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HomeMy WebLinkAbout0258 WILLIMANTIC DRIVE C Town of Barnstable *Permit4,�Q IS 030d Evbw 6 aro in"date Regulatory Services Fee Richard V.Scab,Interim Director Btdlding Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis;MA 02601 _ www.town bamstablemkus Office: 508-862-4038 Fax:508 790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid withara Red X-Piress imprint M&parcel Number D d So Property Address 62 idential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address l>/k.4 Q-0—Yq-A4A` o7S Gl>i//imrh�«-/J� 1710-rocs Metl-S 1#A 07.i6j4P- Conbwtor's Name A SO Telephone Number T O/—7/1`4 3" Home Improvement Contractor License#(if applicable) aZ t'o Email- Construction Supervisor's License#(if applicable) Q7(Do 7 Workman's Compensation Insurance X-PRESS PERMIT Check one: ❑ 1 am a sole proprietor MAY pH Y 2� ❑ I am the Homeowner 20 Y5 I have Worker's Compensation Insurance TOWN OF B A B N S TA B L E Insurance CompanyName lieuA14,8 C�3 ° Woikman's Comp.Policy# W 1 2- ' Y - Copy of Insurance Compliance Certificate must accompany each permit Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping_ Going over existing layers of roof) Re-side Replacement Windowsldoors/sliders,.U=Value 3 O (maximum 35)#of windo #of doors: Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. Where=gmre& bgmcc of this permit does not exempt comptimce with other town&wAment cegtilab=%i t.H'imne,Coumvation,eft. ***Note: Property er gn Property Owner Letter of Permission. A copy of H Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: T:MVIN Muilding Changes S RESS.doc Revised 061313 i IN_ Consw e_ A hozeairs and Business Regulation . �� 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improver�ienf Contractor Registration - - Registration: 126893 - Type: Supplement Cana THD AT HOME SERVICES, INC. - Expiation: 8/3/2016 ANDREW SWEET 2690 CUMBERLAND PARKWAY SUITE 300: ATLANTA, GA 30339 - - - Update Address and return card-1-lark reason for ehnriae:,_ SCA I _. 20>a osni J Address i_� Renewal Gmploymcnt f—I Lost Card �e�a�runeaaeuFetil/�o�C�/�lrie�ric•�ci�c/C `. —Office of Consumer Affairs&Business Regulation License or registration valid for individul use only _ before the expiration date. If found return to: y _:�•LOME•IMPROVEMENT CONTRACTOR P� Office of Consumer Affairs and Business Regulation y Registration:< j.26893 Type: 10 Park Plaza-Suite 5170 Expir6ti&ift3/2016;,.r;; Supplement Card Boston,MA 02116 THD AT HOME SERVICES;ANC:, THE HOME DEPOT�ATHOME==SERVICES ANDREW SWEET.-_�..` ":=.W 2690 CUMBERLAND PARKVIlAY S AM,GA 30339 Undersecretary Nov i wit ut signature The Commonwealth of Massachusetts Department of Indus&W Accidents Offue of Investigations tv "0 WashhWon Street Boston,MA 02111 www.massrgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AApalicant Information Please Print Lem'biy Name(Business/Organization/Individual): 0-me- 24„5 Address: 10g 6 o 54VO City/State/Zip: S v AA4. 0/Sr4' Phone#: SO S- e ou an employer?Check the appropriate box: Type of project(required): 1I am a employer with 4. r'1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.t 7- ❑:Remodeling ship and have no employees These subcontractors have S. ❑Demolition workingfor me in an capacity. workers'comp.insurance. Y �ty- 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.RrOther wl 0 90 comp.insurance required.] *Any applicant that checks lox#1 must also fill out the section below showing their workers'compensation policy info I Homeowners who submit this affidavit indicating they are doing all work and then hire outside conaacturs must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of tln sub-contractors and their workers'comp.policy information. I am an employer Burt is providing workers'compensation insurance for my mW16yees. Below Is the policy and Job site Information. -f M&A� Insurance Company Name: #440,41rc -YJ�$ . (�o Policy#or Self-iris.Lic.#:_w C, 0 / I y < 3 Expiration Date: 3 a o/to Job Site Address: Q� � a `(/IV A-1u 1c, City/state/zipArams. i (S Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$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 D for. ce coverage verification. I do hereby certify uR his pmaides of perJpry that the infonnauou pr»vidrd is byre and correct i ature: / Date: `J Z Phone#: 'e-2) J tO ��- Offxk/use only. Do not write in this area,to be conrkted by city or town offkJai 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#: The Commonwealth of Massachusetts Department of Industrial Accidents ixOffice of Investigations s= I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 'T-d ��L/rjQ /ICXo Address:_ S Uhi-So lul 1(4 City/State/Zip: t kkOfv& d 73'd Phone #: 771 — 76d -L3 Z5'_ Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I wn a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that cliecks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: ��.1 /� Policy#or Self-ins. Lic.'#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $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 certi y nder the pajVsand en ies of erjur that the information provided above is true and correct. ----- - — Si ature:. ... - - — - ----�Date - --- — ----- Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: HOME n►ipROvEMENT:CONTRACT". PLEASE READ THIS Sold,-Fbritished and Installed by.' Brunch Name:Boston North&South Date:�/� 'THD At-Horne Services,Inc. d/b/a The Ilome.Depot At-Home Services Branch Number:31.and 33 908 Boston'lumpike,Unit 1,Shrewsbury,.MA. 01545 Toll Free 877-903-3768 federal TD#75-2698460;W Iac#C W439;Ri Cont.Lic#16427• ,, J Cr Lac#,MC:.0565522;MA Home improvement Contractor Reg.#126893 Installation Address: ,j /1 / !1 � 1`/ Tit S /�CS /—� O C� City State Zip Purchaser(s): Work Phone: Horne Phone: Cell Phone: gtncu 113B94 36 6 Home.Address: (If dill'ercrtt loom Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): 0 i'DO NOT wish to receive any marketing emails from The Home Depot Project Information: Undersigned("Customer"),the owners of the property locatod at the above itlstallatioti address,agrees to buy, and THD At-Houle Services,Inc.("The Home Depot")agrees to furnisb,deliver and arrange for the installation.("installation")of all materials described cm the below and on the rctcrunecd Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: (16W aRe&—) p u�: S Sheet(s) Pro'ect'Amount p Roofing Siding wwodows U insulation 00utters/Covers ❑Entry Doors El 5S a,? $ 6 Rmrzno Siding Ll Windows El Insulation J Gutters/Covers ❑Entry Doors ❑ $ Roofing MSiding 0 windows ❑insulation ❑Gutters/Covers [I Entry Doors❑ $ Roofing USiding U Windows U insulation $ ❑Gutters/Covers ❑Entry Doors ❑ Mmimom25%Deposit of(contract Amount due upon emmudon of this contract. Total Contract Amount $ / �y Marne Purrh+sers may not deposit more than tmo-ihird tithe ContrtictAmamt Customer agrees that, immediately upon completion of the work for each Aruducl,Customer will execute a Completion Certificate (one fnr each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this :Contract agrees to he jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Products)included he:rtan,at its discretion,if The Home Depot or its authorized Service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing-errors or because we irk rcquiro d to complete the job was not included in the Contract. Payment Summary: The Payment Summary#L--Y 21,, included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. in the event-of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any,other ... amounts set forth in this Agreement or allowed under applicable law, THE.HOME DEPOT MAY WITHHOLD AMOTINTS OWED TO THE. HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and1be Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and installation_This AYrncut cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has reed,understands,voluntarily accepts the terms of and has received a copy of this Agreement. pled by: J Subn't by: c r X 4�(al,6�000 16 -4 Custome s Signature pYate Sales C sultant's ignature Date X Telephone No. kb..91- Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL 'PHIS (ar applicublc) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TU THE TOME DEPOT BY MWNIGUT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. _THE STATE SUPPLEMENT AT• ACHE&---_HERETO T CONTAINS A FORM--- O _T USE IF ONE IS SPECi.FiCALLY PiiESCRIBED BY LAW IN CUSTOMER'S STATE. "'NOTICE AD1)ITI..ONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 10-28-14 White—Branch File Yelow—Customer n led WdtVV:Z TTOZ ZZ '^ON ZLZZZ9£809: 'ON XUA Pp6wer: W021d i . ag Ba-. •�Sct4^e�oiR.is 5�•t2� a W rii R33 k> � .. � •tary�.1•ca�..�i;�1Y'+`}� '•%��f� Ai:;;r,'1& ed�'�A �.t R� '�iPCi�W li �{� 1. L f=:ps+' E CS-070077 .OSFAI UAR'j`�! ! F•A W.ST WA/ii NA.M MA t Y .. w q?t4st>,g:[?4ca T16 ► ffite,if l-matite Attain dC Basis",%4gtolnl�t+s .'.s. HOME IMPROVEMENT CONTRACTOR. j Expiration. 4/B1e2P17 �Y � c " SS Far St P°�,^°^� 4'V Town of Barnstable *PermdA0/ Expires 6 mont s • Regulatory Services Fee • seaNsrEM, ; M"M Richard V.Scall,Interim Director 039. Building Division _ S� Tom Perry,CBO,Building Commissioner W� 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION` — RESIDENTIAL ONLY 02104:�o Not Valid without Red X-Press Imprint Map/parcel Number V Property Address residential Value of Work$ 6.3 �7'+ , MAinimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number -0/ 7/V-4 9 Home Improvement Contractor License#(if applicable Email: Construction Supervisor's License#(if applicable) q 7o:2 77 Y. ,., Workman's Compensation Insurance Check one: ❑ I am a sole proprietor OR 17 2014 ❑ 1 am the Homeowner ' I have Worker's Compensation Insurance aWN LeInsurance Company Name e� � � ®FSARAj,3ZA9 Workman's Comp.Policy# W 6- 0-01910 0 P t- Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value g 3 y (maximum.35)#of windo jo #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property er sign Property Owner Letter of Permission. A,copy of H Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: TAKEVIN_D\Building Changes\EXP S XPRESS.doc Revised 061313 Department of Industrial Accidents Office of Investigations 600 Washington Street �;. Boston,MA 62111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/]Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): sg_l ✓/ Address: 5^ - &(J— City/State/Zip: L" 303 Phone#: f '" 5-" f Are you an employer?Check the appropriate hox: Type of project(required): 1.El am a employer with 4. 41 am a general contractor and I ❑New construction employees(full and/or part-time).* have hired the sub-contractors 6.2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees.. These sub-contractors have g, (]DemoLtion working for me in any capacity. employees and have workers' 9. ❑Building addition comp.insurance) [No workers' comp.insurance re wired. 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions q ] 3.❑ I am a homeowner doing all officers work have exercisedr I L❑Plumbing their Plumbin airs or additions re myself.[No workers' comp. . right of exemption per MGL 12.E]Roof repair,s q ]t c. 152, §1(4),and we have no insurance ie uired. 13MOther W Al )U_w employees.[No workers' n�n comp.insurance required.] �'(vffi *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new'affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors arid state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and)ob site information. /� , Insurance Company Name: / ew . llam sf?/iGl-e- .L/�✓5 © .- . / Ll® Q v2 Policy#or Self-ins. Lic.#: VV C 0 /.I 10 Ex piration Date: 3 / ZR, w� ��� Job Site Addres a J a s: � City/State/Zip:&R57Zks Attach a copy of the workers'compensation policy declaration page(showing the policy number and expira(Rp date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of —Investigations of the DIA for ins cd coverage verification. I do hereby certify under th p 'rs and p nalties o ry that the information providedov is true and correct -4 1 '��� Si ature: Date: _ Phone# Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I The Commonwealth of Massachusetts ._ Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 f=' Boston MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 1 S Uhi-Sb iU GU City/State/Zip: l kLO & M'd Phone #: 7 7`( 764 -L3 Z3,_ Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ 1 am a employer with -4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the poliey'and job site information. Insurance Company Name: 1A)S Policy#or Self-ins.Lic.•#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$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 certify,4nder the pahis and en ies of p er'u that the in ormation provided abo a is tr ie and correct. Si ature: Date . ._._. . Phone#: 7 77— 744-2 92_5 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# I Issuing Authority(circle one): I.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: HOME 510PROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name:Ttuu ton North&South Date: /�/ THD At-Hume Services,.Inc. d/b/a The Home Depot At-Home Services. Branch Number:31 and 33 908 Boston Tumpilte,Unit 1,Shre%vsbury,MA 01545 Toll Free 877-903-3768 Fcsdertil ID#75 2698460:ME Lac#C 02439;Rl Cont.Lac#i6427 p- ' Cr Lie#HIC-0565522;MA Home Improvement �Contractor Reg..#126893, Installation Address: & city stateP.. Pu>rcltaSer(s)r ' Work Phone: Home Phone: Cell Phone: Q ant [ I [ I 1Lt l . Hotge A.dilrc'ss:' . (ifdi_fiermt from installation Address) City State Zip E-mail Address(to receive ptojtd communications and Home Depot updates): ❑I DO NOT wish to receive any marketing emails from The Home Depot ro'ect F me ormation: Undersigned("Custor"),the owners of the property located at the above instal ladoo address,agrees to buy, and At- tune Services,Inc.(`"The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectiv8ly, "Contract"): Job#:•c>a+ ttd—t Produew.. Spec Shest(Q k P t Amount Roofing U Siring _Windows bsuiatlm V 1� Gutrcrs/covers ❑hatry Does❑ � �l a u � $ 6 3 4:91 � Roofing siding Ll Windows EJ kulation ❑Guttera/Covers ❑Entry Doors ❑...--__-- Roofing ElSiding Windo-w 0 instdation ❑Guttus/Covers,❑kntry.Doars❑ $ ❑Roofing SidnoU Windows 0 Insulation $ ❑Guttcts/Covers ❑I ntry Doors ❑ bfim t 2596 Mposdof Cmhtad Atmmtt dtr upm emoibm of this eoahlat:t Total Contract Amount $ Main PurehvA ie aw not deposit moire than one-tldrd of the CordradAmtr®L 6 Ctistonter agrees that.immediately upon completion of the work for cacti Product,Clutcuner will execute.a Completion Certificate (one for each Product as refined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under thin Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any Individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental haZards such us mold,asbestos or lead paint,other safely concerns,pricing errors or because wdric required to complete the j6h was not included in the ContracL Pavaient Summary: The Payment Summary# 0 s� included as part of this Contract, sm forih the total�- Contract amount and payments required for the deposits and fmal payment's by Product(as applicable). NOTICE.TO CUSTOMER You are entitled to a completely 5lled4a copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there IS-One Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Produa Is complete. In the event of termination of this Contract,Customer agrees to pay The How Depot the cods of materials,lah(w,expenses and services provided by The Home Depot or Authorized Service Provider through the date of terminations,plus any Other amounts set forth in this Agreement or allowed under applicable law. THE HOME,DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WTI'HOU'1' LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. .Acce ranee and Authorimffttn: Customer agrees and understands that this Agreement is the entire agreement between Customer 'AM ome Depot with regard to the Products and Installation services and supersedes all prior discussions and a'greeritc nL%,.citber oral or written,relating to said Products and Installation,This Agreement cannot be assigned or arumcled except by a writing signed by Customer and The Hoene Depot.Customer aelmowledges and agrees that Customer bas read,tmderstands,voluntarily accepts the terms of and has received a copy of this Agrom=t. Accepted by- Submitt L,r 9-Il f X I - 7 !`7 Cost s Si lure Date Sales Cons tant's Si tune Date X Telephone No. e7!d Ti SIS Custonttr's Signature Date Sales Consultant License No, CANCELLATION: CUSTOMER MAY CANCEL, TMS (as apphcahle) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THIS HOME DEPOT BY MIDNIGHT ON THE THIRD BUS1t m DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECMCALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL.TERMS AND CoNlorrIOM ARE STATED ON THE REVERSE SIDE LAND ARF PART OF THIS CONTRACT 11.08-13 . . W hlte-Branch File Yonow-Customer Tel WHBb:L OTOZ SZ 1-00 TL2'ZZ9280S: 'ON XUJ pe6mf: WOaj <i ce o onsumer an usmess a ation 10 Park Plaza - Suite 5170 Boston, N*sachusetts 02116 14ome Improve�'Contractor Registration RegMvMon: 126893 i t 3uppim"M card +�t tk)h; 8=014 The Homa De t,At-Home Se ANDREW SWEET ,o -- 2690 CUMBERLAND PARKWAY 10 . ATLANTA, CA 30339 s •:`. Opdate Addrm and return card Mark reason for change. ❑ Adams p anal ❑ "oployd"t ❑ Lod card DPS-GA1 O SOM4 0"101@1a Ogee o fi"W vde Spa"' o% License or rogb ftdon vdw for individul user only E NPROVEONT CONTRACTOR %r ' before the a:piratton dam. It togad r}+tura to: Office of Container AfYafn and B Regulation Type., 10 Park Pine-SWte 5170 �L,xptq # SupptemeM Card Boston,MA U116 ANDREW SWE 26W CU M VOPr .GA 908�� :,,; . Uadenecr etary _ iggdare 'm w1 ; e partm e, li c,r. r d RegWations and Stan ' q -%l .,--_, •yY; w rye P `�I iq �!*�? I ��_ License ,- CzS-0 1 C)U7 f 10 s �.,.. .u: .. ... I I li A 1 -7 Y P ►erg 2 `... tie C()ixstl nit ME IMPROVEMENT CONTRACTOR - 3 49 Tyoe,. p i rati on: 1A U20 -';Sf�♦ � ' - d fi '4T�i� k 1.u. 1 i Remodeling •rfi. Y t 1 .y'q' % y Duarte " - a I I St*Wareham , , M r, _ f y May 11, 2013 Barnstable Building Dept. The following is a list of our approved sub-contractors for The Home Depot: Ericsson Torres — CSSL # 100546 HIC # 163528 Michael Viola — CSSL #•099403 HIC # 140993 Vincent Smith - CS # 106837 HIC # 165927 Timothy Thomas — CS # 51899 HIC # 152121 Ronaldo Solano — CSSL # 101027 HIC # 152206 Joseph Duarte - CS # 70077 HIC # 132349 Douglas Szynal — CSSL # 103950 HIC # 146142 Brian Laroche — CSSL # 100478 HIC # 152612 Joseph McKeon — CSSL# 98863 HIC # 132614 If you have any questions please contact Mike Bedard our permit coordinator at 508-962-6942 or myself at 617-438-9017. S' erel �— uss one Bra Installation Manager THD At-Home Services,Inc. 908 Boston Turnpike- Unit 1 •Shrewsbury, MA 01545 Phone:774-275-2139•Fax:508-845-6076•Toll Free:800-657-5182 � I �( G2IfZ � ZO' � Gz � a �- '' 3S Zol �k OZ �f z ��� 3� Id 6 � 6q r 576 07 . Town of Barnstable *Permi0Q * Regulatory Services Fee > 6 m�� bf MM J Uchard V.;3eali,Interim Director Building Division Tom Ferry,C110,Building CommlWoner 200 Main Street,Hyannis,MA 02601 www.tawn.bamstable ma ns Office: 508-862-4038 Fax:508-790-6230 EXPRESS PEA APPLICATION - @DE.NT[4L ONLY /1t� Not VaUd whhow Red X Press Imprug Map/parcelNmnber v Qeo Propmty Address o2,51— 921 1-'V I A-M-1 di A �S l iderdial valve of Work$ 6 ��'+ Minimum fee of$35.U0 for work under$b000A0 Owner's Name&Address��' ��`ylyf A 1/i e c-- 2 Conttactor'sName ' 1,69,Wh A Telephone Number Home Improvement Contractor License#(if applicable} la(c Email: Construction Supervisor's license#(if applicable) 0 7 77 r Workmen's Compensation insurance Check one: _b ❑ I am a sole prWrieter ® lam the Homeowner I have Warlues Compensation Insurance Co Insumuce Corupany Name r� d7�a 9�Sl it /� ' Worlcman's Comp.Policy## Copy of Laurance Compliance Certificate must accompany each permit. PERMIT SERVICES LLC 4 2 6' I PERMIT PAYMENT RECEIPT TT�OWN OFGGB RpN�SIABLE 200� § TREETMENT HYANNIS, MA 02601 DATE: 04/17/14 TIME: 12:57 --------------TOTALS_- ------ PERMIT $ PAID 37.10 AMT ANDERED: 37.10 NG APPLICATION 37.N 0 PLICATION NUMBER: 201402425. PA1' NT METH; CHECK PRINT REF: 4267 PERMIT PAYMENTTTppRECEIPT TOWN OF BLE BUILDING DE MENT 200 MAINHYANNIS, MA 02601 DATE: 04/17/14 TIME: 13:00 ----- ------TOTALS--------------- PERMIT $ PAID 35.00 pA T APPLIED 35.00 CHANGE: .00 APP ICATppION NUMBER: 201 02427 PAYME�T REFH, 4267K I . i Town of Barnstable .. Regulatory Services Thomas F. Geiler,Director P TOV1.111N, GF Building Division "�ftT� 'a i AAgNCPAAT.R, � 9 ass $ Tom Perry,Building Commissioiet� �'F�� f• t659 �0 cup 4., � +._J r u 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fay: 508-79 -623 t 7F71'ee. HOME QQCUPATION REGISTRATION Date: � f I Name: v�?'mac- �K Phone#: �5 -o?— 3 G 7 4 6 -'j Address: � _ (nl t�I�w.�,,.h�2 in Vg- Village:_ _ A�✓7.FaK� /,1�i l J1 Name of Business: Type of Business: LAJr-t-b -�a iw..-1— Map/Lot: _� (�o 0 EVTENI': It is the intent of this section to allow the residents of the Toanm of Barnstable to operate a home occupation �iithinn single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discennible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase im traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of night subject to the followirng conditions: • The activity is carved on by tine permanent resident of a single family residential dwelling unit,located«Rthii that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary ii residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of nornnal residential volumes. • The use does not involve the production of offernsive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no'storage or use of toxic or hazardous materials,or flammable or explosive materials,inn excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length acid not to exceed 4 tires,parked on die same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit.. 1,the undersigned,have read and agree«zth the above restrictions for my home occupation I am registering. Applicant: Z�2Date: Honneoc.doc Re%•.01/3/08 YOU WISH TO OPEN A BUSINESS? For Your Information: ' Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.--it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completedform to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. . ,7.F 'f 4c 5 r _ �� m ,DATE: �/� , r ^Fill in please: { 5 r APPLICANT'S YOUR NAME/S: C�� "o, c� 1An `ksd`�'°K� y - 4 BUSINES YOUR HOME ADDRESS:_ 2� L1/i' I a�a ,r, rig) &LS I�i .Des1�wR �yfrf /'t T1 s i� {� �� TELEPHONE.# .',Home Telephone Number. o - 67— yq .. .. NAME OF CORPORATION .......................... NAME OF NEW BUSINESS BLS (,,;zzs TYPE OF BUSINESS �� - - HOME.f]C .� IS THIS A CUPATION.............. OF BUSINESS ;S g) "` When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you.in obtaining the information you may need. You MUST GO TO 200 Main St. [corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFIC This individual hasberl informed f ny permit requirements that pertain to this type of business. j6thor�izedSignat re* COMMENTS: C JA e ATION VV RULES AND REGULATIONS. FAILURE TO 2. BOARD OF HEALTH CONAPLYMAY RESULT IN FINES. This individual ha$ be q�r� �,Qf the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has en iniftylthe licensing requirements that pertain to this type of business. gg � Authorized ignature** COMMENTS: al J d !)�4��i PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 06/28/12 TIME: 13:33 -----------------TOTALS----- ----------- PERMIT $ PAID 35.00 AMT TENDERED: 35.00 AMT APPLIED: 35-00 CHANGE: .00 APPLICATION NUMBER: 201203954 I PAYMENT METH: CHECK PAYMENT REF: _ i 109825 TOWN Of BARNSTABLE BUILDING PERMIT APPLICATION Map �. Parcel": 7/y ` Application # 6 Health Division Date Issued �� k a Conservation Division Application Fee Y Planning Dept. Permit Fee .. Date Definitive Plan Approved by Planning Board Historic =OKH Preservation/ Hyannis LL Project Street Address 258 Willimantic Drive D Village Marstons Mills AUG 2 3 REUD Owner Gina Schmid Address same Y Telephone 508-367-1699 PermitRequest air sealing, insulate attic (r-38) , ;nsiOntp rrnwI� pace ceiling Q� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1718 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family _0 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ 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: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ .Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RISE Engineering Telephone Number 401-784-1700 Address 1341 Elmwood Ave, Cranston, RI 02910 License# 100459 Home Improvement Contractor# 120979 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �— I2-1 O Erik Nerstheimer for RISE Eng. FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ' MAP/PARCEL NO. _ ADDRESS VILLAGE F OWNER DATE OF INSPECTION: FOUNDATION FRAME _ INSULATION , I f f FIREPLACE ELECTRICAL: ROUGH FINAL f `� PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO: ; _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Flame(Business/Organization/Individual): RISE Engineering a division of Thielsch Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone#: (401)784-3700 or 1-800-422-5365 Are you an employer? Check the appropriate box: Type of project(required): 1. N I am an employer with 4. ❑ I am a general contractor and I 6. 0 New construction employees(full and/or part time).* have hired the sub-contractors 7. 0 Remodeling 2. 0 I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance. I required] 5.0 We are a corporation and its 10. 0 Electrical repairs or additions 3. 0 I am a homeowner doing all work officers have exercised.th eir 11. 0 Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4),and we have no 12. ❑Roof repairs employees. [no workers' 13. N Other Insulate comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. (Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins.Lic.#: 3730961-00 Expiration Date: 1/1/11 Job Site Address: 5 w l�I I1'Y]U-r Wl 2 City/State/Zip: OA f�� 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 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $250.00 a.day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for covera e verification. I do herby certi and the ins enalties of perjury that the information provided above is true and.correct. Si nature: - _ Date: ZI 17 Print Name: Erik Nerstheimer Phone #:(401)784-3700 or 1-800-422-5365 extl 3l Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Issuing-Authority(circle one): 1.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: _� Phone#: ' ACORD, CERTIFICATE OF LIABILITY INSURANCE OP 10 47 alD THIEL-1 F•ROGUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOR The Preston Agency, Inc. ONLY AND C-ONFERS NO RIGHTS UPON THE CERTIFI 1350 Division Rd Suite 303 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXT PO Box 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES East Greenwich RI '02818-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE INSURED INSURERA: Zurich-American Ins CO. Thielsch Engineering, Inc INSURER B: er.lcan cv,rant.. c Ll.bill,ty Thielsch pinup Tech R6alty Inc.Inc. INsueERc: North American Capacity Hi 195 Frances Avenue Craranston RI' 02910 INSURER 0: Hartford Insurance Company •INSURER E' COVERAGES 1HE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA' gED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWnHSTANDIN G ANY RECUIREN ENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUdENrT WITH.RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIW,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ITLSR7iDD LTR INSR TYPE OF INSURANCE POLICY NUMBER POLTY GATE(MM/D'D/Y1') DATE(MMIpp y a LIMITS GENERAL LIABILITY EACH OCCURRENCE 1 1,000,000 TX COMMERCIAL GENERAL LIABILITY 3730962-00 04/O1/10 O1/01/11 PREMISES(Eaoccurenca) a300,000 CLAIMS MADE' ED OCCUR MEO EXP(Any-ono person) A 10,000 ' PERSONAL&ADV IN.iURY S 1,0 0 D,0 0 D GENERAL AGGREGATE a 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $POLICY FX2,0 0 0,0 0 0 -JECPRO- LOC Emp Ben. 1,000,000 AUTOMOBILE LIABILITY , COMBINED'SINGLE LIMIT 1 2,00 0,0 0 0 A X ANY AUTO 37309'63-00 04/01/10 O1/01/11 (Edacciden() ALL OWNED AUTOS -- BODILY INJURY 1. sCHCDULEO Afros (Per person) HIRED AUTOS BODILY INJURY WGN•OVNED AUTOS (Par acclda.N) PROPERTY DAMAGE j ?Per acciGenl) GARAGE LIABIL(YY AUTO ONLY-EA ACCIDE14T .1 ANY AUTO OTHER TF(AAI EA ACC S ' AUTO.ONLY: AGG $ EXCESSIUMBRELLALIABILRY EACH OCCURRENCE . $ 10,000,000 B X OCCUR CLAIMS MADE UMB 9 2 6 3 6 3 7—0 0 04/01/10 01/01/11 AGGREGATE $ 10,000,000 DEDUCTIBLE 1 X REJENTION 410,000 5 WORKERS COMPENSATION AND X TORY LIMITS E-1 EMP LOYERS''LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE 3730961-00 04/01/10 01./01/11. E.L.EACHACCIDE14T ; 1,000,000 OFFICER/MEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under , SPECIAL PROVISIONS bolaN E.L.DISEASE-PCV-Ir_Y LIMIT :i 1,000,000 OTHER C iProfessional Liab DVL0000'26800 04/01/'10 '04/01/11 Prof Liab 2,000,000 D Leased/Rented Eqp 02UUNTD5678 1 04/01/10 1 04/01/11 Equipment 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOvE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 OZYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY 141NO UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHOR(ZF.D REPRESE v ACORD 25(2001/08) @ACORD CORPORATION 1988 I . i rAlo ttail.f., _...tc . .� C., TAEL;;3_ �. }• , _ _ _1I •'!". . ` •. jy I � ''hi:te'"i{w �( �:a ..� .4� .L� v %I N b �S9R:Yl�i I J M St1 i �ti 4 N I.C•j.!'EPAD.}r�' �j� URED�SrtJAMEtTkYi�el c'hit`LhifneeVf or ngineering, a division .of Thielsch Engineering,. Inc. l Associates.; a division of Thielsch Engineering, Inc. BAL Laboratory; .a division of Thielsch Engineering, Inc% ESS Laboratory, a division of Thielsch Engineering, Inc. AI,CO Engineering, a divi.eidri of Thielsch Engineering, Inc. Water Management Services, a division of Thielsch Engineering, Inc. 91teO ice o nsumer fai�r�,; and usmess e u anon o g 10 Park Plaza - Suite 5170 Boston, lkssachusetts 02116 Home Improve �ontractor Registration Registration: 120979 Type: Supplement Card i Expiration: 3/25/2012 THIELSCH ENGINEERING ERIK NERSTHEIMER 1341 ELMWOOD AVE. ° CRANSTON, RI 02910 A h� Update Address and return card.Mark reason for change. Address ❑ Renewal ❑ Employment F1 Lost Card DPS-CAI 0 50M-04/04-GG1001216pp ' ✓�ie 'tDammxovzi�ea� ��� Office of Consumer Affairs&Bu iness 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 Re ulation Registration 979 Type: 10 Park Plaza-Suite 5170 g Expira `— � Q12 Supplement Card Boston,MA 02116 THIELSCH ENC ERIK NERSTH ' - 1341 ELMWOOD CRANSTON, RI 02 Undersecretary Not valid without signature r ale >. oz 1 The Official Website of the Executive Office of Public Safety and Security (EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 100454 Restriction WS,IC Name Erik Nerstheimer City, State, Zip North Scituate, RI, 02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Back To Search Tom.ell.1 1 �✓G� � :�e. .. . _ . .. . Board of J3i,ildino Regulations and Standarrt`s Lkense or registration vartd for individiil use only HOME IMPROVEMENT CONTRACTOR r before the expiration date. If found return to: r Registration:_ 120979 Board of Building Regulations and Standards E'z_pir._aa i:66=`3 25/2010 I One Ashburton Place Rm 7 301 upplemeril CardAla. 027.08 ELSCH ENGINEEJI,N .v = K NERSTHEIMt ,— Sly= 1 ELMW000 AVE•,``4j`.F's \NSTON, RI 02910 -- � it• —_ Admm;sti iior Not valid without si nit �re ; ...: http://db.state-ma.us/dps/licdetailS.asp?tXtScarchLN=CST,'l()0n,SQ N f {x {� F741, i'. NWEPA , 10 +. NAT-24531 - 1 Federal ID#05-0405629 RISE ENGINEERING to RI Contractor Registration No 8186 t� A division of Thielsch Engineerin [ `j MA Contractor Registration No 120979 t (((JJJ CT Contractor Registration No 620120 1341.Elmwood Avenue,Cranston 10 �r (401)784-3700 FAX(4 7 710M n MAY � 4 `O10 CONTRACT p Page 1 �s THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE Client N Gina Schmid (508)367-1699 04/28/2010 109825 SERVICE STREET BILLING STREET ' 258 Willimantic Drive 258 Willimantic Dr SERVICE CITY,STATE,ZIP BILLING CITY,STATE,LP Marstons Mills,MA 02648 Marstons Mills,MA 02648 JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing. 8 man hours. $528.00 RISE Engineering will provide labor and materials to install a 11"layer of R-38 Class 1 Cellulose added to 432 square feet of open attic space. $518.40 RISE Engineering will provide labor and materials to install an easily moved,insulating cover for the attic access folding stair. The cover has integral weatherstripp ing to restrict air leakage. $160.00 RISE Engineering will provide labor and materials to install 320 square feet of R-19 faced fiberglass insulation to the crawlspace ceiling. $416.00 RISE Engineering will provide labor and materials to install 320 square feet of 6 ml polyethylene over open ground in designated crawlspace/earthen basement areas. $96.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for households where total income is less than or equal to 80%of median income, the Cape Light Compact offers 100%incentive toward eligible measures(not to exceed$2,000 total incentive.). -$1,718.40 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***00/Dollars $0.00 UPON FINAL INSPECTION AND APP54VAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 80 DA)YSYE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. -NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES THORIZE SI ATU -R E ENIYEERING MER ACCEPTANCE _ 1 t / 7f � NO :THIS GO Rqe 1 MA'/BE WITHDRAW'rI BV US tE NOT FXEr.U7F.D WRH!N DATE OF ACCEPTANCE 1 ' � - ACCEPTANCE OF CONTRACT-TH=ABOVE PRICES,SPECIFICATIONS AND CONDITIONS AF:E ♦ti -.� � - '' - SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE.WORK jii -. DAYS, AS SPECIFIED.PAYMENT WILL RE MADE AS CUTL?hFO ABOVE r + �f qq 3ia - Nay .�•.,yPv;� �.f� m _ ' P �9 ir �oy PERMIT PAYMEJiT RECEIPT`"" TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 09/10/09 TIME: 16:14 �----------------TOTALS----------------- PERMIT $ PAID 25.00 AMT TENDERED.: 25.00 AMT APPLIED:. 25.00 CHANGE:. .00 APPLICATION NUMBER: r2,00904274_ _ PAYMENT METH: F PAYPENT REF: `?�. Town of BarnstablePermit: Regulatoay ServicesDate: tHE TQ�, Thomas F Ceiler;Director Building Division ee: a BA&'WMM = Tom Perry, Building Commissioner � 200 Main Street,_Hyannis,MA 02601 a www.town,barnsta ble.m a.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: Phone: Install at: it��111n(liAlt� t'�C, Village: t7S1�1s Map/Parcel: a 3/o g 0 Date: {)�P �� Stove A(New/Used B. ype: Radi /Circulating I TA iU,Ao11 b*31 C. Manufacturer: Lab.No. �N5(-1)L q�1�ak U) l D. Model No.: Chimney A. New/ xistin (If existing,please note date of last cleaning) 1 (je pk B. Flue Size "�i(B7t¢-�2if C. Are other appliances attached to Flue?f)O D. Pre-fab Type and Manufacturer + E. Masonry: tlu nlined te55 5 &% Hearth C(3t cxe:1�eckie..va"4\ A. Materials: 01, WeRf-vot,A- n%Aoud- Wfgt oil m2+.3: ht.ty*N ex' S1"') B. Sub Floor Condon: te �� Installer Name: Apt.Address: _h, kqQ - ki���iA Phone: Location of Installation: 'qif\ H.I.0 Registration# 1a0q,5 Construction Supervisor# (,,-:) rJ 8 p OR check_Homeowner Installing,no license required �, a _ � � APPLICANTS SIGNATURE APPROVED BY: g Please make checks payable to the Town of Barnstable -� w *This constitutes an official stove permit after inspection,photographed, and app roved bye Building Inspector Q:forms:stove Rev 103107 Restricted to: 1 G :Massachusetts Department of Public Safety 00- Unrestricted Board of Building Re�-ulations and Standards 1G-1 2 Family Homes Construction Supervisor License License: CS 58557 Restricted to: 1 G Failure to possess a current edition of the KEITIi.A CLIFF Massachusetts State Building Code 1'`x is cause for revocation of this license. PO BOX.90. SANDWICH, MA 02563 :;1. Refer to: WWW.Mass.Gov/DPS Expiration: 2/27/2011 ('.unuu is rune r Tr#:. 11738 Board of Building Regulations and Standards License or registration valid for individul use only u,p HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:.. 120859 Board of Building Regulations and Standards Eicpleation ,9%12/2010 Tr# 264879 One Ashburton Place Rm 1301 — _• ., Boston,Ma 02108 Type .Private Corporation _ ';l • ''___. SANDWICH CHIMNE_Y=SW_ EEP,INC. KEITH CLIFF l` 28.EMERALD C. FORESTDALE,MA 02644 Administrator Not valid w' lt.signature CSIA CCS Code of Ethics Chimney safety-institute of America Certified Chimney 1.To learn and Ul ize at chimney and venting safety practices - and tedWques that are Promoted by CSIA 2.To render -and .�•�..�.`.. 2722 my servings th an p honest roamerngany 2.j CEATIFIED !•regain born enga®ng in daptNe praetlaes'or maldtg airyuecephvestatemerts. CHHIIMNE Valid 1.To eorrpiy wgti Eff ag appiCable building codes in the areas IThrllservice,vrith the mamrfachurers I�tion Instructions forthe products I Instai:.and wkh recoIDtized chimney andJun eventing practices.4•TToo eriote�al�ate consumers abocsafe chimney 5.To Stmre to cQntInU 6y update my.knoledge.skills,and2 0 1 0 lectrique with regard to currently accepted chimney and venting safety pradlces. . g.To conauct myself in a decent•respedfull and professional Keith Malt,"Wren Serving In my capacity as a.ctimxy Sweep. or When attending a kumiton or evert of an orgariratlon in the chlrmeyor hearth products Industry. Cliff 1.To Comply with the proper usage of al CSIA Registered ... . Tradaff-s as defined to the CSIA Tmdemarh Use Guidelines dowunt. Sandwich-Chimney Sweep OZWM Sandwich, MA t II 1 r. Ifl. �I}j,Q :I.1LI'1%9 lt•lT ilV�UR.I 1. DA-M(WIDDA-M) ACORD- . CERTIFICATE OF LIABILITY INSURANCE PRaDua>x V —�T Tiii#� CFATIFICATE IS ISSUED AS is PAP.TTER OF I:+IFORMWTiON HART II�'SltRA>+IGI:AGENCY, INC. ONLY AND CONFERS 40 RIGHTS UPON THE C�FIFICATE p¢pIs19 , 7I°IIS CERTIFICATE DOES NOT AMEND, EXIEND OR 243 MAIN STREET A!.Tk�Tt>IE CCi��RAGIr AFFOI@ K SY TF PULITC BELOW. PO SOX 700 I auzzARas SAY, !CIA 02532-0700 �INSURERS AFFORDING COVERAGE Iysu D Sa'It ttich�hirnney S�v�Ep „N%t,,AoA: MAX SPECIALTY I!�SURANCE i- Po Box 90 INARSA2: ARSELLA PR0'7EC i IOI�I INS r°L� 28 Emerald W-ty Foresldale ,Itu; 4c A T L i'Iy 08MV Sant3'NICI1,MA 02563 SAF URHR D' — COVERAGES-- � - --- - - _ 'Ai POLICIES Of INSURANCE usTEt?1?@6CYIf NAVE SEEN ISSUED TO THE INSURED PIAf'fEC►ABOVE FOR THE PQ11GY PERIOD INDICATED.MC'i'%�ETAN9lNG WY REQUIREMENT,TERM OR CONDn,ON OF ANY CONTRRC7 OR OTHER II)OGUMafil��m� RESP6.;'r Te�vMfCH YsIa4 ces;Ti�?rA'IE{y1r.Y sE ISSUED OR r1IrLY P=P,TAIN,THE iNCURANCE AFFORDED BY 7NE POLICIES DESCRIBED HERVU IS.SUBJECT TO ALL THE TERMS,EXCLUSK)1S AND nND1f-irjNS OF SUCH P$LiG3ES..�r3GREt3fifE LIMITS SHOWN MAY HAVE SEEN REDUCED BY FAIL'_CIAI11 � ?QLI iiaGE vlRter m s'oucyNubiBF.R R87A Ira� ,..v. , Gt�IeRAe.LsaeuYY I MAX01$1400^u1632 �0/Q01d3 10/09/09 MHocc�c���c��s_ 9 OLD-AY GENERAL_49JTr ! i oi2E A S�Q 'aou u'rtrt9 _ QU A 1 =Alps casts acc�uR I t�eu Este(e�,y pia ors I a_ 5.�^fl f i PER gn6i;-DV IIZJuiv !3 000.000 I 1 s - 1rir2NdkalACiroRGGAIF E �0.+}l3Di I ���~ 4f rP�iO�'JCTu��COiII?70PhdG ! 1,000 op 1 I nEtBI AGGREGh-E 1.ITAIT FPFUS.PER; I ! + I Pour 417 , I^I t.ac �,- g ! AurOMOBIL4 LIASMI:Y ' U372400000 +�03"221p9 j 0312210 i gwbjr.fl SINGLEUMit I(Ea R=cr,U I _� i ANY AUTO ' J ALLov.+c:eauros ; I some �ILRY s i00.000 i X(scHeAJLsc v.li;ns I ' tom' rso I HIRED;.VTCS I I H`''�Ry -s(per m4idmp NON OW&0 AV W 1 I ( PROPERTY OAMAO% I � I I CARAGELIAan.1tY � ; xUt T�(iP•E.Y.rr'.AGC'AENT 3 y i ( EAAc1. ANYALTO 5UMMATN' a 1 04.4.Y: ArA l i E%CESSIUMERRel t E LABILITY � {EACH E � s OCG1R 1!ct;.eV.c wAOE ; � I AWREAa'fE----- b — _o I i REYE:CI N s ! WCSYA*u rH!g ^ WORKERSCOTaFWEAMOIAM �WCV0037.7606 00=9 1 091t10/10 �m,�-n�r�nllrs! FF " !E5tPL0YER,3'LIABTlJTY � i F e, -,---- MrFRGPRIf~r,-R?A?T.EF1tCbZt I I Ssf�l�CCIREN— T + 1M:cFJWF McE?t Fx^.4l'nEv' t , I i Cl x E:En Mr LoreEF 5 ___51]�QQ0 ti n Yob.drvrnbe Title! E,POUCY LIW. r IS L�(} J!?ECaA:PROVI°IUN�Oak+W y -• I or►s�e I —,-- I DE561L'FT107i OF OPMATIM4 f LOCArtORSf UtNJCLJM:EXC3J SMI5 ADWJ aY ENYIC3fi".FP�iFJdS!Ss L?!A4 PROVI$iam; OPERATIONS PERFORMED BY NAMED INSURED AS PROVIDED BY TERMS Fx CONDITIONS IN?HE PcOLIvY I CERTWICATE WILDER 4 CARICELLA — aNCWV mrf OF Til^c o e�+L OS£CR1 BE0 w4L3Ci55 s5 uA>YNiL'ED BSFORE T)t€>;X81RR.{?7N 1 DAT9 THYF CIF,THE MVINta INSURER PALL F.NDEA�JR TC,%iX'- 30 DAYL ➢YRITil;N Town Of Barnstable ph)Ylrs 110 WE COUP. rATQ NOLOCR WOW)rD THE LEFT,avr FA"IRE 1*CC SO SHALL 367 IV-sin Street ;IdFOSF.NO 09LPCAW4 OR UiA010W Dt!AKY>n.TO uFW Tw€N$UrM frs Acy"0- Hyannis, MA 02M1 AUTWXh MEDIREPRES1*0`7AY 10 ORfJ 2s¢aao (o�j — -'— --� 0 aCORD CORPOPATION 1es8 i � i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � n Map J0 3 t, O Parcel Permit# 753...8 Health Division '. 9 d a no - 6 Date Issued 3115104 Conservation Division P o 4 Application Fee Tax Collector Permit Fee Treasurer SEPTIC SYSTEM MUST SF_ INSTALLED IN COMPLIANCE Planning Dept. VVITMI TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TONIM REGULATIONS Historic-OKH Preservation/Hyannis .2 aeJ6, S ' Q� Project Street Address C _ /,e l/ Village Aa(1S r/n.JS .� a Owner S V2�.ltr� Z-V(f:dr-R- d ess c2 J Alf-Ma�AJ2 i-c_ )De, Telephone ((,�� Permit Request �(� rbi—' o le bIA�—4(D Born rKa4c Cl `l wy --BaAa = kpmte Square feet: 1st floor: existin j000 W 0 , (hsZ-(( 3 P S q � proposed 2nd floor:existing proposed Total ne 000 Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: O Yes IkNo Basement Type: &Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Aer Half:existing k2new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing new�_ First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil CAElectric Other (,()GG Central Air: 0 Yes l_No, Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing O new size Pool:❑existing ❑new size Barn:O existing ❑new size Attached garage:O existing ❑new size Shed:❑existing 0 new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial O Yes A No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name U • G r GOIP5210 v Telephone Number J GF �3Q—Sq a Address License# 11 C Home Improvement Contractor# O Worker's Compensation# �V ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO P_ SIGNATURE DATE —C� fJ FOR OFFICIAL USE ONLY ' 'PERMIT NO. _ -'Bff SUED MAPJ PARCEL NO. - '^ ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME i INSULATION FIREPLACE F` ELECTRICAL: ROUGH FINAL 'k PLUMBING: ROLMI FINAL.' . C[p GAS: RO _ FINAL T FINAL BUILDING S F: 1 m : ir 1000 r DATE CLOSED OUT m ASSOCIATION PLAN NO. ® - r i Town of Barnstable Regulatory Services • - Thomas F.Geiler,Director Z a S& sT�t�$ . q 3 Building Division lFD � Tom Perry,Building Commissioner ' 200 Main Street, Hyamnis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 permit no. Date AFFIDAVIT HROVEMINT CONTRACTOR LAW �-RuMMNT TO pEpNn APPLICATION MGL c.142A requ �that the"reconstruction,alterations,renovation,repair,modernization,conversion, or construction of an addition to any pre-existing owner-occupied improvement,removal,demolition, than four dwelling „nits or to structures which are adjacent to bung containnig at least one but not more lling such residence or building be done by registered contractors,with certain exceptions,along with other requirements. � / rJ 6�GTe Estimated Cost Type of Work: Address of Work: Owner's Name: lication: Date of App I hereby certify that: Registration is not required for the following reasou(s): []Work excluded by law []job Under$1,000 []Building not owner-occupied Downer pulling own permit Notice is hereby given O that: TERED OyyR,S PULLING THEIR OWN PERMIT IlYIPTtOYEMENT�'a�O�H�y CONTRACTORS FOR APPLICAB,•LE HOME ITgATION PRO GRAM OR GUARANTY FUND UNDER MGL c.142A. ACCESS TO THE SIGNED UNDERPBNALTIES OF PERJURY7r4 - I ere th the owner: Contractor Name RegistrationhTo. D OR Owner's Name I THE PROPERTY OWNER MUST COMPLETE AND SIGN THE FOLLOWING; THIS WILL BECOME PART` OF THE BUILDING PERMIT APPLICATION. as owner of the subject property hereby authori e Edward F Goggin Jr. DBA KMG Home Improvements to act on my behalf in all matters relative to the work authorized by this building permit application for work at 258 Willimantic Drive Marstons Mills, MA. 3 Signature of Owner bate Gr4)yd L Nei0feJ Print Name .I, Edward F Goggin Jr. as authorized'agent hereby declare that the statements and information on the attached building permit application are true and accurate to the best of my knowledge and belief. WardrFggin Jr. Date (Please return this form with your signed proposal/contract) I The Com»wnweaIth of Massachusetts _ -- Department of Industrial Accidents 600r Washington Street - s Boston,Mass. 02111 Workers'..Com ensation.'Insurance Affidavit-General Businesses %/ •F� `� 't.A' `�tVa. .Tea e'"�4.....p,p r •` �'� � .•d�f1 / address: /C state zip: work site location full address �� ' r� I am a sole proprietor•and have no one Business Type: 0 Retail❑Restaurant/Bar/Eating Fstablishment capacity. 0 Office❑ S ales(including Real Estate,Autos etc.) worldng in any P ty . ❑I am an em to er with . em to ees(full& art time): ❑Other %%%�%// I am an'employer providing work-e rs compensation for my employees worldng on this job. '1 .t..:.j'::.t .t,. ..>:•• rr..:..•'.:t..<-.. :1:•,: s',, '5��5':.ta..:.s`:�i;i —r:.:i..•.�,,:.{ t. adiire3s:' '.:'f Fr;; :;• i.:.,' _•-•;t.�: - : ' e. .irisurance.co�' ••�� ////i". T am a sole proprietor and'have hired the independent contractors listed below who have the following workers' compensation polices: 11� s."iJq:.," •�jy(:•L� •S�!ly •�.�• 1v,.f,'f '.r.. ...• y.(. CDYa a DaDi ' l ., T 4"-:'..;:• •-1 .. .:,•p•..• il`e't.• �•'�„ii'i••;rr .::`��'-:`•. .a: ::fr .,e�'�:.' 'r.,: ... . '!•.:.:.,.• :;r.'..t• i. address:. . .i`.l'� �n .uti« 1.':r:•" ,:, 'r..i`':�rr.:�• _ insurance co....: .:Y _�•'' , ;� //%�////////l%%%. 'r•.::: '•:/..- ^':t: ,' ,1i�' ',.i'::• 'r:ya^.r,• :Ji: it:: .:s>.•. `� r .�'• ' address:. • .: . ..•'` , • :,A 7777, insurane--c Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me I understand that X copy of this statement may be fo • ;_TP e Office of Investigations of the DIA for coverage verification. cation. do he e y ee nder th in orirralties ofperjury that the information provided above i a -r Date t�Print name Phone# official use only do not write in this area to be completed by city or town official permit/liceuse# ❑Building Department city or town: ClUceusing Board ❑Selectmen's Office []-check if immediate response is required ❑Health Department contact person: • phone#; ❑Other (ntiud Sept 2000) Information and Instructions. Massachusetts General Laws chapter�152 section 25 requires all employers to provide workers' compensation for'their. employees: As quoted-from the 'law". an employee is.defined as every person m the service of another under any contract of hire; express or implied; oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or mgre of the foregoing engaged-in a joint enferprise, 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. 'Howevei.the owner of a dwelling House having:not'more than three apartments and-who resides therein, or the,occupant of the dwelling house of another who emploYs persons to do.maintenance, construction or repair work on such dwelling house 6r on the grounds or urtenant thereto shall not because of such.employment.be deemedtobe an employer. apP building. MGL chapter 152 section 25 also'siaies thaf every. state'or local licensing•agency shall withhold the issuance or renewal of a license or permit.to operate a business or to construct buildings in the.c6nunonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required: Additionally;neither the- ' commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with t)ie insurance requirements of this chapter have been presented to the contracting . authority- Applicants Please fM it< the workers'•compensation affidavit completely,by checking the box that applies to your situation.. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits maybe 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 regardini the"claw"or if you are required to obtain a.workers.'compensation policy,please call the Department at the number listecl:below. City or Towns . Please be sure that the affidavit is complete andprinted legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license.number.which will be used as a reference number. The.affidavits maybe returned to the Department bY'.marl or FAX unless other'arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a.calt... The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department-of Industrial Accidents efnn of Wesfiu Mns 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 nhnnP#! (6171 777_4900 ext:406 is Board of Building ReguJaEions and Standa ds l HOME IMPROVEMENT CONTRACTOR Re istr tionl=�:38095 -- __ L i .Ezp Vion=21t3/2005 e`=-0SA KMG LANDSCAPI ". r C yI lI PROVEMENT EDWARD.GOGGi JR 4 PONDVIEW DRIV HARWICH,MA 02645 `' --==----- -.:___ :•- Administrator i r � . �n� yu t ' I BOARD OF � BUILDING`�`i� REGULATIONS License: CONSTRUCTION SUPERVISOR 'Nwrrober Ds 086033 I ; B rfhdate;:_12/�—i5119fi5 t•Ez r. P iWtt Tr.no: - p Restricf<ed�'�p=� (�I 86033 f 4 DWA'RD F f i ONO VIEW ' E HA•RWICH MA 02645�'S'- �,�;• � �i ! Administrator Existing Bathroom 30'-9" CD Wo laundry room 2._8-. JI kitchen 4 7-6'X 6'-0'PD a - '4 n 9'-3" 6'-5" master o living room bedroom Mr & Mrs Grant L'Heureux 258 Willimantic Drive Marstons Mills, MA 02648 Proposed bathroom 9'-6" 30'-9" laundry room kitchen 4'-2"-7,1'40.' X-O'x B'-8'PD ry n 6,-F master o living room bedroom Creak, cL lop-+,r 5crve-a 1 ryed S . ins�a.11 ra ian+ hecl- • Mr & Mrs Grant L Heureux f 1 LLMtio t r,$9 258 Willimantic Drive . �n�}a,l( har)Nlw�ed Marstons Mills, MA 02648 Van i+ (AaAej- dvs�+ i `" ^'y✓r`$�.i. as.,.' t�jtL' .._ �+.ir. IV,' -,.i`i{ • .-':t3:".'_ ''dA'?'F."Y _'.e"'r' `'a`�'�''-''G.C+:T-,cY. Y.oS+:si',a'fY'+ �,"t' ` e • TOWN OF BARNSTABLE Permit No. 28345 ---� Building Inspector awsr i Cash -- _—_ wP X— OCCUPANCY PERMIT Bona Issued to Barnstable Holding Co. Address lot #23 258 Wilii antic Drive, Marstons Mills Wiring Inspector Inspection date f--� Plumbing Inspector� ,�,� Insp spec tin date r/ Gas Inspector v /1 Inspection date / Engineering Department 111-�!!!�s%�i/!�/��Inspection date Board of Health ] -� �tG Inspection date 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.................................................... 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SULLIVAN -Attorney-at-Law BARRISTERS WALK DENNIS, MA 026s6 / 617.385.3133 3 A ///ihblv tlz� VIP Z�'--r Al )2( 11 yh� as� tovIf Ald �vi�v Ow�twr • J'� J. d— C9�•M.�� ��j I���k�� l�Po� /yUz, �� y�z• �1 Cc'M� 0�1avS �i-t�� �v Cou�i�o•�o ��r�`" N 7 ' r WILL/M /�T�C r. ( 'o l ' ao 5' y�D° S¢' 3,o C , sv �r •; rx n) 4.6 i �:V L) \ `� v^_ 2-3 OF ROBERT %.L^uR-CGE " No. i9367 3 o r•• LO�'P,e07'�CTIaN '�/��D` 37 40ai �D EGA T� T wt/ CERTIFIED PLOT PLAN LOT -3 I, -/-lM,4 vric DRivE t) 'A 1N SCALE s I"=3 v DATE, Cc)' /'9 9 Q f3��it/srA��6 I CERTIFY THAT THE Fy!//✓/�AT101/ CLIENTL� .�._ SHOWN ON THIS PLAN IS LOCATED }, : �4 t 4118TEREO RiE01STEREO �'�07 b Try, JOB NO. ON THE GROUND AS INDICATED At C • ,f CIVIL LAN® A , A. CONFORMS TO THE ZONING LAWS EN®INFER SURVEYOR DR.By OF BARNSTABLE MASS Cif.- AY' R 3 t 7 12• M A I N �S T R E.E.T ' ' ` HYANRIS MASS. SHEET.LOF ' � � A E REG. LAND SURVEYOR Assessor's map and lot number ZP3.. .��. a(2....'. ..... iTHET + ... . ...... SEPTIC SYSTEM MUST `o Sewage Permit number .....................••a•rJ"Co..C1.l.....�� INSTALLED IN COMP WITH TITLE 5 Z BAHBn98Tg LE, i ,,,6G House number .....................:.. .:....... ..✓.......................... 9 0 ENVIRONMENTAL CODE 679. Nxi . t� TOWN .' OF . BARNS' A AT!®NS . , BUILDING . INSPECTOR APPLICATION FOR PERMIT TO .......,[,t. ".� ........ . .. ................ �.......... TYPE OF CONSTRUCTION ........... D'.:.P. r !®'.... .... ........ ..... ���...........19: � — TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following 'nformation: Location .... 1........ !-.� !�!�✓..�-.�� ....... . /!/ -..........xz�............................... ProposedUse ..../....................................... , ...................................................................................... Zoning District .......... /t .. i District ......4�," 0.............. . .................................. . . .. ........... .. ............................................ C. Nameof Owner ............................................ .. .... _�I ress ................................ ......... .. ...........4........... -.1 �,, ��h Name of Builder !�N!llr.'��if�- -..��.... ..Address .. � �!✓.%?.'.:... �` !Jl�s�riJ Name of Architect Address ..... ..... l�f.sa.!!s. ................................................ Number of Rooms ..........� ..................................................Foundation ....... . ..h-_zt44_-_0.....en.n..:'..e: ...1...... �y Exterior ..f,. ?fd. ..............................�. ..................................Roofing .............4e ...... Xd................................ Floors �'✓' Interior / '�C � ..... ......... .... .... .� . � . . ..... ... . . Heating ....eoAr.. `.................Plumbing..... ....... . Fireplace .... .. .........?........ ................................................Approximate. Cost ......... ..... . ¢G..... ............. ,Definitive Plan Approved by Planning Board ____________________________19________ . • Area ...... ................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPR AL OF BOARD OF HEALTH <S l OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulatio the Town of Barnst regarding the above construction. Name .1b`... tip. ........................... Construction Supervisor's License e.. .el Cgsc....... BARNSTABLE HOLDING CO. 28345 - One Story A-, No ................. Permit for .................................... Single Family Dwelling ............................................................................... Location Lot 23, 258 Willimantic Drive ................................................................ Marstons Mills ............................................................................... &Owner ....Bar.ustable-Rolding-Go.." ............. Type of Construction ...............Frame........................... Plot ............................ Lot ................................. 'August 20, 85* Perm it_--Gra nted .............................. .........19 Date of Inspection ................19 Date "Completed .............19 C.,, A 7 cc M 5 r4 01 Assessor's map and lot number L Q. Q 1 ....... �OFTNET�� Sewage Permit number ...:.... � :- .. WQ ... G Z BASH9TADLE, i House number ....................... ....... ..., ............................. so rasa � _ pow t639• `00 NOX d' TOWN OF BARNS- .,.-ABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO t> ✓, i..................... {............................................................................................. TYPE OF CONSTRUCTION ........... r��•�I �f/ ........... ........................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....�6 el. ..... . ... %....�.... .!?/ G%C:. ../.� ./L..........1.:�e...... ................................. ProposedUse ..../..............4......................... ................. ................................. Zoning District ......... .....Fire District 4 r-..Q !,. .......................................... v s�f �' exe Name of Owner . 44e ze ...�...•.................................... ..........! �ddress ..................... ..... ,,...�....... Name of. Builder /;J� !f /. (f�; �!C. / C1��A, •.Address .✓..C/GJ �s' °s 1/ . ......d ?.. �r . °..° ,�,►�a.. Name of Architect � �oG3t /`✓ ' , `7 ... /....:. .........Address .....r.:::...........�!r.., :.............................. Number of Rooms �....................................................Foundation .... 12V./.• a / ��h C.7CrN:�. f ....... �. y r...... Exterior G.. r.,.. •.. ...Roofing J12.. .% .......... .!'..................................... Floors Interior Y.... � l✓�' ..............::.............Plumbiri ..........Heating ....::f..... !.............�:...:.:..:..:...:.... g Fireplace UNr ..Approximate. Cost .......................•............................... Definitive Plan Approved by Planning Board -----------______-----------19--------. Area j Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPR AL OF BOARD OF HEALTH c� i . OCCUPANCY PERMITS REQUIRED FOR'NEW DWELLINGS I hereby agree to conform to all the Rules and Regulation"f the Town of Barnstable regarding the above construction. �� Name t t Construction Supervisor's. Licensee.•/. � a ,. BARNSTABLE HOLDING CO. A=1,03-080 28345 ONe Story No .....*............ Permit for .................................... Single Family Dwelling ................................................................................ Location ...,Lot 2.3........2.5.8..W.i.llim.a.nti.c...Drive . . .. . . . . . .. .. . ........ . ...... . .... Marstons Mills ............................................................................... Owner ......Barnstable...Holding...Co. ........ . . .... . . .... . ...... . .... Type of Consitruction ....,Frame ................................................................................. Plot ............................ Lot ................................. FAugust 20, ,--85 Permit Granted .................................. 1,9 Date of Inspection .......................... 19 Date 'Completed ........................................19 Assessor's office(1st Floor): Assessor's map and lot number Board of Health(3rd floor): �i �•��/� d�Q �� Sewage Permit number ��:.7"" .7 u � 4� • prK,k•wj� t BABd9TADLL Engineering Department(3rd floor): �J rues House number /S S °o 1639• \0�" 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 �22� r _ TYPE OF CONSTRUCTION 19 O� i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use f iQ ItIA RO0 V �� tY Zoning District I\ Fire District- MAlryte m5 f"t i (Name of Owner Gt 00 -+r LNe,\XWX Address 1S 9a LJ IIWAA+G or JP wf5fm 'Name of Builder G(Aw'C Qk-dlf'eA Address 15 W 1(,dAAo1J,P t)YdP Mav4tOb� Mt l�s Name of Architect&r&MA L%e U(W. , Address �-�� U/t((; epnfi.C. ny t JZ MA,Z+(mf Number of Rooms nhf, Foundation Exterior ���'�ic�l�� Clty IVA0 Roofing (351A81T Floors �A yi-o D Interior DrtA tN'A If Heating Non p -- ' - Plumbing J� Fireplace f to e— Approximate Cost $00 0 Area qoo OC Diagram of Lot and Building with Dimensions t Sy'�o Fee J �' I a l' -S i K 6- h-: 0 .? LA 1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS(�M CJ r • r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name )J41AW.(// � r •. Construction Supervisor's License n U1ne, . L'HEUREUX, GRANT A=103-0'80 _ No 33191 Permit For ADDITION Single Fami 1 v Dwelling Location 258 Wi 1-L imant; c- Drive - Marstons Mi11g Owner ['rant r 'uP„Yeux Type of Construction Frame J Plot Lot F Permit Granted September 7, 19 89 W Date of Inspection 19 Date Completed 19 t PERMIT COMPLETED-1/1/2i la ® ltll�l . TOWN OF 13ARNSTABLE BUILDING DFPARTMENT'. HOMEOWNER LICENSE EXEMPTION Please print. DATE_ -1 I Ca d JOB LOCATION 2 S - hum er Uj! I��WHiv+�-`C. �rt�� • ' treet a Tess ysuAS 141f1 "HOMEOWNER" G RN ect1ono town ome p one . PRESENT MAILING ADDRESS r 5 or p one 1ty town t a t e The current exemption for. " 1P cv e dwellings of six units or homeowners" was extended to include owner-occ iv1 ua for hire who does not ess an to allow such ed acts as su possess a license homeowners to en uin- pervisor. (State Building provided that the ownerOF HOMEOWNER: g Code Section Person(s.) who side owns a parcel of land on which he on which there is, or .is intended attached or detached structures accessory he/she resides or intends to re- side,person who to be, a one to six family- dwellingfa considered constructs more than y t0 such use , a homeowner. one home in a• two_ and/or farm structures. on a. form acceptable to Such homeowner" shall submitatoptheoBuildil not be for all ..such work the Building Official performed under the bui'cial that he/she shall be. responsible The undersigned "homeowner g Permi ect n Building Code and' assumes :responsibility other applicable codes for compliance with the S ` • The undersigned home by-laws, rules and re t.at,, .Barnstable �� regulations. Buildin °Wner certifies that he and that he g Department minimum inspect- understands /she will comply with p Procedures and tre Town of ' said procedures and requirements. . HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family to comply with State dBuiidggs 35,000 cubic feet,. 9 Code Section 127 0 or larger, .will he r . Construction Control . 8 HOME 'S EX EMP'T I ON The Code state that : Permit Is "Any Home Owner. (Section required shall be t�crforming work for 109 1 1 - Licensing of exempt from the which a building Home Owner engages a construction Provisions of thls shall act as supervlsoerson(s) for- hire the provided thatclfon . to do ork , that such Home Owner Many Home Owner " • the s who'Use' this reSponslbllltles exemptlon for Licensingof a supervisor . are Unaware that often Construction SU (see -Appendix Q they ar'e assuming, results In serious Pervlsors, Section. Rules and Re unlicensed Problems, 2. 15 Regulations. Unlicensed Persons. In Par•ticUlarly when This lack of awareness Person this case oue the Home Owner as. supervisor as It would wlth'n Board canhot hires is ultimate) licensed Supervl Proceed against the Y reSPonslble, sor . The Home TO ensure Owner acting communities the Home unities re Ulr•e, Owner certify that q as part of fully aware of his/her last he/she the Permit rethat ttiilltles page of Understands the responslbpp► tlatlon, many this . lssue Is that the Home care to amend and a form cure- es of a su .owner adopt such currently used b pervlsor . On the a form/Certification foreVeral towns use In You may Your commun,lty, • . • Assessor's office(1st Floor): A,23 O 3 d Assessor's map and lot number r THE �o� Board of Health(3rd floor): ,j! SEPTIC SYST5RI � Sewage Permit number ���`' ` � INSTALLED IN C ,. �TH 71TL Engineering Department(3rd floor): Or K'..%. rhea House number, /S S IV o 1639' Definitive Plan Approved by Planning Board 19 E' `'g ®�' EWAL o Arta- APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only d OWN REGULLAAMOD TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO (,(// TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use K' R004 C e' Zoning District R Fire District AA-r) C)Y\S Name of Owner GT&\X'y 041'-WW� Address M q) Ld i 14110814f G Dri JP •n►wP5tm M' its Name of Builder Address5� W i�(;�tAo �f, tl���lP. MArr4fi0y� I"lt��S Name of Architect&r q\tA LL Address--59 LV;11,'�4 RAL s fmf1 Number of Rooms C)NIF, Foundation Exterior 5�! 1919 CT ht"rd Roofing --as PhAIT Floors P1 Interior D r4 W#,11 Heating �jQ-L�r Plumbing Fireplace Approximate Cost 91000 Area V Diagram of Lot and Building with.Dimensions S�'�o Fee ,:- + air a) t j � M OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS) 3 r 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 0 VinW L'HEUREUX, GRANT No 33191 Permit For ADDITION Single Family dwelling Location 258 Willimantic Drive Marstons Mills r ' Owner. .'Grant L 'Heureux Type of Construction Frame Plot Lot Permit Granted September 7 19 89 Date of Inspection 19 r Date Completed ^ 19 L v b.•is .:5 `