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0152 WEST WIND CIRCLE
,� :�, ,�, ��: �y� r°,: t�a- -.-.. .n .. .. .. _ .. _. _._. __ ...._.� r-, � ,. Town of Barnstable Building -, -. a xsrwas8 PostThisCard So That rt is�Visible;From fhe Street Approved Plans`Must be;Retam,ed on Job and,this Card Must'be�Kept Posted Until 16 F�na(Inspection Has Been.IVlade Permit Where a Certificate;of,Occupancy:is R,egwired;,such�Buil ii.-9 shall Not be Occupied.untiI a Final"Inspection has beerrmade. Permit No. B-18-1818 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals Date Issued: 06/08/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 12/08/2018 Foundation: Location: 152 WEST WIND CIRCLE,OSTERVILLE Map/Lot:-121-011-014 Zoning District: RC Sheathing: Owner on Record: TORRES,STEPHEN A& MARIELOS Contractor Name. ,BRIAN D DENNISON Framing: 1 Address: 152 WEST WIND CIRCLE Contractor License: CS-095707 2 OSTERVILLE, MA 02655 Est Project Cost: $4,588.00 Chimney: Description: Replacemtn Door(1) �. Permit Fee: $35.00 F l Insulation: Project Review Req: Fee Paid' $35.00 Y - -'Date: 6/8/2018 Final: Plumbing/Gas ' Rough Plumbing: I ' Building Official € - Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documentsfor which.this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws,and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing -- 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: v All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT II Application number(. 1. .. �... T I,k o.��ii Date Issued................! . .K......................... BAMSTABLE. °i -, . g - ' ' Building Inspectors Initials... ... . ... ................... JUN0 2018 ��11 6 Map/Parcel....� �. ��.�!c1..�..... FOWN O� BARNSTABLE TOWN OF BARNSTABLE �S EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 15 a v✓e NUMBER STREET VILLAGE Owner's Name: 9et/en/tign-e-los ���e S Phone Number 50J'- zlAJ -14'k 0 Email Address: Cell Phone Number Project cost$ Ll S 8 8 — Check one Residential Commercial 7 OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: S e,- ^4z cJ-\a 06�� Date: TYPE OF WONT ,(Siding Windows (no header change)#' 0 Insulation/Weatherizatioi lJ Doors (no header change)#�_ Conunercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to 41&s4e-1,*1gila j Pl7i,/4 d I / L CONTRACTOR'S INFORMATION Contractor's name i�t�an �Rn�;so✓� - So✓ 2�n ✓fPHI �rS<<rn� �_c�c�wS Home Improvement Contractors Registration(if applicable)# 17 3LLl 5 (attach copy) Construction Supervisor's License# 09 Y 7 01 (attach copy) Email of Contractor Phone number 210l- Z Z X -1900 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. I APPLICATIONNUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) -.Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4:30pm. Commercial events may require Fire(Department approval. XWOOD/COAL/PELLL'T STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Cell or Work number Telephone Number . I understand nay responsibilities under the males and regulations for Licensed Construction Supervisor in accordance with 780 CMIt 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 PLICAIT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. kneWal Agreement Document and Payment Terms b,yAndersen. dba:Renewal By Andersen of Southern New England Steven&Marielos Torres ���� Legal Name:Southern New England Windows,LLC 152 Westwind Cir ���+ RI #36079,MA#173245,CT#0634555, Lead Firm #1237 osterville,MA 02655 WINDOW PE LACEMEXT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)428-1980 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Steven & Marielos Torres Contract Date: 05/21/18 Buyer(s)Street Address: 152 Westwind Cir, Osterville, MA 02655 Primary Telephone Number: (508)428-1980 Secondary Telephone Number: Primary Email: 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: $4,588 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: $2,294 Balance Due: $2,294 Estimated Start: Estimated Completion: Amount Financed: $4,588 6-8 wks 6-8 wks 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: GS 50% DP 50% balance upon completion ; Taxes pd in Barnstable 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 contras if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 05/24/2018 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal 7Bndersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature Jack Incollingo Steven Torres Marielos Torres Print Name of Sales Person Print Name Print Name UPDATED: 05/21/18 Page 2 / 10 1 I Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS LL BRIAN DENNISON 26 ALBION RD LINCOLN, RI 02865 Update Address and return card.Mark reason for change. Address - Renewal - Employment - Lost Card =_-0ffice of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. if found return to: Office of Consumer Affairs and Business Regulation Registration: 1 33245 Type 10 park Plaza-Suite 5170 Expiration: 9/19/201 8 Supplement Card Roston,MA 02116 IOLITHERN NEW ENGLAND WINDOWS LLC. iENEWAL BY ANDERSON � ' IRIAN DENNISON .6 ALBION RD _INCOLN, RI 02865 dersecretary Not valid without signature S,P a .L..`c~I i C'.1.~.� i r�.�r.]L d s�1 ; ii '�tri,�a'�.t �L Qr ..ot (j�.a ild9li rSeq:�Iatlo%s ari iri vianda,r SC CS-095707 BRIA.N D DENNISON 7 LAMBS FOND CIRCLE CHARLTON MA 01507 -crr?r ,iS�lor�r 09:0$;'2C1b' I The Commonwealth of Massachusetts Department Of Industrial Accidents 1 Congress Street, Suite 100 ";rz� 0 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensatibn Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/0rganizaiionMdividual): e E e trJ Address: (n AL&Q Q �r. City/State/Zip: p Phone##: 41)1 Are you as employer?Check the appropriate box: l�Iama employer with ZOtemployees.(full and/or part-time).s Type of project(required): 7..❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in any capacity.(No workers'comp-insurance required.) 8. FJ Remodeling 3.[J 1 am a homeowner doing all work myself[No workers'comp.insurance required.]t 9• ❑Demolition 4.FJ I am a homeowner and will be hiring contractors to conduct all work on my propery. I will 10 ❑Building addition _ ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12. Plumbing repairs or additions These sub-contractors have employees and have workers'comp,insurance.! 13.❑R of repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14• Other e�a r! ip 152,§I(4),and we have no employees.(No workers'comp.insurance required.] reCac4--,-1--t— ;Any applicant that checks box g1 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. !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 information for my emplovees. Below is the policy and job site Insurance Company Name: I rf Me n S Policy#or Self-ins.Lic.#: W CA 31S��7 Z,q _ Z�p Expiration Date: / 1 Job Site Address: IS- 2- [�P S�w; (Tr. City/State/Zip: t/ de /`�✓� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expire •on date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation ptlnishable 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 undejith SiLan�ddpenalfies ofperjury that the information provided above is true and correct.Si ature: (O —t0 — (0 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: Pbone##: ACo CERTIFICATE OF LIABILITY DATE(^MI°DNYYY) `� ABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC 12/29/2017 EXTEND OR ALTER THE COVERAGE ATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, ERAGE 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 CONTACT CoBiz Insurance, Inc.-CO NAME: PHONE 1401 Lawrence St, Ste. 1200 303.988-0446 FAX No:303-988-0804 Denver CO 80202 EDoaIL COMaiI cobizinsurance.com INSURE— AFFORDING COVERAGE NAIL 9 INSURED ESLERCO-01 INSURER A:Acadia Insurance Company 31325 Southern New England Windows, LLC. iNsuRER B:Firemens Insurance Company of WA,D.C. 21784 dba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 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 ADDL SUER LTR TYPE OF INSURANCE WVD POLICY NUMBER MNWpY YYYI EFF MOM/uDD EXP YYn LIMITS A X I COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2018 W12019 EACH OCCURRENCE $1.000,000 dLAIMS-MADE a OCCUR —PREMISE occurrence) $300.000 MED EXP(Any one person) $10.000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.0D0,000 X POLICY PERCT LOC _ PRODUCTS-COMP/OP AGG $2.000,001) OTHER: A AUTOMOBILE LIABILITY N CPA3158728 1/12018 1/12019 COMBINED SINGLE LIMIT Ea accident $1 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS I Per accident $ $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/12018 1112019 EACH OCCURRENCE $10.000.000 REXCESS LIAB CLAIMS-MADE [' � AGGREGATE $10.000,00D DED X RETENTION$ $ 8 WORKERS COMPENSATION 1NCA3158729.20 1/12018 1/12019 X PER OTH-. AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNERIMCLMVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $1,00D,000 (Mandatory in NH) K yes describe under E.L.DISEASE-EA EMPLOYEA$1,000,000 DESCRIPTION OF OPERATIONS below F-L DISEASE-POLICY LIMIT s i.ow.000 C Pollution Uabft 79MO73340000 1/1/2018 1/12MS Each Occurrence $1.000,DD0 Claims-Made Policy A99regate $1.0D0.00D Retroactive Date 06202013 Dedugible $10.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE mot— ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I oY �� vwn of Barnstable *Permit#�®I — 1 �- ` MAYBuilding Department � iIT 6 months from issue O 1 2018 Brian Florence,CBO i63 dAr��u5 .udding Commissioner O�p �n� � . Bp Mp'l m Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY of Valid►vithout Rerl X-Press Imprint Map/parcel Number c A `- Property Address 5 2 Ue PtA 0261� I ®Residential Value of Work$ 6,yR-U W Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address s'f--21/e.., �(�P l yZ I hflU,;rQ Contractor's Name�i�! ,L-e"tnC Telephone Number s6r`- Home Improvement Contractor License#(if applicable) 111361 3 Email: _-r_l %, Construction Supervisor's License#(if applicable) l!5 3 _r ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# S SS UQD 2 7m2 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 toL,/rnw�2 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic;Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors.License is requi ed. SIGNATURE: C:\Users\decollik\AppData\L,ocal\Microsoft\W indows\INetCache\Content.Outlook\9NNOKXYW\RESIDENTILONLYEXPRESS.doc 09/26/17 r i ' C��ze�panvnzoauiiect o C aac/ucaelld ? a,` W" OfTice.of Consumer Affairs&Business Regulation License or egistr t�on;valid for md�yiduaI use only i before the eg iralron date. If found return to: i HOME•IMPROVEMENT CONTRACTOR P Registration: f�13053 Type: ,`,`Office of Consumer Affairs and Business Regulation f I Expiratio =^6�' l2018 bBA01aTcfaza Suite170 I �-, .'' •Boston;lVlA 02116. - iKEATING CONST. TIMOTHY KEATING` 54 LOWER BROOK RD.; SO.YARMOUTH,MA 024 Undersecretary. `` i Not valid without signature ' MassachusettsADepartment of Public Safety Board of Building Regulations and Standards License: CSSL-099351 Construction Supervisor Specialty TIM B KEATING 54 LOWER BROOK RU'AD SOUTH YARMOUTHnMA02664 Expiration: _^.A 0511112018 Commissioner The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations r tT 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: Ste/ J_ a w e s G rao 41 City/State/Zip: 02 6 01 Phone#: So 1- 76y z Are you an employer? Check the appropriate box: Type of project(required): 1. I 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. I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling ship and have no employees These sub-contractors have 8. 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. Roof repairs insurance required.] t c. 152, §1(4),and we have no 13. Other. 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 the policy and job site information. Insurance Company Name: C/,//I- Policy#or Self-ins.Lic.#: 6-f 5'q 06a.?2 7-k,-7 Expiration Date: Job Site Address: IS 2 ��(�w,`� C/rc/� City/State/Zip: US1t�r�,rl�e G�..st d2�rf 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 under the pains and penalties of perjury that the information provided above is true and correct Signature: ,_ � Date Phone#: f!)k 7l o Official use only. Do not write in this area, to be completed by city or town official Ci"r 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#: • aMartseMat,s. 19. Town of Barnstable Building Department Brian Florence,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 as Owner of the subject property hereby authorize /c+P- ( G/'S f-re r I-�`� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) er 121 / C Signature o Owner Date �'e✓pr. _.y Pomp j Print Name s If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\W indows\INetCache\Content.Outlook\9NNOKXYWARESIDENTILONLYE`CPP ESS.doc 09/26/17 �r A CERTIFICATE OF LIABILITY INSURANCE '""r) F77locf16/18 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 endorsemen s. PRODUCER CONT-NAME:- JULI MCDOWELL Schlegel 6 Schlegel Ins Broker PHONE---- --I FAX 34 Main Street anal 508 771-8381 JAI NI: (508) 771-0663 ADDRESS: schl@ elinsurance@ ail.com West Yarmouth, MA 02673 _ INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:MOUNT VERNON INSURED INSURER B:CNA TIMOTHY KEATING DBA KEATING INSURERC: CONSTRUCTION ---`- -"` INSURER D 54 LOWER BROOK RD INSURER E--^----__-_--.. SOUTH YARMOUTH, MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - -- - - _ ADDL SUBR - - -- ------I_-POLJCY EFF POLJCY EXP LTR TYPE OF INSURANCE POLICY MlOD/YYW MM/DDrYYYY LIMITS A GENERAL LIABILITY GL 2548741 3120/18 3/20/19 EACH OCCURRENCE ____ $ 1,000,000 DAMAGE TO I RENTED X COMMERCIAL I I $ 500,000 CLAIMS-MADE [ill OCCUR I MED EXP(Anyone person) $ 10,000 PERSONAL&ADV INJURY $-1,000,000 GENERAL AGGREGATE I $ 2,000,000 GE�N'L AGGREGATE LIMIT APPLIES PER I I PRODUCTS-COMP/OP AGG $ 2,O()O,000 I POLICY PRO- I -� LOC I 1 $ AUTOMOBILE LIABILITY CO BINED INGLELIMIT Ea accident — $ I ANYAUTO BODILY INJURY(Per person) S AL O SCHEDULED AUTOSS AUTOS I BODILY INJURY(Per accident) $ _ NON-OWNED PRO d YtDAMAGE HIRED AUTOS — AUTOS $ i $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ l EXCESS LIAB CLAIMS-MADE I AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 6S59UB0224N37214 3/9/18I 3/9/19 9R I� IOTH- i AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA EL.EACH ACCIDENT $ 100,000 OFFICE RAIEMBEREXCLUDED? (Myyandatory In NH) I E.L.DISEASE-EA EMPLOYEE $ 100 000 If ,describe DESCRIPTIONunder OF OPERATIONS below I E.L.DISEASE-POLICYLWArT 500,000 � j l DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) TIMOTHY KEATING HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS COMPENSATION POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE r!*` THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 2 0 4CORMORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of A O D Phone: Fax: E-Mail: IFIE rq Town of Barnstable *Permit#. Expires 6 nths om issue d �T Regulatory Services Fee ] + 1AENSPABU. 9� 1 `0� Richard V.Scali,Interim Director ADS Building.Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �,� 6 11 �� // / Property Address j � fQ�l � 16,(reG� �5 'r,x le 4R6-i—dential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address&v r Contractor's Name Telephone Number /S D 7 z/,� Home Improvement Contractor License#(if applicable)/V3 34 Email: ZT Construction Supervisor's License#,(if applicable) U7 2 �ran'sCompensation Insurance LSS PERM11T Check one: ❑�have le proprietor MAR 13 2014 Homeowner orker's Compensation Insurance Insurance Company Name 2 L/n 64 TOWN OF BARNSTA13LE Workman's Comp.Policy#6z, LJf3 `� 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 ❑Aevnof(hurricane nailed)(not stripping: Going over existing layers of roof) ff Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#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 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 quired. SIGNATURE: Q:\WPFILES\FORMS\building pemut formsTYPRFSS.doc ate C'omvrowtfeaUh of Massachusefts Delwfineret of ladusbial'code its Office aflnyeszkwians 660 WmMagton Street Boston,M,4 02M wmv.tnasxgo,%Qia Workers' Compensation Insnr- -ace Affidavit:Builders/Contractors/MectriciansfPlumbers Apph-caut Infarm.afian ¢� Please Print Legibly Name(Busa�esslO�ganiza onllndividt : a� dam'i /J �� Address:/7 Le,,, /I, { tyfStatrlZip: Phone# 7 $� Y Are 7ain .employer? the appropriate box: Type of project(required): €. employer with 2___. 4- ❑ I atria general contractor and L b- ❑New constninu employees(full and/or part�ime)* have hired the sub-contradors 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' g. ❑Building addition [No workers' comp.inmrranre comp.mcnrance l requir5. ❑ W repairs or are a corporation and its 14_❑Electrical repa or additions �, officers bwm exercised their 14 Plumbing airs or additions 3_❑ I am a homeowner doing all wont; -•❑ g mP , myself[No workers'comp_ right of ever tion per MGL 12-0 Roof repairs insurance required.]l c-152,§1(4),and we have no employees_[No workers' 13-0 Other comp.insurance required_] *Fiery wpEornt that checks boa#1 mast also fill out the section belaw showing they wadtee compPnat+m policy i an- #Hameovners who sabmit this affidavit inc€u4tiag they are doing an walk and then hire amside contmctors sabmit a near affidavit mehrsitin swdi r(A,Utmctars that check this box most stoirl, as additional sheet showing then of the solo-moots z d state whether nrnot those ors have employees If the n*-contmctns have employees,they mast pmvide their workeW comp policy number- lam an empr iha#isprmddittg nrorkers'cotttpsrisnhun irisitrai[ci;far m}T empinyeRs Be7vw is the pa7ic}a>qd job sits ire.formatiam Insurance Company Name: Policy 9 or.Self-ins Lic-9`-k?Z V t3 FxpirationDate: Job Site Address is��it`C�S�✓i'/!ro�/ [2�t CifyfState/Zip: C&�9_/,r1J114 c, Attach a-copy of the workers'compensation policy declaration page(showing the policy number and ezpirxti on date). Failure to secure coverage as regtrireduuder Seetiort 25A of MGL c. 152 can lead to the imposition ofcriminal penalties of a fine up to$1-500.00 and/or one-yearimpr sonmenk as well as civil penalties in the fbna of a STOP WORK ORDERand a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIAL fDr insurance coverage veriffcaft n- I da hereby ce . unAder the • ns air ganatlies u,f'perdury that tie itcjbrumfian pravidsd above'�77 d correctSit3tattuE: Date (7,&W use wily. Do not writs in this area,to be camp eted by cdy or town of jSaiaL City or Town: Pern tUcense# Issuing Authtuity(tarcle one); .. .. -.. zz-_�� __.� n. st�rr,----�^--L • r.�-�---�r---�-- r n�-.i--T---`-- r,. Information and histructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,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 ei4ploys 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, §25C(6)also states that"every state or Iocal 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,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certincaie(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance_ If an LLC or LLP does have employees,a policy is required. Be.advised that this affidavit may be submitted to the Department of Industrial Accidents for confrrnation 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 Departs rent of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number: ne Comm4nnmea ffi of Massaahcusetts Depaitment of Industrial Accidents Office of klvestiodom 640 WaAlim boa Street BQSWz,MA 02111 Ta#617-727-4900 ext 406 or 1-$77 MASS AFE i FRPRE�'EN �rE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS OES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED VE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer.rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 508540 6161 Fax: soS 457-766o cE cT Bob Allietta FALMEIDA$CARLSON INSURANCE AGENCY INC. -0550 w Flo), 508 888 P.O.BOX 554 EMAIL rallietta@almeidacarlson.com FALMOUTH MA 02541 °°DREss: INSURER(S) AFFORDING COVERAGE NAIC# INSURER :Travelers Indemnity Company of Connecticut 25682 INSURED INSURER B :Zurich American Insurance Group DENARDO HOME IMPROVEMENT OF CAPE COD INC. 17 WILANN ROAD INSURER MASHPEE MA 02649 INSURERD: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 26274 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 ADO'L SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MMMDfyym A GENERAL LIABILITY 680883OA359 09/10/13 09/10/14 EACH OCCURRENCE $ 500,000 _5AMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ 300,000 CLAIMS-MADE FXI OCCUR MED.EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000 POLICY PRO LOC $ COMBINED SINGLE LIMB AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDPN�CTOOWLNED HEDUED BODILY INJURY(Per accident) $ AUTOS HIRED AUTOS PROPERTY DAMAGE $ UTOS (per accident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ ExcEss LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WC STATU- OTH B WORKERS COMPENSATION 6ZZUB9859L330-12 12/20/13 12/20/14 TORY LIMITS ER $ AND EMPLOYERS' LIABILITY YIN E.L EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? F NIA E.L.DISEASE-EA EMPLOYEE $ 100,000 (Mandatory in NH) If yes,describe under E.L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) , -CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: Bob Allietta ACORD 25(2010105) @ 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Liability Insurance DeNardo 14ARV1 Home «;no,,;,: Workman's Compensation Improvement MASTIC 4 Year Labor Guarantee of Cape Cod, Inc. uildine Products MA HIC Reg.#143379 MA Cont.Lic.#072276 (508) 477-5574 ,M0)920-�48821Fax(508)477-8999 Vinyl Siding Established 1984 17 Wilann Road,Mashpee,MA 02649 Aluminum Trim www.DeNardoHomexom Date Proposal Submitted To Phone Job Name Other Phones/Fax Street Job Location Email City,State,Zip Code We hereby propose to furnish materials and perform the labor necessary for the completion of the following... j; /c5d ���7 $�(/✓�.ri? /�/cSd�� �6i%, -4e: GC `sc c�/�' N 4' t �✓�r il��`� l�c� *+� ell" aIa.,• (.-j4, 1�... / / u // // / � (/^- ,`/ /y. /DV�.j rl t'�—i✓L t� V!✓lc+'�(:GJ J q/ /rC 74 Lai--r 4,�, 7- .,� ,sue°✓...�G z. / C//�����/i�/����iC; - �?En,;nfy `� �"�` � �`� ^� �A1iMatEria guaranteed to be as spe fied(a/d ' e work is to be omp eted in a su stantial workhn Iskmanner for the sum of... j_;_Me Cf� 41� Dollars($ 5-�,VCM with payments to be made as follows: �. L L Any alteration or deviation from above specifications involving extra costs will be executed only upon written order,and will be- Respectfully submitted Note—This proposal may be withdrawn by us if come an extra charge over and above the estimate. not accepted within_days. Owner to carry fire,tornado and other necessary insurance. ACCEPTANCE OFPROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. DeNardo Home Improvement is authorized to do the work as specified above.1,(We),agree to make payment as outlined above.Owner consents to allow contractor for the purposes of marketing and photographs of the property,name,address,and telephone numbers to be used by advertising on the internet and/or in publications.All legal fees incurred,or made necessary,b the of the dollar amount listed above,shall be the responsibility of the person(s)named a ove n s'gne b ow. Date Signature Signature J t Massachusetts -Department of Public Safety. Board of Building Regulations and Standards Construction Supervisor License: CS-072276 MARL A DENARpb 17 W n ANN RD i MASBPEE MA 6264 NO vJ-,2„,�•,vi_.n "' Expiration Commissioner 02/12/2016 c{ih F k2�c f naq� q/cu1eM' aff�3�� � y�r p�U1�t+on DLO` 9 . �1..n.� r3e 1.Q1{ •.3 �j -1 . 4 ✓, I '"' 61� ' f 2.. �(ILat�7rfw�df{7Q CJ r i :v ti , fff ar 03$aav te 40 1 MA3 P 1,MA 62646 } �llu� got .J" .11 4. y 0 `. oF.►,E Town of Barnstable ermit#6 ge�L" Expires 6 months from issue dt yT Regulatory Services Fee ,� + t3nxrtsTABLE. � MASS. Thomas F.Geiler,Director prFD MA'S A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number —�� �—(�}4 Not Valid without Red X-Press Imprint �Z � Property Address WW/ / rc residential Value of Work$ ZZ Minimum fee of$35.00 for work under$6000.00 / Owner's Name&Address r S Z �� /0a /rc / i OZGS — OS vec- el✓t� en Contractor's Name ►7 elephone NumberO60'7S 3 'O 4SZ Home Improvement Contractor License#(if applicable) 4 � EmailISV GCO831@GwKx_*% Com Construction Supervisor's License#(if applicable) 97 S ' 9 X.-PRESS PERM v� Irw ;orkman's Compensation Insurance Nov — g 2�13 :�`i '`1• Check one: " ll ❑ I am a sole proprietor Eam the Homeowner have Worker's Compensation Insurance TOe�,�OF B11 STABLE Insurance Company Name �� w�e n` �1�¢ CGL yl �5(,�ra/oc e_ Workman's Comp.Policy# w i R C 4 `13 2 Z S 3 4 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) N A —❑ Re-roof(hurricane nailed(stripping old shingles) All construction debris will be taken to N rA — ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) *V Re-side NA ❑ Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows #of doors: #V A ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner most sign Property Owner Letter of Permission. e opy of the Home provement Contractors License&Construction Supervisors License is uir SIGNATURE: 4Z� C:\Users\decollik\AppDat ocal\Microsoft\Windows\Temporary Internet Files\Content.Out]ook\8R DVA\EXPRESS.doc Revised 061313 i Th'e"Commonyvealth:of Marssachusetts .Departnierit;of Industrial Accidents Office of Investigations 600`'Washington Street Boston, MA 02111 www.M&s.gov/dia. Workers':Compensation Insurance Affidavit:Builders/Contractors/Electricia ii/' Umbers Applicant Inforination Please"Print Legibly Name (Business/Organiza6on/Individual): Sears Home.Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL 32750 Phone#: 860-753-0452 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ Lam a employer.with 4. ❑ 1 am a general contractor.and I 6, ❑New'coristniction, employees(full and/or part time).* have hired the sub-bonfractors 2.❑ I am a sole proprietor.orpartner_; listed onthe attached sheet. t 7. ❑.Remodeling ship:and:have.no employees These sub-contractors have 8. ❑Demolition working "for me:in any capacity: 'worker`s' comp.,insurance. 9. ❑But addition [No workers comp. insurance 5. We are a.corporation and its required.] officers have exercised their 10..❑Electrical repairs or:additions 3.❑ I am a homeowner.doing all work right.of exemption per MGL 11.❑.Plum bing repairs or additions myself. [No workers'.comp. c: 152, §1.(4),and we have no 12.❑:Roof repairs insurance required.] t employees'. [No worker$' '13.E .Other / (ln comp, insurance required,] *Any applicant that chedts.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 artidavit-mcaicatmg such. [contractors that check this box must attached an additional sheet showing the name of the sub-contradors and theirworkers'comp.policy information. I am an employer that is.provi.&ng workers,l compensation insurance for,nty employees: Below is the policy.and job site information. Insurance Company Name: Ace American Insurance Company / Phone:866-283-7122 Policy#or Self=ins.Lic. #: WLRC47322534 n Expiration:Date: 08/01/2014 Job Site Address: , S 2 wes f u)l 11 1.1 M le-City/State/Zip • 1 Q`'1"K.L,13 Z S T Attach a copy of the workers[compensation;policy declaration.page(showing lie policy number afid.expiration date). Failure to secure coverage.as required under<Section 25A ot,MGL c..,152 can:lead io-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, Investigations of the DIA for insurance coverage verification. I do hereby cerkfy n r e•pains and pe Dies of perjury that the information provided above is true and correct. Si nature' {Sears Auth.Agent} Date: No V V ,4 Z,0 ),3 Phone#: Home—Fax: 860-935-0346 / Cell: 860-753-0452 i Official use only. DoAdtwrite 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 M i �l A CERTIFICATE OF LIABILITY INSURANCE DATE(MM o7ns/2n013 W) ala THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS o CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 00 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED rn REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. `O 0 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 w certificate holder in lieu of such endorsement(s). PRODUCER CONTACT ar AOn Risk Services Central, Inc. NAME: PHONE Chicago IL Office (IC..No.E.1): (866) 283-7122 ac.No.: (800) 363-0105 y 200 East Randolph EM vAIL c Chicago IL 60601 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC p INSURED INSURER A: ACE American Insurance Company 22667 Sears Holdings corporation INSURER B: Indemnity Insurance CO Of North America 43575 dba Sears Home Improvement Products, Inc Attn: Risk Management E3-219A INSURER C: 3333 Beverly Road INSURER D: Hoffman Estates IL 60179 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570050796993 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYYI (MMIDWYYYI LIMITS GENERAL LIABILITY HDOG EACH OCCURRENCE $5,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $5,000,000 CLAIMS-MADE ❑X OCCUR MED EXP(Any one person) EXcl uded PERSONAL a ADV INJURY $5,000,000 rn GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S5,000,000 0 X POLICY LOCJFCT o A AUTOMOBILE LIABILITY ISAH08719780 08/01/2013 08/01/2014 COMBINED SINGLE LIMIT 'n A ISAH08719792 08/01/2013 08/01/2014 Ea accident $5,000,000 AJANY AUTO ISAH08719809 08/01/2013 08/01/2014 BODILY INJURY(Per person) O ALL OWNED SCHEDULED Z AUTOS AUTOSBODILY INJURY(Per accident)NON-OWNED PROPERTY DAMAGE HIRED AUTOS X U AUTOS Per accident I2 1: d UMBRELLA 4AB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION A WORKERS COMPENSATION AND WLRC47322534 OS 01 2013 08/01/2014 WC STATU- OTH- EMPLOYERS'LIABILITY YIN CA MA AZ X TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $2,000,000 B OFFICERIMEMBEREXCLUDED? NIA WLRC47319122 08/01/2013 08/01/2014 (Mandatory in NH) All Other States E.L.DISEASE-EA EMPLOYEE $2,000,000 It yes,describe under DESCRIPTION OF OPERATIONS bL-lo%v E.L.DISEASE-POLICY LIMIT $2,000,O00 lllllll� DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1540 American way I Longwood FL 32750 USA ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i-. LJ'eCU�.�C Office of Consumer Affairs"and Business Regulation 10 Park-Plaza Suite 5170 Boston Massachusetts 0211.6 Home .I.mprovemen ,Contractor Registration, Registr6tion. 148607 „ Type: Supplement Card m -w Expiration; 10/11/2015 SEARS HOME IMPROVEMENT Pk' DU.C�T LOBOS SVEC { l ' �_`_._._. _. ......._.. 1 _ 1024 FLORIDA CENTRAL PKWY _................. LONGWOOD, FL 32750 w. � � .__..................... __..... .......__. __;.............. update Address and return card.Mark reason for change. seal Co 2or�-os it Address f—'i Renewal r .Employrtient Lost Card .. ellr 1 !•rx9➢llY�rrrvtlG��o��l%�lr irzr,�uv',P/l3" . Rice of Consumer Affairs&Business Regulation License or registration valid for individul use only ,.'P�ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation. Registration 14860,7 ,t Type-; 10 Park Plaza-Suite:5170 Expirat on 10/11/2015 Supplement.Gard Boston,MA 02116 SEARS HOME IMPROVEMENT PRODUCTS INC.. LOBOS SVEc 1024 FLORIDA CENTRAL PfZ1NY --- LONGWOOD,FL 32750 -- ......... "%outig., Undersecretary Massachusetts-Department of Public Safety ,Board of Building Regutazion. d Standards C�iistruc#i�ara$zrper�is�zs �� � License.,CS-097519 1 6 4 t T 827 TNONtPSOi:l.ROAD' Thompson CT 06377 V fetm V� r xpirafioli ? Cor<ilnjss ones 08/3112014 :k Office Location:BOSTON Proposal Date 08/08/2013 lJob Number 16017836 �— Sears Home Improvement Products,Inc. Customer Name P.O.Box 522290 STEPHEN TORRES 1024 Florida Central Parkway Customer's Home Phone Customer's Work Phone Longwood,FL 32750-7579 (774) 521-3105 Home Improvement Products Phone 800 469-4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 152 WESTWIND CIR MA(148607) city State Zip Code Siding All plumbing and electrical services performed by OSTERVILLE MA 02655 Is installation within city limits? licensed subcontractors Installation Address County BARNSTABLE (Yes/No): YES FEIN 25-1698591 Billing Address(if different from above) City State Zip Code Project Consultant Name 8 License No.(if applicable) MUHAMMAD NAEEM 28779 Description of the Project and Descri tion of the Significant Materials to be Used and Equipment to be installed The work to be done under this contract includes the following(where checked): Specifications(2=Included❑=Not Included) Preparation: 1. 0 Obtain all necessary permits and insurance. 2. 2 Inspect surfaces in work area,re-nail loose wood,and replace rotten surface wood where necessary in work area(excluding. roof,decking,rafters,and structural members). 3. ❑ Remove existing siding. Type: 4. ❑ Fir out walls on brick,block,metal,or stucco areas. Location: 5. ® Caulk and seal around all windows and doors in the work area as necessary. 6. ® Install approved non-corrosive starter strip. Insulation: 7. ® Install insulation of flatwall areas that are to be sided with (3/4"or 1/4"): 3/4" extruded polystyrene insulation. Custom Trim: 8. ® Install custom Vyna-Klad aluminum fascia system. Color: GLACIER WHITE 9. ® Remove existing guttering.After removal,existing guttering will be: (re-attached I disposed of): RE-ATTACHED 10. ® Install new guttering and downspouts. 11. ® Cover soffit areas of home with vinyl soffit system(except where noted below in"Work NOT to be done")using: (WB Max/WB Plus/Weatherbeater/Value Line/Other): VALUE LINE Color: GLACIER WHITE Pattern: ANY 12. ❑ Install custom Vyna-Klad aluminum frieze boards. Size: Location: Color: 13. ® Window trim: (jump/butt): BUTT Location: ALL Color: PLATINUM GREY 14. ® Custom wrap windows,sills,mulls,headers with Vyna-Klad aluminum. Color: GLACIER WHITE 15. ® Remove and re-install existing: (storm windows/awnings/shutters): SHUTTERS 16. ® Install new shutters: (Panel/Louver): PANEL Color: CRANBERRY 17. ® Custom wrap door facings with Vyna-Klad aluminum. Color: GLACIER WHITE 18. ® Custom wrap garage door facings with Vyna-Klad aluminum (single/double): SINGLE Color: GLACIER WHITE 19. ® Remove and re-install storm doors. 20. ® Install deluxe corner posts. Color: GLACIER WHITE Siding: 21. ® Install: (WB Max/WB Plus/Weatherbeater/Value Line/Other): WB MAX Solid vinyl siding. TYPE:(Horizontal,/-Jerticai): HORIZONTAL CUIUI; YLAIli�Una:GKEv Porch Systems: 22. ❑ Porch ceilings: Location: Color: 23. ❑ Porch posts: Color: 24. ❑ Porch beams: Color: Clean up: 25. 0 Clean up and removal of all job-related debris. 26. IZI Remove excess materials and re-stock each job is over-shipped to avoid delays). Additional work to be done:FIRRING GARAGE DOOR, FIRRING WOOD FRAME WINDOWS, ENTERY DOOR AND 2 PATIO DOORS. Work NOT to be done: No drip edge covered;no paint applied. MOST OF THE WINDOWS HAVE VIYNL FRAMES, NOT WRAPPING THEM. SPECIAL INSTRUCTIONS:INSTALLING CAPE COD CEDER SHAKES ON THE FRONT OF HOUSE, COLOR: P.GREY. INSTALLING NEW DOWN SPOUTS ONLY. J BLOCKS MUST MATCH SIDING COLOR. CUSTOMER WANTS TO COVER FREEZE BOARD AND DENTAL ' DECORATIONS WITH VIYNL SIDING ON THE FRONT OF HOUSE. All of the above check boxes, "Work NOT to be done," "Additional work to be done," and Customer(s)initials 5-7"Special Instructions"sections have been reviewed and explained to me. SS1-MA (Dig.) Rev 08/01/12 Page 1 of 3 Job Number: 16017836 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 8-10 WEEKS (Approximate Start Date) It will be substantially completed by approximately 2 WEEKS (Approximate Completion Date) These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products, Inc.("Sears")or at any other time by mutual written agreement.Customer understands that the Approximate Start Date is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. ASBESTOS ABATEMENT: This Estimate and Proposal assumes that there are no asbestos containing materials ("ACMs")that would be disturbed in the performance of the installation work. If upon further inspection by the contractor or others it is learned that ACMs have to be disturbed to perform work,then Customer must arrange and pay for abatement of asbestos by a qualified person prior to the start or continuation of work. If Customer fails to arrange for necessary asbestos abatement within thirty (30)days, Sears may cancel this contract upon Customer(s)initials written notice to Customer. 1 F The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 22,406.60 Contract Price M �$22,406.60 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 6,721.98 State Sales Tax( 0.00 %) $0.00 Final Payment(balance payable upon completion of job)$ 15,684.62 Local Sales Tax( 0.00 %) $0.00 Total Amount Due $22,406.60 The form and method by which the Customer(s)will.pay is described in a separate Cash/Credit Customer(s)initials S Card Payment Addendum made a part of and incorporated into this contract by reference. NOTICE TO BUYER: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER)AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ADDITIONAL PROVISIONS Proposal and Approval.Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown.This offer must be approved by the Installation Department.If this is a credit sale or a payment on completion sale,it must be approved by the Credit Sales Department.If this proposal is not approved or the installation cannot be made in accordance with the law,this offer will be withdrawn and any payments you have made will be refunded to you.Any materials left over after the installation has been completed are Sears property and will be removed by Sears. Installation. I understand that Sears will not install the materials but will arrange for the installation.Sears is not responsible for materials or installation NOT furnished or arranged by Sears.Sears'installation contractor(s)will obtain all building permits required by local law. For homes located in historic or landmark zoning districts,Customer will be responsible for obtaining required approvals and related permits prior to the commencement of work on this contract. Authorization. I authorize Sears to: (1)arrange for a contractor(licensed where required by law)to make the installation of materials; (2)issue a work order for this installation to a contractor;(3)inspect the installation;and(4)pay the contractor when the installation is complete if I have signed a certificate that the installation has been completed to my satisfaction. Delays in Installation.I agree that Sears is not responsible for delays in delivery or installation due to weather,fire,strikes,war,government regulations or any causes beyond Sears'control. Oral Agreements and Changes in Contract.I understand that there are no oral agreements between Sears and me.Everything I expect Sears to do has been included in writing in this contract.Nothing can be changed in this contract unless it is in writing on a separate form accepted by me and Sears. Responsibility of Buyer. I agree that any information.or measurements that I give to Sears are.correct and complete. I am responsible for any special work described in this contract. Electrical& Plumbing Service. I will provide adequate electrical and/or plumbing service(s)to run any newly installed appliances or other furnishings. If the electrical and/or plumbing service(s)do not meet the standards of the utility company or electrical and/or plumbing codes,I will make the necessary changes at my expense unless Sears has agreed in this contract to make the changes. Payment.I will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warranty Information.Appropriate product warranty documents will be given to me by Sears.Sears'Warranty on Installation is: SEARS'LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s)used (which warranty becomes effective the date the merchandise is installed), if the workmanship (or application) of any Sears' arranged installation proves faulty within (i) one year for Weatherbeater or other brand, (ii) two years for Weatherbeater Plus,or(iii)three years for Weatherbeater Max,then upon notice from you Sears will cause such faults to be corrected by repair at no additional cost to you.If Sears determines that repair is not commercially practicable or cannot be timely made,then,at Sears'sole discretion,Sears may elect to provide replacement or refund.Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1-800-222-5030,Option 4.This warranty gives you specific legal rights,and you may also have other rights that vary from State to State. SS1-MA (Dig.) Rev 08/01/12 Page 2 of 3 Job Number: 16017836 NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT.KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME,AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY[FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER]AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH, YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING"I HEREBY RESCIND"AND ADDING YOUR NAME AND ADDRESS.A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY In.addition to the-Notice to Buyer shown above, Massachusetts law require.s..that contracts for home.improvement work state that.all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration P.O.Box 871 Taunton,MA 02780-0871 Telephone:(508)821-9375 Please note that owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Notwithstanding any other language in the contract or associated documents, Sears will not remove, replace, or install any heating or air conditioning system, or any portion thereof, if asbestos or asbestos-containing material is known or likely to be present in that heating or air conditioning system,or any portion thereof. If it is determined or reasonably suspected that asbestos is present,either before commencement or during performance of the work, it shall be the customer's responsibility to select, retain and pay all costs of a Division of Occupational Safety ("DOS") licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determination or reasonable suspicion of the presence of asbestos arises after Sears has started the work,Sears will immediately cease performing the work until a DOS licensed Asbestos Contractor, hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R. 7.00 and 453 C.M.R. 6.00 or verifies that none is present. By signing the contract the customer agrees that it understands the above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 08/08/2013 08/08/2013 Customer's signature Date Customer's signature Date Accepted by Sears Home Improvement Products, Inc.("Sears")on 08/08/2013 by: Date Management Representative SS1-MA (Dig.) Rev 08/01/12 Page 3 of 3 oFT„E,� Town of Barnstable *Permit 4c2V/3070/S � Expires 6 niont r 5 ute Regulatory Services Fee • BARNSTaBLE, MASS. g 1639• Thomas F.Geiler,Director �� RFD MA't� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bdmstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 1 of Valid without Red X-Press Imprint Map/parcel Number 12 ( • 0 1 d l Property Address }}Wes Residential Value of Work$ 2—Minimum fee of$35. 0 for work under •$-6000.00 Owner's Name&Address ds v ' ka It Md, o2GSG u 40vs vec - 52 5 ee7 Contractor's Name' Telephone Numbber&90•-7S�3q'O sZ Hoe Improvement Contractor License#(if applicable) 14�36C77 m Em Nu ail:JSV t`wper 3 11tT nGmcx I L. gar), Construction Supervisor's License#(if applicable) ! r E f Workman's Compensation Insurance ��i�-'•�� Check one: ❑ I am a sole proprietor ❑ lam the Homeowner OCT 3' 2013 I have Worker's Compensation Insurance Insurance Company Name kL Ar►ierl ca Yl -+-YIS LA rQMC C_ �FBARNST INIY ABLE Workman's Comp. Policy#��.R� � � �� 2-�34 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check,box). NA —❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to NA --❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) NA jRe-side Replacement Windows/doors/sliders.U-Value 6,30 Jrnaximum.35)#of windows #of doors: AIA — ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. ypof the Ho &Irovement Contractors License&Construction Supervisors License is ed. SIGNATURE• C:\Users\decollik\AppData\Local\Microsoft\Windows\T Files\Conten[.Outlook\8R76BD A\EXPRESS.doc Revised 061313 F IlIE �ARNMASS, LE 1639. $ Town of Barnstable QED Mpl 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 Irre S as Owner of the subject property hereby authoriz 1'YI tb act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Dale q- i�nken 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 Internet Files\Content.Outlook\8R76BDVA\EXPR.ESS.doc. Revised 061313 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 Print Legibly Name (Business/Organization/Individual): Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL 32750 Phone #: 860-753-0452 Are you an employer?Check the appropriate box:. Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑,New construction employees(full and/or part-tnu.e).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7. ❑Remodeling ship and have.no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers'comp. insurance. 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.❑ I am a homeowner doing all work right.of exemption per MGL Ti.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑koof repair; J1 insurance required.] t employees. [No workers' 13.0 Other I )?too I ce rY) h r 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. tContractors that check this box.must attached an additional sheet showing the name of the_sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name; Ace American Insurance Company / Phone:866-283-7122 Policy#or Self=ins. Lic. #: WLRC47322534 n Expiration.Date: 08/01/2014 Job Site Address: 1.., City/State/Ziposfci y 1 ) 1420 No,o,0ZIG SS Attach a copy of the workers compensation,policy decla . ion page(showing the policy number,and.expiration date). Failure to.secure coverage as required.uprider S?ction 25A of MGI:c. 152 ran lead to the imposition of crimir_al 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 maybe.forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certi nd the pains a enalties of perjury that the information provided above is true and correct. Si ature {Sears Auth.Agent) Date: Phone#: ==4fBWe— ax : - 35-0346 / Cell: 860-753-0452 Official use only. Do:not write in this area, to be completed by city or town off cial. City or Town: Permit/License# i Issuing Authority(circle one): 1.Board of Health 2.Building Departm ent 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: DATE(MMIDD/YYYY) A o CERTIFICATE OF LIABILITY INSURANCE 07/19/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES o BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED c REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 0 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 w certificate holder in lieu of such endorsement(s). PRODUCER CONTACT d Aon Risk Services Central, Inc. NAME: PHNE Chicago IL Office (AIC.No.E.1); (866) 283-7122 ac.No.: (800) 363-0105 200 East Randolph E-MAIL 2 Chicago IL 60601 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: ACE American Insurance Company 22667 Sears Holdings Corporation INSURERB: Indemnity Insurance Co of North America 43575 dba Sears Home Improvement Products, Inc Attn: Risk Management E3-219A INSURER C: 3333 Beverly Road INSURER D: Hoffman Estates IL 60179 USA INSURER E: .INSURER F: COVERAGES CERTIFICATE NUMBER:570050796993 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYW MMIDDIYYYY LIMITS A GENERAL LIABILITY HDOG EACH OCCURRENCE $5,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S5,000,000 CLAIMS-MADE X❑OCCUR MED EXP(Any one person) EXCl uded PERSONAL B ADV INJURY $5,000,000 rn GENERAL AGGREGATE $5,000,000 m GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $5,000,000 0 to X POLICY PRO- LOCJECT p n A AUTOMOBILE LIABILITY ISAH08719780 08/01/2013 08/01/2014 COMBINED SINGLE LIMIT $5,000,000 N A ISAH08719792 08/01/2013 08/01/2014 Ea accide t A ANY AUTO ISAH08719809 08/01/2013 08/01/2014 BODILY INJURY(Per person) O ALL OWNED SCHEDULED Z X BODILY INJURY(Per accident) y AUTOS AUTOS .+ X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE v AUTOS Per accident t: JN UMBRELLA LIAB OCCUR - EACH OCCURRENCE U EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTION A WORKERS COMPENSATION AND WLRC47322534 08 1T2013 08 01 2 114 X WC STATu- OTH- EMPLOYERS'LIABILITY YIN CA MA AZ TORY LIMITS R ANY PROPRIETOR I PARTNER/EXECUTIVE E.L.EACH ACCIDENT S2,000,000 B OFFICERIMEMBEREXCLUDED? NIA WL1107319122 08/01/2013 08/01/2014 (Mandatory in NH) All Other States E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) r CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1540 American Way Longwood FL 32750 USA ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Office of Consumer Affa' and Business Regulation 10 Park Plaza - Suite 51.70 ` Boston, Massachusetts 02 116 Home Improvement Contractor Registration - Registration: 148607 Type: Supplement Card SEARS HOME IMPROVEMENT PRODUCT r Expiration: 10/11/2.013. LUBOS SVEC _•._ ___ __. __ ,._. 1024 FLORIDA CENTRAL PKWY -- LONGWOOD, FL 32750 _ Update.Address and return card.Mark reason for change. GP8•CA1 0 :a>i awoe 6��;onto// Address — Renewal Employment •T Lost Card 'x# :r'f`tA L�Y.�w.7YlktlG#( 9� ��ftSSZf�flJfi�r.� ••••• _ .. ,•� «........._ _ _ ...- .r �,. Office of t uusume� >ITurs b Kusrness Re-obtion License or registration valid for mdn tdul use Only t HOME IMPROVEMENT-CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 148607 type: 10Parh Plaza-Suite 5170 r Expiration: 10/1112013 Supplement Card Boston.NIA 021.16 SEARS HOME IMPROVEMENT PRODUCTS INC. LUBOS SVEC 1024 FLORIDA CENTRAL PKWY LONGWOOO,FL 32750 lindersecrewri 4Notalid without signature t Massachusetts -Department of Public Safety ! Board of Building Regulations and Standards Construction Superj•isor License. CS-097519 i LUBOS SVEC = '; 827 THOMPSON_-ROAD� , Thompson CT 06277 i 't I cJ it tst'' Expiration , i Commissiionne'r- 08/31/2014 Office Location:BOSTON Proposal Date 09/25/2013 Job Number 16017836 Sears Home Improvement Products,Inc. Customer Name P.O.Box 522290 STEPHEN TORRES arrs 1024 Florida Central Parkway Customer's Home Phone Customer's Work Phone Longwood,FL 32750-7579 (774) 521-3105 Home Improvement Products Phone 800 469-4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 152 WESTWING CIR MA(148607) city State JZipCode Windows MA plumbing and electrical services performed by OESTERVILL MA 02655 Is installation within city limits? licensed subcontractors Installation Address County BARNSTABLE (Yes/No): YES FEIN 25-1698591 Billing Address(if different from above) City State Zip Code Project Consultant Name&License No.(if applicable) MUHAMMAD NAEEM 28779 Description of the Project and Description of the Significant Materials to be Used and Equipment to be installed 1. Remove existing units to be replaced.(PLEASE NOTE:The removed units are likely to be damaged.) 2. Prepare openings as necessary to receive replacement units.(No finish work other than normal installation is to be done unless otherwise noted below.) 3. Installation includes the clean-up of all job-related debris upon completion of the job. 4. (If applicable)After the completion of the project,the customer will be responsible for the application and removal(storage)of shutter panels. In the event that the project requires the installation of storm shutters or egress windows, Sears Home Improvement Products, Inc. ("Sears") will not re-install any affected security bars. 5. (If applicable)In the event Sears is unable for whatever reason to obtain the proper permits prior to the commencement of any work,Sears will refund any previous payment and this contract will be automatically cancelled. . Summary of Window Order Addendum(see detailed Window Order Addendum for more information): Type: WB PLUS (WINCORE) Quantity: 1 Type: Quantity: Type: Quantity: Type: Quantity: Type: Quantity: The Window Order Addendum is made a part of and incorporated into this contract by Customer(s)initials S'-7 - 11 reference. Additional work to be done:REMOVING MULL, PUTTING NEW BUCK FRAME Work NOT to be done: NA SPECIAL INSTRUCTIONS:NA All of the above check boxes, "Work NOT to be done," "Additional work to be done," and Customer(s)initials "Special Instructions"sections have been reviewed and explained to me. SW1-MA (Dig.) Rev 08/13/12 Page 1 of 3 Job Number: 16017836 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 5-6 WEEKS (Approximate Start Date) It will be substantially completed by approximately 1-2 WEEKS (Approximate Completion Date) These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products, Inc.("Sears")or at any other time by mutual written agreement.Customer understands that the Approximate Start Date is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. ASBESTOS ABATEMENT: This Estimate and Proposal assumes that there are no asbestos containing materials ("ACMs")that would be disturbed in the performance of the installation work. If upon further inspection by the contractor or others it is learned that ACMs have to be disturbed to perform work,then Customer must arrange and pay for abatement of asbestos by a qualified person prior to the start or continuation of work. If Customer fails to arrange for necessary asbestos abatement within thirty(30)days, Sears may cancel this contract upon Customer(s)initials S IF written notice to Customer. The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 1,217.42 Contract Price �$1,217.42 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 1,217.42 State Sales Tax( 0.00 %) $0.00 Final Payment(balance payable upon completion of job)$ 0.00 Local Sales Tax( 0.00 %) $0.00 The Initial Payment is due prior to Sears ordering products. 1 Total Amount Due $1,217.42 The form and method by which the Customer(s)will pay is described in a separate Cash/Credit Customer(s)initials S�� Card Payment Addendum made a part of and incorporated into this contract by reference. NOTICE TO BUYER: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER)AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ADDITIONAL PROVISIONS Proposal and Approval.Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown.This offer must be approved by the Installation Department. If this is a credit sale or a payment on completion sale,it must be approved by the Credit Sales Department.If this proposal is not approved or the installation cannot be made in accordance with the law,this offer will be withdrawn and any payments you have made will be refunded to you.Any materials left over after the installation has been completed are Sears property and will be removed by Sears. Installation.I understand that Sears will not install the materials but will arrange for the installation.Sears is not responsible for materials or installation NOT furnished or arranged by Sears.Sears'installation contractor(s)will obtain all building permits required by local law. For homes located in historic or landmark zoning districts,Customer will be responsible for obtaining required approvals and related permits prior to the commencement of work on this contract. Authorization. I authorize Sears to: (1)arrange for a contractor(licensed where required by law)to make the installation of materials; (2)issue a work order for this installation to a contractor; (3)inspect the installation;and(4)pay the contractor when the installation is complete if I have signed a certificate that the installation has been completed to my satisfaction. Delays in Installation.I agree that Sears is not responsible for delays in delivery or installation due to weather,fire,strikes,war,government regulations or any causes beyond Sears'control. Oral Agreements and Changes in Contract.I understand that there are no oral agreements between Sears and me.Everything I expect Sears to do has been included in writing in this contract.Nothing can be changed in this contract unless it is in writing on a separate form accepted by me and Sears. Responsibility of Buyer. I agree that any information or measurements that I give to Sears are correct and complete. I am responsible for any special work described in this contract. Electrical& Plumbing Service. I will provide adequate electrical and/or plumbing service(s)to run any newly installed appliances or other furnishings. If the electrical and/or plumbing service(s)do not meet the standards of the utility company or electrical and/or plumbing codes,I will make the necessary changes at my expense unless Sears has agreed in this contract to make the changes. Payment.I will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warranty Information.Appropriate product warranty documents will be given to me by Sears.Sears'Warranty on Installation is: SEARS'LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s)used(which warranty becomes effective the date the merchandise is installed),if the workmanship(or application)of any Sears'arranged installation proves faulty within(i)one year for Weatherbeater Value Line,(ii)two years for Weatherbeater Plus,or(iii)three years for Weatherbeater Max,and Weatherbeater Stormbeater,then upon notice from you Sears will cause such faults to be corrected by repair at no additional cost to you.If Sears determines that repair is not commercially practicable or cannot be timely made,then,at Sears'sole discretion,Sears may elect to provide replacement or refund.Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1-800-222-5030, Option 4.This warranty gives you specific legal rights,and you may also have other rights that vary from State to State. SW1-MA (Dig.) Rev 08/13/12 Page 2 of 3 II'll II II'lll'll Job Number: 16017836 NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FORTHEAGREEDTERMS TO THE EXTENT OF THE AVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT.KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME,AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY[FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER]AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH, YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING"I HEREBY RESCIND"AND ADDING YOUR NAME AND ADDRESS.A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY In addition to the Notice to Buyer shown above, Massachusetts law requires that contracts for home improvement work state that all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration P.O.Box 871 Taunton,MA 02780-0871 Telephone:(508)821-9375 Please note that owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Notwithstanding any other language in the contract or associated documents, Sears will not remove, replace, or install any heating or air conditioning system, or any portion thereof, if asbestos or asbestos-containing material is known or likely to be present in that heating or air conditioning system,or any portion thereof. If it is determined or reasonably suspected that asbestos is present,either before commencement or during performance of the work, it shall be the customer's responsibility to select, retain and pay all costs of a Division of Occupational Safety ("DOS") licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determination or reasonable suspicion of the presence of asbestos arises after Sears has started the work, Sears will immediately cease performing the work until a DOS licensed Asbestos Contractor,hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R. 7.00 and 453 C.M.R. 6.00 or verifies that none is present. By signing the contract the customer agrees that it understands the above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 09/25/2013 09/25/2013 Customer's si x IOxPE9 gnature Date Customer's signature Date Accepted by Sears Home Improvement Products,Inc.("Sears")on 09/25/2013 by. Date Management Representative M-MA (Dig.) Rev 08/13/12 Page 3 of 3 JOB NUMBER: 16017836-0003 PROPOSAL DATE: 9/25/2013 WINDOW ORDER ADDENDUM NO DESCRIPTION 1 WP-SLIDER 1 38 W X 38 H WHITE LOWE/ARGON/CLEAR FULL SCREEN TOTALS: 1 COMMENT: 1 of 2 ---____._._ TAT - -- - - ....�_ _ ..- --r�-,�-r- - - - -- i ; MOM ' ' i i ! 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J—P) `Solat'Heal GaI Coelklenl L-0-30 0.24 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance F 0 48: ' w'all!lnma dl;uwnten tfiea mlAla elnilrm.h ryppnele eFBC oraadannNdtllmNRp eAtD prodsale10=311t1.INM udail lie oaueeoeud It?1.I450 ItUt lmlrOijpenlN;epolllonl iM10n 'Aldnc lrooud I Intl.HFgCd-00 INO.'509 My M916 IAd doll let-WFAN The elee6dey al any paadun Io,&IV Aithe u1e.tdltlp mn-I it",otintuh la"be,pred7W pvIOMIha/IM011l911/4. ; wtt;pf:ca:p ENERGY STAR;-11(talified In e { All 50States � ' r Design Pressure:+351-35 Maximum Site:40 1 08 FSC:Nons Taating Slendard:AAMANlDMNGSA'101N821Ad40-05 Test Lab:ARCHITECTURAL TESTING INC. t . f e j I Assessor's map and lot number........XIV Sewage PertRif number ........ . 5 ' E� Z BAHHSTABLE. i z Housenumber ............... MA°a.......... .........s....................................... 9 00 i639, '°TE'G Mpr d� TOWN OF BARNSTABLE � . BUILDING INSPECTOR k1f....... , lit APPLICATION FOR PERMIT TO .....�!. .J.1.. .................................. ......`^!�.�,. ...........�.1........... 5 TYPE OF CONSTRUCTION .........�. w4.�........:.... ......... :..................... . .... ......... ......... ......... ................ ...... .. ..... ..............19, TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: p , Location ... ..�... ...... .s.....W. S ....w � �'l .....<\s.�\ .......�� �e et' v � �5 ....... .......... ........ .................................. ................. rA ProposedUse ... ................................................................ Zoning District ........... ......cx ........... ...Fire District C^.0................................................. Name of Owner ...W..Address .-N4,.... t_ Name of Builder � �cct .� �- � ..... „ �� t�. .. ��.... ®.` ��. ,T► ...... Address ........ .. vVl Name of Architect ....... .............Address .......................... ..... .. . ...... 3 � ��. Y�`�.Foundation �. �.... C ' '' .......Number of Rooms .......... ..................... ......... ......... .......... ...`. ..... (..�.... Exterior ... .................................Roofing ... .�? �. ..:,...`�- �. .�``. ................. Floors �� " .. .1'.....C-..A� . . .........Interior .....�� It �) ........�....... ............... .... Heating ........ ,. .... ...............0.........,....... .......................................Plumbing ........... Fireplace ...............Approximate. Cost . vy p� Q Definitive Plan Approved by Planning Board -----------_______-----------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �4 P . I , d ry NY" 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 9 . THEO CONSTRUCTION C9'.A=.121-1�1-14 No ....�.7 G.$: Permit for ..7....S. AZ.y....S].rig1e ti ..........° family..dwelling....... I................ 5-.Z.lJ. W irk ei ear. D��'— tocati X ... 5......�...�rt-e -�.iisg1e.- 0 . family dwelling ............................................................................... Owner Th. ....eo Construct. . . . . ...ion. ...C.O. ..... .... .... .. .... .. .... .. .. .. .. .. Type of Construction .....................�X.A le........ ................................................................................ Plot ............................ Lot ................................ Permit Granted .................. I?r........2.,..19 8 5 6 Date of Inspection ................................... 19 Date Completed ...... 19........ �..... .. Ile V" r Assessor's map and Jot number ......./ 1......./? ofTNETo �.Sewage Permit number ..... . ..�I. . ....... .. e House number ........................� ca4... ............................ so rnea p 16 3 9. 0 Usk a' TOWN OF BARNSTABLE BUILDING INSPECTOR r _ APPLICATION FOR PERMIT TO ...... .5..1.N...1. .....................................S ���^�\.��......��.�i�t�.�c�� ........ TYPE OF CONSTRUCTION ......... ........ C. Y..1f4. ........................................................... CC 1 ....... ..c k.. ..... .............19 . s TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: aa l Location ...�..©...�......�.7..... �.$. ....�`?.�.. ??�.....L\5.�� ....... .5.'��e V'\ .1�. ........ .......... Proposed Use ...... c X. ...... 4 .\�.).�.........� �.. . �Ae..1. ................................................................ ZoningDistrict ......................J.4.. .................................Fire District ................C.-0................................................. Name of Owner `TN!�C4.. DNS�S'.!f.t.' '�.QM....W'.Address 3\4.... .. .... ..... ..... ...... 4 ` Name of Builder ........S��S:.A.�`.C.4a41�?-`�`.�`�!��.5........Address Name of Architect ............................................Address .................................................................................... ...................... Number of Rooms �. 4............A-k.....WX t.Y' Foundation ..�� ..�.�?? .t..��.....�- v1.�C '�' ...... . r Exterior ..................................Roofing ... .6Cs�j��.Qie. ......��.`°��,. �.� ................... Floors ... � l...... ............Interior ........ ........................Uj- .. ....................................... . ,; `-- g...........:.......................Heating . ... ..::...........................................Plumbing ....... ...... Fireplace ..........�..................................................................Approximate. Cost .............��..f ..:. . ... ........................... .—_ Definitive Plan Approved by Planning Board -----------_______-----------19_______ . Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH t r /.Y �Oa 3 OL 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 ..... .................. . .U.-��44.. .....! .............. Construction Supervisor's license .I.. ..9..�........... THEO CONSTRUCTION CO. A=121-11-14. No?.7683..... Permit for ..aingle family...(ave.11illi r Lot 25 _ '152 West Wi Location ............11 ........ ....................................... Circle, Osterville ............................................................................... Theo Cons ' Owner truCt7.Qri..s~0........... Type of Construction ................f .............. \ Plot ............................. Lot ................................ Permit Granted ....................ANY...1:......11985 U to of Inspection .....................................19 Date; Comple ecl ....!=? '.....19 sJ� � L G� /NEiPEBY CERT/FY TmT TN/S 407/1 NOT GOCAre, /N FEOERA k FLOQO A"AV, SoWWN QN THE FCPC*f.44 FL O&M /NSUoToWE RATE AW FOR THE MON OF CO Ty P.gNE.G W. �,ffFEGT/Yf A47-C N07E: NORTH.4RROWNOT TO ae* ti . � O �/SEo FOR 4a"#v PU�'P O � � cl ti a `+ /OT 2¢ gpz,r Q Zo7-Z,49 0 Q 0 • �2.0 y�� `a1 o ZL; ` y � 7N/S PLOT PLAN WAS NOT A14AE MOAI OU,VDArIQ� Y X 4;W AN /NS7#P4 tAACNT%W#fVEY.Wo /S FOR TNT` /�, /,�/ ' USE OF THE QANIC GW�Y. UNDER NO _o�U T 2 S�IL�j T11Y11W C/RCl/MSTANCES ARE OFFSETS TO de USED FOR FENCES,- *444S0 HICR42 S, ETC. 0,W)VER BY: Tveo OW-5 . T�okl Cam, oH of AffeWY 40VO ECR/NG I/VC RoeERr. 60 EAST F.41o*& *q 4N/GY)MY RAYPfOND E.IST FAlomourm w.4. O.Z,S36 No.zlss 4 SCAdF;, , GATE% 40woeT% ���✓Misr F°�� / tiI ,e,- z "/ o-/ AWWWN RY- CyECKEodh APPQ dY� F.l r1N Na 77777 3 TOWN OF BARNSTABLE BUILDING DEPARTMENT sAUST = TOWN OFFICE BUILDING out ay 039• HYANNIS, MASS. 02601 �o rnr�• MEMO TO: Town Clerk FROM: Building Department DATE: May 31, 1985 An- Occupancy Permit has been issued for the building authorized by 27683 BuildingPermit $k...._ ._.... ._.. ._............_.................._......_........................................................................_......._....... _ ..._� ... Theo Construction r issuedto ........................................................................_..........._.................................................................. __._ �..._._ ..._.. Please release the performance bond. ppl;�_ ' d' y J � � � A 27683 TOWN OF BARNSTABLE Permit No. __----_---__---__�---- ��. ,�L Building Inspector I susnu, s Cash ------------ q��� ' -"OCCUPANCY PERMIT Bond ---_------ Issued to Theo Construction Address '^ lot #25 152 WestWind Circle, Osterville Wiring Inspector �. J � �i Inspection date Plumbing Inspector ! / - Inspection date Gas Inspector Q jil. t.?�- ,f' � Inspection date 2 )ra u Engineering Department Inspection date Board of Health MC) � � , 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. 4 LI 5V ....................................................... 19_....__ .....................................l........:a........... ._........._........_... ..--- - / Building Inspector ector 1Assemr's-offioe (1st floor): Asissor'�map and lot number ....../ /..�... ��:..�%1�.. you THE rot Board of Health (3rd floor): �'" �"- d� .• o"C/-�7 2 �J } (Sewage Permit rtumber _........................._......�(..................� i MUSTODLE, S 11.E c B Engineering Department (3rd floor): � I S�FJ? 'oo "6 9• House number / o, 3 e........................................................................ CFO YAY d� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN. OF BARN�STABLE BUILDING INSPECTOR APPLICATION "FOR PERMIT TO• ... :....1.°1.t..�.e .......G� '� c? V '..,...C!k v TYPE OF CONSTRUCTION .. �1.��^•Y` •�t" \��c,c .. .... ..��:._ .��� ...............................................:......... ., TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 1 Location �. ?. ,.lye.•.1.,4 ��.:4 ... .:�.).L ............. ' \\T ........... LOL...�. 5../....................... Proposed Use ............C.../......'A.xc cR.......... -Z c}-{' YLLf... !! ....��` ........................................................... Zoning District ................:•.I.•. ..............................................Fire District .........................D.....em...................... Name of Owner k��S.` ,• \�} �1.'�.....\' .�:�. ..\..?.n............Address .......... .. :).3..............................:.................... Name of Builder 1.(>. Cy,...1 ...... Q. .�...�. ..............Address li 1QYh Yl'11q Name of Architect ..................................................................Address Number of Rooms '" Foundation 41 ................ ........... . � .... .. ...................... ... Exterior ................ ... Roofing K..5. ................................................... ....... ............................................ Floors ......................................................................................Interior ........�.�C...�... Heating ......................................................................:...........Plumbing ................................:....................................•... .... ✓ J Fireplace ..............._.......<..............................:....... p ...................Approximate Cost .`' F.......,r•..!••.....Q.Y.®................. Definitive Plan Approved by Planning Board --------------------------------19-------- - Area ....! .......-............... Diagram of Lot and Building with Dimensions, Fee ........�./'—' ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH n .- h '\yy FY -) OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS g I hereby agree to conform to oil the Rules and ,Regulations 'of the Town of 'Barnstable regarding the.above construction. A101WS�47 Name .... � Construction Supervisor's License ...0. 1.11.0....... GUERIN, LEE & LYNN A=121-011-014 No't.299DA.... Permit for ...: .......... ........A,C.c-ss.Q.1~y..to...Awe.l ling..................... Location .......15.2....W.....Wind..CzxcIe................ d t'. ..0.stexv.]Ile....................... Owner .......... .................. Type of Construction ......Vinyle....................... ............................................ ................. U Plot ............ ............... Lot ............ Permit Granted ..,..Sept. 12, 19 86 Date of Inspection ....................................19 Date Completed ......................................19. l a Assessor's�offioe,(1st floor)- SEPTIC 0// SEPTIC SYSTEM MUST f THE ter s6.6ssor's.,map�ond lot number ..................... ..............7`.... •- INSTALLED IN COMPLI °Board of Health (3rd floor): �-�} ewage Permit number ...............:...... :...:7: 1....!:Z . WfTH ■ IE 5 1 BABd9fADLE, Engineering Department (3rd floor): ENVIRONMENTAL CODE `6 9 . . � J� r House number ...- ,�5�. .2r, ......,. :.... - , C. , TOWN REGULATIONS YP '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 iA.k..:.Cl S`�V. . ..cx v mL1n�....�� v TYPE OF CONSTRUCTION ... �1�) ...r1.1.� `r`��... ....y..\ � ` ......................................................... C .\ S...... ................19.g b TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..,Q,XrC�\�C_...........Q \E' c17,��\�4.......,.� Q�............:5 ......................... Proposed Use ........... - C1g......... . . ................... Zoning District /.�..�.............................................Fire District .............. .�.....:- .... ....... ............... Name of Owner hQ,_,?�r.A_.V n.n..... �.n............Address ........... ...Y`Y>..Q................................................ Nome of Builder- .1 .0.. .f . .��....QQ.a.�.�� ..............Address ..... . Name of Architect •J 1. .....Address .................................... i Number of Rooms .....:.................................:...........................Foundation Exterior ......f........1�.,S�.SJ...........................................:..........Roofing Floors ......................................................................................Interior Heating ..................................................................................P um ing .............................. ........................................... �~ Fireplace ..................................................................................Approximate Cost .....................,........... ., ....0 Definitive Plan Approved by Planning Board ________________________________19-------- . Area /...... ....................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of he Town of B rnstable regard' the above construction. C�� Name ...�.�� ..............�.�............�. . r --- Construction Supervisor's License o . .� ....... a , GUERIN, LEE & LYNN No .... Permit for ...Build Pool ............................... f'...A.q.q.e s s.o.r.v...t9..Dwelling.................... Loto'ion' ...Wind Circle ............................................ ................0 S t e.r.v i 1.1.e........................................... Owner .......Le e.........&.... ...................... Type of Construction .......:UIRY--l!e..................... ............................................................................... Plot ... .................... Lot ................................ Sept. 12, 86 Permit;Granted ........................................19 Date of Inspection ......................................19 Date C: ....19 pmpleted . .......... 0 4M S o a I oar s ' 7 1`0 1 "� `, �� ,.� -� � �. � . '+ ;,;._a i .'r ' ;�.\,1