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0106 TUPELO ROAD
Tz4 'Pd i A . " AFFORDABLE BUILDING 3 WEATHERIZATION 330 Victor Road Attleboro, MA 02703 June 13 , 2019 Dear Jeff Carter The permit # ;IR17-2230 Job Site 106 Tupelo Rd. , Marstons Mills, Ma. 02648 The insulation job was completed to Mass Building Codes standards . If you have any questions please don' t hesitate to call me Todd Leduc Affordable Building & Weatherization 401-965-8578 Town of Barnstable Building , ��,�� ` Post This�CWard.So�Tha> t'3is Visible From�the;�Stceet-Approved`Plans Must be Retained on�Job�and this Card Must.be Kept M"� � Posted�ntil Fuial°Inspection Has Been IVlade � ^, x` .�� W.here.a'Certificate'pf Occupancy�s Required,,such Building shall Not�be Occupied'until a Finah Inspection has been made. ..- Permit Permit NO. B-18-1225 Applicant Name: LUX RENOVATIONS, LLC. Approvals Date Issued: 05/16/2018 Current,Use: _ Structure Permit Type: Building--Alteration INTERIOR Work Only Expiration Date: 11/16/2018 Foundation: Residential Map/Lot: 057-104 Zoning District RF Sheathing: Location: 106 TUPELO ROAD,MARSTONS MILLS ContactorNames EDWARD T ALLEN Framing: 1 Owner on Record: SHARMA,RAJEEV&KAYLA A. Contractor License:'CS-075131 2 IM Address: 106 TUPELO ROAD p.. . . Est Project Cost: $32,600.00 Chimney: MARSTONS MILLS, MA 02648 � PermFee: $216.26 Insulation, Description: finish portion of basement to be used as family room using Owens sue ` Corning basement finishing systems, Fee Paid; $216.26 ate:F 5/16/2018 Final: roject Review Req: R 19 must be present between conditioned)and ' /conditioned space Plumbing/Gas Rough Plumbing: _ Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work a uthonzed by Phis permit is commenced within sixes A 11 after issuance. Rough Gas: All work authorized by this permit shalt conform to the approved application anii the approved construction documents�for whicF this permit has been granted. * Final Gas: All construction,alterations and changes of use of any building and structuresishalFbe in compliance with the local zoning.;by laws and codes. This permit shall be displayed in a location clearly visible from access street or roadand shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical . > � Service:, The Certificate of Occupancy will not be issued until all applicable signatures by�th�Bwlding�and Fire Off�eials are provgtded�on tFiis permit.. = Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing ° -q_ Rough: 2.Sheathing Inspection - 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.. Work shall not proceed until the Inspector has approved the various stages of construction. Final: —.r "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Perrriit Cards are the property of the APPLICANT—ISSUED RECIPIENT f OFF Application Number..- ..... PmnitFee.......... ........................i�R TOWN OF BA mTABLE Total F=Paid............... ........................................ .. ... ...... to) F, ) 9 e -"W Pm 3.. P=mft A;WDVa.Vby- .................On.., TOWN OF BARNSTABLE - 1)1-�) ........t().,(.................... . . .......................PM=L.. ....... WELDING PERMIT MVISION m-P................. APPLICATION Section 1 owner's information and Project Location -------------- ------ Vffiag Project Address Owners Nam Owners Legal Address !2&�4j State Zip 0 C, E-mail Owners cell#703 4,')3 JT I S'O 'Section 2—JrJJse of Structure- Use Grou E] Commercial structure over 35,000 cubic feet p E]❑ Commercial Structure under 35,000 cubic feet esingie/Two Family Dwelling Section 3 —Type of Permit ❑ FI Move/Relocate n Accessory Structure El Change Of Use New ❑Construction IN ,F] .Finish Basement El Family/ArunestY El Fire Alarm El Demo/(entire structure) D Sprinkler System Rebuild El',Deck Apartment Iffition. ❑ Retaining wall FJ Solar Renovation 11 Pool F1 Insulation Other—Spec Work Description Specify Section -�Wor�kDes�cri T act Tmd;de.&-2/9/2018 Air Application Number............................................... 1 r Section 5—Detail y Cost of Proposed Construction 32,(poc3 Square Footage of Project Age of Structure Dig Safe Number #Of Bedrooms Existing ' Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist WFCM Checklist Design Section 6—Project Specifics [] Wiring ❑ Oil Tank Storage ❑.Smoke Detectors} ❑ Plumbing ❑ Gas [] Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom j i Water Supply ZPublic . ❑ Private , fig Sewage Disposal Municipal Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway { Debris Disposal Facility: Om � I am using a crane ❑ Yes 90No Section 7—Flood Zone i Flood Zone Designation Within or adjacent to a , etland, coastal bank? Yes ❑ No { Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. . 1 Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last undated 2/9/201 S ! y . Application Number.............................. Section 9—.Construction Supervisor Telephone Number�'77�� Q Q 7 Address 6o .r+r k'L City &Z State 971d,., Zip ®� i License Number_07<Zi.3 t License Type Lr Expiration Date I l Contractors Email_A '�ra,p iz)es) QA11 � - cl., Cell# I understandd my responsibilities under the rules and regulations forLicensed 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.Attach a copy of your license. Signature Date Section-10—Home Improvement Contractor Name';I� Telephone Number(774A .4 9 7 Addres RACity ( ,. State Ige- Zip e aQ al Registration Number 13 2 Expiration Date I q I understand my responsibilities under the rules and regulations for Home Improvement Contractors 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.Attach a copy of your H.LC... Si tore ! j !� Date�l��`i� Section 11 —Home Owners License Exemption Home Owners 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 unlderstaud the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date k �f Print Name W.�( ,�(��, Telephone Numbel��7y, q q 3 n6� 7 E-mail permit to: sa.mm1,jnjo Section 12—Department Sign-Offs Health Department ® Zoning Board(if required) ❑ i-iistoric District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ to the fore department for approval For commercial work,please take your Plans directly j .. Section 13—Owner's Authorization I, as Owner of the'subject property hereby to act on my behalf; in all authorize matters relative to work authorized by this building permit application for: 1 (Address of job) date Signature of Owner " • ' . Print Name I • Last undated:2192018 i ME ME NMI 0 M IN d� ww t 10C �� Office of Consumer Affairs and Business Regulation. 10 Park Plaza - Suite 5170 Boston, Mq�p'c usetts 02116 Home Improve me�intractor Registration Type: Supplement Card LUX RENOVATIONS, LLC. .4 Y Registration: 037943 Expiration: 2/04/2019 60 Shawmut Rd Canton, MA 02021 w SCA1 20M-OS/it Update Address and return card. Mark reason for change. ii ❑ A3 v s fi:Fenewal ❑ Employment u•Lt 5.-Card -,,, �e cpommaizcae�o�C�uc�Cuaeltb ' Office of ConsumerAffairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only f ."-'TYPE:Supplement Card before the expiration date. If found return to: stration Expiration Office of Consumer Affairs and Business Regulation 02J04/2019 10 Park Plaza-'Suite 5170 Boston,'MA 02116 LUX REN0 VAT I U160 DB/A Owens C� M nt Finishing Systems EDWARD ALLEt�^�� 60 Shawmut Rd Canton,MA 02021 Undersecretary Not valid without Signature Massachusetts Department of Public Safety , Board of Building Regulations and Standards License: CS-075131 Construction Supervisor EDWARD T ALLEN 3 Iry 30 STORMY HILL DEDHAM MA 02026 • ;: 'Expiration: 1/Commissioner 02/27/2019 f Department of IndustHalAccidents Office of Investigations _ 600 Washington Street - Boston,MA 02111 TV".mass.gov/dia Workers' Compensation Inslaance Affidavit Builders/Contractors/Electricians/Plmnbers Applicant Information ..��L Please PrintLe�ib ly Name(Business/0rganizaEmvTodM&aI):e, ,,e A-�.er_ Address: A4..� City/State/Zip: Phone#: 77y 913 16 U 7 Are you an employer?Check the appropriate box: 'Type of projeef(required): 1._EffI am a employer•with 4. ❑I am a general contractor and I 6. ❑New cons rwtim employs(fall and/or part-time).* have hired the suh-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building admen [No workers'comp.insurance comp.insurance.$ required.] 5• El We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Phmibing repairs or additions myself[No workers'comp. right of exemption per MGL 12❑Roofrepai s ins=ce requ-iYed t c. 152, §1(4),and we have no ] employees.[No workers' 13.❑Other comp.insurance regtm ed] *Any appUcant that checks box 91 mast also fiil out the section below showing their workers'compensation policy information. l t Homeowners who submit Ibis affidavit indicating they are doing all work and then hire outside confractors roust submit a new affidavit indicating such. �Contraetors that check this boxmust attached an additional sheet showing the name of the sub-contractors and state Whether or not those entities have employees. if the sub-contractnrs have employees,they must provide their workers'Comp,policy number. . Jam an employer that is praviding workers'compensation insurance far my enTloyees. Below is the policy anal job site information. Insurance Company Name: Policy#or Self-ins.Lic. Expiration Date: 1 � 1�� Job Site Address: &O(v � _�P 174& Cty/Statn/ZaP: IU 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$I,500.00 and/or one-year imprisomnrnt,as well as civil penalties m.the form of a STOP WORK ORDER and a fine of up to$250,00 a.day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c rrd)i under thepa*ts and penalties of perjury that the information provided abojve is true and correct. Sitmat re Qj6y,,� Date: 4,3!ESr Phone t official use only. Do not write to this area,to be cotqleted by city or town offwial City or Town: Pertaiaicense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3. City/Towa Clerk 4.EIectrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: TOWN OF BARNSTABLE PERNUT CHECKLIST Sign. off hours for Health and Conservation are 8-9:30 am. and 3:30A.30 p.m, A cam kta permit gppkafion inclades,/illing all sech'ans.1-13 1. NEW STRUCTURES/REMODELING/RENOVATION/ADDITIONS ❑ Site Plan showing setbacks of proposed and existing structures ❑ Commercial—One complete set of full sized plans one reduced 11"xl7" (plans may require a stamp by an architect or engineer). El Residential-4 Sets of floor plans no larger than I1"x 17"smoke/co detectors marked ❑ Worker's Comp. Affidavit and policy(if required) ❑ Res Check or COM check from the 2015 International Energy Cod Council(lECC) ❑Letter of financial'Interest for new houses only(not required for rebuild after teardown) ❑Performance bond made out for$4.00/foot of road frontage(new construction only) 2. DEMOLTION OF A BUILDING (NOT PARITIAL) ❑ Everything above plus shut off letters from following utility companies: ❑ Gas ❑ Electrical ❑ Water ❑ Sewer(if required) 3. DECKS/PORCHES/GAZEEBOS/INSULATION/SOLAR/POOLS/SHEDS ❑ Site Plan showing proposed location ❑ Construction plans showing framing detail (if new framing), ❑ Pools—Barrier details,pool specs (engineers design) ❑ Workman's Comp Affidavit and policy(if required) FAMILY APARTMENTS ❑ Section 1 Plus: ❑Family Apartments are SIN ect to approval from the Building Commissioner. Agreement must be signed, notarized and recorded at the Registry of Deeds and returned to the Building Department. ACC> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY1� `.� 11/16/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: g Jane Logan Gordon Atlantic Insurance PHONE (781)659-2262 No:(781)659-4725 306 Washington Street AIL ADDRESS:jane@gordonatlanticinsurance.com INSURERS AFFORDING COVERAGE NAIC 8 Norwell MA 02061 INSURER A:Liberty Mutual Agency 6201012 INSURED INSURERB:Commerce Ins. Co. 34754 Lux Renovations,LLC,DBA Owens Corning of New England INSURERC:Peerless Insurance Co. 24198 60 Shawmut Road INSURER o:Liberty Mutual Agency 6201012 INSURER E: Canton MA 02021 INSURER F: COVERAGES CERTIFICATE NUMBER Master JL 10/26/17 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 ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY CBP8512851 09/05/2017 09/05/2018 EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE FO OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY JECTPRO ❑LOC PRODUCTS-CAMP/OPAGG $ 2,000,000 PRO- OTHER: $ AUTOMOBILE LIABILITY COMB I N E NG IMI $ 1,000,000 Ea accident H ANY AUTO BODILY INJURY(Per person) $ BI & PD CSL ALL OWNED I SCHEDULED LP7677 4/4/2017 4/4/2018 BODILY INJURY Per accident) $ BI & PD CSL AUTOS AUTOS HIRED AUTOSNON-OWNED PROPERTY DAMAGE $ BI & PD CSL AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 `, g EXCESS LIAS X CLAIMS-MADE CU8511953 9/5/2017 9/5/2018 AGGREGATE $ 1,000,000 DED I x I RETENTION$ 10,000 $ WORKERS COMPENSATION R O - AND EMPLOYERS'LIABILITY Y/N % STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE XWS57350449 5/24/2017 5/24/2018 E.L.EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE.POLICY LIMIT I$ 1 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached"more space is required) Cert Holder is added as included as Additional Insured for General Liability Coverage per Blanket Al form 22-133 (01/08) and 22-45 (12/02) Primary & Non-Contributory (22-133 1/08) and Excess General Liability coverage is "follow form" where required by written contract. WC excludes Dan Bawabe & Paul Deguglielmo, both LLC Members CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INSURED'S COPY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICYPROVISIONS. AUTHORIZED REPRESENTATIVE Jane Logan/LOGAN ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 pomot) Owens Corning Basement Finishing Systems of New England Sharma,Rajeer Contractor / Agent Authorization From - 106 Tupelo Rd Marston Mills,MA 02648 703-623-5150 I, �a,f ✓q"— authorize Owens Corning Basement Finishing Systems of Boston to sign the building permit application on my behalf to perform the work at NW5-6A.5- AA-'A S M R OD'co y Co) Home Owners Signature: AA- Date: Project Manager Signature: Date: 60 Shawmut Road • Canton, MA 02021 • Phone: 781-821-0060 • Fax: 781-821-8552 •w-w�=. n-com 4 _"& i p ,> Town of Barnstable *Permit Expires 6 mon8,s from issue date Regulatory Services Fee Z ■nistvsrnsM 64 �ii chard V.Scali,Director EL APR Q 4 2010 Building Division . 1 `'`'Yom Perry,CBO,Building Commissioner TOWN O� bAhNS f Wain Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION = RESIDENTIAL ONLY Not Valid without Red X--Press Imprint ' Map/parcel Number O S7 /aL4 / Property Address /mpg A kc€'. X Residential Value of Work$.2/, 983 — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address SkeLrY,).%&- 1 't,'t i 14T I I s wl,/ Contractor's Name Tjpr iIUE. (.QI tidnt S /rll� U�(1/Sail) Telephone Number ���ZL r—F900 Home Improvement Contractor License#(if applicable) �T 32�fs Email: Construction Supervisor's License#(if applicable) 07 7a 7 AW orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner .,�I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# WM &1 9-7Z.7 72 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will he taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side [IReplacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&, f4re 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 requi d. SIGfL'ATU-RE: • C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOI DHR\EXPRESS.doc Revised 040215 Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Rajeev&Kayla Sharma =.EL Legal Name:Southern New England Windows,LLC 106 Tupelo Rd RI#36079, MA#173245,CT#0634555, Lead Firm#1237 Marstons Mills,MA 02648 10 Reservoir Rd I Smithfield,RI 02917 H:(703)623-5150 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:(603)380-5990 Buyer(s)Name: Rajeev & Kayla Sharma Contract Date: 03/24/18 Buyer(s) Street Address: 106 Tupelo Rd, Marstons Mills, MA 02648 Primary Telephone Number: (703)623-5150 Secondary Telephone Number: (603)380-5990 Primary Email: kaclarck85@gmail.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively, this "Agreement'). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $21,888 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: $7,295 Balance Due: $14,593 Estimated Start: Estimated Completion: Amount Financed: $0 8 to 10 weeks 8 to 10 weeks Method of Payment: Cash/Check We schedule installations based on the date of the signed contract and secondarily on 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: Taxes paid in Barnstable MA; Deposit paid via check#074 Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor. Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 03/28/2018 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 By An ersen of So N w En land Buyer(s) _ Signature of Sales Person Signature Signature Josh Ocharsky Rajeev Sharma Kayla Sharma Print Name of Sales Person Print Name Print Name UPDATED: 03/24/18 Page 2 / 10 Office of Consumer Affairs and Business Regulation -= - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWSILL,, BRIAN DENNISON 26 ALBION RD s = LINCOLN, RI 02865 - Update Address and return card.Mark reason for change. Address U Renewal ❑ Employment 71 Lost Card _..Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the -HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: _ --- Office of Consumer Affairs and Business Regulation :"Registration: .173245 Type: 10 Park Plaza-Suite 5170 Expiration: 9/19/2018 Supplement Card Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON BRIAN DENNISON 26 ALBION RD LINCOLN, RI 02865 Zdersecre ry Not valid without signature f Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-095707 Construction Supervisor BRIAN D DENNISON 7 LAMBS POND CIRCLE, CHARLTON MA 01507 1 Expiration: Commissioner 09/08/2018 1 The Commonwealth of Massachusetts Department of Industrial Accidents 1 'Congress Street,suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER-NETTING AUTHORITY. Applicant Information "I Please Print Legibly Name (BusinesslOrganizaiion/Individual): O t1 e �WS Address: (o ,L�L t51Ott,� ��� City/State/Zip: p Phone#i: -�,fj/ _ 2�8'- Q 6W Are you so employer?Check the appropriate box: Type of project(required): l KI am a employer with ZO 1,employees(full and/or part-time).* 7. []New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. EJ Remodeling any capacity.[No workers'comp.insurance required.l 3.a 1 am a homeowner doing all work myself[No workers'camp.insurance required.]; 9 ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property.t I will 10 Building addition P�'3 ensure that al!contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions S.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.+ 13-[]Roof repairs 6.❑We are a corporation and its officers have exercised their right.of exemption per MGL c. 14.[ tether Qh/S��p( 152,§1(4),and we have no employees.[No workers'comp.insurance required.] rejo 4f rem ev-/-S *Any applicant that checks box i'1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractor and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy dn-d job site information. Insurance Company Name: rllre pien S FJ s. Policy#or Self-ins.Lic.#: W U 3l-S-8`7 Z [ — Z 0 Expiration Date: l f Job Site Address: �Q6 /voe It, �Qll City/State/Zip:94JUL s &//f d-4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violafion punishable by a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator-A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the�azns andpenalties ofperjui y that the information provided above is true and correct Si attire: Dfte: Phone#: QD I- ZZ. cj'PC Official use only. Do not write in this area;to be completed by city or town off ciaL City or Town: Permit/License tr Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r� DATE(MMIDD/YYYY) AC(:?R o CERTIFICATE OF LIABILITY INSURANCE 12/29/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: CoBiz Insurance, Inc.-CO PHONE 303-988-0446 Fn c No),303-988-0804 1401 Lawrence St, Ste. 1200 E-MAIL Denver CO 80202 ADDRESS. COMaiI cobizinsurance.com INSURERS AFFORDING COVERAGE NAIC t/ INSURER A:Acadia Insurance Company31325 INSURED ESLERCO-01 INSURER B:FiremenS Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC. INSURER C:Homeland Insurance Company of New York 34452 dba Renewal by Andersen of Southern New England 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1252851165 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. ADDL SUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DDIYYYY LIMBS A I X COMMERCIAL GENERAL LIABILITY CPA3158728 1112018 1/12019 EACH OCCURRENCE S 1.000.000 DAMAGE TO RENTED rGEN';LAGGREGATE MS-MADE �OCCUR PREMISES Ea occurrence $300.000 MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY $1,000,000 LIMB APPLIES PER: GENERAL AGGREGATE $2.000.000 PRO ❑ LOCPRODUCTSCOMPlOP AGG $2.000,OOD 1:1JECT A 'AUTOMOBILE LIABILITY N CPA3158728 1/12018 1/12019 COMBINED SINGLE LIMB $ DD Ea accident 1 O 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-0WNED Per accident $ X HIRED AUTOS X AUTOS A X UMBRELLA LIAB X OCCUR CPA3158728 1112018 1/12019 EACH OCCURRENCE $10.000.000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10.000.000 DED X RETENTION$n $ B WORKERS COMPENSATION WCA3158729-20 1/12018 1/12019 X STATUTE ERA AND EMPLOYERS LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $7,000,000 N OFFICERIMEMBER EXCLUDED? /A E.L.DISEASE-EA EMPLOYEE $1.000.000 (Mandatory in NH) B yes.describe under E-L DISEASE-POLICY LIMIT S 1.000.000 DESCRIPTION OF OPERATIONS below C Pollution Uabiliry 7930073340000 1/12018 1112019 Each Occurrence S1.000.000 Aggregate 51.000,000 Claims-Made Policy Deductible S10,000 Retroactive Date 05202013 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD d,a -1 -- 17 0, A Ai I �?eon WCTown ofrBarnstable RECEIPT: " iAB1$ 200 Main Street, Hyannis MA 02601 5Q8-862-4.038 Application for Building Permit Application No; TB-17 2230 Date Recieved: 7/17/2017 Job Location: 106 TUPELO ROAD,MARSTONS MILLS Permit For: Building-Insulation-Residential Contractor's Name: TODD LEDUC State Lic. No: CSSL-106019 Address: East Greenwich, RI 02818 Applicant Phone: (401) 965-8578 (Home)Owner's Name; Kayla Sharma Phone: (603)380-5990 . (Home)Owner's Address: 106 TUPELO ROAD, MARSTONS MILLS,.MA 02648 Work Description: Air sealing and insulation of attic flat,.kneewalls,and common walls. o „tea f—P Total Value Of Work To Be Performed: $6,000.00. CD Structure Size: 0.00. 0.00 0.00- Width Depth Total-A-tea au � m I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by . filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property.which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or anyother code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections.performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: todd leduc 7/17/2017 (401)965-8578 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 7/17/2017 $85.00 XXXX-XXXX-XXXX- Credit Card 8065 ..................................:.:................................................................_:.....................,........................._......................................._......................................................................._.............._............................ Total Permit Fee Paid: $85.00 THIS IS N4 TA�NPE " I oF1H�r� rTown of Barnstable *Permit# _ (, 'b Expires 6 mo,uhs from issrr dale Regulatory.Servi&s Fee _ � y BARNSTABLE, » Thomas F. Geiler, Director MASS. C 16:yg Building Division L �� olF� P�p . ER04om Perry, CBO, Building CCommissionero 0 Main Street, Hyannis,MA 02601 OCT ® 2008 www.town.barnstable.ma.us Office: 5p.8- 62-4038 Fax: 508-790-6230 f ""VN fte T t1PPLICATION RESIDENTIAL ONLY ` Nol Valid wilhoul Rerl Y-Press Imprint ' Nlap/parcel Number__ Property Address_ _ A) (P— Residential Value of Work' / y Minimum fee of$25.00 for work under$6000.00 Owner's Name& Addressi' ,Q ( ^ Contractor's Name _ �`' <!��' �y " eY'e�ione Numbers�'t'it) _-_ Home Improvement Contractor License it(if applicable)__ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ I am the Homeowner ❑ 1 have Worker's Compensation Insurance Insurance Company Name •Workman's Comp. Policy# Copy of Insurance Compliance Certificate must-be on file. Permit Request 'heck box) Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side f Replacement Windows/doors/sliders. U-Value ' ` (maximum .44) `Where required: issuance of this pennit 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 is required. SIGNATURE: Q"•WPFII_tS11"ORMS\huildine pennit fonns\EXPRESS.doc Revised 100608 The Commonwealth of Massachusetts Department of Ittdusfrial Accidents Office of In Vestigatio ns 600 Washington Street Bostotc, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumberg A licant Information Please Print LefrzblY amr, (Business/Orgmizel5onflndMivan: . ' Address: - ity/State/Zip: Phone.#: 63N D Are you an employer? Check the appropriate bow T ypeoject(required): 4- ❑ I am a general contractor and I 1.❑ I am a employer with construction employees(full and/or yart-tune).* • have hired the shb-contractors 2❑ I am a•sole proprietor or partner- listed on the attached sheet odeling slop andltaveno employees These sub-contractors have g, ❑ Demolition employees and have workers' addition working for me is any capacity. 9. ❑ , g [NO workers' .•imsrrc�nCo comp.inei,rance. Buildin 5. ❑ We arc a corporation and its 10.❑ Electrical repairs or additi. rtquured]3 I am a homeowner fining all work officers have exercised their 11.0 Plumbing repairs or Additi .,� myself [No workers' comp- eg right of exemption per MGL 12 ❑goof repairs incrrrance r c. 152, §1(4), and we bavc no nrrr�]t employees rs . [No worke ' 13.❑ Other comp.insurance requircd.] '`Any applicant float ehcclx box#1 nnist also fM out the section below sbowing their workers'corop=uMfien policy infant atiort t Homeowners who submit this affidavit indicating they atz doing all work and then hire outside contractors must cubrrut anew affidavit indicating such eo tr-=trectnrs thatebmic this box uvrat attached as additional rbect showing the name of the rub-=b-drlurs and state av}rether or not thosd rntitia have anploycet. If the-mb-conhazborm have angrloyecs,they must provide dear wm-kaz'eornp.policy number. lam an employer rhrd is providing workers'compensahan insurance far my employees Below is the polity and jab site ' tlLfOrJItQtLotL - . . Inn±ance Company Name: Policy#or Sclf--ins.Lic.#: Expiration Date: lob Site Address: City/StatrJZip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration da_ Failure to secure,coverage as requlmd under Section 25A of MGL c. 152 can Iead to the imposition of crimifial penalties c Em tip to 51,500.00 and/or one-year brprisonmLnt, as well as civil penalties is the form of a STOP WORK ORDER and of up to $250.00 a day against the violator. Be advised that a copy of this statrit maybe forwarded 1n the Office of Iavesti ins of the DIA for inerurdnce covcra e verification. I do hereby certify under the pains•and penalhics of perjury th,al the information provided above 7s true and correrl O use only. Do'not writ-in this area, to be completed by city or town officiaL City or Town: Permit/License# Issrdngkathority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspectur 6. Other �oFtKEr Town of Barnstable - Regulatory. Services r r r vaA-RAB US& LEA` Thomas F. Geiler, Director $u'ilding 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 �7( , as Owner of the subject property hereby authorize to act on my behalf, in all.matters relative to work authorized by this building permit application for: o 4P (Ad ess of Job) Signature of Owner Date Print Name • I If Property.Owiier is applying for permit please complete the HomeoNmers License Exemption Form on the reverse side. a: Town of Barnstable �p4TFit'Tp� " Regulatory Services a N • Thomas F. Geiler, Director swxtvsrwBLE, 9 MAS4 i639 Building Division rFD � Tom Perry,.Building Commissioner 200 Main Street, Hyannis, MA 02601 vrw'si'.town.b arnstab l e.ma.us Office: S08462-4038 Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print ATE: lOB LOCATION: �A0 number n street village "HOMEOWNER": �LLC name p QQ home phone# work phone# CURRENT MAILING ADDRESS: , `� Ad 3 a A4 0, city/town y 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 permst. (Section 109.1,1) ibility for compliance with the State Building Code and other The undersigned"homeowner"assumes respons applicable codes, bylaws,rules and regulations. Th'e 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. L Signature of Homc cr 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 12TO Constrpction Control'. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner perfomung work for which a building permit is required shall be exempt from the provisions' of this section(Section log.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work, that such Homcowncr shall act as supervisor." Many homeowners who use this exemption airc 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 hirrs 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 hc/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Engineering Dept. (3rd floor) Map !7S Parcel 16 .1 ermit# 2a-9©© House#, �nQ �(,G Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Pla ) SEPTIC SYS BE 19 INSTALLED I NCE WITH A �• TRONMEI\9 TOWN OF BARNSTAB4� �� - ��;: � � , AND Building Permit Application Project Street Address Village Xb f?STU)\iS M.-L,us Owner PcD 2L0,SS Address t QU- "Tu PG—L.b 2a-,0-r> Telephone Ebb 4 •]rp " 34" 97g- 60S- 530 3 Permit Request p S t p�c �-- �fZw L. i D Lo;:a o-,&N2- First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 1 U oo Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes (J No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure I C) '-eZS Historic House ❑Yes No On Old King's Highway ❑Yes P(No Basement Type: QrFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing 7- V2_ New — Half: Existing V'Z New —" No. of Bedrooms: Existing 4 New Total Room Count(not including baths): Existing 9 New First Floor Room Count Heat Type and Fuel: idGas ❑Oil ❑Electric ❑Other Central Air (]Yes �rNo Fireplaces: Existing New Existing wood/coal stove ❑Yes %'No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes tg/No If yes, site plan review# Current Use eES L-D4- , Proposed Use SSE Builder Information Name --4+C>Ak_e Telephone Number SL:>b 4' �1> 2, Address 10 4 o License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE3(&A DATE , /9 9 f3 BUILDING PERMIT DENIED FOR THE FOLLOWING ASON(S) FOR OFFICIAL USE ONLY r - _ r PERMIT NO. .t -( l 0 O . DATE ISSUED MAP/PARCEL NO. -� ADDRESS _ r' VILLAGE OWNER DATE OF INSPECTION: - — : FOUNDATION i FRAME 4 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH t FINAL ; GAS: �• ROUGH'. FINAL - FINAL BUILDINW1 �- r Fnat DATE CLOSED OUT, M t ary , . r ASSOCIATION PLAN, M. G `' C 0 0 2X6 P.T. 0 0 2x4 P.T. 242 P.T. 4x4 P.T. o Sv u►'`c\ �'u b G �6 f JAI ro".� r a � Zap /vl : ,:. 5� oi CERTIFY THAT THE SHOWN ON THIS PLAN I P4`" of S W`*tea LOCATED ON.THE GROUND AS INDICATED F t"' DATE REGISTERED LAND SURVEYOR LEVY & ELDREDGE ASSOCIATES,INC. CERTIFIED PL®'T PL A � CLIENT I� , ENGINEERS — LANDSCAPE ARCHITECTS JOB NO. 12 2 0_, .-:-.�aoD > PLANNERS- LAND SURVEYORS OR. BY �_�.,_M ' IN r: 889 WEST MAIN STREET CHKD. BY: -2fo" ocr :CENTE6I LLE, MA..02632 ` :..:.. : SHEET -I 'OF I ,._ SCALE DATE 1/ 987`, ° + 1 Lk �r a.. S:i-4 ?: fo drjLL Lk� : tJ „ ..:ice,..... ls. t The Town of Barnstable • e►anrsTnHte. • . 9�A 1Q�. `0�' Department of Health:Safety and Environmental Services rEDrV1A'�� , Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no.. t I Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION I MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: S-1 x3,V�wc--1 Est.Cost 9 L,v Address of Work: 1 0(r, 1I U fn�Z.O _C��� lUTAP�SiZ�X� 6V uLA Owner's Name Date of Permit Application: 4 I hereby certify that: Registration is not required for the following reason(s): ork excluded by law Job under$1,000. wilding not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner Name • TOWN OF BARNSTABLE ; ' BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. • DATES JOB. LOCATION /O %U peq > 4D zr^3 S etc c c_e Number Street address Section of town "HOMEOWNER" /�d.` �T � �e= `SD Z Name Home phone Work hone /-boo- 354=.j �'�U �,. PRESENT MAILING ADDRESS /y Co 1(fo A r> _ City town State Zip ccd The current exemption for "homeowners" was extended to include owner-cc-;:= dwellings of six units or less and to allow such homeowners to engage an i. dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person (sj who owns a parcel of land on which he/she resides or intends to side, on which there is , or is intended to be, a one or two family dwellih". attached or detached structures accessory to such use and/or farm structaz A person who constructs more than one home in a two-year period shall not r considered a homeowner. Such "homeowner" shall submit to the Building Off-: on a form acceptable to the Building Official, that he/she shall be resc- for all such work performed under the building permit. (Section 109 . 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Building Code and other applicable codes, by-laws, rules and regulations. The unders;gned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and require--er and that he/she will comply with said procedures and requirements. :HOMEOWNER r S SIGNATURE p,La� I�PPROVAL OF BUILDING OFFICIAL Tote: Three family dwellings 35 , 000 cubic feet, or larger, will be require: -o comply with State Building Code Section 127. 01 Construction Control.. HOME OWNER'S EXEMPTION 4ati.r The code state that: "Any Home Owner performing work for which.,,a-,,.:;build-:c permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that is Home Owner engages a person (s) for hire to do such work, that such Home Ow: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assumi::c the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing Cons truction • Supervisors, Section '2. 15) . This lack of awaran often results in serious problems, particularly when the Some Owner hires unlicensed persons. In this case our Board cannot proceed against the _nlicensed person as it would with licensed ,Supervisor. The Home 'Owner acm as supervisor is ultimately responsible: '_'o ensure that the Home Owner is fully aware of his/her responsibilities , m. :ommunities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On t: .ast page of this issue is a form currently used by several towns.. You may ;are to amend and adopt such a form/certification for use in your community . 5a.•. The Cinnntonlreulth of Afaseachusetts •!:i: ;_._. 1•�w Department of Industrial Accidents Office oflnyestfgatfons \1'•;" r:�'' 6110 I i uAi,ihtu,r Street Bosru,r.Alasxw 02111 Workers' Compens2tion Insurmnce Affidavit a,l 10-int information• Plc:tse PR11VT leb y l2cition: �vnhone ��- GQo ��- I am a homeowner performing all work myself. I am a sole proprietor and have no one working_ in any capacity Q 1 am an emplover providing workers' compensation for my employees working on this job. cunt tam name: atlrlress• c•tv- hone#- insurance cn. iicl•0 [] 1 am a sole proprie general contractor or homeowner circle one) and have hired the contractors listed below who have the followin- orkers' compensation poll comeam• nnmc: addrescc cin•• �honc H� insimincr ro. �nniiev# tom any name-__.....-. ..:._.��..�._ �...---�== - —_ - — �- - -•----_ addresc- hone rite• 1!• insurance c rVolicy 0 Attach addij: nai sheet if neceisary, c �- + --+ y.:- ---- %� -"•'•• �—•~T' a :•,�,•�.77 Faiiure ttt s-Wjic cavern;e as required under Section 3A of NIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 andiur unc years' imprisonment:ts��ell:ts civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a dap against me. 1 understand that a copy of this statement ma% be forwarded to the OMce of Invcstirations of the D1A for coverage verification. !do her ht ccnift•[order the pains nod penalties of perjury that the information provided above is true an correct. Sianatur• Date Print name SS Phone# ' official use unl% do not[write in this area to be completed by ciry or town official cit% or town: permit/license d r•ttluilding Department C31-iccnsinr Board t- I3 cheek if immediate response is required ❑Selectmen's Office t �'• 011c2lth Department E t phone N: MOther c. contact person: . information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' ctmpensation for :L employees. As quoted from the an cmplm•ee is defined as every person in the service of another under am contract of hire. express or implied. oral or written. An emplarer is defined as an individual. partnership, association. corporation or other legal entity•, or anv twee or me the foregoing enLaged 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 o"Incr of a dwelling_ house having not more than three apartments and who resides therein, or the occupant of the d�\cllin, house of another who employs persons to do maintenance, construction or repair work on such dwellings h( or on the__rounds or building appurtenant thereto shall not because of such employment be deemed to be an empiox,: MGL chapter 152 section 25 also states that every state or local licensing gamey shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for an• applicant ,who has not produced acceptable evidence of compliance with the in coverage required. Additionallv, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. 77 Applicants Please fill in the .vorkers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial ,Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law' or if you are require to obtain a workers' compensation police. please call the Department at the number listed below. City or Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P1. be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returnee the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questic please do not hesitate to _give us a call. . The Department's address. telephone and fax number: r, The Commonwealth Of Massachusetts Department of Industrial Accidents ... Office of Investigations 600 R'ashington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone 4: (6I77) 727-4900 ext. 406, 409 or 375 o�TMe� TOWN OF BARNSTABLE Permit No. .....0838 .. e BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ,639 HYANNIS,MASS.02601 Bond ......X. 4.�g� CERTIFICATE OF USE AND OCCUPANCY Issued to BRIAN GIBLIN Address lot #4 106 Tupelo Road, Karstons Mills USE GROUP FIRE GRADING OCCUPANCY LOAD 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. Septzmber. 25... 19 87 .....a..�.���.. Building Inspector i TOWN OF BARNSTABLE BUILDING DEPARTMENT _ 1.saaar = TOWN OFFICE BUILDING rua HYANNIS, MASS. 02601 j MEMO TO: Town Clerk FROM: Building Department DATE:- An Occupancy Permit has been issued for the building authorized by Building Pe!;2U _ ©,b, o ..... ..............................................................................._.........._........�........__......�.. issuedto ..... .........................................................._............ _... ..._ ..... _. ......_.._..__ Please release the performance bond. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A xk cc"�,�JAO L DATA �TOWN,OF BARNSTABLE, MASSACHUSETTS r�.DIN•G•` PERMIT ;:: ci- DATE i !)'nt'• ;s 19• 7 PERMIT Nib®` "e)lDoe➢�7 APPLICANT 17 ADDRESS i• - ' n . C (NO.) " 'r'-•($ k... ")..... .-..�. .,....� .'.•It ONT R'S�IICEN�E•1.. • NUMBER OF PERMITITO 13u ltt �'+yi)�-�• :.% (�_) STORY =' ? DWELLING UNITS (TYPE OF IMPROVEMENT)` NO. ' (PROPOSED USE) �_I -••7 ZONING AT (LOCATION) ''`i`- il/i iU: x..l.+i,' �.(_) 'I t ._- _- - DISTRICT l•' (N0.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT , SUBDIVISION 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: ri ')— ' C. t . AREA OR i u 1:: �; 1•i:. PERMIT VOLUME 1 ESTIMATED COST t=I% s• U U U . U U FEE (CUBIC/SQUARE FEET) OWNER BUILDING DEPT. ,•Ill i ADDRESS Ll1�il7Lt.� _,�_ _�. :.. __ F If-, THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET. ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OV--R' PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE; MUST BE-AP_ • ,PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED , FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. iSr MINIMUM. OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE.INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN _ ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND (.; I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICA-fE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO.COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY.TO LATH). - :I 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. 1` OCCUPANCY:' P ST ..MS CARD SO IT IS VISIBLE FROM- STREET BUILDING INSP CTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS r V 3 g HEATING INSPECTION APPROVALS ENGINEERI TMENT OTHER 2 (�(�^ Q p _ (�� BOARD OF HEALTH y�, LTOR K SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT •N!LL BECOME NULL AND VOID IF C ONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIt MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE ((i WRITTEN STRUCTION. I 'PE•RMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. r V T4. QC'SiE• ,�' ::fir 1p /1 ' V l' Ir> _ I - fF7}l - Yy 16- V ;.a k Are y�s iy �y j•.. FC / zr ssY r: _I CERTIFY THAT THE :. yl SHOWN ON THIS PLAN IS \,ZN OF yj LOCATED ON THE GROUND N.A�s9n N AS INDICATED lAl ROBIN 9 o.3 p Yi: �.k.wh LA DATE REGISTERED LAND S RVEYOR �; s LEVY SC ELDREDGE ASSOCIATES,INC. CLIENT CERTIFIED PLOT PLAjI u 0 U � ENGINEERS — LANDSCAPE ARCHITECTS JOB NO. 1220 PLANNERS— LAND SURVEYORS DR. �: �o,M ra ......�_ IN 889 WEST MAIN STREET CHKD.BY, aor cr CENTE61 LLE, MA. 02-632 SHEET I..OF!.,, SCALES �~ '¢�� DATE s 4 / i9B�7 � D0 \1,1ro II LoT 3 � ` a 4�I 576 I 5, F ` �, L tprr ►�� x (v ' S�T11y 1 N ' /00 30 106 0 ,4 \ 30 106 ////D I .2Y LEGEND PROOPOSED SPOT ELEVATION �TH OFMgssyRgq EXISTING, CONTOUR ---0——— �� P A U L' �yc ��� s PROPOSED CONTOUR 0 o A. rn y o ROBIPd NOTE: THE LOCATION. OF ANY UNDERGROUND " E E V Y �•. j f SEWERAGE,WELLS, OR OTHER UTILITIES SHOWN ON p No.10050 p WfL THIS PLAN IS APPROXIMATE ONLY AS DETERMINED �0.- O/STE��i. FROM RECORDS AND/OR VERBAL INFORMATION. ,FSs�oNA E_ � �<<, �Ist THE CONTRACTOR IS RESPONSIBLE FOR THE rVNt LOU' VERIFICATION OF THE EXISTING LOCATIONS IN THE FIELD. R I TERED ENGINEE R ISTER D LAND SURVEYOR LEVY 8c ELDREDGE ASSOCIATES,INC. /GL PROPOSED PLOT - PLAN CLIENT L ENGINEERS — LANDSCAPE ARCHITECTS JOB NO. 1-74 6 Z_0T_ TUPEGz� /'061p PLANNERS — LAND SURVEYORS DR. BY: � , IN 889 WEST MAIN STREET z CHKD.BY=� 3,���s TI48 L E CENTERVILLE, MA. 02632 SHEET�OF2 SCALE.1=51 DATE U •AsVss�'or's offioe Ost floor): THE ' �essor's map and lot number -? ��..."....� .. T >o :m `SIC SYSTEM MUST BE poard of Health (3rd floor): �.7. -.' .<>...........:............ " •`STALLED IN COMPLIANCE Sewage Permit number .......... ram.- a: BABdn9oT Engineering Department (3rd floor): WITH TITLE 5 +° House number a............. .... -VNMENTAL CODE•ArD °'°�'b}9'o,�e APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00•2:00 P.M. only_ 1 9''V REOULAT6ONS TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......P)wO.Lck S7 "' �V ........................................ TYPE OF CONSTRUCTION .........D..W...e1'I .......wfw... ........................................................ ......... 19 .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: • , Location .... yy� / .........Q................................. .............../'!/ s ° ?... . .f.l ProposedUse .....: (.clC///*`6 V9..................................................................................,.......................................................... ZoningDistrict ........ . .yr.. .................:............................Fire District ......... ....4 ...................................................... Name of Owner .. 'J/�l.V........lr`��!J/lN................................Address ..6at /' ld ...y:./.J.� �.... �1�.(�Lt....M .!.. Name of Builder .../J`l. /....4.V 1 ! U .................Address .312 PMAkic.9 f'r(!, Cf-.... i Name of Architect ...1I'.6rW)S-.fCi e....6esXy ..................Address Jyl—/7211W.X r....rje0..wW./&'er .......... Number of ..Rooms ...........0........ 100, ..........:.......:.� ,.`,.............Foundation .... ,- ....................................................... Q Exierior Gl1 ...•I"/�.U. r�...s !ll?!!1 ..�� T..Roofing ......�I t,�rj...... ... .�r /?..!T! ....................... Floors .......012....................................................................:.....Interior ......��bl. T'r�................................ ..� Heating .......1X�4+ .......... {�........................................Plumbing .....�p�.o....¢..? ' .............. .......... Fireplace ..... ........................................................................Approximate Cost .. / �IIO(� �...... ....l�r. Definitive Plan Approved by Planning Board _"_____________________________"19__"_____ . Area ... .� ...t.............. Diagram of Lot and Building with Dimensions �� Fee ...../�............................... y� SUBJECT TO APPROVAL OF BOARD OF HEALTH V` l3(p• �JS �03 -4 3i 3a a � � 1 •ice V OL OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ` 1'hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......&'. . �� , cd Construction Supervisor's License ..4' .?' �......... 7 43IBLIN, BRIAN ' 30838 Two Story No ................. Permit for .................................... Single Family Dwelling .................. ..................................................... Location Lot #4 106 - Tupelo Road ................................................................ Marstons Mills ............................................................................... Owner . Brian Giblin ................................................... .......... Type of Construction ......Frame........................ ................................................................................ Plot ............................ Lot ................................ Permit Granted ........June.... ........19 87 Date of Inspection ....................................19 Date Completed ..........19 �' a� g � i t. Assessor's offioe (1st floor): a r Assessor's map and lot number . of tNE To Board of Health (3rd floor): o Sewage Permit number Q. 7 �........................ L BAHIISTADLE, 2 S�.. NAB Engineering Department (3rd floor): if 'oo 039• House number ................................f( ?.............: /..c...... a c gar a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only N TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......1301 ck.................... ............'.`'........ ..................................................... TYPE OF CONSTRUCTION .........Q.WW6111 t1/9....... FO-Mill.y...........................................:............. ................... ..... 19 -- ` TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... �T y "'pG/0 1?05 ! ..1 /..I� .................................... � k ........./�/ Proposed Use ....... ........ .. ....................................................................................:..........:.:............................................. ZoningDistrict ........ .. ...r...E.............................................Fire Distrttt• ......... ....v................................................. Name of Owner ...... ..........................Address :.dDI� ...'''.!.�.f. �. .. � .+t� ....1....f.: ..... a Name of Builder ...Al.//..6�4�/7 ................Address Name of Architect .../P.o1�7?1.srrj,.e....�PS/.y ..................Address .���./!!•Qlvd. f.....rae) 4U .. .......... Number of Rooms .......... ............................. . . .. . Foundation ....�..Y��.y�.......................................................... Exterior L�( (lt.... U r)...w��!/./�! ...��.�T..Roofing ......��.:�:C��...S! !L /e r....................... Floors p� .....................................................Interior ......)OldM. ............:..................../. .. . ......... ..... ....... . ............... g i-/�1G� .................:..........Plumbing ..... p�.P,2...g-..:pdc- �j .................. Heating ....... ............. .... . ............ . ........... ............... " a�Fireplace ...... '" .......Approximate Cost Alal......�.... ,,,�..................•..,:----.. Definitive Plan Approved by Planning Board _______________________________19________ . Area .....�`00.s Diagram of Lot and Building with Dimensions Fee //9 SUBJECT TO APPROVAL OF BOARD OF HEALTH i3G- os I - to3 ' 1 3 t3✓ �Zr ,y 30 it ✓ 2 \ �s '2 �s ' 7+, a - ,� `I7W. Cn 7 t ) .Sl- 1 lit t 11S , , 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. J W - , Name ......... ............................. Construction Supervisor's license ...c.Ul...�( ........' .. J GIBLIN, BRIAN / A=04 No ....3 Q 8 3 8 Permit for ....T..w.o...S.to.ry......... ..........Single...FAMily. ..Dwelling...... Location ........LA.t...#.4........10.6...Tupeda..Road ............................Msir.stans...Mi.11s.............. Owner ....Brian...G.a,b.].a II............................. Type of Construction .........Frame................... ............................................................................... Plot ............................ Lot ................................ Permit Granted June 9, ....19 87 June Date of Inspection ....................................19 Date C/66mpleted ......................................19