O Fire Department Building plans are to be available on site (� 'Y_ All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 5 / TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 106 Parcel f U Application # C�?d f a y Health Division Date Issued 51175 1V d Conservation Division Application Fee (� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village / l l Owner C���S �a�r)r4-L I,c 1 Address S. c Telephone 77�(��► -o�-ok Permit Request �i�<.}1.�r a_ , 4- Pt &J Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation )Szv Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .0" 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) i 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 y CDt Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/cpal stove ❑Yq ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ e fisting 0 new�ize_ Attached garage: Ellexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: `� M Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial 0 Yes '0 No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mire McCarthy Connstrnncflon Telephone Number PO ]Box 52 Address Wect Dennis, MA 02670 License # Cell (508) 280-6964 0si .-5s633 HIC-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE )/III�r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER r i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE _ ELECTRICAL: ROUGH FINAL s" PLUMBING: ROUGH FINAL } GAS: ROUGH FINAL FINAL BUILDING t t ` DATE CLOSED OUT. ASSOCIATION PLAN NO. -77LJ_ R I S 'E MAr1 13 2015 ENCINEBUNG t OWNER AUTHORIZATION FORM I, (AMA (Owner's Name) owner of the property located at: kkk -� (PropeFfy Address) G►3 1 (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineeri , to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. 4Z Owner's Signature Date RISE Engineering 5 Dupont Avenue South Yarmouth, MA 02664 s i as Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCCAR - ` PO BOX 52 s W DENNIS MA 8267 Expiration Commissioner \ 04/10/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 Home Improvement C6ntr'actor Registration Registration: 169393 7 Type: Individual �r,,• *- , Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 WEST DENNIS, MA 02670 Update Address and return card.Mark reason for change. -r Address Renewal Employment ❑ Lost Card 20M-OS/11 The Commonwealth ofMassachuselts Department of IndrlstrialAcchlents 1 Congress Street, Snite 100 Boston,MA 02114-2017 wwnunass.gov/dirr . . Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/P1lirnbers.. TO BE FILED WITH Till;PERMITTING AUTHORITY. Applicant information Mike-M•eGai$•hG vs< wse Print Lepibly Name(Business/Organization/individual): P® $OX 52 Address: Nest Dennis, NIA 02670 City/State/Zip: CSL-f 1 4: HIC-169393 Are yor an employer?Check the a propriate box: Type of project'(required): 1.7m a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 1 am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.fNo workers'comp.insurance required.) 9. El Demolition 3.E]i am a homeowner doing all work myself.[No workers'comp.insurance req,tired.)1 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 Q Building addition ensure that ell contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.► 13.E]Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.LJ Other 152.§1(4),and we have no employees.[No workers'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 hn 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 ehrployer/lint is provlrling workers'compensa/ion insurnnce for my employees. IJelo is lure policy and fob slue Information. M insurance Company Name: LT� / lo4,� Policy d or Self-ins.Lic.#: VW(,-1011—GGi •7(S-6-_i0j Expiration Date: )a k_ )IN Job Site Address: 161. J f�.c)^L 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 MGL c. 152,§25A is a criminal violation punishable by a fine lip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance coverage verification. I do hereby certify un tl al s and allies rjtry that Ili e:informntlon provided ab ve is true and correct. Si nature: bate: S A /I i Phone#: Official use only. Do not write in this area,to be completer/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 ll WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMAT=PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)`876-2765 l`4CCf No 26158 POLICY NO. I VWC-100-6017656-2014B PRIOR NO. I VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P 0 Box 52 FEIN:"-"'3862 West Dennis,MA 02670 Legal Entity Type: Corporation Other workplaces riot shown above: See Location.,. 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000..each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease. $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information.required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annuat Remuneration Remuneration Premium INTRA 0712979 INTER SEE CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV GOV Deposit Premium $7,748 STATE CLASS MA 1 5479 State Assessments/Surcharges $28,601.00 x 5.8000% ? $1,659 This policy, including all endorsements is hereby countersigned b '�` ( P Y 9 � Y 9 Y 12/15/2014 Authorized Signature Date Service Office: Bryden &Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 J Burlington MA 01803 So Dennis, MA 02660 / WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. �1 FTC, Town of Barnstable *Permit# oExpires 6 mon1 ro issue date ' Regulatory Services Fee BARNSTABLE, ' 9� 639. `�$ Thomas F. Geiler,Director Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 0260.1 _ www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION '- RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/ arcel Number Z, Pro erty Address1. 110jJ l �� 'Q c Residential Value of Work -Mini um fee of$35.00 for work under$6000.00 Owner's Name& Address ' � 64Ad a_. Contractor's Name aosep'� Ufa t_ Tele hone Number y provement Contractor License#(if applicable) /✓�1 �i /ion Supervisor's License#(if applicable) y 's5 plt ' a I;ER—Rr"T � t;�„ �an's Compensation Insurance • neck ne: MARI. 7 %(11 I m a sole proprietor Wam the Homeowner .f`:'WN OF BARNSTABLE I have Worker's Compensation Insurance 1 � Insurance Company Name 5r t^ f- - Workman's Comp. Policy# O C/ b 7 3 9 Z Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to VReplacement not stripping. Going over existing layers of roof) #of doors Windows/doors/sliders. U-Value (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 requi p/ SIGNATURE: i Q:\WPFILES\FORMS\building permit formslEXPRESS.doc Revisers 001 In ;t. The Commonwealth of Massachusetts ` t� Department of Industrial Accidents rn-M �r• Jll 5' i j7 Office of Investigations , ��. 600 Washington Street Boston, MA 02111 = 1;y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print Legibly Name (Business/Organization/Individual): Address: g q5� Qzee 5 Lelpram y City/State/Zip: I � � = `�0' 3 y Phone Are you an employer? Check the appropriate b906 Type of pr 'ect(required): 113 I am a employer with 4• am a general contractor and 1 6 ew 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 g. Demolition - 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 iepairs 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 13.❑ Other employees. [No workers' 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. f ,te/r', s Insurance Company Name: ' �� ` Policy#or Self-ins.Lic.#: © � t 4:' 3 off— Expiration Date: Job Site Address: City/State/Zip:AJVJ/�"..Cj cv 77 Attach a copy of the workers' compens on policy declaration page (showing the policy number and expira on 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 and penalties ofperjury that the information provided above is true and correct. � v Si Date:Signature: �}J Phone#: Jib 6 Official use only. Do not write in this area, to be completed by city or town ofjkiaL 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#• NThe Commonwealth of Massachusetts E a Department of Industrial Accidents Office of Investigations 4 H lr- f 600 Washington Street j Boston, MA 02111 c www.massgov/dia Workers'.Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f Please Print Legibly Name (Business/Organization/Individual): Q� Address: S All 5 City/State/Zip: Mi4a> /11 7 Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1. ❑ 1 a a employer with 4. ❑ I am a general contractor and 1 6. ❑ N construction ployees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. $ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I LEJ Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4), and we have no 12•0 Roof repairs . insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation i uranc for my employees. Below is thepolicy and job site information. P Y USInsurance Com an Name: U � 8- Policy#or Self-ins. Lic.#: P P �IO�� ��d't% Expiration Date: Job Site Address: City/State/Zip: AA � A, Attach a copy of the workers'compensa ion policy declaration page (showing the policy number and expiratio 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 der the pains d penalties of that the inj rmaiion provided above is t u d corraclL Signafore: 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#: Information and Instructions I Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or.to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), addresses)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 isTequired. 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 5-26-05 Fax # 617-727-7749 www-mass.gov/cia �/e �Oammwruuea� o�✓�aeaaT.l:uaeCla '• \ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation Registrations:, 1,26893 Type:: 10 Park Plaza-Suite 5170 ' ExpiraEion�ir$f3[201;2... Supplement Card Boston,MA 02116 The Home Depot:j'4 omesSen ices DARREN DEMERS 2690 CUMBERLAND.PARKWAY S WtJ5�M,GA 30339 =%': Undersecretary Not valid without signature I i l J 4 �� -� Office of Consumer Affairs and 2usiness Regulation 10 Park Pla'd - Suite 5170 Boston, Massachlasetts 02116 Home Improvement Cn�tractor Registration Registration: 132349 Type: Partnership ,s:,�_:_:-T.�: •_ i`.:^; ;,;:::,� ;., Expiration: 1/11/2013 Tr# 207392 J & J Remodeling Joseph Duarte 15 Fall St. Wareham, ma 02571 U date Address and return card.Mark reason for change. Address ❑ Renewal ❑ Employment Lost Card )P"At p 6oM-WO"10121e Office of�onaDosum`MIFNA sioccsl'Iregula an License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Registration: _.•132349 Type: office of Consumer Affairs and Business Regulation Expiration: 1/t1/2013 Partnership 10 park Plaza-Suite 5170 Boston,MA 02116 eemodeIing:: Joseph Duarte 15 fall St. Wareham,ma 02571 Undersceretary of v d without signature Massachusetts- Depailincut ot•Puhlic Safef. Board or 8161dim-t Rcl ulaliuns and tilandurd� Construction Supervisor License License: cs 70077 JOSEPH C DUARTE 15 FALL ST WAREHAM, MA 02571 , -� Expiration: 12/3o/2012 ( nm,L�iunct, Tr#: 7048 r i0 39dd Z9L696Z EG:TZ TTOZ/ZO/10 2011-02-23 09:35 2612EXPDTR.PHONE 5089574714 >> Home Depot AHS P 1/6 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed bv: Branch Name. Bltstun Hate: THD At-Horuc Services,Ines rl/b/a The Hume Depot At-IlUme Services 345A(Treeawood Street,Unit 2,Worcester,MA 01607 Toll Free(80(1)657-5182.Pax(508)756-8823 Branch Number:31, Federal ID tt 75-208460;ME 1_ic tt C 02439:Ri Cont.I..io#16427 f� CT lac ti H IC.11565522;MA Home lrnprovcrrtznt C'rn tractur Rcg.ff l x8!) Installation Address: ' }` reef5'�' Ills �a6� City State 75p Purchaser(s): Work Phone: Hume Phone: Cell Phone Ilome Address:_ (if different from Installation Address) City Slate "Lip E-mail Address(to receive project communicaliuns and biome Depot updates): _ ❑I DO NOT wish to receive any marketing entails from The Ilonic Depot Prniect Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and THD At-Hume Services, Inc.("'The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Shect(s), all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment.Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: 0111O. itet--o Products:� Spec Sheet(s)#: Pro ect AouuntORtxTfing SI 'ng ❑'A ndows Elt,,,lation ❑Gloom/Covers t2l&try Doors ❑ _ 1 �j b $ �—�— �—=— ❑Roofing Usiding ❑Windows ❑in,ulation ❑Ciuncn/C'over.¢15ntty lloors ❑_ []Roofing ❑Siding Windows lnsulauou ❑Gutters/Coven []Entry floors❑_ $ ORonfing []Siding ❑Windows Inwlaliun 1 I $ ❑Gutters I Covers ❑entry noun ❑ i Mi.ninnun-'5%Depadtol'CuntntctAmountdueuponerecut[onufthiscontruct Total Contract Atnount $ Q'� Maine Yunluneis nmy not depusit more than une third of We Contrad Amount. Custotuer agrees that,itnmediare)y upon completion of the work for each Product,Customer will execute a Completion Certifrcat t (unc for each Product as defined by an individual Spec Sheet)and pay any balance dote. As applicable,each CustomeT under thi — Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(S)included herein,at its discretion,if The Hume Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the horns,cnviroruneatal hazards such as mold,asbestos or 1 ad paint,other safety concerns,pricing errors or because work required to complete the job was not included in the act. Pavinent Summary. The Payment Summary# included as part of this Cuntr:u:r, sets forth the total Contract amount and payments required for the deposits and final.payments by Product(as applicable). NOTICL TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Shects)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of terminntion,plus any other amounts set forth in this Agreement or allowed under applicable law. THE ROMP DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE: DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMiT NG THE;HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Anthoriration: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Horne Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral err written,relating to said Products,and Insullation.This AgMeltl=cannot he assigned or amended except by a wnting signed by Customer and The!Lome Depot..Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Ace ted h Sub ted by: -21 kJ 0 Custom is Signature Date l Sales C nsultant's Si nature Date X t l 6 ' Telepho a No. _ _�� Customet•'s Signature Date Sales Consultant License No. CANCE,LLATiON: CUSTOMER MAY CANCEL THLS (uxsprt6:ablei AGRF.RMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME I DEPOT BY MIDNIGHT ON THE: THIRD BUSINESS 1 DAY ALTER SIGNING THIS ACREF,MF.NT. THE, STATE. SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO (ISE IF ONE: IS SPECIFiC.&LLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. � NOTICE:ADVITIONAI.TERMS AND CONbrrIONS ARE STA*rED ON TiM RRVERSE SIDE ANT)ARK PART OF THUS CONTRACT 10-18-10 GSC White—Branch Fite Yellow—Customer r-- ao Ioo3Uc °Ft r Town of Barnstable Permit# 'b Expires,6 month r issue date Regulatory Services FdiFV Y Y • BANNSPABLE, s v MASS. Thomas F. Geiler,Director 039• ♦0 AjED MAy A Building Division r1 Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstab le.m a.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number I C Prop Address8�sg, I A. 1� Residential Value of Work Minimum fee off$25.00 for work under$6000.00 Owner's Name&Address N Contractor's Name ON Tolre:5 elephone Number Home Improvement Contractor License#(if applicable)IHO C 3 (o. Constr ction Supervisor's License#(if applicable) S PEW Workman's Compensation Insurance mPS Check one: JUN 16 2010 ❑ I am a sole proprietor ❑Darn the Homeowner TOWN OF BARNSTABLE I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# C-3 , Copy of Insurance Compliance Certificate must accompany each permit. 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) ❑ Re- 'de #of doors_ Replaceme indow /doors/sliders. U.-Value 0, 3 (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 re SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 'Revised 090809 r� The Commonwealth of Massachusetts : Department of Industrial Accidents i t office of Investigations . 600 Washington Street `y Boston,MA 02111 • �.��,�_•, i4'3vw.raass.gov/dttt Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Please Print Le i� bly A 1►cant I3sformatton � .� /�,j ; ., r Name(Business/Organization/individual): ii;, Address: �- 5r l ' � r0� � City/State/Zip: t �t Phone Are you an employer?Check the a propriat7b _ Type of project(required): I am a employer with 4' tn a general contractor and I 1: 6 Ne construction have hired the sub-contractors employees(full and/or part-time).* listed on the attached sheet. 7. etnodeling 2.❑ 1 am a sole proprietor or partner- These sub-contractors have R. Demolition ship and have no employees employees and have workers' 9. Building addition working for me in any capacity. insurance. [No workers'comp.insurance comp. 10.❑ Electrical repairs or additions 5. We are a corporation and its required.]. officers have exercised their I l.❑Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work per right of exemption er MGL myself. [No workers' comp. g p 12.❑ Roof repairs c. 152,§1(4),and we have no insurance required.]t 13.❑Other .employees. [No workers' 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. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. . �5 C Insurance Company Name: 111-v d(L411. .5 t-W, L j� ' Policy#or Self-ins.Lic.#: �a 3 r � `� Expiration Date: '! ( City/State/Zip: Job Site Address: Attach a copy of the workers' compe ation policy declaration page(showing the policy number and expiration date)n of criminal penalties of a a Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the impositio 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 tine 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�cerfipenalti �juryhat the information provided Bove is trueand correct. Date: Si nature• 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#: 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): G sow Address: City/State/ZipU0 4/Aa A0. OXM3 ne.#: /_y A-k i - n �A7 Are you an employer? eck the appropriate box: Type of project (required): 1.❑ in a employer with 4. ❑ I am a general contractor and I 6. ❑N construction employees(full and/or part-time).* have hired the sub-contractors �. 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 working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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 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. iContractors 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 ante for my employees. Below is thepolicy and job site information. / /�t/"/ - //�/ Insurance Company Name: e4et✓V/ 1 1er ins Policy#or Self-ins. Lic.#: Expiration Da J Job Site Address: C City/State/Zip:te: �/ 0)_6V�r Attach a copy of the workers' compe sation 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 ce fy under tf reTralties ojperjury that the information provided abo a is/true 'and correct Si nature:, Date: '! (9 '— At/ _ Phone#: ai �r 7 Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: DATE(MMIDDIYYYY) A'CC?/Rb® CERTIFICATE OF LIABILITY INSURANCE 02/19/10 PRODUCER 1-404-995-3000 —T THIS CERTIFICATE IS ISSUED.AS A MATTER OF INFORMATION ` Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPC'N THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certremiestQu:arsh.cem ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV1. Two Alliance Center, 3560 Lenox Road, Suite 2400 Atlanta, GA 30326 ,_� � ,F C � �_,,` c n/ INSURERS AFFORDING G/ : : G� iC- ?ax�212) 949-0902— -------._.... - -`-.._._ _......_._...._.. - INSURED I IN_CP,cR...Steaccast Ins Cc _._ 3tl._.____.__-_-_-.. The Home Depot, Inc. ' 31 Home Depot U.S.R., Inc. IINaURERB:Zurich_A::._arican Ins Co __,653-5.._.................. 2455 Paces Ferry Road NW INSURERC:New 11amnshire Ins Co — — 1_23841_._____._._ Building C-20 Atlanta, GA 30339 IINSURER D:NATIONAL UNICN FIRE INS CO OF PITTS i19445 IINSURER E:Illinois Union Ins Co 127960 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. INSR DD'l POLICY EFFECTIVETPOLICY EXPIRATION LIMITS TNRRTYP POLICYNUMBER A MI I M I IYY Y A GENERAL LIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURREaA 000,000 -- DAMAGE TO REN000_000X COMMERCIAL GENERAL LIABILITY PREMISES(Ea oc CLAIMS MADE OCCURMED EXP(Any onCLUDED—_--._PERSONAL 8 AD000,000GENERALAGGR000,000-:__- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s 4,000,000 X POLICY PRO LOC .8 AUTOMOBILE LIABILITY BAP 2938863-07 03/61/10 03/01/11 COMBINED SINGLE LIMIT _.. -... (Ea accident) s 1,000,000 X 'ANY AUTO - -- ALL OWNED AUTOS BODILY INJURY s (Per person) SCHEDULED AUTOS - -------- HIRED AUTOS' BODILY INJURY s (Per accident) NON-OWNED AUTOS X I SELF INSURED AUTO PROPERTY DAMAGE (Per accident) $ PHYSICAL DAMAGE . GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS I UMBRELLA LIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE $ 5,000,000 --_ X OCCUR CLAIMS MADE AGGREGATE $5,000,000 DEDUCTIBLE ---'$--- - — = - RETENTION $ $ C WORKERS COMPENSATION WCO20342355 (AOS) 03/01/10 03/01/11 X WCYTIMIT OTH- ---AND EMPLOYERS'LIABILITY Y I N D ANY PROPRIETOR/PARTNER/EXECUTIVE a WCO20342356 (CA) 03/01/10 03/.01/11 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? E (Mandatory in NH) WCO20342357 (FL) 03/01/10 03/01/11 E.L.DISEASE-EA EMPLOYE $1,000,000 ___ If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER E TX Employers Excess TNSC46242373 (TX) 03/01/10 03/01/11 Occurrence/SIR 30M/2M D Workers Compensation WC0910566 (QSI) 03/01/10 03/01/11 C Workers Compensation WCO20342358(XY,MO,NY,WI, ) 03/01/10 03/01/11 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN THE HOME DEPOT, INC. HOME DEPOT U.S.A., INC. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR 2455 PACES FERRY ROAD NW REPRESENTATIVES. BUILDING C-20 AUTHORIZED REPRESENTATIVE ATLANTA, GA 30339 USA ACORD 25(2009/01)Jthornton—hd ©1988-2009 ACORD CORPORATION. All rights reserved. 14481889 The ACORD name and logo are registered marks of ACORD j • ,vim ✓�re Lomvmorwrea�{ ������ \ Board of Building Regulations and Standards i HOME IMPROVEMENT CONTRACTOR RegistraoQgc 126893 - -W/2010 = YIJe _ tipplement Card The Home Depof;lafom_eisrvice ®ARREN l?EMERS�,_'':_=_-: �• 3200 COBS GALLERIA ATLANTA,GA 30339 Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston;Ma.02108 .r i Not valid without signature I Ju1. 1j. '1UU9 9: 10AM U h a r I e s U. Uase Jr. No. 411 ! r. j �fice o onsumer A ai>s anddBusiness tMgu a�ion� 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 163528 Type: DBA Expiration: 7/7/2011 TO 265903 ERICSSON HOME IMPROVEMENT ERICSSON TORRES .. 16 HOOVER RD --+-- -- WEST YARMOUTH, MA 02673 Update Address and return card.Mark reason for change, Address Renewal (] Employment n Lost Card 'IP5-CAI A 40M•08/08.OBELIFORMCA108212008 OffiL�dY s'4Pi �l('Ptdfr3�& lon License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation R®glstrafil'on: 163528 - 10 Park Plaza-Suite 5170 • Expiration: .7/712011 Tr>x 285903 Boston,MA 02116 Type: ZOA ERICSSON HOME IMPROVEKAENT ERICSSON TORRESr- 0�"" 16 HOOVER RD' WEST YARMOU7H',.MA 02673 UnJcrsccrctary Not valid without signnture Ju1. 23. 2009 9: 20AM Charles C. Case Jr.. No. 4717 P. 6 i •Ftesfricted'to:;b.�• . A-1 -Nlass,tchusetts- 0cparhncnt of Public Safef% i IA- Masonr)"o.nly i 80ard of Building Rc-rulmions and Standards : R - Roof.CovOing- Constructi.on Supervisor.Specialty License 'WS-Windo4s an'il Siding License: CS•SL 100S46 SF- Solid Fuel Burning:Devices Restricted to:. WS DM-Demolition only .ERICSSO .TORRES Failure to possess a current edition of the Massachusetts State Building Code 16•HOOVER ROAQ is cause for revocation of this license. -WEST YARMOUTH, MA 02673 Refer.to: WVi/W.Mass.Gov/DPS jL Expiration: 8HBI2012 '0,milt k4alvr Tm: 100546 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DS DATE(MM/DD/YYYY) TORRE-1 11/02/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. Western World INSURER B: Ericsson Torres INSURER C: 16 Hoover Rd INSURER 0: West Yarmouth MA 02673 INSUP.ER 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. I SR OD POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDNY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE' $ 1000000 A X COMMERCIAL GENERAL LIABILITY BINDER 11/02/09 11/02/10 pPEMISES(Eaoccurence) s 50000 CLAIMS MADE a OCCUR MED EXP(Any one person) s 5000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE s 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s 1000000 POLICY PRO- El JECT El LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY s SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPEP.TYDAMAGE s (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANYAUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS/UMBRELLA UABIUTY EACH OCCURRENCE S OCCUR ❑CLAIMS MADE AGGREGATE S S DEDUCTIBLE $ RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMITS EP. EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE s It yes,describe under ' SPECIAL PROVISIONS below I E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Carpentry/Painting/Drywall-*Certificate Holder is included as an additional insured with respect to general liability if required by a written contract. CERTIFICATE HOLDER CANCELLATION THDATHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL THD AT-HOME SERVICES INC IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR and The Home Depot 2690 Cumberland PkwyrSte 300 REPRESENTATIVES. Atlanta GA 30339 AUTHORIZED REPRESENTATIVE H annis Office FROM egad FAX NO. :5083622271 Dec. 16 2006 3:15PM PI HOME 1MPROVEMNT CONTRACT PLEASE READ TMS Sold;Furnished and Installed by: r THD At-Horne Services.Inc. I Branch Name: Boston Dated d/b/a The Home Depot At-Home Services 345AGieenwood SUWL Unit2,Worcester,MA 01607 Toll Pree(800)657-5182; Fax(508)756-8823 Branch Number:31 -Federal ID#75-2698460;MFs Lie ii C OZA39;RI Cons Li*16427. 4 CT Lic#56552-2;Iv1A Home hVrovement C onb=tor.Rog.#i 126893 Installation Address: P� C "� ty state Zip ci Work Phone: Home Phone• Cell Phone; FY7 Home Address: city State Zip (If different from Installation Address) E-mail Address(to receive project communications and Home Depot updates): ❑1 DO NOT wish to receive any marketing cmails from The Home Depot agrees to bu Prefect Information: Undersigned("Customer-),the owners of the property located it the above installationinstallation ad es stgrees to b uI and"fill)At-Home Services Inc.(''The Rothe Depot")agrees to furnish,deliver and arrange ls.described on the below and o n the referenced Spa: Sheet(s),all of which are incorporated into this Contract by this. all.materials along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, reference, "Contract!'): Spec Job#: (1.UA Jnd._) ucts: Shea s # Pro'ect Amount ❑Roofing OS. Windows ❑Insulation // $ v / 00uncrs/Covers Entry Doors ❑ G (O `~✓ ❑Roofing ❑Siding ❑Windows ❑Insulation $ OGuttets/Covers []Entry Doors 0---- Roofing Siding Windows Insulation $ ❑Gutttas/Cuvcrs []Entry Doors- Oltonung []Siding ❑Windows []insulation $ OGuu=/Covers OEntiy Doors n Minimnm25%Deposit of Contract Amwint due upon eseenfl n of this eoWtz'art. Total Contract'Amount $ Mirine Purchasers may mt depmu more than one-third ar the Contract Amwrnt- o��✓ ate mer Will Customer agrees that,immediately upon completion of the work for eac�R°alan�dtsieo applicable,each Customer un-a Completion tdeithts (one for each Product.as defined by an individual Spec Sheet)and pay y Contract agrees to be jointly and severally obligated and liable hereunder. The.Horne Depot reserves the right to issue a Change Order o°Vterminaten this t or ofindividualits�b gancotvsidue toes hewccural its discretion,if The Home Depot or its authorized service p concerns,pricing errors or because pmblem.with the home,environmental hazards such as mold,asbestos or lead paint other safety able). work required to complete the job wag not included in the Contract. included ati part of this Contract, sets forth the total p'avment Summary- The Payment Summary 1i G!/ v1 Contract amount and payments required for the deposits and final payments by Product(as applic NOTICE TO CUSTOMER not rig" Completion Cerl3ticate(note: You are entitled to.a completely filled-in copy of the Contract at the time you sign Sheets)before work er that a(note: there is one Completion Certificate for each listed Product as defined by individual Spec is complete. The Home Depot the costs of materials,labor,expenses in the event of termination of this Contract,Customer agrees to pay the date of termination,pltA any other and services provided by The Home Depot or Authorized Service Provider through amounts set forth in this Agreement of allowed under applicable law. THE HOME DEPOT MAY WITHHOLD W OUN� AMOUNTS- LIMITING THE)HO1vtE IykPO�S OTHER J(t1t;ME1DIlE5 k Olt Ill C V PAYMENTT FROM TgE DEPOSIT OR SUCH AMOUNN TS- MADE, Acceotarice and Authorization: Customer agrees and understands that this Agreement is the entire agreement hetween Cu. .nier and The Home Depot with regard to the Products and Installation services and aupersedcs all prior discussions and agreements,either oral.or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed byr 6)st and hasomer received The Ha copy o£thorne Depot- is Agreement-reemcknowledges and agrees that Customer has read nndetstanda,voluntarily accepts the Submi r Accepted by: ,��� X Date Dale sales Co ul t'S Si tore Customer's Signature Telephone No. X Customer's Signature Date Sales Consultant License No. (ab applicabto) CANCELLATION: CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WPXI'M NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE iF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE TM IIFWRM SIDE AND ARE PART OF TIM CON 1'[tACr IY NITC:f�:ADDPrrONAi.TF.RMS AND CpND7Ti4NS AARS'I'AT6DON Wren-Branch F O-YOVOw-Cam► Pink-Sales C,pnSsdtanl Assessor's map and lot, number ...✓.... .. ...........:... .:.......... Sewage'Permifi umber°"............ . BUT..... t ............ .... J ' y�FTHE T��♦ C, - TOWN OF BARNSTABLE Z MARESTABLE, i • N ! /• RU-I-L=DI-NG INSPECTORc, °o i639• ♦� APPLICATION FOR PERMIT TO cy ....... 1 � ` ................................:.. TYPE OF CONSTRUCTION ........C.G1. ....................:. 9.................................. 9 ?'. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. ... .. .. .. .ilhcR.1.......Y�Y..1.. .. .�tt�....�'l.L.G.Y(.a.. ............................................................................... �f fProposed Use ........... . ....... ....... r�i[,cJ.:...... .f.................................................................................. Zoning District .. .............................................Fire District ...L.�G.�. ...:'.�.... . ............................................ Name of Owner jaea. A A .........Address Name of Builder / l... ... ............Address .�..�. ..�P4.Y ..., a.................... Nameof Architect .... A vet ........................................Address ............ . ...d-W...e. ................................................... Number of Rooms ........... ........................................Foundation .. ..... P.<rvr.? . . . . .. . ... X..�4'............................................................ ...............................Roofng .....Ex1e for ..... ...... Floors i ...... .. ............Interior ..... ,sar?e.:'i...'..i1. . Heating ...... .........�d4ly..`..1GO..l4,4 ....... .......Plumbing ........ �. t?.E.......................................................... Fireplace ......... ...........................................................Approximate Cost ........ ........................................................... -----I 9--------. Area Definitive Plan Approved b PlanningBoard ---------------__________ c�.s� Diagram of Lot and Building with Dimensions Fee ... s J3 3 .....................'..... SUBJECT TO APPROVAL OF BOARD OF HEALTH Q. I hereby agree to conform to all the Rules and Regulations of the.Town of Barnstable regarding the above construction. Name-� � � �' ........................ Michaels, Elizabeth S. No .189.97...... Permit for ....a,ddi.>tion.............. .....single...Eamily..duelling......................... Location Starlight..Drive....:........................... ...........MaBatons..MilU.................................... Owner Eliz.abeth..S....Michaels..................... „ Type of Construction - rood••.frame.....•.••.••.••... ................................................................................ -Plot ............................ Lot ................................ Permit Granted ....March..10......................19 77 Date of Inspection .. .. ........... ....19 Date Completed' .51 ... ..............19 PERMIT REFUSED ................................... 19 I ............................................................................... Approved ............................................................'................... ............................................................................... Assessor's map and lot:,,number ....11'9 .a y� 5� �fl Sewage,'Permit vnumber ................... _ TOWN OF BARNSTABLE THE Z B9BBSTABLE, • y - DI9 BUILDING INSPECTOR v �0 .. , APPLICATION FOR PERMIT TO -t `*.... r TYPE OF CONSTRUCTION -^ f ,~. ..... % ..................................19... .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ,�,` .� t i, �t ;. .�_� ..� 1 •., _r................................................................................ ................................................. . f, j ProposedUse / 4.�n..........�+: �, . /A��f-i .:................................................................................................................................ .f................ .. t /. Zoning District � "Fire District ' Name of Owner ��,..:.'.-� ... ....'ft:.:,r,L.hn,Yn/ Address ..�'C Q^p �S° •tp............. � .. t�... T _Name of Builder.h.'.+.?..: ................Address ....:....... ,d�-a �. ., E. Name of Architect ....� rt.y.i. _ ..C��. :*: . :..................................... .....:............................................Address .......... .... .................. „ _7 Number of Rooms /+-!�'. Foundation .. ram......► ... �- « - �� .............. ............................................ Exterior .... C .gipp. '?..........�� �,;;.... .:!-r ......................Roofing ..... ' c r�.Y�. ......................................... Y L n.. 4 > . Interior �h q7�i rn•1!� • Floors ....................................I ..... !..e,_ a ' x - Heating _.. 1 : .la .......Plumbing ............. .................................. .......... Fireplace -t'•" n1C ....................................Approximate. Cost u Definitive Plan Approved by Planning Board ________________________________19________ . Area Diagram of Lot and Building with Dimensions Fee, ......[!.. .............................4 SUBJECT TO'APPROVAL OF BOARD OF HEALTH v�G V �. J 41 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......... ...............................:....................... Michaels, Elizabe 8, 100-48 No ..1ag9.-7..... Permit for ....adH,U. a n.............. sine••£ami.Ly..dwelling......................... Location 41as•1•i,ght..Ds3ve............................. ................Man.,•tons••Mi11.&............................... Owner ELiaabeth••S.: .MichaaLs.................... Type of Construction )-w"d••£sacne...•.•.......•.. ................................. ............................................ c Plot ............................ Lot ................... Permit Granted :....Marc....i.............:.....19 71 Date of Inspection ../.........................19 Date Completed/.................................19 PERMIT REFUSED ............ ... .... '19 ....... .....! . �.. ..,.................................... ................................... .:�? . �........................... z ................................. ........ .................................. .................................:............................................. Approved ................................................ 19 ............................................................................... Town of Barnstable oFt r Regulatory Services 1% Thomas F.Geiler,Director saxxsTaate. Building Division y� Muas. Tom Perry,Building Commissioner i63� .e 200 Main Street, Hyannis,MA 02601 RFD MA't a Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: ,bD Permit#: HOME OCCUPATION REGISTRATION Date: Name:. �VvIa-A Phone#:-'Oe Address: ?-n S//9-k4J 611-r M Village:172 1•-e N-S M ,-j Name of Business: tlq-�z Is- Type of Business:.11,IMne f J"IL Map/Lot: /460 YP CDT INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carved on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,' odors,electrical disturbance,heat,glare,humidity or other objectionable effects. . • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the unders' ed, u ead and agree with the above restrictions for my home occupation I am registering. Applicant: Date: /o �� 3 Homeoc.doc Rev.5/30/03 i TO ALL NEW BUSINESS OWNERS DATE:Fill in please: UiNlow APPLICANT'S YOUR NAME: MW BUSINESS YOUR HOME ADDRESS: � ,5T�4ie_ TELEPHONE Tele hone'Number Home - �1J-3�IS NAME OF NEW BUSINESS 's 0 TYPE OF BUSINESS a6u4 _5C11 4 IS THIS-A HOME OCCUPATION. YES N. Have you been given approval from the building division? YES=NO Q ADDRESS OF BUSINESS F4, 57Ael_lg; . 1- M,¢eslloltis Awc.cs MAP/PARCEL:NUMBER Id"6 6,oZ When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. -(co r of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING C MMISSI NEW FFI E This individual as q n i orm er it requirements that pertain to this type of business. tho ed Signature** - COMMENTS: ow de� 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Business certificates (cost $30.00 for 4 years)'. A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. QACONSUMER\Lots\CA.Forms\newbusfrm.doc