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0354 WHEELER ROAD
I 1 0 Town of Barnstable _ M Building_. -. Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this CaM'Must be Kept ` b `� IPosted Until Final Inspection Has Been Made. Permit Where a Certificate of Occupancy is Required,such.Building'shall Not be Occupied until a Final Inspection has�been made Permit No. B-17-4343 Applicant Name: Evgeniy Kuntsevskiy Approvals Date Issued: 12/21/2017 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 06/21/2018 Foundation: Location: 354 WHEELER ROAD, MARSTONS MILLS ! Map/Lot: 082-016 Zoning District: RF Sheathing: Owner on Record: PRIZZI,ANTHONY R& MARY ELLEN Contractor Name: EUGENIY KUNTSEVSKIY Framing: 1 Address: 354 WHEELER RD Contractor License: CSSL-105954 2 MARSTONS MILLS, MA 02648 .� Est. Project Cost: $ 12,000.00 Chimney: Description: Existing Roof replacement,Strip 1 layer and re-roof. Permit Fee: $61.20 Insulation: Project Review Req: ; Fee Paid: $61.20 Date: 12/21/2017 Final: Plumbing/Gas Rough Plumbing: - -- _ Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. ----- -- -'� Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:l 1.Foundation or Footing v ry T _ Rough: 2.Sheathing Inspection Final: , 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: f All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT A— -;:_ L Town of Barnstablelb RECELPT ` &UUMAOM ' 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-4343 Date Recieved: 12/17/2017 Job Location: 354 WHEELER ROAD, MARSTONS MILLS Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: EUGENIY KUNTSEVSKIY State Lic. No: CSSL-105954 Address: , North Attleboro, MA 02760 Applicant Phone: (508) 342-5373 (Home)Owner's Name: PRIZZI, ANTHONY R& MARY ELLEN Phone: (508)737-0268 (Home)Owner's Address: 354 WHEELER RD, MARSTONS MILLS, MA 02648 Work Description: Existing Roof replacement,Strip I layer and re-roof. Zi ,-� �ry Total Value Of Work To Be Performed: $12,060.00CIO tn �„' Structure Size: 0.00 0.00 0.00 -1 Width Depth Total Area rn .t= l hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with'the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued, it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. i Signed: Evgeniy Kuntsevskiy 12/17/2017 (508)342-5373 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $12,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $61.20 1 12/17/2017 $61.20 XXXX-)0=)0= Credit Card 8339 __...._.....__..._...................................................................................._......_..._.._...._..........................................................................................__..........................................................__......_...... Total Permit Fee Paid: $61.20 NMI&0T WxPERMIrT `y ,,�``:y',.'�rN` ,a„'"' ,e�"'..wit:. t,wT.s•'...-¢,`..� '. :w'f w..."w ::a1.<.:. I THENORFOLK DEDHAMGROUP® i February 28, 2017 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, C.H. 139, SEC. 3B Building Commissioner, or Inspector of Buildings c/o City or Town Hall 367 Main Street Marstons Mills, MA 02601 Board of Health or Board of Selectmen C/o City or Town Hall 367 Main Street Marstons Mills, MA 02601 Fire Department or Arson Squad c/o City or Town Hall 367 Main Street Marstons Mills, MA 02601 RE: Our File No.: P1721277 Insured: ANTHONY PRIZZI Address: 354 WHEELER ROAD, MARSTONS MILLS, MA Policy No.: H1601214A Loss Date: 02/25/2017 Loss Type: Building or Other Structure Damage A claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, William Lamb Manager, Property Claims 1-800-688-1825 x1137 NORFOLK&DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street,P.O.Box 9109,Dedham,MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone:(800)688-1825 FITCHBURG MUTUAL INSURANCE CO. o Fax:(781)329-1818 r f w Barrows, Debi From: Roma, Paul Sent: Thursday, February 23, 2017 4:09 PM To: Barrows, Debi Subject: FW: Notice of Permit Cancellation From: Scali, Richard Sent:Thursday, February 23, 2017 12:39 PM To: Roma, Paul; Shea, Sally Subject: Fwd: Notice of Permit Cancellation FYI. Please proceed as requested Sent from my iPhone Begin forwarded message: From:Nicholas Pears<nick.pears@sunrunhome.com> Date: February 23, 2017 at 11:54:10 AM EST To: richard.scali@town.barnstable.ma.us Cc: Greta Masiello <greta.masiello@sunrunhome.com> Subject: Notice of Permit Cancellation To Whom It'May Concern; We are contacting you to close the permits issued to projects that we were contracted to build, but for various reason were not built by us. The following is a list of the project we wish to start the refund process and close: Permit# ilj: s 8 for a rooftop solar project located at 83 Dolar Davis Road Permit#`a=sJ242 for a rooftop solar project located at 354 Wheeler Road �2 Aa q1t 7 MM Permit#B-16-2311 for a rooftop solar project located at 74 Windshore Drive a/a y11? Please let us know if you require any additional documentation to close these permits. Thank you for time and attention to this matter. Sincerely, NICHOLAS PEARS Permit Coordinator Sunrun Inc. 1 TOWN OF,BARNSTABLE BUILDING PERMIT APPLICATION , Map Parcel �� `� Application Health Division Dat ssu Conservation Division U lication e Planning Dept. ermit Fee a . Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis OR Project Street Address 359Y W4 /, Village r. ram MI Owner Ah T4,m4 IT d-M 1 NO Pei Zzj Ad ss 561 Wee r'�a/ aysfivn A7,11 Telephone -5)8 Y 73 7- b Z'J /' Permit Request T"sra1 n d cr n JpV s -rc io J214PIC/5 Square feet: 1 st floor: existing propos d floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Z Z r 5'y Construction Typ- Lot Size Grandfathere : ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Hi House: ❑Yes ❑ No On Old King's Highway: ❑Yes 0'No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0 Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: 0 existing ❑ new size _ Barn: 0-existing 0 new8size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: :=: a...r -•.0 CQ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use M APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 5��vyn 11rr411Gr-r c) 4n en✓la5 ff leephone Number 5 7d-197-0Y73 Address ��� .S7 `1 DD a✓l�o�� License # D yD b ZZ 0 7SZ Home Improvement Contractor# 1961 Z U ` w l- 6136 g6��J Email AL �er'p-S Cd c� , • Go " Worker's Compensation # W(_a 3G 01 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �,L, f7avvec.� �'c.S�aS �✓�C. �� !�J �inti'-td01 �Cr,. �1/C57��r(J✓S'h SIGNATURE G? DATE S-1l-.ty 6 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. f ADDRESS VILLAGE OWNER- DATE OF INSPECTION: FOUNDATION c FRAME -INSULATION ti FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ;INAL + GAS: ROUGH FINAL FINAL BUILDING t , DATE CLOSED OUT,' j t r ASSOCIATION PLfgtNO. i DocuSi n Envelo a ID:EF7DFEED-292A-4006-846E-5CF15E1ECCE2 sunrun OWNER'S AUTHORIZATION FORM For Permit Application(s) The sole purpose of this form is to provide Sunrun, Inc. with the necessary permission from the Owner to file permit application(s) for such project work as agreed upon between the Owner and the Owner's Authorized Company and its designated subcontractors. Owner's Name: Anthony Pr'zzi Solar Project sgbY.-3S e,,- I, A/!. 66 ;`/s NA 6Z Signature: Owner's Authorized Company: Sunrun, Inc. Company's Address: 595 Market St 29t" Floor, San Francisco, CA 94105 Affiliation: Contractor Applicable License: State: MA CSLB#969975.NJ#13VH07020300 711 o;;SolarCity. Date: 06/20/2016 To: Barnstable Building Dept. —� o From: SolarCity Corporation cn Cape CodWarehouse 112 Great Western Rd v w South Dennis MA 02660 cn o0 NOTICE OF CANCELLATION M This notice certifies our proposal to install Solar/PV @ -354 Wheeler Rd will not move forward. The customer and SolarCity have decided to no longer move forward with this project. Please cancel Building Permi B 20166013 and Electrical Permit#20160146 Please contact myself directly with any questions/concerns. Thank you for your assistance. Best regards, )� SuG Nathan Tissot Permit Coordinator—Cape Cod SolarCity Corporation 112 Great Western Rd South Dennis MA 02660 Work#508-640-5389 ntissot@solarcity.com SOLARCITY.COM AZ ROC 2.137711ROC 24545"OC277498,CA.LIC3888104,CO EC8041.CT HIC 0632778/L-LC 0125305,OC a7110148WECC902585.HI OT.29770,MA HIC 169572fMA EL-113WAR,r iD MH;C 1289.48. U3 NJHIC013VH06160fi00f34EB0173Z700.OR CB180493/C562/PS1102,PA HICPA077343.TX TECL27006,WA SOLARC'91901/SOLARC•905P.O 2014 SCLARCffv COAPCRATWf M.ALL RIGHM RESERVED. SolarCity Date: April 6, 2016 TO: Barnstable Building Department 200 Main Street o Hyannis, MA 02601 From: SolarCity Corporation-Cape Cod Warehouse ; E co RE: 354 Wheeler Road, Marstons Mills --1 Permit No.: B-2016-0135 ra w Old System Size: 84 Panels @ 21,.84 kW rn Revised System Size: 54 Panels @14.04 kW Our Job No.: JB-0262231 i Note: Attached are the revised plans for our solar installation located at 354 Wheeler Road in Marstons Mills. Since the permits issued, all the panels have been removed from MP1 & MP2 (a total of thirty-three [33] panels),two (2)panels were removed from MP5 and from the panels removed, five (5)panels were added to MP3. We would greatly appreciate the revised plans be added as a modification to our permits. Same Size: 54 modules @ 14.04 kw-DC. Please contact me directly with any questions/concerns. O Cheryl Gruenstern Cheryl Gruenstern Permit Coordinator Direct Line: (508) 640.5397 cjzruenstei-n@solarcity.com. 112 Great Western Road,South Dennis,MA 02660 T (888)SOL-CITY solarcity.com AL 05500,AR M-8931.AZ ROC 24377VROC 245450.CA CSLB 888104.CO EC8041.CT HIC 0632778/ELC 0125305.DC 410 514 0 0 0 0 8 0/ECC902585.DE 2 01112 0 3 8 6/T1-6032.FL EC13006226.HI CT-29770,IL 15,0052,MA HIC 168572/ EL-1136MR.MD HIC 12 8 94 8/118 0 5.NC 30801-U.NH 0347C/12523M,NJ NJHICp13VH06160600/34EB01732706.NM EE98-379590,NV NV20121135172/C2-0078648/B2-0079719.OH EL.47707.OR C8180498/C562.PA HICPA077343.RI AC004714/Reg 38313.TXTECL270D6.Ur 8726950-5501,VA ELE2705153278.Vr EM-05829.WA SOLARC•919OVSOLARC'905P7.Albany 439.Greene A-486.Nassau H240971000Q Putnam PC6041.Rockland H-11864-40-00-00,Suffolk 52057-H.Westchester WC-26088-H13.N.Y.0#2001384.00A SCENYC:N.V.C.Licensed Dectriclen.k12610.#004485,155 Water SL 6th Fl..Unit 10.Brooklyn.NV T1201 p2013966-0CA All loans provided by SolarCity Finance Company.I.I.C.CA Finance Lenders License 6054796.SolerCl ty Finance Company.LLC Is licensed by the Delaware State Bank Commissioner to engage in business In Delaware under license number 019422,MD Consumer Loan Llcense 2241.NV Ins tallment Loan License IL1023/IL71024.RI Licensed Lender.N20153103LL.TX Registered Creditor 1400050963-202404.VT Lender L Icaise p6766 l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 61 Application.# Health Division BUILDING DEPT. Date Issued N 5�. Conservation Division Application Fe t. e S v JAN 0 7 2016 Planning Dep Permit Fee •6 Date Definitive Plan Approved by Planning Board TO YVN OF BARNSTABLE ' Historic - OKH AfQ Preservation/ Hyannis /Vl> Project Street Address Villages Owner AVM Pr-%za i Address Telephone • 13 . L)X \AX-VT,-,- VaK 66 Permit Request o4 At u (4A lei 4-1 c 5� tl �CPm�c U (.�tTv� 1`�r G ca 1 S 'v�L '1� L ncLS Square feet: 1 st floor: existing ` proposed — 2&1oor: existin proposed Total new Zoning District �� Flood Plain Groun ater Overlay Project Valuation651,BUCK. Construction Type Lot Size Grandf ed: ❑ s A No If yes, attach supporting documentation. Dwelling Type: Single Family ,� Two Family ulti-Family (# units) Age of Existing Structure t5 ist c Ho e: ❑Yes No On Old King's Highway: ❑Yes Flo Basement Type: ❑ Full 0 Crawl ❑ l ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existingCs): n w _ Half: existing new Number of Bedrooms: t' g —new r—_ Total Room Count (not including bmg new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing&[fFNew Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new siFool: ❑ existing ❑ new size)* Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new siz9AShed: ❑ existing ❑ new sizell-Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes I to If yes, site plan review # Current Use 261 den- Proposed Use �h t APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �w' (Jhff- Telephone Number Address o'Z ti Q o License# �S S i�w� CJ�(pCo Home Improvement Contractor# Email f14e(nS Worker's Compensation # Lf-Co)) -� ALL CON , RUCTION DEBRIS RESU TING I " THIS PROJECT WI "BEKEN TO 0 QUw e5 SIGNATURE DATE Im r L � �3O lS FOR OFFICIAL USE ONLY APPLICATION # 1 . DATE ISSUED -MAP/PARCEL NO. f4 r. • ADDRESS VILLAGE OWNER 'S DATE OF INSPECTION: h FOUNDATION FRAMEo R INSULATION - � FIREPLACE .: ELECTRICAL: ROUGH FINAL f _ PLUMBING: ROUGH FINAC°%% GAS: ROUGH FINAL `.� FINAL BUILDING �" \ E DATE CLOSED OUT ASSOCIATION PLAN NO? ' SolarCit . OWNER AUTHORIZATION Job#:��— Dz62z3 f Property Address: S �" l��'�'I � � /Iqlat p' ov D as Owner of the subject property hereby authorize S LA CITY CORPORATION to act on my behalf, in all matters ative to w rk author ed by this building permit application. Signature of Owner: lu Date: SOLARCITY.COM ParcelEdit Page 1 of 1 g • SAAKSTAALE yO MASS, Logged In As: Parcel Thursday,January 7 2016 Frank Schlegel r Application Center Road System Reports Road System The record has been updated. Parcel Detail Parcel ID: 082016 Sewer Acct: 1 I T/R ❑ Update: Devel Lot: Owner: IPRIZZI, ANTHONY R & MARY ELLEN Co Owner: Street: 1354 WHEELER RD City: MARSTONS MILLS State: MA Zip: 02648 --------------- Location: 354 � WHEELER ROAD I Village: Marstons Mills Road Index: 11824 Pri Frontage: 315 To set road,you can also enter road index and tab out of field. Secondary Road: Sec Index: 10000 Sec Frontage: J Visions Location: 1356 WHEELER ROAD Last Updated: 1/7/2016 11:10:40 ANI --------------- No. Bldgs: 11 I Account No: 142821 Lot Size(acres): 2.9 State Class: 11010 I Year Added: 1968 —J Fire Dist: I� Deed Date: 7/15/1994 Deed Ref: 9279/256 Land Value: 470900 Bldgs Value: 170800 Extra Features: 70400 --------------- Condo Complex: _ I Building: Unit: Update http://issgl2/intranet/propdata/ParcelEdit.aspx?ID=5117 1/7/2016 Town of Barnstable Department of Public Works Technical Support Division 332 Falmouth Road Hyannis, MA 02601 \t P 082 , ' \ 082 �� T., 0 -00 31 / (.. / P.0 MA 0 ' 2- 01 0 3i �+ #3.59 ¢' I 082 k -001 369 ...... #354 � -PAP 082 I-016 , basemaps.dgn 1/7/2016 11:13:22 AM Property lines shown on this plan are for assessing purposes only and do not represent actual relationships to physical objects. I t . Town of Barnstable OF Expires 6 months from' e date Regulatory Services Fee - MAE& $ Thomas F.Geiler,Director t6;9. �0 Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY /� Z 6 l of Valid without Red X-Press Imprint Map/parcel Number— � . 3I(o k) hkzlo-C i24 - �s nS �tI��S . Mcx Property.Address p(� Residential Value of Work / l u a Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Flo he.Q.(e d . Contractor's Name�aJ I �1�'4kd SDJTherVl /V• Vv'n ���"�� Telephone Number -I U I �Q VJV L3a0s Home Improvement Contractor License#(if applicable) �/ A Construction Supervisor's License#(if applicable) a X-PRESS PERMIT ❑Workman's Compensation Insurance JAN - 9 2013 Check one: ❑ I am a sole proprietor I am the Homeowner TOWN OF BARNSTABLE I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. �0.g �Rna91?tM�Of' Permit Request(check box) 1�1/On�vLVgt TtL ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ 0OM5 Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side _ #of doors Replacement Windows/U00rliders.U-Value b-3 2— (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required.• ;Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is require . SIGNATUR(:::: A. Q:\WPFILES\FORMS\building permit t'orms\F.7PRESS.doc The Commonwealth of Massachusetts Department of Industrial Accidents Offlce of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Le 'bl Name(Business/Organization/Individual): 5ft / Address: / 3 7 Par 5 PP-1 oL, - Ci /State/Zi : Wt&N5&ckf2 �, ®���SPhone#: 4fo � ? Y Are you an employer?Check the appropriate box: 1.(0 I am a employer with oZ-D 4. ❑ I am a general contractor and I Type°f Project(required): 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 woriang for me in any capacity. employees and have workers' [No workers'comp. insurance comp. insurance) 9• ❑Building addition required:) 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12.❑Roof r 3a.❑ I am a homeowner acting as a employees. [No workers' 13.RLOther r`,f,�0.C.Q rn¢�+1 general contractor(refer to#4) comp.insurance required.] 1�bR *Any applicant that checks box#1 must also fill out the section below showing their workers'compensatiolf�,o6ry informatioa Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the mme of the sub-contractors ad state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'co 'mp.policy member, lam an employer that is providing workers'compensation insurance for my employees. Below is the infor policy and job information. she Insurance Company Name: D Policy#or Self-ins. Lic.#: 4r9, 7 6 9 9 3 S�a 3 ! y Expiration Date: Job Site Address: 3 sa U ho,�I�r 2 d City/State/Zip: Q r-3` U 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here under a pa �enahfirs ojp u that the rnfornratlon provided above it true and correct r CLU Da Ph ��' �� ' �yS� Offleiol use only. Do not write in this area, to be completed by city or town of vial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person• Phone#: r Client#:30124 SOUTNEW ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/02/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Anita Little Willis of Massachusetts,Inc. PHONE AX 100 Huntington Avenue LAM,No Ext`856 914.4600 1 IAIC,No): 856-914-1881 AODREss: anita.little@willis.com INSURER 8 AFFORDING COVERAGE NAIC A Boston,MA 02116 INSURER A:Argonaut Insurance Co. 19801 INSURED Southern New England Windows LLC INSURER B:Beacon Mutual Insurance Company 24017 D/B/A Renewal by Andersen INSURER C: 1137 Park East Drive INSURER D Woonsocket,RI 02895 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 CONTRACTOR 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 UB POLICY EFF POLICY EXP LTR R WVD POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY pEAACCH��OECCCURRRRENCE $ rGEWL MMERCIAL GENERAL LIABILITY PREMISES Ea T.ED nce $ CLAIMS-MADE F-IOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ ICY JECT PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Es accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Pere ddenl $ $ UMBRELLA LIA6 OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION AIC927698352394 8/21/2012 08/21/201 X wCSTATU- OTH- AND EMPLOYERS'LIABILITY IFR B OFFICEWMEMBER EXCLUDED?ECUTNE® NIA 68028(RI) E.L.EACH ACCIDENT $1 OOO OOO (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under OESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Named insured is a Renewal By Andersen Dealer CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1137 Park East Drive ACCORDANCE WITH THE POLICY PROVISIONS. Woonsocket,RI 02895 AUTHORIZED REPRESENTATIVE • - 6L ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S212686/M212684 AXL --'4A .. ' l d WINOOMl9•D00 RE 1 ersen . en . NF'�` Erenchwood Glider 'Vinyl-Clad Wood Frame-, Dual Pane Low E Tempered. Natidd Fenastration'. Glazing with Argon Raling councils Product Type; Sliding.Patio.Doors with'Frame .imam '. ENERGY PERFORMANCE RATINGS U facttir:(U.S)/I P Solar Heat Gain.Coefficient 0 .0'.2 00, 32. ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 4:5 . � . evotacturer 6tlpllale6 thal 00*0 ratJ46 e0ntore to inlica0lB NFAC pl'oClAlreb for delereNldq thole pMOUOi perforeanee.NFRG ralings are 010MIMd for a 11Ced Sol of envlronwnlal conditions fled a fplciile prO AX s�e.ra'RC doa6 not recamo0 eny yrhMet aM d.f not warrant me:6ultabillty o1 any proAtct for eny ape0lflo-uv. Oo6 1t earOttetorer'f literature for Other product pertoreance 100reat100. - •a 1 Qualir/id.in All 56 States Y . "i ' .. �'awdiRed . ..� �•• 1 or 2 Pane •DP +40i •40 SGT 0 96a I80, wK Alloroo 4 Panel DP +3of 30 r illadfAC-, 5lbfDCa(dt 931•1C30 192e 180e wtwl.rxlma.com Frenchwood Glider Tested to ANSI W.NhN i01 JI.S,2.97 or blifactorer's'ti kites ccnforonce to the applicable standard` r tag This product meets Green complies with HUD t�sE4< searsenvironmentat �: standards gareming UM Bulletin ' ' ` energyetociencyheavy. A metals in the frame and No. 111 »><'= w sashmateAals,. `Q packagng,and consumer 700637327PKP-1 C61tt educallonmatenals. bets or exceeds u E.C.,C_E;C., 8 I.E.C.0 Air Infiltration Requirements Kv A ttalimarv,certification Program_. �' KenewaI RI ft#12259/30839 Andersen. RENEWAL BY ANDERSEY Cr HIC.0562725 un MA HI#119535 WINDOW REPLACEMENT an An&—Cm Wy 1137 Park East Drive'Woonsocket,RI 02895 Lead Hazard Control Firm Phone 401.671.6401'Fax 401.671.6262 license#6HCF-0059 ' Southern New England Windows,LLC d/b/a Federal Tex ID#46-0566630 Renewal by Andersen of Southern New England CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name Date cf Agreement A 00(2/2 Z- ALLif do 2Z / -- 6 - /L Buyers)Street Address,City,Sute,and Zip Code 6 w1z a fin iq A 41 ro E-Mall Address Home Telephone Number Work Telephone Number i9Pa, ,j.L-z.1 & z Y 42 1- // S'o k 7-o1L Buyers)herebyjoindy 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 on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this"Agreement"). ,Total Job Amount Q Z Estimated Starting Date: Method of Payment O Check O Cash *nanced Deposit Received(33%): (1) 6 t A 7� Credit Cards are accepted for deposit only-maximum 1/3 of the Balance at Start of Job(33%): Estimated Completion Date: project cost.(Please see Credit Card Payment Form.)By signing this Agreement,you acknowledge that the Balance at Start of job and the Balance on Substantial (,t Balance on Substantial Completion of Job cannot be made by credit Completion of job(33%): card and must be made by personal check bank check,or cash. Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing-any of the terms of this Agreement.Buyer(s) 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.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only)Notice to Buyer:(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the fall unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you.notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explana'on of buyer's rights. Buyer(s)received the consumer education materials provided by the Rhode Island Contractors Registration Board. :` (4qw.s In' X Renewal by Andersen of Southern New England Buyer(s) Buy (s) By: ignaturd of Product Manager ature S' atu Print Name of Product Manager Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. - - - - - - - - - - - - - - -�-C- - - - - - - - - - - - - - - - - - - - - - - - - - - - -%C NOTICE OF CANCELLATION �( NOTICE OF CANCELLATION Date of Transaction f/- G` I L .You may cancel 1 Date of Transaction ' I L .You may cancel this transaction,without any penalty or obligation,within this transaction,without any penalty or obligation,within three business days from the above date. f you cancel, three business days from the above date. f you cancel, any property traded in,any Payments made by you under I any property traded in,any payments made by you under the Contract or Sale, and an negotiable instrument i the Contract or Sale, and an negotiable instrument executed by you will be returned within ten business days 1 executed by you will be returned within ten business days following recelpt by the Seller of your cancellation notice, following receipt by the Seller of your cancellation notice, and any security interest arising out of the transaction and any security Interest arising out of the transaction will be canceled. If you cancel, you must make available I will be canceled. If you cancel, you must make available to the Seller at your residence, in substantially as good i to the Seller at your residence, in substantially as good condition as when received, any goods delivered to you I condition as when received, any goods delivered to you under this Contract.or Sale;.or you may, If you wish,, under this Contract or Sale; or you may, If you wish, comply with the Instructions of the Seller regarding the I comply with the Instructions of the Seller regarding the return shipment of the goods at the Seller's expense and return shipment of the goods at the Seller's expense and risk.If You do make the goods available to the Seller and i risk.it you do make the goods available to the teller and the Seller does not pidt them up within twenty days of the Seller does not pick them up within twenty days of the date of cancellation, you may retain or dispose of i the date of cancellation, you may retain or dispose of the goods without any further obligation. If you fail to the goods without any further obligation. If you fail to make the goods available to the Seiler, or if you agree I make the goods available to the Seller, or If you agree to return the goods to the Seller and fail to do so,then to return the goods to the Seller and fail to do so,then you remain liable for performance of all obligations under you remain liable for performance of all obligations under the Contract.To cancel this transaction,mail or deliver a i the Contract.To cancel this transaction,mall or deliver a signed and dated copy of this cancellation notice or any I signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Renewal by i other written notice, or send a telegram to Renewal by Andersen of Southern New England at 104 Otis Street, 1 Andersen of Southern New England at 104 Otis Street, Northborou ,MA 01532,NOT LATER THAN MIDNIGHT Northborough,MA 01532,NOT LATER THAN MIDNIGHT OF - (Date). i OF !- Cf- if .(Date) I HEREBY CANCEL THIS TRANSACTION. 1 I HEREBY CANCEL THIS TRANSACTION. X Buyer's Signature Print Name Date Buyer's Signature Print Name Date RbA Copy:White Buyer Copy-.Yellow Buyer Copy:Pink i Massachusetts- Department of Public tiafet i Board of Building Re-, and Standards Construction Supervisor License I License: CS 42926 i PAUL H THIBEAULT 26 LESTER ST N SMITHFIELD, RI 02896 1 J . Expiration: 2/16/2013 I Commissioner Tr#: 9563 '� MEMOO fice o onsumer Affada d Busines�sR e 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9/19/2014 SOUTHERN 'NEW ENGLAND WINDOWS LL PAUL THIBEAULT 1137 PARK EAST DRIVE WOONSOCKET, RI 02895 Update Address and return card.Mark reason for change. :-CAI tf 50M-04/04-G101218 Address Renewal Employment Lost Card /e leasrrmeaiuuea o�./�aaacu/euaeQa Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration:`..173245 Type: 10 Park Plaza-Suite 5170 Expiration: 9%19/2014 Supplement Card Boston,MA 02116 SOUTHERN NECK ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON . PAUL THIBEAULT 1137 PARK EAST'DRIVE WOONSOCKET, RI 02895 . - Undersecretary Not valid without signature Assessor's office (1st floor): �_�/� (� -�f SEP71C SYSTEM PP � `�'i`.! Q c�THE Board of Health (3rd floor): Assessor's map.and lot number ..... .. ....... ... .. ................... '��� ` � W�w����o q ALUD IN COMPLIAIF,`XE e Sewage Permit number .... -.�.7.�gL..-. ............ WMI TITLE 5 Z BAMTADLL, S Engineering Department (3rd floor): ENVIRONMENTAL CODE AND 'oo `639. 0� House number ................'.................................................... TOWN REGULATIONS Definitive Plan Approved by Planning Board ________________________________19________ ° APPLICATIONS PROCESSED,,8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF * BARNSTABLE BUILDING' INSPECTOR APPLICATION FOR PERMIT TO ....GO!?�Jv�r......�R!^r?�ie.. A�GI!t1..f./..eOJ. t�1.ti ,.11.ppf?��..,....... TYPE OF CONSTRUCTION ......... . ................................................. .......................................... ............. .........:.............19. A TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: f LL Location ... ( .....?���! �z'/`.:/�C ....... .Pry/. !!L. ....��fi.��.P................................/�/ .. '�............ ........................ ProposedUse ..........:!./.h.A! ir-le........................................................................................... Zoning District ......e.F.............................................................Fire District ......O.fr G ! .It�d/.1/......:............................... /� r Name of Owner Q/'�... . .�i1`��iaH. ........ 1 2.4.. .............Address ............. . . ..� et . .......... ltr 1/l/�.....�......2� 'Name of Builder .........(/ .�jy..... .......................Address ....../ Lovcl/s.. sz....mg/6Tl!s. ���........... Nameof Architect ...... ..............................................Address .................................................................................... Number of Rooms ...........�-......:'...........................................Foundation /0...tl�...... /..!y9r ................................ Exterior .......... ........................................Roofing .....�*.e.✓.. ...���4. ...............................:.... Floors ......AIAer4..E!!ea4Q Ad../te. .........................Interior ..... f����C.f"�^eG! .................:............................... Heoting ......4.! .�i................................... .........................Plumbing ..... Fireplace .�................................... ........ Approximate roximate Cost .............../? � 4.!.�.........pO....l o........................ . . . . 7/�...X.. tel. 32�Area Diagram of Lot and Building with Dimensions �ij Fee ` '7 �. /.dY.�'................ moo_ OCCUPANCY PERMITS REQUIRED FOR NEW DWECL"I1�G—S— I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable'regarding the above construction. Name ........ . ............ .. .. .... Construction Supervisor's License ..!fffMJ`Y PRIZZI, ANTHONY DR. -Permit for ...5.IA;L I.CI...Gar.age-. S.in.g.je:..F?kMily...1).we.1.1ing............ Location ..356 Wheeler Road .............................................................. Marstons Mills ............................................................................... Owner ....P)r.t Anthony Priz z i ......... Type of"Construction ...Frame ............................ .... ....... . ............... ................................................................ Plot,; .......................... Lot ................................ ...........19 89 Pe'rmit Granted ........ ,,Date of Inspection .... 19 Date Com,,l ted ........ .................19 (C �'J -� re _{, a _ 3 r T tar a. z .. � � �. .,.. ._ -_-.. ._yy�✓,.-. ., � .-.� ..�. e�..Y-- ,,.t.. �;�U -Avis'.- a„ ,..__-+•'.uc..'1'Jci..:.._ .::�5',,. 1_;�.'.>.,=t.�--:-�..:.,<,.„`✓�,:.r —.- c.c Assessor's office',j1st floor): N� Assessor's mop, and lot number ..... .. � ......... °*TEE tO f Board of Health .(3rd floor): e�Q Sewo,ge Permit number .... -.�..7-g ...-.. .... i B�9?ADLt, J Engineering Department (3rd floor): �, oo `639. 0� House number .::..........................................�.:....................... ''�oraY°� Definitive Plari Approved by Planning Board ________________________________19________ . r APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only - TOWN: OF BARNSTABLE RUILDIHG JNSPECTOR APPLICATION FOR PERMIT TO G ... 4Trv�T TYPE OF CONSTRUCTION ...........�Q .S.�./�✓no� riY. .............................................................................::............ A.? .................. ..................... ?. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �.�� GIi,Gi 1��✓r...�i!X �7 hr .5. ...............Location !..:......f..h...... /�.r�P ....................... Proposed Use ............0!h0!?.9........�". O!?i......�...�.Qra, .....................................:.................................................... / _... _ Zoning District ...... ... .........Fire District ...... r. �l f!�,fov i !.................................... Nome of Owner p/-..14. n.e4x....... ! 1.?Zd ,................Address „�i f ��/ ....�� ...... =�.�f���!.��s.... .. Name of Builder ........./.G.`f'.y.....T. f�.....................:Address .......�...�... .Lev„� f.. !?.... �{s s.s„ Nome of Architect ...............................................................Address ...............................:I..................................................... Number of Rooms ...........`............................................:......Foundation �..��...... v,//., � Exterior ...:.......G<1_1a!u.r...��.r?�ti �,%�................. ...Roofing ..... �./T...�`l <.,, -GS r .................................... Floors y W•lid;?/✓Gt ;s; �r. ..........................Interior .......f!> •fi^or..! ...................................,:........... Heating 'f? .................................. ..........Plumbin �/f.G!`G............ Fireplace .......`.........J.............................................................Approximate Cost ............... .............:....... ed p / Q Area �!^....C?.��1.7.. ....-��..� Diagram of Lot and Building with Dimensions I Ol Ot Al fa f Fee ........ !.../C ................ W OCCUPANCY PERMITS REQUIRED FOR NEW DWE'L' -NGS--,._ e. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ............ Name l' " Construction Supervisor's License .. �.!.............. PRIZZI, ANTHONY DR. A=082-016 0/4 No Permit for ...Build...Gaxag.e. .........SiRgle...Family...Dwe.11ing...... Location .....356....Wheeler...Road................. Marstons Mills ............................. ............................................. Owner P.r.i.z.z.i.................... Type of 'Construction .........Frame ...a...me...................... ............................................................................... Plot .................... Lot ................................ Permit Granted ...July...1.8..................19 89 Date of Inspection ....................................19 Date Completed .......................................19 FI E Tp Town of Barnstable *Permi # ' 3 ti Expires 6 months from issue date BAR vsrnBLe. : Regulatory Services Fee 3� HAss. . 039. ♦0 Thomas F.Geiler,Director A,Fo , 6-3-03 Building Division Elbert C Ulshoeffer,Jr. Building Commissioner o 367 Main Street, Hyannis,MA 02601w PRESS PERMIT Office: 508-862-4038 JU N3e1003 Fax: 508-790-6230 EXPRESS PERMIT ot Valid without XP PPLress IpCATIONTOWN OF BARNSTABLE rint Map/parcel Number Property Address 357� Residential OR ❑ Commercial #4174 � ' Value of Work 0 Owner's Name&Address ,3 Sr Ld �,�� A" Contractor's Name % elephone Number -, ,�i Y �j Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Wetcnan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I a,whe Homeowner have Worker's Compensation Insurance Insurance Company Name , Workman's Comp.Policy Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side a teplacement Windows. U-Value _(maximum.44) ❑ Other(specify) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature expmtrg i HOME IMPROVEMENT INSTALLATION CONTRACT Branch Name:Aewbvloy, Date:_��=� /V1 Sold,Fumished&Installed by The Home Depot Installed Sales Branch Number: Job#: y30��� 345A Greenwood Street,Worcester,MA 01607 Toll Free(800)657-5182; (508)756-6686; Fax:508-756-2859 Federal ID#75-2698460 RI Cont.Lie#16427 CT Lie#565522 MA Home Improvement Contractor Reg.#126893 Installation Address: S L, City 1 State Zip Purchasers : Work Phone: Home Phone: Home Address: -?. lh izh« er 914 W (if different from Installation Address) City State Zip Project Information I/We("Purchaser'),the owners of the property located at the above installation address,offer to contract with The Home Depot("Home Depot")to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet#1(Y 7y0 ,incorporated herein by reference and made apart hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home or because work required to complete the job was not included in the contract. DEPOSIT PAYMENT OPTIONS (Subject to fund verification and/or credit approval.) y /� 1. Check,Cashiers Check or US Postal Service Money Order CONTRACT AMOUNT $ // rJ (made payable to The Home Depot). *LESS DEPOSIT $ 1?Q 2. Credit Card*and/or other payment options-Circle One Below BALANCE DUE Visa Mastercard Discover American Express ON COMPLETION Home Improvement Loan Home Depot Credit Card *25%of Contract Amount due upon execution of this Available Credit:S �,9 000 (IUL&HDCC ONLY) contract.One-third(1/3rd)of Contract Amount is required Exp.Date: for MASSACHUSETTS RESIDENTS ONLY. Q /,r Name as it appears on card: ///J//JO%lI/ Indicate Payment Method For •Bv niy/our signs re belo ,1/We a w The Home Depot to charge the BALANCE DUE ON COMPLETION` �abovcreferen cred' a for th t' dicated.l olders Sign ure Date If this is a finance transaction,the agreement for financing is contained in a separate document,which is incorporated herein by Reference,and made a part hereof. At-Home Services Credit/Loan Application Ref.# Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate and pay any balance due(unless the job is financed,in which case,upon submission of the executed Completion Certificate,Home Depot will be paid in full by the lender). Purchaser also agrees to bejointly and severally obligated and liable hereunder. For Mass.Residents Only: Contractor,at owners expense,shall procure all permits required by law as follows: Owners who secure their own permits will be excluded from the guarani),fund provisions of MSL Chapter 142A. Unless otherwise noted within this document,this contract shall not imply that any lien or other security interest has been placed on the residence. Entire Aereement: This agreement and its attachments,including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign any Completion Certificate or agreement stating that you are satisfied with the entire project before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 25%of the contract amount if the job is cancelled by Purchaser AFTER the third business day. BY MY/OUR SIGNATURE BELOW,I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. If-WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MYiOUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT AND RvIA HOME SERVICES,INC.,A HOME DEPOT AUTHORIZED CONTRACTOR, TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM /JFROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. SUBMITTED BY: J �/Y Date: ales Want P ACCEPTED BY: Date: F l i H n eownc Date: Homeowner NOTICE:ADDITIONAL TERMS,CONDITIONS A\7)IYARRANTIF_S ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT white—Bnnch File Ycllt —Costumer Pink—Sales Consultant 7-18.02 C-SC WINDOW SPE9IFICATION SHEET - Spec. Sheet #: 1 6 4 7 9 O Sheet: of Customer: Job#: -2Ronsultant: / / ?//�L' �iP� Date: Existing Window New Window Orig. Measure: SC Re-Measure: FI Grids Pattern' Window Hinge Locations s t Rough Opening c =o &Glass MISC. Csmt,CPC,Bay,Bow, Rough Opening Size o 0 WLocation Style Metal Style Series c Tip-to-Tip n o '� .L N Options Items Patio&Garden Doors f H (Room/Floor) "Code" Y`/N "Code" "Code" U Width Height UI Width Height UI 1' 0 > 2 "Code" 'Code" (from outside,Lt to Rt) 3 0 bra/ W Q o14 3 �- S c 4 RaA a Al 6lr- 3.1 sA s' 5 N DH 'Soo ►✓ s g a 3 AC l �/ _ inn LA 3 ya w 3 A SIC A 3 � SC 1�rf a D Grr�o �✓ 3 �g o S W 4 3 a 1 SC l��t- d/,� iY Alt 6sva w a �� S �✓ s 10 v✓ 7,9 /4rf- a c3 01/ /t1 L sbo w ay 12 Reli. ,�X /f 6/00 UI 3� !3 — 00 S� For every window sold with grids,the Grid Pattern MUST be indicated. COIOr Of � G ' For Csmts,CPC,Bay or Bow,use'L`,'R'or`S'(Stationary). For Patio&Garden Doors,use'S`(Stationary)or'X`(Operating). Window/Door Wraps BAY/BOW WINDOW GARDEN WINDOWS Projection Angle: (Bay:300 or 05o]i Top of Window to Soffit (inches) WALL THICKNESS° (inches) Bay window Flankers-DH/Csmt. Width of Overhang (inches) SEATBOARD MATERIAL Seatboard Material-Birch or Oak If tied to Soffit,color of Soffit material Specify Birch or Oak Veneer or White Pionite New Interior Casing(Say/Bow/Garden/Patio Doors) Construct Roof 3 (Yes/No) ° Additional charge for wall thickness of 6"or more. Clamshell(CL)or Colonial(CO) 3 There is no guarantee that new shingles will match existing color. ,f I ha re w nd agr a with all of the SPECIAL CONSIDERATIONS: A-.)' tMWe d �,� job e ' I tion escribed above. er ature Date 7-2-02 SA-W-SD WINDOW SPECIFICATION SHEET - Spec. Sheet #: 164789 Sheet: of 4 Customer: tL2 Job#: 0W Consultant:fi /�LIiY/i�L� Date: Existing Window New Window Orig.Measure:SC Re-Measure: FI Grids Pattern' Window Hinge Locations 2 ac Rough Opening c c & Glass Misc. Csmt,CPC,Bay,Bow, .. Rough Opening Size g o M Location Style Metal Style Series C Tip-to-Tip e, o 2 N Options Items Patio&Garden Doors CJ r _ L (Room/Floor) "Code" W N "Code" "Code" U Width Height ul Width Height Ul U � > 2 Code" "Code" (from outside,Lt to Rt) t o Al 0� 1 �:W i✓ 'ag' 3� G s h/ A 3 � 96 kvo l✓ 3 ifJl ti P)7' ks i✓ 7 s �,✓ a- s C 4 0d� l � h/ r oo -W If '79 � W a sr 7 8 9 10 11 12 ' For every window sold with grids,the Grid Pattern MUST be indicated. Color of ' For Csmts,CPC,Bay or Bow,use"L','R"or"S"(Stationary). For Patio&Garden Doors,use'S"(Stationary)or"X'(Operating). Window/Door Wraps a C/� c BAY/BOW WINDOW GARDEN WINDOWS Projection Angle: (Bay:30°or 45) Top of Window to Soffit (inches) WALL THICKNESS° (inches) Bay window Rankers-DH i Csmt. Width of Overhang (inches) SEATBOARD MATERIAL Seatboard Material-Birch or Oak If tied to Soffit,color of Soffit material Specify Birch or Oak Veneer or White Pionite New Interior Casing(Bay/Bow/Garden/Patio Doors) Construct Roof 3 (Yes/No) ° Additional charge for wall thickness of 6"or more. Clamshell(CL)or Colonial(CO) 3 There is no guarantee that new shingles will match existing color. I have revie agree wilt-all of the SPECIAL CONSIDERATIONS: 1,1414 yt,�,�J 1Y�(jWl 'el jobs I ns described a ove. o gna Date 7-2-02 SA-W-SD f Board of Building Regulations and Standard; HOME I VEMENT CONTRACTOR R o: 6893 plement Card Home Depot At MARK AU DE TT e 3200 COBB GALLS `#26 � :ALTANTA,GA 30339 'Administrator