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0148 TANBARK ROAD
oFrrur�y Town of Barnstable Permit�#/`v/�U (Y ZO F rprres 6 rrlfrs jr�r rssrr d r Regulatory Services 1{ee v �6 �m1b Thomas F. Geiler, Director Building Division - Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION : - RESIDENTIAL ONLY Not Valid tvithout RedX-Presr imprint Map/parcel Number �� 01 v Pro erty Address Residential Value of Work —50 CS tvlinimum fee ofS35.00 for work underS6000.00 Owner's Name Address Contractor's Narne ,,jj!I� L n, � T (//r��`ej''�/i�5 NC O$t° ' (/� elephone Number Home Improvement Contractor License#(if applicable) 3 T 7_iT� Cons ruction Supervisor's License#(if applicable) 70077 RMIT- Workman's Compensation Insurance Check one: I am a sole proprietor MAY 17 201-2 [],.Kam the Homeowner have Worker's Compensation Insurance llA TOWN OF BARNSTABL E Insurance Company Name e l/(/ �t/�n^��S r eic Workman's Comp. Policy# G/ yA 6 I/ S Copy o.f Insurance Compliance Certificate must accompany each permit. Permit Request (check box) Ej 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) ❑ e-side #of doors Repiacement Windows/doors/sliders. U-Value O, (maximum .35)#ofwindows *Where required: issuance of this permit does not exempt compliance with other form department regulations,i.e. Historic,Conservation,etc. �* Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is required, _ a'PFIt ES',`0?ti?Slbui?dingpernit fo:msacxPRr-SS.doc The Commonwealth of Massachusetts Department of Industrial Accidents Offlce of Inves6gadons kv 600 Washington Street Boston,MA 02111 www-massgov/dla Workers' Compensadon Insurance Affldavit: Builders/Contractors/Electrlcians/Plumbers A2gff¬ Informadon Please Print Legibly Name(Eushmstorganindodlndividualy �OSe Address: 1 // oN WA Ci / te/Zi : ff/' le p -0')3W Phone#: Are ■as employer?Check he appropriate box: 1. I am a employer with 4. 0 I am a general contractor and I Type of project(required): employees(Rill and/or part-time).* have hired the sub-contractors 6• g on 2.❑ I am a sole proprietor or partner- listed on the attached sheet, 7. Remodeling ship and have no employees These sub-contrsctnn have working for me in any capacity, employees and have workers S. ❑Demolition (No workers'comp, insurance comp. insurance,: 9. ❑Building addition required] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11. Plumbing myself. (No workers'comp, right of exemption per MGL ❑ g repairs or additions insurance required] t c. 152, §1(4),and we have no 12•❑Roof repairs 3a.❑ I am a homeowner acting as a employees.[No workers' 13.0 Other general contractor(refer to#4) comp.insurance ] Any aPPlicaot fiat checks box 01 mutt do fill out the section betow showing their wotkese,compen"dod t Homeownms who submit this affidavit indicating they are doing all work and then hits outside coatmctots�g�, dot. mutt submit a new affidavit utdtcatitt dh tContnsctotn that check this box mutt aaaed an additional shoat showing thn eamn of the suboonunctots and state whether or tro g such, t thorn eatitati have employees. it the Mb conuactas have ea�loyeer,they must provide their worker'comp,Policy numb I an an employer that Is pmIdind x vrkers'compemadon haumnee for my employgm Below!t the o lnforntadom I 1 p iley and fob site Insurance Company Name. L!p e ( �/'�v / N S Policy#or Self-ins. Lic.#:: //W C S 3IS $ 0 - 0 Expiration Date: Job Site Address: `7 A City/StatdZip:-&�z 4 S Attach a copy of the workers'compensation policy deciaratlon page(showlot the policy number and eipirsdos date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal ties of a fine up to S 1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of [nvesdpdons of the DIA for insurance coverage verification. I do Aemby con* da the p and ps dkla of psr/ that die btformadow NOW provlds t abvw L tvfre and corr+rrt Phone#: Of'kelol rare onlyt Do not write In this area,to be complstrd by city or town oJjkcial City or Town: Permit/License# Issuing Authority(circle one): I- Board of Health L Building Department 3.Cityrrown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone* Information and Instructions—Uftus 4 Dental Laws chapter 152 requifft ad empbYdrs tO w&wodSavkw awdw under anycontr t VW punuaat to this Sfthd ,an gmploym is defined PUM capvm of itflpiied,ord or wdtme As sayl isdaHned»was itadinidt saaoaiadab cmp°e'Itanor-ate deeeaiod mob w.at ths b a Dial gwity.or my two or and ��� o[the tbeep�gnp j moc��or othtttt tepi eatitPi�employhM cool K°�cc is reeeirer at ertsabrt o(aa iadltrldt pm thm�Wwwo md win,eai lee�or rho oeettpast otths owoat ots dwoUing bares babi co�edom or rgsk work on such dweltla fi honed dwroWay boost o[aOAW wbs a vloye POISON es do be deemed to be as®tpioW or as the ooundt or bvil�i OM SW°0t beatdt otsoelti empbymnu 132,4 61 also stttttr that»rreT1 atbtt K focal ilatmel■t;apmy shale mid&"fllo bosom or reschaplet a brrtmtt e w tm artrmd bodilktp v is a�1e'e- tlttr amy remswsl d•ifestsss Prrmit . °tea �idattrt e[temtpYstres wit d o tmttmama anenP roq*w sppduw wbs bao met prrdmttti "Neidw the coattorswealt!not my o(ifr politied mbdi+WWW shad Addidase ft.MM chaplrr 2+IMM of lis wak undl acceptable enidemcr otconvdis oe wits rho imwtrasce ender in*my conwe 1bt the p m the caeaeetlot ►• rcgt�{rsmeete o[this ehapttt bane has p� Appmesaft worhart he bosee that V*to your simadom wA it Phaes at/Adaft b7► bleti ta „ their eadAeatr( ) PINs)o■ma(aj�ddeeta(et)and phmt umber( )df�o ft other them the necagamsorm wo L d LLmbft Carapaaiee(LLQ or L.iatited L.W Wy Parmaahipt(ILLY)With 00="bye" noamb�at P�aA mot tegsi ed to eery worbno'companadom If=LLC or LLIP does Garr pow is • its advi d do*this am" -may be submimed to rho Depsrtartat of lndwetW entploysa%• Aar easftmadrm o[101- oo corersp► ALro bo sire to dp and daft too xgWavIL Tbt atlidnit ld a shou ale town th•t tbs br the permit cr if eaas b bd"isgtra-1A s�dW of /10 idemt 3horla Y'am bare aafqusedems ism IbS tbt taw at i[yom nor eegtdee a to obfdm a WON co Wearer Psl�P�ad�D��stmbet liatea beltwz 3dElewod shoed eatit thtit sdEiaa■raese lieeast rtmber Cob a!Tswm Omeitlr . pteaes be me that the a8ldanie Is and tee kgt*- 'U Dural hes pronfdod a spaot at the bonier of the atndrrk fbr you to IM out is dw avast the Ounce Of tareadpdoms hN to contact you NPWb i the plasm be ms to jW in do po mWft@'de anmber whM will be uaad as a ret',o ea onmbett. is addkkM am IPPUcut that moat suttmit mnidple prrmi111faaes aPPH-1 -b nay OM ye'�and 0°h snbedt amt a®denit isdieada{caat:at pow Iabrmatiom(heel sassy)end usdis"Job SM Add'the wed should wraw"ail loeadoms it_(city oe cowsy»A copy o[tbt attadeRit Chet has beam odWady dmlpsd or atsrlmd br tbt city or tow may be pug lathe �pplieaat tr pttoo[thet•rsild a®danit b om No hr titfttrtr paemile at lleaoaaa A asw altiidttrit meet bt tllltd out Bark year.11Ytiaes aboar owner er eifbs b {a Itteast or permit not rebled ed nay bnsioas ale ooteorttteW venetrt doe Ileeatt or pwmk to buss teav a eat.)said paean is NOT meq hed to caviets We aiNdIviL Tar()film o[Iaradpdons would like to thatk yatr it mh be your cooperadom and should yotr haw nap gwsdm* please do Dot hesitate t•[fw us s O L rM DeNat's 3ddru%tetapboss and fax mar*M Thf Commoewe dtb of Matmhusetb Depattfm t of tedusirld Aceidenb OA1a of<ii"vdo" 600 wm6b&u sweet eosW6 MA 02111 Tel. M 617-121-4900 nut 406 of 1471 MASSAER Fa Al 617-nl-7749 Revised 11.224)6 w"nuia pv/d)s of pgrtment o `Industrial Accidents 600 Washington Streell Boston,AM 01111 17VWW1 . as .goo dia Workers' Compensation lnisurance Affidavit: Builders/Cone-cdo�°s��3�ctt'�cl���'Pits�bers Applicant Information Name (Business/Organizationlindividual): o of�✓ Address: City/State/Zip: lt.n1 6 - 3°� Phone#: Are you an employer?Check the fippr,opriate TyFRemode:g' ' ct(rquired): L'A I am a employer with_ 4. I am a general contractor and I 6ruction 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. ship and have no employees These sub-contractors have g, ®Demolition working for mein any capacity. employees and have workers' 4 ❑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.E] 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 Homedwners 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 a employer that is providing workers'compensation insurance for my employees. Below is the policy and job site . Information. Insurance Company Name: Niew Policy#or Self-ins.Lic.MWCOIq730161 Expiration Date: 3 Job Site Address: b �� City/State/Zip: N ` � Attach a copy of the workers'compensation policy declaration page(showing the policy number and expire 'on date). Failure to secure coverage as required under.Section 25A of MGL c. 152 can lead to the imposition of criminal plrnalties 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. 1 do hereby cerdify under the ' s and penalties of ary that the information provided above is taste and correct I..——, /,?— / . Si a r Date: Phone#' i O,f)4clal 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#:�� lrl 'v_ CERTIFICATE OF LIABILITY INSURANCE D 02/27MIDDlY2/27/2012 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 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 1-866-966-4664 CONTACT Marsh USA Inc. NAME: PHONE — FAX A/C o Ext: (A/C,No): homedepot.certrequest@marsh.com E-MAIL Two Alliance Center, 3560 Lenox Road, Suite 2400 ADDRESS: NAIL# Atlanta, GA 30326 INSURERS AFFORDING COVERAGE Fax (212) 948-0902 INSURER A: Steadfast Ins Co 26387 INSURED INSURER BZurich American Ins Co 16535 The Home Depot, Inc. Home Depot U.S.A., Inc.' INSURERC: New Hampshire Ina Co 23841 2455 Paces Ferry Road NW INSURERD: Illinois Natl Ins Co 23817 Building C-20 NATIONAL UNION FIRE INS CO OF PITTS 19445 Atlanta, GA 30339 INSURER E: INSURERF: Illinois Union Ins Co 27960 COVERAGES CERTIFICATE NUMBER: 25776028 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 ADD SUBR POLIPOLICY NUMBER MM DDY EFF POLICMM/DDY EXP LIMITS LTR A GENERAL LIABILITY CL04887714-02 03/01/1 03/01/13 EACH OCCURRENCE $ 9,600,000 X--1 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 1,000,000 CLAIMS-MADE M OCCUR MED EXP(Any one person) $EXCLUDED rGENI MITS OF POLICY XS PERSONAL&ADVINJURY $ 9/0001000 SIR: $1M PER OCC GENERAL AGGREGATE $ 9,000,000 GGREGATE LIMIT APPLIES PER: PRODUCTS'-COMP/OP AGG $ 9,000,000 ICY PRO- LOC $ B AUTOMOBILE LIABILITY BAP 2938863-09 03/01/1, 03/01/13 COMBINED SINGLE LIMIT 1;000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS $ NON-OWNED PPPtoaccident)DAMAGE HIRED AUTOSHD AUTOS X SELF INSURPHY DMG $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ TATUC WORKERS COMPENSATION WC019736915 (ADS) 03/01/1 03/01/13 X WCSLIMIT OTH- AND EMPLOYERS`LIABILITY D ANY PROPRIETORIPARTNER/EXECUTIVE YIN WC0 197 3 6 9 17 (FL) 03/01/1 03/01/13 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N❑ N I A E (Mandatory In NH) WC019736916 (CA) 03/01/1 03/01/13 E.L.DISEASE-EA EMPLOYEEI$ 1,000,000 If yes,describe under MIT $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LI E Workers Compensation WC1192494 (QSI) 03/01/1 03/01/13FIR (AOS)/SIR (GA) 1M/750,000 C Workers Compensation WC019736918 (WI) 03/01/1 03/01/13 F TX Employers XS Indemnity TNSC46566397 (TX) 03/01/1 03/01/13ence/SIR 30M/1M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) RE: EVIDENCE. OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HOME DEPOT U.S.A., INC. ACCORDANCE WITH THE POLICY PROVISIONS. 2455 PACES FERRY ROAD NW AUTHORIZED REPRESENTATIVE BUILDING C-20 ATLANTA, GA 30339 'USA ©1988-2010 ACORD CORPORATION. All rights reserved. `�• Office of Consumer?►rfairs Bas+sess ReggEsr►ou ;74HOME IMPROVEMENT CONTRACTOR Registration : .:42fi893 Type: r Supoment EXpirati:C $/3+"��12 The 'Home pepot *Home Services DAR.REN DEMERS., ' 2690 CUMSERULND PARKWAY S GA 30339 Undersecret:rr License or registration valid for individul use only before the expiration date, a rs and Bus Hess Regulation d retur" to: Office of Consumer A 10 Park Plaza-Suite 5170 :aro Boston,MA 02116 Not valid without signature 4/26/2012 8:30:17 AM PST (GMT-8) FROM: 100005-T0: 15087302086 Page: 2 of 2 c?F CERTIFICATE OF LIABILITY INSURANCE °"'�°`�°°"'"Y' 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(les)must be endorsed. It SUBROGATION IS WANED,subject to the toms 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 Iku of such endomeane s. PRoow- PAUL B SULLIVAN INS AGCY INC 1467 S MAIN ST PHONE FALL RIVER, MA 02724 INSURE AFFORDWO COVERAGE NAIC8 MSURER A I JOSINSURERS: EPH DUARTE&JOHN DALEY DBA J&J REMODELINGINSURER C 15 WILSON WAY "SURER°: MIDDLEBOROUGH MA 02346 INSURERE: R . 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. estt v CY PDU EXv LIMIT L TYPE�INSURANCE L POLICY NUMBS . GENERAL IYUl0.1TY EACN OCCURIENCE f El COMMERCIAL G94ERAL LIABILITY IS S a ecarrenoe f CLAMS4IDE OCCUR MED EXP An one person) f PERSONAL 8 ADV INJURY f GEWRALAGGREGATE S GEN%AGGREGATELIMQTAPPLIESPER; PRODUCTS-COUROPAGG S POLICY PRO LOC f AUTONOBNJE UABILITY •arc e f BODILY MURY(Per person) ANY AUTO Au OWNED SCHEDULED BODILY vuexly(Per accidenl) Auras NON-OWNED roc erd GE f HIRED AUTOS AUTOS f f UMBRELLA LU1B .OCICUR EACH OCCURRENCE f EXCESS I" CLAIMSMADE AGGREGATE S f OEO RETENTION f ICW S I A Wastf"sCOMPENSAnoN WCEr31S384800-012 2/2/2012 2/2/2013 AND ENiLOYERT UAWLITY YIN E.L.EACH ACCIDENT f 10000 ANY FROn%jORMAR"eKXECVTNE — OFFICEwNENBEaEXCLUDEO? NIA E.L.OISEASE.EA +EMPLOYEES 1 0 (Mandatory in NMI 50000 It yes,desabe under E.L.DISEASE.POUCY LMIT S DESCRIPTION OF OPERATIONS b�ek1w LEISCIOTIONOFOPERATiONS/LOCATIONS/VENCL.FJl (AlI�hACORO181,AdditioeYRerrrdcaBehedu4,R,pWespacabrequlred) Workers compensation insurance coverage applies orgy to the workers compensation laws of the state of MA. NO PARTNERS ARE COVERED BY THE WORKERS'COMPENSATION POLICY. ERT AT H ER CANC;EL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE 1MLL BE OELIV(XtEO W 200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUT►ORIZEDR®RESOWATNE Jeff EW e 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201 OXIS) The ACORD name and toga are registered marks of ACORO this Cartilicate7cancels andC50persedes,A}1 pzevlouslysis3ued2Ce=0 111Cete*- Pegg 1 0! l W t—/&wx Office of Consumer Affairs and usiress Regulation 10 Park Plaza - Suite 5170 Boston, Massaghpsetts 02116 Some Improvement Gb�tor Registration Registration: 132349 Type: Partnership Tr# 207392 Expiration: 1111I2013 J &J Remodeling h Duarte ;- �,;..Joseph ,_:..:�r: _ , 15 Fall St. Wareham, ma 02571 Update Address and return card.Mark reason for change d Address [� Itenewai 0 gmployment [� Lost )PS.CAt A 6ppt.0a,bA-pt012t6 a nine"1 R�cgu a an License or registration valid for iadividut use only Omen o eum n before the expiration dam if found return to: vem HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: .:•132349 1p park Plaza-Suite 51'10 Expiration: :j./t1/2013 Partnership Boston,MA 02116 Tye' odeling.::": :':::: ^'.. Joseph Duarte ` 15 Fall St. Vvdwithout signature Wareham,ma 02571 . Undersecretary 7T4 11a:>uchu:ctt�. Dcpar anent of Puhiic'xfet% 1 Board of Building-' Re-," eh ,Licensett►durd� Construction Supervisor License: CS 70077 jOSEPH C DUARTE 15 FALL ST aw ) WAREHAM,MA 02571 • �, Expiration: 11130120t2 Tcft: 7048 (..nut,l.viuncl' r I - - - Z9L656Z EG:1Z 110VZ0/10 10 39Vd HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,IFurnislrexl and installed by: Branch Name: Boston Date: 5 ' 1�— THD At-Home Services.Inc. d/h/a The Home Depot AL-Home Services " -- 908 Boston Turnpike,Unit I,Shrewsbury.MA (11545 Toll Free(ft011)657-5182;Fax(509)845-0)17 Branch Number:31 Federal 11)#75-269 460,ME Lie#C 02439;Itl Cont.Lie#16427 Cr Lis#H1C.0565522;MA Hume Itnprvvcttrcrd Contractor Reg.L8 126893 Installation Addrec9: City State Zip Purchaser(s): Work Phune. Hume Phone: Cell Phone: _ e r I r itsa Home Address: (If different front Installation Address) City State Zip E-mail Address(to receive project communications anti Home Depot updates): ❑I DO NOT wish to receive any marketing entails from The Home Depot Project lnformatiun: Undersigned("Customer"),the owners of the property located at the a1mve installation addrtms,agrees to huy, a11d THI)At-Home Services, Inc.(—she Hrane Depot")agrue-s to furnish,deliver and arrange fur the installation("Installation")of all materials det.,tsrihed on the below and on the referenced Spec Shoet(s),all of which are incorporated into this Contract by this referent,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): job#; u"a+.a,wa—) Products: Sheet(s)s)#: Pro'ee9 Amntmt _ I ❑ltoxtfing Siding Windows insulation 6a�rsd.Yo ❑Gutters/Covers ❑EntryDours ❑ G� 9 Itnnfing OSicfin Windows U Insulation (p �•-1 ❑Gutters/Cuvurs ❑entry Duv s ❑ F-JRoofing USiding LJ Windows U insulation 1 $ f ❑(7uuers/Owers ❑Entry Doors❑ J _ Ruvfuag OSitfing El Windows ❑Jnsulation I I $ ❑Gutters;/Covers ❑Fntry I)t(trr. ❑ MJrmmun25%Deporat.dC•txdradAmuuntdmupunemuUmuflt16conl+art. Total Contract Amount $ Maine Purvjw ers may not dgtndt m mtc ore than third althe Centred Amount 0 Customer agrees that,immediately upon completion of the work for cuh Product.Customer will execute a Completion Certiliwle (one for each Product as defined by an individual Spec Sheet)and pray any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally ohligatul and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate,Ibis Contract or any individual ProduLt(s)included hur6n,at. its discretion,if The Home Depot or its authorized service provider dctumincs that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint.other safety concerns,pricing oxrors or because work required to complete the job was not included in the Contract. Payment Summary. The Payment Summary ri_.__..•_. included as part of this Contract, x:t.% lirrth the total Contract amount and payments required tier the deposits and final payments by Product(as applicable). NOTICE TO CURrOmEK 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'Sheets)before work on that Product is c(tmplele. In the event of termination or this Contract,Customer agrees to pay The Hume Depot the costs of materialx,Labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT t.FR OTHER PAYMENT's MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER RF,MEDIFS FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: C:ustRsner agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard 10 the Pro ducts and installation services and supersedes all prior discussions and agreements.either oral or written,relating to said Pro duct:and installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home M-put.Customer acknowledges and agrees that Customer lttu;read.understands.voluntarily accepLs the terms of and has rt.•a:ivcd a copy of this Agreement. Accepted by: I Sub d by: AA I Cusco cr's Signature. U Sales C sultatn' Signature Me )O )'elephoric No. t� q 6 D Customer's Signature Date Sales Consultant l icense No. CANCELLATION: CUSTOMER MAY CANCEL'THIS (as applicuble) AGREEMENT WMIGUT PENAIXY OR OBLIGATION BY uDF,I.TVF.RTN(; WRI'17FEN NOTICE TO THE.HOME DEPOT BY MIDNIGHT ON THE, TFURD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED i1FRF,TO CONTAINS A DORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. I NOTICF.:ADDITIONAL 1T.RMS AND CONDITIONS ARE STATED ON THE REVEXSK SIDE ANT)ARE PART OF TIQfi CON I•RACT 9/6 d SHV ladea SWOH « yll'1156805 3NOHd-Ni0dX3Z69Z LZ�£Z '10-50-UOZ OpTME rqy, Town of Barnstable *Permit# ti Qn Expires 6 months from issue date Regulatory Services Fee BARNSTABLE, MASS Thomas F. Geiler,Director �plED� �Aa S PERMIT Building Division 1) f% 7 01+, Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 TOWN OF BARNSTABL.� www.town.barnstable.ma.us "11 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - .RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Ze)40 61,6 D 0 9 b /Rerstiydential Address Vic, Value of Work 1774 fee of$35.00 for work under$6000.00 T -0wner's Name&Address , m e Contractor's NameTH ' V Telephone Number Home Improvement Contractor License#(if applicable) /ac g�3 Vornuction Supervisor's License# (if applicable)kman's Compensation Insurance Check one: ❑ am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance •Insurance Company Name Workman's Comp. Policy# G G 5- 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)+ ❑ side #of doors Replacement Windows/doors/sliders. U-Value 0,30 (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with P P other town department regulations,i.e.rustonc,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is require SIGNATURE: �' y Q:IWPFILESTORMS\building permit forms\EXPRESS.doc Revised 070110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia AM Builders/Contractors/ElePl Workers' Compensation Insurance A ease Print Legibly Applicant Information IT Name (Business/Organizations/Individual): (� Address: ��SJ tGteeS —�� r c,4-b ` = -30339 Phone#:—goo City/State/Zip: Are you an employer? Check the appropriate b Type of pro' t(required): 4. I am a gener1hedhee tractor and I 6 [] construction I am a employer with ,* have hired t -contractors employees(full and/or part-time). listed on theed sheet. 7. Remodeling 2.❑ I am a sole proprietor or partner- These sub-ctors have 8. ❑Demolition ship and have no employees employees ve workers' working for me in any capacity. 9. ❑Building addition comp. insur [No workers' comp. insurance 5 We are a coion and its 10.❑ Electrical repairs or additionsrequired.] officers havrcised their I I E] Plumbing repairs or additions3.❑ I am a homeowner doing all work right of exen per MGL 12.❑ Roof repairs myself. [No workers' comp. c. 152, §1( we have noinsurance required.] t 13.❑ Otheremployees. orkers' 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 hey are rtional sheet sho all wing he name ork and then are outside contractors must submit a new affidavit f the sub contractors and state whether or not those tentities have such. tContractors that check this box must attached an add p.policy number. employees. If the sub-contractor have employees,they must provide their worker'com p Y I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. f r/�, Insurance Company Name: � 5 ILt �v s Insur P W l Expiration Date: Policy#or Self-ins. Lic. #: � 1 � � k City/State/Zip: Job Site Address: S/OJ✓ Attach a copy of the workers' compensation policy declaration page 2 shocan i d t ng he poln y n umber of crties anuninal par aln date). of a Failure to secure coverage as required under Section 25A of MGL c. fine up to $1,500.00 and/or one-year imprisonment,as well as civil penaltiesstatement may f forwardedoo tKlie00ffice of d a fine STOP W of up to$250.00 a day against the violator. Be advised that a copy of is Investigations of the DIA for insurance coverage verification. I do hereby certify and pains and ties of perjury that the information provided -vie is true. correct Date: Si ature: G� y Phone#: Official use only. Do not write in this area, to be completed by city or town ofj`iciaL Permit/License# City or Town: Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations - e 600 Washington Street Boston, MA 02111 Workers' Compensation Insurance Affidavit: Builders/C'orttractors/l lecti-icians/Plumbers Applicant Information `` Please Print Le ibl Name (Business/Organi aiiun/Indivichrtl): �i --- Address: -- — 'I1 t' UA) City/State/Gip: /z/.�0�"4 � Phone #: Sao Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6 ❑ N construction mployees(frill and/or part-time).' have hired the sub-contractors 2. _ I m a se1e.rreprtetot er partner- listed on the attached sheet. 7. Remodeling These sub-contractors have g. ❑ Demolition ship and have no employees working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.$ 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their I LEJ 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#i must also fill out the section below showing their workers'compensation policy information. •- — - - H womeowners o rr-ut-su this affidavit mdicatmg—ht ey are doing all'work and then hire outside contractors must sa'bntira new'aflidavttmdtcatmg 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. Viepria"i Insurance Company Name: Policy#or Self-ins. L)i(c�#: GO''�� Expiration Date: Job Site Address: / T N k PtfCity/State/Zip:4's OJI� t� S V/Q-r Attach a copy of the workers' compensation policy declaration page(showing the policy number and expir on date). raiiure to secure coverage as required under Section 25A of MGL c. i52 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 Investi ations of th DIA for insurance coverage verification.. s I do hereby certifj r nder the pa•is and per ' s of perjury t at the information provided a ve is irl e a rrect. Si nature: Date: Phone#: Official use only. Do not write in this area, to he 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. O,ther Contact Person.: Phone#: i Information and Instructions 1\•lassachuSells General Laws chapter 15? requires all employers to provide workers' compensation for their employees. hul'Suallt to tills slatwe, an enrp/0,rec is defined is "...every person in the service of another under and'contract of hue, cxpress Of H-rip'llcd, oral or writtell." i\n eltiplorer 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, assoriati(')n ur other legal-entity, employing employees. However the owner of a dwelling lllltlSe having not more than three apartments and who resides therein or Iht:;i�cc 11 allt of the dwelling 110USe of another who cnlploys persons to do maintenance, constructidn or rel air•�\vurk on such dwelling house or on the grounds or bidding appurtenant thereto shall not because of such eiriploynlent.be deemed to be an employer." MGL char?. : 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or re!) al of a license or permit to operate a business or to construct buildings in the commonwealth for ally .Vplicant who has not produced acceptable evidence of compliance with the insurance-coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the corrunonwealth 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 chaprer have been presented to rile contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s)of . insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should -be retume44e-t-he-Gity-Gr-town-that-tine pp isat-ion-for---the pemmit 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 td fnhfin the permi License number which will be used as a reference number. jn addition, an applicant that must submit multiple permit/license applications in any given year, need only sub nut one-affidaavit 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 oil file for future permits or licenses. A new affidavit lniusi be linen Out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax # 617-727-7749 www.mass.gov/dia 0 . Office of Consurnzr Affairs&Business Regulation " —= HOME IMPROVEMENT CONTRACTOR Registration : :426893 TyYe: ry Expiration:;;8/3�201.2 Supplement C The Home Depot*..,,At-Hom*e- ervices DARREN DEMERSs'='>` 2690 CUMBERLAND PARKWAY S �-��- A =AN�`A, GA 30339' Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 ;ard Boston,MA 02116 Not valid without signature o .i CA 7 �, TE(MMIDDIYYYY) Ai� za CERTIFICATE ®F LIABILITY INSURANCE 02/21/2D11 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'Pblidy(ies) 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 1-404-995-3000 CONTACT Marsh USA, Inc. PHONE homedepot.certrequest@marsh.com EMAIL - ------- -- - - ADDRESS_-_, Two Alliance Center, 3560 Lenox Road, suite 2400 SURERS AFFORDING COVERAGE NAIC# Atlanta, GA 30326 -----IN— -----------__._._.__.__.._.._._._....__... Fax (212) 948-0902 INSURERA: Steadfast Ins Co 26387 INSURED — INSURERB: Zurich American Ins Co 16535 _-__-.- The Home Depot, Inc. INSURERC: New Hampshire Ins Co 23841 Home Depot U.S.A., Inc. - 2455 Paces Ferry Road NW INSURERD: Illinois Natl Ins Co 23817 ----- -----------._...._.. Building C-20 INSURERE: NATIONAL UNION FIRE INS CO OF PITTS 19445 At GA 30339 ----------------------------•-•-'-----'----__--...__.._._......._._...----• INSURERF: Illinois Union Ins Co 27960 COVERAGES CERTIFICATE NUMBER: 19834682 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 AOUL SUBR _ - POLICY EFF POLICY EXP — LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A GENERAL LIABILITY GL04887714-01 03/01/1' 03/01/12 EACH OCCURRENCE $ 91000,000 X DAMAGE TO RENTED 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence)-__ $_— X MED EXP(Any one person) $EXCLUDED CLAIMS-MADE �OCCUR � -- -- - --'- X LIMITS OF POLICY'XS PERSONAL dADVINJURY $ 9,000,000 X OF SIR: $lM PERjOCC GENERAL AGGREGATE $ 9,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 9,000,000 -- - X POLICY PRO- LOC Is _ B HAP 2938863-OB 03 0 1 03 O1 12rEa,,, NED SINGLE LIMIT 1,000,000 POLICY ident X ANY AUTO INJURY(Per person)- ALL OWNED SCHEDULED INJURY(Per accident) $ AUTOS AUTOSRTY DAMAGE NON•OWNED cidenl $ ....... HIRED AUTOS AUTOS —� X SIR AUTO P Y $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ -_._...__. EXCESS LIAR CLAIMS-MADE - AGGREGATE__ $ -____.•___.-- DED I I RETENTION$ WORKERS COMPENSATION WC061967352 (AOS) 03/O1/1 03/01/12 X OR,LIMWC U- FR C AND EMPLOYERS'LIABILITY — YIN D ANY PROPRIETOR/PARTNER/EXECUTIVE NIA WC061967354 (FL) 03/01/1 03/01/12 E.L.EACH ACCIDENT $ 1,000,000 � _ OFFICERIMEMBEREXCLUDED7 WC0 619 67 3 53 (CA) 03/01/1 03/01/12 E.L.DISEASE-EA EMPLOYE $ 1,000,000 E (Mandatory in NH) ---- II yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below C Workers Compensation WCO 6 19 6 7 3 5 5(KY,MO,NY,WI, )03/01/1 03/01/12 . F TX Employers XS Indemnity TNSC46244151 (TX) 03/01/1 03/01/12 Occurrence/SIR 30M/lM E Workers Compensation WC1192378 (QSI) 03/01/1 03/01/12 SIR 1M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HOME DEPOT U.S.A., INC. ACCORDANCE WITH THE POLICY PROVISIONS. 2455 PACES FERRY ROAD NW AUTHORIZED REPRESENTATIVE ' BUILDING C-20 �- ATLANTA, GA 30339 USA ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD jfiero_hd 19834682 ACORP, CERTIFICATE OF LIABILITY INSURANCE DATE(mwDDM'YY) 03/23/2011 PRODUCER 508.295,4440 FAX 508.295.5864 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION Paul B. Sullivan Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2870 Cranberry Highway HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 551 East Wareham, MA 02538 1 INSURERS AFFORDING COVERAGE NAft# INSURED ] $ ) Remodeling INSURER A: Vermont Mutual Insurance Co. 26018 1..5 Wilson Way INSURER B: Middleborough, MA 02346 INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR . MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH. POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR OkL)D,L POLICY EFFECTIVE LTR NSRE TYPE OF INSURANCE POLICY NUMBER POLICY EXPIRATION DATE MhVDD/YYYY DATE MN.IDD! LIMITS GENERAL LIABILITY BP1102OS20 03/22/2011 03/22/2012 EACH OCCURRENCE $ 11000100 X COMMERCIAL GENERAL LIABILITY PREMISES Eeocarrence $ S0100 CLAIMS MADE l OCCUR MED UP(My one person) $ S,OO A PERSONAL$AOV INJURY $ .1,OOO,00 GENERAL AGGREGATE S 2',000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 PDLICY JEC LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT AN'AUTO (Es accident] $ ALL OWNED AUTOS BODILY INJURY $ S:HEDULED AUTOS (Per Pelson HIRED AUTOS BODILY INJURY S NON-OWNEDAUTOS (Peracdden:) . PROPERTY DAMAGE $ (Per acdden:) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S AN"AUTO OTHER THAN EA ACC $. AUTO ONLY: AOO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR D CLAINS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETORMARTNEWEXECUTIVE� E.L.EACH ACCIDENT $ OFFICERW EMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 8 Yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMB '$ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS HD At Home Services, Inc and the Home Depot are included as additional insureds ith respects to general liability linsurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAR. 10 DAYS WRITTEN THD At Home Services, Inc. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE T00030SHALL 3200 Cobb Galleria Parkway IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Suite 200 REPRESENTATIVES. Atlanta, GA 30339 AUTHORIZED REPRESENTATIVE ,o Edward Sullivan/MARIE r rBet�y - ACORD 25(2009101) FAX: S08.7%.8823 ©1988.2009 ACORD CORPORATION. Ail.rights reserved.- The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs'-and Ausiness Regulation 10 Park.Plaza - Suite 5170 Boston, Massai 4usetts 02116 Home Improvement Cintractor Registration Registration: 132349 Type: Partnership Expiration: 1/11/2013 Tr# 207392 J & J Remodeling — Joseph Duarte _ 15 Fall St. Wareham, ma 02571 Update Address and return card.Mark reason for change Address ED Renewal 0 Employment Lost Card )P6-CAI p eotn-0wn 0101211e Omce/�' o�OO a r9&18i foes ego a>Ird License or registration valid for individul use only �•\ SOME IMPROVEMENT CONTRACTOR' before the expiration date. If found return to: Registration: ,..1323,0 Type: office of Consumer Affairs and Business Regulation 10 park Plaza-Suite 5170 Expiration: . /11/2013 Partnership Boston,MA 02116 Joseph Duarte 15 Fall St. ` t signature Wareham,ma 02571 . Undersecretary ouof — �la::a�hu•�tt•. Dclnu-tmvut ul Ptrt►lic�afct� . ! Beard of Buiiditr2 Rl�,ula(iuns oral�t:uttlartf� ConstruCtion Supervisor License License: Cs 70077 JOSEPH C DUARTE 15 FALL ST WAREKAM,MA 02571 ®r. Expiration: 1?/30/2012 d Tr#: 7048 ._. _ . ._. Z9L696Z E5:1Z 110Z/Z0/10 10 3E)Vd HOME TMPROVF MFNT CONTRACT PLEASE READ THIS Sold,Furnished and lnstalled.by: �+ Branch Name' Boon Date:g'C J/,f THD At-Home Services,Inc. r d/b/a The Hume Depot At-Hume Services. 345A Greenwood Street,Unit 2,Worcester, MA 01W Toll Free(800)657-.5182;Fax(509)756-8823 Branch Number.31 Fcdaal rD q 75-2698460;ME I io#C 02439;RT C'unt.l,iu#16427 CT Ucc 4(HAIF QS6552(2;;,{M�4�Hurtro im�pPrvrvernenlCini/true it Reg.N 126893 Installation Address: 7 U for `r^f r ►" , f (/ / �`��� City State Zip Purchnser(s): . Work Phone: Home Phone: Celt Phone: 10 l Home Address: (If different from Installation Address) City State Gip E-mail Address(to receive project communications and Home Depot updates): ❑i DO NOT wish to receive any marketing emails from The Home Depot Protect Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy,. and THD At Home 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 Sheet(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#: nmernal W--j P acts: Spec Sheets Project Amount ❑Roofing Siding Windows ❑Insulation c $ Q []Gutters/Cuvers DEntry Doors ❑ Rtwfrng ElSiding ❑Windows ❑Insulation Ttv- []Gutters/Covers []Entry ayurs - ❑Riwfrng ElSiding ❑Windows ❑Insulation $ cc) ❑Gutters/Covers []Entry Doors❑ �Ruufing Siding ❑Windows ❑Insulation $ QGuuern/(:avers []Entry Doors ❑_ Dlinimtun 25%Depa,it of Contract Amount due upon exaction ur thq cvRUWw4M Total Contract Amount !� Blaine Purchasers may not deposit more than one-third of the Contract Antormt- Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and Gable hereunder. The Home Depot reserves the right to issue a Change Order or teratinate.this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authori7ed service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental ha7ards such as mold,asbestos or lead paint,other Safety concerns,pricing errors or because work regtiwed to complete the job was not included in the ontr�t D Payment Summary: The Payment Summary # ooCC . luded as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE 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 Sheets)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 termination,plus any other amounttt set forth in this Agreement or allowed under applicable law. THE HOMY DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WfrHOU'r LIMITING THE.HOME DEPOT'S OTHER REMEDrES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either . oral or written,relating to said Products and Installation.'Ibis Agreement cannot be assigned or amended except by a writing signed by Customer and The i-lome Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement pted by: _ Suh ed by: /r Customer's al re. Sales C Sultant' 19= /j ){ Telephone No. v Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (as applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THF. 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. NOT.I,CE:ADDITIONAL TER,NIS AND CONDITIONS AM STATED ON THE REVERSE SIDE ALND ARE PART OF THIS CON'1 RAC 1' 12-27-10 C-SC White-Branch File Yellow-Customer pe5we( Tel WdZt7:6 800Z 8Z "AeW TZZZZ9£80S: 'ON XHil W02fil .�`W�jtd�G� � 't y�1 . !Fl�,v'i�i'�11R t ��%"4'i � �'�.i,71• •A�I�` '2t7 `p'�+��: ,.f 2 TOWN OF BARNSTABLE 32?96 .Permit No. . BUILDING'DEPARTMENT TOWN OFFICE BUILDING Cash t '► ,6,0. ,• you+ HYANNIS.MASS.02601 Bond NSA, CERTIFICATE OF USE AND OCCUPANCY Issued to Greenbrier Corp. Address Lot #124, 148 Tanbark Road ' Marstons Mills, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD i THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .........m4y.17.1........ 19....89........ ..... .. ... � .......... Build' g Inspector TOWN OF BARNSTABLE, MASSACHUSETTS .'ERMFT B U I L D I N Gi: 2�=lUO-025-016 DATE a v 1.7• 19 89 PERMIT NO. APPLICANT (.)wntE;r � 4 ADDRESS L; d licl6w ;9001397 (NO.) (STREET) (CONT-R'S LICENSE) 'F r -11 i NUMBER OF PERMIT TO BU' I STORY Dw�z' nqDWELLING UNITS (I YPL 01 IMPUOVCMLNI) NO. (PROPOSED USE) AT (LOCATION) Lot i2 4 , 148 -i'Zi j*_%'-W,d, o,-,trstons mil is ZONING CT_ RF (NO.) (STREET) DISTR BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT LOT-BLOCK-SIZE BUILDING IS TO BE FT, WIDE By FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP -BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: !i Ei,v/u cl 4 8'9,-5 1 I. N[A AREA OR 7 6 8 �,Q, . L L VOLUME PERMIT (CUBIC/SQUARE FEET) ESTIMATED COST 45, 000. 00 FEE MIT OWNER A ADDRESS P. U. 5 11)• BUILDING DEPT. 'c.(2 r BY I�r-rrry re FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RMASt THI! AP�LIL,ANI OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINALANSPECTION HAS BEEN ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. Z. PRIOR TO COVERING STRUCTURAL OUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 "b" ` / cl�yl wlat, 3 S HEATING INSPECTION APPROVALS ENGE EERING DEPARTMENTr. r OTHER BOARD OF HE 0 WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIOULIS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. PERMIT ;S ISSUED AS NOTED ABOVE. NOTIFICATION. -- I 1 I . E f I I LOT 127 of- LOT 124 15,629 SF �o /%v 7 ,off p1' I LOT 125 0- ss9• —� 1 = 15.88' LOT 123 i i i F1 4 12 88 INITIAL ISSUE CF N0. DATE DESCRIPTION BY AS—BUILT FOUNDATION PLAN—LOT 124 MARSTONS MILLS WOODLANDS N BARNSTABLE, MASSACHUSETTS K WOODLANDS ASSOCIATES REALTY TRUST I CERTIFY THAT THE FOUNDATION o�`^ SCALE: 1' = 50" ,10B No. 13M 4. I PAUL A. SHOWN ON THIS PLAN IS LOCATED LEVY �, :+` 0 50 100 ON THE GROUND AS INDICA D. " No. 10517 ^� LIM, %LDMU k TAGNKR MOCIAM INC. DAT RE RED LAND SURVEYOR 689 WEST Yen+ STPJ= C>QrrlsMIZ IU 02632 �I f Ke((W Assessor's office (1st floor): U r5;. •, •a THE t0 Assessor's map and lot number 04.K/.•?Q......0.as 0016 i��.SYSTEM �f a Board, of Health (3rd floor):r ' �'��LLED IN Sewage Permit number 6 - Engineering Department (3rd floor): y� !/� ( ,Y� �' —�/ �-N I Q ;'639• 0� House number 'l . . G e .................................. ............ .............. ........ ow Definitive Plan Approved by Plonning. Board _________./a__:_._ 9 ----- 9 N r�EE�vi,,4 i APPLICATIONS ,PROCESSED 8:30-9:30 A.M. and 1:00•2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..:.....C.O..!�Srl? G� )u���-�j✓(r ........................................................................................ TYPE OF' CONSTRUCTION ......... ` � Wig,.......... .. ................... ..................... %a TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �.P.T........� y �i°w�A�zGt �o�� J ���SfG/�S �t-IS C CS.......................... ....................................................... . . .............................................. ........ Proposed Use ..........................................f .......... .....%J��.F �✓�-tSL.. ................................................ . ........................................................... ZoningDistrict ....... .. ..t!...�.........:...........................................Fire District ...� .e .......................................................... Name of Owner .......R:.E•16 rZiC� 2Q�d ...................Address � 0., Sl0 ? ✓1G�... ........... . ...... ff . �. . i Name of Builder .........S �F............................................Address .....-/.o..................................................................... Nameof Architect .......... .....................................................Address ....................:.................................................... Number of Rooms ...............................Foundation U�E� �NC2 � . ........................................................................... Exterior ......�...... .... ...5•v1 /(rC:�.. C........ ..........Roofing ........ Floors . 7......�V c'NyL .sNT�O� K !!! ` ...................................Interior .. Heating �A 5............................Plumbing Fireplace .......... ................................................................Approximate Cost ........ .' .....:�. ....... .... .. ......... . Area ........ �.. ..: : .................• Diagram of Lot and Building with Dimensions Fee `C 3a x ay �A 6 IV-;S/jF't� ST,0.7,Cs OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the T wn of Barnstable regarding the above construction. Name .......... .... ..................................... Construction Supervisor's License .0 7 / GREENBRIER CORP. 0"No ' ...... ............... Permit for ....1.?1...Story S .n.c Sl.q......Fa.mi1v Dwel.l.i.n.g .... ..................... .. . .. ......... Location .-Jot....#.1.2 4........jAP...Tanbark Road ...................... tQns..Mills .............. .................... Owner .....GXQ.QXjj:Atier...Corp ........ ........ . .................... Type of Construction .......F.r.ame...................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ....May... ................19 89 Date of Inspection ....................................19 Date Compi ted - (, Y......... 19 3,X, v. oa a o-o.,. r"^'.• _ '�-ti•^r 2'• :1 s;.t.' Ka- Assessor's office (1st floor): . THE Assessor's map and lot number F t Board of Health (3rd floor): Sewage Permit number ........ Z BAM9TODLE, . Engineering Department (3rd floor): NAB&1639- � House number ............... ' ...:. . a ! Y� o'EOYA1 a- Definitive Plan Approved by Planning Board _________y ___ ________19 ,y,?& PL CATIONS PROCESSED 8:30-9:30 A.M. .and 1:00-2:00 P.M. only U TOWN OF -BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ 1/N:S.1.l?&,Ct Y /��,�/c�C ... ......................................... Y TYPE OF CONSTRUCTION .........5 �F � �. L. . . . t ................................... t �9 �!....�.. ...............1 9. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: o /��v�AiZ'L<. .. �bPh Location ......... ,COS t... ..r ........ ............... ........... ................ ................................... ................................................. ��r , ProposedUse ................. /' Jy ......... ............................................................ Zoning District ......:a.�r.r.T..t......................`.............................Fire District .... . ..............: Q�. .. ' Name of Owner ..........F......................�.:....................Address ............... Name. of Builder ..........SA ................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms. .......Foundation CGArrIZFT"C .................... r Exterior ......�.!�..AQ:�.. ...5!�I!A ,CC`� - ('E l�f/1T g f1.5.41* Roofing Floors (?AeA,j..... : ...!.1. .y.�,........................ S1VF E k' Interior ............ ............................................................... Hedting -�/� ..... .. G..s Plumbing dA Fireplace .......... D '%� p ...Approximate Cost ............r....................................................... Area .......................................... Diagram of Lot and Building with Dimensions Fee 0 AJ) 5/j C .00CUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding'the above construction. Name /.., G� v V �N Construction Supervisor's License ����� GREENBRIER CORP. A=16 0-,0-2--5---0 16' No A.?.9 Permit for ... ...Stor ..... ...Y............ ......sincjke...Tarhi ly..... ....... ..:..... ..... Location JL9t...#.1, A........1.48...Tanbark..Road ....................M.ar.sto.n.s...Mills....................... Owner .......Greenbrier...Corp................... .... .. .... .. .. . .. .. .. .... Type of Construction ....Frame.......................... .................................... Plot ............................ Lot ................................ Permit Granted .....MY..1.7...................19 89 Date of Inspection ....................................19 Date Completed ......................................19 I SHEET 7 OF 7 lea,• � I Ab ! , MARSTONS MILLS LOT 130 1.u•••s LOT 129 tw lit LOCATION MAP tit � a X 101 \ o LOT 12t .'\ 0' i ,�, 40 LOT 31 i 1/ / t0.ttw3i LOT 124 i i I- ti � .� t , S " � 1•A �s >,� j �5. 5� �`� LOT 106 `!t 1 •C ,r 4 LOT 123 -� '�' LOT 126 tt,O• r. 'uw• 1 I y II ( > '�' 4� #. L 7� ( l.4 I t �' LOT 13 yi \` ► LOT 149 ♦: l r � tattw-• - -<.. - a LOT 136 .. _. 40 00 l07 1]i y �, ��'' J LOT 122 tstt•• �• ) xLLOT 121 �\� COT 107 LOT iN 147ff t I�,y `\ ,t� �► \ ' tp>A 11 Aae LOT 119 'LOT 141 lttr• G A: it '�` tar `� r po '` `\ fit" •• 1y o > iOT f tdt 'l. \ > �' �.i \ � • ♦ 'L 'per•• L LOT 120 '96 � �� f' � 'o• ' `� i LOT 117' • LOT 43`\ - / �`S ''�.\ a'�r M o. a r *4 fit ' ftY� tit r� • � R1orwa s 1`, L"M *~r 9A OF Fe1C Seel, vas 1►•4D LOT 115 ' '\ -4rs�wanal ;18ar. ems. i L 14s a lot - -; '' LOT'146 0.7fa s \ te` tar r p t.4Y sItN T'.. r�A o1 7 Ip!<.•wrsND' i Iwo 16. LOT 116 •r `� } �. 1 i O LOT 11lot �• \ O tar• lei i ' LOT 11 iwwli r`LO 114 tar 1� � tz • •• .o. wa i 1 r 1�P Lit ' 11 29 S6 FINAL /AG.L AND SEPTIC LOCATHM PAL I 10/12JU INITIAL 1ELX \\ ,s NO. DATE DESCRIPTI ��� \ti"Iq• `'' ,:t }"f BUILDING LOCATION PLAN tt MARSTONS MILLS WOODLANDS LOT 109 IIAM w ; BARNSTABLE, MASS CHUSETTS WOODLANDS ASSOCIATES UST SCALE- 1 ` 50' JOB N0. 1338/(as•u �..!::�f,� • w no BBB ww um vw= CZNIIZW= KA 02= I