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Home My WebLink About0021 WEST WIND CIRCLE N r.. _ .�.,,,...,._.r �' r �: I i r � 4 ; M i :. � �� i � �. (' '� I I �� i I if t� l �� ii f 4� ► .� Town of Barnstable Bti11C11_ _ g .Anxsrw Post This Card So That it is Visible From the Street Approved Plans Must be Retained on Job and this Card Must be Kept b , 1Posted Until Final Inspection Has Been Made. - 4 Permit eea�` (Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. E Permit No. B-20-593 Applicant Name: Steve J Spengler Approvals Date Issued: 03/04/2020 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 09/04/2020 Foundation: Location: 21 WEST WIND CIRCLE,OSTERVILLE t Map/Lot: 121-011-029 Zoning District: RC Sheathing: Owner on Record: PHILLIPS, NADINE MARIA&SMART, DEXTER Contractor Name:' ,VIVINT SOLAR DEVELOPER LLC. Framing: 1 Address: 21 WEST WIND CIRCLE Contractor License: 170848 2 OSTERVILLE,MA 02655 Est. Project Cost: $ 16,060.00 Chimney: Description: Installation of roof mounted photovoltaic solar systems,23 panels `'3 Permit Fee: $ 131.91 Insulation: 7.36kW } , Fee Paid: $ 131.91 Project Review Req: - _ Date: 3/4/2020 Final: Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuan Final Plumbing: 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. Rough 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. s i Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work:, 1.Foundation or Footing Service: 2.Sheathing Inspection i Rough: 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 Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Application number.....��..��,,,, DataIssued.................1...fAtAsTABLE .......... ...... ................ -' MAS& �� a639. �0`$' . qUG Is Building Inspectors I itials.... p/Parcel...... /".. .........../.. ...� TOWN OF ]BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATIERIZATION PROPERTY INFORMATION Address of project: 2 ' TIUMBER STREET VILLAGE Owner's Name: A r Phone Number_ Email Address: Cell Phone Number Project cost$ Z Z3Q � Check one Residential ✓ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: eP -,L\-{{ 0�-\fr4 Date: TYPE OF WORK Siding 0 Windows (no change)# Insulation/Weatherization Doors (no header change Commercial Doors require an inspector's review Roof(not applying more ' ayer of shingles) Construction Debris will be going to '4 She-Zn4„A SP,, p, A�evr�a t-1✓-� CONTRACTOR'S WFORMAI'ION Contractor's name rAn �� ,�„' Pe� — o,re / ��-� ✓S Home Improvement Contractors Registration(if applicable)# //Z 7 8 5 (attach copy) Construction Supervisor's License# LIN2Y7 (attach copy) Email of Contractor ,,�,ee-� Ste@ yna r e, Phone number ^yo/- 71V-(3'?9 ALL PROPERTIES THAT HAVE STRUCTURES 01dq 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Vents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X 9 X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval, *WOO} /FCOAIL/P EILILIET STOVES Manufacturer# ° Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEEOW11ER'S LICENSE(EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand nay responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 Cliff the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applicatio are subject to a building official's approval prior to issuance. SPECIAL SERVICES CUSTOMER INVOICE Page 1 of 15 NO. H2612-76431 Store 2612 HYANNIS Phone: (508)778-8948 65 INDEPENDENCE DRIVE Salesperson:TDS1562 HYANNIS, MA 02601 Reviewer: VXG1123 Name Phone 1 • SMART NADINE (318) 529-7058 REPRINT Address 21 WESTWIND CIR Phono2 company Namo Z C L� V • Gty - OSTERVILLE JobDoscnption patio door instlal 2018-08-1310:21 state MA Zip 02655 County BARNSTABLE INSTALLER DELIVERY41. MERCHANDISE AND SERVICE SUMMARY sWe reserve the r old toc sttomershttolimitihequanlitiesofinerchandise REF# 101 STOCK MERCHANDISE TO BE DELIVERED: REF# SKU CITY UM • DESCRIPTION PI I TAX PBrj EXTENSION R03 0000-254.294 3.00 EA 3/4"X5-1/2"X8'PVC TRIM/ A $16.13 $48.39' R04 0000-154-687 24.00 LF 11/16 X3-1/2 PINE WM444 CASING/ $1.66 $39.84• R05 1002-961-477 1.00 EA 6"X50'WINDOW&DOOR SEALING TAPE/ Y $13.09 $13.09' R06 1 0000-715-499 1.001 RLI MULTI-PURP 16"X48" ROLL INSUL 5.3SF/ TA Y 1 $4.001 $4.00' R09 0000-218-126 1.00 EA 72X80 ST IS RH WHT LOWE2 15/15 PD/ A Y $338.26 $338.26' S/O-MDSE TO BE DELIVERED: REF# S10 D ARRIVAL DATE: 08/27/2018 P.O.#12526844 REF# SKU QTY UM DESCRIPTION PI TAX PRICE EACH EXTENSION S1010 0000-370-008 1.00 EA NA/INTERIOR PREMIUM COMPOSIT UBLE/INTERIOR A Y $991.48 $991.48' PREMIUM COMPOSITE DOORS D L NGING DOOR ACTIVE/INACTIVE 50.25 X 79 IONS #1 S1011 0000-370 008 1.00 EA NA/(CONTINUED)/IN I MIUM COMPOSITE DOORS DOUBLE A Y $0.00 $0.00 SWINGING DOOR TI CTIVE 50.25 X 79 GLASS OPTIONS(CO ) NGLEBO BACKSET=23/8",QALOCKSETBOREPOSITION=44",O ABO E R=21/8",QAHINGEPREP=3- P ,QAHINGETYPE=BALLBEARING.QAHINGESIZE=31/2"X31 o $1,435.06 DELIVERY INFORMATION: D ATE: INSTALLER WILL SCHEDULE •'•CONTINUED ON NEXT PAGE••' O Check your current order status online at %wvw.homedepot.conVorderstatus 4�) Paqe 1 of 15 NO. H2612-76431 " Indicates u men Coov down SPECIAL SERVICES CUSTOMER INVOICE-Continued Name: SMART Page 6 of 15 NO. H2612-76431 INSTALLATION #3 (Continued) REF#108 'DRILL HOLE IN JAMB FOR ALARM WIRING IN SAME LOCATION AS 'CUTS TO TOP OR BOTTOM OF THE SLAB FOR FIT UP TO EXISTING DOOR MANUFACTURERS SPECIFIED TOLERANCE 'INSTALL NEW CUSTOMER PROVIDED SINGLE LAYER INTERIOR CASINO AND EXTERIOR TRIM/BRICKMOLD OF THE NEW DOOR WHEN THE UNLESS STATED ABOVE THIS INSTALLATION DOES NOT INCLUDE: JAMB EXTENSIONS UP TO 5 1/4'(INSTALLER PROVIDES) PLASTER,DRYWALL OR SIDING WORK INSTALL DOORS OVER 7ZX96 DISCONNECT AND RECONNECT OF SECURITY SYSTEMS/WIRING REPAIR CARPENTRY TO EXISTING OPENING SPECIAL NOTES: IT MAY BE NOISY DURING YOUR INSTALLATION '-AN ADULT OVER 18 YEARS OF AGE WITH THE AUTHORITY TO MAKE THE INSTALLER WILL BROOM CLEAN THE IMMEDIATE WORK AREA DECISIONS ABOUT YOUR INSTALLATION MUST BE PRESENT DURING THE BEFORE COMPLETING THE INSTALLATION.AIRBORNE DUST IN OTHER INSPECTION(WHEN APPLICABLE),DELIVERY AND INSTALLATION PARTS OF THE HOME IS A NATURAL OCCURRENCE AND IS THE RESPONSIBILITY OF THE CUSTOMER. END OF INSTALL#3 TOTAL CHARGES OF ALL MERCHANDISE & SERVICES Policy Id(PI): u - II- --RAM $2 149.58 A:90 DAYS DEFAULT POLICY; SALES TAX $89.69TOTAL $2,239.27 BALANCE DUE $1,377.89 PAYMENT TERMS : Refer to the Home Improvement Agreement for payment terdns The Home Depot reserves the right to limit/deny returns. Please see the return policy sign in stores for details.' END OF ORDER No.H2612-76431 j 9stomei's Signature Date Page 6 of 15 No. H2612-76431 Customer COPY t`}:1L 4.0 !';F',r'}}•, •(C-��.tit• r-f.` <t ;r , .. r i �•��:r• CS-074247 PAUL M DOWNING x 180 KESWICK ROAD BROCKTON MA 02302 Commissioner 04/04/2019 r ` e' Tlie Commonwealth of Massachusetts 1 = Depatnent of Industrial Accidents (� Office of Investi ations 2 I Congress Street,Suite 100 Boston,K4 02114 2017 www.mass gov/dia Workers'- Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Plumbers Applicallit Information Please Print Legibly Name(Business/organization/Individual): l_- i Address: j. i� Si, l is I 1 c°, City/State/Zip: 'r�, ; -;r, AJ �� . Phone# Are you an employer?Check the appropriate box: 1.❑ I ama employer with 4- ❑ I am a general contractor and I Type of project(required): ,employees(full and/or part-time)* have hired the sub-contractors 6. El New construction 2.LJ 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' 13.0 Other comp.insurance required.] 'Any applicant that checks box r1 must also rill 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 afn an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.-#: Expiration Date: Job Site Address: City/Sthte/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 certt under the pains and penalties of perjury that the information provided above is true and correct. Signature: w-- - , . =3 Phone#: Official use only. Do not write in this area,to be completed by city or town.of 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#: f -j _' ulati `�:. on Y. ._. Office of Consumer Affairs and Businesc.. e9 10 Park Plaza - Suite 5170 -- Boston. Massachusetts 0211 Home Improvement Contractor Registration Type: Supp!ernent Card Registration: 112:85 Expiration: 041221201 HOME DEPOT USA INC 2455 FACES FERRY RC C-1 i HSC F.TLANTA,GA 3033e Update"dress and return card. Mark reason for chance. Address E]llenewa! C Employment ❑ Lost Cart pffiee of Consumer Affair=8 Business Regulation Registration valid for individual use only �—� before the expiration date. M iound return to:ulation HOME IMPROVEMENT CONTRACTDR TYPE:SUDDlement Card Office of Consumer Affairs and Business 9 Excitation , Suite E�7C Re^isfiation ,G Park Plaza- _3 78� 04i221201° Boston.MA 02116 ~ iTOME DEPOT USA INC � .,�� \ �' d. ithou signature ANDREVt'SWEET �i HSC 2455 PACES FERRY.RD G Undersecretary ATLA�p,GA 30339 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' w 1 Congress Street,Suite 100 Boston,AL4 02114-2017 a y www.mass.gov/dia Workers'Compensation Insurance kffidavit: Builders/Contractors/Flee tricians/Plumbers Applicant Intformation Please Print Le 'blv Name (Business/Organization/Individual): �O �i k/ 0 — A.ddress: City/State/Zip: 51Xp*A)sd l4f • a/Sy,S- Phone#: 7 VY— ! A' you an employer?Check the propriat b•.x: Type of project(required): 4am a general convactor and I , ]: I am a employer wiiu ') 6. ❑New construction i;'employees(full and/or part-time).* aye hired the sub-contractors ; l r- listed on the attached sheet. 7. ❑Remodeling � I am a sole proprietor or partner- i These sub-contractor have i g, ❑Demolition ship and have no employees I wor)dn- for me in any capacity. empioyees and have workers' ! o p ny. i 9. �❑Building addition: comp.insurance.= [-No workers' comp.insurance 10.❑Electrical repairs or additions 5• ❑ We are a corporation and its required] 3.C I am a homeowner doing all wort: o$cers have exercised their 11.❑Plumbing repairs or additions ri t of exemption per MGL myself. ;No workers' comp. P 1�.❑Roof r air ! insurance required]± c_ 152,§1(4),and we have no + 13. Other ✓ emploveeq. [No workers' i comp. insurance required] •Any u 6ftam Thai--freaks box d t must also fill out the section below showing their workers'compensation policy information. Homeowners who submitthis affidavit indicating they are doing aD work and them hire outside contractors must submit anew affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and stare whether or not those entities have employees. s 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. hisurance Company Name: Expiration Date: 3 Policy#or Self-ins.Lic.#: Ci xP City/State/Zip Job Site Address: 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 e. 152 can lead to the imposition of criminal penalties of a fine un 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 under the pains and penalties of perjury that the information provided above is true and correct Si ultra: �/ Date: Phone T 57F a�y �b� ! r fficial use onlv. Do not write in this area,to be completed by city or town offtciaL ity or Town: Permit/Liceuse suing 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 i DATE(MMIDDlYYYY) ACo CERTIFICATE OF LIABILITY INSURANCE o2ati2o1s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS HE POLICIES BELLOW CERTIFICATE AFFIRMATIVELY NEGATIVELY THIS CERT F CATEOF (INSURANCE DOES NOTCO STI UTE A CONTRACT BETWEEN THCOVERAGE SSUING NSU ER(S)TAUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,Certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME MARSH USA,INC. PHONE I FAX ac No: TWO ALLIANCE CENTER No- E-MAIL 3560 LENOX ROAD.SUITE 2400 ADDRESS: ATLANTA.GA 30326 INSURERS AFFORDING COVERAGE NAIL 0 CN101642069-HomeD-GAW-18.19 INSURER A:Old Republic Insurance CO 24147 INSURED INSURER 9:New Ha hire Ins Co 23841 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C:HomeRisk live Insurance Com n 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA.GA 30339 INSURER E: IN SU RER F COVERAGES CERTIFICATE NUMBER: ATL-004353439-16 REVISION NUMBER: 3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AODL S B POLICY E F POLICY EXP LIMITS L. TYPE OF INSURANCE POLICY NUMBER fMM1DDNYYY1 IMMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY MWZY312717 0310112018 03101/2019 EACH OCCURRENCE S 9,000.000 6A_ffZT TO CLAIMS-MADE �OCCUR PREMISES Ea occurrence S 1,000,000 LIMITS OF POLICY XS MED EXP(An one person) S EXCLUDED OF SIR:SIM PER OCC PERSONAL 8 ADV INJURY S 9,000,C00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 9,000.000 X POLICY1:1 PRO- LOC PRODUCTS-COMPIOP AGG S 9.000.000 JECi S OTHER: A MWTB312718 0310112018 0310112019 COMBINED SINGLE LIMIT s 1,000,000 AUTOMOBILE LIABILITY accident X ANY AUTO BODILY INJURY(Par person) S OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accrdent) S AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED s AUTOS ONLY AUTOS ONLY Per a ent S UMBRELLA OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE s S DIED RETENTION S B WORKERS COMPENSATION WC 014122577(AK,NH,NJ,VTi 03/012018 03101/2019 X PER OTH- STATUTE ER B AND EMPLOYERS'LIABILITY YIN WC 014122578 WI 031012018 03/01/2019 E.L.EACH ACCIDENT S 5,000.000 ANYPROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBEREXCLUDED? a N!A 5,QOQ000 (Mandatory In NH) EL.DISEASE-EA EMPLOYE S 11 yes.describe under Continued on Additional Page EL.DISEASE-POLICY LIMIT s 5,000.000 DESCRIPTION OF OPERATIONS below C Excess Auto 297-1-10011-00.2018 0310112018 03r0 12019 UmiC 4.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA.GA 3D339 AUTHORQEO REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee �2oLuoo►�% ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo arc registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta ACO ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA.INC. THE HOME DEPOT,INC HOME DEPOT U.S A.,INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA.GA 30339 CARRIER NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier.Indemnity Insurance Company of North Amence Policy Number WLR C64763191(AL,AR,FL,ID,IA KS.KY,IA.MS.MO.NE.NM,ND,OK,SC,SD,TN.WV,WY) Effective Date:031012018 Expiration Date:03N72019 (EL)Lirtet:S1,000,000 Camer New Hampshire Insurance Company Policy Number.WC 014122576(DC.DE,HI,IN,MD,MN,MT,NY,RI) Eftactive Dale:031012018 Expiration Date'03/012019 (EL)Lund:S1,000,000 Camer:ACE American Insurance Company Policy Number.WCU C64783221(QSI)(AZ.CA,IL,NC,OR,VA,WA) Effective Data:031012018 Expiration Date:03/012019 (EL)Limit:S1,DD0.000 SIR S1,000,000 SIR for the states of AZ.CA,IL,NC.OR,VA,WA Camer:National Union Fire Insurance Company Policy Number XWC 4595580(QSI)(CO.CT,GA,ME,MI,NV,OH,PA,UT) Effective Date 031D72018 Expiration Date.0310112019 (EL)Limit-$1 000,000 $1.000,000 SIR for the states of CO,ME.NV,MI.OH,PA,UT S750,000 SIR for the state of GA $350.000 SIR for the state of CT Carrier.National Union Fire Insurance Company Policy Number.XWC 45955BI(QS0(MA) Effective Data:03101/2018 Expiration Date:031012019 A- (EL)Limit:S1,000.000 SIR:$500,000 TX Employers XS Indemnity. , Cern,11inios Union Insurance Company Policy Number.TNS C4916693A(TX) Effective Data:0012018 Expiration Date:0310112019 (EL)Limit:S1D.M0.000 SIR,S 1000.000 ACORD 101 (2008101) ©2008 ACORD CORPORATION: All rights reserved. The ACORD name and logo are registered marks of ACORD AWE Town ®f Barnstable *Permit-4 Capires 6 matt ro r� Regeulatory Services Fee s + aARNSrABLF- HAM 9$' L .0�q Richard V.Scali,Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PER112IT APPLICATION - RESIDENTIAL ONLY ^ © Not Valid without Red X-Press Imprint iviap/parcel Number Property Address[Residential Value of Work$ 1 SLZ71P Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /.." ' Contractor's Name �nc�vul 2?/► / /I r.5017 Telephone Number yo f 2 2-ef—Fd"t Horne Improvement Contractor License ff(if applicable) /' '3 Z4 S Email: Construction Supervisor's License#(if applicable) oaWorkman's Compensation Insurance Check one: 1* j�� ❑ 1 am a sole.proprietor J�Aj� 11 ❑ I m ��the Homeowner ©O L�yy �� I have Worker's Compensation Insurance W181v ti D Insurance Company Name Fi f oie- n.s: /ABLE Workman's Comp.Policy# W C A 1 5-8 72 9 2-L Copy of insurance Compliance Certificate must accompany each permit. p 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 - ca Replacement Windows/doors/sliders.U-Value 4 3 y (maximtun_32)#of windows #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 e-xempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. - -... A copy thLHome mprovement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\Decollik\AppData\I.ocal\Microsoft\Windows\Temporary Internet Files\Content.0utlook\2P101 DHR\EXPPESS.doc Revised 040215 ` kenewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Nadine Phillips-Smart Legal Name:Southern New England Windows,LLC 21 Westwind Circle RI #36079, MA#173245,CT#0634555, Lead Firm#1237 osterville,MA 02655 WINDOW RE LACEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(318)529-7058 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Nadine Phillips-Smart Contract Date: 11/15/17 Buyer(s)Street Address: 21 Westwind Circle, Osterville, MA 02655 Primary Telephone Number: (318)529-7058 Secondary Telephone Number: Primary Email: nadephil@yahoo.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total job Amount: $15,276 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $7,638 Balance Due: $7,C38 Estimated Start: Estimated Completion: Amount Financed: $15,276 8-10 weeks 8-10 weeks Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date.Rain and extreme weather are the most common causes for delay. Notes: 50% deposit by bank,balance on completion Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor. Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entided to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 11/18/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:RenewL�rn New England Buyer(s) Signature of Sales Person Signature Signature Paul Sandrey Nadine Phillips-Smart Print Name of Sales Person Print Name Print Name i UPDATED: 11/15/17 Page 2 / 12 - Office of Consumer Affairs and'Business-Regulation _- _- 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration == "= Registration: 173245 ^ 7 Type: Supplement Card =� Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS`aL:".`.:a. BRIAN DENNISON 26 ALBION RD = LINCOLN, RI 02865 - =- _ Update Address and return card.mark reason for change. Address Renewal Employment Lost Card Affice of Consumer Affairs&Business Regulation Registration valid for individual use only before the expiration date. If found return to: it�HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation ¢: Registration:-.:173245: Type: 10 Park Plaza-Suite 5170 Expiration.:-- �,19/20�8. Supplement Card Boston,NIA 02116 SOUTHERN NEW ENGLAND'WINDOWS LLC. RENEWAL BY ANDERSON_ BRIAN DENNISON 26 ALBION RD LINCOLN, RI 02865 Mdersecre ry Not valid without signature Massachusetts Department of Public Safety -19 Board of Building Regulations and Standards License: CS-095707 Construction Supervisor ,. BRIAN D DENNISON 7 LAMBS POND CIRCLE` CHARLTON MA 0160'_ - l� Expiration: Commissioner 09108/2018 The Commonwealth of Massachusetts Department of Industrial Accidents a I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electriciaus/Plumbers. TO BE FILED WITH THE PER UTTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): e u-) ows Address:_ „Z& .d.us10Q I�A • City/State/Zip: P Phone#: 2�� Q Are you an employer?Check the appropriate box: Type of project(required): 1,KI am a employer with Zo temployees(full and/or part-time).* 7..❑New construction 2. am a sale proprietor partnership or or parnersp and have no employees working for me in ❑I l 8. E]Remodeling any capacity.(No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.(No workers'comp.insurance required.)t 4.❑I am a homeowner and will be hiring contractors to'conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hued the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.= 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.I2 Other 152,§1(4),and we have no employees.[No workers'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 thepolicy dn-d job site information.Insurance Company Name: lre Ir1 e $ dp p Policy#or Self-ins.Lic.#: WC A3 2- Z- Expiration Date: Job Site Address: �I /K-� �to City/State/Zip. 7*lam" Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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_A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th ains and penalties ofperjury that the information provided a7(,01,> ve is ue and correct Si ature: DA Phone#: I- 2Z,e-T S-t';Q 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#: F CERTIFICATE OF LIABILITY INSUR DATE(MM/DDfYYYY) INSURANCE DATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(-ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CAME:ONTACT N CoBiz Insurance, Inc.-CO PHONE 303-988-0446 AIc No:303-988-0804 1401 Lawrence St., Ste. 1200 E-MAIL Denver CO 80202 ADDRESS: COMaii cobizinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC. INSURER C:Homeland Insurance Company of New York 34452 dba Renewal by Andersen of Southern New England 10 ReServior Rd INSURER D Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1252851165 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLITYPE OF INSURANCE INSD WVD SUER POLICY NUMBER MM/POLICY D//YYYY MMI UEFF YIYYYY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2018 1/1/2019 EACH OCCURRENCE $1.000.000 - DAMAGETO RENTED dLAIMS-MADE M OCCUR PREMISES Eaocwrrence $30D,000 MED EXP(Any one person) $10.000 I PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- - PRODUCTS-COMP/OP AGG $2.000,000 X POLICY❑JECT LOC $ OTHER: A AUTOMOBILE LIABILITY N CPA3158728 1/1/2018 1/1/2019 COMBINED Ea accident SINGLE LIMIT $ 1,00D.000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED Per accident) den RTY DAMAGE $ HIRED AUTOS AUTOS A X UMBRELLA LIAB X OCCUR CPA3158728 I 1/1/2018 1/1/2019 EACH OCCURRENCE $10.000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10.000.000 DIED I X I RETENTION$ I $ B WORKERS COMPENSATION WCA3158729-20 1/12018 1I1/2019 X STATUTE ERPER A AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $1,000,000 OFFICERWEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000.000 C Pollution Liability 7930073340000 1/12018 111/2019 Each Occurrence $1.000.000 Claims-Made Policy Aggregate $1,000,000 Retroactive Date 0620/2013 Deductible $10,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER I CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i For Informational Purposes i AUTHORIZED REPRESENTATIVE I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD R Town of Barnstable *Permit# � 0) S7 Expires 6 months from issue date Regulatory Services Fee5 • L►atvsr,►at.E. ME '""M $ Thomas F.Geiler,Director 039• 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 ��nn I .Not Valid without Red X-Press Imprint V Map/parcel Number l �- 0 Property Address 1+ IN 01 L-L J [Residential Value of Work O •a0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address &\O Contractor's Name Telephone Number 5(22 S`7o Home Improvement Contractor License#(if applicable) i Ito _) w �, „ Cons ction Supervisor's License#(if applicable) — (`� �, WPRES ��Workman's Compensation Insurance p SEP 2 7 2012 Check one: ❑ I am a sole proprietor am the Homeowner I have Worker's Compensation Insurance -TOVVN OF BARNS TABLE Insurance Company Name Workman's Comp.Policy# f p �p \) �j �-�!-� 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 - #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows '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 . required. SIGNATURE: C:\Users\decollik\AppData crosoft\Windows\Temporary Internet Files\Content.0utlook\DDV87AAZ\EXPRESS.doc Revised 072110 i The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _\ Please Priid Legibly Name(Business/Organizat n/ln(Jividual): O LA"� P C� Cs�n1 \{ 011� —1 V Address: City/State/Zip: W Phone#: Are on an employer?Check the appropriate box: Type of project(required): 1.71 am a employer with 1 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• # 9. Building addition [No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 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.❑ of repairs insurance required.]t c. 152, §1(4),and we have no 13.Ev Other A3 "L employees. [No workers' comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 2Contractors 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: r ' S (5 J-0 Policy#or Self-ins.Lic.#: [g l) �- Expiration Date: Job Site Address: W��ll�i� C (�Gi7-0-kJl LAJ 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 n r the pains penal es of perjury that the information provided lbove ' true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town ofciaL 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#: lime a > A • 3 9. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 IDD'YYYYI R CERTIFICATE OF LIABILITY INSURANCE DATE(MMg/27 12 is"CP-R-TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THS CERTIFICATE DOES NOT AFFIRMAl1VELY 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 CeRlflcate holder is an ADDITIONAL- INSURED, the poIIcYC�) must be endorsed. If SUBROGATION lS WAIVED,9ubJect to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights t1D the certificate holder in lieu of such endorsement(9). CONTACT PROWCER NAME: United Insurance Agency, Inc. pM AL 5081 759-6595 X (50e) 759-3e22 199 Main Street A�eS P.O. Box 1013 INSUMF011 AFFORDING COVERAGH NAICA Buzzards Say, MA 02532 rrU �utilus Tnaurance Co IrsuRFo - art£ord Underwriters Tn CCo Roger Wheaton 663 Main St Wareham, HA 02571 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ExCLUSI0INS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. A UBR PODGY NUMBER MImIYE MM0' U'�3 11 TYPE OF IN6URANCE A GENERALLIABILITY NN244665 5/27/12 5/27/13 t7D CURRENCE T ],000,OUO RENTED 5O,OOOX COMERCIALGENERALUABIUTY �'CLAW-MADE EX OCCUR mono on► 5 000PAL&AOVINJURY 1 000,000 GENERAL AGGREGATE 1 S 2,000 000 PRODUCTS-COW IOPAGG 3 1 000,000_ GEN'L AGGREGATE LMT APPLIES PER i X1 POLICY PRO LOC t1OeaBcc INED LM1IT S AUTOMOBILE LIABILITY BODILY INJURY(Per oewon) $ ANYAUTO BODILY INJURY(Per eocldent) $ ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNED o0raead nD�GE S HIRED AVTOS AUTOS 5 UMBRELLALIA9 OCCUR EACH OCCURRENCE S EXCESSUAH CIAIMS.MADE AGGREGATE $ DED RETENTION S 5/15/12 5/15/13 WC STATU- OTH- B v4AKERSCOMPENSATION 6S60UR4234P30312 X oRYLI AND EMPLOYERS'LIABILITY E.L.CACHACCI NT S SOO OOO ANY PROPR�TOR>PArzrNERrE xEMMVE YIN N FNI 10 0 0 00 OFPICERlMEb16ERE7(CLIpED7 E,L,DISEA3E-EAF LOPE Ifra(Mandatory In NMI 500 000 If ee Oesorl6n under E.L.DISEASE-POLICY LIMIT DBCRIPTION Of OPERAnoN3 below ceSCMPTIONOFOPERATIONSI LOCATIONS IVENICLES (ARoch ACORD 161,AddMlonslRormftSchedulo,Ir more s�oeleregUrd) Carpentry *The Workers' Comp policy does not provide coverage for Roger Wheaton 21 West Wind Cir Osterville MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main St AUTHORIZED REPRESENTATIVE 508-190-6230 xyannis, MA 02601 Tammy Buckle ®1988.2010 ACORD CORPORATION. All rights reserved. ACOR0 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mall: dl'/ze`tpo""'zaruoea'N o/'C�/GCaddacheedeO- }fit Massachusetts -Department of Public Safety ? � Office of Cnesumer Affairs&Busi ess Regulation f Board of Building Regulations and Standards OME IMPROVEMENT CONTRACTOR Construction Supervisor_ a egistration:6/1812;41 6546 Type: xpiration::_:. 014:, DBA I License: CS-069581 ®' •. WHEATON CONSTRUCTION,�.,.. ,, j ROGER E WHEA�N j ,E _ l 663 MAIN ST - ROGER WHEATON`'i �--� N WAREHAM MA=02571 I rS r�s�E• �.�� I 663 MAIN ST.. � `'` ��f � �rn��• WAREHAM, MA02571 Undersecretary �js( Expiration Commissioner 06/30/2014 j i I . - Town of Barnstable �° *Permit# Expires 6monthsfrom issue date Regulatory e>t-vices Thomas F.Geiler,Director Build.ing.Division 'Ess PER A41 Tom Perry,CBO, Building Commissioner . 200 Main Street,Hyannis,MA 02601 OCT 9 ��12 www.town.barns tab le.ma.ts Office: 508-862-4038 T0WNW#$.,jK_fif30 EXTRESS PERAUT APPLICAT'YON IdIESIDENI'L4L, ONLY ABLE Not Valid without Red X-Press Imprint Map/parcel Number a 7V-� Property Address 1 V�� WResidential Value of Work I I i O�O • V Minimum fee of$25.00 for work under 6$ 000.00 U.m i�rYi I-ht Owner's Name&Address `� Sh& Iq Sven t �oc� 1►��I�� - _ Contractor's Name J t 1 lV_ Telep one Number ( v Home Improvement Contractor License#(if applicable) I d" 1.0 �J Construction Supervisor's License#(if applicable) 6-I I ❑Workman's ompensation Insurance Ch one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name -------------- Worlanan's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request check box) R, roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: lssuance.of this permit does not exempt compliance Aith other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property er si roper Owner Letter of Permission. A copy fthe Ho Impr ve ontractors License is required. SIGNATURE; Q:Forms:expmtrg Revise061306 pFIHEr TOE Of Barnstable. 1AxTlsrAELE, Regulatory Ser.�vices q ass sB Thomas F. Geiler,Director . $9, Building p� Al�D h1AI A Builril ng Division Tom Perry, Puilding Commissioner 200 Main Street.Hyannis,MA 02601 vm'w•town.barnstable.ma.us Office: 508-862-4038 Fax: 508.790-6230 Prop olty owner Must Complete and Sign This Section If Using A Builder 1, Scam is r �hQIA nn , as Owner of the subject property berebyautEiorize T G S bkat' to act on my beb4 in all matters relative to work authorized by bnildin g permit application for: ja Lk (Address of Jo Signaaire of Owner v U I�— Date Print Name WOW Ms:OWNERPE}MygsroN The Coin Arlonhvealth ofHassaehusetts Departr7r,eyttt ofdjizdttstrjajAccidents - Cfftee of-1ytveszYgcrttans 600 1 ashijr _eon Sfreei -Bosco;",.l1 4 02xz-r Workers,"Com,pensatioin Tnsiir�nceAffidavit:}vow Mass.gov/dra A licant Ynformation .Builders/Conti actors/Electricians/Plumb ers , Name (Business/Organizationllndividual , q Pjease Print Le. •bY t Address: � x _ /7 City/State,/Zip (�,�'' + Are you an employer'. Check the appropriate box: }'hone.#�: 1 I a Gmployer with 4. I am a general contractor and T employees (full and/or art�e + ❑ Type of project(required):. 2 I am a'sole proprietor or partner) listed on hired the attached sheet ors 6, ❑New construction . ship and have no employees These sub-contractors have 7' ❑Remodeling working for me in any capacity, employees and y e workers' II Demolition [No workers' camp,insurance coin . ' required] P wsurance,t' 9. []Building addition 3.❑ T am a homeowner doing5' We are a corporation and its 10. all work ofcers have exercised their J Iectrical repairs or additions raysrx [No workers' comp. right of exemption per MGL 11.[]plumbing repairs or additions insurance,required.] t g. 152, §1(4),and we have no 1_0 Roof repairs employees, 1No workers' 13.0 Other msura 'Amy applicant that cbccics box#1 must also fill out the section bclaW�showing lair Worlce ecrs'rc m] t Homeowners who subrpit this d lidavit indicating they arc doing all wrnk and?hen hire outside colt rrs. I th check this box must attached an additions]shectahowing 1ho n,unc of the side contractors s d st omzatron c�rrployces. Tf the sub-contractors Piave employees,they a contractors must submit a new af�davj(indicatin y must providL their whether or not those g such. ►Yorkers comp.policynumbcr, entities have, T am art errrployer cleat is providing 1Varlcers' on compensati irescu ance for t>ry employees Ilelnyu ' information. • tslhe policy and j Insurance Company Name: ob site Policy##or Self-ins.Lic.##: Job Site Address: --•Expiration Date: Attach a copy of the workers' compensation policy declarafioll atr City/State/Zip: Failure to secure coyerege as required P'be(shotving the Polley number and e fine tip to$1,500.00 and/or one-�ed under Section 25A ofMGT c. 152 can lead to the imposition of criminal expiration date), of up to$250.00 a daya Y onn'ent, as Well as civil penalties in the f riminal Penalties of a against the Violator. De advised that a co form Of STOP WORK ORDER and a fine Investi ations of the].��for the, covers a verification,ropy.of this staternerit maybe for warded rwarded to the Office of I do hereby certify;r der th p ins-a d pertalties o er'rr , C -' �,. fp J rj dial ilce inforntatiort rovidecl a Sit?aahire �`'; p Ve is ire and correct Pbone�#t "..� l�� ^] t ` Date; 1 V official use only. Do not write in this area Yo be corn • � pleted bJ'cfty ox to}tin o�ciaL City or Town: YssrringAuthority(circle one); Permit/License# •X.Board of Health 2.BuiIdingDepaz-{went 6. Other 3. 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F ..,.-,.:+*.. ..' __..�... w J.a'$3 .a;u-;.h-.:ct.r.•�:utr•-� -..t-..._ii;i •++'rJoii _ _ �•arcr r�-.�4•+F r'`�i-"K-New'-�#a-aty'f"" e� f�E",,tFayv}a 11".+ '- - �^, ._"� _. ,_ s r • ,.,.� .,-:. .v,t ..:.:..•--r,.. a,_�;.a. •.'r:;.�.. -,. .....-} -, •-.`"+ I>a�-+ru .=,.a.y .,�am�' ;tii r^'. .w r w�:r� •'�" +}o-,;A, 15c�*J•.!x••• ,i#,,.L-.w, J-c +J�t..i::-rar r..'...1..«a. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -otl p Map " '° Parcel Permit# 9 C) S 2 Health Division AWN—1/ZP 0 Date Issued Conservation Division 03 Application Fee Tax Collector d/� ,��/��f Permit Fee 'FC2. 6�'D Treasurer INSTA!LED IN COMPLIANCE Planning Dept. YM TITLE 5 � Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANOTOWN REGUU-TIONS Historic-OKH Preservation/Hyannis Project Street Address Village F'" .a-o:�. �, l ( ., ��—c 2�,� cIL ams Owner Address S a.. r Telephone t— Ya o — 3.2-,/ Permit Request V y a 12,P L-1< AQ," X f 5 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay \ Project Valuatio Construction Type Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family M" Two Family O Multi-Family(#units) Age of Existing Structure Historic House: 0 Yes 0 No On Old King's Highway: El Yes 0 No Basement Type: O'Full ❑Crawl O'Walkout 0 Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: 3 Full: existing 3 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: ZGas ❑Oil 0 Electric ❑Other Central Air: O Yes ❑ No Fireplaces: Existing ! New Existing wood/coal stove: O Yes ❑No Detached garage:0 existing 0 new size Pool:0 existing ❑new size Barn:O existing ❑new size Attached garage:Ming O new size Shed:0 existing ❑new size Other: deGlL �� Zoning Board of Appeals Authorization 0 Appeal# Recorded O f„ Commercial 0 Yes ❑ No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Q k&yeZ_ Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE t FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED r MAP/PARCEL NO. ; ti ADDRESS VILLAGE OWNER ('A DATE OF INSPECTION: d FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH} FINAL FINAL BUILDING DATE CLOSED OUT c,� Lel ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts Department of Industrial Accidents ==•• = _ Olflce ot/ases�gat�oos _ 600 Washington Street Boston,Mass. 02111 iiiiiiii �i�i tion insuranc%%%%%///%%%%%%%///////%%%%%%%%///////%%//////%%��%////////�/% name mil/ iV cOu1311 kV P 64 location. t V 1 Affa C-OkC le -�ci l.e phone# am a homeowner performing all work myself. ❑ I am a sole netor and have no one workingin ca achy /GG% ///%%% %//////%%/////%%%��%%%O%%/%/G%/%%%%%%O%%%%%%%/G/�/�%%�%/%%%///l/%%///%�%/% 1 rovidin workers' compensat. ion for.:.my employees worldng on this job.::::•:::::•::r::::::•:::•::::::::;:.,.,,,,:,:.v.:tv...,:•..:.:..:::.: I am an em g ...................:: ..................::.::. },...}}.,.....::.... ,'•i43}k an. ... ........... .......v..................... ................................:.......v.............v........................•..........:..................... v:.n:::..... ... ?tiYY r.Y.Y.. •Y:Y:YYYf.........:.......... ..... ............... vi i}}}}i'::Fi}}}:J:•}}}}}:?r.r..... ......•:v:..::.v.v:•....n:::.....:...v::::::::v::•w:::.:w:..;;:......•............... •y .::::.v:::v; ......v.}:?•:v::•:::::::::::::::::::::.;;:::•;J}}.;.....w::...:::t.;:;:;:j;!:'^Yi•{:i!::iY Y:T:4�i::{:}::;}::•}:4X:.}:Y�j'riii}:{?{{4:tv^:•}:^}:•}}+ dt'eSS ... ..... ii:::j{i:;:•i:?•iii:ti4:4}:?4}}}}}'r'?C}:??�:•}:4:v.+:ti{ti{???ti??:4:•'r.•:ii}::}ii�.i}:?:..{?4:?•:}ii•..?d:w:nv•.v::...:.:..::....... :?{?•}i}};.;?^:j•:j;?4.:?;:;:{•.:.}:•is6:C+}i}:^:4:{•}}i;:{•}:•y}}:4:�:•}`}}:nv::::::•:::•:::.:v::::::.::::n................... ...::.v:•}:?•}:}:}:?:::?v::::;:v::;:.;.}.}v:n}:???•:iv:+':?tJy:}:?.}i:.:;;.::::.v.}'•i-:::::•.?•::::::nv:.v.v{•}:•�::;:•:i:.vi'r :..::..nv::.;.:::.:v..•:v:.::.:.:i;•:v:.:.:.::::..v:•..::::•:.:::.w••:'•v}:v:}:^:!�r.}•}:•}}::�:N:•}:3::::it::?;}:::•:::}:::::::.........:;......... ..:::....v.:..v::::::.v:::.:}::•:.:::::..::•..:::..::v:.v:::::i}}iX:•i::,v:}}::•;}}.:i:•.v.:.v..v:::::.v.v..:n::�::tv::::.v::: ,;?m;^:{v}':.}isb}:????4}}:?•i}:•S:•}}}:•i}.??;'F.j?::::i::$$:YY4iiij}{;i}:;:;Yi::Y}. ....:.:.................... ..............:.. ................ how ...:..:......::.:.::}.;.}}; '''saran ////i ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have e followmork ers' co ensation olices: ,:.>:�M :%<;:,:�::,:.:t.} mP ..... ...t. ........ ...... ......... ......... .........:v:::::v:.w:::::::d}ii:4}i}:•:r.?v::::::::::x}:;.}}}:+:•}i}}}}}i};.}}:•}}:}•:::i.v.v:. ...nxf.�• ..... 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As quoted from the "law", an employee is defined as every person in 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 more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,Partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct.buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. 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 the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be ^k. submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the penmitllicense number which will be used as a reference number. The affidavits may be retaumed it the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like.to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Deparrtuent's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Ilivestlgations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �oFtHe rOkti Town of Barnstable Regulatory Services RARNS LA ' Thomas F.Geiler,Director - MASS. 059. ABuilding Division �p�FD MA'S Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. vs� Type.of Work: 19 p C tC 7bQ17_ZaA1 Estimated Cost ?5 o-&d©o Address of Work: ei Owner's Name: L F'sf aAy- Date of Application: t-p-.V y I hereby certify that: Registration is not required for the fallowing reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied Dawner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME ZUROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registratron No. OR Date Owner's Name I 'LOP C-'/I 3 i �� 7 �"6( Elaio , I - �� ic: ro �uoSoorJo04 t N 1N1: PAGE 01 120.0' COT 38 k,) A 3 '15,000-+SF C71 U 0 21 0 i 120.0, WEST WIND CIRCLE THIS CERTIFICATION IS MADE WITH REGARD TO LOT 36 AS SHOWN 1N PLAN BOOK 290 PLAN 55 I HEREBY CERTIFY THAT THE BUILDING(S) SHOWN ON THIS �CF PLAN ARE LOCATED ON 774E GROUND AS SHOWN AND MORTGAGE INSPECTION CONFORMED TO THE DIMENSIONAL REQUIREMENTS OF THE PAUL ZONING BY--LAWS OF THE TOWN/CITY OF B "STABl.B JOSEPFiSON PLOT PLAN MASS. WHEN CONSTRUCTED OR ARE EXEMPT-FROM No. 35035 WOLA77ON ENFORCEMENT AC710N UNDER MASS GENERAL IN LAWS CHAPTER 40A SEC. 7. ('. I ALSO CERTIFY THAT THE BUILDINGS) SHOWN HEREON.� �"�O �ARNSTABLE, ,MASS. ."r LIE WTHIN A FEDERALLY DESIGNATED FLOOD HAZARD AREA AS DEFINED ON THE F E M.A. FLOOD HAZARD BOUNDARY Scale 1" 30' MAP FOR THE TOWN/CITY OF BdRNSTABLd' MASS, THIS PLAN WAS NOT MADE FROM AN INSTRUMENT SURVEY P.N. ASSOCIATES, INC. AND IS NOT TO BE USED FOR THE CONSTRUCTION OF P.O. Box 693 FENCES. ETC. (TO BE USED FOR BANK PURPOSES ONLY) Framingham, Mass. 508--958-2914 Signed Data J Z --�Z Fox 508-231-5281 --�j i The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ./ 7 3 2-o_y_7 _ JOB LOCATION: / litt S L-u�,�17 C"i tiCA, 0 91f,e l,&�Zg number street village "HOMEOWNER": S7,6"pl/� .P�X3L�P`7 C22F— fe_4e= name T— home phone# work phone# CURRENT Iv1AMINGADDRESS: orc o/r- city/town T— state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more.than one home in a two-year period shall not be considered a homeowner. Such"homeowner"'shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and —other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. ignature ofH er Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work far which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Manyhomeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed•Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a nity. fnrm currentiv used by several towns. You may care t amend and adopt such;a fform/certif cation for use in your commu ��1.f� '. _ _.�+�..�E''as'•`w�}Ig"' ,...�`1�','�{i1r'+�i' '"9\1�?§�'�'-��'.,�i�t��?+�� ;y � ��}-�Nt^pitiRpltS: Assessor's office(1st Floor): R-- 1NE O`Assessor's map and lot number �- t Board of Health(3rd floor): � Sewage Permit number 39i/ �J Engineering Department(3rd floor): � Z ssaWAS& Ltjr } Grua • House number °° i6}9' Definitive Plan Approved by Planning Board 19 o YtaY d APPLICATIONS PROCESSED,8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE ° BUILDING INSPECTOR _ - QQ j1 L pp /I APPLICATION FOR PERMIT TO �{I(l� �V Ytc-6- eo &Rc 11 .1Nelo G .XS � r ecx- TYPE OF CONSTRUCTION 19 �_ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1 1' r l2 Proposed Use Zoning District '- II_ Fire District J �,C Name of Owner �C, �T ��(�NC�t'1 Address CP 41 �1A k' ( �I_jyLe -yrllp Name of Builder �7/�ROt rtlFvD I ,fJ2C c� �S�S Address it b Iye Gt r a N Gi 41— Name of Architect /� Address Number of Rooms Foundation 5isn/a I/IPS 14 a14l 121U WN -1 Exterior 06d uu � �' Roofing AS 4114 -74 Floors Y-11• N Q Interior Heating A/ / Plumbing Fireplace Approximate Cost Areal jhd-51,?I s Diagram of Lot and Building with Dimensions Fee • f � 1 �C t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name , t 1 Construction Supervisor's License a� 70J i FRENCH , MRS . A=121-011 . 029 ADD PORCH'' : No 33695 Permit For TO,'' DWELLI•N"" Single Family Dwelling Location 21 West Wind'. Circle Osterville Owner Mrs . French Type of Construction Wood Plot Lot Permit Granted April 24 19 9 Date of Inspection 19 Date Completed 19 PERMIT COMPLETED 1/1/,�. AZA' RF�Y CERT/�"Y w mi LOT a Aor LOC�iTEO /N FEDERAL IRLOO�P i/ o ti,,1 AS S/, WN GW THE. FEDERAL FLOOR MSURANCE RAtE Alili� FO/t THE ITOIYN CO.NAWN/TY f'.WL ADO. EifECT/YE /GI YMONO, .L. RITE NOTE: NORTH ARROW NOT TO BE IMP FOR 604.49 PJl1RPOSES..� y �; a y'°�° � ox � SST hII _CJL�C , . . •'ice:a�� y �' a Lo /s..000_.�_(......�. h.. , N gnsr. N (n Z /Zol oo MAI PLOT ALAN' WAJ mr mAw rma FOUNOA�T/ON.40CAT. P�.A AN /NSTilY/AIENT su�YEYAwv FLtit THE �oT-3-6-:h1E=.IVZLv-_C SC 44gE OF THE QANK ML Y. IINOER MO ' O S.L-..��_V��-� � ' MA -- -.. CIRCUMSTANCES ARg OFFJETJ m BE l/JEO MR FENCE,% IIWALLJ, NERVEd.- 7 ETc. . %1H of Mq AAWO)vEA CPO %17P E NEE/r�A/G /NC. ROB S: SST Fit�t.�lOeUTH A1A. O�Z556 ' a; cal E.. • -- t p_ IWO.215583DTOP . �NEET C T you ii6f/16V D-w-lowcapAmimm.OK% PUN NCl r Assessor's office(1st Floor): ' `TME T Assessor's map and.lot number - ALL e ie NN r3r o Board of Health(3rd-floor): _ �� , r Sewage Permit number , 3d � ENVIRoN Engineering Department(3rd floor): MENTA(.CO E s•rsntt I oZ 1 TOW{t�REGULAMONS �•�1°9-d House number � . Definitive Plan Approvedby Planning Board 19 c Nix APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN . OF BAR.NSTABLE BUILDING INSPECTOR a APPLICATION FOR PERMIT TO /). 4�/ 4) �C TYPE OF CONSTRUCTION ,9 90 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Lor 3 Location r ^ + Proposed Use 09�` Zoning District Fire District Name of Owner t Address s� /�A/�/ /�� S ' Zyct Name of Builder Address 46- VA- Name of Architect / Address Number of Rooms Foundation. S&N-L-& < DLL 61zemN s Exterior nl_r P dA2 > P S° Roofing Floors 'Ey 1-.At A)Q Interior Heating Plumbing AViL J Fireplace Approximate Cost Area //l.0 Diagram of Lot and Building with Dimensions Fee C d� 0 �C2y OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License c��:-L70 700 1 FRENCH, MRS . a ' A- PORCH p_ No 33695 permit For TO`DWELL I-NG` Single Family Dwelling Location 21 West Wind Circle ' Osterville Owner - Mrs . French Type of Construction Wood , �.. s Plot Lot Permit,Granted April 24 1990 p; Date of Inspection 19 Date Completed 19 � (0) • r A 1 YOU WaSM TO OkN" A 6:6SINESS? For Yci,.�,• Information:. ' bu,:;P_ss certificates(coy ,.$40.00 for 4 yeal"sl,. A business certifit e!;.(:ONLY REGISTER,"Yt.)UR NAME in tovvr� (�,�l ch you must t.;,. iby M.G.L.-it does rl il:give you permissiL)ri l,,a operate.) You first obtain the ner.-::rsary signatures on This form at 200 f ilh, St., Hyannis. Take tl;;-. completed form to the Town Clerk's Ufiis;e, 1st FI., 367 IVti hi St., Hyannis, MA 0rf;01 (Town Hall) 8110 get the Business 0, .,;;ficate that is re.yuir;:,.I by law. Dh,T (Pj Fill in le ses ,L APPLICANT'" YOl old NAME/S: h i �� —S� 20c`Ie;� r BUSINESS ® YOl):I� HUC)I�ADDRESS:: 2 I .(�� , W( C:� SAC( _ I2 ' �. 5 _$ 97 TEL-.E HbNE # HgrPe TelE phone Num150 IE4 , NAME OF C N: l WV Ceanuji-14 NAME OF.IVIEW BUSINESS f✓le . Cast r� 1�n._I Ins: T�'PE OF BUSI.I�jE.pS_.�1��.�1a I i'THIS A A'JN*k ' ' PUPATION tom,. . ' YES ✓ ,. INQ h ADDRESS QF,:QUSIN,SS 2_1 :�! _lvtc' ,�c �c7 S dot ��. �MAp/PARCEL rV.UM$ER_ I I;-V I.I t/ 1 (Assepsing) When startiN a new business there are several things Qu m�,gt do in order to be in compliance with the,rNles and regti9adons of the Town df Barnstable: Tj1is form js intended Ed assist you in obtaining the:! ' mation y6b may rir3e You MUO'f GO TO 2)XI,Main St. - (corner!Af Yarmouth Rd. & ,in Street) to Trial - ure you have the �;, ,r'opriate permits J licenses regUirc:c�. i legally operat b;c business in this t, n. 1 i BUILDI!Yp, I;ON'IMISSIONE0,..OFFI& This jhdividu l has been infbr�ed of any permit rpquire,je(its that pb"in to this type of business. Authorized.Slgnat'ur: 60MMENTSc BOARD Q,F.HEALTH This ndividugj has been irifa flied of the'-permit. .requirer-nents that pbrt-aln to th'i type of bu inese. Authorized S gnatif e* COMMENTS: , CONSUMPI AFFAIRS(LICENSING ALYMORITY) This Inciividul has been ihfioried of the licensira requir:prrlents that of?`r'Lain 1;0 this type of business; Authorized Signature** ' .. 6OMMENTS -- :R:. � -. . _ m rip 3� 'Assessor's'map and'Iet number ..... .........� Sewage Permit number ..... ;...C�...G�'................................. Z BJHB9TADLE, i House number r�....... b........ r raga ` Op 1639. . AEG YPY a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO \ v` � � o, S. TYPE OF CONSTRUCTION .............................�.......5......U.......�... ..............�..:................................................ ........................ ...........:..... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the ®following information: Vocati . ........ . ..........�. .. ..w.�'<•. >. .... .. .......................... t,...................................................... Propose 'Use ...... .. .. G. ...... v!!�.�..�I.......�.w -..�`..... ..... Zoning District .............. . r.............................................Fire District Name of Owner Cl!" C,,,s....ACf. . Address Name of Builder c. � �q- 'e .` � S 'I I� Address ................................ t Name of Architect .....................................Address................:............. Number of Rooms ... . ..L . h ��1 '�1.. .1� O v < CC \ ...�.......1.......�,�.......... �. oundation ...............�..... ... ...... `� ............. Exterior .....Cn..T&Cx................................Roofing ...l.S S .`!l ......5. �.�n.q.�.'c�............ FloorsC � �..................................................Interior ..... .............0. l ...................................... C> � 4" W ..._......Plumbin.. �.. 1, . '�...Heating ...................................:..........:..........c................... g ............ ...... Fireplace ......Approximate. Cost Definitive Plan Approved by Planning Board -----------______-----------19_______. Area Diagram of Lot and Building with Dimensions Fee . . SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 ..a . It 3� OCCUPANCY PERMITS REQUIRED-FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ?. ....l.. ... ....................................... Construction Supervisor's License .. ..i..�.�9. :i........ CEDAR ACRES REALTY TRUST A=121-11-29 . No 26828..... Permit for ..Qne..Stor. .............. .........Single.F .]y...Welli ng..................... Location ... ......21.Weslr.Wind Circle .................. . .................................... Owner ..�aX:.,ACM.9..Realty.Trust.......... Type of-Construction ..Fame............................ ................................................................................ Plot ............................ Lot ................................ Permit Granted .......Au9.ust..9.r.............19 84 Date of Inspection ................19 Date Completed .......................................19 . �° /007 Aft e,ly f.:Y v� A. ',.� sfi+a�``°-�tl�'�aR'.��..r *�'�`�,.�="'.�G!'+4v,�ji-h .�s�sSFr`+,�",n,y,•d�4."I�...u•�i rY��<-�.+F..1bP�".!r+r?F9'.:�" r�',.r� Y - u t TOWN OF BARNSTABLE Permit No. _-__26828-_______ Building Inspector Cash ,Wa p� OCCUPANCY PERMIT Bona I. Issued to Cedar Acres Realtv llrust Address Lot #36, 21 West Wind Circle, Osteraille t.. Wiring Inspector Inspection date Plumbing Inspector/--/ iGf� Inspection date Gas Inspector Inspection date 1 Feb L XEngineering Department Inspection date Board of Health 7 (7-M1 Inspection date, _ i3 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. - a i9 3 ,.. .ate Building Inspector '�• TOWN OF BARNSTABLE BUILDING DEPARTMENT t sasa�r ! TOWN OFFICE BUILDING gab rb 9 �� HYANNIS, MASS. 02601 �0 SAY i MEMO TO: Town Clerk FROM- Building Department DATE: An Occupancy Permit has been issued for the building authorized by Building Permit # ...... ... ...._ ........ ............ »........._.....»»..».....»»»». issued to ...... ! ..Jt- ' _.! 4e .:;.4Q..... / !t '�... .... . . ._.»_._w Please _release the performance bond.444,� i /r, - rtTHE Assgssor's map and lot number, ......1 �^ ��` C Ott 2, r fAY�, Sewage Permit number .......,...GJ...G'.r ..:............. 8anTI� y - d`` ♦� y y # ��++ 'r o ED IN AB House number ......................................0 �....... (. ...:...... �/1/I�'�1 TITLECo J"' ' '90o K I �s 'HE'D i 9. ENVIii(�l�Mij .T YP a� TOWN OF 'BARNSTA10"s , : ` = r BUILDING 11SPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION .......... ...�!�.1.�\:C. ....... ................................................... ...............g..../... .................I g.b.4 I j TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...� ..^- ® �. .: .... �.�/1. .......C �� ....... ....... i Proposed Use ..... .. .. 5. . ,...... .............. .). ............. ......... ............................................................. ZoningDistrict �..�.............................................Fire District ............ ............................................................ Name of Owner ...\VS9 kl. u ..Address .$)A...�.�.Cc*�. CC' �� \ �c�` \ ` ii 1 1c Il tl' It Iij Name of Builder ..s�7:................�........`�,........�1'�?►�:1�?1N�Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ....1.a.*.Nrx 1.koundation ...�.zoft ..0 ............. -Exterior ......�.-..:. 9.J............................Roofing ...... .... � � • Floors �.�..��.�..�.�..................................................Interior ...................�....... �..................................... _ t hieating S. ..............Plumbing ........ ......: ? '. .......................................... .. ........�:...... ......................... Fireplace ........... ... .5........j.............................................Approximate. Cost ..... .:... ................................... Definitive Plan Approved by Planning Board ---------------- - 19 Area �l�d ........... Diagram of Lot and Building with Dimensions Fee ��•��77 '��....... ....1..7...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH f �f n 3� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............... Construction Supervisor's License ...Q.. ... .(...t A....... CEDAR ACRES REALTY TRUST 26828 One Story N,� ................. Permit for .................................... Single Fan-Lily Dwelling ............. ................................................................ Location Lot 36, 21 west wind Circle ............................................................. Osterville ............................................................................... Owner Cedar Acres Realty Trust .................................................................. Frame Type of-Construction .......................................... . ......... ...................................................................... Plot ............................ Lot ................................ Permit Granted ... ....... 19 8 4 Date`of Inspection ....................................19 Date Completed .........19 Re,&Y cEEr/ Tiyfif TNT LOT/J MDT Ic,Or.4 /N FEVERAIL ItaOrP tIAZAA ® $ .n S S�MO�YN4Y-TNE. FERERA4. A400o 4/NMIXA/MCE RITE AMP' f0/t ME�rOIYM CO,MAEI/N/TY. PANE,, M. Efl�EG7/YE at Al7BERT E. RAYA40N0, .L.. �l1 TE NOTE: NOR.M ARROW NOT TO 0 4 BE IMP FOR 3044R PY/RROSES.k ay x y: EN -41 an sT N O y Z N C � Gj • -' , . Cry . It /ZO,Q7 Pt3 � 4A- - - O It 1 Co On rvia �4or � Nus �aT AAA �UNDATION�GOC,4T/ON PkA,N. . /#Sr"*ENr OUVVEYAMP a ME 44SE OF THE QA VIGY.NK O !/NOER /MO . C/Rc&AfsrANCES AMC OFI SETS MBE &%MV FOR FENCES IYA44J, NEME�9, 49 H OF Mq ARW0 60. EAlsr �Aomo�H ISl/CH1 AY ROEERr ,z.rsr F. L*Ouri , A(�. O.Z.�536 RAYM OND ft 21583 J oAT TO-, _ 4NEET / AVOW/Y: GyitECKEO �IMQ_RKL . IJIGAN N41_;. • .. - ;r' ��^r�/off B¢ '� � . : _ . . � - � 1 t _ i r 1 '1 ell i TF Aim oil ILA r' . q. a — — 1 i � r ham... ,. ... 'F.'-:. --_. ,....- -v.._... _. .... ._...... ......,,.�«.. Y �.r e 1• /•' ,y. ice......_ '. .... �....,,....... ...__..._..:. '.. '..... , 1 ...-.x..._ Y Y , F ter l,r , : r - I • J O v' / V t 1 st"S"Vement ,. a►E C+crpf r - APPFIOVEO BY JORAWN.By OATE iaia i _ w - DIUIIAN 11tR w r. improvement Speckdiists of cape Cod SCALE =,a f ��PPAOVEO err [um .M, nr"tea 84c.