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0093 CAPES TRAIL
12543 UPC 3LOR ' No. 5OR HASTINGS, UN Sl2 1 g� F Town of Barnstable *Permit Lp—j �1• E�re s 6 months from issue date Building Department Fee Brian Florence,CBO I O O v� mass %ilding Commissioner �OrEp R� , �� m • 0 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 ��( n 1 2018 Fax: 508-790-6230 �S'PLRAHT APPLICATION - RESIDENTIAL ONLY w Not Valid without Red X-Press Imprint Map/parcel Number ,- / Property Address /� `���'�S Tf,411,, 4,57 0 Residential Value of Work$ /U, va U Minimum fee of$35.00 for work under$6000.00 ,{ Owner's Name&Address �`�r�_�����. /. / [D� .e-S y Contractor's Name VCrC,C.4 4/5 I�CoA 2 TY /L6,T Telephone Number ,OoP-S``�� �/� t Home Improvement Contractor License#(if applicable) Email: i Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance � � Check one: ❑ I am a sole proprietor R 0 10 ❑ I am the Homeowner �'® ❑ I have Worker's Compensation Insurance wOF Insurance Company Name / VwW rl��5 LE Workman's Comp.Policy# /11A1754 S,R Copy of Insurance Compliance Certificate must accompany each permit. 4 Permit Request(check box) . Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof] ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILESTORMS\EXPRESS2017 Town of Barnstable i L �OFTHE Tqf� Building Department a� Brian Florence CBO ? Building Commissioner BALIMSUMM v MASS. 200 Main Street, Hyannis,MA 02601 ' 1639• ♦� 'OrEp Mpg°' www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION YPlease Print DATE: JOB LOCATION: �-- number -� /ten �{ street / village "HOMEOWNER": J'Jl CL // �!//U L` G / �J�iI^✓ !/" !�' name home phonnee�# work phone# CURRENT MAILING ADDRESS: GJ -If/I e2_1vS11-/7-413 LIC 11,711-7- city/tDwn state zip coac 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 . Si i'ofHomeowner L/ 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 person(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 to amend and adopt such a form/certification for use in your community. • °*'THE Tp Town of Barnstable Building Department • sysrnsr.E. t Brian Florence,CBO 059. a.�� Building Commissioner lED MA'S 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This.Section If Using A Builder I , as Owner of the subject property hereby authorize to act on my bebop in all matters relative to work authorized by this building permit application for: (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. } Signature of Owner Signature of Applicant Print Narne Print Name Date Q:FORM&OWNERPERMISSIONPOOLS Rev:10/17 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington-Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: �- City/State/Zip: Phone#: -�7 33 11 —3 S- Are.you an employer?Check the appropriate bob: Type of project(required): 1.❑ I am a employer with 4.,., I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp.insurance comp.insurance# required..] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑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.[1 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hive outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy 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 up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify urn4er the pains and penalties of perjury that the information provided abov is7/p and correct Si ature: Date: / Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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-contractor(s)name(s),address(es)and phone number(s)along with their certificates)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 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 Commonwealth of Massachusetts Department of Industrial Accidents office of Investigatims 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-977-MA.SSAM Fax#617-727-7749 Revised 4-24-07 www.maSS.govldia r ne Coentfromvag&h of M-wsaclr=&ft Deptn taent o,f Indwa id Accidmft Office ofbrMsligations 600 washfugton,S`treet Boston,AKA 02M mnv mas&gov1dia Workers' Camp ensafianInsurance Affidavit:BuilderslCantrActursMecfricians/Plumhers AppFcant Information Please Print Name Vea ern Address R o x Ca SS- vvw4( A,c, 0J.23!� Are you an employer?Checkthe appropriate bow ' Type of project(reclaireq: 1.EX I am a employernith 4. ❑I am a general confrsctffr and I employees(fall andfor pact timed* 'have hired.tbe subb-comh Ct= 6- ❑New oomst oa 2.D I am a sole proprietor or partner- listed onthe attached sheep ?- ❑Rem &Hng ship and have no employees. These sub-cantmdars hive 8.❑Demolition g for aye is employees and have worms' wodand 9. ❑Building additica INC wpikecs'=Mp-i snr= a Camp-insurance-I require&] 5. ❑ We are a corporatim and ifs 10-❑Electrical repairs or additions 3-❑ I am a homemx=doing all work officers have exercised their 1 L❑Plumbing repairs or additions. myself.[No yaoilmrs'corny- right of ememgtim per lit(M 12.[]Baofrepaics insurance required]i c_152,§1(4h andwe have ao employees[No wodcers' 13-❑other comp-inso»e mquire ] ;Any a Bamtdhetdmdsbaa 91alsofiIloaEthesactionbeIowsh�ndggttieirwoslsexs'cotapeasatioapaFcyinCv�sEan �ameaaraea Who sabot dais af�dae$i rating they aze fain;sg War}ago char hiix outside r,n,}f�ren.c�t{submit a nem ZMdaV1t iodic— sacIL tC,0n ectoa 1b=cbecB*V boa must&=ehed as sddid® sheet shouag theme of the sub-cenWectam end stile wbethm ar nor those e2ities haae employees 7ftbasnb-�eskmonpIoyees,theynmsrpmvidedww aRrkes'to�P•po F�m�beL Iant au employer t jat;is prauFdfr;g workers'compensrdiart Lamrance for my=Tfayw= 6eTbiv is tfiepa&7 and job x&e infornratiom Insumnce companyName: 'Policy 4 or Self-in&tic-. FspirdionDafe: Job ate Address: cityfStatemp: Attach A copy of the workers'compensation policy-declaration page(shaving the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$UOD 00 anNor one-yearimpaisonment,as well as cavil penalties.in the farm of a STOP WORK ORDERand a$me .of up to$250.D0 a day against the violator. Be advised that a copy of this statemed maybe forwarded to the Office of Investigations ofthe DIA for insurance coverage vedfccation- I do hemby car . gander tkoiWas w dpenalties afperjrsry that Ste inforwu as prmided abatis B line and correct Date: C a 9 zs 9 Ofjicitd use enty. Do ttat tvrite in this area,to be camp]eeted by city artoirn oficiat City or Town- Permi f Acense 9 Issuing Authority(cu de one): L Board of Health 2.Building Department 3.City1rown Clerk 4`Electrical Inspector 5.Plumbing Inspector ti.Other Contact Person: Phone 9: -- — - 6 formation and Instructions Massachusetts G2tieaal Laws chapter 152 req=m all=pIoyeas'to prande wall= compensation for their MnplaY=- PaMUM3ttD this StSfntD,an eMV&Y=is defined as.-.every person in the service of another under any coni=ad of hiir, express or implied,oral or wr_" An E2"P&yer is&E ed as'an individual,partnership,assocrdi6A corporation or other legal etd>ty,or any two or more of the foregoing engaged in aJoint entexprim,and inchuimg the legal representatives atives of a deceased employer,or the receiver or trustee of an in&dnal,partnership,association or other legal entity,emrploYmg employees However the owner of a dwelling hanse having not more than three apartments and who resides therein,or the occgmt of the - dw d ling house of another who employs persons to do mainteumce,construction or repair woIk on such dwelling house or on.the grounds or buildmg appuntc nantthereto shall not becanse of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also siafns that"every sfatE-or local r=nsing agency Shan withhold the issnaace or renewal of a license or permit to operate a business or to constrict buildings in the coanmonePealth for any. applicant who has producednot acceptable evidencem of comp&ance with the. snra �u coverage required." AdditionaIly,M(rL chapt=152, §25C(7)slates-Neither the canmmrz¢vralth nor jay ofifs political subdivisions shallenter into any contract for the pmf=ance ofpubho wail-until acceptable evidence of compliance with the inso c-6._ reT3i ents of this chaptPa have Beer presented to the cont-acting aufhozity." Appfican s Please fM out the worio~rs' compensation affidavit completely,by ch=Idng the boxes that apply to pour sitnation and,if necessa ,supply s)name(s), address(es)and Phonen=ber(s)along with their cerhficate(s)of mmm-once. Limited Liability Compames(LLC)or Limited LiabRity-P easbips(I LP)withno employees other.than the members or partners,are not required to crop woricexs'compensation insurance. If an LLC or LLP does have employees,a policy is req¢aed Be advised that this affidavit may be submitted to the Depa-iment of Industrial Accidents for conf=ation of insurance coveaagf. Also be see to sign and date the affidavit The affidavit should bezutmned.to the city or fawn that the application for the permit or license is being requested,not the Department of . 1-finstrialAcddmIm gWnldyou have ray gnesti®s regardmg the law or ifyou arm rcgai red to obtain a work=' compensation policy,please call the Department at the immber listed below. Self-tossed campaaies should ear their self-insurance license n mber on the appropriate line. City or Town Ofacials Please be sore that the affidavit is complete and primed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Inve-t iia ons has to contact You regarding the aFPlicant Pleas a be s a a to fill in the peami t(licrose number which will be used as a rrfereace number. In addition,as applicant that must saba it noulfiple pennh/Iicense applications in any given year,need only submit one affidavit indicating dent policy mfonmation(if necessary)aid Hader`Job Site Address'the applicant should va ite:'all locations in (CItS'or town)-A copy of the.affidavit t3�at has been officially sFm aped or marked by the city or tiown maybe provided to the applicant as proof that a valid affidavit is on file for futnre*penmits or licenses A new affa must be filled out each year.Where a home owner or eiti=is obtaining a license or permit not related to any business or commercial vendor (it. a dog license or permit to bran leaves etc.)said person is NOT reqaired to complete this affidavit The Office of InTestigations would him to thank you in advance for your cocper,&on and should you have any gaestions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Thy t�of Mc,1lnsetts , mt Gif 1n�Accident% OffiCe tOfegtioJr 6 hmgtan S#r� TRt1l�fA E�l,1F Ta 4 617- -49W eat 406 or I-&771vWSSAFF, Fax 9 617 727 7749 Revised 4-24-07 A R 0 DATE(MMIOD"M CERTIFICATE OF LIABILITY INSURANCE 04/30/2018 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 CONTACT NAME: Kim McAlpine PAUL PETERS AGENCY INC UV .PHONE . (508)548-2500 FAX No): CRESS: kim@paulpeterr.agency.com 6 FALMOUTH HEIGHTS RD INSu S AFFORDING COVERAGE NAIC0 FALMOUTH MA 02541 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURERS: TERRENCE ROGERS INSURERC: VETERANS PROPERTY MANAGEMENT INSURERD: PO BOX 655 INSURER E: EAST FALMOUTH MA 02536 1 INSURERF: COVERAGES CERTIFICATE NUMBER: 263426 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER D MMMD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S GE TO CLAIMS-MADE F—IOCCUR PROEM SES(Ea occurreD nce $ MED DIP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JJEECTT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY CE0,MBMSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per aa�dent S UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION X I PER ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/D(ECUTIVE YIN E.L EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED7 NIA WA WA VWC10060226142017A 09/29/2017 09/29/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 100,000 IL describe der DESC under RIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached it more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Kvd/workers-compensabonfinvestgabons/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Dan Mooers ACCORDANCE WITH THE POLICY PROVISIONS. 92 Capes Trail AUTHORIZED REPRESENTATIVE West Barnstable MA 02668 Daniel M.Cro_Mey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD vo Poet to IV F'IKE Town of Barnstable *Permit#� •t,G Expires 6 montGs from ivsue date Regulatory Services Fee sn>zrtsrtsr.e. v� suss $ Richard V.Scali,Director ON i6s� �0 130 Building Division ,F-RIkU #016 erry,CBO,Building Commissioner 00 Main Street,Hyannis,MA 02601 OCT 04 201 7 www.town.bamstable.ma.us Office: ¢�� 8 Fax: 508-790-6230 PLiCATiON - RESIDENTIAL ONLY �f tVot Valid without Red X-Press Imprint Map/parcel Number OM �l 7 Property Address �o P S r� W �Lt�"�S 4 le— Residential Value of Work$ / — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address r-DuAl-C 1 n o er 5 C40ej ll- 4 Contractor's Name W 00 WotQ JGFF ' Telephone Number 7�f�`�3Z Y�� of 30,cnDo Home Improvement Contractor License#(if applicable) / 0OZ�<' Email: Construction Supervisor's License#(if applicable) 87 Z:7 7 2— YNorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 4AyTIPAL `f'lIZ;1= 1u1Qu In Workman's Comp. Policy# ZZ W I�.ct-T Z6 34 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) Ve-side q q Replacement Windows/doors/sliders.U-Value 2 1. (maximum.32)#of windows 9 #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. *Where required: ISSUanCI'of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired_ SIGNATURE: C:\Users\Deco)i eta\ cal\Micros endows\Temporary Internet Files\Cbntent.Outtook\2PIOl DHR\EXPRESS.doc Revised 040215 f °Window World of Boston,LLC MA HIC Registration Offices&Showrooms Number: O 15A Cummings Park U 295 Old Oak Street feral t Woburn,MA Ot801 Pembroke,MA 02359 481 MI)932-4605 (781)828-Ml "Simply the Best for Less" www.WindowWoddofBostan.com Customer_—zLh EL /TIQ� Phone(66/7-25—ri Cb Instal Address: z C-4-X T�i4/G Phone(w) qty ti� .► �1lCSTJ��LF State:MA Zip 006 E-mail WINDOW WORLD GLASS OPTIONS 1000 Series Single-hung AllWekl $189 AV SolarZone Elite $119/07/ 2000 Series DH MeoNWekled Sash $215 _Triple Glazed TG2° $195 T4000 Series DH AJI.Weld $225=VZ5 ("Series saw OnW _6000 Series OH All-Weld $260 wlNDOW OPTIONS 2 Ute Slider $354 Glass Breakage Warranty $15 WCLUDED ^S Lite Slider ore vane WC ^txve $545 1/2 Screens $9 _ _Picture/Fixed Ute $354 Foam Insulation on Jambs and Head $11 INCLUDED Awning $280 1 Double Strength Glass $15 tNCWDED ^Casement $310 _Dottie Lodes(>26°) $5 I_ CLU NDED _ 2 Ute Casement $6gg _Full Screens $� 3UteCasement OAvava VAIAtre $880 —Colonial Grids(Contoured/Flat) $45 Basement Hopper $334 _Prairie Grids $51 _ _DianandGrids• $69 _Bay Window-Soffit Mourn!INS Seat$2660 _Simulated Divided Ute $182 _Bow Window-Soffit Mount/INS Seat$2788 _Tempered DH Sash(BSO)(fSO) $65 _Garden Window $2040 Obsre Glass(SS0)(TSO) $35 Spec"window $ — cu Oriel Style(4U76D or 60/40) $30 _Beige/Almond $40 —Foam Enhanced Frame $35 _Wood Grain Interior(S MS 4Doo/600 QIW$100 PRE 1979 BUILT HOMES(EPA LEAD SAFE RENOVATION) (Ught Oak]Dark Oakl Cherry/Fox Wood _Lead Safe Practim Required $30 Rich Maple) MY HOME WAS BUILT IN THE YEAR z fnl0al _S mvn Eztedor ojctL Brarae/�rlcenTena)$100 MISCELLANEOUS _Designer Color Extedor $176 Custom Exterior Aluminum Cladding Window Color_/_/�',,�5� O7111dured 675 poth$75 $. D, Facing Color WITAF NON CUSTOM DOORS —Metal Window Removal $50, _NewCauoucttonVinylRemoval $175�_ Vinyl Rolling Patio Door 5ft or 6R $loss _Spey Window Sderior Trim $ Vim RoWn9 Patio Dior 8R. $lies _Add to base prim for Custom Rolling Patio Door$1250 _Mull to Form Multi Unit $30 _French Rail SBding Patio,Dour 51L err 6% $1595 _Install Interlor/Extenior Stops $50 _Fretcdh Rail Sliding Patio Door Bit. SUBS _Install Interior Casing Starts At $95 _Frend1 Rag Siding Patio Door 9% $1695 _Insulate Weight BWces $20 _Custom 5derior Cladding $15D _Roof for Bay/Bow Windows $500 _Sdaaano Elite or ETC Gass .$= _lEtlsting New Const.Ed.Retro Fit $150 ,Grids Patio Door $149 Removal of Existing Bay/Bow $290 waoayain bmerlors $285 _Repair S ll,Jamb orreplace sill nos nil'$SO�O —_Etderior Designer Colors Full Sub-Sig(Single)replacement .$150 _Interior Casing 20 Sm $176 _Mullion Removal $30 Handiest Options $ _Say/Bow Conversion Ext.Retro Ft $350 $ (New Sing Will Not Match) Door Color / ' aIslde Outside Customer declines exterior wrap and understands painting and/or repair may be red IE�1ial Customer declines rids on oQZ windows/doors Initial Dminerisrespanslblefortlmtdo*gNeaelacM with Into=*actI'lli ,SlaftMrmSyshlmdboarvoulfecaartectBNMagPtamgfeesln excessatM.00,HomeownerandorCaboAwdelionAMR MNatarkWftAppend.WVd Began Datld&stdawa0cPermutesincanneolbn%MInstallation. NO OKRA WORK IF NOT IN 1NR1TiN01 Customer agrees to thip terms of payment as follows: �) Extra Labor&Materiels $ — ICE�i)'C Site Set Up,Permit,Disposal 8 Del"Fees$ 89•00 Total Amount ; O—r Order Or Deposi150% $ Ck# Balance Pald to Installer upon Completion Amount Financed $ Window World of Boston anticipate;staling ins work onj and being substantially eamplehd I� dints Socially Merest Yes_Na Any dt9adt required in advarme d otart S of lire walk MALL tier exceed 1/a%d the tams contract into ar ttaakral cost d anp matc( egb al a pmmt a1 a spedlal order or custom made nature,wNch must be Ordered in advance ofthe W of to workto amoo 01the Pmhct Will proceed On sou&*&Ro Mai payment shall be demanded until the contract Is completed to tosatslacoon of both parties. Al home tnp rterneat conbadare and subcmtradors aloti be registered and that arty YquYes abob a eodraat a srbeamadar relal no to a m4isMn striutd be (treated to:01110 er Counter Attrbs and aaateers Replla kin,tan park Pi M Saito 3170 Bata%MAlk116.PMae:(m7)dirt ma No work shall begin pier battle sipiag 01 tha cadmd cad ttemanliial to the owner d a copy of suc b ca*ld. Window wad(01 Boston under paNalol Of Chapter 142A Of the gem laws Is required to apply for and obtain M eoniructiol•reJaled per00s Wlndm World of Boston shall rat be deemed respoasDte for delays 10 the work desrt0ed in fis agreement caused by regurdtory,permit pAV aganeMs,ein hortifies or indMiluals. Natca Rib pulle 11(s)obhlsNo4wncmrbudHOArelatedperrotatotileworkdomeeCOderthisgaeompodeadwitheorealoteredctotraciam tiro PLOCHASER(S)Is hereby stbuitei dial in is r rom at a dispute,Inyeramt aY mpayoraet,the PURBHASER(S)toll rat Of emkkr to INM a shim or collective Imm Ore gaera*tuad emlillsbad by chapter 142A,11.6.L you the buyer may Centel l strSosaaBon at any pmor g o n kzas a s tralfsah2laa Naim of cancellation must be is wits g postmarked ho beferthae er*W of the following MN ba sNem da(L ft Villndaw Warr ftxft is Indelleriftylly avahed and aerlNd by wndwv 101arldlit6o tr.C.undafxreeYSmWk*V rwl sign I/tlmroan any Wang aptheea. i swesfi=Do ant sign if Ayblarrikepwati. EWIV otmw..Do riot dgn H there sro arty Wards s ne& Data ae,m Dan Whore Oam-OrlgLml YeI1 wfbpV-Fine P1nk Copy-Cud=a Rip.nfmpaeaeernne Massachusetts Department of Public Safety ® Board of Building Regulations and Standards License: CS-072772 Construeion Suoer-/iscr JEFF C STEELE 24 SHERWOOD AVE DANVERS MA 01923,=„ `t14 r , " Expiration: Commissioner 04/07/2018 -..ro nira•u:,ar/�ri: �It:..;,;a�i.rr.,.- --_OISce of Consumer Affairs&Business Regulation - —' HOME IMPROVEMENT CONTRACTOR Registration: 166025 Type: Expiration: 4/1i2018 LLC WINDOW WORLD OF BOSTON,.U-C. JEFF STEELE 24 CUMMINGS PARK SUITE 15-A WOBURN,MA 01801 Undersecretary License or registration valid for individual use only before the expiration date. If found return to'Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,M[A 02116 i j�ot valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents 0 I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TH TO BE FILED WI THE PERMI TING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Indi.ddual): (�,/ilC4 uJ Address: 1.,�fl� C n,., r►__T K City/State/Zip: � n O o 8 Phone#: -� I -9 3 z - UR o s Are you an employer?Check the appropriate box: Type of project(required): L[g I am a employer with TQ employees(full and/or part-time).* 7. New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.l ° 3FJ I am a homeowner doing all work myself[No workers'comp.insurance required.)t . ❑Demolition 4.�I am a homeowner and will be hiring contractors to conduct all work on my property. ]will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.r7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑we are a corporation and it officers have exercised their right of exemption per MGL c. 14.�ther 1N I I t 152.F1(4),and we have no employees.[No workers'comp.insurance required.l *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state wbether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'camp.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: (4 Tn S J RA 9 C f- Ce . Policy#or Self-ins.Lic.#: Z Z WE C L.)2 a- S Expiration Date: /— Z 7/— /R Job Site Address: 93 C1o2es /a i City/State/Zip: . t -f Ue q Attach a copy of the workers' compensation policy declaration page(sbowing the polici;number and expiratio date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi oR 1 do hereby car under a psi erjury that the information provided above is true and correct Si atria: Date: /0— Phone#: — 3 Z ' �� use only. Do not write in this area to be completed by city or town official Citv or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: WINDO-2 OP ID: HI ACO- RO CERTIFICATE OF LIABILITY INSURANCE DATE 0510412 0 1 7 Y) 05l04/2017 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 CNAMOMNTACT E: Carli Witcher CISR,CBIA,CIC Marsh&McLennan Agency-GSO PHONE FAX 3925 N.Elm St AIc No,Eri.336-272-7161 Arc,No-336-346-1397 Greensboro,NC 27455 EE-MARE� C.Timothy Ward,CPCU,CIC ;Carli.WitCher@marshmma.com INSURERS AFFORDING COVERAGE NAIC 9 INSURER A:Hanover Massachusetts Bay 22306 INSURED Window World of Boston, LLC INSURER B:Allmerica Financial Benefit 118 Shaver Street INSURER C:Hartford Fire Insurance Co. 19682 North Wilkesboro, NC 28659 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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; DLiSUB I I POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE 1INSD'WVD: POLICY NUMBER MM`DDIYYYY MMIDD/YYYY j A ; X COMMERCIAL GENERAL LIABILITY ' 'EACH OCCURRENCE 'S 1,000,000' CLAIMS-MADE X OCCUR ' 0D6790252708 04/01/2017 04/01/2018..PREMIET(Eaoccurrences 5 500,000" MED EXP(Anv one person) S 5,0001 _ PERSONAL&ADV INJURY S 1,000.000 GE%AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE —- 2,000.000' POLICY JECTT LOC PRODUCTS-COMP/OPAGG S 2.000,000i OTHER: S AUTOMOBILE LIABILITY :COBIKEaccident)SINGLE LIMIT(Ea S 1,000,000` B X ANY•AUTO !AW68757615 06/16/2016 06/16/2017.BODILY INJURY(Per person) S ALL OWNED SCHEDULED I AUTOS —AUTOS BODILY INJURY(Per accident) S NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Peraccident) S — 5 )( UMBRELLA LlA6 X OCCUR I EACH OCCURRENCE S 2,000,000 A EXCESS LIAB CLAIMS-MADE` ;OD6790252708 . 04/01/2017 04/01/2018 AGGREGATE S DED E RETENTION 5 S !WORKERS COMPEN LISATION X PER OTH- ' AND EMPLOYERS' ABILTTY STATUTE : ER C 'ANY PROPRIETOR/PARTNER/EXECUTIVE Y!N ',22WECLJ2635 01/27/2017 01/27/2018 :E.L.EACH ACCIDENT 'S 500,000 :OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-Eb.EMPLOYEE 5 5001000' 'If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Addklonal Remarks Schedule.may be attached H more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE t ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Town of Barnstable =Permit Aoo29� O Expires 6 mo rom issue e s a Regulatory SerAces = Fee e ono 9c� a6 q; �� Richard V.•Scali,Interim Director p�FO J4A[��A 'Building Division Tom Perry,CBO,Building Commissioner ft 200 Main Street Hyannis,MA 02601 1«1r%tttown.bamstable.ma.us Office: 508-862-4038 Fax:508-790-6230 MRESS PERAUT APPLICATION - RESIDENTUL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 g,�F- O /L/ / l Property Address_- l 3 e a,-- ` 14; l [Residential Value of Work S 14 �3 Minimum fee of 535.00 for work under$6000.00 Owner's Name&Address• lJLtr�l r e (l I h y r S Y l a D�`Z S (?3 Cie- 7-C * I Oe54 (2-arnsfa bte nA r,)z 6R Contractor's Name_-5x4fr/1 pl,e.t J;r�Z•,�,S / j�� ;�,,, �n i c„n Telephone Numberap 1))X Z g-Gl k o Home improvement Contractor License_(if applicable) /73 j qS- Email: Construction Supervisor's License 1(if applicable)_O 5 S 7 n-, 2fworkman's Compensation Insurance Check one: ❑ I am a sole proprietor • ❑ I•am the Homeowner I have Worker's Compensation Insurance J �� Insurance Company Name A r u � 1ns u< tit c� TO AN 0 s?gjs Ur Workman's Comp.Policy �rVC q�gp S$3`SZ 3 cry - RIVSTq pI C Copy of Insurance Compliance Certificate must accompany each permit. D`e Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑ Re-roof(hurricane nailed)(not stripping Going over _ existing layers of roof) eReplacement side Windows/doors/sliders.U Value - 3 0 (maximum 3 r of ti doves of doo - ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections re Separate Electrical&Fire Permits required. YWheie required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. "Note: Propetty,P weer must sign Property Owner Letter of Permission. A copy,61 the Home Improvement Contractors License&Construction Supervisors License is required. _ - lr � SIGNATURE: QA%1PFILESIF0RR4Stbui1ding permit formslEXPRESS.doc Revised 061313 i . Renewal yAnder�en m�tf.e w A��MahF if�ltc rrrF,�3�a7 R[�iR.�h555 wrr�as rcra�cemcmh �.�.,c-mo�aTr 26 AR&n Road • linco1n,Rl 02865 UW P.=1-11tE37 PhoneSb6-i6"155•Fax9.401-63.16602 a ftamiTaoc D+t6�881v' Soudle a New Exalaad.Wtldowa.Id,G dtbfa IianswasbyAmd4mmof SoadmuNewEmzlwW CUTWX%'1�1i DOi1t A,ND DOOR RLMODELLNGAORI MIT CWD iN �WA 647 LL11 n -- "'Riy�t(ef8noc�6lnot:�q�guNlpCa4fPlk&a�• :�' ®' ��lYNfiA '� /��/Y�� - BaycrW,ftw*joil*und se%vra *agrm to pum kasc the Fmducb and/or smices of Saa&uu New Wand ' do%%LLC d/b/aItEnnni: by Amkom of Soulmm l`few Egd3nd VCo1 uacE-'j in acaotdmam aith the wrm3 and condWoali deatsil eel,m tlae fKat and The reties of Kai�ditanaDiefmtidl�4Cc&1d m'fteo*&4:6�dLis' }•--- -r mjsj�j c--A'`conda 13 wb�IJa6Amois,e;. f�G$3 EWmmd Smt@V Dear Modxd of Fwfimm O Ciied( O C mh allm7i G:*edFt Cards are aaceptod for dam»only-i> m its of the; aoianix u Shirt d1�Ol —}� Esanoeod t arrplmGms t?a>Y: DmieR th- + .you admai tirp tl,a:dm Hahne at smut oflob aid.&e tiattneear 5�aaariti#s � BatVh�era 5ia�ar,m1 Co,ipledat of job meet bt mate by credo ����� :'w�..- s�r�i reel meat be C by o�ats�l died4 5aikc3ie€5�or saw. BayWs)a$cees and m dersta*ds that this efte tbum,the us a naderstaadlng between tke parrt➢w,and thsi tai:arm do vtsbai asdazt as R Ira-'of.the sprt>va of C:A yet•Du asfaw!ledg-that iiaye=(s)', (1)has reed tM.As oneot,hilt 1;mtinda fh!t of'tttffl Agreectmt,end bak>rsiceis�d'a eomp4ted,"Wed,+vim dated. of tlm isclhndim theu%a attacwd Natdee4 of ileac 5 cBo14n4os>t.t]iooda0t.5Mtvrltteaabo•c+and(Y)was otrt[ly informed of Buyerss right to canto!dds Agreen egm DO NOT SIGN TMS'COMRA"IFTEOM'AhE.4,NY BIANK SFf UEL 6 feisiul.Serf'es On}y1'[1l'otice[n Bayer.(k]1]e sat egs i5i s Aarrsninant if only m4 iha spacesiatvaded ins the osreed teams to tfic estGnc oYcketa aysdtable lafocsoah•aaa[►ltR btws�(Tj?rm era 0otlt8ed to s eat of tl6AWmemeslR as the Hume you 3fdµ it @)Yav may at any time giy ofF tl<e Foil iepaid,6alasnoe tfue;®derthis![g ti est,and in,so doing yott e,tuy be en i1leed to rsceiva a paid.al rehom of the#;---and4asuravice charges.(4)The sehher has no dAt in hmlawfi�ny ewer rat pmiihes vrootamha�heaaaia►i�pesee ins�e�s'goodePus��er�.le��rKisA�a�t,:(S��S?at>gtaaR�o�;��jgetemrst it it has not be tin ilwm6d at"roman affiee or a branch olkcc o£the softer,provided yo-motif-tbt sellar at His aster niafn oiRce or branch olio•sbowa fin doe Agreement by tteete and or ceestitied:.mai36 which shad be posted not!%hair span midnight, oft�stifndt d>arwa7 Ikktbe bay-sWisthcAgrecum cmcluding,t3andaysandemTiandapomwhlcb repbr resit deliveries are not mzde.Sae t11 c aocampanybng notice of cancell":on forts for an mplaim lei of bayou's right•. 8nyc4`s1 romaed tlx n ,-pmvj&d by the Rbode lslnnd.CowtWEM Fi &ttaddn hoard: Renewal toy And ea o bear}nTew Anglund Bssyee s - 8i >�t�ram :ua� r l�;fizlY� P I3atae YOq THE BUYW4*. .X" CLENC EL '[T{LS TRANSACTION AT ANY TIW PRIOR TO,11IIY1NIGHT OF THE THERD IEFUSD SSS DAY AFMR-f HE DATB OF THIS TRANSAMON.SIB THE ATTACMD NO ME OF CANCli.LATION FORM FORANSSPfANATIOIN OFTHWAIGHT. =ro - X--- - - ---- =F - - - - - -- - - - - -- Dace of Tronsact%on �! :Yao may►'eaiae�ef 1 Date of Transaction -Your may txltoei ffils'ast>rsae> y..Mltdtio++`t eny �emaIc� Or obftgmelon,withiet this treamcdoey without any'penalty or ob6gatioxa.-within tfittie btn6»' 1FoAt tlh•dbvrhrdat�'IF7ou eutceF,atrp t ttihrae business,days from Atka,tbovs hirer:if yro»ealfloel talj► P opem trended any plan"'made by yov under the t ptsperlY traded in,sits payments 1,4 by You under tts Cosstrart—Sam Wa any amo lttstrt,tnam ammuted 1. Coonntract�,4zlk anti mty neptiabie Ingtnmiml returned within traGtUtied by ynu wIIP be rerne thin bu3i,--da i k4civeing i by You will be returr-d with-tan�businoss Wowla S race*by the Setter of p%-e uncetlaiaon notice,and say 1 rmfQt by the Seller of your-cancellation notice,and � __moR:gr:orbet.at arms.attt Rf,. e.Zt sawd>jgn.Will 4e_ ,oeo,r. • Ana : q-o_#,titer oCa nn relit b�,__ caf,csled.if-oaf tonne!,you must malty sra,`taFile to tic 5eev t�rtae(esChryau e.076-oy—o.m,-us*nm&z"able do fJte 806r at your rssidenee,en s ibsta dall)r as good:condition Itswhti<t l at your resktenc%In substandaAy as tfftd condition as when rcecered,arty goods deflve"W to YOU under this Cctdra k or'I reeeired,any Soots del6wred to you under this Contract or Sawoe you frkif yew yrish,comply with xhe fnatructlops of h Safe;or you mays it you wW%.eGMP1Y with the imstru of —tars g♦.q Rtn®nt of dto gooft.attlw t th�SeElerre ard�hgtlfs�ratQetsfFhtTTpmerit of the go`bdis of tiie Se®er'b expense rhk tf you de.ma erthe avallable � Serler'a eXpa se and rfsk.If yob do rn $m the av*fth1s di m im Satfir and`the Seller does,tot pica tfm. up within to the SeE6Er mm!the Seller does not pick trWm up within fwi tyr days of--dw date of amceffatioty you mast retch Or 6 tivhxity ofthe date of cencelkWon.you May ruin or d7sposa of goons without airy father obliyp0on.If you I d4wo,of file goods without my rurtber obligation.if you fai€to nisloe the goods sysi(able to the Seller,or If you agree I fail to rna lm the goods available to the Steer,or If you agroo to mtum thei ods to the.Seller and fill to do so,then You I, to return dve goods s die Seller and fail to do so,than you renrrain!;able rvr perfoh� e+of all obliitdoins under the 1 tomairi liable for par%mmuice of ill oboSatfons under the . ContmCiLlb cancel this Wansaction,.t 3 or deliver a signed Contract..To cancel this trensacdoc%rniall or d'elfrar a s' and elated copy of this mnmeiladon notFae or any other I wW dabd copy of dth cartcenmeon mWce or any r written rtotice,ar send a.tele prn to Renswah byAnders n of 1 «ritten netlee,or hued a trl■g*sm to MeltaWai Mel of Soudtere New England at U Albion Road, .R10266 t �ulhern New 6gghknd#2f Albion Road,ti R102865, NCFr LATER T14AN MIDNIGHT Of l (NpCTf LATER THAN MIDNIGHT OF� -' f 000aY CAJMCEI_THISTRAr4SACT1ON. 1 f HERRjBY CM(*j.THiSTRANSAC n0?L auymH tAeisae• FWnt leamsN axle 7i fttyr4 tanatus• - 64At Name nac� RbAa Copfr.vvh da Buren Capfs Yd luw Buren Cow..+'ink Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts-Department of Public Safety i t Board of Building Regulations and Standards I Construction Supervisor If License: CS.09M HRIAN D DP 7 LAlMffi POND'Cal s Charlton MA OM Expiration Conunissioner 091084INK6 �>� �t?�l9P/l�ZQ�l1E'�TL�,���GGCf2flQP� Office of Consumer Affairs d Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration RegWinow: I M45 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL- Expftbon* 9119=16 DENNISON BRIAN 20ALBION RD LINCOLN,RI 02865 .Update Addr en and return otd.Mark reasoo fcr dmogL eta r a wuaem OA&hren o Beoewal oEmooyeaeut O Lout Card a of Comemer AOyin @ Bmioen Resoistios License or registration valid Lor lndiriM use only IMPROVEMENT CONTRACTOR before the espitadoo data if found return to: 1TS46 Typo. �'ce of:.ovmmer Affafn and Boriam Regulation El�iradan 17 24018 10 Park Pbm-Saite S170 raid Boston,MA OZ116 SOUTHERN NEW ENMAND WINDOWS LLC. RENEWAL BYANDERSON DENNISON BRIAN 26 ALBION RD Z - LINCOLN.RI 02665 Not valid wiWtem aignatare .r i The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114 2017 �M www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are you a_n employer? Check the appropriate box: Type of project(required): 1.0 I a a employer with 20+ 4. ❑ I am a general contractor and I employees (fill and/or part-time).* have hired the sub-contractors, 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers' comp. insurance comp. insurance T required.] 5. ❑ We are a corporation and its l 0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑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 �✓to A,-) comp. insurance required.] r P laC *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. b t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such- 4-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:ARGONAUT INS. CO. Policy#or Self-ins. Lic.#:WC 928058352394 Expiration Date:8/21/2016 Job Site Address: " Ct 3 ecc 2e I rn. 1 City/State/Zip: tnj- Gcl'n s-ta 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�fNfGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for Insurance coverage verification. I do hereby certi under the and penalties of perjury that the information provided above is true and correct. c � Siagnature: Date: /_ �o - /6 Phone it: 4012289800 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#- i r SOUTNEW-01 SHETTYSHT AC�RO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)8119/2015 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 CONTNAME: Willis Certificate Center Willis of New Jersey,Inc. PHONE 877 g45_7378 F4X (888)467-2378 c/o 26 Century Blvd AIc No Ext:( ) Arc No P.O.Bo)(305191 ADDRESS.certificates@willis.com Nashville,TN 37230,5191 INSURERS)AFFORDING COVERAGE NAIL! INSURER A:Selective Insurance Company of Southeast 39926 INSURED INSURER B:OneBeacorl Insurance Company 21970 i Southern New England Windows LLC INSURER C:Argonaut Insurance Company 19801 DB/A Renewal by Andersen 26 Albion Road INSURER D: Lincoln,RI02865 INSURERE: y INSURERF: COVERAGES CERTIFICATE NUMBER:" REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM.'6R 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 ANQ.CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTR ADDLSUBR TYPE OF INSURANCE NSD WVD POLICY NUMBER M�M/LDIDY/YYYY EFF MNWDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY _. EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE MOCCUR S 2029459 08/10I2015 08/10/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 M*OTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY D JEa LOC PRODUCTS-COMP/OPAGG $ 3,0$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANY AUTO 2029459 08/10/2015 08/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS peraccldeM X UMBRELLA LU\B X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S2029459 08/10/2015 08/10/2016 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY YIN ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 0000068028 08/21/2015 08/21/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Workers Compensation WC928058352394 08/21/2015 08/21/2016 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance ' 4 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel oI �{ F..i. t 4��7t^�f4h��� Permit# «� 5 Health Division )'�� rl ti i�J Date Issued Conservation Division d R -` "` '- I 1 A 11: 24 Application Fee co Tax Collector 0 o� (� K, L ® lD 3 Permit Fee 'K, 7 .Treasurer �(�()a —" o —A)I- —g/�<.�."���r-_"' `�� SEPTIC SYSTEM MUST BE Planning Dept. WSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board W TN TITLE S EAIARONMENTAL CODE ANL Historic-OKH Preservation/Hyannis TOWN REGUUTIANS Project Street Address Village OC Owner t occ, Address ( K ' 9 Telephone / l Per it Request Qom' Cl1 OU Square feet: 1st floor: existing proposed 2nd floor: existing �� proposed Total new Zoning District Flood Plain Groundwater Overlay ..Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Z,S� Historic House: ❑Yes O No On Old King's Highway: dYes ❑No ° Basement Type: 5b Full ❑Crawl 0 /� Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new " 3- Half: existing new -�- Number of Bedrooms: existing new `Q- Total Room Count(not including baths): existing new l First Floor Room Count 5� Heat Type and Fuel: ❑Gas A Oil ❑ Electric ❑Other Central Air: Cl Yes $No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage^4existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION NameS6Tes Telephone Number Address \�� (70"_ Nf 9v_,,�'fl License# 0 A4 W o>Z r�`��� Home Improvement Contractor# � ass Worker's Compensation# r�(,o1)6 V9 6��f ALL CONS S RE UL ING FROM THIS PROJECT WILL BE TAKEN TO I- J SIGNATUR DATE _S h FOR OFFICIAL USE ONLY PERMIT NO. j, DATE ISSUED MAP/PARCEL NO. } ADDRESS, VILLAGE " OWNER DATE OF INSPECTION: FOUNDATION aW,0 i!t s�� �$%/i• 44VoY g_fw, G /s^go�✓s sff /o/�y�o3 FRAME 09, A✓•�i , s INSULATION f FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH . FINAL FINAL BUILDING { /((�lam/9�1 g/�4 DATE CLOSED OUT �, ASSOCIATION PLAN NO. Application to ® ilitt�' tg�jbnap EgiAtti�Y i�tDriC i�trf Ct �Diii t p TABLE In the Town of Barnstable. 2003 JUL.3 I PN 159 CERTIFICATE OF APPROPRIATENESS--�IvlsloN Application is hereby made,with four complete sets, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings, or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: o 1. Exterior building construction: ❑ New MAddition ❑ Alteration T' r`"*� Indicate type of building: House Garage Commercial Other ❑ El 2. Exterior Painting: ❑ C/) 3. Signs or Billboards: ❑ New Sign El Existing Sign ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other r.. w TYPE OR PRINT LEGIBLY: DATE tD N ADDRESS OF PRO OSED WORK ASSESSOR'S MAP NO. OWNER �-- !r SESSOR'S LOT NO. HOME ADDRESS -I C, ne HONE NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across.Ry public street or way. (Attach ad ' ' al sheet if necessary.) -tr I kr� �" e� ki r t-4 -=; �n AGENT OR CONTRACTOR / 0,r(2) e-� TELEPHONE NO.. 0/ ADDRESS_LLfa . DESCRIPTION OF PROPOSED WORK: Give articulars of work to , including materials to be used. Please in de locations of proposed signs. -LX Z.2 � I Signed Ow r-C actor-Agent For Committee Use Only This Certificate is her2Signatures: Date ?'7' pr ed/D i d Committee Members' ,pp IME Tpy� The Town of Barnstable '• BARNSSTABLE.o Department of Health Safety and Environmental Services t6}9• `00 'PEED MP Building Division 200 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection 614 ,p A rl B Al Location !3 C- 4ges IR-A-,L 422) Permit Number 71 / 1 (- Owner /'� �L� /�1//2RA�' Builder /?,Gl//�.�,y ✓ /��i� One notice to remain on job site, one notice on file in Building Department. The following items need correcting: t° S'v i L//els lox Ale IV D I/PVDA-->-.o PE F"41Zs'o,�p 1/,geos ifaA1,1/RL'r> afvS 'fP E Y/5,7-,',�V4 ri Teal L,9 iy e u/i°T i-, 'Al /V oT Al rR/9,Q ( 36a 3, 2t� . e . ,e e ne&7-zo e✓ of -,Flom i-a z ',o/r/ 11AIA 'IL R IF C*V817/7. e4 D/sc v4 ,o6t/ W 'Tf/ A►c,Vw > Wi'tt C-&XA< r-- //'c )_C far,/�le e ,e 9,V Please call: 508-862-44038 for re-inspection. Inspected by Rlte '�/ Date �D�22 > goD3 a • s .The Town of Barnstable T Department of Health Safety axed Environmental.Services M'y Building'Division 367 Main Street,Hyannis,MA 02601 )8-8624038 )8.790.6230 PLAN RE'VMW >wner: M, Yq urr;2 Map/Parcel: 0'" 01 q YojectAddress: q��S �'� � Builder' Che following items were noted on reviewing: 7�- haVC -rz%-4�'YL5-�'�b�-� ��s �5�ib�laor �,eQleJ ro�f 4w, vapor 9 �0�3 TUPPER CONSTRUCTION 17 Coachmans Ln. Phone:508-778-01 1 1 W.Yarmouth,MA Fax 508-778-011 1 web site:www.TupperCo.com attn: Building Dept. To Whom it may concern, I authorize Rick Tupper to pull tNiV)N'� essary to complete the project described on the permit a . Thank you . 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Faitm a to secure coverage as required ection 25A o[MGL 152 can lead to the imposition of ulminal MOLICY penalties of a fine up to S1,500.00 andtor one yam, secure coveOnln � dvfi penalties a form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understmmd that a copy o may fo to the OMc of Investigations of the DIA for coverage verification. hereby c t e p penald of perjury that the information provided above is trice d eorre Date Z Signature i J. phone#(— Print name � official use only do not write in this area to be completed by city or town official city or town: permittlicense# ❑Banding Department ❑Licensing Board response is required ❑Selectmen's Office ❑checkltfmmedlaterap 4 ❑Health Department Other contact person: phone k; _ OrAsed 9/93 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an.individual,Partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,'address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Depa rtment of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and �z date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be number. The affidavits may be retained to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts' Department of Industrial Accidents amce of Invesugations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 • I' ��ie Vi arn�naruuep,� BOARD OF BUILDING REGUL-ATIONS License: FCC NSTRUCTION SUPERVISOR Numbek G _ 069058 N1-1' RICHARD S TUP 47 COgCHMANS WEST YA"RMOUTH, �M1�-02s73 L'E""o-`, •. 7 Administratortj �! Baara6 ai B�34aing atnds t a io98d5 crE• t .04 RE1 �e ry dual '' ' RICWARD TUPPR ' ;ate RICWARd'"TUFPE- 17'CdI�0FtMANS,LA UV:YARM06T1i 5 MA 02613. A eistt {� I l ' s I RESIDENTIAL BUILDING PERMIT FEES • APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE Q S n square feet x$96/sq.foot= w' / —x•0031= U' ' pluis from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.f� >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: x.0031= square feet x$961sq.foot= STAND ALONE PERMITS Open Porch x$30.00= ' (number) Deck x$30.00= Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) permit Fee projcost �OEVE Town of Barnstable - P Regulatory Services BAMSTABM Thomas F.Geiler,Director fo;A. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ' Type of Work: Estimated Cost Address of Work: --1 3 Owner's Name: c (` Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PR0§MAb4 OR GUARANTY FUND UNDER MGL c.142A. tage=fth R P TIES OF PERJURY I hereby a ply for a permit as owne Date Contra t Name Registration No. OR Date Owner's Name Q:forms:homeaffidav Permit Number REScheck Compliance Certificate Checked By/Date 1995 MEC REScheckSoftware Version 3.5 Release la Data filename: C:\Program Files\Check\REScheck\murray.rck TITLE:Addition CITY: Hyannis STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: Single Family DATE: 08/25/03 DATE OF PLANS: 7/30/03 PROJECT INFORMATION: Murray Addition 93 capes trail rd COMPLIANCE: Passes Maximum UA=85 Your Home UA=81 4.7%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Cathedral Ceiling(no attic) 288 30.0 0.0 10 Wall 1: Wood Frame, 16"o.c. 522 13.0 0.0 38 Window 1:Vinyl Frame:Double Pane with Low-E 46 0.340 16 Door 1:Glass 16 0.340 5 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 264 19.0 0.0 12 COMPLIANCE Sqsub nd building design described here is consistent with the building plans,specifications, and other calculatit application. The proposed building has been designed to meet the 1995 MEC requiremen m Re la (formerly MECchec4 and to comply with the mandatory requirements listed in the RESch cklns Builder/Desig Date /,0/6-3/4 J� IL ,r pre e J e eOld i S� addition to be wrapped wl/2" p,t, plywood Q-10 20'-0" sauna tubes to be 12"x4' deep All outside band ,Joists to be doubled __ ----------------------- ------- -----=0--'--__ °=O =-"--- -- ---- -- -- '-- -" -- bottom of floor ,Joists to be m 3-2x10" Built-up girder to be p.t. 18" above grade as per CMR 3603.22.4.1 ?' (see table 3605.2,3.3b and CMR 360�' 2,4, 6 Floor system- WO ,Joists mll poly vapor barrie r-IS insulation w/3/4" tdg N as-per figure 3604,3,Ic rd 2" sauna tube 4' de p underlayment over p O O At ` O O N See table 3606,2,E band to be lagged to house using 4 1/2" lag bolts 93 capes tra i I rd REVISED PLANS Date: 43 ,�,� SCALE APPROVED DRAWN BY DATE 10/23/03 REVISED Revision of plans approved 9/30/03 DRAWING NUMBER L+ i FR - Roofing to match exieting Windows to be ® Andersen Narrowline 24310 W/Grills - — - Proposed addition Proposed Addition to Murray Residence 93 Capes Trail Rd. SCALE 1/411 = i' APPROVED DRAWN BY IG DATE July 30, 2003 REVISED DRAWING NUMBER Proposed Addition full length ridge vent FH FIEfl] 11L-LLUHE]1 'HIM 12'-0" — - — white cedar siding to match existing Proposed Addition for Murray Residence 93 Gapes Trail Rd. SCALE 1/411 _i- APPROVED DRAWN BY DATE July 30, 2003 REVISED Left Elevation DRAWING NUMBER f DSO fl •48. LOT 32 44,707f SQ, FT. CC' 1.03f ACRES, QP . ti 6� O� t NOTE: EXISTING DECKS (NOT EXIST. SHOWN) IN AREA .OF ADDITION DWELL. TO BE REMOVED. o 4v cis 2ND STORY °o• OVER HANG a \pp. ADDITION ON o PILINGS OAPPROX. LEACH PIT AREA LP It96. EXISTING SEPTIC TANK �fd �'9•A �5�8 , . 6J JOB# 03-222 CERTIFIED B UILDING PLAN FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT PREPARED FOR: LOCATION : 93 CAPES TRAIL (WEST) BARNSTABLE, MASS. MICHAEL MURRAY SCALE : 1" = 30' DATE MAY 23, 2003 REFERENCE : PB 462 PC 34 ASSESS. MAP 88 PCL 14 I HEREBY CERTIFY THAT THE STRUCTURE SHOWN. ON'THIS PLAN,IS LOCATED ON THE GROUND AS SHOWN HEREON. off. 508-362-4541 1H Of M I fax 508-362-9880 ��` ARNEAs��yG� down cape engineering, Inc. Z H. CIVIL ENGINEERS 9 o 634 Q LAND SURVEYORS DATIf R °NaLE+dN OR 939 main st. yarmouth, ma. 02675 w . 2'-O" sauna tubes to be 10"x4' deep W �°b�'�`SS band joist to be 2 2xi0 floor system- 2x10 Jolsts d r-19 insulation w/3/4" t4g p RIDGE VENT underlayment over 'i li jd`�11 roof const.-2x10 rafters w/proper vents and R-30 insulation 1/2 o.e.b - shingles to match existing O Q collar ties to a yp on cat a ra O O typical wall covet. cxi 2x4 w/R-13 insulation 1/2"o.s.b. w/typar over w/cedar shingles to match existing band to be lagged to house using 4 1/2" lag bolts 2x10 FLOOR JOISTS ® 16" o.c. 2'-9%" x 4'04%" x 4'-W'x 2'2!;S3b" x 4'-IWIB%" x 4'-04" floor coast.2x10 *16 o.c. R-19 Insulation 3/4 t4g o.s.b. as T x x 4 � � N x N Proposed Addition to Murray Residence 93 Gapes Trail Rd. SCALE 1/4" = i� APPROVED DRAWN BY- Rick 60-0" x 6'-8" 2'-4" x 9p'-811 + � DATE July 30,2003 REVISED Floor Plan DRAWING NUMBER — - — Slider to be Andersen 5'10"x 6,'8" Proposed Addition to Murray Residence W Gapes Trail Rd. 5GALE I/4" = 1' APPROVED DRAWN SYK I G DATE July 30, 2003 REVISED DRAWING NUMBER TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# Health Division ` ��' ��" �E _ Date Issued I Conservation Division / 1A / Feef A Tax Collector /GIIr" CYSTE � i. �� -• Treasurer - )-q INSTALLED IN COMPLIANCU � WITH TITLE 5 Planning Dept. ENVIRONMENTAL CODE AND 7 TOWN REGULATIONS Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis t -Project Street Address Village CA Owner Address Telephone 3 e 8 'Permit Request ffo)� r Square feet: 1st floor: existi 691 proposed lAnd floor: existing proposed Waaotal new Estimated Project Cost 9� Zoning District Flood Plain Groundwater Overlay Construction Type )2Ar1;kf^Q 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 15dNo On Old King's Highway: e9Yes ❑No Basement Type: 0 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 14mg 47 Number of Baths: Full: existing new H(al�f: exisfing new Number of Bedrooms: existing new f 3 Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 Gas )M Oil ❑Electric 0 Other Central Air: ❑Yes Q4 No Fireplaces: Existing I New -0' Existing wood/coal stove: O Yes P No Detached garage:O existing 0 new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:g1I existing 0 new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial 0 Yes ❑No If yes, site plan review# Current Use Proposed Use i - BUILDER INFORMATION (� �/) Name ' Telephone Number 1 /� Address License# � Home Improvement Contractor# Worker's Compensation# I ALL CONSTRUCTION DEB TING FROM THIS PROJECT WILL BE TAKEN TO U SIGNATURE DATE M1 FOR OFFICIAL USE ONLY a PERMIT NO. , ~DATE ISSUED ' MAP/PARCEL NO. , I I r ADDRESS VILLAGE y I F OWNER DATE OF INSP',ECTIO FOUNDATION r FRAME INSULATION V + V `�✓ ,.�! �W' , FIREPLACE - .-!� .. ��•r ELECTRICAL: ROUGH; FINAL i PLUMBING: ROUGH' FINAL r GAS: ROUGH ,"� FINAL FINAL BUILDING ' DATE CLOSED OUT ( F ASSOCIATION PLAN NO. 1 , s o fl LOT 32 02500• 44,707f SO. FT. 1.03f ACRES ti O 6 Ov ti NOTE: EXISTING DECKS (NOT EXIST. SHOWN) IN AREA OF ADDITION DWELL. TO BE REMOVED. o 2ND STORY �= °o• OVER HANG o \oo• ADDITION ON o PILINGS APPROX. LEACH PIT AREA O EXISTING SEPTIC TANK CO F �tfh 6po 6J JOB# 03-222 CER TIFIED B UILDING PLAN FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT PREPARED FOR: LOCATION : 93 CAPES TRAIL (WEST) BARNSTABLE, MASS. MICHAEL MURRA Y SCALE : 1" = 30' DATE MAY 23, 2003 REFERENCE : PB 462 PG 34 ASSESS. MAP 88 PCL 14 I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. - off. 508-362-4541 `1H OF M �r - I fax 508-362-9880 �y�� ARNE down cape engineering, inc. H. G� C CIVIL ENGINEERS 9 o Q I+ LAND SURVEYORS DATIf R UN OR 939 main st.' yarmouth, ma 02675 it Zk8 Ic, .+FH I4 4 -�- o 2nd FLOOR JOIST PLAN 14"TA JOISTS 16"OC 1/8" : 1 ' 1/1 t I 2nd FLOOR PLAN 23'-0" I BEDROOM#3 4 N BEDROOM#2 24"X 24"WINDOWS 20'-0" MAScheck COMPLIANCE REPORT Massachusetts Energy Code --Permit ## MAScheck Software Version 2 . 0 Z-1j_ Q /� Checked -by/Date J CITY: Hyannis STATE: Massachusetts HDD: 5 9.73 CONSTRUCTION TYPE : 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) f' DATE: 1-21-1999 DATE OF ..PLANS-: _1./4./.99 TITLE: MURRAY ADDITION COMPANY INFORMATION; TUPPER CONSTRUCTION 17 COACPMANS LN YARMOUTH, MA COMPLIANCE: PASSES Required UA = 77 Your Home = _6.9 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 484 30 . 0 0 . 0 17 WALLS : Wood Frame, 16" O.C. 484 13 . 0 0 . 0 40 GLAZING;: .Windows ..or .D.o.ors _2.4 _0._A9D .12 -------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The .proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with_,..the. permit....application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code . The heating load for this building., and the. cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code . The HVAC equipment selected at or cool the building shall be no greater than 125% of the es s specified in sections 780CMR 1310 nd J4 .4 : Builder/Designer Date </ Q � � � 7 / I MASche4__INSPECTI.0N,..S'HF.CKT,TST Massachusetts Energy Code MAScheck Software Version 2 . 0 MURRAY ADDITION DATE: 1,-..21719 9 9 Bldg. Dept . Use CEILINGS : [ ] 1 . R-30 Comments/Location WALLS : { ] 1 . -Wood -Frame, 16" O.C. , R-13 -Comments/Location WINDOWS "AND -GLASS -DOORS : { ] ' 1 . U-value : 0 .49 For windows without labeled U-values, describe features : # Panes Frame Type ' -Thermal Break? J ] Yes ._[ 7 No Comments/Location AIR LEAKAGE: [ ) Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside -an appropriate. ,-air-tight assembly with a 0 .5" clearance. _.from. combustible -materials and .3" ..clearance _.f.rom._insul.a.t.ion. VAPOR RETARDER.: [ ] Required on .the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ ] Materials -and equipment- must- be ideas-tified= so that compliance can be determined. Manufacturer -manuals for all inst•alled�heating and cool-ing -equipment -and service water heating equipment must be provided. Insulation R-values and-glazing U--values -must be cl-early marked -on--the building plans- -or,-speci-f-ications . DUCT INSULATION: [ ] 'Ducts in unconditioned spaces must-be insulated to R-5 . 'Ducts outside the building must be insulated to R-8 . 0 . DUCT CONSTRUCTION: [ ) All ducts must be sealed with mastic and fibrous backing tape . Pressure-sensitive tape may be used for fibrous ducts . The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS : [ ] Thermostats - are required for _each. .separate HVAC system. A manual or automatic means to partially restrict or .shut .off the heating and/or .cooling input_,to-each ..2.one.--or-..f.l.00r_-shall be.-provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 1250 of, the design load as specified r .f in sections 78.00MR _131.0 .and J4 .4... MISC REQUIREMENTS : [ ] Refer to 780 CMR, Appendix._J for requirements relating to ..swimming pools, HUAC -piping conveying . f-lu-ids -above 120 F or chill-ed fluids below 55 F, -and circulating hot -water. -systems . ----NOTES TO FIELD (Building Department Use Only) --------------------- --- Application to ' ,.1999 006 Old Kings Highway Regio al Historic,District Committee rJ:: 1�1 ithe Town f Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateneseder Section 6 of Chapter 470. Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photograph accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building' Addition Alteration Indicate type of building: 10 House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE 0 ADDRESS OF PRO OSED WORK ASSESSORS MAP NO. OWNER r (71 U ASSESSORS LOT'' NO. HOME ADDRESSA TEL NO. �.n�^ �a(�� FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name f d'acent property owners across any public street or a y. Atyccll� addiSinnayhee if necess�ry)� ��g� �(,� 1 v�22T �TW► C7 j �- n L v P)vs AGENT OR CONTRACTOR TEL NO. ADDRESS QA13- .0 t, DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No.8,other side),including materials to be used, if specifications do not accompany plans. In the case of signs, cation f existi signs and p oposed locations of gsigns. (Attachadditional sheet, i neces5 sary). � I�g�M� ��1 �A .2 0 0 C" • � . . 'o�J< � lei( +`;t Signed Space below line for Committee use. _77O r- n actor-Agent Received by H.D.C. COST/NG,(�/t ,A.! ,rAr a /,?Z:m NJ-V-47/L�4/ g , t Date The rtificate is hereby VIC-_10 Date .5>/40 Time ice- Q/l ,0 �64� 1-'' t t By y y n Approved z ❑' IMPORTANT If Certificate Is approved,approval is subject to the 10 day appeal period provided In the Act. Disapproved 0 The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street - Boston,Mass. 02111 i Workers' Com ensation Insurance Affidavit 5 name: ocation:A city w < Q-P L hone# I am a homeowner performing all work myself. 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EU ..}Yiiiibi?i??:??:•??:�i:•i.::v::ii???::: :.:v:::::::::}}}?4}{:.4.`.L•.?+;?:;�:,}.;:Jr.}}�i:-??:: Fafi�e to secure coverage order Seed=25A of MGL 152 can lead to the tmpoddion.of atmind penalties of a fine ap to$1,500.00 arai/or ono years'bnprisonuou as wen as eivfi es is the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I undentmd est a copy of be the of Investigations of the DIA for coverage valf athm I do Reby under e P P efPM*q drat the information provided above is true cn cct Signs Date Print name Phone# ---------------------------- Oucensin Board COErhvek do not write in this area to be completed by cdny or town ofilchd peaise# :CO3Heafth g Dew diate response is regodred dectmena OIDee Depnrhomt phone#; aw 4rand 9/95 PlA) Information and Instructions f Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any coatrac: 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 c: trustee of an individual;partnership, association or other legal entity, employe g 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 hounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewai of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the . commonwealth nor any of its political subdivisions shall eater 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 contacting authority. ,Applicants ' Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is :being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permi liccose number which will be used as a reference number. The affidavits may be retuned io the Department by mail or FAX unless other ariangem have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate-to give us a call. i The Department's address,telephone and fax member. The Commonwealth Of Massachusetts Department of Industrial Accidents Olden of Imtesugadons 600 Washington Street Boston'Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 i e Town of 13arnstable SARMAWX �MAM Department of Health Safety and Environmental Services Fc► ' Building Division t 367 Main Street,Hyannis MA 02601 - Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition, or construction of an•addition to any pre-existing owner-occupied building containing at least.one but not more than four dwelling units or to structures which are adjacent to h'sucresidence or building be done by registered contractors,with certain exceptions,along with other requirements. { Type of Work: Estimated Cost C0 Address of Work:--Tt 0it Owner's Name: r Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied t3Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBTTRATIOIV-PR- M OR GUARANTY FUND UNDER MGL c. 142A. S ER LTIES OF PERJURY I he by pply for a pe t as the nt the o er. D to on If ame Registration No. OR Date Owner's Name q:fomu:Affidav Jan-22-99 03:04P MID CAPE HOME CENTERS 508 398 4559 P.Ol THE NK:KERSON COb�R4NtE5 - Material List Report r="• M_c.H.c.-� �L:I-�1+�15 Mid Cape'Home Center NAME- TZPS QQ&-.AZT' MANIFOLD= PO Box 1418 ADDRESS Route 134 SALESMAN �'� ► `� So. Dennis MA 02660 ..TEL., 508.398.6071 508.398.4559 JDB LOCATION Level Name:2ND FLOOR Report Date: 1/22/99-1-29iMTM Joist Products Plot Product Net Unit Net ID Length Label _-.. ..Q-ty. _-Ply ...Qty... Price 11 24' 14"TJI/Pro-35.0 joist _.1.4 _3 AA ._-S23.7J2 $7-96.32 J2 24' 14"TJUPro-350 joist 1 2 2 $2.37/11 $113.76 J3 iT 14"TJI/Pro-350 joist . .2 1 . 2 .....4237/t3 _.S5648 14 4' 14"TJI/Pro-350 joist 1 1 1 $2.37/ft $9.48 Sub-total $976.44 Sub-total $0.00 Accessories Plot Product Net Unit Net ID Length Label Qty. Qty. Price Price Bbl 1' 1"net Backer Blocks 3 3 $0.0(llpc $0.00 Wbl 10 3/4" 1"x 2 5/116"Web Stiffeners 2 4 $0.(I(i(pc $0.00 Rml 16' 1 I/4"x 14" 1.3E TimberStrand LSL . .5 S $2.4a ft $14;40 Fbl 2' 2x8+ 1:/2"plywood Filler Blocks 1 1 S0.4.11c $0.00 Shl 4'x 8' 314" Plywood 7 $0-00 Sub-total $194.40 HANGER-LIST --,Sim son..Stron -Tie.Han -ers Plot Product Hanger Net Net ID Label Support Member Ply Notes ....Qty. Price HI WP3514 I-Joist.; 14"TJI/Pro-350 joist _S32 72 Fasteners Top: 2-N10 Face: Member: 2-N 10 T1-Xpen 5.3 (9613)A Page l MURRAY.IOB l)&-ign Date: 1/22/99 1:22:58 PM Jan-22-99 03:04P MID CAPE HOME CENTERS 508 398 4559 P.03 Its � h- _� a i 3 oil .91 0 a i G F w a c QQQQ FI I Jan-22-99 03:04P, MID CAPE HOME CENTERS 508 398 4559 P.02 Level Name: 2ND FLOOR Report Date: 1/22/99 1:29:09 PM H2 MIT3514 I-Joists 14"TJI/Pro-350 joist 1_ ....(5)(6)- __..1. S-540- Fasteners Top: 4-N 10 Face: _..2.-.N.1.0 Member: 2-N 10 Sub-total $38.52 Hanger Notes: i (1)Indicates non-stocked hanger (2)Web-Stiffeners Required (5)Backer Blocks Required (6)Filler Blocks Required Sub-total. SALES TAX( 5%): $60A7 i a Sub-Total: $60.47 REPORT TOTAL: $l 269.83 TJ-Xpen 5; ( ol*k ..Page 2 $ 'MURRAY1011'Diisign"Dale: IR2/99 1:22:is PM RESIDENTIAL ADDITIONS OR ALTERATIONS If located: North of Route 6 - any work visible from outside- needs approval from OKH ❑ In Hyannis -If work visible from outside- Check to see if it's included in the Hyannis Historic Waterfront District- if so it needs approval from them APPLICATION PACKAGE MUST INCLUDE: dMap/parcel number Sign-offs fronii Health Conservation(if exterior work) Tax Collector 1 Treasurer treet address 9� Owner's name & address [Permit request- full description of proposed project Square footage -proposed project Estimated project cost Complete Dwelling information for Assessor's Office Builder's information Si tore of plan 2 sets of reduced (8.5"x 11: or 8.5"x 14")plans with cross section& framing schedule Home Improvement Contractor's Affidavit Worker's Comp form must include: Insurance company's name & Worker's Comp policy n ber Energy Compliance Form Copy of Construction Supervisor's License & Home Improvement Specialist's License OR Homeowner's License Exemption Form. Fee NOTES: CHIMNEYS Need Home Improvement License No plot plan required PIERS & DOCKS E]Need Construction Super license AND Home Improvement License Owner cannot pull own permit q-forms-PERMITS I Rev 12/14/98 ,!I �� TOp7I7/rItOOZU/P,Q.GCIL v��� •, ' I O.ERARIMENT OF PUBLIC SAFETY - 4, CONSTRUCTION SUPERVISOR LICENSE a f Nu�ber ,r Expires: '- �- -- - --- Restricted 'T'o 00 �i.RICHARO S TUPPER G�i ►'��1 ,.,.;..r-:PO•BON 117, ,r GENTERVILLE, MA 62632, HOME MPROVEMENT CONTRACTOR , J r ° Yjrp��INDIVIDUAL. of� �JS �,_ �. z nation 06/19/00 g ICHARD 1UPPER t� 3 PHINNEY'S LANE/ OMB. 1, " s T° CENTMILLE MA 02632 ` t2� � ZkB� ICo`©L LA w � L LLLL Ulu _0 09S • 414 ; air..m ! ---- C► i�- 1/8„ : 1 , 1�1 2nd FLOOR JOIST PLAN 14"TJI JOISTS 16"OC l .. 2nd FLOOR PLAN 23'-0" I BEDROOM#3 4 N BEDROOM#2 24"X 24"WINDOWS 20'-0" Assessor's office(1 st.Floor): S [� `� $� assessor's ma and l d"d"number Re (I�y ,�/��,' 1 � o�THE>o oar o e r floor): w Sewage Permit number �j.—����` �p � 9+�`L� �F. r? t fit`!.!i p1�;- AND = zisaa9rsncc Engineering Department(3rd floor). MAO& House number �3 pi�., ; F ,� p _ o Definitive Plan'Approved by Planning Board —' / ©�. 19 onserva � C p oho d• APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only st e Ion CommjSSZo TOWN -. OF BARN- B �, n BUILDING INSPECTOR °a=a APPLICATION FOR PERMIT TO �V �� i TYPE OF CONSTRUCTION �FG" `!� " UDC �(IA6,cE VillL ' c 72 9KJ 9 SP1 0 7 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use S71)V4 Ce Zoning District Fire District /�_` � Name of Owner,JJl1N>o'tL1� f�/� i uL(.�f121� Address �'Pr 12 f=-(J 90_Nbk1&+ n �'lJ Name of Builder 1K yPDr2�-t� n —_JVVL Address q10 R 6/4• til SOX �1�r !i - � fl�lll6t� Name of Architect It/O/�dlS Address Number of Rooms Foundation C� �01�2im loweA,molt/ Exterior �� nj)4 �"' AYZJM Roofing .&MK r Floors Interiors -[y�17� N Heating �fL ` '07- WY7 ��L. Plumbing �iR/b 2 0�v2V4fZ_ Fireplace ply al-tweT Approximate Cost ®� �r Area /. Diagram of Lot and Building with Dimensions Fee , 1 U ` l S�� Ll$ G9 V7 'S Cp Se OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 1 Name C Construction Supervisor's License w McCORRISON, DONALD & VELIA No -3 4 714 Permit For One Story ,Single Family Dwelling Location Lot #32 , 93 Capes Trail West Barnstable Owner .-Donald & Velia McCorrison Type of Construction Frame ; Plot Lot { Permit Granted November 27 , 19 91 Date of Inspection - 19 Date Completed 121 a 7— 19 r� �3a r C9 h 0 TOWN OF BARNSTABLE Permit No. 347;.4 BUILDING DEPARTMENT a TOWN OFFICE BUILDING Cash �. 600.00�„ 7 ,619 �E79• HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Donald & Velia McCorrison Address Lot #32, 93 Capes Trail West Barnstable, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 2 /'February 7, 19.......92..... " Buildin Inspector i i TOWN OF BARNSTABLE Permit No. 347I . BUILDING DEPARTMENT i '��• I TOWN OFFICE BUILDING Cash U 6 0 0,,0 0 ., ' .qo. HYANNIS.MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Donald & Vel.ia McCo.rr-ison Address Lot #32, 93 Capes Trail West Barnstable, Mass. USE GROUP FIRE GRADING OCCUPANCY:LOAD';` s?s,�;::• :' :;: THIS:PERMIT WILL.NOT.BE VALID;i.AND THE. BUILDING .SHALL NOT QE.00CIIPIEQ L1.NTILN* tJ SIGNED BY;THE:.:`BUILQIN.G INSPECTOR.'`UPON SATISFACTORY",COMPLIANCE WITH`- OYVN REQUIREMENTS AND IN ACCORDANCE WITH SECTION:119.0`OF THE MASSACHUSETT $TATE 'BUILDING CODE: •. February Z" 92 ..... .... Buildin inspector . . , TOWN OF BARNSTABLE 13UILDINQ CIOMMISSIONERS OFFICE DATE ,y 9 PAYABLE TO: ACCT.#'04 4 657/.2/ep Joel Bayport Homes, . Inc. VENDOR# �� 478 Route 6A AMT Box 80 � �PO# East Sandwich, MA 02537 APPROVED BY k TOWN OF BARNSTABLE, MASSACHUSETTS BUILD A-0$8-014 November 27 91 � 7�4 DATE 1Q PERMITO, �s !_ ' APPLICANT Bayport Homes. Inc. ADDRESS jj�t�e•w`i a'OX ZSU� •bAn(Z®� IIS6�J (NO.) (STREET) (CONTR'S LICENSE: PERMIT TO build dwelling ( 1 ) Single family dwelling NUMBER OF l (TYPE OF IMPROVEMENT) NO STORY. DWELLING UNITS . (PROPOSED USE) AT (LOCATION) lot 32 93 Capes Trail, est arnsta a ZONING (NO.) (STREET) DISTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT LOT BLOCK S`ZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTI TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION Sewage 091-420 (TYPE) REMARKS: I, (Bayport H.Omes) $ 600.00 AREA OR IlV4 SQ. f t• + FEEMIT OWNER s, 55.50 VOLUME ESTIMATED COST $" (CUBIC/SQUARE FEET) Donald & Celia YIcCOrrisonii9 Tapper i Hand, BUILDING DEPT. ADDRESS BY l ..• VI `I c/ THIS PERMIT CONVEYS NO RIGHT 10 OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY I PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE A PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAIN[ __FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIO ,I OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL WHERE APPLICABLE SEPARATE-APPROVED PLANS MUST BE RETAINED ON JOB AND THIS INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR A'LL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN 1: FOUNDATIONS OR FOOTINGS. ELECTRICAL, PLUMBING AND MADE. WHERE A 'CERTIFICAT;E OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST .THIS CARD SO IT IS VISIBLE FROM STREET BUIL ING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 a l� 3 HEATING INSPECTION APPROVALS ENqIN EERIN_CLD_EPARW ENT 1 t 2 OF HEpgT OTHER • SITE PLAN REVIEW APPROVAL t r< f WORK SHALL NOT PROCEED UNTIL THE INSPEC- „ PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIODUS STAGES OF WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITT NOTIFICATION. r• CAPES TRAIL R=6025.00' L=150.46 --� I � 1 46.o m LOT 31 00 LOT 33 c �p LOT 32 co 44. 709 +/- SF (1.03 +/- AC) i 1 157.89' MID CAPE HIGHWAY ( RTE ' 6 ) # 91-242 CERTIFIED PLOT PLAN LOCATION : CAPES TRAIL W- BARN. PREPARED FOR: SCALE 1 " = 60 ' DATE 11118191 REFERENCE : L— 32 PB 462 PG 34 BAYPORT HOMES I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE OF Mqs GROUND AS SHOWN HEREON. sq JOHN P�3.:3602 down cape engineering inc. c 4L. CIVIL ENGINEERS — LAND SURVEYORS 9 RTE 6A - YARMOUTH, MASS. DATE PEG. LAN J VEYOR� Application to / �SyNP S+PPMN'`5 EP `GN // !AV BP �eP,NSt�pOP�pN�, . Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: eNew Building ❑ Addition ❑ Alteration Indicate type of building: House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE -� 6 ADDRESS OF PROPOSED WORK 5'2-- CrJ �vf`- ASSESSORS MAP N0. OWNER ,.)off -f- Ile)cC� C ( C� b-✓I So Y1 — ASSESSORS LOT NO. ' HOME ADDRESS 00 I*h I I (I uod i "CCU J�C'Aj YII I (iS' TEL. NO. . L-� FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). CL?,L'/ 0 I('�(' vC Gv (�- <v✓J[a7lF, Q—VvtevS c �-eGtav J - AGENT OR CONTRACTOR 1c'-, TEL. NO. y yS ADDRESS Pao C J 'f S2- [-Cty✓l I hStI-Y2 DETAILED DESCRIPTION.OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). (p;+)S wac,+' Ne-,,tJ D z kriSigned Owner-Contractor-Agent Space below line for Committee use. C"Ir Received by H.D.C. � � �� The® Date l'��✓i g/ V- �^ Certifica is Date ' he Time P..� (I. ` iAy By Approved ]- IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act, Disapproved ❑ Form "A-1" '1 OLD KING'S HIGHWAY HISTORIC DISTRICT S p a c S h e e t Foundation Type �LN�Ly_4lc_ U✓'4e- / I I � Siding Type f C2CILLV' C 16(J2 L2C,r� c; W ( CCdur S"In�nc `f: Chimney Type Color 1Zle.� Roof Material /� '1ulX� giv-d J � Color Oka 1✓2 Pitch L" Windows W P) (�� "e. 1a Size L Trim Color Doors y d F�c;nT t (tzu✓l Color Shutters 00 R t Gutters U1j Ile M . Deck d� �v� ✓act f D �(l Z y MTh v� 14l✓� Garage Doors Color Notes: Fill out completely, including measurements and materials/co-lors to be used. Three copies of this form are required for submittal of an application, along with three copies .each of the plot plan; la'nfiJZrreCpVaZF0nd elevation plans, when applicable. - ®KHRHDC "Plot plan need not be "Certified", but should show all structures on the lot to scale. ri 1 jg91, �`.� •....n_„ ` ,•µ••�;,v��j it I i �ii � lir I Ip 1 � I n TV ! � � c V O " , (A I ?top, 1 M c (\ � c 40� °j .• ti c mD I � 1 I i N de ELr i T2At c, z6-o•' � '-s ' ,i 1 ! N•gtTN � �'p if o a a - m -` _ �. ct Zs T °l s I 2c- V. AL o I• R �. •------- - I ! r n •' D y wl i /� d Ne 4 !' Y- �•o w '• G o � o rn o Ti17 e C L