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0066 JENKINS LANE
#r NO. 1521/3 ORA MADE IN u.SA. ESSELTE' Im . Town of Barnstable Building t ; Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted Until Final Inspection Has Been Made. Permit Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-216 Applicant Name: NEWPRO OPERATING LLC. Approvals Date Issued: 01/24/2020 Current Use: X. „, Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/24/2020 1 Foundation: Location: 66 JENKINS LANE,WEST BARNSTABLE Map/Lot: 128-004-009 Zoning District: RF Sheathing: Owner on Record: GRIMMER,THOMAS M& KATHLEEN D Contractor Name: JEFFREY CONNORS Framing: 1 Contractor License: CS-110763 Address: 66 JENKINS LANE 2 WEST BARNSTABLE, MA 02668 Est. ProjL Cost: $4,369.00 Chimney: Description: replace 1 door Permit Fee: $35.00 Insulation: Project Review Req: Fee Paid:, $35.00 Date: 1/24/2020 Final: Al 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 within six months after'issuance. All work authorized by this permit shall conform to the approved application and theI approvedconstruction 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. I I / . 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: J 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 Application number................................................ Date issued............1.� ,� L`?.............................. BAR.ws'rABM BUILDING DEPT. �"""' ' MA& $ Building Inspectors Initials....................................... Fo 3, 9. JAN 2 3 2020 oD Map/Parcel..... 2..........V........ ............................. TOWN OF BARRSTABLE 3� TOWN OF BARNSTABLE SCANNED EXPEDITED PERMIT APPLICATION: JAN 2 9 2020 ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY EWORIiUTION Address of Project: 6(P J erg K i A.5 �'n S�l8Q r)efia D �� NUMBER STREET VILLAGE Owner's Name: !► Offi LS ar i Amer Phone Numb Email Address: Cell Phone Number Project cost$ Check one Residential _ Commercial ®WNER'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: fee 4a L.rk� Date: TYPE OF WORK 0 Siding Windows (no lunge)# El Insulation/Weatherization Doors (no header change) t Commercial Doors require an inspector's review Roof(not applying more than layer of shingles) Construction Debris will be going to : �4. P�,�� �✓ �� �^ �`'� CONTRACTOR'S INFORMATION Contractor's name•1 Mn o r S - -w �!u 'ec -� I-t-'e- Home Improvement Contractors Registration(if applicable)# 1 l-1(v 5 8 �1 (attach copy) Construction Supervisor's License# I( O-1 0 3 (attach copy) Email of Contractor et f Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVE 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER.......................................:.................... *For Tents OnflY* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a:for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a health Department approval between the hoops of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require pare Department approval. *WOOD/COAL/PELL ET STOVES r 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 any responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction-inspection.procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date t�JC�8JA�1.49 S SIGNA Y W Date 6 jZ:Signature All pe it gapplications are subject to a building ofiacial's approval prior to issuance. Page 1 of 9 MA Reg#146589 ' CT Reg#0605216 r i Federal ID#20-2625129 r�y� 1 Window/ Door Contract r1 � � !- ! + Customer Information Thomas Grimmer (508) 364-6419 O<br>(508) Date: 12/14/2019 Kathy Grimmer 364-9811 (Secondary Mobile) Rep: Kurt Raggio 66 Jenkins Lane tgrimmer@verizon.net Office# 800-242-9974 West Barnstable MA 02668 Location Agreement r`isYi`a I.lat`or a cll-matt/"'rfa< - r:mentioned -' u 1 n . �.. _I NEWP;RO;hereb ;.a tees:that°it:wEIIJ';#,or.';thecansi�ier�#ic}n';hereinafte, n. _ i c r n -anntli'itf eaeirns descriliewtiri tl e''follovtiri'" neeessa . to;insta.11.#he: oods;p�tchased:by.Owner:p;a co da ce... . Y._ :. .:......9........... _h.. JI !I Bement' co{ectrvel -::this:.:A �eement.',of:�this;agr tea: 66..Jenkms.Lane .. -...... ,.......-:.. .....:....:.....:•:::>.....:.,_ . :. 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J,. . ..... ,.....;:.. ... ........; �:.,-y. ,:::-:,.:..:;>; :,�:;<::,..;,-,.;e::•:-::.::.;;}.::,,..'':'�' ts;�All'" r0 0'SY'�'~', 1,yfewo:o:will}terno e.ah.; emoed;.or_i stallation;de'ris<f>=:om.the; .,ro erk' <,ir_r..e(:atlonrto�thfs,cglltrac_,,; ,.�:...,p.,;, moti-..r!- _};y,_�...,. .+,;].,. :r. ::1:..)s:..�,t:C'�.�, .,�,.�.-:,:�Fa�, •:')�;. wry: _..,..� .,<:<Y,��,.. - --� p•h<p,... ..Y i y J�Es�-• ,<_ �,�>� _� ..-;is .::a.:•»'.: w_Yr_er..-.r.r.ee-.-.z.,.<�,.t.�p..�a lta:".✓,.1::...:.-.,.s,:,o.{✓...'_1'%.y?'cet:.ii, orL-i�..r-r...... e..rt a'th.,>>;d.::a cia<.,tG,.�r:;^;_;.a"n`.'.o:t.+R,<�6-'-e-.-.-'.s:c¢o rrn b>m.Y,.-.e:.:<i/i�r`sw-:.c L f.h.!,,::C.a'S ir.y>rxa^.:f..c�Y,U.:.,:i.t%uhis I•.e:.;•,i;<oi'ff..emr""s!.r.:-;i,.i:::h_:_,r:�.-r::e-:;>r?,'..c.::tnY,::'/r'/>..r�.��:t�!.4.:�fs'".rr'.-;>�?-;L>>.?'`,ci.ti-r.r,,��w:✓orf:;,2.-.•,¢...>a,��.;vj+�tit s�,:-•r•='»r..,n.a_.�o,<)/`"-c-S3'- ...r.-St,.,f.z. >:S. ..1: 'u'?t.�,.,>.>•:::5:::::.-::>:,..::<r, ,ys. .ski:(:.., Payment .. ..s:r.................. ..,................,..:: - t ) . .....,-. -i._�......_. -... r.r.->... ..\> .... ....... .. .. .. ,...-. .:;�.. yi3>. ...:ter'., _......z................:.....:....n.. ..:....._.......,.. .... ..... s..s....,...�.. •:5....: 'n , ..:...>....,......... ,t .... .., .i , .. .......:.....:.. :.:.:c��... ,�:.:�.�n:�';F _ - - �}5'i:v�{sun -,.'i:,: •)(_..�<t,�Ct,r•.S'�,.�%'-J"1•� f. <$4369 .D.ue U on Co r P ent Method . .. ... r. ,�., ._..... . ..... ...... . :.,. .. . Estimated Start&Completion Dates , t tart Date.. ..... ......................::: ..-..:....,,... ,._.,..,.;<=; ��01:29;2019.' _ � .fir e ........ ... ......... ... ._.............. >, ..<., .. -.< ... ... .. ... ....... .. .. . . .,.. .. ... ,...... - ter'.::. .i Est ted_Co et�o .Date........ ........ ... ..... ..... .. : , . ,...... ._. ... - Q/2 - 9r. r:../...- ,.J. f..... .........,1. .. ..- ... ... ...._><..:...:.. ,.j✓::S cry?, „ :'. efstaiids't at't ese'are:est•mate ateS;an :will;be<contacted to scli'edule`actUalKda`"te; x:: � : ........ .......... r , r ra < t : j. 6' r : r r i r' �i T� his'spae�� nteritionally left blaFk 's , - .a" J ,e t - F i - i x : Y< : L.eapToDigital-rom 1.5.3 i .y i Page 8 of 9 Terms and Conditions Owner has read and agrees to the terms and conditions of this Agreement. Owner specifically agrees to the (1) Total Cash Price; (2) work being performed; and (3) work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two (2) copies of a cancellation form explaining this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. YOU THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY OF THIS TRANSACTION, SEE THE ACCOMPANYING NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. The undersigned gives NEWPRO permission to debit their checking/savings account, or process a credit card transaction, for the deposit amount indicated on or after the contract date. Subsequent payments, such as start payments, or completion payments will remain in effect until I cancel it in writing, and agree to notify NEWPRO of alternate payment intentions. If the above noted payment dates fall on a weekend or holiday, 1 understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that NEWPRO may at its discretion attempt to process the charge again within 30 days. 1 acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute the scheduled transactions with my bank or credit card company; provided the transactions correspond to the terms indicated in this authorization form. Thomas Grimmer Kathy Grimmer"" 12/14/2019 12/14/2019 Date Date Z4/ Kurt Raggio 12/14/2019 Date = = top jf : r ' a r .r R ,r i Y. ,: i :r i i This spacelntentiona efx an tt Ily l f k.: , : : r v' r r' r Br re t" ,r E' d 4•, P J�Ft Or : .st's^ '1 ' Al r r LcapToDigital• ram 1.5.3 )711 Or-fi-ce ol' Consumer Affa',3 and &Isines-s Rqguliatjon 1000 11V ashingto n Street - S Ote 710 Bost.C)n, Nlasisaohusefts 02113 Home 1morovemen-t.:Qontracfor ReOlra-ion Type: Supplement Car,,, - 89 Registration: 1;.4,6-5- i14EINPROOPERATING 1-1-0, E;Oration: ',5 W2.021 26 CEDAR ST. WOBURN, kIA 0-130i Update Address and Return Card. Office of Consumer Affairs 9,Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individuai use only TYPE;-SIjazilement Card before the expiration date. If found return to: Registrattore. Expiration Om. of onsumer Affairs and Business Regulation f4BM1--- 05iG4/2021 Ington Street Suite 710 f 1000 NE101 PRO OPERAT .6.lonn, A 02118 JEFFREY C0NN0'RS,.!;-:-- 26 CEDAR.3T. y q V. 'NOSURN.XFLA 01801 Undersecrestarl v of valid without signature v. Massachusotts Department of Public SYety Goard of Building Regulations and Standards License: CS-110763 JEFFREY CONNORS 64 OLD FIELDS ROAD* SOUTH BERWICK ME 03908 .xpiranon. OS/0512020 f The Commonwealth of Massachusetts set s JD Department of Industrial Accidents -ess Street,Suite 100 1 Cong> Boston,ALA 02114-2017 y�> www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEM IITTING AUTHORITY. na Alicant Information Please Print Le ibiy Name(Business/Organizationdndividual): , r pro ��Pt'6v�i ll 5 LL- Address: Z�„ ('p�,(, City/State/Zip: Wo rn O t7 ( Phone#: /—8 0 2 Z 1 Arc you a employer?Check the appropriate box: Type of project(required): 1. [am a employer with 1. employees(full and/or part-time).' 7. [:]New construction 2.❑I am a sole proprietor or partnership and have no employees working'for me in any capacity.[No workers'comp.insurance required.] $• ❑Remodeling 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]* 9. ❑Demolition 4.❑I 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 I will 11.[]Electrical repairs or additions proprietors with no employees. �.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12. Plturibing repairs or additions These sub-contractors have employees and have workers'comp.insurance.: 13.❑Roof re airs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.('Other 157,§1(4).and we have no employees.[No workers'comp.insurance required.] TC +Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infbrmation. 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 subcontractors 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'coy nation htsurance for my employees Below is the policy and job site Information Insurance Company Name: Policy#or Self-ins.Lic.#: � q27 -7 Expiration Date: S' Za Job Site Address: S�O leo W City/State/Zip: (�, Qg Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiratiod date). failure to secure coverage as required folder MOE c. 152,§25A is a criminal violation punishable by a fine up to$1,300.00 and/or one-year impriso ment,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 viol r.A y of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio . I do hereby certify_t nd t pains and penalties ofperjury that the ittrormation provided abovA�rsrue and correct. Sienature: Date: i y Phone#: —8 Y y— 2 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#: DATE(MMIDD/YYYY) AC:iZ® CERTIFICATE OF LIABILITY INSURANCE 12/31/2019 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(les)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 andorsement(s). NAME Melissa Pflug PRODUCER N The Hilb Group of N.E.,LLC dba Mackintire Insuranc . PHONE (508)366-6161 FAX (508)366-5202 A/c No Ext. A/C No): 11 West Main Street E-MAIL s: melissap@mackintire.com ADDRE INSURER(S)AFFORDING.COVERAGE NAIC as Westborough MA 01581-1931 INSURERA: EMC Insurance Companies INSURED INSURERS: Guard Insurance Group Newpro Operating LLC INSURER C: Colony Insurance Cc 26 Cedar St INSURER D: INSURER E: Woburn. MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER: 19-20 Master 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSLTR TYPE OF INSURANCE N POLICY NUMBER MMID EFF PMMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one personi 15,000 A 6D15090 12/31/2019 12/31/2020 PERSONALBADV INJURY g 1,000.000 GEN'LAGGREGATE UMITAPPUES PER: GENERALAGGREGATE g 3,000,000 X POUCY ❑JEa LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1.000.000 Ea accident) ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 6Z15090 12/31/2019 12/31/2020 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED FXj NON-OWNED ONLY P � PROPERTYR DAMAGE $ AUTOS ONLY fj Uninsured motorist BI $ 250,000 X UMBRELLA LIAO OCCUR EACHOCCURRENCE $ 5,000,000 A EXCESS LIAB HCLAIMS-MADE 6J15090 12/31/2019 12/31/2020 AGGREGATE $ 5,000,000 DED I X RETENTION$ 0 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/F_XECUTIVE E.L EACH ACCIDENT $ 500,000 B OFRCER/MEMBER EXCLUDED? NIA NEWCO28778 05/01/2019 05/01/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Limit $1,000,000 Pollution Liability C� CSP304242 12/31/2019 12/31/2020 Aggregate $2,000,000 DED $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN To Whom It May Concern ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD L ZM4E r Application number........N.....L.5.... .... .. gC{'� Date Issued..........I......�.0....-1..�.........................� ® ���` tl snR.Nsrnst�. . Building Inspectors Initials....0 6r 1639. iO�Fc,ns► �,,�� 3 /Lk OOLI009 f OW 6 i � BARNSTABLE Map/Parcel................................................................. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION . PROPERTY INFORMATION Address of Project: 66 -,�& k n s La.ne- NUMBER STREET VILLAGE Owner's Name: Tt,,o n,a S h KQ�YI., 'r;mnic�/ Phone Number &415 7 Email Address: fi r;en r-,e r- (S ✓er i zc,n ne-4 Cell Phone Number Project cost$ 3 0'-((o Check one Residential ✓ Commercial OWNEWS AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Siding ✓Windows(no header change)# - 2 ❑ Insulation/Weatherization l� Doors (no header change)# Conunercial Doors require an inspector's review Roof(not applying more than I layer of shingles) Construction Debris will be going to coa s-E�7kAAA&C,-e� e •�� COlV 1L R AC g OW S INFORMATION OR1V1 A A IO Contractor's name r KrOcky,' sl��/�/�J�w Home Improvement Contractors Registration(if applicable)# /�O,�q (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number 800- 3 - - 2 2 i ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For 'Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X. X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a:for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STONES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side i HOMEOWNER'S LICENSE EXEATTION 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 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CM R and the'Town of Barnstable. � Signature Date APPLICANT9S SIGNATURE Signature I/V - Date /- Z H— l q All permit applications are subject to a building official's approval prior to issuance. i G /1 Page 1 of 12 Reg 5 CT CT Reg g060060521216 Federal ID # 20-2625129 Window / Door Contract Customer Information Thomas Grimmer (508) 364-6419 () Date: 12/17/2018 Kathy Grimmer tgrimmer@verizon.net Rep: Kurt Raggio 66 Jenkins Lane Office# 800-242-9974 West Barnstable MA 02668 Location A reement NEWPRO hereby agrees that it will, for the consideration hereinafter mentioned, furnish all labor and material necessary to install the goods purchased by Owner in accordance with the terms described on the following pages of this agreement_ (collectively, this "Agreement").at the premises located at: 66 Jenkins Lane West Barnstable MA 02668 Windows Being Installed: 2 Doors Being Installed: 0 Window Details Location: Bedroom 1 Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Y�. Exterior Color: White Grid Pattern: None Hardware Finish: White Grid Type: None Additional Labor: (Conversion) Glass Options: None Location: Bedroom 1 . Series: Ecomax Double Hung Interior Color: White Screen Type: t 1/2 Exterior Color: White Grid Pattern: None Hardware rinish.: White Grid Type:: . . None Additional.Labor: (Conversion) Glass Options: None Window Capping Type Standard Capping Capping Texture PVC Capping Color Aspen White 28321 Additional Details Newpro will remove any demoed or installation debris from the property in relation to this contract. All promotions were applied at the time of purchase and can not be combined with any future offers. Pa ment Total Price: _ $3,046 Deposit $1,015 Due Upon Completion $2,031 Payment Method qP D Cash This space inLentioriall'io lefI blank Page 12 of 12 Terms and Conditions Owner has read and agrees to the terms and conditions of this Agreement. Owner specifically agrees to the (1) Total Cash Price; (2) work being performed; and (3) work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two (2) copies of a cancellation form explaining this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. YOU THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY OF THIS TRANSACTION. SEE THE ACCOMPANYING NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. The undersigned gives NEWPRO permission to debit their checking/savings account, or process a credit card transaction, for the deposit amount indicated on or after the contract date. Subsequent payments, such as start payments, or completion payments will remain in effect until I cancel it in writing, and agree to notify NEWPRO of alternate payment intentions. If.the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that NEWPRO may at its discretion attempt to process the charge again within 30 days. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. 1 certify that I am an authorized user of this credit card/bank account and will not dispute the scheduled transactions with my bank or credit card company; provided the transactions correspond to the terms indicated in this authorization form. Thomas Grimmer Kathy Grimmer 12/17/2018 12/17/2018 Date Date Kurt Raggio 12/17/2018 Date This space intentionally left blank Commonwealth of Massachusetts r Division of Professional Licensure r Board of Building Regulations and Standards Construacd66'Sapervisor CS-105188 E pires: 11/01/2019 s VLADIMIR KR-UCHYNSFCY`1.` PIN 1 PAVILLION ROAD AMHERST NH 03031 '�%i�L'.i-jam' • Commissioner - _ ���N 1'Gr.�n:�nn�iraealf/e r,•�•�CttJxiclv.�;e1.t� �F Office of Consumer Affairs&Business Regulation r _ HOME IMPROVEMENT CONTRACTOR r.'PE:LLC �•- � - ` �@�on iration 5 03123/2019' ALL WORK CO13S3A;t=CtbitVE VLADIMIR KRUCHYRSk t 1 PAVILUON RD. - AMHERST,NH 03031 Undersecretary The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 "w www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electiicians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information 1 Please Print Legibly Name (Business/Organization/Individual): Ale-W P t 0 C70P rd';,i 4-1- C Address: a 62 eedar S-t City/State/Zip: 4110 b ur✓1 /"1 .4 OI fft2l Phone k /- ?00 -3 9/2-L Z It Are you an employer?Check the appropriate box: Type of project(required): I.6d'am a employer with S employees(full and/or part-time).* 7. ❑New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.(No workers'camp.insurance required.) 3.[]I am a homeowner doingal.I work myself 9. ❑Demolition y [No workers'comp.insurance required.]t 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I ell ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.[-]Plumbing repairs or additions 5.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.+ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[]Other 15Z§1(4),and we have no employees.(No workers'comp.insurance required.) *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: 1 (`C� �• f'OJ Policy#or Self-ins.Lie. 7�( Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number Aid expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment 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 copy statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veri.5 ) . I do hereby c rti un er epaiAls and penalties of perjury that t 't ormation provided above is true and correct Si nature: Date: Phone#' (- go b- 3 N Z -Z 2 ] 1 Official use only. Do not write in this area,to be completed by city or town offciaL 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#: �_.�� .rY•V i��.N.'1,11/F<�(:!�'a .S'y"l�y�'j `i�'.� 4�:! ��(' -1 "C is"Y.-�-- '/ i%vy ' ir v'i.•. Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home lmprovement'Contractor Registration Type: Supplement Card NEW PRO OPERATING,LLC. Registration: 146589 26 CEDAR ST. Expiration: 05/04/2019 WOBURN,MA 01801 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SuoDlement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 148589 05/04/2019 10 Park Plaza-Suite 51- 0 NEWPRO OPERATING,"LLC. Boston,MA 02116:'� VLADIMIR KRUCHYNSKYY 26 CEDAR ST. J WOBURN,MA 01801 Undersecretary Not valid Without signature ACORO® DATE(MMIDDNYYY) `� CERTIFICATE OF LIABILITY INSURANCE 01/05/2016 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(les)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). PRODUCER CONTACT Melissa Pflug Mackintire Insurance Agency Inc PHONE (508)366 6161 F (508)366 5202 AIC No Ext: A1C No 11 West Main Street E—MAIL : melissap@mackintire.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC A Westborough MA 01581-1931 INSURERA: Sentry Insurance INSURED INSURER B: Guard Insurance Group Newpro Operating LLC INSURER C: Colony Insurance Co 26 Cedar St. INSURER D: INSURER E: Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 Master 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. IPOLICY EXP LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MMILDD ICY EFF MMIDD LIMITS no' CMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1.000.000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence S 500,000 MED EXP(Any One person) S 15,000 A A0062403003 12/31/2017 12/31/2018 PERSONAL&ADV INJURY s 1.000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE S 3,000,000 X POLICY JEo- LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: I S AUTOMOBILE LIABILITY COMBINED SINGLELIMIT S 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) S A OWNED SCHEDULED A0092403004 12/31/2017 12/31/2018 BODILY INJURY(Per accident) $ X AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE S AUTOS ONLY I� AUTOS ONLY Peracddent Uninsured motorist BI s 250,000 UMBRELLA LIAR '"""' S,000,000 OCCUR EACH OCCURRENCE S A EXCESS UAB HCLAIMS-MADE A0092403006 12/31/2017 12/31/2018 AGGREGATE S 5,000,000 DED I X1 RETENTIONS 0 S WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500,000 B OFFICERIMEMBEREXCLUDED? NIA NEWC874066 05/01/2018 05/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500.000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S Pollution Limit $1,000.000 C CSP304242 12/31/2017 12/31/2018 DED $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Boxborough Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 29 Middle Road AUTHORIZED REPRESENTATIVE Boxborough MA 01719 � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD i 3 �S. � ® Application number sna.Hsrnsi.s slued............tifi. ... .............. NAM ApF . r®�� 1 Phu?�ing Inspectors Initials.. ... �. end• AJ-l�8 ap/Parcel.....�z 80 C� .... �18/1y8 ................ ...................... TOWN OF BAR STABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATIiERIZATION PROPERTY INFORMATION Address of Project:6,1, _J;1 k,-,,S Lit, 1 i7 s� NUMBER STREET VILLAGE Owner's Name:-c±i Phone Numbers pR- G �( - 6 y 1 Email Address: X �;�,, ,.., r o �-�✓ tion C- --, Cell Phone Number Project cost$ 7 (o c{ — Check one Residential Commercial OWNER'S AUTHORIZATION ON 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" A-As cha C��-{c -�- Date: TYPE®IF WORK Siding Windows (no header change)#* Z 0 Insulation/Weatherization Doors (no header change)# Z Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to 4d a sfe-/Gila g P�IP� - �,�c o/•'► /� CONTRACTOR'S INFORMATION Contractor's name (�(�Gn ire n�,'so✓� - �„ .2 c� �e�! �r (ti,� 'n��ow S Home Improvement Contractors Registration(if applicable)# 17 3 Z.g{-� (attach copy) Construction Supervisor's License# 09 S 7 0' (attach copy) Email of Contractor Phone number 110 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC,DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. r � APPLICATION NUMBER............................................................ *For 'Vents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X , X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent df food is being served at your event please obtain a Health Department approval between the hoary of 8:00am-9:30 am or 3.30 pm-4.30pnL Commercial events may require Fire Department approval *WOOD/IC®AL/PELL 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 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documeantation required by 780 CMR and the Town of Barnstable. Signature Date PLICANT9 S SIGNATURE Signature t) Date 7 All permit applications are subject to a building officials approval prior to issuance. r Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Kathleen ALACEMENT Legal Name:Southern New England Windows,LLC 66 Jenkins Lane RI#36079,MA#173245,CT#0634555, Lead Firm#1237 West Barnstable,MA 02668 WINDO 10 Reservoir Rd I Smithfield,RI 02917 H:(508)364-6419 Phone:866-S63-2235 I Fax:401-633-6602 1 sales®renewalsne.com C:5083649811 Buyer(s)Name: Kathleen Contract Date: 07/05/18 Buyer(s)Street Address: 66 Jenkins Lane, West Barnstable , MA 02668 Primary Telephone Number: (508)364-6419 Secondary Telephone Number: 5083649811 Primary Email: kgrimmerpbt@yahoo.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: $17,643 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: $17,643 Estimated Start: Estimated Completion: Amount Financed: $0 8 to 10 weeks 8 to 10 weeks Method of Payment: Cash/Check 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: 1/3 dep ; 1/3 due at install ; 1/3 due a compl 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 07/09/2018 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Rw England Buy enee� y d n of o [hern Ne -�sC� Signature of Sales Person Signature Signature Kevin Desmarais Kathleen Grimmer Print Name of Sales Person Print Name Print Name UPDATED: 07/05/18 Page 2 / 12 r: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2018 BRIAN DENNISON 26 ALBION RD =- LINCOLN, RI 02865 Update Address and return card.Mark reason for change. Address Renewal - Employment — Lost Card -=-Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the ` HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 1 i 3245 Type: 10 park Plaza-Suite 5170 Expiration: 9jl9j2018 Supplement Card Boston.MA,0=116 OLITHERN NEW ENGLAND WINDOWS LLC. :ENEWAL BY ANDERSON RIAN DENNISON 6 ALBI ON RD INCOLN, RI 02865 �;adersecreiary Not valid without signature C i``-+v ` L.-.i-.''C vv�- _Csiri1 0`' Cs . 11Ls1ii ��e:alati;13r C and '+an�aivJ BRIAN D DENNISON LAMBS POND CIRCLE HHARLTON MA 01507 L "' The Commonwealth of Massachusetts ' Department of Indusirial 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 WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le 'bl- Name (Business/OrganizaiionMdividual): E e t Address: City/State/Zip: Its Phone#: Are you an employer?Check the appropriate box: 1,KI am a employer with Zo femployees.(full and/or part-time)-* Type of project(required): 7..�New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. ❑Remodeling any capacity.(No workers'comp-insurance required.] 3.❑I am a homeowner doing all work myself[No workers'comp.insurance requvedl 9• ❑Demolition 4- m a homeowner an wl be hiring contractors to conduct all work on m 10.D Building addition ❑I a h dU y property. I will � ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.[ Plumbing repairs or additions 5.Q 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have worker'comp.insurance.+ 13.❑]RRoof repairs 6.❑We are a corporation and its officers have exercised their right of exemption,per MGL c. 14.F2 05ther4i,n d/jws 152,§1(4),and we have no employees.[No worker'comp.insurance required.] ree lacen e4 7"�5 *Any applicaurthat checks box!?l must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my emplovees. Below is thepoLicy mind jab site information Insurance Company Name: �lre men S S. 69 M wq Policy#or Self ins.Lic.#: C 31-87 Z q — Z- Expiration Date: j Job Site Address: /6,1 S 4/2. City/State/Zip:/f 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. 152,§25A is a criminal violation ptkiishable 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. - I do hereby certify under th sins and penalties of perjury that the information provided above is true and correct Sianafore: e - Ddte: 7 Phone#: QD I-2z.g% j 91MD . Official use only. Do not write in this area,to be completed by city or town ofciat 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##: ' f CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIYYYY) 12/29/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CoBiz Insurance, Inc.-CO NAME: PHONE 1401 Lawrence St, Ste. 1200 303-988-0446 A/c N.:303-988-0804 Denver CO 80202 EADDRESS: COMaiI cobizinsurance.com I INSURE S AFFORDING COVERAGE NYC 9 INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 Southern New England Windows, LLC. INSURER a:Tremens Insurance Company of WA,D.C. 21784 dba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1252851165 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL SUBR - LTR TYPE OF INSURANCEimsn POLICY NUMBER POLICY EFF POLICY EXP MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILJTY CPA3158728 1112018 1N2019 EACH OCCURRENCE $1,000.DOD CLAIMS-MADE OCCUR D—AM-A-GE TO RENTED PREMISES Ea oavrrence S 30D,D00 MED EXP one person $10.000 PERSONAL&ADV INJURY $1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.00D.DIro i X POLICY FACT LOC t PRODUCTS-COMP/OP AGG $2,000,OOD OTHER: ( A AUTOMOBILE LIABILITY N CPA3158728 1112016 1/1/2019 COMBINED SINGLE LIMIT Ea accident $1 OOD 000 X ANY AUTO _ BODILY INJURY(Per person) $ ALL OWNED SCHEDULED � I AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS I Per accident $ I S A X UMBRELLA LIAR X OCCUR CPA3158726 1/12016 1/12019 EACH OCCURRENCE $1D,ODO,000 EXCESS L1AB CLAIMS-MADE AGGREGATE $10.0D0.00D DED I X I RErENnON$n S B WORKERS COMPENSATION WCA3158729-20 1112018 1/12019 X PER OTI+ AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNERM(ECLITIVE OFRCER/MELIBM EXCLUDED? NIA E.L.EACH ACCIDENT $1.00D,000 (Mandatory in NH) EL DISEASE•EA EMPLOYEE $1,OOD,000 H yyeess describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$1.000.000 C Pollution Liabft 79M073340000 111r2018 1112019 Each Occurrence S1,000.000 Gains-Made Policy A99regate S1,0D0.000 Retroactive Date 06202013 Deductible $10.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25.(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable Approved Regulatory Servic&W-N OF BARNSTABLE Fee Thomas'F.Geiler,Directgr03 JAB 2] p Building Division L� 4 33 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA-42601 DIVISION Office: 508-862-4038 Fax: 508-790-6230 Home Occupation Registration Date: J�Name: ✓/�Ltf�it� Phone / ��t-�� O` � Village: Address: l.P Name of Business: Type of Business: � �� � e n�6�Map/Lot:� INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal r 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 dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: —7 / — ilnm Anr. NOTES RECEIPTIV : .:._ DATE /�' 7 � No. 7156 RECEIVED FROM �' t ADDRESS �. ACCOUNT HOW PAID AMT.OF CASH ACCOUNT AMT. CHECK PAID BALANCE' MONEY By DUE ORDER ©2001 REDIFOR`M-8L808 . ` Assessor's offioe (1st floor): p� rr�Y� J �FTNET� / d O 00 Assessor's map and lot number �,/........�....................s �Q� o Board of Health (3rd floor): Sewage Permit number :1..!....!..v...... `!'......,111 � t BASd9?ADLL, i AM Engineering Department (3rd floor): - / / o +�b 9 e� House number ........................:7..............v ''�c Max a� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only, TOWN OF BARNSTABLE BUILDING INSPECTOR ...r... Win. . ............. APPLICATION FOR PERMIT TO �..�'.� ��.. ..�. ........................... TYPE OF CONSTRUCTION ............::...(ltJT ..... ............................................................ ......... �....................19......._ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...(.... .. ... /vl� •! `5...... /.......�.e.. ..: �QA.)5'�fliC..F...... � ........• ...... ProposedUse ..SO �.:� 1FAN 1.(-.U'.�...................................................................................................................... IF ZoningDistrict ......!` 1...........................................................Fire District .............................................................................. i, Name of Owner ... .......��f. :........Address .....6.xX....... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... l^ n • Number of Rooms ..............I• ...............................................Foundation .........t���.�I�.....t......��t��...�..�. ........ Exterior .. &=-.1�fT 1 ..... � i!t�,�i�.,�1..�I, (_��.....Roofing �,�1 �7.: �. .�!1�.�� .......... Floors ..CAkef .............................Interior .................59-.7�..J..eX................................ Heating . , ....... ...... ...............................Plumbing ............... .......A f -,T Fireplace ...N6.......................................................................Approximate Cost ..........�45�K..............................�..... Definitive Plan Approved by Planning Board -----Z,,Z_`_-7--------19 Area .......................................... A Diagram of Lot and Building with Dimensions Fee y ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ' � Via,.!�.��(2�• `�ji�-�� •. r 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 ...... • a Construction Supervisor's License ....�J �?�..1... ........ GREENBRIER CORP. = 8-004 No .3.3.4.8.2... Permit for .......?............KY........... Single .Family ......... Location ...Lg:t...#.7 ......66..Jenkins..L.an.e ..................W.e_s.t..J3.air X.1*.t- . ........................ Owner .....Greenbrier...Corp. .. .. .... .. .... .. .... .. .. .... Type of Con struction ...Frame ***............. .......... ............................................................................... Plot ............................ Lot ................................. Permit Granted ....January... .......19 90 Date of Inspection ....................................19 Date Completed ............................... ......19 PERMIT COMPLETED 1/1/V1 A6ses7sor:9 offioe (1st floor):. 7. - f 77pp ® T Assessor's map-an lot num er �.... :./....�(.4...�0(1 �° THE Board of Health (3rd floor): Sewage Permit number . .... ................... .....! o t/ IN TODLE, . t Engineering Department (3rd floor): - ♦° House number � ���'® APPLICATIONS PROCESSED 8:30:9:30 A.M, and 1:00.2:00 P.M.'•onlyTOWN WA`C®®rz-41 TOWN, OF BARNSTABLE BVILDIHG IHS'PECTOR APPLICATION FOR PERMIT TO ...... . d`Z!l5. TYPE OF CONSTRUCTION ..................W. ...... 1 " ,..........................-.......................................... 1.. .. ...........19 '� TO THE INSPECTOR OF BUILDINGS: —,,,,_The undersigned hereby applies for a permit according to the following information: _ Lo ation ...� 7.....� /o .....L�". ✓j...... ,Rt�. : f{" !1�s� �✓.t � �:..... .....Q. i�J �............... ProposedUse ....ti �AJI..Lr......}VM. t-.Y j(..................................................................................................................... f Zoning District ...... ..... ................:......................................:...Fire District p Name of Owner ... .{ :..... ,,' (••.'........Address, ....5�X......?1.0. C��_;&_41VdLL /k �� Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ...................7 ....:..............................:.........Address .................................................................................... Number of Rooms .............. ............................................:..Foundation .........FL ... ......����.�<(�. ......... Exterior ..( .(! ..... � 1iV..�j.Z6..,1....a.�-v�......Roofing ......`.......... �TI�T......�/���.l�l -......... Floors .....vl.jj..�t. ......�Aze-r.............................Interior .................�J(I. '�i...( F-G. .? ................................ zr Heating ... !'r........ v11......6, ..............Plumbin .....13,11` .. #Fireplace ....p"• 1# ................... Cost ...............-4.................................. . ........ I! Definitive Plan Approved by Planning Board -----4p_-__ _7--------19 D_ Area .......4O S .................................. Od Diagram of Lot and Building with Dimensioris Fee ..............�.:......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH �Q . t 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 ......Ad44 i. .....L.....�........ ..... .. Construction Supervisor's License .....�W vREENBRIER CORP. � 71, Nb .33482... Permit for ....1 Story........... q a .....Sncile Family Dwelling ............... Location .Lot .,#7, 66 Jenkins Lane'. West Barnstable ............................................................................... Owner ...Greenbrier Corp. Type of Construction ...Frame . ............................................................................... Plot ............................ Lot................................. Permit Granted .... January 29, 90 ..........................19 Date of.Inspection ...........................4........19 Date Completed :.....................................19 ts Ito oo . j t N/F JOHN h PAUL MERLESENA 68.40' 108.21' �o o " r- 97.4' rn o T.0.F. N N 59.8 ti. 94.5' 2Z4' LA co Lot 7 W 49,036 sq ft.f > o o ' t Lot 6 N/F TAISTO RANTA . N 0� �ltK• oa L-39 76' �o % Jen L=389$ jf n's I, Lot 8 I (50' Md.) a n e THIS PLAN IS NEITHER INTENDED ' wrnAR� N0. DATE DAiE .. .--__. DESCRIP710N gy FOR, NOR SHALL IT BE USED FOR � AS-BUILT FOUNDATION PLAN-LOT 7 MORTGAGE LOAN PURPOSES. tee,` S LANE � BARNSTABLE, iMACHUSETTS —.tN o—M GREENBRffit DEVELOPUM CORP. scAm 1" = 50' im Na 1120 1 CERTIFY THAT THE FOUNDATION °4 PAUL A. �`"_ 7 so too SHOWN ON THIS PLAN IS LOCATED LEVy ON THE GROU DICA �[110• 10617 y �' : 1811Y, NiDIiBDGB k Tim BMW INC. bAtt REGI RED L D SURVEYOR S►dR � ® +�®� i �X� Big vm um slRmzr MA.02632 ° t ----rt I- 'llo• I '� s•��:. a ie IH I I 2V°h t lG•OL. 1 r e w ix pa c ¢ WWC erA-fp�o CTtp7 I fly— Tr _1� IJf1•. O►)�'1{�r l�{•�f* {�i'i'b���d`��•��T�n✓�' . r I !/•+'fl•+•� faer,..tf :-Z4'.cv�•H2'td-moo ? --' ��J �i IQ� ..._._._. -- -��''�•�u•�-<N NFI iYrFEI�o¢. 3 APPROVED ; O HANGES TOWN OF BARNSTABLE wue W+ti b• ...worms.�1A�Y�./s-tl:li'!_ o.w�.K J•�. I Building Inspection Department i I - r��"/ `�'�y� µ1 r,n,iNi»✓1 +'r*la! aAa4 .. - i�g_-�- aivo a E �. �.u40 r�-J:. 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