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0053 CURRYCOMB CIRCLE
r i 11 �Ll � NO. 152 1/3 0 RA i1� t � M ♦ J♦ ti��}T k•i I LEI i�..tit{±•� � � ` �.M{f�7 s1 A. _ �.• Y?t =.1Y 1 V c 110"i lZ 1� i� 7i fir , it �s• -t, .t � 4 `O-j t I so ` T 1 [ ] [R151 070 . LOC] 0053 CTY] 05 TDS] 500 �WB KEY] 356983 ----MAILING ADDRESS------- PCA11011 PCS100 YR186 PARENT] 87417 THORNTON, LAURIE MAP] AREA] 82BC JV] 377719 MTG] 2012 415 RACE LA SPl] SP21 SP31 UT11 UT21 . 35 SQ FT] 1616 MARSTONS MILLS MA 02648 AYB11986 EYB11987 OBS] CONST] 0000 LAND 42900 IMP 92800 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 135700 REA CLASSIFIED #LAND 1 42, 900 ASD LND 42900 ASD IMP 92800 ASD OTH #BLDG(S) -CARD-1 1 92 , 800 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 53 'CURRYCOMB CIR TAX EXEMPT #DL LOT 11 RESIDENT'L 135700 135700 135700 #RR 1973 OPEN SPACE COMMERCIAL INDUSTRIAL MGFM: 87435 EXEMPTIONS SALE10.4/87 PRICE] 190000 ORB15682/305 AFD] I LAST ACTIVITY109/03/92 PCR] N . I i . i i i i R151 070 . P P R A I S A L D A T*_F�l KEY 356983 THORNTON, LAURIE LAND BLD/FEATURES _ BUILDINGS NUMBER ZN/FL=RF 42, 900 92 , 800 1 A-COST 135, 700 B-MKT 90, 200 BY 00/ BY AM 5/87 C-INCOME PCA=1011 PCS=00 SIZE= 1616 JUST-VAL 135, 700 LEV=500 CONST-C 0 ----COMPARISON TO CONTROL AREA 82BC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 82BC WEST BARNSTABLE PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 429001 LAND-MEAN +0% 1357001 64557 IMPROVED-MEAN +440-6 256 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 100%] LOCATION-ADJ APPLY-VAL-STAT LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] i i i i R151 070 . �> P E R M I T [PMT] ACVT [R] CARD [000] KEY 356983 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR oCMP NEW/DEMO COMMENT [3288381 [01] [86] [ND] ] [AM] [01] [87] [100] [NEW ] [WB 11/2 ST] [ ] [ ] [ ] [ ] ] [ ] [ ] [ ] [ J [ ] [ ] [?] i I . Via Town of Barnstable _ Building '$[ARt� : Post This Card So-That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept • s , M"S& Posted Until Final Inspection Has Been Made. y� �� 6 `� Where a Certificate of Occupancy is Required,such Building shall Not be.Occupiedl until a Final Inspection has been made. Permit ' Permit No. B-19-1188 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC Approvals Date Issued: 04/11/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/11/2019 Foundation: Location: 53 CURRYCOMB CIRCLE,WEST BARNSTABLE Map/Lot: 151-070 Zoning District: RF Sheathing: Owner on Record: RUSSO, PETER J Contractor Name` BRIAN D DENNISON Framing: 1 Address: 53 CURRYCOMB CIRCLE Contractor License: CS-095707 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $14,734.00 Chimney: Description: replace 3 doors Permit Fee: $75.14 Insulation: Project Review Req: Fee Paid: 5 75.14 Date: 4/11/2019 Final: Plumbing/Gas Rough Plumbing: _.. Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced withir'six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. -_ — _- ---- Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection - 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT f..... o�q Application number...&/1 � ! f Fi A Date Issued.................. .......................... IIARNAM � APR 1 CO 1 070�� Building Inspectors Initials....................................... CFO MA'S I��A �sl /� jABLf Map/Parcel............................ ..... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY FORMATION Address of Project: _5 3 ('u pry roM 1D C�,r ��„s��He NUMBER STREET VILLAGE Owner's Name: ?e+,e{ 4RJ5 5-0 Phone Number (c r-T- Col q- 4 9 6 2- Email Address: COSOn ea lee getad. Co.--x Cell Phone Number Project cost$ Iq 7 3 1{— Check one Residential V/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: S e,- OT-4&4 Date: TYPE OF WORK ❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization Doors (no header change)# .3 Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) (� / Construction Debris will be going to lil c sfe-/Y?al?a 9 eH/P/i - m—I'��-3 CO1V A Rf' C Y OWS INFORMATION Contractor's name I���an `7R n.�,so� - -SoA2 cr, dP,J &5(cn4 rf-n chow S Home'Improvement Contractors Registration(if applicable)# 17 3 2-L[� (attach copy) Construction Supervisor's License# Z 5 7 07 (attach copy) I Email of Contractor Q S-,Jee� C 6 M Phone number 1101' Z 2 R -9 goo ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS/N A HISTORIC DISTRICT, YOU MUST OBTAIN H15TORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER *For Tents OnIY" Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X I X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours Of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. XW®®D/COAL/PELLL ET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 C R the Massachusetts State wilding Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date FLICAN 1L 9 S SIGNATURE Date Signature All permit applications are subject to a building official's approval prior to issuance. r Renewal Agreement Document and Payment Terms ` byMdersen. dba:Renewal B Andersen of Southern New England Y gl Peter Russo MREL....El Legal Name:Southern New England Windows,LLC 53 Currycomb RI#36079, MA#173245,CT#0634555, Lead Firm#1237 west Barnstable,MA 02668 10 Reservoir Rd I Smithfield,RI 02917 H:(617)699-4862 Phone:866-563-22351 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s) Name: Peter Russo Contract Date: 03/28/19 Buyer(s)Street Address: 53 Currycomb, West Barnstable, MA 02668 Primary Telephone Number: (617)699-4862 Secondary Telephone Number: Primary Email: rusoncape@gmail.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document, the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $14,734 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $7,367 Balance Due: $7,367 Estimated Start: Estimated'Completion: Amount Financed: $14,734 6-8 weeks 6-8 weeks Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: 50 5 deposit by bank balance on completion by bank Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor. Buyer(s) hereby acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 04/01/2019 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renee de n of So kern New England Buyer(s) ` ?-d i Signature of Sales Person Signature Signature Paul Sandrey Peter Russo Print Name of Sales Person Print Name Print Name UPDATED: 03/28/19 Page 2 / 10 Office of Consumer ,affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card 3245 SOUTHERN NEW ENGLAND WINDOWS, LLC Registration:10 RESERVOIR ROAD Expiration: 09/18/2/18/202U SMITHFIELD, RI 02917 I II Update address and Return Card_ SCA 2%1-05,17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 173245 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS.LLC Boston,MA 0211 1, _ 1 BRIAN DENNISON ��k C -- - 1.0 RESERVOIR ROAD SMITHFIELD.RI 02917 Undersecretarywithout signature p�p���1 per, A., !�y,,�� t LcL�[ss§ [1`1Ji ±W 'th ©j I��.aj�ssac l:JsettJ Division oo Professional Licensor¢ Board of Building Regulations and )tandards Construction Supervisor S-0905707 _ expires : 09/08/2020 BRIAN ® DENNISON 8 BLACK ELL®RIVE CHARLTON MA: 01507CIL Commissioner The Comntonwealdlt oflTvlassachusetts �: 9? Department of Industrial Accidents I Congress Street, Suite 100 ;a Boston,MA 02114-2017 www mass go v/&a Aorkers'Compensation InsuranceA6idavit:Builders/Contractors/Electriciaas/Plumbers. TO BE FILED WITH THE PERNMENG AUTHORITY. Applicant Information f� Please Print Legibly Name(Business/Organization/Individual): G ,`e r 000 Address: /USer UDt r �e� City/State1Z ip:S m t-Hl A e-Q Ji t 0 LQ l 7 Phone k 40 l—ZZ 7r— ? ff-0 4) Arryan employer'Check the appropriate box: Type of project(required): aemployer with 7'0+—employees(full and/or part-time).* 7. New construction 2M I am a sole proprietor or partnership and have no employees working for me in 8: Remodeling any capacity.(No workers'comp.insurance required.] 3.[]1 am a homeowner doing all work myself.INo workers'comp.insurance required..]t 9. ❑Demolition 4.[] YProperty. [wilt 1 am a homeowner and will be hiring contractors to conduct all work on m 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Ro repairs f[epai These sub-contractors have employees and have workers'comp.insurance.6. We are a co 14. Other,R&f, 0 G- rporation and its officers have exercised their right of exemption per MGL c. 152,§l(4),and we have no employees.[No workers'comp.insurance required.] r eo 14 r—e,-e � 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lain an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site information, Insurance Company Name: - {rM Tn�SUK aAM— l0 • o Policy#or Self-ins.Lic.#: WC a .3 15 S 7 ZCi L Expiration Date: Job Site Address: 3 Cjrr�4Co/1, r City/State/Zip:ti/./I rn c J Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. I52, §25A is'a criminal violation punishable by a fine up to$1,500.00 and/or one-year impdsbnment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the p ' d penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: 10.1 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit[License# Issuinap g Authoritj(circle one): 1. Board of Health 2.Building Department J.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACC>RL> CERTIFICATE OF LIABILITY INSURANCE F DATE(Mh11DD/`/YYY) 12/28/2018 >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). PRODUCERCONTACT CoBiz Insurance, Inc.- CO NAME: 1401 Lawrence St., Ste. 1200 PHCCN o t• 303-988-0446 Fuc No:303-988-0804 Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:FlremenS Insurance Company of WA,D.C. 21784 Southem New England Windows, LLC. dba Renewal by Andersen of Southern New England INSURER C:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURERD: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:787175890 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER . POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MM/ODIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1l1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a OCCUR DAMAGE PREMISES Ea occurrence 8 300,000 MED EXP(Any one person) $I0,000 PERSONAL&ADV INJURY $i'DW.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000.000 X PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000.000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE LIMIT $ Ea accident 1.000.000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per acc dent $ $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15.000,000 EXCESS L1A8 CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$ $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000.000 Ire describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY OMIT $1,OD0,000 C Pollution Liability 7930073340000 1/1/2019 1/112020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 06/20/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0_1 0 Application # Health Division E0, &T�6�j Date Issued C ) Conservation ision Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis I� Project Street Address Village Owner P a ss O Address�� C���cc n Telephone 0 Permit 'eq e t \ t Y� Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 000F6') Construction Type Q r%j" VA,�V,a n�1 n J 4- \ro O yn) Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 19' Two Family ❑ Multi-Family (# units) Age of Existing Structure v 4 !AVS Historic House: ❑Yes I/No On Old King's Highway: ❑Yes ❑ No Basement Type: 4Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) �— Number of Baths: Full: existing a- new '0- . Half: existing new _ Number of Bedrooms: existing _new Total Room Count (noYG luding baths): existing new First Floor Room Count Heat Type and Fuel: - El Oil ❑ Electric Ll Other Central Air: ❑Yes C�'No Fireplaces: Existing � New Existing oy coal stove: ❑Yes o g�' �(V Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: M/existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ c Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use +. 77 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Telephone Number u, c) d ,¢C 9 I 4 0U�— Address S CQrT,!j Lpy..NV_.% C%2 d Je. License # \AJ 9- ►6 N- # Home Improvement Contractor# O 2 Worker's Compensation # ALL CON TION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE d i I ' FOR OFFICIAL USE ONLY 'APPLICATION# DATE,ISSUED MAP/PARCEL NO. . ADDRESS VILLAGE.- : OWNER - t DATE OF INSPECTION: FOUNDATION FRAME INSULATION pl e� 3/o f1d foMPIC-- ; FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL - FINAL BUILDING ; DATE CLOSED OUT - a ASSOCIATION PLAN NO: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IT 600 Washington Street c C Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A Iicant Information Please Print Legibly Name (Business/Organization/Individual): Address: �� Cv City/State/Zip: WeSrt'. I Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑ New construction have hired the sub-contractors employees (full and/or part-time).* listed on the attached sheet. 7. Remodeling 2.❑ I am a sole proprietor or partner- 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.$ 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additic required.] officers have exercised their 11.❑ Plumbing repairs or additic 3._ I am a homeowner doing all work yself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4);and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address: City/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 fine up to$1,500.00 and/o ne-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a of up t 250. a day agar s the violator. Be advised that a copy of this statement may be forwarded to the Office of Invest lions o e DIA for • urance coverage verification. 1 do hereby rt' tinder the pa , and penalties of perjury that the information provided above is trite and correct Si nature: z, Date: — S-- 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 S. Plumbing Inspector 6. Other Contact Person: Phone#: I . information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for.their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto'shall not because of such employment be deemed.to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." .. Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until.acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP)with no employees-other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a'policy is required. Be advised that this affidavit maybe-submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit.. The affidavit should be returned to the city or town that the application for the pen-nit or license is being requested,not the Department of Industrial Accidents. 'Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e: a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would 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 Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia Town of Barnstable of THE r o Regulatory Services Thomas F. Geiler,Director � KAS& Division 16 p. Building PrEO ji°� Tom Perry,Building Commissioner 200 Maid-Strmet._Hy_annis,MA 02 01 www.town.barnstabie.ma.us Office: 509-862-4038 Fax: 509-790-6230 ETOMMOWNER LICENSE EXEMPTION Plcarc Print DATE: n JOB LOCATION: CV U.1'►^ C 2..(A number street village ! w _ HOM AWNER ` R.i 'DVSS 0 S6 L1 A 1 1 AW name home phone# work_pbone# CURRENT MAiLING ADDRESS: Sal "L 1 r 0 ., cu� city town stato zip code The current exemption for"homeowners" was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. ' DEFNIITTON OF EOMEDIVNER Pcrgon(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 sball 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 complianeo with the State Building Code and other applicable codes, bylaws,rules and regtdations. idc�rsigncd'"nomao)p�mce'ccrtifqs that_he/sbc understands the Town of Barnstable Building Dcpartrucnt inspection procedures and requirements and that he/she will comply with said proccdtsres and cnts. o a Approval of Building Official Note: Three-fan-Oy 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 homcowncprrforming work for which a building permit is required shall be exempt from the provisions of this section•(Scctio n 109.1.1 -Licensing of construction Supervisors);provided that if the horn cowncr cngagcs a parson(s)feu hire to do such rk wo that such Homcovmcr shall act as supervisor." Many homeowners who use this exemption are unaware that they arc assuming the responsibilities of a supervisor(sec Appendix Q. Rules&Rcgulations for Liccruing Construction Supervisors,Section 2.1.) This lack of awareness bftcrr results in serious problems,particularly when the homeowner hives unlicensed persons. In this case,our Board cannot proceed against the unlicensed person.as it would with a licensed Supervisar. The hotneONrrer acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responnbilities,many communities require,as part of the permit application, Wer that the horncOn certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns. 'You.may care t arnend and adopt such a form/ccrtification for use in your community. r ti `awn o-f Barnstable Regulatory Services Thomas F_ Geiler,Director 619. Building bivision. Torre Perry, Building Commissioner 200 Main Strcet, Hyannis, MA 02601 www.town.barnstable.mq.us Office: 508-862-4038 Fax: 508-79( I Property Ovrher MU*st Complete and Sigh This Section If Usina A Builder as Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of rob) Signature of Dormer Date Print Name If Property Owner is-applying foi-Permit please complete the Homeowners License Exemption Form on 'the reverse -'side'. 1 Q i 1 i 1 Q r ` 1 s f i /l ^J v I ) TIN i O 000 Q 1 F,►+e r Town..of Barnstable Permit# �•� EVires 6 months from u3ye date . ERMIT Regulatory Services Fee ch 9�A MASS, S, `�$ Thomas F. Geiler,Director �a,. rA 1008 Building Division . Tom Perry,CBO, Building Commissioner 0. TOWN OF BARNSTABLB 200 Main Street,Hyannis,MA.02601 Yr www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel;Number. S d Property Address S3` u rr CEcIle- >�(Residchtial Value of Work�� -G __ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address SU rf, Contractor's Name ra' o y� P d "A Wye 1,4ak 11 elephone Number 36 ' `J 3 Home Improvement Contractor License#(if applicable) 14 8 6 O l EX jQ ^ 1 U( l l zUU("I Construction Supervisor's License#-(if applicable) ! ! S / g E X p — 08131 1 f 0 0 ❑Woi•kman's Compensation Insurance- Check one: ❑.I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name AO N Pt S &C'(-V 1 C GS C,V,l�G i'l C �gG'� zQ3�t`j l ZZ Workman's Comp.Policy# U)r! RC 4 Z 84*-I RS Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) nl/A ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not-Aripping. Going over existing layers-of root) R(?n1oV �A — ❑ Re-side . / k I I N . a rci5 e- �DUv;r�. fVl,� — ❑ Replacement Windows. U-Value (maximum.44) Sa •1Vtiere required: Issuance of this permit does not exempt compliance with o0ier town department regulations,i.e.Historic,Conservation,etc. ***Note: P operty Owner must.si n Property Owner Letter of Permission. om provement actors License is required. SIGNATURE: t' Q:Forms:expmtrg. Revise071405 l the E Town of Barnstable . .eaxauu�. .MAM 039 Regulatory Services •639 A� Thomas F.Geller,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I �(� f �AG.S C7 ,as Owner of the subject property r S e (44J _ cGLSrrPC toact on mhereby authori�P LLIJY behalf, in all matters relative to work authorized by this building permit application for: (Addy ss of Job) )�V/0L C Signature of Owner Date Print Name Q:Forms:expmtrg 'Revise071405 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 10 600 Washington Street Boston,NIA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orgw&,ationiindividual): Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood,FL. 32750 Phone#: 407-551-5402 Are you an employer?Check the-appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).` have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7.' ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity: workers' comp. insurance. 9. ❑Building addition [No workers'comp. insurance 5. We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof.rcpai.a insurance required.]t employees. [No workers' 13.� Other comp. insurance required.] Al *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 anew affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Aon Risk Services Central,Inc. / Phone:(866)283-7122 Policy#or Self-ins.Lic. #: WLRC42847859 Expiration Date: 08/01/2009 c �5 Job Site Address: S3 CLA(' �-rILcity/state/Zi 0ZIG6S 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DI A.for insurance coverage verification. I do hereby cerd a pains a7genaldes of perjury that the information provided above is true and correct. Signature. J {Sears Auth.Agent} Da Zc�B Phone#: Home:860-792-8106 Cell:860-753-0452 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M 1 08/06/2008 08:55 4077678536 SHIP PERMITS8LICENSE PAGE 01/01 , a TE �CORa oa FAM/DD o.r /3 zos PRODUCER AOn Risk Services central Inc. TKIS CRRTIFICATE IS ISSUED AS A i►fATTER OF TWORMATION ONLY , flea Aon Risk services, In;. of Illinois AND CONFERSNORiGMS UPON TIMCLRTJFICAT9110LDEFLTHS 200 East Randolph cERTWICATLDOF$NOT AMEN%UMND Olt ALTEILTHE Chicago IL 60601 USA COWRAGE AFFORIIED BY THE POLICIES BF.I,AW. PyIroNE. 66 '283-7122 vex. 53-5390 INSURERS AFFORDING COVERAGE TWC a PMMIM mqu®eA: Aa American Insurance companX 22667 Sears Holdings corporation iNSURERB: Indemnity xi cc of North America 4357; dba sears Name Improvement Products, Inc a Attn: Risk management 63-219A nrs(n)BRa Self-Insured Retention 006SAL � 3333 Beverly Road Hoffman Estates n 60179 USA INSU mt). National union Fire Ins cc of Pittsburgh 19445 b INSURER THE POLICIES OF INSURANCE LISTED BELOW 14AVPDEENISSUFIDTOTHEndSVRW NAM ABOVEFORTIMPO7.TCY PERIOD MMICA7W.NOTWITHSrAND1h0 ANY REQUMEMENT.TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICHTHM,COMFICATH MAY BE ISSUED OR MAY PERTAIN,THE TKSURANCE AFFORDED IIY THE IPMCE4 DESCRIBED I EDI iS SUBIECI'TD ALL THE TERMS.WCO.USIONS ANn CONDITIONS OP SUCH POLICIES. ACCIRROATE LIMITS SHOWN MAY HAVE BEEN RWUC4.O BY PAID CLAIMS. LINKS SHOWN ARE AS REQUESTED LTR TY►EOPIMAANCE MIJCVNUMIMR rGUCVVFxCTM POUCV&VK ATIOIi Ulm" DATP.(MMOrATY) DATR4RMMYY) C RAALLTABIIJTV self Insure 08/OVO8 08/01/09 EACHOCCURMM COMMFaCiALC&N1 ALVA8ILfrV DAMAGE T'0RENIEo OAIMS MADE [n 0=M, PRFAn865 I ARC V gAgI 1 aeeotmee) PERSONAL A ADV INJURY N N W OUNBRnLAGGREGATD OM AGGREGATE UWr APPLIES PGA PRODUCTS•COMPlOP AOG ~ 11 mtrcv 13 PRO O LOC p I IErr sia/oeductlble SS,000,OOD ,t`„ A AUrOMORME LLARIUTY ISAW08247274 O8/01/08 08/01/09 COHEnvFl>SINGLE unrrt A ANV AUTO ISAN08241310 08/O1l/08 03/0.1/09 (macaw) 35.000.000 ALL M ED AUros AODTLV INJURY cL'HBnULBD AUTOS (PQ P=W) t(MAUTOs BOnnYTNARV 14P NON OWNED AUTOS (Per aoidem) PROPERTY DAIVAriF. . (Pa eccldmll GARACR MADILITY AUTO ONT V•GA ACCIbt W ANY AUTO + . OTirEitTRAN FA ACC AUTO ONLY Ar.C. D MCCPSSIUMBIttL"•WABnITV 60816zz 08/01/08 StaraCURRENCU OCCUR . ❑ CLW&MAW AMEOATB n,000,00D ) 4 OOFDUCnDLE�• '' r Al . RMOMON t3 WORKERS COMMSA-MON AND ADSC. X C firATU- OTH. fi30,0YERS,LABILITY p A tcLRC42847938 08/01/08 08/01/09 F.t.eACH ACCIDENT 11,000,000 ANY P0.nPAlEnDR/PARTNER!Ex[CllrrvH CA A oFFrcERTUrnenBRl>XawE6? 9CFC42847979 08/01/08 09/01/09 e.LbIREAaFAAGMKOYFA 11,000,000 ITJas,dmawWlft SPECIAL PROVISIONS WI U,L,OTSEASO•POLHyTrMtT S1.000.000 Wow 0T1ILR DEBrAIPTTON OF UPFRAnONSAACATIONSNEMCIMUg CUlSIONS ADDED 8V MCCASPAEWtSPP.49AL PROWSIM � .,;�'q'.i7•^J�,�'q•'4 d• wyy,n � f I'qi. •eAi:,l'I '� •'�%.:�!?:°J;' •d .,� v•, '1 i Sears Home Improvement Products, Inc SHOULD ANY OF THE ABOVE DESCRiBRD POLICIES BDCANCEuF.OBEPORE THE EXPIRATION 1024 Florida central Parkway ( DATE THEREOF:,TIMISSUENODISURER WILL,ENOEAVORTOMAII, Longwood FL 327SO USA X DAYS VPRITTF.NKOrnCBTOTHE CERTIFICATE HOLDER NAMMTOTHELEFT, � RUT FAILURE TO 00 80 SHALLIMPO-M 190 aaBLIOATIGN OR UADRITY OF ANY IGNDUPON THFINSURI'<t llSnOF.N13ORREPAfiaBwTATiVFS. AUMORTEMRUPRIISBI.TATTVb Jae"�e54646—o 0 �w d�ioin Received -on 8/6/2008 '8:56:02 AM Jre e Boar o u mm a ula rls an an ar s g g One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 148607 Type: Supplement Card Expiration: 10111/2009 SEARS HOME IMPROVEMENT PRODUCT _iSears Authorized Agent LUBOS SVEC Home- 860-792-8106 1024 FLORIDA CENTRAL PKWY Cell- 860453-0452 LONGWOOD, FL 32750 Update Address and return card.Mark reason for cl►ange. �CAI rs soe�-c7,n7-rren3o Address j] Renewal (—I Employment , Lost Card :1en�nrrzc�rriw?�ill�o�JI/zu«cic , IX Board of Building Regulations and Standards License or registratioti valid for individul use only t HOME IMPROVEMENT CONTRACTOR before the expiration date: It found return to: _ T{r Board of Building.Regulations and Standards Registration: 148607 Expiration: 10/11/2009 m One Ashburton Place R 1301 Type: Supplement Card Boston,Alfa.02108. ' SEARS HOME IMPROVEMENT PR "• 1024 FLORIDA CENTRAL PKWY LONGWOOD,FL 32750 AJministrotor Not Valid without signs Boaz o WC g �ar One Ashburton Place -Room 1301 Boston.. Mass louse 02108 -Home Impmvemer Ntiaaor Registration Redtst:atian: 148607 T"e: Public Corporation ` Z__.. .._ Explllitle►v. 1011112CM Tr# 2!sr5r. SEARS HOME IMPROVEMENT ALFRED NYMAN JR. 1024 FLORIDA CENTRAL PKWY —�'-- LONGWOOD, FL 32750 Upaft Addtas And Mont eard.Mat,eau for chW,. e� ❑ Address ❑ lRoswX F, Emisloym mt n Lost Cal OP&CA1 A 50M4 A'mPM4W me �onea�rasetra 7W V of&dttAng R-&-t-to g imm ar rq0 tlou valid for indiividul use truly HOME IMPROVEMENT CONMCTOR befen the ttntion date. It fonnd wtnra to: Remiatrtif•1 148687 Board of lnliding)Regulations tuft!Standands E o 9I11/�09 �'t43 28 $2 One A38 bm in Piaeo IRm 1301 Bostbu,ftZ 02108 , 8W.S HOME I .- ODUCTS INC. ALI-RED NYM A' "t 1024 FLORIDA CEO -.y _ LONGWOOD.FL 3275if `" Admtntstntor Not vffil€d Zont Signature Board of Building Regulations and Standards One Ashburton Place.- Room 1301 Boston, Massachusetts 02108 Construction Supervisor License License CS: 97519 Restriction: 00 Birthdate: 8/31/1963 Expiration: 8/31/2010 Trt/ 97519 LUBOS SVEC 827 THOMPSON ROAD -- - -- THOMPSON, CT 06277 -- Update Address and return card.Mark reason for change. oPs-CAI 0 SOM-05106-PC8490 i - (� Address i'.] Renewal 1-1 Lost Card 07Xe�amzrraaruaeaz o�✓�?'auielld i 4 Board of Building Regulations and Standards r• + r r Construction Supervisor License AL I 97519 ass 0 tteur B t�dois M _ License: CS s.+c M iW ts-02 [7os HAZ lm,.e:tt8-232007 _ `� Birthdate: 6/31/1963 SVEC s I'' Expiration: 8/3112010 Tr# 97519 t180S,, 1. t _- r Restriction: 00 27 TMtO�IP'SOf1 RD� � ---- t tT}IOMPSONCTW12jr .-- + _ ` W LUBOS SVEC ` 827 THOMPSON ROAD .�, THOMPSON,CT 06277 Commissioner Bloar o u, a afons/a�nan ar- s g One Ashburton Place - Room 1301 Boston. MassaPhusetts 02108 Horne Imp rovemeK, Ntractor Registration - -r- Registration: 148607 Type: public Corporation - Expiration: 10/11/2009 Tr/t 2!59662 SEARS HOME IMPROVEMENT ALFRED NYMAN JR. - 1024 FLORIDA CENTRAL PKWY - LONGWOOD, FL 32750 ' r Update Address and r change.` card.Mark region for chan Address Reue%T1 [:,. Employment ® Lost Card U&CA1 d1 5W471M-PC6499 Board of Building Regulgtto and Standards .License*,or registration valid for iodividul use only HOME IMPROVEMENT CONTRACTOR before the aspiration date. If found return to: -r° Board of Building RegulatioW and Standards Reyistrokft_�1488oT One Ashbarton Place ll;rll 1301 Ex'ttat1 1110009 Tr* 256Iit32 Boston,MR.02108 It. -- =i Corporation SEARS HOME I ISODUCTS INC. ALFRED NYMAN` 1024 FLORIDA C�tN'ii11=t ,..+ — LONGWOOD,FL 327 f Admintstrator IVotMalid �,uig�natnre J �w ` II'll�I'II III�II Proposal Date I 1 1_J mS I ,lob# Sears Home Irtiprovennent Products,Inc.. Customer Name P.O. Box 522290 F6'CG✓Z. 1�v$ p �6 Ove 1�'�s 1024 Florida Central Parkway SCustomer's Home Phone Customer's work Phone Longwood, FL 32752 2290 - Home Improvement Products Phone j(800)469-4663 _ Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 3 eu lf2 C+D r R,� CT(#H IC. 0607669),. Garage Doors City State Zip Code g MI:(BIdr.#2102131369); NA pZ(y, $ Is installation within city limits? RI (Resid.Cont:#27281); Installation Address County 3 .4 is L-4, ' Yes ❑No WV(Resid. Bldr#WV025882) Billing Address(if different from above) city State JZipCode Project Consultant Name&License No.(if applicable) Description of the Project and Oescription"of the Significant Materials to be Used°and"Equipment to,fie installed The work to be done under this contract includes the following: 1. Remove existing garage door(s)to be replaced. (PLEASE NOTE:The removed garage door(s)are likely to be damaged.) 2. Prepare openings as necessary to receive garage door. (No finish work other than normal installation is to be done unless otherwise noted below.) 3. Installation includes the clean up of all job-related debris upon completion of the job. 4. Install the products as described below: GARAGE DOOR SIZE & QUANTITY GARAGE DOOR MODEL SIZE(1): X ❑ Sears 1000 ❑ Premier 1000 ❑ Wood Carriage House SIZE (2): ' X Sears 2000 ❑ Premier 2000 ❑ v SIZE(3) X ❑ Sears 3000 - _1:1 Premier 3000_ w- 0 SIZE(4): X Notes: j NOTE: Special Order Garage Doors require 100% payment arrangements at the time of sale. Returns and cancellations of uninstalled Special Order Garage Doors are subject to a restocking fee equal to fifty percent (50%) of the'purchase price,'plus applicable freight charges. However, the 50% restocking fee will not be charged (1) if your order was cancelled in accordance with the Notice to Buyer section of this contract before the described deadline;or(2) if your merchandise does not match your order specifications, has a defect in manufacturing, or is damaged in shipment or installation performed by Sears or at Sears'direction. PANEL DESIGN: _❑Sliorf Panel-Lon g'Pariel ' '❑'Flush'Panel ❑•Ribbed Panel- FI'usb'and'Ribbed ISan6lavailable in 3000 only) COLOR: ❑True White Imond ❑Sandtone ❑Brown' ❑Hunter Green` ❑Gray* '3000 only) DECORATIVE INSERTS: ❑NO WINDOWS_ Glass Type: ❑Clear ❑Obscure ❑Cathedral ❑Cascade ' ..❑Prairie ❑Stockton Sunray ❑Full Sunray ❑Waterford ❑Wagon Wheel ❑Moonlite LP Only) Premier Base Design ❑'A ❑B ❑C ❑D ❑Ten Lite Square Top Section Design ❑Solid Arch ❑Solid Square ' ❑Double Arch ❑Diamonds El Quad Arch ❑Plain ❑Ten Lite Arch Decorative Hardware ❑Traditional Handles included ❑Strap Hinges included ' TRACK& HARDWARE: ❑Std Lift(12" radius) ❑15"-Radius ❑Low Headroom (61/2"ext,9 5/8"torsion) ❑Low Headroom-Front Torsion ❑Low Headroom-Rear Torsion ❑Extension Spring LOCK: ❑No Lock Inside Slide Lock(included) ❑Outside Keyed Lock(Sears Traditional) -❑Lever Handle Keyed Lock(Sears Premier) " GARAGE DOOR OPENERS' Craftsmen• Oty: RaiLLength: X7 ❑8' (Extension required) Chain Drive - Model 53985: X1/2 hp Chain Drive - Model 53990: ❑3/4 hp ❑Customer Furnished',' Belt Drive - Model 53914: ❑1/2 hp ❑Reconnect existing opener (must be equipped with safety photo beams) -Additional work to be done: Work NOT to be done: Painting,treating or'caulking of any wood surfaces, electrical Work(grounded outlet must be within 3'feet.of 47 garage door opener), mounting track to concrete ceiling: SPECIAL INSTRUCTIONS: All of the above check boxes and the"Work NOT to be done section have been reviewed"and explained to me. Customers APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately) 1 wc3C3� (Approximate Start Date) and will be substantially completed by approximatelyt! v Ai�I�S-�-.'(Approximate Completion Date). These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products,Inc.("Sears'')or at any other time by mutual.written agreement.Customer under- stands that*the Approximate Start Date is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. The TOTAL PRICE including all labor, material,taxes and any applicable discount is"$-- Contract Price $ OS Initial Payment(not to exceed 30% of Total Price unless Special Order);$ State Sales Tax( ., %) $ Final Payment(balance payable upon completion of job) $ 0 f Local Sales Tax( %) -$ xi;�- The Initial Payment is due upon re-measure and/or prior to Sears ordering prod The form and method by which the Customer(s)will pay is described in a separate Cas Cred' Card Total Amount Due $ B Payment Addendum made a part of and incorporated into this contract by reference. Customer can.buy at this price until close of Customer(S) initla business on= / . NOTICE TO BUYER: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY [FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER] AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Additional provisions of this contract are;stated on the,pages following Customers)in ' GD1-NE Rev 02/08 ADDITIONAL PROVISIONS Proposal and Approval. Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown.This offer must be approved by the Installation Department. If this is a credit sale or a payment on completion sale, it must be approved by the Credit Sales Department. If this proposal is not approved or the instal- lation cannot be made in accordance with the law,this offer will be withdrawn and any payments you have made will be refunded to you.Any mate- rials left over after the installation has been completed are Sears property and will be removed by Sears. Installation. I understand that Sears will not install the materials but will arrange for the installation. Sears is not responsible for materials or installation NOT furnished or arranged by Sears. Sears agrees to procure all permits required by local law. Authorization. I authorize Sears to: (1) arrange for a contractor(licensed where required by law)to make the installation of materials; (2) issue a work order for this installation to a contractor; (3) inspect the installation; and (4) pay the contractor when the installation is complete if I have signed a certificate that the installation has been completed to my satisfaction. Delays in Installation. I agree that Sears is not responsible for delays in delivery or installation due to weather,fire,strikes,war,government reg- ulations or any causes beyond Sears' control. Oral Agreements and Changes in Contract. I understand that there are no oral agreements between Sears and me. Everything I expect Sears to do has been included in writing in this contract. Nothing can be changed in this contract unless it is in writing on a separate form accepted by me and Sears. Responsibility of Bnder. I agree that any information or measurements that I give to Sears are correct and complete. I am responsible for any special work described in this contract. Payment. I will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warranty Information. Appropriate product warranty documents will be given to me by Sears. Sears' Warranty on Installation is: SEARS' LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s) used (which warranty becomes effective the date the merchandise is installed), if the workmanship(or application)of any Sears'arranged installation proves faulty within one year after products are installed (two years for Series 2000 doors; three years for Series 3000 doors),then upon notice from you, Sears will cause such faults to be corrected by repair at no additional cost to you. If Sears determines that repair is not commercially practicable or cannot be timely made,then,at Sears'sole discretion,Sears may elect to provide replacement or refund. Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1-800-222-5030, Option 4. This warranty gives you specific legal rights,and you may also have other rights that vary from State to State. NOTICE TO OHIO CUSTOMERS OHIO LAW CONTAINS IMPORTANT REQUIREMENTS YOU MUST FOLLOW BEFORE YOU MAY FILE A LAWSUIT OR COMMENCE ARBITRATION PROCEEDINGS FOR DEFECTIVE CONSTRUCTION AGAINST THE RESIDENTIAL CONTRACTOR WHO CONSTRUCTED YOUR HOME. AT LEAST SIXTY DAYS BEFORE YOU FILE A LAWSUIT OR COMMENCE ARBITRATION PROCEEDINGS,YOU MUST PROVIDE THE CONTRACTOR WITH A WRITTEN NOTICE OF THE CONDITIONS YOU ALLEGE ARE DEFECTIVE. UNDER CHAPTER 1312 OF THE OHIO REVISED CODE, THE CONTRACTOR HAS AN OPPORTUNITY TO OFFER TO REPAIR OR PAY FOR THE DEFECTS. YOU ARE NOT OBLIGATED TO ACCEPT ANY OFFER THE CONTRACTOR MAKES. THERE ARE STRICT DEADLINES AND PROCEDURES UNDER STATE LAW, AND FAILURE TO FOLLOW THEM MAY AFFECT YOUR ABILITY TO FILE A LAWSUIT OR COMMENCE ARBITRATION PROCEEDINGS. NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT. KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME, AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY [FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER] AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH, YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING "I HEREBY RESCIND" AND ADDING YOUR NAME AND ADDRESS. A DUPLI- CATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES.UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS.PURCHASED UNDER THIS AGREEMENT. kgAtomer's ature Date Customer's signature Date Accepted by Sears Home Improvement Products, Inc. ("Sears")on (Date). by: Management Representative Registration number(if applicable) GW-NE Rev 02/08 Town of Barnstable Approved , y Regulatory Servit,'esO B %,Q'S 0LE Fee -7,S- 0- 0 Thomas F.Geiler,D,iFector 17 OGT-28- P1112: 24 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis;-MA 0260.1___,__ C��4�IS10� Officer 508-862-4038 Fax: 508-790-6230 Home Occupation Registration Date: Name: G nb Phone#: Lf Address: 5 C c t iZ-C (—C Village: w for RN s 1�'�I-c Name of Business: r E S a 1 l w i4 Type of Business:- a m'P TL S Q L( F N G L N-E E 9-N4p/Lot: 1-3-1 d 0 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4=1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling.unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration, smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwe ing unit. I,the undersign ,have ead and a ee with the above restrictions for my home occupation I am registering. Applicant: Date: C o zS l2 csa Z Homeoc.doc TO ALL NEW BUSINESS OWNERS DATE: 10 '9 02 .� t + c. Fill in please: ����� �. APPLICANT'S ° YOUR NAME:r'-A k k C• A.t 1 G�6c7 BUSINESS rz 5oz3 _. YOUR HOME ADDRESS: 5� C-u tLCL�I Co yo G��• -6 8 5 -S g z-t � a? , �� TELEPHONE ° ���'d' '#�P Telephone Number Home o1 20 't I (, NAME OF NEW BUSINESS v {L.ka>c�F S DF Tw►k F- TYPE OF BUSINESS Co wve• ' SoF-Tw►4 g-r. F1.1 IS THIS A HOME OCCUPATION? YES LZ j NO Have you been given approval'from the building division?' YES= NO _ ADDRESS OF BUSINESS 5'�. L«V-V-:l co,mg' C-\?-. , Vx;2 t�jN s T AtLe **`MAP/PARCEL NUMBER. g)f' O /d When starting-a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable.-This form is intended to assist you in obtaining the information.you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office(Ist floor-Town Hall) or if you get the business certificate first You MUST go to the following office to make sure you have all the required permits and licenses.. -GO TO 200 Main St.—(corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING C ISSIONER'S OFFICE, ; This individual s 9'en i rme rmit equirements that pertain to this type of business. o ' ed Signature" COMMENTS:. 2. .BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Business certificates (cost $20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. � t The Town of Barnstable Department of Health, Safety and Environmental Services BAaxsret3r.>+ : Building Division HAM 1"9.��0� 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen ' Fax:. 508-790-6230 Building Commissioner Home Occupation Registration Date: (L2� 7 Name:Ay� ,,et, Fiwck�r:r� ��,�- �i�TrihS:c �l�cTr o �5 Phone #: �`� Address:, G1Lr4XGr��x1_ C)'YC/z° Village: W,C57` B e f,1ST�4'' Type of Businessi/;101 aG /pr7r���GS ����� iTiO� Map/Lot: �`�! 67� INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance.provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by-uhe_pe manent resident of a single family residential dwelling tout.located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling-which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter. odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or haiardn i mie or ezpio"slue*na Eram;-a* G »- of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of matesiais or equipment- • There is no commerc al vehicles related to the Customary Home Occupation,other than one van or one pick up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet is length and not to exceed 4 tires,parked on the same lot containing the Customary Home O adon. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • in the Customary Home Occupation who is not a permanent resident of the No person shall be employed dwelling un1L I,the undersigned,have read and agree-with the above restrictions for my home occupation I am registering: ate: Applicant BARNSTABLE HOUSING AUTIORITY LEASED HOUSING DEPARTMENT TELEPHONE(508)771-7292 146 SOUTH STREET-HYANNtS MA 02601 ZONING VERIFICATION TO: Barnstable Building Inspector FROM: Leila R. Bruce, PHM, Leased Housing Coordinator RE: Uerifying legal rental unit Date: � DRAFT Address: Village: Unit type: Bedroom size: The f the aboue listed property is entering into a contract with us for the rental of the property as listed above. Please uerify by signing below that the unit is legal and meets all zoning requirements for a rental in the town of Barnstable. If it does not, please list reason here: Th k� ou for your assistance in this matter. A) Z/j9'1)v i. ature Print name � - 7 ✓ y � Date MRVP Section 8 111E Barnstableo Telephone(508)771-7222 • ARM M.A Mg • g Autho rity 146 South Street•Hyannis,Massachusetts 02601 Housin ZONING VERIFICATION TO: Gloria Urenas ' FROM: Leila R. Bruce, PHM, Leased Housing Coordinator RE: Uerifying legal rental unit Date: Address: Village: Unit type: Bedroom size: Map D Parcel No.: / ���— G - The owner of the aboue listed property is entering into a contract with us for the rental of the property as listed aboue. Please uerify by signing below that the unit'is legal and meets all zoning requirements for a rental in the town of Barnstable. If it does not, please list reason here: I Than you fo r ass' ance in this matter. v Signature Print name .Date VIA FAX: 790-6230 MRVP section e Rev. 10/96 Equal Housing Opportunity Agency DIN SE ICES >;:.i::�::.;;:.;::.;::.::::.::.:::.i>iiii:.:i:.>ii::.i>i:.i;i;:.;ii:.ii:.i:.ii:.>::>::::>:>�:::>::::::::> ::<::::: 151/070 . . .. .::::::::..:..:.:.. ::.:..............1:...:.. . .::.:....::.:.........:.::................:.:..:............... ....::.... :::::: N. is C•::::>RRYM::>: �i: iigii CIRCLE 1 :..t....;:. ..> .:.: 1 xx . .12 AL LEG :,.. € ...........:...i:::::::::. :ti{vti.. 'tioJ'.r �.f u! 9 ^:U.. 3 ...................... :.:,:•:::;....vvv.:w::::::::::::::::�::::::ii::;;;.i:�:}i:i:4:v:iii::::t'{ .........................................................iij�;:?�;n.?(Lvv;viiiiiv::ti?iii`}<{ 1 { I 1 TOWN OF BARNSTABLE REPORTS PLEMENTARY/CONTINIIATI REPORT Gv� c NAME (LAST, FIRST, MIDDLE) c DIVISION /DHPT VVV \ NOTE DETAILS 6 OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL OS ETC. -Th u� Lox "RE a � 7 Z SUBMITTED BY 1 �Tj /b � _Ct PAGE f I 5 -Z3- 9 =v Al TOWN OF BARNSTABLE •` r � REPORT SAPLEMENTARY/CONTIN UBTI�REPORT DIVISION /DeP7 NAME (LAST, FIRST, MIDDLE) NOTE DETAILS 6 OBSERVATIONS-ITEMIZE EVIDENCE, S`ERI�AL 1S ETC. SytI.GLE SUBMITTED BY �` ��j'\I ��"�1� PAGE 1 1 O AOPERTV ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTEDI CSTATE LASS I PCS I NBHD KEY NO 0053 RF 500 05W8 07109 r LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS y UNIT 'ADJ'D.UNIT MAP- Land By/Data FF- Dimension LOC./VR.SPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE DescriptionTHORNTONi LAURIE Mqp- CD. F•Detn/Acres #LAND 1 42,900 CARDS IN ACCOUNT -- 10.1BLDG.SIT:1 ; X: .3! ,=10C I=115 194 .54999.9S 122704.98 .35 42900. #BLDG(S)-CARD-111 92,800 01 OF 01 i BATHS 2.0 , U ' 1rX: C= 100 7000.0 7000.0 #PL'53 CURRYCOMB CIR' OST. '135700 1.00. .7000_.e: #DL LOT.11c IIARKET 90200 A F.TO LACE U X! C= 100 3100.00 3100.00_ 1:00 3100.E #RR 1973 INCOME SE D PPRAISEDIVALUE J _ _ _ • 135.700 U ARCEL'SUMMARY S AND 42900 T tTAL DGS 92800 M IMPS E 135700 CNST T DEED REFERENC Type I DATE M Recoroeo R I O R YEAR VALUE Book Page I.M. MO. yr. Set-Prue A N D 42900 S 5682/305- I04/87 190000 ILDGS . 92800 5059/004: I05/86 172000 OTAL 135700 1 I I I BUILDING PERMIT M/L 5/87. ber oate Type A' *VIEW. ...... LAND LAND-ADJ - INCOME SE SP-BLDS FEATURES BLD-ADJS UNITS Num 42900 10100 28838 1/86 ND Class Const. Total r 0 ill Norm. Obsv. Units Units Base Rate Adj.Rate' A e Aga CND Loc %R G Rept Cost New Repo Value Stones Ha ht R- Rms Bathe aiia. P Dapr. Cone. AW P Ip enywNl Fec. 01Akuk 000 105 105 60.20 63.21 86 87 7.94 100 94 98688 92800 1.5 7. 3 2.0 7.0 Orion Rate Sq.-Fee .t Rapt.Cost MKT.INDEX: 100 IMP.By/DATE: AM 5/87 SCALE: 1/00.77 r ELEMENTS CODE CONSTRUCTION DETAIL 11 ,100 63.21 . 648 40960 LI CNST GP: 00 1 SB. 100 63.21 . 320 20227. --1 TYLE_ _ 04CAPE C00 0.0 FWD ' 85 8.50 . 192 1632 ! " B15 ! ' ESi6N ADJMT _01 ES fGN ADJ U ST----5.0 G13 44 . 27.81 t 308 8565 .*-----16----- 11 XTR:wA1LS _f0 LP6D%SHfN6lE 815 42 26.55 648 17204 ! FWD ! ! EAT/AE T _ __ _____ _________�.0 YPE 02 AS 0.0 ! ! *----14----* NTE R _ RY .FINfSH 64 YALi:_________ 0.0 12 12 613 ! ` NTrA LAYOUT f2 VER /NO_RMAL V.0 j ! ! ! ! NT_C9 III ALTY Q2 ANE A5 EXTER. �.0 ! 34 A. LOO(f STRUET_ 62 D JOIST/BEAM 0.0 D W *--*----20------* BASE 36 V E LabR-CDYER-- U4 AItPEI------------Tf.Q TotalA_rea, Aaa. 500 Base. 968 ! ' ! ' 22 22 OOF-TYPF---- _T A-91E=A_S_P_H-SN -If.-O E BUILDING DIMENSIONS ! ! 2$ ! L EtTR I Z A L Qf Vri A�! .0 T BAS W18 NO2 1SB W20 N16 E20 FWD 16 16 ! ! OUV(FATTON--- _Qf bulfED-PONE 9T:9 A N12 W 16 S12 E16 .. 1SB S16 --------------- --- ---------------------- BAS 'N34. E18 S11 .G13 E14. S22 W14 ! ' ! ! ! -----NEIGWUORH D BZBC-il>`ST-BIrFFNSI'li8 L N22 .. BAS S25•.. - 815 N36 W18 ! " 1S8 ! ! LAND TOTAL' MARKET S36 E18 .. *-------20------* *---- 14 PARCEL 42900 135700 *-----18-----X; AREA 4034 VARIANCE +0 +3263 STANDARD - - 25 _ L z� Assessor's map,.and lot number , .A0..7n49.. �1 J - 'THE Sewage Permit numVer�:............ ...._..., .......�_..... ..... " S3 aHouse number .........................: ......................................... . 9 �, GD 039. 3 9' `00� 1 ON d TOWN OF BARNSTABLE BUILDING INSPECTOR i APPLICATION FOR PERMIT TO ...�jvi �.. ..�Z..... ..................................................................... fJ��� -S,C�z� TYPE OF CONSTRUCTION ...................................................................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fQr�,. ?pr Ptacording�a th following information: Location .. /1. .... .��.........?..�� y.............../.�1................,�°'.:...-��c/�f?5 .�� .... ProposedUse ..... ............... ..................................................................... Zoning District .........��.0�—....................................................Fire District..�:.- ....r...,............................................. s �s Ti� %Di9 se- ��a Nameof Owner ......................................................................Address .................................................................................... Name of Builder .. ('.. !'I.-...,act/�Ocy�`... e�/P .....Address ............-.�'� � ...................................................... ....... Name of Architect ..,. �2?` �S� .. ......Address -.............. . ............. Number of Rooms .................. ............................................Foundation ..... ......................................................................... Exierior ��ij' s �� ....................�./P.......................................................Roofing ........1...........................................................:............ o"....................................................Interior .......:5�`�e'l/wC/G Floors ......��.�. /y„�y .......................................................................... Heating ......... .gaS............................."............... ...........Plumbing .....��c/GGa�,! c......�d�`' �s..... Fireplace '........... .PjS............ ...........................................`......Approximate. Cost ..............Y(�,«.,OOC�........d.................. r Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ......A-11-:11/.a ............. Diagram of Lot and Building with Dimensions Fee .......... �............:'............ SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r garding the above construction. Name . ! ... r:.......................................... Construction S pervisor's License (^�.�(.✓..../...�/� _ S L S TRUST 3 28838 No -----.. Permhfor —..��l�—S�— nr. �----.. Single Fami Dwelling � ------------------=------.. Location ......L»t...l.l.......53...Currvtomb_Circle * ' � ' West Barnstable ' --------------------------. | ' S L S Trust C�vne, ---____ ___..� r---------'' | Type of Construction ...Fr�.me............................ ' ` ' ^ ' ^ -------------------------- ^ . , Plot ............................. Lot ..................... .......... � Permit.Granted ......Jazuuury...l3...........l9 86 ' � Date of Inspection —_------- ...... . . � Dote _-----------]9 ' ' . ' . ^ ' � � ~ ' � . ' ^ ^ � ' . . . ^ . ' - ^ ° • ° TOWN OF BARNSTABLE Permit No. __2883 Building Inspector MWITAU t Cash --- --- OCCUPANCY PERMIT Bond Issued to S L S Trust Address Lot 11, 53 Currycomb Circie, Lust Barnstable Wiring Inspector l� Inspection date Plumbing Inspector --. �� Inspection date Gas Inspector a �%� s r'! Inspection date A Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 1 ! / 192f tli'. .......................... �,� ........................ ram Building Inspector TOWN OF BARNSTABLE Permit No. Ulm Building Inspector Cash OCCUPANCY PERMIT Bond Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date A7, Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WrM SECTION 119.0 OF THE BUSSACHUSETTS STATE BUILDING CODE. ............i............................ -------------------------- Buil(fing inspector �,.� T�••e TOWN OF SARNSTABLE �, BUILDING DEPARTMENT t sssaSrAU _ TOWN OFFICE BUILDING rua +679• HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: a An Occupancy Perinit'has been issued fdr the building authorized by , r BuildingPermit #.........2-S.—La-a........_.............................................._..................._.......... ......� . ... ._ . issuedto ....._...................................._........................_..........._.. ... � � . .�...........�._.....�.��............ Please release the performance bond. •4 Assessor's ma and lot number . ... .l. O... p �/ ,. f U M�\S� _ �.� .T,r / Sys VpL1 Sewage Permit number ..................... .P....... - 0` CQM -J $- S 4AL E0 E 5 iTADLE. . House number ......................................................................... � W�� NTp�'C 10 M639 TOWN OF : BARNS ' `SIf"' BUILDING INSPECTOR . APPLICATION FOR PERMIT TO ....ld�.................................:..............I....................................................................... TYPE OF CONSTRUCTION ..........62a.0. ......rr.'2ledi?e.:................................................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies f•r r 6gcco�ding to thy`following information: Location ... ............. .........!`.'....�-�..�.........................�........................................... Proposed Use ................ ,;.,. Zoning District ........ y� Fire District ....... .L.v — ......./..�. .... ....................................................... Name of Owner .S LS T2✓sf Address �,O�� 1—fa Name of Builder .. ��. .. 4/�I�cy�`... e/! .....Address ............ ........................................................ ,00-5119 ......Address .....( .... / ..., aie/�?ov o Name of Architect .................................... .. .... . .......�G�.�7`_' Number of Rooms / ° �-� Cw� 4?.............................:..............Foundation ..... ....................................................................:..t Exterior .......:SLi...../P�.......................................................Roofing ........��.7 ........................................................,..... ao� Interior ......$Z':' �C Floors �i, .uJU..................................... ..................................................................... Heating ,q ...Plumbing ..../w .,l.(-� ' ......._76cisl! s Fireplace ...........cf P- ............................................................Approximate. Cost ../.... .. ��(�/..P..��v.............. Definitive Plan Approved by Planning Board -----------______-----------19_______. Area ......��` . ................. Diagram of Lot and Building with Dimensions Fee ........f ............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and,Regulations of the Town of Barnstable regarding the above construction. Name .0........................................... Construction S ervisor's License �. ...... .l..a/.... S L .S TRUST ,-'No ...28838.............. Permit for ..... .LStory . ......... .............. Single Family Dwelling .........................................................t?..................... Location ....Lot...11, 5.3..Cu..riryc.o.mb...C.i.r c l.e ... . .... . . ...... West Barnstable ..........: ........................................................ Owner ........S.,L...S......Trust................................ Type of Construction ......FTaTRe.......................... ................................................................................ Plot ............................ Lot ............................ ti nuary 13, 86 Permit Granted .....Ja....................................19 Date -of Inspection 9..W:75.6.................19 Date Complete r 19 r � J "SECTION - SEWAGE I c -SEPTIC TANK- 5 -"D"BOX - -LEACH PIT - TOP F FDN =M(MSL)M .2"OF IISTO w E k- ' WASHED STON rnrn t coY r IN• OUT+ IN• -- OUT• IN• SEPT C 12 SEPTIC � ( r7 TANK I 3-I ELEV. ELEV. ELEV. ELEV. � V ELEV. ELEV.' • ( o g _ ,(Q4 GO � �/� • AtA V Q1 WASHED STONE. 19o.Ol ` 12�of �-et+ de ( ��� K wit cam' `/ 1 r O O ' TEST HOLE LOG ° � .TEST BY 2.Pm.-bank Co i I Qrt (- � 3•c . �,� ' `�` '�'�JA' 61 'WITNESS Z t TEST DATE BEDROOM HOUSE I `I T.H.- 1 T.H. 2.► DESIGN �o A4 ELEV. I 3 ELEV. NO I`� L �2 DISPOSER DISPOSER ► 4 �y ! ®. � �i� (q PERC RATE MIN/IN. - , .. FLOW RATE 2Zo (GAL./DAY) 12 r` SEPTIC TANK z� Fy REt1'D SEPTIC TANK SIZE 146 F \ .LEACH FACILITY - �2 !Iq 133 SIDE WALL Z,`71 - n •G/D. BOTTOM (elZl?-r- `�C�. I t.�► jO G/D. TOTAL -0& - 1 ! / I98. 5p�` USE. LEACHING I T �� ( 0 -WATER ENCOUNTERED �- NO-MS:' (UNLESS OTHERWISE NOTED) 1.DATUM(MSLJ:TAKEN FROM 6A1-1QW ICE• QUADRANGLE MAP / 2.MUNICIPAL WATER 1! oVAILABLE 3.PIPE PITCH:I&"PER FOOT— t 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- -44 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. `�94 OF ,}ye 6.PIPE JOINTS SHALL BE MADE WATERTIGHT i 7_CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. C STATE ENVIRONMENTAL CODE TITLES �� AP, E H. y`'� SITE PLAN S. Ty.S Pis. F FQ� �IC�7Cy'x� ►�,cstJC c ,�.r �+.-�p '5 ��� c . O�,A' Ii`{: LOCUS: LOT ( CV12.(ZYCOMf3 JOT �E uSBD r=a� .�'.Zo.�•3Z-•`f L.F`sc. �'3r�.Cd+._►V ..V vy t`' i` OFMA 1� Va,5UITAgLt%i MATe4ZL AL.TO lbe F-E!ID\fCC-/ NN1D R P11�1•Ea� RE !�L`�l(GINEER �S A WITH C.L;_N. MEDll1M TO C0,6, _ 6AnID Pore- L*1re-Our L-4 SSJfIN�- �G%r• I . . o RNE I G�\ R ^L y EF: t-dT �' VNT �IC[ eC1� �J 3Z�o I t act(Il tc�-P.(Z;frA - 04�!! CQ �/1 AA1@'��AOA o�ALA. .� - 1--C- W0 .1 S�ta�rS N 3 PREPARED FOR: CIVIL ENGINEERS l i LAND SURVEYORS %E ri L y R /_ 80ARD OF HE�A�LT�H� CONTOURS (EXISTING )- D--- 070- APPROVED DATE ST `='MA - - �v 0 SCALE (PROPOSED)-0-0�-0- �