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0017 THATCHER HOLWAY ROAD
a � � � 0 --�-�. - ..�. -�� v. _ _ �. �.. . ._ �. �� ..,...� :L._. _ __ -, IRE� I�' �y Application number 0 ........................................... ... h �j w anR.NSTAst, Date Issued.....6--2..1.`.�. .. . o. .. . 1639. �Quilding Inspectors Initials... . ...... RFD MA'S a ....................... m ® _ Map/Parcel........../Z.3.....0- 1 T® ABLE SlTi. 0 0 EXPEDITED PERMIT APPLICATION: ROOF/SID1NG/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY M FORAIATION Address of Project: / •7 -A�-Iz/ier NUMBER STREET VILLAGE Owner's Name:�/o�iha� � � L n e� Phone Number Email Address: moo_ ,•�Q r� �,o Cell Phone Number 777 Z L i Project cost$ /c, (o Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: S 00.71-4 Date: F- TYPE OF WORK ❑ Siding Windows (no header change)# Z ❑ Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name -SA-ern r kiJ & (rv4 J'n Aw S Home Improvement Contractors Registration(if applicable)# 17 3 2_q- (attach copy) Construction Supervisor's License# 01 S 7 07 (attach copy) Email of Contractor GGtjea 9 qS@ ; • C br'n Phone number V01- z z g - I RDo� ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X , X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLE'T STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. I Signature Date PLICANT'S SIGNATURE Signature Date 6 —26 -/ 51 All permit applications are subject to a building official's approval prior to issuance. i Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal B Andersen of Southern New England y g Norman&Rhea Lipner Al....EM Legal Name:Southern New England Windows,LLC 17 Thatcher Holway Road RI #36079, MA#173245,CT#0634555, Lead Firm#1237 Marstons Mills,MA 02648 MR00 10 Reservoir Rd I Smithfield,RI 02917 H:(508)420-4524 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:7742381862 Buyer(s) Name: Norman & Rhea Lipner Contract Date: 06/13/19 Buyer(s) Street Address: 17 Thatcher Holway Road, Marstons Mills, MA 02648 Primary Telephone Number: (508)420-4524 Secondary Telephone Number: 7742381862 Primary Email: normanlipner@yahoo.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: $5,196 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: $1,731 Balance Due: $3,465 Estimated Start: Estimated Completion: Amount Financed: $0 6-9 weeks 6-9 weeks Method of Payment: Cash/Check 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: 1/3 DEP 1/3 ON START 1/3 ON COMP TXS PD IN MARSTONS MILLS MA 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) ))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 06/17/2019 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:Renew y Ande of Southern New England Buyer(s) -4, r>4N Va-z4rA--,- Signature of Sales Person Signature Signature Eric Woods Norman Lipner Rhea Lipner Print Name of Sales Person Print Name Print Name UPDATED: 06/13/19 Page 2 / 10 J !�C��'i�20/ICIt�CGG/ ell' A Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement-Contractor Registration Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS,10 RESERVOIR ROAD Expiration: 09/18/2020 - SMITHFIELD, RI 02917 - scn i c, zonn•osin Update Address and Return Card. �T� �cvrrirznn.�aea,�ifc���a:-:�uo�clG� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Renist6ti6n. Expiration Office of Consumer Affairs and Business Regulation 1:Z324_5=:_ 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLANb WINDOWS,LLC Boston,MA 0211 s � 1 BRIAN DENNISON 10 RESERVOIR ROAD u SMITHFIELD,RI 02917 Undersecretary va, Without signature l' 7 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constru_ct bn `uperviser CS-095707 pires : 09/08/202.0 BRIAN ® DENNISON 8 BLACKWEL -DRIVE CHARLTON MA=01507 M1 Commissioner CIL I The Commaitwealtli oftlassacitusetts Department of Industrial Accidents 1 Congress Stree4 Suite 100 Boston,MA 0311 4-?017 www massgov/dia Workers'Compensation Insurance Affidavit-Builders/Contractors/Electrician&Mwnbers. TO BE FILED WITH THE PER-NIITTI:YG AUTHORITY. Avolicant Information Please Print LeLribiv Name(Business Organizadan/Individual): son,&Jhern, Q U.� Address: 16 er Vol r Z1 i City/State/Zip:SM t -�j eld t 7?1 OLg 17 Phone#: 40/-X2 r- 9 ffoo Are you an employer'Check the appropriate box: Type of project(repaired): 1. 1 am a employer with 7 'employees(full and/or part-time).* 7. �New construction 2 am a solo proprietor or partnership and have no employees working for me in 8: (�Remodeling any capacity[No wotirers'comp.iratuance required) 3.C]1 am a homeowner doing all work mysel£(No workers'comp.insurance required.] 9. ❑Demolition 4.❑1 am a homeowner and will be D hiring contractors m conduct all work on my property. I will 10 Building addition MUM that all contractors either have workers'compensation insurance or are sole 1 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.Q I am a gaeneral contractor and I have hired the subcontractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.t 13.� of repairs re 6. We a a corporation and its officers have exercised their right of exemption per MGL a 14.0t er 4J 1%� r✓ 1 A§t(4).and we have no employees.(No workers'comp.insurance required.) r e,4la c,4-n t 4:S *Any applicant that checks box 4I 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 conhacton must submit a new affidavit indicating such. iCantracoors 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 employe m they must provide their workers'comp.policy number I am an employer that is prokidlne workers'compensation insurance for my employee.. Below is the policy and job site information. Insurance Company Name: 1 rteg nyr l.l�I Q/lam°_ GO . OF Wfi I Policy#or Self-ins.Lic.#: WCjq�1,�lj�]R Qp? Expiration Date: 1' 1—2 D Z.O Job Site Address: / ? ��-��e r //o!ra/a/ 1p City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration te). Failure to secure coverage as required under MGL c. I52,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifkation. I do hereby ce m&rthe pa-iml of perjury that tthe information provided above is true and correct Signature: Date: 2.6—/ Phone#: 4 n 1 7a ) Official use only: Do not write in dds area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i CERTIFICATE OF LIABILITY INSURANCE F__� TE 1z/2srzo s 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(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 CONTACr NAME: CoBiz Insurance, Inc.-CO ONE FAX 1401 Lawrence St., Ste. 1200 IAI N 303-988-0446 prC No:303-988-0804 Denver CO 80202 ADDRESS: COMailiMcobizinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:Firemens Insurance Company of WA D.C. 21784 dba Renewal by Andersen of Southern New England Southern New England Windows, INSURERC:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER 0: Smithfield RI 02917 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:787175890 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 ADDL SIJ R . POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a OCCUR PREMISES occurrence $300,00D MED EXP(Any one person) $10,0D0 PERSONAL&ADV INJURY $I AW,000 LA GATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000.000 X JET LOC PRODUCTS-COMP/OP AGG $2.000.000 POLICY❑ OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED ditSINGLE LIMIT $1.00a 0 0 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS ALTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIREDAUTOS N AUTOS eraocidem $ A X UMBRELLA LIAR X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,ODo EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DED I X I RETENTION $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X SER TATUTE ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $11000,0m OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1 000,000 C Pollution UabOity 7930073340000 1/1/2019 1/112020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 06/20/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES-ONLY AUTHORIZED REPRESENTATIVE N� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD �' • TOWN OF BA$NSTABLE permit No. ------24267------ Building Inspector • "': �'` �. _ r Cash ------------- - p` OCCUPANCY _PERMIT Bond --------------- %- Issued to Hilda Traf trni t Address lot #13 _ 17 Thatcher,Ilolway Road, 'Marston Mills Wiring Inspector Cam. �^ Inspection date Plumbing Inspector�� O Inspection date Gas Inspector 1 Inspection date Engineering Department ��� �A,� Inspection datep� -v Board of Health Inspection date co�ZI71 "' 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. BuildingInspect6V f r V I � r �c� I ' • ..T 1� l�1 G\-�-�r12, l�C•.�/lJ/�`r �vA.l7 .- ►7 O S:r• `n Q f biq� •�``� tic �' - WIWAM nrE ,p Ita. 19334 STti LOCI>T_ 1_�T MST I-`Il•�•s �-1�QEd�a GaM���S W ITN T�-tE Stet=.�1►-1� � I?J .. A►.I� S�Tt3ACK K'CQut2E�t�cc�TS of TNT R 'To W U of BA2NS $w' A"D 2.8 I Paces, LoGATVSD Wl'r"I Fl..;$1 US'TEP-V%LLG o IwG. t�AT� � �- �--•. <ZE G I S t-C--1Z�.D 1-�+.t-!p 5u ev�Yo�. This p L A W !s W nT SAIS CIV �XasS. i��r;r���,����.i;- Su�vrY �� -T:�� o�=r_,r-:c"S -,1•toe��D. �;t�1�I_t �A.ti.IT'_ u�`pA ��,�1.) ,� .. _.. .•.. . �, r� r� -�'... T'1 r�'�`rt t'�A.11 t.I I'-' L.U'r L_I i-:C C..+ Asses. is map and lot number .... ....."�............................ dg_ ��L 'r�t$� i / � CF TM E a 30C.SeGrage Permit number 8 -5.......................... SEPTIC SYSTEM MUST INSTALLED IN COMPLIA . o� House number ............................�/r7c..................................... c i°JiR E`�91ViEftlT `+L CC3U� 1WITH TITLE 5 MAOIL 6 d�e� p TOWN OF BAIRNST'A"ALE ' BUILDING - INSPECTOR APPLICATION FOR PERMIT TO Sam AMJL� Dui TbR f ................... &.....FA!.... ......................rs........ J ..................... i. TYPE OF CONSTRUCTION .......................WOR_b........r ................................................................. ....................... ....g............... 19. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: LocotionThatcher Hollway..Rd.......................................Let..#..13. .................N�Q,iTa�l15 ...M/�'sa................. ..... .... .... .. Proposed Use .....single„family.,dwelling...................................................................................................... .................. ZoningDistrict ............... .....r`. .....................Fire District .......�.....d......................................................... Name of Owner ...Hilda„Trafro ......................................Address .k'AIMI'l.#h..k9.]:t;,...M ir5a....................................... Name of Builder'(;Qntempo);arY„ oH$tr ctaAn..CQ.,...LAddress .5.QX ,9B...... ................ Name of Architect .......................................Address Box...532..... .............. Number of Rooms ....6...... ..................................:.................Foundation ..P.Aux.ed..C.Qncr.e1 e........................................... Exterior Reverse Board & Batten ...Roofing Red Cedar ............................................ .................................................................................... Floors one...storX...with Oak &....Caret...:>....................Interior :..blueboard............................................................. ` Hot water 1;: Oil PVC and CO er Heating ............................ ..............Plumbing . ............................................. .................... ................... .................................. Fireplace ..Yes,,..with„wQQ.d$tQYR.....................................Approximate Cost O.Q. .QQQ -74 Definitive Plan Approved by Planning Board __ -—-----------19 Area /.V..... ..........00 Z Diagram of Lot and Building with•Dimensions- Fee .... ... .. . .. .. SUBJECT TO APPROVAL OF -BOARD OF HEALTH Q ' I OCCUPANCY 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 ... X....... .................... . ..... ....../LO.... ? TRAFTON, HILDA n _ _._ __._._. . - -�....._. ..__ .. :_. ... _.,� __ . _ . - _. .....a_.-• .-- ___ __a . 24267 1i Story 6 No ................. Permit for .................................... Single Family Dwelling ............................................................................... Location.,.Lot #13 17 Thatcher Halway Road ................................................ Marstons Mills ............................................................................... Owner Hilda Trafton ......................................................... � •' Type of Construction .......Frame................................... ................................................................................ Plot ............................ Lot ................................ August 5, 82 - ' Permit Granted ...............................:........19 Date of Inspection ....................................19 Date Completed AK 44".�-�.....1'9 ' f �2 9�5 Town of Barnstable *Permit# 3 '• Regulatory Services 6a e�aLt4l�yt • !ham Richard V.Sceli,Interim Director . Building Division Tom Perry,CBO,Building Comm isioner MAY _ 12014 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 IAp k..NO-6230 EXPRESSPERMIT PLICATIO - RE I ONLY Not valid wf%wa Red X-Press tn�►rW Map/parcel Number /oZ3 CS� Property Address )I -kh_w 4401waA Rd M M , Residential Value of Work$i q. 1 1 I AMiniim in fee of$35.00 for work under$6000.00 Owner's Name&AddressuoymaLinumn 1 1►1 aL+f- Ho M 0,V&-h ns Si Contractor's Nam& U flpn,nl �al�$�LPA9'a '�(� .� Telephone Number 0 2Z 5 Home Improvement Contractor License#(if applicable) /2 j4 74j' Email: Construction Supervisor's License#(if applicable) ®96d AW o man's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name &a on&u;t Iris e"d - Workman's Comp.Policy#_ ff1 L 9 2 -7!Bf 6 3 E?.394 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value ` 30 (maximum.35)#of windo (�Z) #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is uired. SIGNATURE: T:IKEVIN PkBuilding Changes SS PERMfi\EXPRESS doe Revised 061313 �. Renewal Rr NEt VAr BY ANLL Rs u\TArdGe taYu!rJ su wI:c..a.a.v►.seur:::::lurr},t1 acrx UMT .-:Fsf -.., 3G I,inr.Rnrd Ia1�.uL�2,It D?BGrr Phunc866.563.435 Fax4d1A33.fifAri2 Soaffisrn New E4andV&ndovm LLC d/b/a Ream-al by Andursen of Sawberu New F-CI—A C WMMWINDOWANDDOORREMODELINGA N-r j _. poxalA�-ou I I 3per6)s--=A�sa�•Gryk:h TrpCo&_ .J.Bw:� ?rut aiEn s NQ(M4,41 H / �+ _t11� NorcTdsiE ore N cifx:�aQ /4_ �11�r1 - rhea. Buyrr a�letvehY{ointhr arch>z•rally ,�ren m p`,rrlu leis the itrt,tlnr�:k�setts/sir torviurs Ld'SDthtbcrn Nety LetAviel Atrmdamv LLC d/h/z Rent-mil hty?►n>tr:sYut of 56uttiens!1rrc,•Eno vid f::QxtuW.u'ir"1,it utY"'st urr vr£th the ttmn and cu rlidom ties::• on ibc fmin and the z cane,:of ibis:tgn-eu ni and on the au wix-cl a pedficastion eit ate(co1hC-d%,,Ihis*Agratim Ot')• D Historic 13 Condo O HOhA4 Totallo's An•.Wnt L_I��%�1 �?fr dSVeqz V�—, mod of Pryrnent•. U Check G Crib a Fitrmed Deposit Reaaived(33%): // L Cm4ft Sr&are=n;wd for dcpoett only-trrximwm III 0 thr 1 AAA Warm at Smrz of job(33%): l,l project cote ftm m GedL Cad rapmmi Fanny By signing ehc f fsOrzu CwL*don 0=e: Ayaemea,y�,u aarsov%le4pt1NI"Balince at Sum djcban�the Balaneo on Svbsarvt:al Ehbnce en SdmmnrW CamFlecon W)Ob:amor be male by croft COrnPUM C()Cb(33%)I�s ,��. card o d mwt be rnade by penzvl check Lank chr;Ac er each: Rayrr(a)agrees and unders a that-this Agreement constitutes the entire understanding between the parlieer,and that there are no verbal unde:rstaim itgs tba ig ag any of the terms of this Agreemest.Buyer(s)acknowledges that Bayt,(s) (1)has read this Agreement,u demiands the term of this Agreement,sad has reoehtd A completed,sinned,and elated copy of 0&4-4greement,iastuda the t wo ansebed Noticed of Cancellation.an the date first x�>above and(2)tram or4y informed of Rotes right to tas~Ieal tltisA,rreemeat_DO NOT SIGN TEIIS CONTRACT IFTl [tE ARE ANYBLANK SPADES. (Rhoda Isrand salts Oaty)A` to Buyers(1 I Do not sign skis Agreement it any of the spaces intended for the agreed terms to the eztent of then available is formation are left blank.(2)You are endued to a coley of"Agreement at the dme you sago it.13)You may at anytime pay 4 R'the fulluapaiid balance slue under thiv Agreements and in too doing you maybe entitled to receive a partial rebate of the f}}nnaaet and ittsarance charger.(4)The Seljw has"tisut to unlawfully ratter your prearises or commit any brea&of tbept We to Mommss goods purchased under this Agreement.(5)Yoa suay cancel xhis Agreament if it has not bows Jgaad at rho main offco or a hraach o6ce of the stiller,provided you notify the&Aer at his or her main office or brands-Mee shown in he Agree+ enEby registered or eetalfied ma%which diallbe posted not later than midnight of the&h d n a ay after day on w4deh the buyer signs theAgreement.excluding Sunday and any hol)day on which resstlarm delivorles snots lude.SeNt6eaecwppstst)iesgnoticeofe9wtvtlsttiosafvrmlvrats.r,Isiaoaorbuyvr'sr;ghtw Buy rerSsl •.. t etI the rnttsorn ed"". tion ircaiefiah siridea.'by the TuhM:�Isom]Cnnir", i%ReEbutticr t Bt>ard lPap�v fry i.'iJ Renewald of the? .Vet En®r Nnd Duyer(6) 1lrayrGr(c) By: 4'> 'ury rndueL hlan:suer S,ao:.trkr. .1'iKrtnwte A* Vd,4AA 1'ri zinc of Ptuduci?,hat g r print rearm. Faint Nnrnc YOU, THE BUYER(S), MAY �� -CEL YZf1Y,S T1tWSACTION AT ANY TIME PRIOR TO hf[DNIGHT OF THE THIRD B;kumss DAY AFTER THE DATE OF'i ff1S TRA\SAG'IYON.SIM THIi ATTACHED NOTICE OF CANCEUATION FDP-MS FORA:\'EXPLANATION OF TfQS RIGErr tc- - - - = - - - - -ae- - - - - - - - - x- -O - - - -x mailGt`�l:GA 1= f� N13ITiC£ P t_ANCHLLATION Date of Transaction _,You may cancel II' Date of Transaction -You may tanGal this transactor.Withhout any penalty or obligation;within this trarimbon,without any penalty or 9SGgW6u3;.within three business days from the more date.N you cancel.arry 1 three busirxus d-r,firm tht above date,if you cancel,any property traded In.any payme is made by you candor dto I property traded in,any payments made by you under the Contract or Sidra,and any ncgtitiWe instrument executed I Can&at t or Sale,and any negotiable Inswument executed by you win be returned within Eon btulm ss days following I by•yutt"I be rewmed within cen business days following recmpt by the Seller of your .l>.tkedlation notice,and any I receitpptt by die Seller of your cancellation notice,and any scarify interest arrwing out �f the tlraosaction will be security Interest arising out of the transaction will be canceiod.if you canecl,rw musrt maim available to the Seller I canceled.lfyou cancel,you must make available to the Seller at your residents,in substantial�r is geed condition as when I at your residence,its substantially as good condition as when received,any goods delivered tci iron under this:Contract or I received,any goods delivered to you under this Contract or Side;or You may,if You wish;c6t��tc ly with the inswix0ons o1 I We;or you m*-If you wish,comply with the insaut dons of the Seller r*24rding the return rn 4spiptrhent of tfhe goords at the the Seller regarding the return shtprnent of the goods at the Seller%expense and risk.If you!o make the goods available Shcees expense and risk.if you do make the goods srAUMt Vick to the Seller and the Seller aces not OC4 them up within to the Wier and the Seller does not them up within twenty days of the date of canceilation.you hens ietain or I twenty days of the date of cancellation,you may retain or dispose of the goods wit houC 2 further obligation.If you I cispuse of tehe Sods without any further obligation.If you fail to make the goods avail to the Seller,or if you agree I fail to mike the goods available to the Seller,or if you agree to return the goods to the Sell and fell to do sN then Yaa I to t swan the goods to the Shcer and W to do so.dawn yell remain liable for performance of all oUthpitions under the remain liable for performance of all obligations undor the Contract:To cancel this tran n,mail or defter a signed I Conttaet.To cancel this transaction.mail or dditrr a signed and dated copy of this rencerlatlon notice or any other I and dated copy of this cancellation notice or any other -wattles%notice,orsend atelegralitta Renewal byAndmenof I written noticc,o►Send a telegram to Renewal byAndersenof Southern Now England at 26 Almon Roof.Lincoln,RI QU65, I Southern New England at 26 Albion Road,Lincoln,RI 02865. NOT LATFA T14AN MIDNIGHT OF � I NOT LATER THAN MIDNIGHT OF IDHEREBY CANCELTHISTRA 41SACTION.ace) I I HE(Date) CANCELTHISTRANSACTION. auyrrk Stgnawrc PKM Name Dice eon stgraaua -'r t t nsnw F.bA Copy:iWire 3uyer Capyt Yeflow Buyer Ceps^.Fink 0/10 3-�Jd cO1S71:riil NAVU ZESTESLeea ZT:0Z VIOULTfVO Southern'. New England Windows d.b.a . __ ��w. ��-r-�..�. .._ .�- ++s .,—_may.. .-� �....-.. a�...-.r.._.._� a�r - wM..r ►mot .�r--.w -.__ .I� � .• ?- �'- _- Renewal by Andersen of SNE -Massachusetts -Department.of Public Safety Boardof Building Regulations and Standards Construction Superiisor License: CS-095707 - BRIAN D DENNIS E)N 7 LAMBS POND Ciwrv, Mf _ Chariton MA 01507 i Expiration Commissioner 09/08/2014 Office of C nsum��sand Busess 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Caro SOUTHERN NEW ENGLAND WINDOWS LL Etralra0on: W1912014 DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET,RI 02895 Update Address sod return card.Mark reason for change u . s r 0 m.�at Address ❑Renewal Employment ❑Lost Card 0.00EStPladIM Lreese or registration-lid for MlAdal use only before the-pintioo dam If found return to: o1Rce orConsumer Again sad Business RegaWion ratton: 173245Type: 10 Park Plan-Sulte 5170 M112014 Supplement::ard Boma.MA 02116 SOUTHERN NEW ENGLAND WINDOWS I.I.C. RENEWAL BY ANDERSON BRIAN 1137 PARK 1137 PARK EAST DRIVE � � \��T.�Jy\�\•—•� WOONSOCKET.RI 02895 Uaderseretary Not-lid without signature I -K .w-' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ,{ 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibl Name(Business/Organization/Individual): �N Ize Address:_ 9 (o 10A/ gO City/State/Zip: LIII/COIN , /e �24S Phone#: yoI ,?a ?YD0 Are you an employer?Check the appropriate box: Type of project(required): 1.[!0 I am a employer with AD 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for mein any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp•insutance.t required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.[1 I am a homeowner doing all work officers have exercised their ILL]Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.2rOther Wr employees.[No workers' comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 3Coirtractors 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. 4 Insurance Company Name: Q SUl'�l�lt! aai/14 Policy#or Self-ins.Lie.#:R'�� ����J d 3 S�3�V Expiration Date:___ oZ 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 STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do/tereby certi under the pains andpenalties ofperjury that the information provided above' true nd correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S.'Plumbing Inspector 6. Other Contact Person: Phone#: Olal>dfi 5042E CAW 0010WftfM SOUTNE911 ACORN, CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE Is MINED AS A MATTER OF INFORMATION ONLY AND COWMW NO Ri>MM UPON THE ceRTIFICATE NOLML 7M CERTFICATE DOES NOT AFFIRMATIVELY OR NEGAITIMLY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLKWI BELOW.THM CERTIFICATE OF INSURANCE DOES NOT CONSTTIVrE A CONTRACT BETWEEN THE[DING IN8URER(S?.AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLD6t. N�BROOATpN IS WAIVED,auNjed to 11!'ORTANT:If the RI hoidsr ADDITIONAL WBURED, an sndomment A statsmsnt on this csrWasta doss not toff sr AQMs to the the grins and condMloes of the�►.Ca ce h�kh pogclas may nt�irs aswdlioats holder in Hsu of such w WoatsnNTat(s PROOIJBER 1 Anth LilUe WBHts of Nw%lemy,I= U6 9144M Inn.,wm4.1881 1015 BrIM Road,PO Sox S atnita<I 1118•COM PO Box 5005 A"WWOW COVERAGE HMO Mount Lauf@,NJ'08054 slate A•Setead"Insumnm Co Of the 8 3112$ shnlaEhes Aa�ponaut lnsarattce Co. 18801 Soulhsrn Now E4antd WUdom LLC swl�c:Bwcon Muttiat Itls.Co. 24Q1T DNA Raute"by Andalfsm r�aleto 26 Albion Road slsKamE Lincoln,RI 02865- saanshat , COVERAGES CERTIFICATE NUMBER: REVMIO NUMBER: THIS IS TO CERTIf Y MT THE POWES OF INSURANCE.LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABM FOR THE POLICY PBt10D INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY COIhRACT OR OTHER DOCUMENT WITH RESPECT TO W 141CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE *MPANCE AFFORDED 13Y THE POLICES DESCRIBED)IEREIN IS SUBJECT TO ALL THE TERMS' EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS, TMM OP I+a1JRAHM POLJCYmUII=h 1111La017 A aealeu►LtlAanaTY 8202945900 w.fti1061101301 EACHOCCURREMCE s1 $100 0)0 i 10 000 mm%I.MAK X11 oocurt E PetSONAL i AOV INA1RY 4 000 GEIEFK AGOROOATE s3,000M � •` 'PROFx1CT8.00N�A0►AG6 i3900 OM AGOMIATE UMIT AMNS PW- I : p EweD mr tx 5202945900 012W 3 08M0/201 4 0 000 • DODLY tN.A1RY(PR Pam) i SOD�Y IN AAlRN(Per scdON� i "GINNED 110AUTO SCHEDULED ' PROPERTY OAaAAflE i X All A ° OCCUR 8202045M , 0121H3 08MOM EP.CM C AGGREGATE i5 000 wOR1400wreuATION ;000weem-RI , t=3 08/21/201 X vMCsTATLL VA OTM Ow C AIomPLOMehsuAesmr vaa B erA �AIC927M83m384 71=3 08121/201 E.I..EAC►�ACCIDEIaT i1006 N 1 DEL DISEASE rA mpLaym 61000 Q00 pir�.cwytaaHl D ��OPERATlaiB bolcw t E.L.OLREASE•POUCYUMIT i1 090 p�TIOM OP CPERA1tOMS J LOCATlOaa IVY tAh�ACC 10h,Adi19aM Ibn�wk�OaRMM E- sp�e�b�quk�d) • i $pt>them WE LLC MIOULD ANY OF THE ABOVE DEMMED POUCE A3 BE C "U"BEFORE THE EXPIRATION DATE 7HOWN, NOTICE WILL BE DELIVERED N 26 Albion Rand ACCORDANCE WITH THE POLICY PROYOMM. Lincoln,RI 02865 AIlThpRfi®RElMRa{HNTATNE t • ®19a ,M# CORPORATION.Ap tlaftbs rasaTYed• ACORD 25(2010" 1 of 1 Ths ACORD atshns and hW we ahgktw*d maTlls of ACORD AXL a 18215109IMZ15088 a f t, i 1 I � r r 1 . .16 of � AA i E �i T S t Town of Barnstable Permi o ., Regulatory Services ate: 6 1 of THE rOky Thomas F. Geiler, Director Building Division ` BARNSTAELF, Tom Perry, Building Commissioner 9. a�� 200 Main Street, Hyannis, MA 02601 www.town.ba rnstable.ma.us Office: 508-862AO38 TOWN OF BARNSTABLE Fax: 508-790-6230 SOLID FUEL ST 'VE PERMIT -77 Owner: 020, it/ Phone: Install at: . 1..• Village:�,�'2�i DES ,!.(�LL.S Map/Parcel: J(�,� Date: , Stove A.O/ Used B. Type: Radi t/Circulating C: Manufacturer: ,y' Lab. No. O L D. Model No.: Chimney A. New Exist'' (If existing, please note date of last'cleaning) = a o B. Flue-Size C. Are other appliances attached to Flue? ;.y CDP D. Pre-fa b Type and Manufacturer. Xl�A _-- c� E. Masonry: t/ ine alinedUj " Hearth �- cam, A. Materials: B. Sub Floor Construction: 4,9002 ` NJ ` Installer Name. r—i C�F� i`lcCif .� Address: Phone: O- Xo S94ck'a � Location of Installation: ✓e. gv2 H.I.0 Registration# 1 QO c'��• 3/ d�q. �s 1 R - �t Construction Supervisor# C-S p j8-S7 t- , OR check_HomeownerCS Lstalli g, I'cense required: APPLICANTS S7 ATURE-, _APPROVED BY: Please make checks payable to the Town o Barnsiable *This constitutes an.official stove permit after inspection, photographed, and approved by the Building Inspector. e7/;, laf Mass7,cnusetts : Department of Public Safety Office ofConsumer Affairs&Business Regulation Boara of Building Regulations and Standards ii-2 HOME IMPROVEMENT CONTRACTOR Construction Supervis(or I & 2 Family VRegistration: '120859 type: 57 License: CSFA-0585 Expiration: 3/12/2014 Private Corporatior SAN66CH CHIMNEY SWEEP,,INC. KEIT[l A CLIFF PO BOX 90 KEITH CLIFF SANDWICH MA702561 28 EMERALD WAY'.. FORESTDALE, MA 02644 L-Apiration Undersecretary Commissioner 02/2712015 COMMONWEALTH OF MASSACHUSETTS'" -SHEET METAL WORKERS 04 C/) AS A MASTER-UNRESTRICTED� ISSUES THE ABOVE LICENSE TO:' LLW� > ;=Z:E T K E J TH...A CLIFF cc _E '0 & EMERALD WAY U) ...... FORESTPA L E MA 026 4-1 .5 30'.'. CU C/) 02/28/15 1-088 . 30094: Licen'se or registration valid for individul use only Restricted -One- and two-family dwellings or any before the expiration date. If found return to: accessory building thereto, irrespective of size. Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of the Massachusetts Not v thout signature State Building Code is cause for revocation of this license. li'� For DIPS Licensing information visit: www.Mass.Gov/DPS m CONTROL a'. 5.-q # H575047 ,2on° n g C) IMPORTANT 3If this license is lost or destroyed, notify your Board at the: 1 CA ag Division of Professional Licensure, 1000 Washington St., 1.71 RAI 5'. Suite 710,Boston,MA 02118-6100. -'.; 0 g i;i; ;; if your name or address shown is changed, notify your board 2 - E� 5- Sw - 2-g.6 of correct name or address to insure proper mailing of next e ;:g-� 0 Renewal Application. Always refer to your license number. Ty.A -E 0 4 o g. z�aa M This license is subject to the provisions of the General Laws as amended. It is a personal privilege,and must not be loaned or assigned to any other person. Keep this license on your a g person or posted as required by law. I ACO i DATE(MM/DDIYYYY( � CERTIFICATE OF LIABILITY INSURANCE 09/20/2013 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 CONTAC Laura J Murphy HART INSURANCE AGENCY, INC. 243 MAIN STREET PHONE , (508)759-7326 ac No:(508)759 7366 PO BOX 700 AIL ADDRESS: Imurphy@hartinsuranceagency.com BUZZARDS BAY,MA 025320700 INSURERS AFFORDING COVERAGE NAIC# INSURER A: MAX SPECIALTY INSURANCE 20079 INSURED Sandwich Chimney Sweep INSURER B: ATLANTIC CHARTER INSURANCE COMPANY 44326 PO Box 90 Sandwich,MA 02563 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY) (MMIDDfYYYY1 LIMITS A GENERAL LIABILITY MAX013100005253 10/09/2012 10/09/2013 EACH OCCURRENCE $ 1,000,000 C DAMAGE TO RENTED OM PREMISES GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS-MADE ©OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ P 1 1 AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WCV01032500 08/28/2013 08/28/2014 wC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 :EE DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required( Operations as performed by Terms&Conditions in the policy. Re: Norman Lipner CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIV ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth.ofMassachusetts . Department oflndustridZXccidents Office of Invesggations ' 600 Washington Street Boston,AL4 02111, Vwv o.mass.gov/did Workers'Compensation Insurance Affidavit: Builders/•Contractors/Electricians/Plnmbers Applicant Information Please Print Legibly Name C[3usiness/Organi72tion/Indi7idual): . •Address: City/State/Zip: 5;44dwJ/,4 k'04 OjqS-,�3 Phone.#: Axe you an employer? Check the a propriate.box :Type of project(required): 1,�I am a employex with 4. [] I am a general contractor and I employees (full and/or part tune).* have hired the stab-contractors 6. ❑New construction . 2.0 I am a'sole proprietor or paibaer- ' listed on the'attached sheet 7. ❑Remodeling ship and have no.employees These sub-contractors have 8. Demolition 'i7orldng for me in any capacity, employees and have workers' $ 9, ❑Building addition [No workers' comp,comp.iDseiance insurance, required] 5. [] We are a corporation and its 10,❑Blectrical repairs or additions Officers have exercised their ,3.❑ I am a homeowner doing all work . 11.❑Ph�bmg repairs or additions myself [No workers'comp, right of exemption per MGL 12,Q Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.1,;A-Dther W64J sy',)ve comp, inama„ce reqiL�red.] *Any applicant that cheeks box#1 must also fill oat the section below showing their workers'compensation poEcyinfmmatioa. t E3omcowners,wbo submit this atfdavit indicating they are doing an work and al=hire outside contractors must submit a new af5davit indicating such tContracton that check this box must attached an additional sheet showing the name of the tub-contractors acid state whether arnotthose entities have en-iployees. If the sub-contractors have employers,fbeynmst pruyidh their workers'comp,policy number, : I am an employer that is providing workers'compensation insurance far my employees. Below is.ihepalicy andjob site' information. Insurance CompanyNate:�v►/ Policy#or Self-ins. I ic.R �S O/() 3 7(,� Expiation Date: g- .-,;?D/q 7ob.5ite Address: L2 /.�1�7 P� 1�fJ�WAy ''ICI City/Statr0p:M,(LlI Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure,to secure coverage as.required ender Section 25A of MGL e, 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisoranent, as well as civil penalties in the form of a.STOP WORg;ORDER and a tine of up to$250:00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the-Office of Icyestigations of the DIA for inc,rraTit a coverage verification. ' I do hereby cerr and t a' 7E'�W alties ofpe)jury th the viformadonprgvided above i true and correct;.Si hire: ^ t I'm -/ Phone# Official use only. Da not write in this area, fa be completed by,city or torn official City or Town: Yermit/License# Issuing Authority(circle one): A.Board of Health 2.Buildinp-Denartnaent 3- n'tv/Tntvn r qap lr d Win +,.;—I T. .,., - } � E r � Town of Barnstable Regulatory Services •. BARNSrasi.s, + 9 Mass. g Thomas F.Geiler,Director 1639• �0 'O�Fn �A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, /V 4��"q ���e� , as Owner of the subject J . property hereby authorize to act on my behalf, in all matters relative to work.authorized by this building permit. (Address of Job) 104Y�P 7PiV5 /0,�, t **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. I Signs e of Owne Signature of Applicant A/72�'I 't/ 4 PyG2 Print Name Print Name Date Q:FORMS DA NERPERMISSIONPOOLS 6/2012 �oCI Teti Town of Barnstable �l n Regulatory Services 1 S Caz/ a r aARtvsTnst,E, : Thomas F.Geiler,Director MASS. i639• ,•0� Building Division lED MA'l i Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department ,minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such. work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the 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 forn/certification for use in your community. Q:forms:homeexempt i Town of Barnstable *Permit#,,007o0?Y1 . Expires 6 months from issue date Regulatory Services Fee ,6 1 X®il"" ESS PERMIT Thomas F.Geiler,Director MAY 1 2007 Building Division Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 O�f EXPRESS PERMIT APPLICATION - RESIDENTIAL ONTLY 11rot Valid without Red X-Press Imprint �Y p/parcel Number ,petty Address �i 0 mer's Name&Address Ajd VAd P w L I ,e.4vv /P mtractor's Name S �� Telephone-NTumber Me Improvement Contractor License#(if applicable) 94 � 'sot'rL�enSe T{�applieable-) .. ]Workman's Co nation Insurance. one: I am a sole proprietor ❑ I am the Homeo-,A'ner ❑ -I have Worker's Compensation Insurance surance Company Name 7—V?&in'L,:S; orkman's Comp_Policy 7 E=ZA opy of Insurance Compliance Certificate must be on file. srmit Request(check box) �e_Toofping old shingles) All construction debris)7.0 be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) 'Where required: Issuance o;this permit does not exempt compliance with other town departmentregulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission.- of t, o Improvement Contractors License is required. (GNATURE: Forvu:expmtrg :vise061306 ACORL/ CERTIFICATE OF LIABILITY INSURANCE DA4E WWDDIYYYY) 04/09/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SCHLBGm INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 34 MAIN ST HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WEST. YRF440MR, MA 02673 INSURERS AFFORDING COVERAGE NAICa# INSURED INSURER A:NORTillikND INSURANCE Paul Buckmill®S INsuRER a TRAVELERS DBA BUCMaLLER ROOFING INSURER C: INSURER a Hyannis, MA 02 601 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER EFFECTA/E POUATE EEPHtAT10N LTR INSRD TYPE OF INSURANCE POLICY DATE UMITTB A GENERALLIABBITY CP46859503 05/15/2006 05/25/2007 EACH OCCURRENCE S1,000,000 R COMMERCIAL GENERAL LJABILTTY PRFIJDSES(FA omrenae) $50,000 PERSONAL BADVMAY $1,000,000 GENERAL AGGREGATE s2,000,000 GEATL AGGREGATE LIW APPLIES PER PRODUCTS-COMPIOP AGG , s 2,000,000 POLICY ACT El LOC AUTWAOBI E LIABILITY COMBINED SINGLE LIMIT 8 ' ANY AUTO me aowelyD ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS I1w Pemw) HIRED AUTOS BODILY IWURY $ NON-OWNED AUTOS ewttenp PROPERTY DAMAGE S (Per ewoam) GARAGE LIABBJTY AUTO ONLY-EA ACCIDENT S ANY AUTO EA ACC S OTHER THAN AUTO ONLY: AGG $ EXCEGRAMORELLA UABIUTY EACH OCCURRENCE S OCCUR ❑CLAIMS MADE AGGREGATE S ffi BLE S RETENTION S S i WDRIERBcoMPENBATIDNAND 7PJUB-743OA7-06 04/11/2007 04/11/2008 T 'STAATS ER B EMDLOYERS'LIABILITY E.L.EACH ACCIDENT 3100,000 ANY PROPRIETORIPARTNERIE)ECVTIVE OFHCERIMET+tBEREXCLUDED7 E.L-DtSEASE-EXEMPCOYEE" 'TD000D.�__ -.- - SPECIAL PROVISIONS pelow-7FE$' - E.L.DISEASE-POLICY LIMIT ls500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPE•CY1L PROVISIONS PAUL BUCKMLLER IS ELUDED FROM HIS WORKERS COHMSATION :ERTIFWATE HOLDER CANCELLATION "OBEY S COREY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E7(PIRATION 1694 FALM07TH RD DATE THEREOF, THE ISSUING INSURER WILL DmEAvoN To MAIL 21 DAYS WRITTEN MRITERVILLE, MA 02632 NonCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO BO SHALL IMPOSE NO OBLIGATION OR LNBILITY OF UPON THE INSURER, ITS AGENTS OR _ REPRESENTA AUTIIORQED REPRES � !aj sCORD 251200IMS) 0)ACORD CORPORATION 9988 i ,au ro e�`st<at:o aa�ea l��S a�aov Stia da�as �ieeosetbe x��tatioReg�au,3pv p beto�e o(Bxlx1a�YXaeeRm • L°� ,`�ndards . $oa'�d sbbo�p°�pg • a�a S re A a OZ C o R a`a�lons N-toG�pR r4 Boar)o` 4R�O..v,��� NOM�� t`036120 8 a��a`a�tboat5�g� '°'� Y10M w��. f � •Seca GpFt LES GOR GNPR �MOU�N Pp2632 AGB�vkq\ �� M 'r A REY The-e- Roof-ers Roof E* ms Cape Cod Sim ce 197 0 1694 Falmouth Rd. #115, Centerville, MA 02632 PHONE q775 -8,240 C ERTAI N-TEE D LANDMARKWOODSCAPE PREWUM ARCHITECTURAL STYLE RE - ROOFING, PROPOSAL April 24, 2007 NORMAN LIPNER 17 THATCHER HOLWAY ROAD Phone: 1-774-238-1862 Cell MARSTONS YALLS,MA 02649 Phone: 1-'508420-4524 Home CORE' & COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturers specifications and local building codes. .Remove and Haul Away All of the Old Asphalt Roofing Shingles Remove the Two Small Vents and Fill in the Openings E-Z Plugs. Remove and Re-Install the Collapsible Awning on the Rear of the House. Supply and Install CERTAINTEED LANDMARK PREMIUM: LIFETIME WARRANTY 15 YEAR SURE START PROTECTION, CLASS A FIRE RATED, 15 YEAR STREAK FIGHTER WARRANTY-ALGAE RESISTANT, 300 POUND EXTRA HEAVY WEIGHT, SELF-SEALING, 110 MPH WIND WARRANTY, CATEGORY H HURRICANE, STORM/HURICANE NAILED (6 NAILS PER SHINGLE),, MULTI-LAYERED, ARCHITECTURAL STYLE LAMINATED, FIBERGLASS BASED ASPHALT SHINGLE with New England's exclusive COPPER/CERkMIC STONES with a FULL 10 YEAR WARRANTY AGAINST ALG CONTAMINENT COLOR: ko/V77tv ok4 V Supply and Install SMART SOFFIT VENT SYSTEM on All of the House & Garage Eaves. http://www.dcipToducts.com/htnil/smartvent.htm Supply and Install CERTAINTEED WINTER-GUARD (lee & Water Shield ) WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves, Valleys & Under the Flashing on the Chimney. Supply and Install CERTAINTEED ROOFERS SELECT UNDER-LAYMENT Supply and Install AIR VENT SEIENTGLE VENT H RIDGE VENT on the Three Main Ridges. Supply and Install COPPER& NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. i TOTAL INVESTMENT --- $ 139450.00 Payable immediately upon completion. POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of S 60.00 per Hour. PAYMENT SCHEDULE: A Deposit of One Ralf is due at the Signing of this Roof ProposaYaid the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 30 Days of Acceptance and Receipt of Deposit providing the Materials are Available. Please Make Checks Payable to: CO SY & COREY Warranties the Shingles and Labor for 10 years. As we are a CERTIFIED CER'TAIN'TEED SHINGLE MASTER COMPANY we will do the necessary paperwork to extend the SURE START WARRANTY which cover Materials, Removal & ;installation and Disposal 100% for 50 Years FREE OF CHARGE to you on the CERTAiINTEED LAND-TVIARKWOOIDSCAPE SINGLES. CERTAIN TEED Warrants the Shingles up 11 to a 110 i' 'PH WIND WARRANTY ( CATEGORY 2 HURRICANE) . . CERTA*,L TEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. Any alteration or deviation from above specifications,will be executed only upon written orders and will become an extra charge, over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado,and other necessary insurance upon the above work.. This proposal may be withdrawn by us if not accepted within thirty days. COREY & COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: ACCEPTED BY: SUBMITTED BY: 2- .4�f� N0RAT 1 tR C HA RL E, ORE HOMEOWNER C0 Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' 'r w>ow.mass.gov/dia ' Workers -Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information .Please Print Legibly Name(Business/Organizationadividual): Address:-� !041ro�x1 City/State/Zip: l .a-+A vtJi 140 Phone.#: 7 Are you an employer?Check the appropriate bog: :Type of project(required):. 4. am a general contractor and I 1.❑ I am a employer with 6. ❑New construction . employees(full and/or part-time).* • have hired the sub-contractors listed on the*.attached sheet. 7. ❑Remodeling 2.❑ I am a•sole proprietor or partner- These sub-contractors have g, ❑Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. ❑Building addition ' insurance comp.insurance. ' [No workers comp. 10.❑Electncal reports or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work . officers have exercised their 11.❑Plumbing repairs or additions ' Lmyself.[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 anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub contractors and state whether or not those entities have employees• if the sub-contractors hale employees,they must provide their workers'comp.policy number. I a an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site. nt information. / Insurance Company Name: LAO Policy#or Self-ins.Lic.#: `1 2P YAWA 7 7,& Expiration Date: Job Site Address: /ALP' 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 the violator. Be advised that a copy-of this statement maybe forwarded to the Office of of up to$250.00 a day against Investi ations of the bIA for insurance coverage verification. Ido hereby certify e hepains•andpenalties ofperjury that the information provided above is true and correct.Si tune. D at Phone#: Offccial use only. Do not write in this area, tb.be completed by.city or town official City or Town: ' ,Permit/License# Issuing Authority(circle one): A.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and instructions Massachusetts General Laws chapter 152'requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hiie, 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." IvMGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced,acceptable evidence of compliance with the insurance coverage required." AdditionaIly,MGL ehapter.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 evidenee-ofto4l!a*withtlie insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-conf actors)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 Towli 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/liceuse 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 Colx onwWth of Mmarhusptts Dgnrtmi ent of IndusWal Aeoxdmts Offt"of fanw uous o 600 Washington,Street Boaton,_MA€12111 . Td.#617.727 4000 ext 40,6 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22:06 w .massmgov/dia 1 , ' Assessor's map and lot number .... .. n.....lZ....... .. ... 0K ;�,?>A- �o�r� � THE F Toy♦ !,,(—Sewage . ..: ..... Permit number .................. .:............................. BAEB9TABLE, $ v�F House number .......................... , ........................................ a. qoo M I 6 d ON a` TOWN OF BARNSTABLE DUILDIN=G l INSPECTOR u��.� Soa�-cf, �1 ►�r� 7f �' ��- APPLICATION FOR PERMIT TO -:.f.����...........:.......:.. TYPE OF CONSTRUCTION a4 :'.C:°.:.. .........r�A.�i 1 ........................................................... ..............................8 l...........19.� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Locations'hatcher..HollwaY...�?o ....................................Lot..#...1:1........................ 11......................................................... Proposed Use .....Aa nq!e azga y cicve�] �xg.......................................................................................:............................... .......... ........... Fire District ' Zoning District . �,.� `::.......................................................... Name of Owner ...Hil.da Tra.frnx�......................................Address ):al;mcanth,,,J,P,nv—.V maaan Name of Builder*gPntg ►taaxar,Y CAn.,5tnAgtjc n..C-g,,..TA,ddress ROXAM ............... Name of Architect Dona. mew-m nx , � ;ra,_ x� . ........ :.:...:..........................................AddressP... ..... ............. ....,....!�m�„t;t,.;..M�.:...0.?65A.............. Number of Rooms ....6............................................................Foundation .von ne.r..3..CO.rxmet e........................................... Exterior } verse Board & Batten....................... ,,..Roofing ........,Red„Cedar ......................... ............................................................. Floors ` k Oak & C Interior ...blueboa.rd ............................................................ ............... . Heatingro' .........e......+°:...9 ... ".........:.................Plumbing,........... ...:: . Dry: ....................................... P' Fireplace ..YP�%.... ......................................Approximate Cost .........SPQ,,,,SPAAQQ.Ap...................................... Definitive Plan Approved by Planning Board Mu___��__--------1924. Area Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH o • i OCCUPANCY 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 .. ... ...... Le TRAFTON, HILDA A=123-31 No24.2...67.. Permit for 3,2 Story ..... .... ................................. Single ............ .............. ...... . ..... Location Lot #13 17 Thatcher Halway Rd. ................................................................ Marstons Mills ................................................................................ Owner ..,Hilda Trafton .............................................................. Type of Constru&ion ......Frame ......................... .. ....... ................................................................................ Plot ............................ Lot ................................ Permit Granted ........Au.gus.t...5, 19 82 ..... ....... .. Date of Inspection ......................................19 Date Completed ......................................J9 o 4py s11104 kio Assessor's map and.lot number .... ....................................... CF T"E ro ' Q Sewage•-Permit num ...................... Z 33AR3STADLE, i House number y..................................... a ......... :.... ro 1639- TOWN OF BARNSTABLE BUILDING INSPECTOR �� APPLICATION FOR PERMIT TO ..........! tA... � ..�........./.`:;?. �'� .,. �........�..................: TYPE OF. CONSTRUCTION .... C-�e D. ?'... :!�?... ��....................................................................:........ r a�lA,.......... .:.............,9.R.Y TO THE INSPECTOR OF BUILDINGS: The, undersigned hereby applies for a permit according to�the/. following information: Location ................................. Proposed Use .. / /.. ............ Zoning District .../577 ......................................................Fire District ....... Name of Owner 1*5� ..XlZer 'elx......A el..........Address ......�i9 / .../S'��'.........! S.......................... Name of Builder .../....t.eel :.. I:........ .. ../../x-iri Y.4' Address ....I/ZIY .../.�Xrof/' Ir Name of Architect ............... ..........:................Address /C 1/7 Numberof Rooms ..................................................................Foundation ....,..................... a......... ./............. ...N.....,.......... Exterior ..... P ..........5 � Roofing l� .........C?..e!S ..... s ! Z. Floors .... .....o...... ....................................... Interior ............................:.............. / P'. ................... ^y t Heating .............. ....Ot/2..................:...................................Plumbing ............��WM.. ..............................:...................,. f / o Fireplace ........... ............./(/p!t/Q.....................................:....Approximate. Cost............ ...I GQ.......... n . ► , - ........... �o s. Definitive Plan Approved by Planning Board ____________________________19_______ Area ...........Q..��.............. ' Diagram of Lot and Building with Dimensions Fee / SUBJECT.TO APPROVAL OF BOARD OF HEALTH Y� b � ? I �f { OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS i hereby agree 'to conform to all the R u I Is and Regulations of the Town of Barnstable regarding the above construction. 4 y Name` ......a..... .... i 9� -C f ........ Construction Supervisor's License d . TRAFTON, HILDA A=123-31 No ,26473.... Permit for Accesso Location 17 Thatch?r..HA�. ay...�aad........... ..........:.................. Owner Hilda. 'rafQxl.................................... Type of Construction ...Fxame...............::.......... ....................._..................................... _ ....... . ..... I Plot ............................ Lot ................................ ,., Permit Granted ............ May .22.....,................. ......19 84 Date of Inspection .....19 Date Completed .......................................19• 0 z-- Assessor's map and lot number .... SEPTIC SYSTEM MUST B THE INSTALLED IN COMPLIANC WITH TITLE 5 Sewage Permit numb& .....................: ENVIRONMENTAL CODE A 33AMMILBLE, MU& House number. ............1.. .................................................... TOWN REGULATIM111S) 039. a MPR TOWN OF BARNSTABLE BUILDING 1'.NSPECTOR APPLICATION FOR PERMIT TO ......... Ra.. ...........6egce -11471a-rc........................................ TYPEOF CONSTRUCTION ..........0 ........................................................................... ..........?-.7................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......11o,4 4.! 5................................... ProposedUse ....... ................................................................................................................................. -A' Zoning District .../51=,1C .....................................................Fire District K.e..e.I.W4 . ............. ................ Name of Owner ..........Address ...............r .............................. Name of Builder ...cla7-?v--.0....... /VA . .......el.*r.. _6ddress ....4� 100'a /r Nameof Architect .................................................... ...Address ........................... ................ Number of Rooms ...................e�...... . .... .................Foundation .......6F........ . . .......... Exterior ..... .......... ......Roofing.......................... ......cl-,'..ee`.��..evk 57G1C Floors .... ............... ...................................Interior ........................................... Heating ...................941.e.....................................................Plumbing ............... .................................................... ................... . ....... Fireplace .............. ...........W:mg...........................................Approximate Cost ........ ................. Definitive Plan Approved by Planning Board -------------- --—----------- p Area ... ............................ Diagram of Lot and Building with Dimensions Fee ...';........./............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH ,e S II 17 - 69 IN, OCCUPANCY PERMITS REQUIRED FOR NE DWELLINGS I Hereby agree to conform to all the Ru 12 s and Regulations of the Town of Barnsta le regarding the above construction. Qz� Name r44A .. ........ eZr Construction Supervisor's License .....d374- 4... TRAEMN, HILDA No .44D.... Permit for JM..G...... . .....USE... Accesso..Y..tq.T:N e11 g......................... Location ......1.7.. ..Road....... ..................... ........................... Owner ....Ui!a,-A..ar.QLf Qr1................................. Type of Construction Fraim............................. ................................................................................ Plot ............................ Lot ................................ Permit Granted ..... ....................19 84 Date of Inspection ....................................19 Date Completed ..... ........19 ...............