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0242 JOE THOMPSON ROAD
r r - r= � S E ck r . � t Town of Barnstable *Permit# 261 O Expires 6 months from issue dote Regulatory Services Fee _ s. snarrsrwzm Uj MAM $ Richard V.Scali,Director (/P AjED MA't� Building Division �RESS rn Tom Perry,CBO,Building Commissio er NOT 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us JUN 18�015 Office: 508-8624038 TOWAI f)1: �F�ax- 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONEVABLE Not Valid without Red X-Press Imprint Map/parcel Number J 7 �0 40 Property Address "residential Value of Work$ �3 Minimum fee of$35.00 for work under$6000.00 /Owner's Name&Address Contractor's Name R Telephone Number y^O� /3 Home Improvement Contractor License#(if applicable) �y� Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance , Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value 3 �Cimum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property OwnerLefter of Perm issi A copy of the Home Improvement Cont rs License& tr do isors License is required.. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 i i The ComnlmxwwealNt ofMassackmw& ' Aar>tntent ojlndus&WAccidm& I Congress Stree4 Sm&e 160 Boeton,MA 02114-2017. �,a ,Coin �: gov/dia Pmatim hwarance Affi kft BmI&WContractonmectricians/pWmbers TO BE FILLED WITH TIM PEBbIITI NG AUTHORITY. A�alicant Ltform=bon i Name(Bns,mes� ; / __ i '' / Pies"Print Lenz-bly i Address: City/State/Zip: i Phone#:4V I7 3'5'3 VwC) Ant yea an esptoyer!Cunt me appraprum boor: ! t.[]I amL oyerwith ea�loyees(5il1 and/or aType of pro1�(requi�: [2.[]ImnasdepmpieWorporamrshipmdbavanoemployamwmt,ng�� 7. ❑New conshvction a°y ww1ms aeAaao= l for me in g, []Remodeling 3.0 lam a homeommr digh *M,OMp l t 9. ❑Demolition 4.01 am a homeowner and wilt be hiring Ocuftdars to coodad all wash an my property. I wall 10❑Building addition C°S=that A eomractocs either have washers'oompeasation i or are sole proprietors VA&no emPk y� I LEI Electrical repairs or additions s. am a gmwal caetnoctw and I have hired the 12.Q Plumbing repairs or additions sab-�mactara listed on the dWchad sheet halve employees and bave watt m,comp.msmwmt 13. Roof repairs 6.0 We are a catpowtien and its affwns have used their ' of 14.Q Other]A§1(41 and we have no employees,[No wart M,000i !d MQ,a `Ek aP,Mn that cheats boot#I t must also fin Outdo aection blow Aawbg their walms'comp�on Ply insos,�who submit this affidavit fix ics&g they are d0bg A wash aad then biro auffiide k OMIXI s that check this bar must easmeaetoramist submit a new affidavit' emPbyees If the an additional shed showigg the naome of the sab.coahac6ors and arsine vvlidher or not dwae have cm*yeM>hY mast psavide their v/GIb a'camp,Policy mmnba �1 P eg rvor rra'co oar hiU"wx e,jor rmy m9doyees, sdowJs A&ep0Jk7 t=djbb S* r , e�`�i e T»smance Company Name: ��N@�zk/ / 1 ry Policy#or Self-ins.Lit. ©1 7� y Expiratio n Date: � Job Site Address: Attach a ceP9 of the wotrkera'oompeastrtion ply ration pap(showing the Policy numberLeKpirztjon da(e Failtn+e to sectae oGverage as requu+ed under MGL c.152,§25A is a criminal violation and/or one-.year i nm�as well as civilpunishable by a up to $250. O day the violator.A penalties in the form of a STOP WORK ORDER and afire of tutu to 250C�0 a copy of this may be forwarded to.the Office of Investigations of the DIA for instirane coverage verification. I do herby cm* o ' e Froviderd above' bite caornut Phone i 4ffiefal use only. Do not write in this asro�m be coed i3y crty or town o daL i City or Town: Perms# f Isar Aaffiority(�one): i L Board �of Heaitli Z. g Department 3.City/I'own clerk 4.Electrical Inspector pectur S.Plumbing Inspector i i Contact Person: Phone#: �ie,nn� CE verner,�- ,rN��t- �1 roceA ��4C "w r aco 03131/2015 CERTIFICATE OF LIABILITY INSURANCE DATE /YYVY) ��• 2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Marsh USA Inc. NAME: 100 North Tryon Street,Suite 3600 A/C N o Ext: (FA C No): Charlotte,NC 28202 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N 47095-CASUA-ONLY•15.16 INSURER A: National Union Fire Ins Co Pittsburgh PA 19445 INSURED INSURER B: New Hampshire Insurance Company 23841 Lowe's Companies,Inc.and subsidiaries including Lowe's Home Centers,LLC INSURER C: Steadfast Insurance Company 26387 1000 Lowe's Blvd. Mooresville,NC 28117 INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: ATL-002939185-31 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY Self Insured-See Below DAMAGE O RENTED PREMISES Ea occurrence S CLAIMS-MADE OCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S POLICY PRO LOC $ A AUTOMOBILE LIABILITY CA5260749 (AOS) 04/01/2015 04/01/2016 COMBINED SINGLE LIMIT 5,000,000 Ea accident $ B X ANY AUTO CA5260748 (MA) 04/01/2015 04/01/2016 BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED CA5260760 (VA) 04/01/2015 04/01/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED $ AUTOS Per accident $ C X UMBRELLA LIAB X OCCUR IPR3792301.01 04/01/2014 04/01/2017 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S - 5,000,000 DED I I RETENTIONS S B WORKERS COMPENSATION WC017731584 (ADS) 04/01/2015 04/01/2016 X I WC STATU- OTH- AND EMPLOYERS'LIABILITY TO Y LIMITER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC039901583 (WI) 04/01/2015 04/01/2016 2,000,000 OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ B (Mandatory in NH) WC017731585 (MN) 04/01/2015 04/01/2016 E.L.DISEASE-EA EMPLOYEq $ 2,000,000 B ID SCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ f yes describe under WC039901584 (AK,AZ, NH,VT) 04/01/2015 04/01/2016 2,000,000 E A Excess WC XWC9883959 (AOS) 04/01/2015 04/01/2016 WC:Stat/EL:S3mil;xs S2mil SIR A Excess WC XWC9883960(FL) 04/01/2015 04/01/2016 WC:StaUEL:S3mil;xs S2mil SIR DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insured is self insured for General Liability for the period of 4/01/2015 to 4/01/2016. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE and subsidiaries THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 1000 ACCORDANCE WITH THE POLICY PROVISIONS. Mooresville,NC 28115 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Paula Stapleton pA../w AtAAfve.. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth o.f Massachusetts Department of IndustrialAccidents C I Congress Street,Suite 100 Boston,MA 02114-2017 r• ' www massgov/dia Workers'Compensation Insurance Affidavit!Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / Please Print Lezibly Name(Business/Organization/Individual): rQv x3 4 'r <e,o kj LL f 4d-t-rL_L +t Address: City/State/Zip: &4 1�A J s 1 Phone#: -CA I , 5 5 Are you an employer?Check the appropriate box: Type of project(required): 1.[]1 am a employer with employees(full and/or part-time).* i 7. �New construction 20 am a sole proprietor or partnership and have no employees wonting for me in � any capacity.(No workers'comp.insurance required-) 8. Remodeling 3.)1 am a homeowner doing all work myself o workers'co 9. ❑Demolition (ld comp.insurance required] 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10❑Building addition ensure that all contractor;either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 50 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp,insurance.: 13.❑Roof rep/airs 6. We area ration and its officers have exercised their right of ex 14.Q Other COS gh exemption per MGL c. � 152,¢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. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Connectors 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: ,P ecity/State/Zip:_ Attach a copy of the workers'compensation policy d aration page(showing the policy number and 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,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 the pains and penalties ofpe4Ury that the information provided above is true and correct S1ana� I Date .3 Phone#: 0,Twial use only. Do not write in this area,to be completed by city or town o�ircial 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#• cFIKE r, • snxrrszesz.E. • 9� ' ,0� Town of Barnstable ArED�p Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, f-4;'l �� J /l�y t//U ,as Owner of the subject property hereby authorize � JP to act on my behalf, in all matters relative to work authorized by this building permit application for: • � I �2 Q Gl �fi► "_ (Address of Job) 6P Signature of 04ner Date uc Print p4amme If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services IME Teti Richard V.Scali,Director ' Building Division WxxszT"M ' Tom Perry,Building Commissioner NAM 1639. ��� 200 Main Street, Hyannis,MA 02601 ATFowww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the,responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 i Massachusetts -Department of Public Safety Board of D:.:d;^••y ul• Re^y atio�s a^d Standards l^..Illllil tl l�l l'/ll super v iswir License: CS-075153R� Kenneth DKendal¢` S,Wceden Place Fairhaven MA 02119 3 � Expiration Commissioner 01112/2017 o ��ie �Oammonu�,al�i o�G�ac�ivarlla trice of Consumer Afrairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: istration: j68027 Type: Office of Consumer Affairs and Business Regulation 'ration: 12f.l 01& : DBA 10 Park Plaza-Suite 5170 KENNETH KENDALL' Boston,MA 02116 KENNETH KENDALL 5 WELDEN PL 4 . FAIRHAVEN,MA 02719 Undersecretary Not valid without signature ��� ((•niirrnrrira�rnl(�r/(?6•(nJJn[�rrJr//J ' ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 148688 Office of Consumer Affairs and Business Regulation Type: 10 Park Plaza-Suite 5170 Expiration: 1p/182015 Supplement:,ani Boston,MA 02116 LOWE'S HOMES CENTERS INC ROBERT ABBOTT 136 TURNPIKE RD.SUITE 100 Not vali w' out signature SOUTHBOROUGH,MA 01772 Undersecretary i I Town of Barnstable *Permit# Expires 6 mont s m issue date Regulatory Services Fee anxNsraLa,e M^A Richard V.Scali,Interim Director XPROS Building Division r Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 TO W/V OF SAY BA 4 ?015 -•- www.town.barnstable.tna.us R Office: 508-862-4038 Fa�`�08- Q6—fi230 i EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ` Not Valid without Red X-Press Imprint Maftarcel Number �� '1, Property Address � la �O� � /Xy8�01V ��� W� [Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address I-E-S ZJVZ- a_de 77fiefitzsc>w 6A' SW t4z N1 dZ6�8� , j Contractor's Name S o c J-Help F_• �/�/t�j vtf)SZ6 EMA)L5O Telephone Number 1b 8` 9'00 Home Improvement Contractor License#(if applicable) c173 Z`7(,_5_ Email: Construction Supervisor's License#(if applicable) D /6'70 7 XWoi-lanan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ 1 am the Homeowner Al have Worker's Compensation Insurance Insurance Company Name ''II ''^ nM IPS r Workman's Comp.Policy# Wt� Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Reside Replacement Windows/doors/sliders..U-Value , i3 (maximum.35)#of windows #of doors: Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,Le.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement.Contractors License&Construction Supervisors License is required. e _ s SIGNATURE: TAEVIN MBuilding ChangesTYPRESS PE.RMITUTRESS.doc Revised 061313 Renewal ' RI I.ictiue#ak;OT. RENEWAL BY ANDERSEN AIA 1!cauc#17M! t b'A�l&mm Cr 1:.w.#063455t WINDOW rrruetnrn a-ANb.nOay..r 26 Albion Road - Lincoln,RI 02865 hcd 15mh#12s7 Phone 866.563.2235-Fax 401.633.6602 1 1'edernl Tsa ID—0Srd68C Southern New England Windows,LW d/h/a Renewal by Andersen of Southern New England CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Daft dA menr c Buyer($)Name ¢,s L ?F TJ ��` Buyer n ts)SumAddes.City Soto and Zip Code f P.O_am E•Maa Addresr ZVf'T_5Lr'SL/k0 �r///}L. CAN llomeTelepMne Number` 13i3 Nbr4T ne ho Number. 9alN Bulct(s)hereby jointly and severally agrees to purchase the product.%and/or services of Southem New England Windows,LLC d/b/a Renewal by Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the,attached specification shect(s)(collectively,this`Agreehnem"). O Historic ❑ Condo ❑HOA? Total)obA'�3i%moount: Estimated Starting Date. Methpayment:`of payme U Check U Cash 01nanced Deposit Receive6( ):F/,)fJk cl) —S--vU 'y`a Credit Cards area accepted for dep osit posit only-maximum 113 of the Balance at Start of fob(33%):- Estimated Completion Date: project cost 0%ose see Credit Cord Rryrnem Form.)By signing this Agreement you acknowledge that the Balance at Stan of job and the Balance on Substantial _�- () 'ai Balance on Substantial Completion of job cannot be made by medic Completion of job ):JEj4�WEZ card and must be made by personal check bank check,or cash. Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agreement.Buyer(s) 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.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only)Notice to Buyer.(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the full unpaid balance due under this Agreement,and in so doing you may he entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement. if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight; of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights; Buyers)received the consumer education to terials provided by the Rhode Leland Contractors Registration Board. (Buyer's Inienlr) RenRignature Andersen of Southern New England Buy s) Buyer(s) By: 6ffrccluct Manager Signore Signantre Print Nance of Product Manager Print Name Print Nance YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. x- - - - - - - - - - - - - - -:�-c- - - - - - - _ _ _ _ _ NOTICE OF CA ELLATI )C NOTICE OF CANCELLATION - l Date of Transaction -Yu may cancel Date of Transaction You may cancel this transaction,without any penalty or obligation,within this transaction,without any penalty or obligation,within three business days from the above date.If you cancel,any I three business days from the above date.If you cancel,any Property traded in,any payments made by you under the I property traded in,any payments made by you under the Contract or Sale,and any negotiable instrument executed I Contract or Sale,and any negotiable instrument executed by you will be returned within ten business days following l by you will be returned within ten business days following receipt by the Seller of your cancellation notice,and any I receipt by the Seller of yotir cancellation notice,and any security ecuri y interest arising out of the transaction will be I security interest arising out of,the transaction will be canceyou cancel,you must make available to the Seller canceled.If you cancel,you must make available to the Seller at your residence,in substantially as good condition as when I at your residence,in substantially as good condition as when received,any goods delivered to you under this Contract or I received,any goods delivered to you under this Contract or Sale:or you may,if YOU-wish.comply with the instructions of I_.Sale;or you may,if you wish,comply with the instructions of f die Seller regarding the return shipment of the goods at they the Seller regarding the returns shipment of theigoods at°the Seller's expense and risk If you do make the goods available Seller's expense and risk.If-you do make the goods available } to the Seller and the Seller does not pick them up within to the Seller and-the Seller does-not the d ,pick them up within dispose of die gooddate withoutany further obligation..If you I dispos retain or e of die goods without any ate of lfurther obligation.If you fail to make the goods available to the Seller,or if you agree l fail to make the goods available to the Seller,or if you agree to return the goods to the Seller and fail to do so,then you I to return the goods to the Seller and fail to do so,then you remain liable for performance of all obligations under the I remain liable for performance of all obligations under the Contract-To cancel this transaction,mail or deliver a signed Contract.To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other I and dated copy of this cancellation notice or any otter written notice,or send a telegram to Renewal byAndersen of I written notice,or send a telegram to Renewal byAndersen of Southern New England at 26 Albion Road,Lincoln,RI 0286S, I Southern New England at 26 Albion Road,Lincoln,RI 0286S, NOT LATER THAN MIDNIGHT OF _� , I NOT LATER THAN MIDNIGHT OF II RE -BY CANCEL THIS TRANSACTION. I (Date) I HEREBY CANCELTHISTRANSACTION. Prim Nor flab s„r,ery Mla Nrr be" RDA Copy:white Buyer Copy:Yellow Buyer Copy:Pink f Southern New England Windows d.b.a Massachusetts-Department of Public Safety Board of Building Regulations and Standards ; Construction Supervisor License: CS-095707 BR1AN D DENNMN 7 LAMBS POND 03t Charlton MA 01507 r Expiration Commissioner_ 09/08/2016 Office of Consumer Affairs d Busine ulation ss Reg 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9119/2016 DENNISON BRIAN 26 ALBION RD LINCOLN, RI 02865 Update Address and return card.Mark reason for change. SG11 0 2A-05111 I Address F-1 Renewal f-71 Employment ` Lost Card " J/re�co»rnrauucal(�o`'t��l�ti:;nc/roc/1�Mee of Consumer Affairs&8usiness.Regulation License or registration valid for individul use only - 'F ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation SaRegistration: 173245 Type 10 Park Plaza-Suite 5170 Expiration: 9/19/2016 Supplement•;ard Boston,MA 02116 , SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD LINCOLN,RI 02865 Undersecretary Not va' ithout signature , A4COPRU CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 08/12/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willie of New Jersey, Inc. ME:: c/o 26 Century Blvd PHONE FAX P.O. Boa 305191 E-MAIL •1-877-945-7378 A/C No:1-888-467-2378 � Nashville, TN 372305191 USA ADDRESS:certificates@willis.cam INSU S AFFORDING COVERAGE NAIC 6 INSURER A:Selective Insurance Company of SE 39926 INSURED Southern New England Windows LLC INSURER B:The Beacon Mutual Insurance Company 24017 D/B/A Renewal by Andersen INSURER C:Argonaut Insurance Company 19801 26 Albion Road INSURER D I Lincoln, RI 02865 : , INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER W529169 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMfDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I X1 OCCUR DAMAGE TO RENTED $ 100,000 PREMISES Ea occurrence A y MED EXP(Any one person) $ 10,000 S 2029459 08/10/2014 08/10/2015 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY a CTT a LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY EO aBIANdED SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A ALL O SCHEDULED AUUTOSS AUTOS S 2029459 08/10/2014 08/10/2015 BODILY INJURY(Per accident) $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident A X UMBRELLA LIAB N OCCUR EACH OCCURRENCE $ 5,D00,.000. EXCESS W18 CLAIMS-MADE S 2029459 08/10/2014 08/10/2015 AGGREGATE $ 5,000,000' DED RETENTIONS $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATII TE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? a N/A 0000068028 08/21/2014 08/21/2015 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT 1$ 1,0D0,000 C Work Comp/EL Covg: NC927938352394 08/21/2014 08/21/2015 E.L Ea. Accident - $1,000,000 Statutory Limits - WC E.L. Disease Policy Lint - $1,000,000 .L Disease Ea. Employee - $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required own of m ttapoisett is included as an Additional Insured as respects to General Liability when required by written contract/agreement as per policy orm. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Town of Mattapoisett 16 Main St ttapoisett, MA 02739-0000 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD SR ID:6629625 BATCH:Batch $: 79627 The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnva ggations 600 Washington Street Boston,MA O1111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name (Bnsmess/0rgaairation/Individual): &tJ —FV �1�� Address: c�k City/State/Zip: /aria n! - 0a96,5- Phone k LI l - vZP F- 9 za Are you an employer?Check the appropriate box: a of project(required): am a general contractor and I ] ( e4 �: -1.Vam a employer with p-o 4. ❑ I g 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ' shipand have no employees - These sub-contractors have �P Y 8. ❑Demolition working for mein any capacity. employees and have workers' [No workers'comp.insurance comp. ce 1 9. ❑Building addition required.] 5. [] We are a corporation and its 10.0 Electrical repass or additions 3.❑ officers have exercised their I am a homeowner doing all work 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑ of repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13. Other 1J comp.insurance required] •Any applicant that checio3 box#1 must also fill out the section below showing then wed= 'compensation policy' ica t Homeowners who submit this affidavit indicating they are doing all wo&and then hire outside contractors must submit a new affidavit indicating such tContraetors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether cr not those entities have employees. If the sub-contractors have employees,they must provide their wad='comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: pS Policy#or Self-ins.Lic. �,j C 3 SoR 3 `? Ll Expiration D,&: Job Site Address: / 2 `"� - Sao City/StatemZ- (� &(kV"11P1 A14 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 Tie form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby de , pains and penalties ofperjury that the information provided above ' true nd correct Si Date: Signature: / ` Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/Ucense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.-Other i 5:f Map J_7� Parcel 061 , 0(48 Permit# 3').;L House# n2 y a R1S Date Issued 8 Board of Health(3rd floor)(8:15 -9:30/1:00- -6�_7 ' �Aee 04'(&. Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) SEPTIC SRICNS ST EE INSTALLLIANCE Definitive Plan Approved by Planning Board 19 W ENVIRON 'DE AND TOWN OF BARNSTABLE TOWN Building Permit Application Project Street Address C'". �t311 Lei 1 0 Village w 3!ie�s t/}N 2 Owner V) JiA U i2�()t4 Address ..jUG 110:1 i'S(Jl✓ Rrz�. Telephone 512 2-0 — l Permit Request �I/<� (7C� . 'K 3o First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 7-0 a90 Zoning District Flood Plain Water Protection Lot Size 3 0`7 Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. 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 ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information L /l Name S()db S 14 J,? C/2 u i T e= Telephone Number /V Address 2- 5T . License# C5)s & / 7-11 `/! Home Improvement Contractor# �Q �Y �00 �� Worker's Compensation# WC; t N11 ��l Iv0 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTTII)N`G,FROM S PROJECT WILL BE TAKEN TO M, I - T , 14 SIGNATURE DATE Z BUILDING ZRMIT DENIED FOR THE FQLLOWING REASON(S) �/lie FOR OFFICIAL USE ONLY 33 � z �l- PERMIT NO. DATE ISSUED', MAP/PARCEL NO. ADDRESS VILLAGE w OWNER r DATE OF INSPECTION: FOUNDATION D 4 fwre FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGIl FINAL GAS: ROUGH ,, FINAL FINAL BUILDING DATE CLOSED OUT '`, ASSOCIATION PLAN NO.' � ' s �—__'__' .,'�-:'_, -� •••�--i•-..�: _'ter Y.L�_..: T•• :* �' ^-{'T'i-•�-•= + �`�r$.r,.ci+.i—i•F:�.�.L1. 1.�..i_' �, 1...I_,•:;._' •c.� .{ v.• � � FT uxx 4. i.'r..:'1_f--•--•-_.-• • � r�:.!'•-�.:a.�_ �_(.i.�►a-J-•1-{_.:�j.µ -L..�•..�. y � ;-• �-i--••. .- � '` '1.�. .�, �L//4,�f���. 4;4- - ;_ _;.���_. :� ;} ;_� •_' PAL Lj �• . - •�' -�-�-:-,fir•• �-� A t �... • .. ` I�..T�1 - i _iti_t _ y'i. ...; !...; ► -? 4-c.;-1;�_T:. .._... _._ , _. \j.-1 M--7--1-LW-7or _ Mx mrf 47* o p jt Po � t' - -� dot ••SO! � ;4:D�". , _�...,-� - CE,eT%�/EO P,Gp7' 7/AT Tf/E: . .�-� . LaC.4T/Oti CE=JJT��ViL.,Lt NOWNyE.E?EO.!/COMPLYS•W./Tfi�:{ ':. 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I _ J Q 141 -1'•6"C,ONCJZETE ��/iaL-l_S 1 -CUT (-0 2 9' 9 o c rM t- -• I II/..-1 c.". to- co WiG2 FOOT I IJ( S\ 1 i 1[ 1 o "i Co' o" C` 2to GE PL. rJO4 �ja 40' 10 �4jEAL-TL1�ASPt-IOIT �V2" c ny Pt-Y Sf1 EA7N n.1Ca �PLK D cAr-A" R_.-uo Ft�icet�uaS Al.u/ntn+u/n uTTE2S a t_ IYB Pt"'r- (-L':.C_t I. �- (x9 Sor F:T y.. Nt .FRIEZE P�10/-2I� To TOP o 8cx 49 op `. _._. .. ..- !LX.6 Sru,q 5 CY I(o O.C. ..r. -ro` FIgrLEGL.Ah INSUI_AT -... r 1NjI . j L.Ap Rb on2 Flo GLlt`IH 4i':.�.71 • @ ! C .G LES .fit �_.lasull,c.n4y'g vEluX. QD ,tk SEAL-TA ASPt-t 4LT Ft.+� N_8ep¢po/n E� In+ AA / ID-Y "2K.9 2AP-rE 2�7 pp Io R+�oF SHWGLGS t/Jt LY:..3 �Fq .... P F �� Ft�rLE6LAh - L }v ' a � 2111o�Co-�16•` � I \� vENrtNG ran iT -- a.�41t6 \'< A, Nn '�ti �to Oa 14- FtIJIgH Ft-oc.rr.�Nb .519 B PW Su n...+o.Qtti-'FA�tuY R��^ o�' 2xto @ 1 - Ter.-►.,e�,�.;'��`(o-�. � _ .. � -- >>TtLrra g z�.lr _. •1. { t<,r.: t Q h v�olT I I .iiSo 1•f.L )ILi.O�FJ•�tty+�,... I�A1=�•—_ ��ti I An+G►+ rt ��O L...__. ... ''r, J,� r 3'I2:'OEAN COIy/A 1JS •, z c 9e I r � s . W-0' Q2Q - 12'-cr S o M I ELD e - _ z SCALE: DATE: The Town Hof-Barnstable MAE&. uxrrsrne� • 9e}�A 1m� Department of Health Safety and Environmental Services rE1659. 6 Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. 14-1 l2 f Type of Work: �s tt" I "VI ri , 1, C;. ��(�1 Est. Cost Address of Work: Oqj— v!6— t+()M 16 t0 P 0 l t/ 3A 12 A 4(3e- i ^- Owner's Name z. \ /� sr t L ( 2 U Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): ' Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY .1 hereby app y for a permit as the ent o he owner: D e Co tractor i e Registration No. OR Date Owner's Name i 'C_ "`_ The Commonwealth of Massachusetts n^ -r Department of Industrial Accidents -= Office offniresffoly oils 600 Washington Street . Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: location: city nhone# ❑ I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one workin in any ca acity % /%//%%%%%%%%%/��%%%/O/%%%%%/O///%%D�%%%%%%%%%%%%%%%%%%%%%%%%%%%%/�%�%%/%�%%��%%%%�%%%%%%%%% Q I am an employer providing workers' compensation for,my employees working on this job. company name in, -i-r ::::: :::.... �. - address.. ::.;.:.:.::::. j. t:. . hone ... ci :... #i ? -7 insurance co.:,,,*, 1!1:�LT�i fj"-� olicv ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comoanv name: ,:.: ...... ..................... ::::.:.: :::.:::...:::::::::. ;;;.>:::Ph one#.:: ; :;:;:::;:::::»::::><:<:>:::;;::;>::»>:::;»-<::::::;»>» ;: >::>::>::>::>:::;:: 'insui�an ce:ca,.;.: ... ... ?'.Oli ,#f,:::,: >< <: ;<;:.'z;'f <>`< �z' > < <<:.............. 2 ;.;:.;:::.::..:.:<: ..... . . .. ....:::. .... ::name:;%''"'` >:'•:> > ..... cd an m v P address: . ..... ...... .::::::::::.::::::.:..:........::.:.:::.:. .Ct . . .... :::...:;....::::::.:.....:. Phone#: - :::..::.:: :.r.::.::'i.>:>::>::;.;:<:;:::;::;:;::;.;:.;::<:»:::>::::>::>:><;:::..,... aiev >: i Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be fotws rd to the Office vestigations of the DIA for coverage verification. I do hereby certify un the psi and p aft' of perjury that the information provided above is truo and co r�ect Signature Date � A Z i -r iJ Print C 4 Z Phone# S official use only do not write in this area to be completed by city or town ofilcial city or town: permit/Hcense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑B:ealth Department contact person: phone#; ❑Other (revised 9/95 PJA) Information and Instructions A;t Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or.local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. 'Additionally,neither the commonwealth nor any of iti political subdivisions,shall enter into any contract for the performance of public work until acceptable,evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants r r Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. ne affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimit/license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. Ttie Department'.s address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Invesugallons 600 Washington Street - .. Boston; Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 i POOLS If located in okh,fence only requires certificate of app 'ateness If located in Hyannis Historic Waterfront District,pool _&��fence need certificate of approp ' teness Sign-offs from: Health ✓ Conservation Tax Collector ✓ Dimenslo s 9� Estimated Cost " Owner's name&address Complete dwelling information for the Assessor's depth Applicant's telephone number Signature Construction drawings or factory brochures&specifications_ Certified Plot Plan Workerman's Comp. form Fee In-Ground pools Home Improvement Specialist's License OR Homeowner's license exemption Home Improvement Contractor Affidavit Above ground pool -no license required-(18' or more needs a building permit) NOTE: INGROUND POOLS MUST BE FgNCE6 WITH A 4' HIGH,NON-CLIMBABLE FENCE WITH A SELF-LATCHING GATE. FISH PONDS . Any pond equal to or more than 24" deep MUST BE FENCED WITH A MINIMUM 41,NON-CLIMBABLE FENCE WITH A SELF-LATCHING GATE. q-forms-PERMITS 1 Rev 2/10/98 The Town of Barnstable °FTME ro Department of Health Safety and Environmental Services Building Division BAMSPABLE. ' 367 Main Street,Hyannis MA 02601 nL►ss Off 'OrEvnu'ta Ralph Crossen Fax: :)u2S-/yu-o2.9u Building Commissioner Building Permit Procedures for Pools (pools over 250 sq. ft. require a building permit) 1. (:_ P of r mortgage survey required for zoning compliance. Placement of structure must be sketched in, and distance from boundary lines indicated. Pools must show the location of backwash pits. 2. Old King's Highway Historic District Commission approval required prior to construction/demolition for any properties located in the Historic District (north of the Mid Cape Highway). 3. Application sign-off must be obtained from: in e `—Tax Collector- 1st floor Town Hall —Conservation Department (4th floor Town Hall). (8:30 - 9:30 am & 1:00 - 2:00 pm) --Health Department (3rd floor Town Hall - 8:30 - 9:30 am & 1:00.&A;A&#k m.) �easwer - 3", fl. - sdM . 'Bldg - 016, PM 4. Basic Construction drawings indicating materials to be used or factory brochures and specifications are required. 5. Note: Residential pools require a minimum 4' high, non-climbable fence with a self- latching gate. 6. Copy of the Home Improvement Specialist's License is required for an in-ground pool. 7. No license is required to install an above-ground pool 8. Home Improvement Contractor Affidavit must be submitted for an in-ground pool. 9. Workers Compensation Insurance Affidavit form must be submitted 10. Homeowner License Exemption Form must be submitted if homeowner is acting as general contractor or builder for the project. 11. Fee to be paid before permit is issued. PERMIT Rev 2/22/96 47 -'BOND' ca J :1 1 , t , 1 , I 1 t `� 1 - +. _ ... ._ 1 .. _ r I -'�' :� -f. �) ��• '. �� ELE!//'Q"'. , - IFFf PTA .. _ 1 , 1.. .. r:T �' WA - - 1 _ O VIE - - _ 44 :7 -TY, _ - _ - - 41 T :1 C'UT F AS ,1VOTEO _ r.. .f_r N/7TE [!J'e9FF A[rE.P Ltd. � t.. 1Bi9.Cs - ELEV '7 O JK6/N.DlCA/ .....: . .. •: :RE,lISrVALl�E 1 ICJ/N• - _ f 3 + • �r p/REC TJ� PUMp Ell' Exa - R EL El!7r9 . AU _ -- ---7-7 8 0 j 1 1 ' .�/Oy: E6EK ' r /NkV �. '1/ � � �• TYP _ _ _ � .. - � •- .. .. . . .... . . .. ..... ..�•.�j.. •- - OR RE/NF. <M3 i619R3� C. 17. OlT1 WRYS.JYP i Wl�LL S'ECTi'l�N �• � .i� STi9NDARD , _ - _ _ a _ _ o -- .. --- - - ;. . • C/NC3 S3EEL SHALL ' ... _ .6 CQN '!7R/I!':773 L/7Y DEBT H S T �P S_°TR!' �/V S —l.. -. R�/NFOT./+%l LIES_/G/1Y�9 IONS' / F/9r30S /'`/'4 S�F. .rOlJ SrT NDARL) . _.... . SA,41 Z'_ _b — �:._ .� i �, _ a ►. •_j.) /N.G:-LzDRRDI:IYO PFRY1?l _.QN P�2LY.S _. D/i9A'JtTERS OR /3 IUHENE SPL/GES _. 7.*.•: --- _ a ' o 771AN'E/GhIjT FEET 7N D PTH R7 80,q 0• OC"UR a C -. : • o ° = �yyou/r %' _ L TH EPT_ PPR40me :.REDU/RED. FOR /TIE Ct>/YSTflUC T/O/V __�_ - •• - j -- Cd�fM j IL- T?'PE P<?nL�, • ;SUN/lF SNi9l C E/J>ACH/NE M/.CEO ANO /EO PN4-vlINT/C/ILLY.. M/X -AM9LL BE _ ._ - t _ _• .. ,.r. .�'/�� ONE /�//R: CL-Mf NT TD FDUR HND I J fbIc —+-- P T.P 1 .. . . .._.. .. � � . .....___. _. .. __�.._.. .... .. ..-- _ •_ ' '---•-y--;�•�[S: DfSIG�N 'E'DNF�R�'93- 'TD' LOC-AL-'L-�ODE' '/�VL) Lr C'Dm S E/VGTH _ ' •• ..i� f0:UPON.A.REASON,,9l3L:Y_LEYEL ..S1TE. J" PSI & JS O-19YS U EOU/IL/IER L/Nf :l/VD i9PPR0!/ED NAT!/RAL GROUND /U/Tf//N 2 FEET • WA,-fP_Cc�MENT ,�i9T/O SHf7LL AEU'T EXCEL�D. ± Ca�nin;ON r o �.�;; G9WA/O CLRM, LJF' TDP OF IjONO 6EA/"1, HNV E!'CEPT70NS F o W&L REDL•'/RE SUPPLEME/V TR.RRY OL°TA/C fDFS/GN �2 GALS G!/ATER PER S�7C/IOFC/riENT AUTOMRT/C SU,RFACf SK/MMfR o y • cilee GUN/TF BYAL/G11ru1,9TER s., PewY EN C E 7;:,tEE r117 A DAY Fo.P SEVEAv ORKS .:2lUNER SHALL. PROV449E '4 NC/NG /N CO/11PL ///NCf _ l 1,r11 LOCAL f/lYoR IOGf//V ORO/NANCE' <N 0 UNDER 'WATE�C L/GHr !i9TFS TD GE SELF fLOS/NG 1 C.9TCN/NG• o WAITER G o s �LfCTR/CSC Sf1�9LL CGNFORnf To STATE I�1- 12 a- -y RNO COCA[ REOU1,?C1YENTS F �� '='1� •.: PcarE .t _ M Irer, d, U 'CAK5 6, -C c fiorN a/AYC �• KO S774r7C o - ► -y CD b' o: SEr ogrrgCNE0 PLOT PL.9N ORnw1.*VG H SHORE G /Y/ E P 71URE�FREooJ r,a SOU. T U T LY�LS,ING STA/YDARD SM111 MIA1G fWL NAMF� �RRrEL soRJ? 6 r �r�N/7S L. INRNO /y, 1G S2 3 .I'I!y . f DEP�RTtlEWT OF PUBLIC SAFETY a CONS.TR C - % . U�I01i.S.UP�ERVISOR LICENSE Expires: . t MF- iy � '-``" F 41£NARO'E BENOIT `GUSHING HILL RO s� HORNELL, HA 01061 HONE,INPROVENENT!CONTRACTOR ` f` :'Regstratioa�� 105485 .,. _ v�Trpez:i,PRIVATE`CORPORATION i y;i~ `;�'Ezpication rr°O7/17/00 SOUTHINOREj6UNITE POOL &`.SPA �RICHARVOtNOIT'" - ► � ADLEY:ST' � s , f. 9ILLERICA NA 01862 ADMINISTRATOR NIL AwQp PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE •LAKESIDE INSURANCE AGENCY, INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 88 Stiles Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Salem NH 03079 COMPANY .. A CNA Insurance Companies ESUREID CCWANY South Shore Gunite Pools B 12 Hadley St COWWn, IN 111111011116111 MA 01862 C COWANY • D. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIRCATE MAY BE tSSUEO'OR MAY PERTAIN.THEINSURIWCE AFFORDED BY THE POLICIES-DESCRIBED 1,08NAS SUBJECT TO ALL THE TTS' % D( ONS AND-CONDITIONS OF SU N POUCIES, UMITS SHOWN MAY D CO TYPRE OF NSUIWtCE POLICY MMIER UR CAVE POLICY OWPATION UQfB LTR DATE O&WD" DATE Q YI' A 09*M UABLJTY "C143430331 04/01/98 64/01/99 Deem AOOFMATE s 2,000,000 X CM.awax Geam ugaw - Pswoucm.COMwAOP Am s 2,000,000 CLAYS MADE F OCCUR PERSONAL i AIN INJURY $ 1,000,000 VM=iCONTRACTORSPROT ECH OCCURRENCE s 1,000,000 X AGGREGATE LIMITS PROJECT �MA onetime S 50,000 X AGGREGATE LIMITS LOCATIO F MRED pw am ►eN = 5,000 A AUTOMOBLEILIABLmr 7229951 04/01/98 04/01/99COMB INEI)SINGLE LMT s 1,000,000 ANY AUTO ALL CWNED AUTOS BODILY P JURY X saTEouLEo AtTfOS (Per person) s X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS } - (Per accident) _ PROPERTY DAMAGE ti GAMGE LusLM AUTO ONLY-EA ACCIDW S ANY ALTTO OTHER THAN AWO ONLY: A am SS LIAa1JTY TO BE DETERMINED 04/01/98 04/01/99 EACH oomwecE s 1,000,000 X UMBRELLA FORM AGGREOATE s 1,000,000 OTHER THAN UMBRELLA FORM S WORKERS COMPENSATION AND .......... e.G'LOY61S L.IABLITY A WCC144784168 04/01/98 04/01/99 EL EACH ACCIDENT s 500,000 THE PROPRIETOPJ INCL EL DISEASE-POLICY LIMIT s 500,000 PART1 CUTNE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE S 500,000 OTHER DESCRIPTION OF OPERAflMOCATIONSNEHICLESIS IAL ITEMS COVERING WORK PERFORMED BY THE INSURED. .'..pw�'r. }}ti-}}};}•}: :CERIIF[CA7'£�OEAER:::.,.:._:rr.,.:r::.::.:::::::::::::::::.:..,.:::::.::.....rv:r::::::::::::::::.,.:r:.:•::.,.:::rr.:-..:.:::,,:•:,,r:••:�:I.tNCE A .................:...,.....:::::•.}}}::?}}!::::•:}.;:::::�:.}.<:}•.<;:.:?:._!:.}•:�:.;•:::.::::!}�<«:�:.�:. A"Y-VM:{,WN.YM1�h.m.lNll.fm:.:....t:.r..v.:xnrxL•.,:.I.r.r..r..xr..,.vn,xn4rnv\rrmrmx:a,�iY:iT<: SHOULD ANY OF THE ABOYE DESCRIBED POLICES BE CANCELLED BEFORE THE MR. DAV ID THORTON D"ATION DATE THEREOF,THE ISSUMO COMPANY WILL ENDEAVOR TO MAL 242 JOE THOMPSON RD. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, WEST DARNSTA$LE, MA. BUT FAILURE TO MAL SUCH NOTICE SHALL IMPOSE NO OUXIiI&I 0WtV8ILrrY OF ANY KIND UPON THE COMWANY,RS OR AUTHORIZED REPRESENTATNE ::?}::n}:•..:::::?:....- ..n:. ..... ........... ....::•.:.::......... .. :.....:w:w::.::m••.w.v:x::::•r:::.:........v v..rr..v ::... ..x.• w:::v.:w::�.;in;^}:l.vi.}:Cry}}}}:^:i{xrm}:•}}::}}:.};!r!�y,? +:Firm vx.:• ::::: ..: :. .,. ...........:...............................:....:....:..........:::::::::::::::w::::::::::: ::: ;:.v:: ti:::w::::::.}v:nv::yC:w::::::::::::::::}}isr�:??•i}:•}}i:::::..v...nw:•,.•:.. ..:::::.::::::::::.:.::::::..... ............................................................. ............................... ........ ...... ..................... .:::...:::::.:::.::......:..:::::..::....t9::::.;•A�ORT3}:C�FOR 39 tM�> TOWN OF BARNSTABLE Permit No. ......3 :.69 .. ...... BUILDING DEPARTMENT t ....n TOWN OFFICE BUILDING Cash ,,,,,,,,,,,,,,,, .Yl V a4YF HYANNIS.MASS.02601 Bond .......L.1........ CERTIFICATE OF USE AND OCCUPANCY Issued to Bayside Building Co. Address Lot #140, 242 Joe Thompson Road West Barnstable �, ... USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. i June 14, 93 19. ........... .................... Building Inspector t I'��'7T'I}wl'rT ik.y',k'Y /l.l'"r•1 1' ti•.�I N r I f' �✓tri���i I 1 "7..•'e• •,'• .. .:i''aa ...., _ '.i.•r..Yr.+ 'lya � tiR . F�, rf , '+i fiOWN OF BARNSTABY, MASSA.�CHUSETTS � i � r.PERM'y 11� ,rt l fs i + ('A=174-00.1--40 IA.Y t,y �j DATE �.::i l.•L;il l;. i 93 E i� ^' �f 19 PERMIT NO. r e e r APPLICANT owI10i ADDRESS �1StC(:1 K.:J.•.-'�'� r0r5G4cz (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO 13t3i1C7 Jwr��iia.ricj (_) STORY �'''• I�;.1.L�.+.' .)W,%i. _;; NUMBER OF DWELLING UNITS r (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) .Ut 4140, i:i rlii)::'•..: i.3r.(1� i'j. ijal;...S k.)�t1 ZONING iCt, 't (NO.) k (STREET) DISTRICT a •='i. BETWEEN AND ! ';k '.•'+c.ld ; (CROSS STREET) (CROSS STREET) 'LirV 47��[xY) SUBDIVISION LOT �;tt.�rr7 LOT BLOCK SIZE rye r tkn 1•��F�f'�i7 BE BUILDING IS TO F +._ T. WIDE! BY - FT. LONG BY. FT. IN HEIGHT AND SHALL IN dd CONST.RUCTI A l / Ty 7 ff 1 1 T �•tr 1 +1� TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION • ? II ' ri 7 l ri 1 A (TYPE)' Y REMARK SC'WCArg ys x S: 14 t it ',y c� F 4Bond`,'I ` r+'i`p l "`-'{ ct AREA OR."+� VOLUME 1944 sq. ��• 18'U� ��t�. FEEMIT.$ 186.25 ;I4R, Lri i� ) •try . •r-, (CUBIC/SQUARE FEET) ESTIMATED COST k$ + r i it t!r 4�r4st i: ,OWNER` gc3k1:;1C�C BuildingBuilding '(c ; r AOORESS' y BUILDING DEPT.BY 41� 1 t frt I�f t 9 k. 1 :�4i, r Ytii HIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET. ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY C k''IPERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST.BE."A 4 ROVED BY,THE JURISDICTION, STREET OR ALLEY GRADES AS'WELL AS DEPTH AND LOCATION OF PUBLIC SEWq,RS'MAY BE OBTAINS �1FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT-FROM THE CONOIT101 ANY,APPLICABLE SUBDIVISION RESTRICTIONS. + INIMUM OF,. THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE; i u+ INSPECTIONS REQUIRED FOR PERMITS ARE .REQUIRED ATEd ALL CONSTRUCTION WORK. CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ELECTRICAL, "PLUMBING ' AND 1. FOUNDATIONS OR FOOTINGS, MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.:'2. PRIOR TO CO MEMBERS TO LATH). STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL ks FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE• r r" r r• .',,OCCUPANCY. POST THIS CARD SO IT IS VI k`'BIBLE FROM STREET y5t+ BUILDING INSPE ION APPROVALS PLUMBING INSPECTION APPROVALS E C RICAL INSPECTION ROYALS �ritre it�1 fir, •t �'' !' i .t' 1. r wr 3 HEATING INSPECTION APPROVALS ENGIN IN P T EN 2r I ARD Of SALT OTHER SITE P N REV APPROVAL — Y�i(4L t t1r ,4,f + F', WORK SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION { TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED EP THIS CARD CAN I y+ ARRANGED FOR BY TELEPHONE.OR'WRITTI CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. E, NOTIFICATION. 1. 1+Li r_`� a� I _ 1. � [_��t_ —l.��j 1 _ _ � ��---•-__- i .I. I. r I .r I. i � �l I ' , ' +� _f..�• .•t 1 { _, , 1 . !�' .� -+- _x -:- y - { 1. • _ : . I .. • � a. . ! , t -i- , I I � rJ I_i ' '^, l� t ' , � i � � 1 GaY �� .=�t6�.K t r ^ .. I 1 1� 1 • l:8 I , •-} � I - + I -'7 `�� i ! 1 1 1� k-{--'i-r , I_.• � r . ._ r�:i::'a R.. 141 --I . i F �..-�_1-_,_I' + 1 _F.:-•.l.l._ 1 f ' .�..-1.-f-...j -}'.�'_ - t t r T * - �I..irl`J•:� f'':. I 1 •_Yi T I � i - _rt.'._� , � ' �� I_T�_ 1 I_�_i l��l 7 T ^_._ � . , J� yr' �� I +.f_:_�..1 f �_' -1 ' �' �..1.-� I- ' ' _� ' _ ' I � 1 '.L..I'� + rL .. , .._... ..�_. �E'a _1�., q• { { � i_ , _ ' � , ; � •4n Sao �� ' i�•� � �_%.I ; � ?.i , � t MAP /7¢ c 1.4 _. G,4T �L/ C �J MP-Vr�.c WiV!1�E.2E0.C/'C"Otil.�?L!YS1:Gl�/Tyl ��".. SC.4 L G— ��/ •�O� 0. 17E ,L EQU/, Eit'1E.t/TS O.�-T,�1�' ,�-wit/_ 4F •�.L Ai(/ E C� I.riirh�/vr Tye • ;_ +• , /N✓`T,2l�ir'1.�it/T�,SU.E?lYE} -r I I _ ...� �s"ETssyowy�s.�/ov�a idol ! i ►-;_-; ;. �,4Ss. 4E�-7� OET��-jLl/i!/�i.�-dT•�:/�t/SS,•1 '} .4�i�.L/C,Q/t/T" ,8�-yS�DE .(��,Gv�,�s ` Permit No. .....TMF> TOWN OF BARNSTABLE 35 :96.� ° ....... . . BUILDING DEPARTMENT t ■,un I TOWN OFFICE BUILDING Cash ■Y� 6)0 HYANNIS.MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to b,a,':,,idC BUiiding Co. Address Lo it140, 242 Joa Thompson Road west Barnstable USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. June 14, 93 . 19. ................ Building+Inspector Assessor's office(1st Floor): �J�J Assessor's map and.lot um '/'(, 7 y ! O� _ y� f - THE �o o� Conser4ation sP-- SE�'/C..�•Y��E Board of Health(3rd Cory tN A w Sewage Permit number ��{�E�'.N CO Engineering Department Ord floor): House-.number Z. Z �L 1= � 4vlao��E •�� o yEY Definitive Plan Approved by Planning Board — jg . � / �wN FIEGUC 0®E AND APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2-W P.M.only (� ®lvs TOWN OF. BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION — 9 19 Q-3 — TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1 V 0 /6/- �. Proposed Use Zoning District Fire District W 4g4/11 Name of Owner Address If Name of Builder , Address Name of Architect l�, Address Number of Rooms 00 X Foundation Exterior = c�rGg Roofing Floors l�'/i�. P�f Lg�2f l Z, & b� (/C1� Interior /-64teW / Heating 4� �(� � �- 'LYl4 �/! Plumbing �V e '� C���� �� Fireplace �%� 66T�L r ��c- Approximate Cost 3v20 Area 9� 2 o-43 aa Diagram of Lot and Building with Dimensions I �p�2y a Fee 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. a}, Name ` 3-uWa 1 7 lzc� Construction Supervisor's License s� y BAYSIDE BUILDING CO. No 35696 Permit For Two Story Single Family Dwellinq ,Location Lot #140 , 242 Joe thompson Road •" W. Barnstable �- Owner l Bayside Building Co. " Type of'Construction Frame r' Plof Lot Permit Granted March llf tg . 93 t Date�;nspecj n �` p"�7 19z' I •-D let d "" - 19 ` t tt s I \Wd . �.e. la, _