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HomeMy WebLinkAbout0022 DERBY DRIVE e o :-�-_�.': ___::-ems .�:_.�'�:..,e..'�.ou:de.4_��=._.._..rn:.S.'.:...ar.._,. .. _.=.,L.,aNik�ea:::.ae:..a.-.i,..�__ ..:.. �.,e��...�"+:...LaeL�—��.-�� ma::3A.,,..:_��a.".�......�.. x�..�:�..us,�,�:�.:�<•�.nL':.:��_.._., r....:.:�..�--�..-wau...._._L..._.._.�.__..._._..3a:nuhv� S ET Town of Barnstable Building 0 FvxNSI'AaLs Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept p v MASS.3g, Posted Until Final Inspection Has Been Made. Permit . i6S9 Where a Certificate of Occupancy is Required, such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-17-4134 Applicant Name: SOUTHERN NEW ENGLAND WINDOWS LLC. Approvals Date Issued: 11/30/2017 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 05/30/2018 Foundation: Location: 22 DERBY DRIVE,WEST BARNSTABLE Map/Lot: 175-019 Zoning District: RF Sheathing: Owner on Record: FRIEL, CAROL ANN Contractor Name: SOUTHERN NEW ENGLAND Framing:' 1 Address: 22 DERBY DRIVE WINDOWS LLC. 2 Contractor License: 173245 WEST BARNSTABLE, MA 02668 Chimney: Description: Replacement Windows(10) U-Value .29 Replacement Doors(1). Est. Project Cost: $20,852.00 Permit Fee: $ 106.35 Insulation: Project Review Req: Fee Paid: $ 106.35 Final: Date: 11/30/2017 Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within 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. Final 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 Electrical work until the completion of the same., Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT r 1 I1 oF'ME Town ®f Barnstable *Permit. ' E.�pires 6 at Whs front issue date Regulatory Services Fee ` 6ARNSfABLE, 9 [Kass. m°' Richard V.Scali,Director iegq. 10 Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,vIA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PE&VUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Ltap/parcel Number �7 5 O �• Property Address � _���by r �/ a n Stet I P [ L� esidential Value of Work$ �?0/ Minimum fee of�$35.00 for work under$6000.00 Owner's Name&Address 0rrTo 1 -An/Ie k r;L Contractor's Name lle1Qu1 2?n / /I t 5011 Telephone Number NO( 2— Horne Improvement Contractor License 4(if applicable) l 73 s Email: Construction Supervisor's License#(if applicable) Col. s e ❑Norkman's Compensation Insurance 01'� Check one: 30 2 ❑ I am a sole proprietor � �®�Iq, �� ���I�IC�AgLE �m the Homeowner ki 1!I J f! I have Workers Compensation Insurance Insurance Company Name F; r e n; In S i i ray K�o. Workman's Comp. Policy# tit/C A _,a 7 2 9 2-O Copy of Insurance Compliance Certificate must accompany each permit. Y 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 lavers of roof) ❑ Re-side [ZReplacement Windows/doors/sliders. III-Value (maximum.32)#of windows #of doors: I ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. #Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property caner must sign Property Owner Letter of Permission. A copy the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet FIIes\Content.0utIook\2P10I DHR\EXPRESS.doc Revised 040215 r. Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal B Andersen of Southern New England_ Y g Carol Ann Friel Legal Name:Southern New England Windows,LLC 22 derby drive RI#36079, MA#173245,CT#0634555, Lead Firm#1237 West Barnstable,MA 02668 winnow FE LACEMEMT 10 Reservoir Rd I Smithfield,RI 02917 H:(774)836-5457 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Carol Ann Friel Contract Date: 11/12/17 A Buyer(s)Street Address: 22 derby drive, West Barnstable, MA 02668 Primary Telephone Number: (774)836-5457 Secondary Telephone Number: Primary Email: hurleycal07@gmaii.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: $20,852 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: $0 Balance Due: $20,852 Estimated Start: Estimated Completion: Amount Financed: $20,852 8-10 weeks 8-10 weeks Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: 50%DEP 50% ON COMP TXS PD BARNSTABLE MASS 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 11/15/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal By Andersen of Southern New England Buyer(s) 4d,, o Signature of Sales Person Signature Signature i Eric Woods Carol Ann Friel Print Name of Sales Person Print Name Print Name UPDATED: 11/12/17 Page 2 / 12 Massachusetts Department of Public Safety p Board of Building Regulations and Standards License: CS-095707 onstruction Supervisor 'BRIAN D DENNISON 7 LAMBS POND CIRCLE7. CHARLTON MA 016W'-;' •Un�j - V, «k^f . Expiration: Commissioner 09/09/2018 1iean���cr�ea� aGr 'ra�aac �trse ' Office of Consumer Affairs And Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improveni ntContractor.Registration Registration: 173245 Type: Supplement Cana SOUTHERN NEW ENGLAND WIN& S IL I� `1<��,' `_-r t- Expiration: 9l19/2018 + BRIAN DEtVNISON ; - 26 ALBION RD r-m"^ LINCOLN, RI 02865 c•` ;.�.-``•Update Address and return card.Marl:reason for change. scn I c pM-MMI —" o Address E—j Renewal _j Employment [j Last Card �' tfirP of Caasamer Affairs&.Bosiaess R%mlatioa Registrntion valid for individual use only before the expiration date.If fo®d return to: OME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Reglstradonr-7�g5:. Type: 10 Park Plaza"Suite 5170 , Expirdtlon:_9/.i9/201t1. Supplement Boston..� -�. _ PP Boso,MA O.11li SOUTHERN NEW ENGIAND.. 6OWS LLC. RENEWAL BYANDERSON EIgy`1 BRIAN DENNISONcE'-= 26 ALBION RD L INCOLN,RI 02865 'LOnde ry Not valid without signature ` The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED V1'ITH THE PER-M TTLNG AUTHORITY. Applicant Information Please Print Lelzibli, ?game (Business!Organization/Individual): e K.) -e-P41A,4 U ij Address: 2(e ALIS112L) _kj CM,/State/Zip: /J Phone 4. Are you ao employer?Check the appropriate box: Type of project(required): l..X]am a employer with Zo femplovees(full and/or par-time).' 1. New construction 2.F�I am a sole proprietor or parmership and have no employees working for me in S. �Remodeling any capacim.[No workers'comp.insurance required.) :.Q I am a homeowner doing dill work myself;No workers'comp.insurance reauired. s 9. ❑Demolition 10 Building addition 4.❑1 am a homeowner and wilt be hiring contractors to conduct all work or my properly. I will ensure that all contactors either have workers'compensauon insurance or are sole I L[]Electrical repairs or additions proprietors writ,nc employees. 12.Q PJtlrnbine repairs or additions j I f.❑1 am a general contractor and I have hired the sub-contactors listed or the attached sheet I-'.�P>zof repairs These sub-contractors have employees and have worker'comp.insu—artce.' �,/ i E. We are a corporation.and i*_officer-have exercised their right of exemptior.per MGL c. 14• Other l tl il'IUi*✓S d6lo6.r r SL.F 1(4),and we have ne employees.;lvc worker'comp.insurance reguirec.i -Any applicant thal checks box Wi1 must also fill out the section below showing their workers'compensattoc policy information,. _Homeowner`who submit this afndavit indicating they are doing all wort:and thep hire outside contactors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. Lithe sub-contractors have employees,they must provide their workers'comp.policy number. I am an emplover that is providing workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: `Irf One S - Q�M — Policy or Self-ins.Lic. ik/ 6 Z 7 ' Z' Expiration Date: 6 1 O Job Site Address: 2- 2— '�d2-r `1 r City/State!Zip:l.J.( f t� Attach a copy of the workers' compensation policy declaration page(showing the policy number and ex) ati n date). Failure to secure coverage as required under 1,4GL c. 152: E25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment as well as civil penalties.in the form of a STOP)WORK ORDER and a fine of up to S250.00 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 certif}!unde:L�-: penalties of perjury that the information provided above is true and correct Si attire: Date: Phone# Official use only. Do not write in this area,to be completed by cih°or town official City or Town: Per-mit/License s Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityrTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone€: ESLERCO-01 SANDERSO 1 DATE(MMIDDIYY" A CERTIFICATE OF LIABILITY INSURANCE 06/07/2017 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER ME CoBiz Insurance,Inc.- PHONE FAx 303 988-0804 1401 Lawrence St,Ste.COO (AIC,No,Era:(303)988-0"6 lac,No):( ) E-MA1L COMail@cobifinsurance.com Denver,CO 80202 ADDRESS: INSURERS AFFORDING COVERAGE NAIL z INSURERA:Acadia Insurance Company 131325 INSURED INSURER e:Firemens Insurance Company of WA D.C. 21784 i Southern New England Windows,LLC.dba Renewal by INSURER c:Liberty Surplus Insurance 10725 Andersen of Southern New England INSURERD: I 26 Albion Road,Suite 1 Lincoln,RI 02865 INSURER': 1 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. ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR I POLICY NUMBER MMIDD MMIDD TYPE OF INSURANCE INSD 1NVD 1,000,000 A X I COMMERCIAL GENERAL LIABILITY EACE OCCURRENCE 5 01/0112017 01/01/2018 DAGE TO RENTED 300,000 I CLAIMS-MADE OCCUR CPA3158728 PR I E Ezoccurrence 5,0001 MED EXF An•one erson 5 i I PERSONAL S AD\�INJURY 5 I,000,000 •L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2,000,0001 GEN _ 2,000,000I X j POLICY❑jEp7 C LOC PRODUCTS-C GAT AGG 1 5 � EBL AGGREGATE 5 2,000,000' OTHER: COMBINED SINGLE LIMIT 5 1,000,0001 A AUTOMOBILE LIABILITY Ea accident 1 L CPA3158728 01/0112017 01/01/2018 BODILY INJURY Per erson 5 i X ANY AUTO �—OWNED SCHEDULED BODILY INJURY Per accident' 5 AUTOS AONAOS I PROPER T\"DAMAGE HIREDI Per acutlenl AUTOS OS ON SA X I UMBREOCCUR EACH OCCURRENCE 1,000,OOOI ExCESCLAIMS�JIADE CPA3158728 01/01/2017 01/01/2018 AGGREGATE 50 Aggregate 15 1,000,000 WV,WY DED X PER OTH- B WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY YIN CA3158729-20 01/01/2017 01101/2018 1,OOD,000j i E.L.EA ACCIDENT ANY PROPRIETORIPARTNERIEXECUlnVE N 1 A I 1,000,000 FFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE 5 (OMandj y m NHI 1,000,000 If yes,describe under E.L DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS below 1,000,000 g Worker's Compensatio CA3158730-20 01/01/2017 01/01/2018 117 01/01/2017 01/01/2018 1,000,000 I.DESCRIPTION 7 18 Work rs OPERATIONS p—,n nation Inc Includes-All states except pt ND,OH,1WA,a Schedule,may be aeached a more spare Is required) � I If I � . I 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 POLJ6Y PROVISIONS. AUTHORIZED REPRESENTATIVE I F R i n I P r ©1988-2015 ACORD CORPORATION_ All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD WEATHERIZAT( N H ate Town of'Sarnstable �,VY Building Division. 200 Main St. :;• Hyannis, MA 02601 n work at D(�== The insulation -dc*- - '• �•. as been come leted in aceo('.lam 'b '-J e�^• r - ~, =x• T �y •r '� ,7�- N{Sc _ ,5::.�r.!i;�^-.:.;j•Y;:!=rr;:' �-�. ... s.-.6.c J'r�.:7. rA.,`.-Ss::�• �.0 Y�i •'1.:?f� -: :h,r„•r1'a.j j.1',:.• 3�'J•, _.r.-.,.a .;::: *f f�;ii{:i%vr.'Ir1 i�.:}S !�_'•.: .:t•,;`:C"S'7.�c CChy W President - = 's CSL 105454 3 N 58 DICKINSON STREET I FALL RIVER,MA 02721 I (508)567-4240 I ALTERNATIVEWEATHERIZATION@ IMAILCOM TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - Map Parcel • Application # Health Division Date Issued If Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved b Planning Board t PP Y 9 f , Historic - OKH _ Preservation/ Hyannis Project Street Address as , Village Owner lg.0 0 ` Addres b 1J. �2 Telephone 17 4 - O 3(v 0 I / T Permit Request PtIS w1s c.1Tt.�AS triti o �3��i'�-Ih- Ccdct11S2 kn��- ( g, c i c �, ,fin�u-1 e �:-rt o ii-+ ela.nc�x.�'r� � Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District l Flood Plain Groundwater Overlay Project Valuation W ?3,0 ) Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family N' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes Cl No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new _ Number of Bedrooms: existing _new , , Total Room Count (not including baths): existing new First Floor Room;Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0 Yes„0 No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ ri'o size_ Attached garage: ❑ existing ❑ 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name-F1 M Di CA&2d Telephone Number yV��U� /���y C) Address 7 s�� �r �� License �Gty /�{ V C/j b�7� Home Improvement Contractor# �v?,3 /'L AffW,4CGS. _' g• 0,0 . Worker's Compensation # ALL CONSTRUCTION DEBRIS RES LT NG FROM THIS PROJECT WILL BE TAKEN TO � SIGNATUR DATE I ' 4` FOR OFFICIAL USE ONLY -APPLICATION# _ DATE ISSUED MAP/PARCEL NO. � ADDRESS VILLAGE OWNER I, rx DATE OF INSPECTION: . FRAME - ^INSULAT:ION_ € p FIREPLACE . ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 7 GAS: ROUGH FINAL FINAL_BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. �ytinofI PARTIMPATING CONTRAMR mass save , ,tsrra9,tra,�+m,7Y rtl,icla,Kv PERMIT AUTHORIZATION FORM owner of the property located at: (Owner's Name, printed) I (Property Street Address) (City/Town) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's ignatu e" L( Date FOR CSG OFFICE USE ONLY i Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: i Cabo Participating Contra or Date Rev.12132011 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations ' ? I Congress Street, Suite 100 Boston, AM 02114-2017 - www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual):ALTERNATIVE WEATHERIZATION,INC. Address:1440 STAFFORD RD City/State/Zip:FALL RIVER, MA 02721 Phone #:508-567-4240 Are you an employer?Check the appropriate box: 1.21 I am a employer with 8 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance) 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1111 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no l2.❑ Roof repairs employees. [No workers' 13.2 Other INSULATION 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 anew affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. i I am an employer that is providing workers'compensation insurance for my employees. Below is the information. policy and job site Insurance Company Name:ACE AMERICAN INSURANCE CO. Policy#or Self-ins.Lic.#:6S62UB5B918901 4/5/15 Expiration Date: Job Site Address: I J L City/State/ZipW4 _ _% .�r� Ie 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 DM for insurance coverage verification. I do hereby certify unde *Pains adaftipf_aperiury that the information provided above is true and correct Signature: Date Phone#:508-567-4240 Official use only. Do not write in this area,to be completed by city or town offrciaL 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#: Office of Consumer Affairs and Business Regulation a m 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 175683 Type: Corporation Expiration: 5/29/2015 Trl# 241009 ALTERNATIVE WEATHERIZATION, INC. TIMOTHY CABRAL 1440 STAFFORD RD. - FALL RIVER, MA 02721 _. Update Address and return card.Mark reason for change. sCA 1 0 20M-05/11 Address F Renewal J Employment 17 Lost Card ���I' I�f_///J/II'J//C'('ffl��f./•�t'(f/JJI/C�J/�C•II Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ,,Registration: 175683 Type: Office of Consumer Affairs and Business Regulation yfExpiration: 5/29/2015 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 ALTERNATIVE WEATHERIZATION,INC. TIMOTHY CABRAL 1440 STAFFORD RD. FALL RIVER,MA 02721 Undersecretary N+bt validLtthout signature _,.n<trurtiunu�tcrti.,,; CS-105454 TINLOMY CABRAL ;"" • 58 DICKERINSON ST FAU River KA 02*721 - 05/08/2015 aco CERTIFICATE OF LIABILITY INSURANCE DATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: VIVEIROS INS AGENCY INC. PHONE FAx 375 AIRPORT RD A/c No Ext: ac No E-MAIL FALL RIVER,MA 02720 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:ACE AMERICAN INSURANCE COMPANY INSURED INSURER B: ALTERNATIVE WEATHERIZATION INC INSURERC: 1446 STAFFORD RD FALL RIVER,MA 02721 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. LLTTRR TYPE OF INSURANCE NSR SVWD POLICY NUMBER MML/IDCD E� MM/DD POUCYEYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PR AG ETO a NTErrDence $ CLAIMS-MADE OCCUR - MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: _ PRODUCTS-COMP/OP AGG $ POLICY 1E T LOC $ AUTOMOBILE LIABILITY a MBINaoudentED SINGLE LIMIT g ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED �2AUT 0aE�RTY AMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORaRS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVFN � N/A E.L.EACH ACCIDENT $SOO,000 OFFICER/MEMBER EXCLUDED? 6S62UB 04-05-2014 04-05-2015 (Mandatary in under If yes,describe under 5B918901 E.L.DISEASE-EA EMPLOYEE $500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 - F-I 1- DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attaeh ACORD 101,Additional Remarks Schedule,H more space is required) CERTIFICATE HOLDER CANCELLATION NATIONAL GRID SHOULD ANY OF. THE ABOVE DESCRIBED POLICIES BE 40 WASHINGTON ST CANCELLED BEFORE THE EXPIRATION DATE THEREOF, WESTBOROUGH,MA 01581 NOTICE WILL BE DELIVERED IN ACCORDANCE. WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE JOIN J.LUPICA,President ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • TOWN OF BARNSTABLE Permit No. -- 29098 - _ Building Inspector sauxm i Cash -- — • .163 ` OCCUPANCY PERMIT Bond _%-- Issued to S L S Trust Address Lot #61, 22 Derby Drive, West Barnstable Wiring Inspector� Inspection date i Plumbing Inspector Inspection date F 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 WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. /r < Building Inspector r � `' ��..� °•.ew TOWN OF BARNSTABLE .�. BUILDING DEPARTMENT I 313T = TOWN OFFICE BUILDING �g a79 �o1uY►� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy. Permit has been 'issued for the building authorized by BuildingPermit . ......................................................................_.........._......... .»._...... ......_ _..».»»» issuedto ..._.51...! / ! .......».................................._...._.......... ... Please release the performance bond. a _ BLE, MASSACHUSETTS . PERM-IT JOB WEATHER CARD DATE march 2.6, 86 Ui.101►g, 19 PERMIT N0. �� + ADDRESS `ij aniS u008121 (NO.) (STREET) (CONTR'S MPROV ellil!q ( 1 STORY Sin};ia %'.. y Jwl'Bill BR OF EMENT) NO. (PROPOSED USE) pWELNG UNITS d6l, 22 Derby Drive, West Barns-teble. ZONING (STREET) DISTRICT (CROSS STREET) AND (CROSS STREET) LOT BLOCK LOT SIZE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CON USE GROUP BASEMENT WALLS OR FOUNDATION e #85-96/ (TYPE) &)r ESTIMATED COST .� SS,O(1O,(jO PERMIT � i r (CUBIC/SQUARE FEET) FEE Trust & BUILDING DEPT. By NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPO ACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER T'!c DICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLUILD ERS CODE, E,BEU OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASETHE APPLICANT FROM THE C BDIVISION RESTRICTIONS. ALL R APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SE RK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRE OTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL ELECTRICAL�INSTgMBIAT 1 STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL rl LATH).EFORE FINAL INSPECTION HAS BEEN MADE. ST THIS CARD SO IT IS VISIBLE FROM STREET ION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPR 1 1 2 HEA T"NG INSPECTING APPROVALS REFRIGERATION INSPECTION APVU G RC "QMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS iNDICATED ON qr r RK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE cAN sE ARRANGED FOR BY 'UT IS ISSUEr) AS kl^TED ABOVE CA WB cu r rIC a_._ ITT_ NO.I. Al,C,: - -- -- 'r f2 a 30.00 / V F,gom5sD L-T Liwe A-69.47 �Ay2 APPUCA�1�-1_FI�Fo� R'60.00 � 3/I�►/SL, 6ARNSTA►B�-E _. r 1—o-T O , you wip, 'o_ m L-=o-T � 14848 FTZ± 0 o 0 s"0.0 JOB C-. 85-215 CERTIFIED PLOT PLAN PREPARED FOR: LOCATION: LOT-61 DERBY DRIVE SCALE: 1=40 DATE: 2/26/86 REFERENCE: LEBEL / SOLLOWS I HEREBY CERTIFY THAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON OF ARNE yc down -cape engineering 'o A CIVIL ENGINEERS LAND SURVEYORS ROUTE 6A YARMOUTH MA DATE Al RVEYOR SECTION - SEWAGE _ �F fg-041 0 61 GUSg'TE12 12 -SEPTIC TANK- "D"BOX - CO -LEACH If 17 .} TOP OF FD 6 Al oko •(MSL)* "2"OFIIST0 W" 301- 7ig1 ' WASHED STONE _ I � - 7r '�1 IN• OUT• IN OUT• IN• 4 / I cic G SEPTIC TANK `mil gOJ,O61 ELEV. ELEV. ELEV I L q 'ELEV. Q.,� 3'. ELEV. ELEV. ;C/IrO� �',.. - ,.. f t e--` •..•.ram �. +/ A "WASHED STONE TEST HOLE LOG p 4z-117. - TEST BY 02K;�G{t; El�lelr WITNESS TEST DATE -� DESIGN BEDROOM HOUSE T.H: • 1 T.H. 0 2 Q -r E V l� 1G 0 _-A[ lE . ( ,� ELEV. ' t,o >J>3 101� No IOD Q7 AP IL �-5.O PERC RATE C2 MIN/IN. DISPOSER DISPOSER t3oli�P FLOW RATE (GAL./DAY) �00 -- \ \GI(O\ \ �Z t o I 330 `t- Sot At-( kl M' I�� SEPTIC TANK 330 ,(1.5)- 4 \� _ f T / �" ,1 oXl A Ga`L/ -6 N D W REO'D SEPTIC TANK SIZE 10 eta, I LEACH FACILITY 6�.IJ 5I T of SIDE WALL 12rr = I�O� 8 (2,5 ) . 3'17,0 ,•G/D. / Fit 4 BOTTOM 12 2 1T = ICJ, ISO o I ( 3 �.G/D. 132" gl TOTAL 2ro3,q SF _ IIn , \ ElUSE: F—: LEACHING �`0 WATER ENCOUNTERED �1 EFF- PP''T 4 X 12' QPI-K i I I� \ \ \ �� ' I O 00, i NOTES:' (UNLESS OTHERWISE NOTED) 1�2 1 \\� \ I I I 2.DATUM.(MSL):TAKEN FRO&A 44p�4 1 QUADRANGLE MAP ``jK or 2:MUNICIPAL WATER AVAILABLE 3.PIPE PITCH:%"PER FOOT !� ! 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO- �- �0 -44 ARNE N. G S.MIN.GROUNDCOVER OVER ALL SEWAGE FACILITIES:(2)FT. OJALA ` 6..PIPE JOINTS SHALL BE MADE WATERTIGHT CIVIL c 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. NO.307 STATE ENVIRONMENTAL CODE TITLES f N Of I�, /SITEV�e� e�PlL�AN 8. Ty�-5 ptA:.J F oL ?ePvc7^�cD wo+C.fC C► ��`� t+. �0 �:�o���'p t• ' 'kt ,% ` LOCUS: ��-�) 1✓ril 111 F-I Y f/ ARNE G� 1�+ • 134 Ie , M A�, REG.PROFESSIONAL ENGINEER O,IALA - f M348 REF: do wit cape en�inee�ing PREPARED FOR: CIVIL ENGINEERS LANDSURVEYORS. -- -------- I�BOA��R``DIIOF HEALTH t REG.LAND SURVEYOR. CONTOURS (EXISTING)--•---------- APPROVED �r v��TD�� MA .YK SCALE I (PROPOSED)-O-O-O-O- DATE -�J GATE 9 Assessor's map and lot numbe .......�.at�..-.y 6........ .f( FTFIETO Sewage Permit number g S,^ 16� I. SEPTIC G@°4'd t�P ���p' 0 INSTAL e.,`: .. e 1 6.9N - -. BAHB9TADLE, i House number ... ...a...............m........................ A t639 p\0 G _ 0 YFY TOWN OF B^ARN9 TA 84-j"E `� s BUILDING INSPECTOR APPLICATION FOR PERMIT TO . .. �1...�. TYPEOF CONSTRUCTION ... , ...(./ ..Q.D...Y�...................... .... ................................................................ /!g .. ......................1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... .7 .�„�../......... ' 11 V� �.. ................. ...�. lr ........ . ProposedUse ....... 4T"`-..�..� / ......................................................................... ................................................ Zoning District .... ...............................................Fire District ............ .. . ..... ............ //�� .......`........................................... Name of Owner ..... .E`"'�` ..r `�v.7.. .......Address .... ........................................................... Name of/ iI �'�r �J e ( 1,�.��.%...............................Address ...... ............................................................................. Name of Architect ��.���.�� , ..............Address ... .. Numberof Rooms .... ..... ....... ......................................Foundation .......�.// .................................. 9 Exterior .............C,��....f.. ..... .. ...... ....................................Roofing ....... .. ... ........................................................... .... .........................Interior ........ ��� Floors f............................ Heating ............ ... .... ..... .......................................Plumbing ��. ......... Fireplace ..................: . .................................................Approximate. Cost .... .......... .......... Definitive Plan Approved by Planning Board __________ ------19K_ . Area 6............ .. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH � 6 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the7pwn of BaMler, g the above construction. Name .. .. .... .. ............................. Construction upervisor's License S L S TRUST NO 2.9098 Permit for I.J...Story . ............ ........................... Single Family Dwelling .............................................................................. Location ......Lot...#.6.1.......22...Derby. ..Dr.iv.e...... . .. . . .... . . .... .... ... . West Barnstable ............................................................................... Owner ......S L—S ...Trust Type of Construction ....Frame.......... ................. ................................................................................ Plot ............................ Lot ................................ March ,26, 86 Permit Granted .................!.................... 19 Date of Inspection .....................t.. ..........19 Date Completed .....0. 71 • TOWN OF BARNSTABLE Permit No. 29098 = Building Inspector cash onr► Bond ' OCCUPANCY PERMIT ----------------. Issued to 5 L 5 1 ruu t Address Lot '61, 22 Derby Jrivu, !.esC B..rnntsble Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector `�` Inspection date Engineering Department Inspection date Board of Health F"�Iuspection 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 . '4�5 �- 1 Building Inspector Assessor's map and lot number — ° /gb d E Sewage Permit number ............g:. .. .6..?................... : . Z BABBSTABLE, i House number ... ...a.............. .�........�"........................... . rasa ro t639- QED MAI d� TOWN .OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �� ........................................................ ._....t... ................................................. TYPE OF CONSTRUCTION .......... ....��........................ . ........................................................ 19 TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies for a permit according to the following information: Location ...... i ..... . . . . ... ProposedUse ....... ................................................................:................................................................... ZoningDistrict ....v........ ................................................Fire District .................. ...f..................................................... r �Name of Owner .....��" / / I ....................Address .. ' ������ �.... .... .... ..................... .... ... ...................................................... Name o fj7�ild'er .. :�.�1,�: -' ..............................Address .......t* ... ................................................ -42 Name of Architect ....,....,. .......Address ......................................... Number of Rooms ........ ?. ...�..........................: ...........Foundation t/'"� .. �,���� c ....Exterior / � ....... Roofing ....... .................................................. Floors ....................�.... .....................................................Interior r� ' t Heating �� . ....................Plumbin :.. "oo44r............. .. g .......... .v....... ./.......................... g .. .. Fireplace .............`...... ...r................................................Approximate. Cost .... ....... . —a%.! ........................ Definitive Plan Approved by Planning Board llwze-�q------14 Area --a.. . ..66 .......... C� Diagram of Lot and Building with Dimensions Fee i 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 Barastablere 'ding the above construction. Name . . ................................. , . z. • Construction upervisor s License .���!�.....�(....... S L S TRUST A=151-4+6 No ... Permit for ................. Siggjq.jATi1v..Dw .11ipg................. ............. ...... .... Locati6ri .....LP.t..k.6.1........ ...... ........................W.e,5.t..DA.r.W9.t.aug.......................... Owner ..........S...L...S.....Trust............................... Type of Construction ...Fr.a.me............................. ................................................................................ Plot ............................. Lot. ................................ March 2,.6, 86 Permit Granted ............... ..................19 Date of Inspection ....................................19 Date Completed .......................................19