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Home My WebLink About0146 WINTERGREEN CIRCLE 0 �._ - �. . _n _ .�.�_�__ __._.._ .__��.____.�� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 Map pp I Parcel U 1 `J Application #0% Health Division Date Issued Conservation Division Application Feer Planning Dept. Permit Fee !� 0 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address � - 6 Qipl e2 02em 0P_ Village 02655 Owner Du Ur��HS�-1 Address %�fF 6�117 47- ,2. we_ ere , Q�nmla l��Q Telep o e^'4',pf 3S'� - 3�06 I > 'Permit=R9gu.est��c> �Xe i Irl 20 'X l� oec 00 4AO {0Qe Cn 4ke /t-oc use,. Square feet:,1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay roject Valuation—r- 0C'> T Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other o Q o Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wok coal stove; ❑Ss ❑ No Detached garage: ❑ existing 0 new size—Pool: ❑ existing ❑ new size _ Barn: O xisting ' 4 never size_ Attached garage: ❑ existing ❑ new size _Shed: 0 existing ❑ new size _ Other: _. .. ra Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ca Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name JUAN 1UaA1tus(-re/v4y Telephone Number 509 36Y 6909 Address 1'?V (70CZ MV Q0 License # CS "�0596tl &-nnTS Lae7) . lO 02,639 Home Improvement Contractor# Email 7UA1V/vk1V1rq5Ne1Vz-0 @_ yC?Hoo.CoA4 Worker's Compensation,# r ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 03. 3i. q0-(Y I FOR OFFICIAL USE ONLY K APPLICATION# DATE ISSUED MAP/PARCEL NO. t�F 1 ADDRESS VILLAGE iz 'e OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL f,,ANAL BUILDING DAT-E-CLOSED OUT _ ASOTION PLAN NO.. r The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / , Please Print Legibly Name(Business/Oiganization/Individual): Aje/ Is IanI dg (oma J"10, ' 7 . Address: A? .r` # PwD RD City/State/Zip: V. Yyem©ulh , fl�#, Phone#: SM 36(( 6 Are you an employer?Check the appropriate box: Type of project(required): 1.[X I am a employer with �L 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance# 9. ❑Building addition required..] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their l 1.❑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 D2GL employees.[No workers' i 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: 811clQ&V sc e/fi o q(U Policy#or Self-ins.Lic.#: : Expiration Date: Job Site Address: /1/6 Oin �.eR CN G n� (�STeR 0,��e City/State/Zip: HA-, 02 65$ 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 erage verification. I do hereby c der the pains d penalties of perjury that the information provided above is true and correct Signature: rJo Date: 22/Y Phone#: og 36 V 66? 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 CIerk 4.EIectrkaI Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i . . Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to 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 employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter-152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,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 number(s)along with their certificate(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 confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston,MA 02111 TO,#617-727-4900 ext 406 or 1-877-MA88AFE Revised 4-24-07 Fax#617-727-7749. WYMMass.govf dia r I RD® DATE(MWDD/YYYY) i CERTIFICATE OF LIABILITY INSURANCE 3/25/2014 IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE 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 J. 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). CONTAPRODUCER BRYDEN & SULLIVAN INS NAAME.OT 88 FALMOUTH RD PHONED FAX Not: HYANNIS, MA 02601 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Cor oration 33600 INSURED INSURER B: ANDREI YARMOLOVICH DBA BEL ISLAND HOME IMPROVEMENT INsuRERc: 29 MILL POND ROAD INSURER D: WEST YARMOUTH MA 02673 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 19576541 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. I ADDLSUBRTYPE OF INSURANCE INSO WVD POLICY NUMBER MMI DPOLICY/YYYY MMIDDIYYYY LIMITS LTR LTR COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE 71 OCCUR PREMISES Ea occurrence $ MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ,S POLICY 0 PRO-- LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) S __ AUTOS AUTOS NON OWNED I PROPERTYDAMAGE $ HIREDAUTOS AUTOS UMBRELLA LIAB EACH OCCURRENCE $ I OCCUR I EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC5-31S-384176-024 2/25/2014 2/25/2015 3 STATUTE ER H AND EMPLOYERS'LIABILITY i ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA A E.L.EACH ACCIDENT $ 100000OFFICE j I(Mandatory In N )EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 100000 (Mandatory In NH) It es,describe under E.L.DISEASE-POLICY LIMIT $ 500000 i DESCRIPTION OF OPERATIONS below I i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. ANDREI YARMALOVICH IS COVERED BY THE WORKERS'COMPENSATION POLICY. i CERTIFICATE HOLDER CANCELLATION i i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE L LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 19576541 CLIENT CODE: 1588030 Anne Chandler 3/25/2014 8:33:48 AM Page 1 of 1 f r �ZHE T Town of Barnstable Regulatory Services � AAAh7�9'AR],g s Muss. �, Richard V.Scali,Interim Director i63q. ♦0 'moo 39. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barustablema.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete.and Sign This Section If Using A Builder I, �0C` t4 �� "' '{ as Owner of the ro subject J property hereby authorize 'T "7 � ✓O k' u - 9 Al 0 to act on m7 behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or.utilized before fence is installed and all final inspections are performed and accepted. SignaLie of Owner Signature of Applicant 1v w .1u1q1Z1JUsP1e1U4o Print Name Print Name 2 9 - 2© 1y Date Town of Barnstable - Regulatory Services oF� Toryti Richard V.Scali,Interim Director Building.Division ReRrNrr-433 r_ II Tom Perry,Building Commissioner BUSS. 9� 1639, 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6250 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB 10(CATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. -Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Appioval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 1091.1-Licensing of construction Supervisors); provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption*are unaware that they are assuming the responsibilities'of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness.often results in serious problems,.particularly when the homeowner hires unlicensed persons. In this case;our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. n-+tsrovrr❑c�r�v��rc�lnrilrlinc nP+mil fnrmclF.XPRFSS.dnc . Massachusetts - Department of Public Safety j Board of Building Regulations and Standards Construction Supervisor License: CS-105964 .r:rr.ti IVAN V IVANTUSJk0.. "174 Upper Coun"d Apt 1-14Dennis Port MA 01,63 Expiration I Commissioner` 01/01/2016 .I +wr;�n...--......�..p-..�s �.5+�w.�,3vu:+.....'y r.G{.•ate•.,,;,". ,p� ✓lie �oo�vrrca?auiea,�d� ��,/�aeadc�ucaelta . -\ y Office of-Consumer Affiifsll Business Regulation OME=IMPROV,E�MENT CONTRACTOR Registration��q;N76• TY,Re;` Expira SuPplementi BEL ISLANDS HQ EF PRO_Y.WENT i It I IVAN IVANIU$H1K0 29 MILLPOND' 5 VU YARMOUTH;MA t)2673 g b Undersecretary ... - V Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-105964 I rvAN v rvANru"NKO--' 174 Upper Count Rd Apt 1-14 Dennis Port MA 4� 39 �!.`. )! lk% Expiration 01/01/2016 Commissioner ,,..fie•t1e ?'rt�•'"t°."T"`." � � x chi 46nse'or registration valid':for mdividul'use only before the exp►ration.date.'-If. If foundt:return to Office of Constimer,Affairs:and Business Regulation 10 Park Plaza Suite 51'70' "ard. B'os46n,MA 02116 i,. `. Notcvalid withopt• griafure:,.. ' — i "TOWN`OF SARNSTA,3LE 2Q1�1 P►AR 31 pM t1: 0q - h r �3)�X10 p� sx 6 PT Pc)s-,- DI lIV o1� STFp i m Y Assessor's `map and lot number ..../.-y. ....••:.•f�� f U C1600,/Tjo.0&l4c 1L^ in Sewage Permit number ..:.... ......... ....................................... r ��T"Er°�� :a TOWN OF- BARNSTABLE W Z MAMSTLUX i .a 9 MAa �O Y BUILDING INSPECTOR CG •FPY 0•- °. ca —r APPLICATION' FOR: PERMIT TO .....Zna 764 aT� rr�"� .....ate....... �P c!1?� Y1%/r��-- e�• .r. P` .......... ..... .... ............ ....... ................. TYPE OF CdWSTRUCTION �C .L..... zi ........' — /7 .19.T.. TO THE INSPECTOR OF BUILDINGS: j The undersigned hereby applies for a permit according to fthe following information: Location .........��1.. .......".v1. ��1...'�:�...?...... � Gf .....................s �. ' .r// .......................................... ProposedUse ........................................................................... ................................................................................................. ZoningDistrict ..........................................................................Fire District .............................................................................. h.k.!�!....� CA//!'r/!►;� . Address ..� �'....�i �I ��.0.... Name of Owner ...... z ...... 1;/i'� ........CJ� Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... I Numberof Rooms ..................................................................Foundation .............................................................................. Exlerior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ................................................................................. �� ar, Fireplace .............................................................Approximate Cost ....:... . Definitive Plan Approved by Planning Board ---------------_—-----------19_______. Area .... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..../ fl.. .. '. ........................................ Burchell, Richard B. . U63 install bathroom No ..................Permit for .................................... I.........................;................................................... Location 146 Wintergreen Circle ................................................................ Osterville ............................................................................... Owner Richard B. Burchell ........... ....................................................... Type of Construction frame .......................................... ................................................................................ Plot .............................. Lot .................... Permit Granted ........November 17........19 75 ........................ Date of Inspection .......... ....... .................19 Date Completed ..... .............. .... PERMIT REFUSED ...................... ........................................... 19 ............................................. ................................. ................................................................................ ................................................... ................... ................................................................ ............. Approved ............................... ................. 19 ............................................................................ ............................................................................... Assessor's map and lot number .... a��'�,�!�. ......... Sewage Permit ,number ....................................� ..��` ........ '� a ��Qy°f?"ET°�♦ TOWN OF BARNSTABLE Z BARNSTABLE, "b 9 BUILDING INSPECTOR Op�O YPY a APPLICATION FOR PERMIT TO ..... !..1. ``� ...a ✓Ii f �rem.::........�?'�................................................... TYPE OF CONSTRUCTION ................ / ....... ......19.� .V TO THE�NSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Loc ttlon ..............:.... ProposedUse ..................................................................................................................................................:1......................... Zoning District ...........•.............................................................Fire District .......................................: Nameof Owner ....... .................... �..........., �...... s .. ........................................... Nameof Builder ....................................................................Address ............................................................................:....... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ...................................:..............................Foundation .............................................................................. Exierior ...........................................................................:.........Roofing .................................................................................... Floors ......................................................................................Interior .................................................................:.................. Heating ............................................ :.....Plumbing ;!�.......... .................................................. Fireplace ............................................Approximate Cost Definitive Plan Approved by Planning Board ---------------_____________19_______. Area ..............�........................... Diagram of Lot and Building with Dimensions Fee 5 ' SUBJECT' TO APPROVAL OF BOARD OF HEALTH n r ,A4 I hereby agree'to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...2....... ....I.................................................... Burchell, Richard 119-45 '18053 install bathr�m No .................. Permit for ...................................... ................................................................................. Location ...............1.46..Wintergreen..Circle .... ........ ...... . .. .. . . ...... Osterville .............. ................................................................ Richard B. Burchell- Owner ................................................................ Type of Construction .....................frame..................... ............................................................ Plot ............................. Lot .......... ..................... Permit Granted' .........Nqvemb.e.r. ...1.7.......19 75 .. ........ . .. Date of Inspection ....... 19 Date Completed ...... .......19 ...................... PERMIT REFUSED . ................................................................ 19 ................. ................. X, ..... •. ........... . . .....................;....................rA ................. ...... .. .. ..... .......... ... .................. .. 1 7� ......... .............. v mil' Approved ................................................. 19 . ............................................................................... ...................................................... Town of Barnstable Approved Regulatory Services sYAg�E {{}} Fee �� . r/7J Thomas F.Geiler,Directap Building Division 2 4 2 JUG Is Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862'-4038 Fax: 508-790-6230 Date: Home Occupation Registration Name:� � \ \ \1 Phone#:� CL5 Address:�T� ! ,^ "�St/'�2�� l_�fc'UC Village: 0 (--Cr "�— Name of Business: I ��`'��— —ems✓�� Type of Business: LA-eG,-1 Map/Lot: � INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation, and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1,the undersigned,have re r i the above restrictions for my home occupation I am r//egiste ' g. Applicant: Date: I I Homeoc.doc f - W Town of Barnstable *Permit# Expim Regulatory Services 6=dwe • BA10WABIX g• uaee. Richard V.Scab,Interim Director 00%A Building Division � - SS Tom Perry,CBO,Building Comgp i 200 Main Street,Hyannis,MA 02601 2 1 2014 www.town.bamstable.ma.us kV a Office: 508-862-4038 F 7 -6230 EXPRESS PERMIT APPLICATION - RESIDEN Map/parcel Number Not Valid without Red X-Press Imp►ijq l �/' /�� + b Property Address Ur(t Residential Value of Work$ ! TQ. 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address / at—d -I/a/17 0A jib W I h QM�W (�,l s Uj&NMU Contractor's Name d n C f f7 Telephone Number Home Improvement Contractor License#(if applicable) /oZ(� f3 Email: Construction Supervisor's License#(if applicable) 1 MT4(p Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 1 have Worker's Compensation Insurance ®,� Insurance Company Name keo Tl o�Co S#Ar- 1A/ S . Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit- Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Ae-side.'KY Z Replacement Wmdows/doors/sliders.U-Value • 3t� (maximum.35)#of windo #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property er sign Property Owner Letter of Permission. A copy of H Improvement Contractors License&Construction Supervisors License is required. e____ SIGNATURE: TAICEVIId_D�Building ChangesTYP S RESS.doc Revised 061313 a Office of Consumer Gl�� NMI mer Affairs and Business Regulation 10.Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement'.Contractor Registration _ Registration: 126893 - - - _ Type: Supplement Card THD AT HOME SERVICES, INC. - : - Expiration: 8/3/2016 ANDREW SWEET 2690 CUMBERLAND PARKWAY SUITE-30Q.'.:..;' ATLANTA, GA 30339 _ Update Address and return card.Mark reason for change. SC:>, •::• 20,NI-05/11 L iJ Address E] Renelval !__I Employment Lost Card �N — Office of Consumer Affairs&Business Regulation License or registration valid for individul use only "' = before the ex ir. .,••. =JFiOME IMPROVEMENT CONTRACTOR p' ition date. 1f found return to: Registration: Office of Consumer Affairs and Business Regulation = 9 126893 Type: 10 Park Plaza-Suite 5170 expiration: 8112016 Supplement Card Boston,NIA 021 IG TI-in AT unAAC cr_o�„r`Cc `,nt�` THE HONIE DEPOT AT HOME SERVICES ANDREW SWEET 2690 CUMBERLAND PARKWAYS ,per The Commonwealth of Massachusetts �\ Department of Industrial Accidents Office of Investigations 600 Washington Sheet Boston,l-A 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Bul1ders/Contractors/EI ctrigibly Ple�e n t Lmeb rs A liZMiDZwS-:Mn'-:=0'r t fomation 14aMegaaizationitndividual): ^ Address: r�,l City/StateJZip. Phone Are you an employer?Check the appropr{ate�°x: Type of project(required): with 4. pd 1 am a general contractor and I 6. ❑New construction 1_❑ I am a employer -time).a have hued the sutrcontraC.crs employees(full and/or p listed an the attached sheet 7. ❑Remodeling 2,❑ I am a sole proprieto*or partner- These sub-contractors have 8. ❑Demolition ship and have no employees employees and have workers' - 1- 0 . ❑Building addition working for me in any capacity. c instnance.� [No workers'comp.insurance comp. 10.❑Electrical repairs or additions 5. ❑ We are a corporation and its airs or additions req�.1 all work omcers have exer= d their 11.0 Plumbing rep 3,❑ I am a homeowner doing �of exemption per MGL 12.❑Roof repairs myself;[No workers'comp. e. 152,§1(4),and we have no I {� insurance required.]t t employees.[No workers' comp.insurance required.] . . applicant that checks box#1 moat also fill out the section below showing their workers'coition Policy inf on. y t Homeowners who submit this affidavit indicating i are=c�.3 ad"rock and thm hire outside contractors must submit anew affidavit these ent►'des ha ech. lContractars that check this box moat attached an additionalmust� their showing he nu 'of the ff sub -polco^�u>t�an 6 w1:a'e..:_..__. ermloyees. If the sub-contractors have employees.theyP� I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. lnsursace Company Name I l S Policy#or Self-ins.Lie.#: W C Q 7u lj Q f �;L Expiration Data: Job Site Address: G awstate/Zip: ® Attach a copy of the workers'compensatial 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 iwgpe cnn'm.ri:,as weal as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against lator. Be advised that a copy of this statement maybe forwarded to cite Office of Investi a* ns of the DIA for ce c vera verification. I do hereby certljy under a altles of perjury that the information provided ve true and correct Date: Si attire: — Pho a#: p l use only. Do not write In this area,to becontp y city or town q,Q?clal City or Town: Permit/Ucense IN I=uing At-Aorlty(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrileal Inspector 5.Plusrehlno inspector 6.Other Contact Person: Phone.M The Commonwealth of Massachuse& Department of IndurhW Accidents Office of Investigations mvav rr caurDclDs¢cYii&a&zr_+i Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /) Please Print Leeibly, /a1�11aV tuu�iucssrvigar�izdiionr"lndividusi j• �t�%�''. ;y JUl 1 M )l11 C - I ly W fc);l f If Mf I L., Address: rigZ> � tt? I —City/State/Zip: f-A1Qi 1.� •MA- Phone#: �62)T—33 a-`Cc 959 FAre you an employer?Check he appropria-bog: Type of project(required): t1 A r �.,..,., .e..e a ..: _'_a. 1.�f I trill U Umployer wlln `J 1.111 u gVllLlcla wVuurl.iV1 allu 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.;kI am a sole proprietor or partner- listed on the attached sheet. 1 [Q Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.: 9. ❑Building addition reouirell,l 5. f 1 We are a corporation and its 10.Q 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 employees.[No workers' 13.❑Other comp.insurance required j` *Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information. t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConftctors that check this box must attached an additional sheet showing the name of the sub-conbutors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp,policy member. I am an employer that is providing workers'compensation insurance for my enq*yees. Below is the policy and job site Information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine, too @1 cnn M Ji ___ _ _ _ �y wl,✓vv WAW VA uili-ycae tILIF11.3VIUMULlt,4A WIPAI US CI-Vil peyllalura Ill LUC ItirM oI a JIUr wLn i ufw- ik and a tine 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 cerd der the pains a allies of per jury that the information provided above is true and correct Si Mature: Date: Phone#: J�� `.-��t r t!19 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/Liceuse# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i CERTIFICATE OF LIABI ,I TY INSURANCE I :^11-yftd THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE COLDER. 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), 4UT50R1Z=- REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. :ri:.rRQFTAN' t_. - S:B za.—ms Eno zondiiic'ns OL Via PoUCY,•CEtiain policies,ina raqui--a an and,'_''t•-= -=^ N ! ••25 o co-i y 4 OTo c,Ti2f i. i�Siai�TiaUi Cfl iiti3 Cr_i 11i1Cd1�iiG25 AAI'Cil";it':ci+7yiii5 -r;Erti#IDa1e holder in lieu of such endorsem2nt(s). - � PRODUCER CONTACT MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHONE ;-Ax 3560 LENOX ROAD,SURE 2400 AIC o EX. ), 1 IA.C.B7o): ATLANTA,GA. D32 36 AcESS: ' INSUR_R(S)A FORCIN NAI G CO',-=PAGE —_—C c ' L=. INSURED — 7 i.';'SURER A.!' -__?:1_i•:. _ i THO AT-HOME SEERV!CES,INC. INSURER a:Zurich Amencan I's> pce a r w 68A THE HOME DEPOT AT-HOME SERVICES INSURER C:Ne al Hair pshiro Ins Co ----—-- —-- 2455 PACES FERRY ROAD --- _ !23641 ATLANTA.CA 30339 INSURER D:Iffincis National Insurance Ca.}any 123MI7 — INSURER E: i ,_ - INSURER F: 1 R' ;"L`'" C?;iStIT)LilrL i li,iiBER - THIS fi-a �U=C,• c_ I .,..;. 1 IS TO^_ER,';lF`;'N9T I ES OF -..,� ,i f�i N�ir7= t :r!E ri,_C_ iiiSl�=�i�= ii= I _�cLvLiA7=^ rEsi!_SUED ' E? 'S_ F. s=D o _ INDICATED. NOTWrtIHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUf%gE-NT Vb1TH 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 SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE I LIS POLICY NUMBER POLICY EFF POLICY IXp A I GENERAL LIABILITY ;GL MM1DD MMIDD LIMITS b4887714 04 103101/2014 03101/-15 EACH OCCURRENCE I S 9.C%O;GGO I I COMMERCIAL GENERAL LIABILITY ooc 4 ecc 1,CC)0,000 -- �_ I0F SItZ$•�M_ LEROCC y1 r I I I PERSONAL L AD`:IN.SURY i S GENERAL AGGREGATE j S 9,000,000 GENiAC-GREGATcLIMITA??LIES PER:. I El X I PRODUCTS-COt1PlOPAGG IS 9,'JOO,000 POLICY I PRO LOC 8 •AUTomBILELIABILITY I I i6AP2938863•1I I g 03n.1rd014 I03I01/2015 C^vM'bL'dEG SiiJGLE LIMIT„_•i_'_•_� Ea accident S 1,C0%GCHIEDULED �, 'AUTOS ....w is;t_•.. . .':it D'.... NON-OWLYEO HIRED AUTOS I` i ".Y ii:St::Y:?2; AUTOS I PROPERTY DAMAGE S et accident S UMBRELLA LIARHCLAI.W.LMADE OCCUR EACH OCCURRENCE S EXCESS LIMB AGGREGATE g DED I RETENTIONS - ! AitD EF4PLO-,sn L,-i>IUT'. ! -:1 - ._-_..__.. _..'.,�:__._ r•`•�-u.T ;-- '` t' I Ah'YPRDPRIETOR�Axt:ER/F.XE^i1TN'� 1 i�.li+—Iviuirw(iri,:.%,�-% �Wi01!" - ^-•-• •,,• i.- T:;+-i`I;,r`i ,•" - - -+ D cu:.4 Il�v:icV is i E( L EACH A.CCIDE:7T S _ OFMCERIMEMBER EXCLUDED? I + NIA (Mandatory In NH) WC049101883(FL) i0310112014 03/Ot/2015 —I_----- Ityes,describe under EL DISEASE-EA EMPLOY S 1,000,000 D SCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S I.0W,0C0 C WORKERS COMPENSATION WC0491M885(KY,NC,NH,VT) 03/01/2014 03/01/2015 (EL)UMJT 1.0m.000 ., C 1WC04910i886(NJ) ,0310112014 03101/2015 .I S.4C^IPTw::OF CPCPAT S/Lv A,.S I VF;. t F rri aC�AI:_n-iGi,i.tr,;:l0?_%Ret•.t>;r:_a'9 i.eQ�l- I.'owe c EVIDENCE OF INSURANCE `e'�`•r i i CEFcTiF{CATEHOLDER _ _ CANCELLATION THD AT-HOME SERVICES,INC. DBA THE HOME DEPOT AT-HOME SERVICES SHOULD'ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATLANTA,GA 3033.9 ACCORDANCE WITH THE POLICY PROVISIONS. of Mass{t USA I nc. Manashi Mukherjee k'L . , 01988-2010-ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD VL � t 'Aassarchusetts •Department of public Safety Board of Building Regulations and Standards C• tt4lr'it.t>> r! �ul�rri;irS�tc.'t:tlti ryty; ��. Li1.6 nse ySSL-Oiiiii" ERICSSON TORRES P.O.Box 373 South Yarmouth MA lr o'i �'* ��t�tf8tlOn Conu ttssioner � i FROM :jamgad FAX NO. :5083622271 Feb. 24 2011 4:46PM P1 HOME IMPROVEMENT CONTRACT PLEASE READ•VhjS 10 1 J Sold,Furnished aiid:Tnstalled Branch Name:.Bosron North&South •Date•iJ "� THD At-Home Services:lne:'. dA)/a The Home Depot At-Borne-Services. Branch Number.31 and 33 908 Bostan.Ttrrnpike,'Unit•1,Shrewsbury;MA G1545 Toll Free 87.7-9.03-3768 Federal ID#75 2G9&t6D:ME lie#C 02439:RI Cont.Lic#16427 CT lic# C.0565522;MA Home Iroproverneni Contractiw Reg.#126893 Installation Address: 1 1 w r ��r �Qh t�Cr�P vi/!� ♦ "`� City State Zip Pur chaser(s):: Work Phone: Home Phone: Ccll Pbdtie: hr-L) 011]3513-2-0 Home Address: QPdirYercnt from installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing emails fiom The Home Depot Project Tnformation: Undersigned("Customer') the owners of the property located at the above installation address,agrees to buy, and TrKD At-Home Services,Tnc.("The Home Depot")agrees to furnish.deliver and arrange for the installation("Installation")of all materials described on the helow and on the referenced Spec ShwA(s), all of which are incorporated into this Contract by this reference,along with any.applicable State Supplement and Payment Summary attached hereto and any Change'Orders"(collectively, "Contract"): Job#: a t..,d ate[--) ' ' r acts: S Sheet(s)# Project Amount Roofing Ljsiding LJWndows U Insulation 3 5, ❑Garters/Covers ❑Entry Down ❑ (,(�f! $ d Roofing Sidige 0 Window, 0 Trmulation $ ❑Gutters/Covers []Entry Doors ❑ Roaring USiding LJ Windows U Insulation $ ❑Gutters/Covers ❑Entry Tkxxv❑ Roofing tDSiding El Windows EJ Insulation ❑Gutters/Covers ❑Entry Doors ❑ $ minimum 2590 MpWit of Ctmtrad Amatmt due upon execudw of this eonft•aR Total Contract Amotmt $ Matne Purchimrs may net depordt mom than tarc�-tMT d of the CoutradAmount. Custumca awea� that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. AS applicablc,'cach.Customer under this Contract agrees to be jointly and:severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider cletennines that it cannot perform its obligations due to a structural problem with the home,environmental hazard~such as mold,asbestos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract. Payment Sutttmarv: The Payment Summary#0� , included as part of this Contract, sets forth the total 'C'ono•ict amount and payments required for the deposits and final payments by Product:(as applicable). NOTICE TO CUSTOMER. You axe entitled to a'completely filled-in copy of the Contract at the Um you sign Uri not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on.that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the cents of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other arm)unts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED-TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT T.iMI:I;INC TILE HOME DEPOT'S OTHER REMEDiES FOiL RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and tmdcrstutds that this Agreement is the entire agreement between Customer and The Hume Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and Ibe Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Acg pted by: Submit by: L� XX -- � X - f Custcnner's sign re Date Salty Con ulrant'S Signature D/ale X Telephone No. �� Customer's SignElee Da Sales Ccnsulmrtt License No- CANCELLATION: CUSTOMER MAY CANCEL THIS (as appleablc) AGREEMENT WI'T'TIOUT PENALTY OR OBLIGATTON BY DF,T,TVFRTNG WRI'rfEN NOTICE TO THE HONE DEPOT ,By NIIDNICHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE: SUPPLEMENT ATTACHED HERFTO CONTAINS A FORM TO USE IF ONE VS SPFCiFTCAT,T,Y PRESCRIBED BY LAW iN CUSTOMER'S STATE:. NOTICE:ADDMONAL TERMS AND CONDTTTONS ARE STATED ON THE REVERSE,SIDE AND ARE PART OF"H8 CONTRACT 03.07-14 Wtite—BrarnchRa Yarrow=customer I ` ( 1 ` v Town of Barnstable *Permit# Expires 6 mo the fro a date Regulatory Services Fee • st axsTABLK • � MASS'i639• a Thomas F.Geiler,Director prEO MA'S� Building Division P Tom Perry,CBO, Building Commissioner I" 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number Not Valid without Red X-Press Imprint f�� "`l� Property Address Residential Value of Work$ 2j!!�06 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address lc LI/ f/ LtuZ !� Contractor's Name 1 JA N 1i) 11J 1 (.l S I-P Q yV fL() Telephone Number 3 V 3 of Home Improvement Contractor License#(if applicable) 1gl_tf�6 Email: Construction Supervisor's License#(if applicable) C czml Q 6 E� n P ! ❑Workman's Compensation Insurancem�r� �}te Eck one: I am a sole proprietor MAR 2 5 2014 ❑ I am the Homeowner ❑ Lhave Worker's Compensation Insurance Insurance Company Name Sr tfoed✓ (� J ce(d t_ U,}N TOWN OF BAR STABLE Workman's Comp.Policy# 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 ❑ P-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: El 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 perry Owner.Letter of Permission. of the Home I ro ement Contractors License&Construction Supervisors License is re ed. SIGNATURE: QAWPFILESTORIAMbuilding permit forms RESS. oe Revised 060513 t The ConrstnonweaM ofMassachusda Department of rndusft ial Accidents - Orke of Inm igations 600 Wzwhington Street Boston,MA 0 111 wnwanuss:govldia Workers' Compensatian Insurance Affidavit-BuCdders/Contractors/ElectricianMt tubers Applicant Information Please Print Lezibly Na=(H a dnao- 1',� /s l hds U� rin . Address: N Httl/ Ponc-4 eo Yap wLCL1- - M 0a-6 f-S City/Stat&Zip: Phone#: -S 6 Y -6 9(0 9 Are you an employer?Check the appropriate box: Type of project(required): I_ElI am a employer with 4( I sin a general contractor and I 6- ❑New cons5nsction employees(full and/orpart4time).* Y havehiredth,e sub-contractors- 2:El am a sole proprietor or partner- listed on the attached sheet �- ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition w for me in an capacity- employees and have wormers' ozizng Y9. ❑Building addition [No workers' comp.insurance camp.insurance., required ] 5. ❑ We area corporation and its 101-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11_E]Plumbing repairs or additions myself [No workers'camp. right.of exemption per MGL 12.❑Roof repairs insurance ]i c.152,§1(4),and we have no employees-[No workers' 13.0 Other comp.insurance required..] *Az[y applicur that checks boa#1 tm<st also fill out the section below showing their voikes'compensation policy iafirmstion- T Snmeawners Who submit this affidavit indicstilrg they are doing all Wok and then bile outside contractors most submit anew affidavit infra su L lConhscrors that check this bins mast attached as additional sheet showing the name of the sub-eomft2cbors aid state Whether ornot those entities have u*lvyees. If the sub-cont mctars bsve employees,they must provide their warkess'comp.policy number. I am an employer that is providing workers'competrsnlion insurance for uty employees. Betoty is the paScy and job site inf ormatiorr. /� t . Insurance Compa�Name: �oZUo2�t/ (� -gu trU,4d Policy g or Self-ins.Lic#: Expiration Date: Job Site Address: f C/6 O t l/t rltyfStatelzip: Attach a dopy of the workers'compe-nsatian 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 ofcriminal penalties of a. fine up to 31,500.00 and/or one-year imprisomment,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 cetii a thepains d p atties ofpetdwy that the information profited above is true and correct Sienature: Date: 0 I LY 1 LI Phone#: 0,07ciai use only. Do not trrite in this area,to be completed by city or town officiaL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing.Inspector 6.Other Contact Person: Phone#: 6 Information and Instructions w ' 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 employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,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 number(s)along with their certificate(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 confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. 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 permitllicense 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. The Gommo vmgth of Massachusetts Depaitment of Industrial Accidents Office of 1.uvestigafiom 600 Washington Street Boston,MA 02111 Tel. 617-727-4900 ext 406 or 1-877 MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia y � Eti . Town of Barnstable Regulatory Services HAMSrABr$ Thomas F.Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnsta6le.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 ' o fie ✓t e n4 ram`'✓eru to act on my behalf, in all matters relative to work authorized by this building permit i (Addres f Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name 0,3 2 2,q/� D Ye 11 Q:FORM&OWNERPEFMISSIONPOOLS 62012 > Town of Barnstable Regulatory Services ` YdAS& Thomas F.Geiler,Director �Eo •`�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village •HOMEOWI�TER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner ' Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persou(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Loca]\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc Revised 053012 i STANDARD AGREEMENT BETWEEN HOMkOWNER'S AND CONTRACTOR ARTICLE 1 AGREEMENT This agreement is made on this Z date of /�1-)!01/J in the year 9-0/ti by and between OWNER: / Name: �.� Ila GA//S,1 Address: �� ✓Z-z Ga T�� t;?5 �✓�� Phone number. / and the BEL ISLANDS Home Improvement 29 Mill Poud Road West Yarmouth, MA 02673 Ph.# 508-280-1794 Andrei@belIislands.com www.belislands.com for the services connected with the following PROJECT: Notice to the parties shall be given at the above addresses. ARTICLE 2 GENERAL PROVISIONS 2.1 RELATIONSHIP OF PARTIES. The Owner and the Contractor agree to process with the Project on the basis of mutual trust, good faith,and fair dealing. I 2.1.1 The Contractor shall furnish construction administration and management services and use the Contractor's diligent efforts to perform the Work in an expeditious manner consistent with the Contract Documents. The Owner and Contractor shall endeavor to promote harmony and cooperation among all Project participants. 2.1.2 The Contractor represents that it is an.independent contractor and that in its performance of the Work it shall act as an independent contractor. 2.1.3 Neither Contractor nor any of its agents or employees shall act on behalf of or in the (F e 09/0) CERTIFICATE OF COMPLIANCE M.G.L. CHAPTER 148, SECTIONS 26F, 26171h t+I City or Town HYANNIS FIRE @ISTRSCT Date: This Certifies that the property located at f V,T f rogy)�Jjz has been equipped with.approved smoke detectors, and carbon-monoxide alarms*and was found to be in compliance with Massachusetts General Law, Chapter 148 Sections 26F,26Fyh and 527 CMR 31, et seq. Inspection/Testing completed-on: as l 13 By: j/lnsperxor Fee Paid: a�?�• --Head of Fire Department: CHIEF HAROLD S. BRUNELLE Note: This certificate expires"sixty xp xty (6D) days after date of issue. SELLER'S COPY PERMIT # i name of Owner except as provided in this Agreement or unless authorized in writing by the Owner's Representative. 2.1.4 The Owner and Contractor shall perform their obligations with integrity, ensuring at a minimum that: 2.1.4.1 Conflicts of interest shall be avoided or disclosed promptly to the owner Party and 2.1.4.2.The Contractor and the Owner warrant that they have not and shall not pay nor receive any contigent fees'or gratuities to or from the other Party, including its agents, officers and employees, Subcontractors or other for whom they may be liable,to secure preferential treatment. 2.2 EXTENT OF AGREEMENT This Agreement is solely for the benefit of the Parties,represents the entire and integrated agreement between the Parties, and supercedes all prior negotiations, representations or agreements,either written or oral.This Agreement and each and every provision is for the exclusive benefit of the Owner and Contractor and not for the benefit of any third party except to the extent expressly provided in this Agreement. ARTICLE 3 CONTRACTOR'S RESPONSIBILITIES 3.1 GENERAL RESPONSIBILITIES 3.1.1 The Contractor shall provide all labor,materials,equipment and services necessary to complete the Work, all of which shall be provided in full accord with and reasonably inferable from the Contract Documents as being necessary to produce the indicated results. 3.1.2 The Contractor shall be responsible for the supervision and coordination of the Work, including the constructions means, methods,techniques, sequences and procedures utilized, unless the Contract Documents give other specific instructions. In such case,the Contractor shall not be liable to the Owner for damages resulting from compliance with such instructions unless the Contractor recognized and failed to timely report to the Owner any error, inconsistency, omission or unsafe practice that it discovered in the specified construction means, methods, techniques, sequences or procedures. ARTICLE 4 OWNER'S RESPONSIBILITIES 4.1 INFORMATION AND SERVICES Any information or services to be provided by the Owner shall be provided in a timely manner so as not the delay the Work. 4.2 FINANCIAL INFORMATION Prior to commencement of the Work and thereafter at the First Mortgagee Name of institution: Sovereign Bank Address: P.O. Box12649 18002325200 Telephone number: Account Number: 1316059366 44. Seller shall have a licensed professional complete the following list of items, prior to closing, with paid in full receipts forwarded to Buyer's Attorney at closing: The following electrical issues addressed by a licensed electrician need to be done: a. replace entire electrical panel with a new 150 amp panel" b. add the baseboard electric heat to the bathroom c. wire two switches for the light in the hallway to the downstairs d.add the dryer outlet for an electric dryer and wire to the new panel e.a$2,000 credit at closing for the buyer to use in addressing any other issues they choose. vA�¢av�wtCt 04/10/2013 eSinned 7CPT-OK @ 5:43 PM EDT J.Anderson Vazsabrina,SELLER A--, — )**,— A , Anastasia Gleason, BUYER Andrei armalovic E I written request of the Contractor,the Owner shall provide the Contractor with evidence of Project financing. Evidence of such financing shall be a condition precedent to the Contractor's commencing or continuing the Work.The Contractor shall be notified prior to any material change in Project financing. 4.3 WORKSITE INFORMATION Except to the extent that the Contractor knows of any inaccuracy, the Contractor is entitled to rely on Worksite information furnished by the Owner. To the extent the Owner has obtained,or is required elsewhere in the Contract Documents to obtain, the following Worksite information the Owner shall provide-at the Owner's expense and-with reasonable promptness: 4.3.1 Information describing the physical characteristics of the site, including surveys, site evaluations, legal descriptions, data or drawings.depicting existing conditions, subsurface conditions and environmental studies,reports and investigations; 4.3.2 tests, inspections and other reports dealing with environmental matters,Hazardous Material and other existing conditions, including structural,mechanical and chemical tests, required by the Contract Documents or by law ; and 4.3.3 any other information or services requested in writing by the Contractor which are j relevant to the Contractor's performance of the Work and under the Owner's control. The information required by Paragraph 4.3 shall be provided in reasonable detail.Descriptions shall include easements,title restrictions,boundaries, and zoning restrictions. Worksite descriptions shall include existing buildings and other construction and all other pertinent site conditions. Adjacent property descriptions shall include structures, streets, sidewalks, alleys, and other features relevant to the Work.Utility details shall include available services, lines at the Worksite and adjacent thereto and connection contours, and elevations,drainage data, exact locations and dimensions, and benchmarks that can be used by the Contractor in laying out the Work. 4.4 BUILDING PERMIT,FEES AND APPROVALS Except for those permits and fees related to the Work which are the responsibility of the Contractor,the Owner shall secure and pay for all other permits, approvals, easements, assessments and fees required for the development, construction,use or occupancy of permanent structures or for permanent changes in existing facilities, including the building permit. 4.5 MECHANICS AND CONSTRUCTION LIEN INFORMATION Within seven (7) days after receiving the Contractor's written request,the Owner shall provide the Contractor with the information necessary to give notice of or enforce mechanics lien rights and,where applicable, stop notices. This information shall include the Owner's interest in the real property on which the Project is location. 4.6 CONTRACT DOCUMENTS Unless otherwise specified, Owner shall provide ( )hard copies of the Contract Documents to the Contractor without cost. the Internal Revenue Service,as required by the Act. SELLER does hereby forever release and discharge BUYER from all liability resulting from,or arising out of, BUYER's good faith compliance with the requirements of the Act. 37. if there is a conflict between the provisions of this Addendum and the printed form of the Purchase and Sate Agreement to which it is attached,the provisions of this Addendum shall control. 38. The premises shall be delivered in broom-clean condition at the time of closing, free of all trash, debris,and personal properly, including but not limited to clean and remove all items on the deck, in the attic and in the storage room (except that property Buyer and Seller have agreed is included in the sale)_ 39. The SELLER and the BUYER warrant to each other that each has dealt with no real estate broker, salesperson, finder,or other person entitled to a commission or fee in connection with this transaction,and each agrees to hold the other harmless from and indemnify the other against all damages,claims, losses and liabilities, including legal fees, incurred by the other as a result of the failure of this warranty. This paragraph shall survive delivery of the deed. 40. Limited Power of Attorney: BUYER and SELLER hereby authorize their respective attomeys (as the case may be)to execute on their behalf any extensions to the time for performance or to mortgage financing under this Agreement and any change of location and/or time for delivery of the deed. The BUYER and SELLER shall be able to rely upon the signature of said attorneys as binding unless they have actual knowledge before the execution or other consent to such extensions,that either party has disclaimed the authority granted herein to bind them. For purposes of this Agreement,facsimile signatures shall be construed as original. 41. if,pursuant to paragraph 10 of this agreement, the SELLER extends the time for performance and the terms of the BUYER'S mortgage commitment expire during the extended time and cannot be extended at the same terms, BUYER may have the option of voiding this agreement and receiving their deposit funds in full without recourse to either party. 42. Should BUYER obtain a report or reports that the level of radon gas at the premises exceedsAD- pCi/L, then, at BUYER's sole option, BUYER may terminate this agreement by written notice to SELLER of BUYER's election to terminate no later than April 17,2013, in which case at BUYER's option and upon written notice to SELLER on or before 5:00 P.M. on April 17, 2013, this Agreement shall be null and void and without recourse to either party and all deposits shall promptly be returned to BUYER unless SELLER confirms in writing that SELLER shall remediaie the level of radon gas at the premises by installation of a radon gas remediation system at SELLER's expense prior to the closing and to then obtain an acceptable inspection report evidencing that the level of radon gas at the premises is below 2.0 pCi/L. SELLER shall provide BUYER,Aith a copy of the vmrraniy for the system provided by the installer at the time of closing. 43. SELLER hereby authorizes BUYER's attorney to obtain payoff information from SELLER's Mortgagee(s)or other security holder(s)listed below and in connection therewith hereby authorizes any equity mortgage tender to freeze the equity account, in the event closing does not take place,BUYER or BUYER's attorney will authorize lender to free-up the account. SELLER hereby authorizes the mortgagee(s),upon receipt of the payoff funds, to close the account and forward a discharge of the mortgage in accordance with the instructions provided with the payoff check_ I 4.6.1 DIGITIZED DOCUMENTS If the Owner requires that the Owner, Architect/Engineer, and Contractor exchange documents and date in electronic or digital form,prior to any such exchange,the Owner Architect/Engineer and Contractor shall agree on a written protocol governing all exchanges in Standard Agreement Between Homeowner and Contractor or a separate Agreement,which,at a minimum, shall specifiy: (1)the definition of documents and data to be accepted in electronic or digital form, or to be transmitted electronically or digitally; (2)management and coordination responsibilities; (3)necessary equipment, software and services; (4) acceptable formats, transmission methods and verification procedures; (5)methods for maintaining version control; (6)privacy and security requirements; and (7) storage and retrieval requirements. Except as otherwise agreed to by the Parties in witing,the Parties shall each bear their own costs as identified in the protocol. In this absence of a written protocol, use of documents and data in electronic or digital form shall be at the sole risk of the recipient. 4.7 OWNER'S REPRESENTATIVE The Owner's authorized representative is . This representative shall be fully acquainted with the Project, and shall have authority to bind the Owner in all matters requiring the Owner's approval, authorization or written notice. If the Owner changes its representative or the representative's authority as listed above,the Owner shall immediately notify the Contractor in writing. I 4.8.OWNER'S RIGHT TO CLEAN UP In case of a dispute between the Contractor and Others with regard to respective responsibilities for cleaning up at the Worksite,the Owner may implement appropriate cleanup measures after two (2)business Days' notice and allocate the cost among those reasonable during the following pay parties. 4.9 COST OF CORRECTING DAMAGED OR DESTROYED WORK With regard to damage or loss attributable to the acts or omissions of the Owner or Others and not to the Contractor,the Owner may either(a)promptly remedy the damage or loss or(b)accept the damage or loss. If the Contractor incurs additional costs or is delayed due to such loss or damage,the Contractor shall be entitled to an equitable adjustment in the Contract Price or Contract Time. ARTICLE 5 CONTRACT TIME 5.1 PERFORMANCE OF THE WORK 5.1.1 TIME Substantial Completion of the Work shall be achieved in S' Days from the Date of Commencement. Unless otherwise specified irKthe Certificate of Substantial Completion, the Contractor shall achieve Final Completion within)Days after the date of Substantial Completion, subject to adjustments as provided for in the Contract Documents. 5.2. DELAYS AND EXTENSIONS OF TIME 5.2.1 If the Contractor is delayed at any time in the commencement or progress of i 2K Seller is not aware of any written notice of violations having been received by Seller from any municipal,county, federal or state governmental agency during the time that Seller has owned the Property with regard to violations of any rules, ordinances, orders, requirements or regulations imposed on or affecting the Property. 29. Lead Paint Notification: BUYER acknowledges receipt of the Massachusetts Department of Health lead paint notification, and has been made aware of the possible presence of dangerous levels of lead in materials on the premises, and requirements for removal, liability for nonremoval, and prohibitions against discrimination. 30. Maintenance of Premises: Between the date hereof and the closing,SELLER shall maintain and service the premises and its appurtenances at the same or greater level of effort and expense as SELLER has maintained or serviced tine promises for SELLER's account prior to this Agreement. 31. Operating Systems: At the time of dosing, all appliances and operating systems of the premises, including plumbing, utilities, and heating will be maintained in the same order as they were at the time of BUYER's inspection. 32. Pending or Threatened Lawsuits: SELLER states that to the best of SELLER7s knowledge there are no lawsuits currently pending or threatened which will in any way affect title to the premises. 33. Title and Practice Standards Any matter which is the subject of a Title Standard or Practice Standard of the Massachusetts Real Estate Bar Association at the time of the delivery of the Deed shall be governed by said Title Standard or Practice Standard to the extent applicable. 34. Good and Clear Record•Marketable Title: It is understood and agreed by the parties that the premises shall be in compliance with the provisions of]his Agreement only if: (a) The premises are equipped with all necessary utilities, including without implied limitation, electricity,gas(if available in the street), telephone and cable television. (e) 'the premises are served by municipal water, and the quantity and quality of the water furnished thereby is potable and adequate to serve a single family residence/the premises and their intended use; (f) The premises do not violate the tuning ordinances of the Town of Barnstable (the"zoning ordinances")or the provisions of Massachusetts General Laws Chapter 40A("Chapter 40X)or that the premises are validly nonconforming in accordance with said zoning ordinances and Chapter 40A. 35. Delivery of Documents: SELLER shall execute and deliver simultaneously with the delivery of the deed,and when required shall on oath swear to the truth of the matters therein set forth, such documents as may reasonably and customarily be required by BUYER's lender or attorney, including,without limiting the generality of the foregoing,certifications or affidavits with respect to: (i)persons or parties in possession of the premises; (u)facts or conditions which may give rise to mechanic's or materialmen's liens;(iii)absence of urea formaldehyde on the premises;(iv)tax reporting information; (v)a settlement statement(form HUD-1); (vi)an affidavit concerning secondary financing,and(vii)an affidavit regarding smoke detectors being in compliance with state law. 36. IRC Section 1445(b)(2): SELLER hereby warrants and represents that(i)neither SELLER is a "foreign person"as defined by the Internal Revenue Code("IRC"), Section 1445, and(ii) SELLER shall execute and deliver to BUYER at closing an affidavit or certificate in compliance with IRC Section 1445(b)(2)and the applicable regulations thereunder. SELLER acknowledges that if SELLER fails to deliver a completed non-foreign certificate. then BUYER shall be authorized to withhold from the closing proceeds an amount equal to len percent 00%)of die gross amount to i the Work by any cause beyond the control of the Contractor,the Contractor shall be i entitled to an equitable extension of the Contract Time.Examples of causes beyond the control of the Contractor include, but are not limited to,the following: acts or omissions of the Owner,the Architect/Engineer or Others; changed in the Work or the sequencing of the Work ordered by the Owner or arising from decisions of the Owner that impact the time of performance of the Work; transportation delays not reasonably foreseeable; labor disputes not involving the Contractor; general labor disputes impacting the Project but not specifically related to the Worksite; fire; terrorism,epidemics, adverse governmental actions, unavoidable accidents of circumstances; adverse weather conditions not reasonably anticipated; encountering Hazardous Materials; concealed or unknown conditions; and delays authorized by the Owner pending dispute resolution. The Contractor shall submit any requests for equitable extensions of Contract Time in accordance with the provisions of Article 8. i I 5.2.2 In addition, if the Contractor incurs additional costs as a result of a delay that is caused by acts or omissions of the Owner, the Architect/Engineer or Others, changes in the Work or the sequencing of the Work ordered by the Owner, or arising from decisions of the Owner that impact the time of performance of the Work, encountering Hazardous Materials, or concealed or unknown conditions, or delay authorized by the Owner pending dispute resoultion, the Contractor shall be entitled to equitable adjustment in the Contract Price subject to Paragraph 6. 5.2.3 NOTICE OF DELAYS In the event delays to the Work are encountered for any reason,the Contractor shall provide prompt notice to the Owner of the cause of such delays after Contractor first recognizes the delay. The Owner and Contractor agree to undertake reasonable steps to mitigate the effect of such delays. ARTICLE 6 CONTRACT PRICE 6.1 PAYMENT: Option I As full compensation for performance by the Contractor of the Work in conformance with the Contract Documents, the Owner shall pay the Contractor one third (1/3) of the Total Estimate.Price prior to the commencement of work and two thirds (2/3)of the Total Estimate Price payable immediately upon the conclusion of the Work. or ALTERN TIVE PAYMENT FOR WORK OVER TEN THOUSAND DOLLARS. ($10,000.00) Option II ' "_" As full-compensation for performance by the Contractor of the Work in conformance with the Contract Documents, the Owner shall pay the Contractor one third (1/3) of the Total Estimate Price prior to the commencement of work and one third (1/3)half way through conclusion of the work and the remaining one third(1/3) of the Total Estimate Price payable immediately upon the conclusion of the Work. ADDENDUM"B" TO PURCHASE AND SALE AGREEMENT BETWEEN J.Anderson Varsabrina,as Seller AND . - Anastasia Gleason and Andrei Yarmalovich, as Buyers Dated: April Oth 013 24, Notice:All notices required or permitted to be given hereunder shall be given in writing by registered or certified mail, proper postage prepaid, return receipt requested,and deposited with the United States Postal Service,or hand delivered,or sent by receipted facsimile transmission, and shall be deemed given and effective when so mailed or hand delivered,or sent by receipted facsimile transmission, evidenced by a transmission receipt evidencing a successfully completed transmission thereof(with a copy sent by registered or certified mail), addressed to the Seiler or Buyer, as the case may be,at the following addresses: In the case of Buyer: Telephone: Facsimile: Email: In the case of Seller: Christopher J. Collins, Esquire Collins &Cabral, P.C. 1047 Falmouth Road,Suite 4 5 Hyannis,Massachusetts 02601 Phone: (508)815-3422 Facsimile:(508)463-4777 Email:GC011ins@collinsandcabral.com 25. Entry Upon Premises: From and after the date of this Agreement, SELLER agrees to permit BUYER and BUYER%designees to enter upon and within the premises, at reasonable times,after reasonable prior notice to SELLER,for the purpose of matting measurements, survey,financing inspection, and the like. 26. Pursuant to Title 5 of the State Environmental Code(310 CMR 15.301),SELLER shall have the on-site wastewater system(the"septic system")which serves the property inspected by a licensed professional in connection with the transfer of the property. Such inspection shall have occurred within nine months prior to the Date for Performance. At least ten(10)days in advance of closing, SELLER shall provide to BUYER a certified copy of the"Subsurface Sewage Disposal System Inspection Foram"on file with the municipal Board of Health. Should the form indicate thatthe system is a"failed system'or a"nonconforming system"as defined by Title 5,at BUYEWs option and upon written notice to SELLER within rive(S)(lays of receiving a copy of the inspection form,this Agreement shall be null and void and without recourse to either party and all deposits shall promptly be returned to BUYER,unless SELLER elects to repair the system at SELLER's expense prior to the closing and to then obtain an acceptable Inspection Form. 27. Seller warrants there are no complaints, suits, leases, rental arrangements, options to purchase agreement or purchase and sale agreements (other than this Agreement) involving the Property Which will be binding upon the Purchaser after the Date of Closing or would have an adverse effect on the Property or Seller's ability to consummate the transactions contemplated hereby. r 6.1.1 Upon notification from the Contractor that the Work is completed and ready for inspection and accepted. 6.1.2 When Final Completion has been achieved the Contractor shall prepare for the Owner's acceptance a Final Application for Payment, stating that to the best of the Contractor's knowledge and based on the Owner's inspection the Work has reached a final completion in accordance with the Contract Documents. 6.1.3 Claims not reserved in writing by the Owner with the making of a final payment shall be waived, except for claims relating to Liens or similar incumbencies, warranties, defective work, and latent defects. 6.1.4 Payments due but unpaid shall bear interest from the date payment is due at the statutory rate in place, billed monthly at twelve percent(12%) compounded daily. ARTICLE 7 INSURANCE 7.1 Prior to the start of Work,the Contractor shall procure and maintain in force Worker's Compensation Insurance,Employee's Liability Insurance,Business Auto Liability Insurance, and Commercial General Liability Insurance. ARTICLE 8 SUSPENSION,TERMINATION OF AGREEMENT 8.1 OWNER'S RIGHT TO TERMINATE If the Owner suspends Work, he must place in writing to suspend delay or interrupt the performance of Work for such period of time as determined to be appropriate for the convenience of the Owner and not due to any act or omission of the Contractor or the person or the entirety for whom acts or omissions the Contractor may be liable, then the Contractor shall immediately suspend,delay or interrupt that portion of the Work as ordered by the Owner.The Contract Price and the Contract Time shall be equally adjusted by change order for the cost and delay resulting in such suspension or termination in proportion to work performed plus 15%termination fee of the total cost of the job. 8.2 CONTRACTOR'S RIGHT TO TERMINATE Upon seven (7)business Days written notice to the Owner,the Contractor may terminate this Agreement if the work has been stopped for,a thirty (30) business Day period through no fault of the Contractor. ARTICLE 9 DISPUTE MITIGATION AND RESOLUTION 9.1 WORK CONTINUANCE AND PAYMENT Unless otherwise agreed in writing,the their respective liclr5, devisees, executors, administiators, succesors and assigns; and may be canceled, modified or amended only by a written agreement executed by botli the S1 1.I_l-R and the BUYER. if tnfo or more: persons are named as BUYER their obligations are joint tend several. 1P the SELLER or BUYER is a inlat, corporation, j limited liability company or entity whose representative executes this Agreement in a respresentative or ftducllu•y capacity, only the principal or file trust or estate represented ;hall be boutid, and neither the tnlsice, officer, sharelloldcr or beneficiary shall be personally liable for any obligation, express or implied. The captions aml any notes are used oniv as a matter or convelliclice and are not to be considered a part of this Agreement and are not to be used in cletermining the intent of the parties. Any matter or practice n•hich has not been addressed in this Aurcernent and which is the subject of a Title Standard or Practice Standard Of the \•tassachusetts Conveyancers Association at the time For performance shall be governed by the Standards and Practices of the lblassachuselis Conveyancers Association. 23. Additional Provisions. Addendum`B"attached hereto and made a part hereof. Buyer to receive from Seller$2,000.00 towards Buyers pre-pails and closing costs. UPON SIGNING; HIS DOC' j4 ENT WILL 131�C'ONME A LEGALLY' BINDING ACiREULIEN-l". ]I- NOT UN]�L)tS"1'O(�D LIC:iD I C'E •1tOM AN ATTORNEY. 04/10/2013 _ eSigned XVCT-NV @ 5:43 PM EDT ate S •I It ate BUYER Date ST:T LER, oi-spairse Tate BUYER Date SELLER Date Lscroic Auc lit. By signing-, below. talc escronr agent agrees to pert-ornl ill accordance with paragraph eL but sloes not otherwise becoillt: a par1V to this AgrC'.elllent. Date BUYERS Initials BUYER'S Initials BUYER'S Initials SL=LI EWS Initials SI I_L.L•R'S Initials SLLI-_lC-1tS�lnit—tar: MASSFORMS c 1999, 2000,2o01, 204)2. 2006 \1:\SSt\C'tIUSCiTTS ASSOCIATION 01 RE ALTottS u: �41en ide�ll-J.J Rrd 1'<Ok for a, I i Contractor shall continue the Work and maintain the Schedule of the Work during any dispute mitigation or resolution proceedings. If the Contractor continues to perform,the Owner shall continue to make payments in accordance with this Agreement. 9.2 DIRECT DISCUSSIONS If the Parties cannot reach a resolution on a matter relating to or arising out of the Agreement, the Parties shall endeavor to reach resolution through good faith direct discussions between the Parties' representatives, who shall possess the necessary authority to resolve any indifferences within five(5) business Days of the date of the first discussion. 9.3 If the Parties are unable to resolve their dispute,the Parties agree to submit this matter to binding dispute resolution procedure through Arbitration using the current Construction Industry Arbitrational Rules of the American Arbitration Association or the Parties may mutually agree to select another set of Arbitration Rules. The administration of the Arbitration shall be mutually agreed by the Parties. ARTICLE 10 CONTRACT DOCUMENTS 10.1 This Agreement is entered into as of the date entered in Article 1. OWNER. PRINT PRINT TITLE CONTRACTOR: BEL ISLANDS ANDREI YARMOLOVICH PRINT NAME PRINT TITLE 19._C'erfiticate of Amwoved installation. ,the SGi.i.F.R shall equip the: knit with ahhi-owed smoke detectors and tiri'rtish BUYER with Certificate. of Approved Installation from the local Fire Department at the time fi r perlbrnla nce. 20. lVarranties :1itd Representations. The SELLER represents and warrants that the Unit ❑ is! Jis not [choose onel served by a septic system or cesspool. [If yes, a copy of the 'title 5 Addendum is attached.] The SELLER further represents and warrants that SELLER has mull authority to enter into this Agreenlent and that the SELLER'S -,house, if any, has agreed to execute the deed or to release all statutory, common law or other rights or interest in the Unit. The SELLER further represenis that SELLER hats no actual knowledge of any lawsuit pending against the condominium association, the developer or any contractor that affects the title, use, ownership or occupancy of the Unit: that SEl_LE:k has not received notice of any special assessment; and that SELLER ha; no actual knowledge of malt'-, which are likely to increase the common expenses for the Unit or 1'CSltlt ill a SpCCial asscssnaent. "file BUYER ackuow-ledacs that 13UYER has not relied upon any wirl<anties or representations other than those incorporated in thia A-rcenhcnl, except for the rollowing additional %v;u-ranties and representations, if any, matte by either the SELLER or any real estate agc;nt. none P'nolle, vale "11011e": i/'rnit'listed. inelicale hr irhom the 01,;-c171•eseulcrlioll wets Inarle.J 21. Notices. All notices required or pci-mittecl to be made under this Agi-eenlent shall be in writing and delivered in hand, sent by certified Mail, return receipt requested or sent by United States Postal Service overnight Express Nlail or other overnight delivery service, addressed to the BUYER or SELLER or their authorized representative at the address set forth in this paragraph. Such notice shall be deemed to have been gi�-en upon delivery or, if scat by certified mail on the (late of delivery set Birth in the receipt or in the absence of a receipt three I)(ISilleSS clays after deposited or, if sent by overnight nail or delivery. the next business day after deposit will) the overnight mail or delivery service, 11vhether or not a signature is required. Acceptance of any notice, whether by delivery or hall, shall be sufficient if accepted or sinned by a person having express or iluplied authority to receive same. Notice shall also, he deemed adequate Ifel -cn in any uther,fibrin permitted by la"-. 1.7 BUYER ChristopherJ. Collins, Esquire SELLER J. Anderson Vazsabrina. Collins &Cabral, P.C. 1047 Falmouth c/o Darci Gervais, Keller Williams Realty Road/Route 28, Suite 95, Hyannis, 1600 Falmouth Rd Massachusetts 02601 Centerville;IVA 02632 22. CQit11t(TI)A1•ts I Facsimiles l Construction Of Ayreenient. This .agreement may be executed in Counterparts. Signatures Iransinined by ftesimiie %hall hart the effect of original signatures. This :Agreement Shall be construed as a tMassachuscits contract; is to take elll ct as a sealed insirunlent: sets forth the entire agreement between tide parties. is binding upon and is intended to benefit the BUYER and SELLER and each of 6 _ Y r Q ak [iUY 1Z5 Iniitials SELL ZCI 'S lnitiaals MA531'70 ZMS' 11199. =uaw,200i,2u02.luau, tMASS: CHUSUTTS A i)',OCIATION yr izFAI. ORS �:.ba{Jr SUt,1u.1 KJ 1iWt I'vcu � CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY) 3/25/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER BRYDEN & SULLIVAN INS NAME:CONTACT 88 FALMOUTH RD PHONE FAx (LC-N3,_Uxtr C.No): HYANNIS, MA 02601 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: LM Insurance Corporation 33600 INSURED INSURER B: ANDREI YARMOLOVICH DBA BEL ISLAND HOME IMPROVEMENT INSURER C: 29 MILL POND ROAD INSURERD: WEST YARMOUTH MA 02673 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 19576541 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE IN Wvp SUER POLPOLICY NUMBER MM/IDYL MMIDD� LIMITS LTR --- I_lCOMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TRENTED CLAIMS-MADE OCCUR PREM SESOEa occu ence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 ECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Para ccdent) UMBRELLA LIAB OCCUR EACH OCCURRENCE I$ EXCESS LIAR HCLAIMS-MADEJ AGGREGATE $ DED RETENTION$ I$ A (WORKERS COMPENSATION WC5-31S-384176-024 2/21/2014 2/25/2015 3 SPER TATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? ❑N N/A (Myandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100000 DESCRIPT ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. ANDREI YARMALOVICH IS COVERED BY THE WORKERS'COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATIONTHE 200 MAIN STREET ACCORDANCEW TH THE POLICY PROVIS PROVISIONS. WILL BE DELIVERED IN HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 19576541 CLIENT CODE: 1588030 Ame Chandler 3/25/2014 8:33:48 AM Page 1 of 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards i `Oli Construction Super•l•isor office of Consumer Affairs&Business Regulation License: CS-105964 a OME IMPROVEMENT CONTRACTOR Registration:, 17ti4,76 Type? IvAN v IvANI sM111K" ii 174 Upper Coun"d Expirat�tn TL/044 Supplement +l Apt 1-14 7 I 11 BEL ISLANDS HOME IMPROVEMENT Dennis Port Na Og63 Fr IVAN IVANIUSHENKO''r = r ��,.. ��ul . " 'sr Expiration 29 MILL POND F =` �� g Commissioner 01/01/2016 -1 =- I W.YARMOUTH, Undersecretary r I _ o •x .,, :µm. .-aw•;ir+'�sx:c�„tr2:,w51�-�rtasr�:e,..csa�..,.i -ik.c ^ - "~ Ocense,or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business.Regplation ._ 16.Park Plaza-Suite 5170 and Boston,MA 02116 ' i Not--valid without gnature. . 4 I 9 OSTEKVI LLE, MA ps Ritrer I .) Assessor's Map 1 19 Parcel 45 LOCUS 2.) Deed Book 25095 Page 23 3.) Plan Book I GG Page 107 4.) This property is In a Zone Il of a Public Water Supply 5.) flood Zone: RC _ Wintergre Gr v a. 0 a O SITE LOCUS NOT TO 5CAI i I Wlnter6reen Circle 40' Public Way LEGEND EXISTING SPOT GRADE N 89°4 P 0"f- 24x5 PROPOSED SPOT GRADE EXISTING CONTOUR 24 PROPOSED CONTOUR` WATER SERVICE LINE o OVERHEAD UTILITY LINES —u UNDERGROUND UTILITY LINES GA5 SERVICE LINE EDGE OF CLEARING o —a-- IFENCE 'P TEST HOLE LOCATION ® ST SEPTIC TANK 13 DISTRIBUTION BOX LOT, 28 SAS SOLI: ABcRPTItN S rSTEM .Area. 20, 103 S.F._ 4: I Exist ln 9 41.p Patio W Shwr O �� m Proposed - Deck z -`� o Existing ISeptic 3 per As-Built b ` 0 O n I o 0 he m x survey iYork by .- I 19.30 A & M Land Services 8!°39j2o,,iy 818 Route 28, Suite 3 West Yarmouth, MA 02673 Pb. (508) 737-1777 Email.• anmland®comcest.net repare or: Paul t- Claudia Vadash 14G Wintergreen Circle Osterville, MA �. ilk OF Propo5ed Deck 14G Wintergreen Circle Ostervlile MA Prepared by: (J o3�31 ey —� ,, ,,•� 0 20 40 GO _ P.O.Box 201 Phone:(508)299-3250 Brewster,Mfg 02631 Fax(508)896-1783 SCALE 1 "=20' Date:0 Scale:As Shown By:UP Check: MTA Project No.CSN0000