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0148 STARLIGHT DRIVE
/�� —sue �-,�— � �- e a ACTIVE Town of Barnstable Building Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept i v "'"� Posted Until Final Inspection Has Been Made. �e�n11t ,asq. �0 cj 1639+. Where a Certificate of Occupancy is Required, such Building shall Not be Occupied until a Final Inspection has been made. Permit NO. B-17-4124 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals Date Issued: 11/30/2017 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 05/30/2018 Foundation: Location: 148 STARLIGHT DRIVE, MARSTONS MILLS Map/Lot: 099-048 Zoning District: RF Sheathing: Owner on Record: PRATT, BARBARA J Contractor Name: BRIAN D DENNISON Framing: 1 Address: 148 STARLIGHT DR Contractor License: CS-095707 2 MARSTONS MILLS, MA 02648 Est. Project Cost: $4,986.00 Chimney: Description: WINDOE REPLACE 3 .20 UVALUE Permit Fee: $35.00 Insulation: Project Review Req: Fee Paid: S 35.00 Date: 11/30/2017 Final: 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. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: 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 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. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations: 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). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT i oFm� Town of Barnstable `-Permit# / — �{ a �. Expires 6 arottllrs front issue date Regulatory Services Fee 7% !E�__ s + ■ARMAHL& 1 .0�q Richard V.Scali,Director �Fo Ntp't a Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,VIA 02601 www.town.bamstable.rna.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERIMIT APPLICATION - RESEDENTLAL ONLY Not Valid without Red X-Press Imprint Vtap/parcel Number Property Address Sfax Dr AC!/'S J✓t'S / !i U Residential Value of Work ST�,('f j — Minimum fee of�$35.00 for work under$6000.00 Owner's Name&Address �f le�G rti I ra 7 S7G���cLit Dr. /�.rCf/,)/l .5 ti�lS /,//I - Contractor's Name '11dc7,,,J aril /!t soli Telephone Number('t-(O( 2 Home Improvement Contractor License;"(if applicable) 1 Email: Construction Supervisor's License#(if applicable) (g Norkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ f m the Homeowner I have Worker's Compensation Insurance Insurance Company Name E r e- n -Eas1.1 'a-,a t�_ K"CI Workman's Comp.Policy# tit/C A a :7 Z 9 — 2 o Copy of Insurance Compliance Certificate must accompany each permit. Y Permit Request(check box) ❑ Re-roof(hurricane nailed)(strippin,old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing Payers of roof) side ❑ Replacement Windows/doors/sliders.L1-Value - ZR (maximtnn 32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. I *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property wner must sign Property Owner Letter of Permission. A copy EliHome Improvement Contractors License&Construction Supervisors License is require C. SIGNATURE: !k4 n-d-qb, C:\Users\Decollik\AppData\Locai\Microsok\Windows\Temporary Internet Files\Content.0utlook\2P101 DHR\EXPRESS.doc Revised 040215 I r Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Barbara Pratt Legal Name:Southern New England Windows,LLC 148 Starlight Dr NORi RI #36079, MA#173245,CT#0634555, Lead Firm#1237 Marston Mills,MA 02648 winnow NE UCEMEMT 10 Reservoir Rd I Smithfield,RI 02917 H:5088788647 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Barbara Pratt Contract Date: 11/09/17 Buyer(s) Street Address: 148 Starlight Dr, Marston Mills, MA 02648 Primary Telephone Number: 5088788647 Secondary Telephone Number: Primary Email: barbpratt@comcast.net Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $4,986 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $2,493 Balance Due: $2,493 Estimated Start: Estimated Completion: Amount Financed: $4,986 8 to 10 weeks 8 to 10 weeks Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date.Rain and extreme weather are the most common causes for delay. Notes: 50% depo GSky/ 50% bal GSky.Tax Barstable Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 11/13/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE°IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal By Andersen/°f Southern New England Buyer(s) Signature of Sales Person Signature Signature Cory Scanlon Barbara Pratt Print Name of Sales Person Print Name Print Name UPDATED: 11/09/17 Page 2 / 10 Massachusetts Department of Public Safety pill Board of Building Regulations and Standards License: GS-095707 I Construction Supervisorh- BRIAN D DENNISON 7 LAMBS POND CIRCLW` 4; CHARLTON MA 01507 �..M Expiration: Commissioner 09/08/2018 _J 7��i ll- tJ�fi Office of Consumer Affairs nd Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement;Contractor Registration Registration: 173245 ',c;r Type: Supplement Card '— 1 �. Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS L ! BRIAN DENNISON jam' 26 ALBION RD LINCOLN,RI 02865 • •'�ti F_��°.' Update Address and return card.Mark reason for change. Su a zaM-osn; ❑Address (-j Renewal _I Employment ❑Lost Card C.- ��u,umi ro�r,lN .i//a ,r/a✓! (fire of Consumer Affa' B.Bndaess Regulation Registration valid for individual use only before the 010E IMPROVEMENT CONTRACTOR expiration date.If found return to: office a Consumer Affairs and Business Regulation Reglsbation:c7if3245; Type: 10.Park Plam-Suite 5170 iratlon=9119/2018: Supplement Card Boston,MA 02116 Exp - _ SOUTHERN NEW ENG6AND-WRJDOWS LLC. T.v- RENEWAL BY ANDERSON BRIAN DENNISON 26 ALBION RD '-_ ` LINCOLN,R102865 l-Drtdc Not valid withoutsignatu e f ` The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia )Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTLN'G AVOORITY. Applicant Information Please Print. Le 'blv Name (Business!Organizazion'Individual): e L EP VA L Owl Address: 2& AL4 f dip I Cifi/State/Zip: btj&lp P I 0a ne, Phone:6: �,p� - 2�g= FEW Are you so employer?Cbeck the appropriate box ` Type of project(required): 1,Kl am a emplover with ZO "employees(full and/or pan-time).' 7. ❑New construction 2.❑I am a sole proprietor or parmership and have no employees working for me in S. ❑Remodeling any capacky.[No workers'comp.insurance required.) 9. ❑Demolition :.❑i am a homeowner doing a_i!work myself,P%To workers'comp.insurance required.] 0 ❑Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work or,my property. I will easure that all contractors either have workers'compensation insurance or are sole 1 LE]Electrical repairs or additions proprietor`with no employees. 12.❑Plumbing repairs or additions f 1 am a generz contract and]havehid thebc act o or an hired sub- ontrors listed or the attached sheet. �❑ 1-,.[]Roof repairs Tnese sub-contractors have employees and have worker:'comp.inswrance. E.❑we are a corporation and iu officers have exercised their right of exemptior.per MGL C. 14.�ther /,✓/�l i 52 f l(4)_and we have no employees.(?vo workers'comp.insurance required.i 'Any applicant that checks box must also fill otn the section below showing their workers'compensajoc policy information. Homeowners whc submit this affidavit indicating they are doing all wort: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. Lithe sub-contractors have employees,they must provide their workers'comp.police number. I am an emplover that is providing workers'compensation insurance for my employees. Below is the polio and job site information. _ Insurance Company Dame: Ire PW /S - Q�f'"l — Policy t or Self.ins.Lic.t: �A v IE8" z 7 — — Expiration Date: f O Job Site Address: 1�1'f /ar//C 4-f- — r City/Stater'Zip:4/Sfe+1 S M./I r �r`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 MGL c. 152. 625A is a criminal violation punishable by a fine up to 51,500.00 and/or one-year imp"ri sonment.as well as civil penalties,in the form of a STOP VdORk ORDER and a fine of up to$250.00 a day against the violator.A copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Idoherebycertgob'underthe ains and penalties ofperjun°thar the information provided above is true and correct Si afore: Date: " Phone#: �{D I- ZZ I 9�a Official use only. Do not write in this are&to be completed by city or town offrciaL City or Town: Permit/License 4 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Tomm Clerk 4.Electrical Inspector 5_Plumbing Inspector 6. Other Contact Person: Phone ' i ESLERCO-01 SANDERSO A`� Q DATE IMMrDDY CERTIFICATE OF LIABILITY INSURANCE ow0712o7no17 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COMN FACT PRODUCER FAX CoBiz Insurance,Inc.-CO PHONE 303 988-0804 lac,Nc,End):(303)988-0446 lac,Nb):( ) 1401 Lawrence St,Ste.1200 E-MAIL comail@cobtfinsurance.com Denver,CO 80202 ADDRESS: INSURERS AFFORDING COVERAGE NAIL X INSURER A:Acadia Insurance CompanyI31325 INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 iSouthern New England Windows,LLC.dba Renewal by INSURER C:LibertySurplus Insurance 110725 Andersen of Southern New England INSU...D 26 Albion Road,Suite 1 Lincoln,RI 02865 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. =GENERAL DDL SUER POLICY EFF POLICY EXP LIMITS INSR INSD 1 UB POLICY NUMBER MMIDD MMIDD A I X TY EACH OCCURRENCE 51,000000 DAMAGE TO RENTED 300,000UR CPA3158728 01/01/2017 01/01/2018 pREMI E Eaocrvrrence 5,000I MED EXF Anyoneperson) 5 PERSONAL d ADV INJURY 5 100010001 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE t L- I POLICY❑jRa C LOC PRODUCTS-COMP/OF AGG I S 2,000,000i EBL AGGREGATE 5 2,000,000 OTHER: COMBINED SINGLE LIMIT 5 1,000,000 �—A AUTOMOBILE LUU3ILITY Ea accident) i I 01/0112017 01/01/2018 BODILY INJURY Per ersonN S 1 ANY AUTO CPA3158728 I rl OWNED SCHEDULED BODILY INJURY Per accident 5 i I AUTOS ONLY AUTOS ElPROPERTY DAMAGE i HIRED NON-OWNED I Per accident AUTOS ONLY AUTOS ONLY 1,000,000 A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADEI CPA3158728 01/01/2017 01/01/2018 AGGREGATE 5 0I Aggregate I 1,00010001 DED X RETENTION 5 X PER OTH- j B WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY Y/N 1,00iT000 ANY PROPRIETORlPARTNER/EXECUTIVE CA3158729-20 0110112017 01101/2018 E L EA ACCIDENT 'S FFICER/MEMBER EXCLUDED? N/A I E-L DISEASE-EA EMPLO i 5 1'00Q'000I (Onnandatory m NH) 1,000,0001 it yes,describe under E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS below 1,000,000 g Worker's Compensatio CA3158730-20 01/01/2017 01/0112018 �17 01l01/2017 01/01/2018 1,000,000 FD Workers Compesnation Includes-All states except pt ND,Additional IWA 1NVarks s we may be attached a more space required) i I ' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE PQLJE'Y PROVISIONS. AUTHORED REPRESENTATIVE I IF OR InformationalP ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Town of Barnstable Building HAANM$CA6L&�:1 Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept i y Posted Until Final Inspection Has Been Made. Permit 0►Aa<° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-17-4126 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals Date Issued: 11/30/2017 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 05/30/2018 Foundation: Location: 460 MISTIC DRIVE, MARSTONS MILLS Map/Lot: 061-023 Zoning District: RF Sheathing: Owner on Record: WOLFE, MARK W&CHERYL L Contractor Name: BRIAN D DENNISON Framing: 1 Address: 460 MISTIC DR Contractor License: CS-095707 2 MARSTONS MILLS, MA 02648 Est.Project Cost: $ 17,160.00 Chimney: Description: REPLACE 2 DOORS.29 U-VALUE Permit Fee: $87.52 Insulation: Fee Paid: $87.52 Project Review Req: Final: Date: 11/30/2017 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. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: 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 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. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 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). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT I r , oFIKE T Town of Barnstable =Permit# s I_ — I a 4p Gipires 6 maulis front issue date Regulatory Services Fee 2:7. S c_�X s • ■ARNSTAaI.E, . 9 mass. 004 Richard V.Scali,Director � 1 t639. �0 �FOMP�� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.town.bamstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PEMNUT APPLICATION - R1 SIDENTLAL ONLY Not Valid without Red X-Press lntp ittt Map/parcel Number 0(o / 0oZ Property Address H /� �c �' /'iQ/ on S //� A _ (Residential Value of Work$ /7, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Ma,X i rAe,-y��Li /, s/,L Dr, /y&rs ns K-16 dA Contractor's Name ;F Afii7k.J5- 2?/1 / /tt:59/7 Telephone Number (qo l 2 Home Improvement Contractor License 4(if applicable) l73 2 44 S Email: Construction Supervisor's License 4(if applicable) 7 O [TrWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor the Homeowner I have Worker's Compensation Insurance Insurance Company Name E r e me__as Tn an c e I D -ti Workman's Comp.Policy# fit/CA 3 1-5'8 7 2—9 2 L Copy of Insurance Compliance Certificate must accompany each permit. 3 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 Z-9 (maximum.32)#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 caner must sign Property Oa ner Letter of Permission. -- - A copy thL�ome mprovement Contractors License&Construction Supervisors License is require SIGNATURE: G - " C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\21`101 DHR\ExPRESS.doc Revised 040215 l Rimewal Agreement Document and Payment Terms byAndersen. dha:Renewal B Andersen of Southern New England y gl Mark&Cheryl Wolfe ���� Legal Name:Southern New England Windows,LLC 460 Mistic Drive i RI #36079, MA#173245,CT#0634555, Lead Firm#1237 Marstons Mills,MA 02648 WINDOW RE LACENENr 10 Reservoir Rd I Smithfield,RI 02917 H:(508)778-1829 Phone:866-563-2235 1 Fax:401-633-6602 1 sales@renewalsne.com C:(508)367-3979 Buyer(s)Name: Mark & Cheryl Wolfe Contract Date: 11/09/17 Buyer(s)Street Address: 460 Mistic Drive, Marstons Mills, MA 02648 Primary Telephone Number: (508)778-1829 Secondary Telephone Number: (508)367-3979 Primary Email: markwwolfel@gmail.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $17,160 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $4,000 I, Balance Due: $13,160 Estimated Start: Estimated Completion: Amount Financed: $13,160 8 to 10 weeks 8 to 10 weeks Method of Payment: Cash/Check We schedule installations based on the date of the signed contract and secondarily on Financing the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date.Rain and extreme weather are the most common causes for delay. Notes: Deposit paid via check; ; Balance financed via Greensky Plan 2521; ; Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 11/13/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Nam .So kern New England Windows,LLC dba:Rene++�B}' ndersenofS ernPNew England Buyer(s) Signature of Sales Person Signature Signature Josh Ocharsky Mark Wolfe Cheryl Wolfe Print Name of Sales Person Print Name Print Name UPDATED: 11/09/17 Page 2 / 9 Massachusetts Department of Public Safety Off Board of Building Regulations and Standards License: GS-095707 Construction Supervisor BRIAN D DENNISON 7 LAMBS POND CIRCLE.- CHARLTON MA 01507E • 5;� Expiration: Commissioner 09/08/2018 �� /l 0ad�6.tZ Office of Consumer Affairs nd Business Regulation mill," 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor.Registration Registration: 173245 r 1 di=• Type: Supplement Card 1�! _ 1. Eviration: 9/19/2018 SOUTHERN NEW ENGLAND WIND,OWS_= {� BRIAN DENNISON °" 1 ' 26 ALBION RD "A LINCOLN,RI 02865 = •.tir.� ;',Update Address and return card.Mark reason for change. scn1 6 zaasovn: Address ❑Renewal _I Employment G Lost Card Coasomer ARoirs&Bosiaess R g ladoo Registration valid for individual use only before the I.IMPROVEMENT CONTRACTOR expiration date.If found return to: Ottireof Consumer Affairs and Business Regulation Reglstra0on_:�Z�gs Type: 10 Park Plum-Suite 5170 fir N?n:=9%79/2018 Supplement Card .Boston.MA 02116 SOUTHERN NEW E*646,,WINDOWS LLC. F RENEWAL BY ANDE S K. ., BRIAN DENNISON 26 ALBION RD LINCOLN•AI 02865 l:0bde ry Not valid without signature f y� The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 sl www.mass.gov/din Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNUTTLNG AUTHORITY. Applicant Information Please Print Le "bly Name (Business/Organization/Individual): e �ws Address: ,2& &A)OAD City/State/Zip: PJ Phone P: :!fkl - Are you so emplover?Cbeck the appropriate box: Type of project(required): 1,K]am a emplover-Mth ZL employee (full and/or pan-line).' i• New construction 2.a I am a sole proprietor or partnership and have no employees working for me in S. Remodeling any capacity.(No workers'comp.insurance required.) " 9. [I Demolition Oi am a homepwner doing ai!work:myself,LrNo workers'comp.insurance required.:s 10 Building addition 4.❑I am a homeowner and wd:'be hiring contractors to conduct all work or.m;•property. I will ensure that all contractors either have workers'compensauoh insurance or are sole 1 I_❑Electrical repairs or additions prop-iemrs-Aith nc employees. 12.QPltunbing repairs or addition 1 am s gene` contractor and I have hired the sub-contractors listed on the attached sheet. `-•0 13. Roof repairs These sub-contractors have employees and have worker-'comp.insurance. 14.[ / er E. We are a corporation and.its officers have exercised the right or exemption.per 1,4GL c. (- 152:f 1(4),and we heve ne employee`.Tq workers comp.insurance requiree., I re lQ C ent e t->LS -Any applicant that checks box r'must also fill otn the section below showing their workers'compensmoc polio•intfarmation. Homeowners who submit this afndavit indicating they are doing all work:and.then hire outside contractor 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. Lithe sub-contractors have employees,the-,•must provide their workers'comp.policy number. I am an emplover that is providing workers'compensation insurance for my employees. Belot+ is the polio•and job site information. _ Insurance Compare Dame: t1re dplie s Police or Self-ins.Lic. k: UL/ v�-a>V A z Z- Expiration Date: O Job Site Address: l 5/C City/State/Zip: n s M� Attach a copy of the workers' compensation policy declaration page(showing the police number and expiration ate). Failure to secure coverage as required tinder MGL c. 152:E25A is a criminal violation.punishable by a fine up to S1,500.00 and/or one-year imprisonment.as well as civil penalties_in the form of a STOP VdORK ORDER and a fine of up to S250.00 a day against the violator.A copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification_ I do hereby cer*!under th ains andpenalties ofperjuyy that the information provided above is true and correct Signature: Date: eZ d'— Phone# Official use only. Do not write in this area,to be completed by city or town offtciaL City or Town: Permit/License g Issuing Authority-(circle one): 1.Board of Health 2.Building Depat-tmeni 3.City!Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone : �1 ESLERCO-01 SANDERSO ACORO DATE IMNUDDrvYYY) CERTIFICATE OF LIABILITY INSURANCE 06/07/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER ME CoBiz Insurance,Inc.-CO PHONE 303 988-0"6 LAIC,No):(303)988-0804 1401 Lawrence St,Ste.1200 ilMSURER ERF: F ) Denver,CO 80202 AD DR COMail@cobizinsurance.com RERS AFFORDING COVERAGE NAIL>: surance Company �31325 I INSURED Insurance Company of WA D.C. 21784 Southern New England Windows,LLC.dba Renewal by Liberty Surplus Insurance 110725 Andersen of Southern New England 26 Albion Road,Suite 1 Lincoln,RI 02865 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR POLICY NUMBER M D MMIDD TR_L TYPE OF INSURANCE INSD 1NVD 1,000,000 A X I COMMERCIAL GENERAL LIABILm EACH OCCURRENCE S CLAIMS�VIADE OCCUR CPA3158728 01/01/2017 01101/2018 DAMAGE TO RENTED 300,000I PR MI E Ea ocaurence 5,0001 MED EXF An•one person) I,000,0001 i PERSONAL&ADV INJURY S I j GENERAL AGGREGATE c 2,000,000! GEN'L AGGREGATE LIMIT APPLIES PER: 2,000,0001 X I POLICY C PRO ❑LOC PRODUCTS-COMP/OF AGG !5 I i JECT EBL AGGREGATE 2,000,000 OTHER: COMBINED SINGLE LIMIT S 1,000,0001 A AUTOMOBILE LIABILr Y Ea amdent ANY AUTO CPA3158728 01101/2017 01/0112018 BODILY INJURY Per one 5 POWNED SCHEDULED BODILY INJURY Per accident S i AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED Per awdent _AUTOS ONLY AUTOS ONLY S 1,000,000 A X ;SSELLA LIAB X OCCUR EACH OCCURRENCE LIAB CLAIM&MADE CPA3158728 01/01/2017 01/01/2018 AGGREGATE s 0 Aggregate I s 1,000,0001 X RETENTION 5 ! _ B WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILfrY Y/N CA3158729-20 0110112017 01/01/2018 1,000,0001 ANY PROPRIETOR/PARTNER/EXECLMVE r E.L EA ACCIDENT OFFICER/MEMBER EXCLUDED? NIA 1,000,000 (Mandatory in NH) I E.L.DISEASE-EA EMPLO -S It yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 B Worker's Compensatio WCA3158730-20 01/01/2017 01/0112018 ! 117 01/01/2017 01/01/2018 1,000,000 DESCRIPTION Workers C ERA71O S I LOCATIONSIncludes-ATI EH II States except. OH,Additional Rem W Schedule, Y ule,may be attached it more space is requ;Ied) I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ! THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELJVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1 AUTHORED REPRESENTATIVE ! I F R InformatjonalP ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i Shea, Sally From: Shea, Sally Sent: Thursday, February 09, 2017 11:13 AM To: esweeney@powerinstall.com' Cc: evieira@powerinstall.com' Subject: 148.Starlight Drive Attachments: 2017_02 09_11_10_06.pdf Here you go! I 1 - i EVERS4004' URCE ATTACHMENT 2 CERTIFICATE OF COMPLETION SIMPLIFIED PROCESS INTERCONNECTION Ilnstallation. Information Check if:owner-installed Interconnecting Customer: 7 Mailing Address: t (a Contact Person: _ Location of Facility (if different from bove): City;_ n State: m Zip Code: Telephone (Daytime);.. . .(Evening): Facsimile Number: Electrician: E-Mail Address: Name: A0 We Mailing Address: ./ City: "�- State: �{� Zip Code! Telep hone (Daytime): 9:1q S-3 P-a (Evening): Facsimile Number: _ E-Mail.Address: wi0ira 0 COT" License number: / 7 Date Approval of Install Facility granted by the Company: Application ID number: Inspection: The system has been installed and.'inspected:in compliance with the local Building(Electrical Code of -IbWA) (City/County) Signed: Local ElecMcai iring Inspector, or attach signed electrical inspection Name (printed): 1=J 6-e r1;e N. Fadef11,y e Date: Asa condition of interconnection you are required to:send/fax a copy of this form along with a copy of the signed electrical permit to(insert Company's name below): Name: Pyong"Bruce"Kim Company: EVERSOURCE Electric Mail 1: One NSTAR.Way Alad 2: Maiistop: SW300 City, State ZIP: Westwood, MA.'02090 Aax:No.: 7$1-44:1-8531 EVERSA"' URCE qW AT1%-kV1UN1'VN`I' _ t'1;`H C1101V A M t11e('t)NIPI;l+TIt1N 81IN1111 1R'1K1) ItH()t'1;`41N'i'KRVONNEC'1'ION tat#Ntt�ttgn tr�ti►rtrrati�+a Chpvk it olvim'—I1141ailed tt����s����ntt.*.�t�n�t'ttiih��ir��� �` '� t�+�:2. � 4 �t•t�"' t;.►nt�r.�t 1'ersatr:_.�.._...._..... �ittrl.� It tr\t _ t Eta I tt r �t� �t{rtr; rY _.��..Zip Codo;._Cw.iLL�- .�..e. t'��tt�t�lhu�.��t#a��•ttttrc�l� (l.4rrnitt�tl; : .. ._ .... .._. _- ,,...._ ___.__ 1';�. urtei.� Ntuntk�r: li-Nair r\cidtr�s; ..M__ --��..._......� ----�•- 0t� ..�tt{, � r6 .. 5tt<te; ._� _Zip Cade: 1'rtc^trh�vrr t iki,�ttt»rl'. � ?.( vmniag), F,A%amdo Numtvr;M E-Mail Addra ss< ' 'r td S te i i.veitaa ttutrrber: ..._A 'I �?''' •' Mite ApIm wal, 4 instalt Ncility grunted by the Company; Ajsplicgti.m 11)nuniher: lnsNrrtlun: 11w aystcm has bode installed and invocted in cOmpliOce with the la:ai Building/Electrical t"We .tit` _ 6O44N 577d P7� ASV/t/s m L Z-S (Ctty/'County) Local Blevvicaf Wiring Inspector, or attach signed electrical inspection Natne Winced): E L1C-,ff1t16 !l Fac1XA14& Datc: 01-- C-17 As a condition of interconnection you an required to sendNhA a copy of this form along with a copy of the signed clechical permit to (insert Company's name below); Noma: Pyong'8nice" Kier Coftwis , EVERSOURCP Electric Mail 1: One NS`I'AR Way will: Mailstop: SW390 City, Star#ZIP: Westwood, MA 02090 Fax No.: 781-441-8531 y 405 Barrows, Debi From: Carrie Balch <cbalch@powerinstalls.com> Sent: Tuesday, February 14, 2017 9:37 AM To: Barrows, Debi Cc: esweeney@powerinstalls.com Subject: [Scan] 2017-02-14 09:33:38 Attachments: 2017-02-14 09-33-38.pdf,ATT69132.txt Here is the new COC for the electrical inspector to sign for 148 starlight in Barnstable. If it can be signed and emailed back as soon as possible that would be great,we have been waiting for it for some time now. I know it was already signed but since it appears it can't be found here is the new copy. Please let me know if there are any questions. Thank you, Carrie (603)-547-0763 Power Installs Sent with Genius Scan for iOS. http://di.telapp.com/genius-scan i i Town of Barnstable Building e Post This Card So that it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted Until Final Inspection;Has Been Made. ` r.. - - -� - - Where a Certificate of Occupancy is Required,such.Building shall Not be Occupied u�ntil a Final Inspection has been made.,' .: Permit Permit No. B-16-3129 Applicant Name: John Ghiringhelli Approvals Date Issued: 11/17/2016 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 05/17/2017 Foundation: Location: 148 STARLIGHT DRIVE, MARSTONS MILLS Map/Lot: 099-048 Zoning District: RF Sheathing: Owner on Record: PRATT,BARBARA J Contractor Name: JOHN R GHIRINGHELLI Framing: 1 Address: 148 STARLIGHT DR Contractor License CS-064408 2 MARSTONS MILLS, MA 02648 T ` Est. Project Cost: $58,000.00 Chimney: Description: Installation of 40 solar panels on existing roof Permit Fee: $345.80 Insulation: Project Review Req: Installation of 40 solar panels on existing roof Fee Paid.1 $345.80 Date,: 11/17/2016 Final: -r_ I:* D — Plumbing/Gas Rough Plumbing: ��NBuilding Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afterhissuance. r y z Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: 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 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. Service: Minimum of Five Call Inspections Required for All Construction Work: 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). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable ; RECEIPT ` MASS " 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: B-16-3463 Date Recieved: 11/23/2016 Job Location: 148 STARLIGHT DRIVE,MARSTONS MILLS Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: WARREN WRIGHT, SR State Lip. No: CSFA-047769 Address: Franklin, MA 02038 Applicant Phone: (617) 281-3388 (Home)Owner's Name: PRATT,BARBARA J Phone: (508)878-8647 (Home)Owner's Address: 148 STARLIGHT DR, MARSTONS MILLS,MA 02648 Work Description: Strip and Re-roof Asphalt Total Value Of Work To Be Performed: $8,840.00 a aaa I .3 �a Structure Size: 0.00 0.00 u 000 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Warren Wright 11/23/2016 (617)281-3388 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $8,840.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $45.08 11/23/2016 $45.08 XXXX-X)M-X)M- Credit Card 8966 Total Permit Fee Paid: $45.08 11/28/2016 ($45.08) XXXX-XXXX-X)M- Credit Card 8966 11/29/2016 $45.08 )CM-CM-i Credit Card 8966 THIS IS NOT A PERMIT ,a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 6A Application #3961 G a 0 Health Division Date Issued I �Z-- Conservation Division Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis rr�LPPro ect,Street Address T .S'tar t I)t ^Village r5 .S � Owner,: e�a,44 Address V rlvkiot r. S�ils�•��S Ted lephone Permit Re` ues _ LQeV 112,%�UlVlell A a iG Split 6O cn _ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay I � Project Valuatio= o o�S Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. r- 0 Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) ►"^'- r) e'er' Age of Existing Structure Historic House: ❑Yes ❑ No On Old King'61Highway: =0 Yes ?❑ No Basement Type: ❑ Full ElCrawl ❑Walkout ❑ Other ! r Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) - Number of Baths: Full: existing new Half: existing new,' _12 Number of Bedrooms,,__ existing —new Tot, Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑ Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ame 6 J. Aiz Telephone�Number CAddress -/7 f Jfa i )t f r- License # LJ rS �0A S M` / S Home Improvement Contractor# i ! A 0 `` Worker's Compensation # --�---� ALL CONSTRUCTION'DEBRIS RESULTING FROM THIS PROJECTWLLBE-TAKEN TO ItII A iSIGNATURE 4,01DATE 'T FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: , FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - r r DATE CLOSED OUT ASSOCIATION PLAN NO' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 sY www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ate- caant Information r Please Print Le 'bI N� ame(B" ' ess/Organization/Individual): . Cl/' Cty/State/Zip: ! I dA /l5 �aGa hone.#: Are you an employer? Check.the appropriate;box: Type of project(required):. 1.❑ I am a employer with 4.,0-I-am a general contractor and I employees (full and/oi part-time). * have hired the stab-contractors 6. ❑New construction . 2.❑ I am a sole proprietor or partner- listed on the aftached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in an t employees and have workers' Y capacity.P tY• t. 9. ❑Building addition [No workers' comp. insurance comp.insurance. 10. Electrical repairs or additions _. �'q �] 5. ❑ We are a corporation and its ❑ P L3. I am a homeowner doing all work officers have exercised their l l.❑ 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. 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 I am an.employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: - Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure•to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$256.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the Rains•and penalties o jury that the information provided above is true and correct. Si storeµ '� = Date: _ — _ Phone#: Official use only. Do not write in this area, to be completed by.city or town offlciaL City or,Town: Permit/License# Issuing Authority(circle one): .1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to.this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more 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. H8wever 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 A enewal 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 presentedto 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-contractors)name(s),address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials, Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to_contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in _(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The COMM011wealth Of Massachusetts Diepartmgat of Fziclusbrial Accidents Office Of lnvestigat m 60.0 Washingtaii Street BWGn, MA 02111 Td.#617-727-4900 ext 406 Or 1-977-MASWE Revised 11-22-06 Fax 4 617-727-7749 www.maagov/dia q BIKE Town of Barnstable - , `� • Regulatory Services anatveDOEX : 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 HOMEOWNER LICENSE EXEMPTION Please Print D TE: a o/2_ PB_L.00ATION: l air A ,115 number/ street /� /village "HOMEOWNERz:_ u✓bLt�w �- IOct SQS� 7 g 5�1L� name yy, home phone# work phone# rc---1JRRENT MAILING-ADDRESS: S' A 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 l09.1.1) 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 require `n�ts� Sigriatuie 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 responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15)-This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is full aware of his/her Y 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:forms:homeezempt SEPTIC sysT EIW MUST' BE INSTALLED 1 IN COMPLIANCE . WITH ARTICLE II STATE SANI"'y CODE A e�QOF7NEt ULATIONS. mrOVN OF BARNSTABLE i BARNSTABLE, i MABEL ,e� - BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...0A.v... 7Xotrr..... 4-4......5 .. ..........: TYPE OF CONSTRUCTION ....U-00A........ ! .............................................................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. .. ....... .......0. A4C?.-T........(/.1.lem..... �.....me"ll.... ............................... ProposedUse .....( v ... .�A/1Y.le.17..........................:.................................................................................. ZoningDistrict ........APa� ..............................................Fire District .............................................................................. Name of Owner ��c!r✓AaQ..... ..... °i�1�{ .0�✓............... .....Address Name of Builder .•:/ G-....e.0at.RAV.f%2.6!6 ...............Address ...Ov.il..3.7�.,1x/ A wji...0..�(1/............. Name of Architect .t.p.w.. I,lve.........Address ..lvi4 v/t r..N..G. .................... Number of Rooms ......4 XAR.e*:S................................... Foundation Exterior .G�!9P....befx.o.... -.. �it�. s/lr> A ...Roofing � Floors ..4.L.Y/./....01..u!!19�..(il til..-..y^✓- Interior ..............,..................................................................... Heating ...Irfjt orx,,!,C ........................................................Plumbing ......... ........................................................... Fireplace ...../......................................................... .....Approximate Cost .,2,r Definitive Plan Approved by Planning Board ----------------______________19 Diagram of Lot and Building with Dimensions /�c�i OG SUBJECT TO APPROVAL OF BOARD OF HEALTH _ f I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Na (�..�.... .. . . . . . ........................... / ` Carron, leonard B. ( � � 16»73 . .,. Permit. .~ single=^y�- family� � dwelling _ /'. Starlight Drive Location ^; x .......................................... '----- — � ^azw^ons N^lls . -_ .......-------- Owner ~~~^~^~~ B. -a~^~^ - r V Type of frame, / . � ~ / ~^ Plot �� n�"� � ,------,-- ----..�-----. . . i � Permit" . Granted . - ' Date- of Inspection` -- '' —'' ~~'~ Completed = ~�p ) | r ' , PERMIT REFUSED ` ' � ............................................ 19 | | . . ^^---'^—'—^^^----^'�^—'.—r'''--^--' ' � , . ___--------.—...------.------ | | —^---- ' | ` '--~^—'—'^^^---'—^^'~------^'~`^--` { ' .^----.--.---....—_._.,.,,-.—....^.—. ° . \ Approved .. t—.—.. lA � ' .-------.-----.—......--.....—,,. -------------____,____,_,_,_ | \ \ � �� 1 . .� Town o �� r f Barnstable �*l�m,t# Regulatory Services �ees6mon% ,rigs edale T ARN51'Agj,E, . 9 MASS , i639 ,0�' Thomas F. Geiler,Director Building Division O 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 D 0 J Not Valid without Red X-Press Imprint. Map/parcel Number Property.Address 1 lt� (- AS Zesidential Value of Work 5 7 CO Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name � 'A C Telephone Number Home Impiovement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) orl an's Compensation Insurance 012 Check ElI am.a sole proprietor El am the Homeowner BAR�STABI.E i EJ41ave Worker's Compensation Insurance 'TOWN 0� Insurance Company Name i. 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 EJ —Replacement Windows/doors/sliders.U-Value y #of doors ; (maximum'.35)#of windows ❑ 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 Prope Owner Letter of Permission. A copy of the Home Impr me Con ctors License&Construction Supervisors License is required i IGNATURE: ' :\WP ORMS\building permit forms\EXPRESS.do� j .evised 053012 I . i The Commonwealth of Massachusetts Department oflndustrialAccidents 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): et 6 —Z 3 � "I�k Address: 44,&. City/State/Zip: Phone.#: Are youW employer?Check the appropriate box: Type of project(required): 1. am a employer with c.i 4. ❑ I am a general contractor and I employees(full and/or part-tim )e .* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. QRomtZeling 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.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#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 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 andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: ,*� 2 7 f� ? Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation olicy 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations e DIA for insurance coverage verification. I do hereby under the pai n ties of perjury that the information provided above is true and correct Si atur Date:. / Z Phone#: Official use only. Do not write in this area,to be completed by city or town officia4 . City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:- Phone#: r h\fit 7r'•^+ -' T 0 r t'yt \w }� 7;�'r,, ,� •( 7r7y. 7ti r ! i,.+�Pr�` . .� e: �. �'.. st ��n t _1.,;4 `7•. ,, Vt a,• a a� xq. , Yr y�' t ,w'''rye r fx ,ti"'7C r, •j a� Massachusetts-Department of Public Safety �tf �� ai�,2- ���} N`a �'.aytiav r a •`� .t -F �`{ f Jl Y I � n ` � },:�,�N• �2* is°a^�' } x Board of Building Regulations and Standards �� � � a��Y.��`•at2C,{. 4a ".f, .J4$ti: Construction Sujicn-ISUr' ss�'.ir�^'�''" rj' i��' •�. `rJ'`�n.�;'`r <� . License: CS-095228 Ica �, } � •�. ty i a�a r,�•h �♦1S,v� ���i t';•-�y.' Y'.1'7:S` t-". s/�! 3•"ya'+'Y Q+,f� '}���'• '"a'3y *�7 yr \ \a ti �: ♦ I•• �{... � . ,/I,J�s�''�'�r �S• rl�+ y;/ -'+f .,y;J�rr. jam` '�k; � G: PICIMN v'j,vli♦• ` F S �; , K- +y�4%Ny''kT19 HAMLETS 'Vt' U + � a !j f Fairhaven MA 02 :1 -� � y�.f�! ri/ ` J J }t'�fiarr 14�n ly Expiration Commissioner 03/22/2014 S —Akp l '. . � � __r....•.:�e �panvnaaluuea��za��aeac�ucae%ta . ffice of Consumer Affairs&Business Regulation" License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR ' before the expiration date. If found rerun to: Office of Consumer Affairs and Business Idegulation egistration: 100503= Type, 10 Park Plaza-Suito 5170 i� — - 1 Supplement' and Boston MA 02116 Expiration:-=6/19720j4�r h-1 CARE FREE HOMES;It-C: ; DANA PICKUP JR. 1 239 Huttleston ave Y " Fairhaven,MA 02719 Undersecretary Not valid without sig re `+ ` I ' �\ Ir•.P'i•'....i�..irn..•.. -... ........ .. ....�..-....ry.a..•.-o.<..iM1vi J +i A �'!:' i a�'� • '•.. ! ..a• .. .+}•',• ! .v.''•r' r;t.. r' a as r ; •' ''..Y. 'r ;y. }�.. f' J. .f ::j•• Client#:33723 CAREF ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/07/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Herlihy Insurance Agency, Inc. HONE, 508 756.5159 A/C No): 508 751.5747 51 Pullman Street L Worcester, MA 01606 ADDRESS: 508 756.5159 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Interguard Insurance Company Care Free Homes Inc 239 Huttleston Avenue INSURER B:Safety Indemnity Insurance Comp Fairhaven,MA 02719 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE B POLICY EFF POLICY EXP POLICYNUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ B AUTOMOBILE LIABILITY 6213850 07/01/2011 07/01/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNEDAUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N CAWC244043 9/01/2011 09/01/201 X WC STATU- OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED9 NIA E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 367 Main Street AUTHORIZED REPRESENTATIVE Barnstable, MA 02601 , >� s 1@1911114909 AltlbiRO eORKORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered matA of ACORD #S48858/M48747 PB2 i OFFICE: (508) 997-1111 ;; MA. Builders Lic. #021330 W;,(50$) 997-1297 flWRE FREE Home Improvement TOLL FREE: 1-800-407-1111 Contractor's License WEBSITE: men inc. #100503 MA. www.carefreehomescompany.com 239 HUTTLESTON AVE. (FIT 6) • FAIRHAVEN, MA 02719 #15179 R.I. NAMEs�A,C,�A��/-� T�,/��n// /� /�/� ,y / DATE Z/,o�?��y��� ADDRESS ,� � � I��C�sT_'/ � iC S ADDRESS OF JOB HOME MIR e S r/l EMAIL ADDRESS CELL JOB DESCRIPTION T� Pao -4 ram_ Scheduled Start j �1��' Scheduled Completion— A. Replacement of missing or rotted lumber is not included unless specified. B.All start&completion dates are approximate and could change due to weather conditions. C'Stripping of roof includes removal of up to two(2)layers of s i e , ea0h additional layer to be charged @ ftz. D. Replacement of rotted roof boards/plywood to be charged ` w. E. Existing chimney flashings will be reused; replacement, if n essary, is not included. F.Care Free Homes, Inc. is not responsible for mold/mildew conditions that are pre-existing or result from leaks not brought to the attention of C.F.H., Inc. promptly. The Company hereby proposes to furnish labor and material to complete the above work for the amount herein. Fulfillment of this order is contingent, however, upon the want of strikes,fires, and any natural disasters,the ability to obtain materials, or any other conditions beyond the control of the Company. Cost of Project$ PAYMENT TERMS Date S1 Zol Z 1. You,the Owner may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. 2. You, the Owners agree to pay any and all expenses incurred by Care Free Homes, Inc. in collecting money due under this contract and enforcing the terms of this contract, including but not limited to, reasonable attorney's fees, interest and court costs. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CAR R E HOMES, INC. ',�h � / CCEPTED: l�i L���N �' `- �?�� Buyer acknowledges Owner By: receipt of fully completed copy of this Agreement Owner: All contractors and subcontractors shall be registered by the director and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Tel. (617)727-8598 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ` 4 0C Map arcel• Vs, Permit# s55992 I ' Health Division )9 Iq 5 Date Issued 7�.3 Id Conservation Division Fee Tax Collector 0_910 I Treasurer `j a 2001 ' �-1r?7 cC SYST Ervi FOUST BE Planning Dept. INS"ALLED III CCMPLIANC Date Definitive Plan Approved b Planning Board 4 WITH TITLE 5 PP Y 9 ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street A/d�ddrress ir1I'Tht �J r1 y- ,tillage�l1_I( fi01LS 1 ► 11 I S Owner�Ea'f� Address %kg Telephone Permit Request TO bu,ld a Pt@SwVP -- cPaA:ed �rnio < W1WLe kaDY'/ e d-cance ) Crd -to C„or st rucf a cbrl -& ba&P -2f Q wKw-1 9 r 16-CA cR tAk n j04S LXV'1Q f('eG t4j Q bJk&j V 5 I M F d r e v� Ujay . Square feet: 1 st floor: existing AROO proposed ' I 2nd floor: existing proposed Total new Valuation ®G f?-0 Zoning District Flood Plain Groundwater Overlay Construction Type kset. CCC)nC Y dQ , LC=d 'b r' �1 Lot Size 5 C,(cr Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes �O No On Old King's Highway: ❑Yes XNo Basement Type: I(Full ❑Crawl Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing oZ new Half: existing new Number of Bedrooms: existing .3 new Total Room Count(not including baths): existing 9 new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil Electric ❑Other Central Air: ❑Yes �No Fireplaces: Existing a?,— New Existing wood/coal stove: Cl Yes /%No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ( No If yes site plan review# Current Use ��i( 10 CD Proposed Use /j1j 674�44 L BUILDER INFORMATION r Name Arha a �J - I La f Telephone Number Address I Yq oZ(I License# ©1, oct/ I/ Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ,/a FOR OFoPICIAL USE ONLY PERMIT NO. DATE ISSUED I MAP/PARCEL NO.- ADDRESS TJm4 VILLAGE OWNER 2 DATE OF INSPECTION FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 'r - GAS: ROUGH } - w— FINAL FINAL BUILDING • DATE CLOSED OUT, ASSOCIATION PLAN NO. • Y t r ifs f jI• P,OF(HE The Town of Barnstable BARV$TABLE. ' Department of Health Safety and Environmental Services MASS. �PTE039. a Building Division 367 Main Street, Hyannis, MA 02601 Office: 508-862-4038 „Fax: 508-790-6230 PLAN REVIEW Owner: IIFiY rPr N, Tr^tt Map/Parcel: Project Address: Builder: The following items were noted on reviewing: R i h '�" � T ,o. rA bc� nw, r:a gnu (, VIC -s be? r C�PP�) bc+ weev). Reviewed by: Date: , (Q f! q:bu ilding:forms:review y SEPTIC SYSTEM�C�� MUST BE INSTALLED IN COMPLIANCE WITH ARTICLE II STATE SANITARY CODE ULATIONS. A''�' N OF B A R N S T A B L E THE? ii • i 13AUSTAU i 0 pYa�e� BUILDING . INSPECTOR APPLICATION FOR PERMIT TO ...0,0.v..,17X00 .... ......5.Y. .7........... TYPE OF CONSTRUCTION ....W.00.0......... t•!. .......................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following Information: Location .. ..4...T...... ....... ................................... ProposedUse .....Ja UZ.....I A.I.A (...Q�.t! /�1.�4y...................................................................................I......................... Zoning District11 0� / ,! Fire District ` Name of Owner kC.a6,/-4A 1..... ......................Address ...AQ4.11.7.r...W;7.0&tWfr... �Jfi i Name of Builder .......eAMS774V07-).4'.e✓..................Address' Name of Architect ..l.LW..T.r.k>~N.7?9 ..everll.S'..%nlL:........Address ...1". !��P11*..lcChW..h SAC.................... Number of Rooms ......6......9uR.ay.S.....................................Foundation .At?A .'.aAJ4,zZ................................................... ��� Exterior ,.��!9.�?....�7.�R%iA.....�"'..�,iC...s/.flit�t.�K�.............Roofing .. .... .�.�J.1.1....:....................................................... Floors ..41/.4/1. .9�P.. ...................Interior .............................................................. ....:............. .Plumbing �, �, Heating ...��;��Tx1.C...............:........................................ ......... . ...� ........................................................:.. Fireplace ... ./................... ...............................`....................Approximate Cost .a�i1L7�..�S..Q ... . ...4z.......... Definitive Plan Approved by Planning Board ___ —___-------19 Diagram,of Lot and Building with Dimensions d 'c= OC, SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. No .,..... .. . . . . . ..... .................. The Commonwealth of Massachusetts _..... Department of Industrial Accidents office 011HY85998flons 600 Washington Street Boston,Mass. 02111 Workers Com ensation Insurance Affidavit name ,131 1P1, location: rlhone# ci I am a homeowner performing all work myself. I am a sole rietor and have no one workin in anv capacity %% % /%%%O�% %// ///// // ❑ I am an employer providing workers' compensation for my employees working on this job. cbmpnny name: address: hone M i ci insurance co. polig# �/ ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: conivany name: - \ - ) hone# n�arance co address: >.... .. ran cc co. amp �. Fsflrue to secure coverage as required under Section 25A of MGL 152 can lead to the imposmon of criminal penalties of a fine up to sl,Soo.00 and/or one yam,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certi under the pains and pen jperjury that the information provided above is true and correct signature Hate /T 4 O — Print name Phone# official use only do not write in this area to be completed by city or town official permit/license# � ❑Building Departrnmt city or town: ❑Licensing Board ❑Selectmen's Office ❑checkif immediate response is required ❑Health Department contact person: phone#; ❑Other Orrsud 9ro5 PlA) i Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted.from the"law",an 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference nimlier. The affidavits may be retuned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Invesdoadons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 The Town of Barnstable . 91&"a' g Regulatory Services `b i61,9' Thomas F. Geiler, Director QED MA'S� Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the'reconstruction.alterations.renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work:�/I,,&,Ararp io 4- U al6a Estimated Cost Address of Work: qW 5 44&a A Dr /r ►a`-d o f& rn l c Owner's Name: 60fbGC J PC"-' f Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Dob Under$1,000 ❑Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING NT WORK DO NOT CONTRACTORS FOR APPLICABLE HOME IMP ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. . Date Contractor Name Registration No. O Date Owner s Name q:forms:Affidav �A R 44,?�A/ 7�7- WO /ate►'\t M5' ter— f� N;FRS .c T - � �e t- �ou9� r - m At Ro Div Ale rr t � 'y -5' tG l� SIN (f AIV Ar-d 1- w TO1A/ /�G(N d l ��� iL r�'s'n �R1J 'y''` N ` t. &,/¢I R .14101OR B X /� j�� jam/ r e-//' e, �i�r� —�o bu t Building permit requested to make house wheelchair accessible. % ConcY�teSe ->Gr C I eCt-(,G I i f f L4 q x 53 ?c --7 Existing deck is 67 inches high. F �Ia PYessc-'(e SlclsLr �YlVewct�I Raised Ranch: l 148 Starlight Drive 1,3 P Tess c-r e Marstons Mills ��� 39 Owner: Barbara Pratt G'�ltr-c�ncQ Fr un ro-`mp �Q r Entmkl eacl- 5 a steps of {vz'�> 1`� I Lt 1 P 15 � 2 ' � I'Cfi would (ole i n S�c�.�� �c1 �h��alAor�I�Ct�►c L�f-tCo- 9'0 ((t5{On . MA 1 BARNSTABLE- MASS. �0 Regulatory Services 16,39. '°�Eo r,►a{' Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-62,0 HONEOWNER LICENSE EXENIP'I'ION ff Please Print DATE: (/!.{w �� � o�U / JOB LOCATION: number f street �/ �J village {'t1o� ..HOMEOWNER": (�/�CVCJLt►y v 0 'G�l t TGO lo��S �5�6 SVK _7i `4, / name home phone# work phone# . CURRENT MAILING ADDRESS: P -f k ae- VJ( 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,Qrovided 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 requiremen Sign tune 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 ENEME TION 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 responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors.Section 2.15) This lack of awareness often results in serious problems.particularly when the homeowner hires unlicensed persons. In this case.our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities.many communities require.as part of the permit application.that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page 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:FORMS:EXEMPTN