Loading...
HomeMy WebLinkAbout0505 MAIN ST./RTE 6A(W.BARN.) li �lll__l _n J�aEcraEo�o ll7//ILI;QI�0 2 ym UPC 12543 ; Now HASTINGS,ON lam$ Town of Barnstable *Permit O� Exphw 6 rp.' e date Q 4 Regulatory Services Fee aArxsrns� �$ i g; Richard V.•Scali,Interim Director 0 A�Q}1AAYA Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 %N%vvv.toivn.barnstable.ma.us Office: 508-862-4038 Fax:508-790-6230 PRESS PERMIT APPLICATION - RESEDENTIAL ONLY / Not Valid without Red X-Press Ilnarint Map/parcel Number�L 3 3-0 3 Property'Address J 5 Mesidential Value of Work S _7T!— Minimum fee of S35.00 for work underS6000.00 Owner's Name&Address__'Rl cha& G Darn Cta /to C 6 _b s A1aa7L\ 5t z Pa.sa A17 s- - Contractor's Name_'jNrfwern a�,�.,J;r�r, S / �;G,,, ton n sn(I Telephone NumberL C)t))X2_k-q kZ0 Home Improvement Contractor License_(if applicable) /7 32 4 S' Email: Construction Supervisor's License a(if applicable)—Q 5 S 7 n , CgWorkman"s Compensation Insurance �� �i � � Check one: � I am a sole proprietor JAN O 6 2016 ,I'am the Homeowner I have Worker's Compensation Insurance BARNS TABLE OF ® TABph.E Insurance Company Name__A rem ri ci rY Il �7 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 ofroof) ❑ AIL-side Replacement Windows/doors/sliders.U value O (maximum 35)r of windows —1 of doors: - ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate EIedheal&Fire Permits required. "M11he`m required. issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. "Note: Propertytphvner must sign Property Owner Letter of Permission. A copy o the Home Improvement Contractors License&Contraction Supervisors License is required. _ • SIGNATURE: QA%rPFILES1F0R11%uildi%tr permit formsNE7PRESS.doc Revised 061313 r ,eel sr Ua=os newts! RENEWAL By ANDERSEN 11 wse �yt9 Cara ��,,5 rnnt�wn ttninraasr m�ai.,n�:w�e, 26 Albion Road .• Lincoln,Ri 02W5 3 S im3hsm oms? Phcmc 866.563.2M•Fax 401-633.6602 —� 1�' ferf7al T.v.9.1 ed&,X^e6B.'io 3a �A at>ters New EagUrA md&w%Ll C dfhla I Renewal by Aa&er"a of Sswaem New Fmgtsad CUSTOM WINDOW AND DOOR REMODELING AGR8SAUNT `V Byer(a)Sven Addrm Ow Scut.ant ZP Cedt I PO-tlw: J �-�✓�•L—.-l_(J—tG��x—VVS --_ Ed�ItA03ar. ►kmaTtl�liaKtd�nOrr�a'.LLaS=�7/n Nb+kiL+'C7�Na!rocr,.��.,�,�j_.�.tr� Ruper(s)hcmbr joitaly and severally agreed to purchase the products and/or services of Southern New England Wine w fi.LLC d/b/a Renewal by Andersen of"Suuthtra New England C Cwtttactor j,in accordance with the terms Snd conditi6at described on the&ant and the reverse of this agreement and cxr'thc attached specifm n this"Agreement"). 0 Historic Q Cando ❑HCkA7 Tonl)obAmounr ErtinadSnr4tKO40; Method of Payment O Check al6oh r]ftrarrced Deposit Received(33%k,�33. �f ' Credit Cards ors accepted for daposk only-arnt6rrntan Ili of the 8aiana at Sears of)00(D37ek - Esiirrted Candeuon erect cost(Please see Ca t Cad ft Went kmW By sttntrq skits r Agreamsnt,yet►arlorowt*dp dot fie Btlance st Stare of Job and due fthr m on Subsmtdal G� /(,-12 AWeA i BAnce on 5 1 Compkion of Job cannot be tmfde by ada e completion �yy of job(33%)VIE� card and mtuv be made by persagl ctaeck bmk dm:k or mh. Buyer(s)agsrtm mad understands that this Agreement constitutes the entire understanding between the patties,and that there are no verbal understandinga ckaaging any of the terms of this Agree"%cl,Buyes(s)ecAxowledgcs that Buyer(s) (t)has read skis Agreement,understands the terms of this Agreement,and has retxived a completed,signed,and dated copy of this Agreement,including the two attae3ted Node"of Cancellation.an the date fiat 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. (RAods Island Salts Onty)Notice to Sayer:(1)Do not sign this Agreement if any of the spaces inaeaded for the agreed terms to the extent of then available information are left blanit.(2)You are entitled to a copy of this A.greomens at the time you sign it.(3)Yoe may at say time pay off the!fill unpaid balance den Lander this Agreement,and in so doing you may be erdded to receive a partial rebate of the finance and insurance charges.(4)The stetier kae no right to unlawfully eater your premises at commit any breath of the peace to repossess goods purekased under this Agreement.(S)Yon may cancel this Agreement if it has not been signed at the oral-office or a branch oice 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 mall,which shall be posted stet later than midnight of the third calendar day after the day on which the buyer signs the Agreements excluding Sunday and any holiday on which regular mail deliveries are not trade.See the accompanying notice of cancellation form for an explanation of buyer's rights. Ruhr(.,'reed%1!d:ire consumer education material,pn aided by the.Rhode Island Contractors Reptradon Board._(lArwrY f , ) d by An cram of Southern New Enean_d Buyer(s) Buyer(s) B�: k c 44, d ,�ot w ar Siimu—e t P,oduct Manager Signature Signature 1`61t N um-of Prodnrt:Maroger Print Name i'riru Name. YOU, THE BUYHR(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MDNIGHT OF THE THIRD BUSLWSS DAY AFM TIM DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. NOTICE OF CANCELLATION Jl� ltE OF CAIsIt:J;1,LATYON _ — — Oaco of Transaction /a��"I You may cancel I Date of Transaction .You may cancel this transaction,without any penalty or obligation,within this wansactron,without any penalty or obligation,within dime business clays from the above data.If you cancel,arry I three business dqs from the abaft date.If you cancel,any Cron party traded payments made by you under the I property traded in.any payments made by you under thetract �- - any negotiable Instrwnent exe—ted I Contract or Sake,and any negotiable instrument executed by you will be returned within ton business days following r by you will be returned within teen business days fallowing receipt by the Seller of your cancellation notice,and any I receipt by the Seller of your cat Ration notice,and any arising security interest out of the transaction will be security i+ttareist arising out of the transaction will be canceled.if you cancel,you must make avallable to the Seller I canceled.If you cancel,you mutt matte available to the Seller at your residence.in substantially as good condition as when l at your residence,in substantially as good condition as when .eeeiv*4 any goods delivered to you undsr this Contract or i received.any goods tither od to you u n&r this Contract or Sale;or you may,if you wish,comply with the instructions of I Sato,or you may,!(You wish,comply with cite Instruections of the Seller regarding the return shipment*(the goods at the the Seller regarding S the return shipment of the goods at theSeller's expense risk,if you do make the goods available X Seller's expanse and risk.If you do make the goods available to the Seller and the Seller does not pldt them tip within to the Seiler and the Setter does not pick thorn up within twenty days of the date of canceRation,you may retain or [ twenty days of the date of c ncelado,%you may retain or dISPOSe of the goods without any furthw obligation,if you I dis�poos0 of the goods without any further obpgadon.if you dal to-alto the goods available to the Seiler,or if you agree I fai(te make the goods available to the Seller,or It you agree re return the ponds to the Seller and fill to tile so,cite,you I to return the goods to the Seller turd fail to do t,,then you remain tTO Tor performance of all ail o deliver under the i, remain liable for performance of an obligations under the Contact To cantxA this transaction,Mail or deliver a sighted Contract.To cancel this transaction,mall or defiver a signed and dated Copy of this cancellation notice or arty other I and dated copy of phis etncolEacion notice or any other written notice,or send a telegram to Renewal byAnd41 ft of I written notice,or send a teleggrraamm to Renewal byAndarssn of Southern New England at 26 Albion Road,Lincoln,R10266S, I Southern Now England at 26Albion Road,Lincoln,Al 0286S, NOT LATER THAN MIDNIGHT OF_ I NOT LATER THAN MIDNIGHT OF (Date) ID-.% (HEREBY CANCEL THIS TRANSACTION. HER BY CANCEL THIS TRANSACTION. a++r+rlr swear t trrbtr Naar nits owl-%strhu,ev PA"No" Data RbA Coplr White Buyer Copy.ralow Buys►c"y pbytt Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts-Department of Public Safety f Board of Building Regulations and Standards Construction Stilpertzsor License; CS.09S707 ; BRIAN D DEN 7 LANIW POND t s Charlton MA 01597 �,,�„�.d.6tgc• 'r'a'' Expiration Commissioner 09/0812016 • Office of Consumer Affairs end Business Regulation " 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 175245 Type: Supplement Card SOUTHERN NEW ENGIA_ND WI7<IDOWS LL E>mlration. B/1812018 DENNISON BRIAN — — 26 ALBION RD — LINCOLN,R102865 'Update Address and return card Mario reeson for cbngL Sur o aa+eem 0 Address C Renewal 0 Employment C]Last Card Me of Coaeem r Affairs&Bnsinm Rgaladoa License or registration valid for individul one only E a/PROVEMENT CONTRACTOR before the apindion date.n foand retoro ow OtCux of Comames:.tTain and Basinm Regulation 173245 Type. 10 Park Plea-Su1te 5170 Eaphadon: 9MSM16 /Supplernerd•:aid Boston.MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BYANDERSON DENMSON BRUW 26 ALBION RD ? r LINCOLN.RI 02865 Uradvserrcury of valid without signature Ike c.ommonweattn qj massacnuserrs Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114 2017 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orpnization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address: 26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are you.an employer? Check the appropriate box: Type of project(required): 1.0 I a employer with 20+ 4. I am a general contractor and I 6 New construction employees (full and/or part-time).*.� have hired the sub-contractors 2.❑ I am a sole proprietor or partner- ._ listed on the attached sheet. 7. ❑Remodeling ship and have no employees. These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp.insurance comp.insurance required.] 5. We are a corporation and its l0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per.MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no // a employees. [No workers' 13. Other l,)t n d� comp. insurance required.] Ili �c P�n'r S *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. <> t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:ARGONAUT INS. CO. Policy#or Self-ins.Lie.#.WC 928058352394 Expiration Date:8121/2016 Job Site Address:.S 05J Q t kn '2�yfcee, City/State/Zip:k PS� 'gaff15fun�P. U l4 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'� MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well;as civil-penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a-copy.of this statement may be forwarded to the Office of Investigations of the DIA for' prance coverage verification. I do hereby ceriffix under the ' s and penalties ofperjury that the information provided above is true and correct. c Si afore: Date: — Phone#• 4012289800 Official use only. Do not write in this area;to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i i SOUTNEW-01 SHETTYSHT ACORO" CERTIFICATE OF LIABILITY INSURANCE 1 DAT/1D/YYYY) 8N9/2 9/2015 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 endorsemengs). PRODUCER CONTACT NAME: Willis Certificate Center Willis of New Jersey,Inc. PHONE 877 945-7378 Fax ( ) c/o 26 Century Blvd A/C No Ext: ) Alc No: 888 467-2378 P.O.Box 305191 E-MAIL Nashville,TN 37230.5191 ADDRESS:certificates@willis.com INSURER(S)AFFORDING COVERAGE NAIC q INSURER A:Selective Insurance Company of Southeast 39926 INSURED INSURER B:OneBeacorl Insurance Company 21970 Southern New England Windows LLC INSURER C:Argonaut Insurance Company 19801 D/B/A Renewal by Andersen INSURER D 26 Albion Road Lincoln,RI 02865 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE + POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE CLAIMS-MADE T OCCUR S 2029459 08110/2015 08/10/2016 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY JECT T LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY - COMBID SINGLE LIMIT E accident) $ 1,000,000 A X ANY AUTO S 2029459 08/10/2015 08/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS N AUTOS Per accident $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S 2029459 08/10/2015 08/10/2016 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE I I ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N 0000068028 08/21/2015 08/21/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Workers Compensation WC928058352394 08/21/2015 08/21/2016 See Attached DESCRIPTION OF OPERATIONS/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. AUTHORIZED REPRESENTATIVE Evidence of Insurance A4 @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1 � > Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee s . • BARNSTABLE. 1639. Thomas F.Geiler,Director Building Division ©►` Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNHT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address ,Residential Value of Work �t Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ( Cn CL.K& °� �l l.(�y k n t Q)0"I �fSOX ya w. UA 69 06? Contractor's Name 1,, L. Telephone Number s Q Lm 0 0pd Home Improvement Contractor License#(if applicable)_ I G o 1p 4 Construction Supervisor's License#(if applicable) �J r(p �3� ®PRESS PERMIT ❑Workman's Compensation Insurance JUN.— 6 2012 Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 'WI have Worker's.Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name ACC, L 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 �1�� J �Ca ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requi SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\DDV87AAZ\EXPRESS.doc Revised 072110 i tNe r 3p Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.ba rnstable.m a.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, " tA j V4 t W 02 ,as Owner of the subject property hereby authorize Ge,6 av cd to act on my behalf, in all matters relative to work authorized by this building permit application for: 1L3' IOLIC (o A ; o. jd.ywirtn (.e, (Address of Job) --� - "t I I ka Signature,of Owner Date JUD I714 YOTLJ 0 .S Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Usersldecollik1AppDetaUcallMicrosoRlWindowslTempomry Imemet FileslConteirt.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 The Commonwealth of Massachusetts r Department of Industrial Accidents Office of Investigations 600 Washington Street + Boston,MA 02111 www.massogov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): C)e . rQ6 (I o-y a iLe. Address: �3�9 Nor1 k) I�i l�L E__ t City/State/Zip:,[ 1, Phone Are you an employer?Check the appropriate box: Type of project(required): ].R I am a employer with 4. ❑ I am a general contractor and I ❑ Q 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 ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12,KRoof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13,•N Other Sl� 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A CO rn i7 e r ,yq- C a j u,01�V Policy#or Self-ins.Lie.#: T 6 l , d'.3 1 a y 21 Expiration Date: , 13 Job Site Address: M5 I ob-t G G City/State/Zip: G}, (?a (A,X rA(6 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un a pains and penalties of perjury that the information provided above is true and correct Si afore: Date: Phone#: k 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#: A(:UKi CERTIFICATE OF LIABILITY INSURANCE DATE 3/05/D2012) ' 03/05/2012 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 Brenda G i I I ette NAME: NE Mason & Mason Insurance Agency, Inc. PAIC.N Ext: 781 .447:5531 Fa No:781.447.7230 458 South Ave. E-MAIL ADDRESS: Whitman, MA 02382 PRODUCER Brenda G i I I ette INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Charter Oak Fire Insurance Co 25615 George Davis, Inc. INSURERB: NGM Insurance Company 14788 33 North Main St. INSURERC: ACE Property & Casualty South Yarmouth, MA 02664 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 11/12 BA 12/13 WC, GL REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 SUB POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY GENERAL LIABILITY 1680790OM226COF1 01/12/2012 01/12/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ 50,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 RO POLICY P - LOC $ JECT AUTOMOBILE LIABILITY M9M28491 10/26/2011 10/26/2012 COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO 1,000,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION TWC3312481 03/05/2012 03/05/2013 OR LIMIT ER AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER C ANY P R/MEM ER EXCLUDED? ❑ N/A OFFICER INCLUDED E.L.EACH ACCIDENT $ 500,000 OFF(Mandatory in NH) E.L.DISEASE-EA EMPLOYE9 $ 500,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMff I$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101 Additional Remarks Schedule,if more space is required) hen required by written contract, CERTIFICATE HOLDER is recognized as an Additional Insured as respects General Liability insurance for the ongoing operations of the Insured on ehalf of the Additional Insured, see explanatory note attached. CERTIFICATE HOLDER CANCELLATION FAX: 508.394.5460 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 'Office*Office Copy*** ACCORDANCE WITH THE POLICY PROVISIONS. George Davis, Inc. Attn: Dacia Bowen AUTHORIZED REPRESENTATIVE 33 North Main Street So th Yarmouth, MA 02664 113hilip W Mason ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts- Department of Public Safeth Board of Buildin!- Re! ulations and Standards Construction Supervisor License License: CS 56130 GEORGE F DAVIS 33 N MAIN ST S YARMOUTH, MA 02664 Expiration: 3/1/2013 Commissioner Tr#: 12051 Office of Consumer Affairs&B siness Regulation THOME IMPROVEMENT CONTRACTOR Registration: '160164 Type: Expiration: .712/2012 Private Corporation GEGEDAVIS tNC - 1 GEORGE DAVIS . 33 NORTH MAIN STREET.. SOUTH YARMOUTH 4i'_026 9 Undersecretary W' se or registration valid for individul use only [ befc"e lie expiration date. If found return to: 6%Le cf Consumer Affairs and Business Regulation s 10:P,arl.4;Plaza-Suite 5170 �. ,Bost., MA-02116 Not valid wffhout signature F J 1 1 '-JMV t iM r m T d : n A/11 a.16 d 33 Q,*T)THE TOWN OF BARNSTABLE SARXSTABLI. t631;. BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... ............... .............................................................. TYPE OF CONSTRUCTION .....�4p..a.. ....................................................................................................... ........ v-j TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies- for a permit according to the following information: Location .... ....T. G ...... . .. .5. ....R. ).. ............................................ ProposedUse .. . ................................................................................................................................... ZoningDistrict ........................................................................Fire District .............................................................................. . Name of Owner ........Addressl Nameof Builder ..............�& ..................................Address. ............ .......................................................... Name of Architect ............5.AOO ...................................Address ..............5....Pq.....4.......C................:...................................... Numberof Rooms ............. ...................................................Foundation ..... ............................................ Exierior .... ....................................Roofing ........................... Floors ......(7).AA_15.5t, ...............................................................Interior ...Lb,aA....4..<S et c-74- . . . ............. ...... ............ Heating ....... ...............................................Plumbing ....I.: ald; iR............................................. ...........................Fireplace .............................................Approximate Cost ............. ........... Definitive Plan Approved by Planning Board _6 —--------- Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH Uj U) _j CD 0 noUj 0- X Uj < LL) (D X IM 03 LL 0 CL r,, LL C) U_ CLI 0 0 vy-,5! < 0 c� ALj Z) U-1 Ld d J) LLI < (D Uj (f,) < L74M LIJ ZQ _j LLJ < a_ • I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... ................. ........ | "� � Mullin, & Sons � ° . . � 8o7 two � ���.. Permit for ----..��.��---' ' � .. single ----' -' ^^` -ily '°-----'' ' > .~~ - 614 k1 Location --.. ----------'' ' ' - 0 West 8azo ---------------:�........------.. / ^\ , Owner W. D^ & ��oo \ ------------=-----^-- Type of Construction -----%;NqAQ................ < ^ . � � 6� � ----.---.-----..------------. ~ � Plot ............................ Lot ................................ ! ' | u�ouar� I2 �? Permit Granted -----.--. . . l� ' ~ ' r~--' Date of 1 . cti _» -' -_- Completed_ -v .. ~� 10.00 / ~~ | PERMIT REFUSED .-----_----.----------. lg -------.------.------------. ...................................... ---.----.--------------.----. *'� ..--------------.-----------. Approved ................................................. lg �. .. ' ---------------------'--`- --------------------.----.,, ` � | | / 4 e .Y w r e r SS V. i 4: rr T I 0 +k �I. 9/16 v®�D.. }4. ry„n� �r k r ►`�`v 1� a a `Z ; f�U 1 e.s O C.4 Y/ON ---- G 1.1 t r,+ C.�L , �! Q.U._ =,,,i e'1.x ' C. RAJ a WiLFRED C �, .-= F. I AVE-2E8Y CERTIFY'7A A T ZVE EII-r1r, e TAYLOR v /MG FO41AIDA�'/OA/ L_OCL8T6OR!AS CACT 9F �O .45 Tr=�/Obi1/+/AMO�.Zv a.�_C®iV�OZ/� rs/STER o SURA A 7AVE 81J/LD/MG .YE_T43AC�R694li-v4E FRIEDLINE& CARTER ADJUSTMENT, INC. 436 Main Street, P. O. Box 338 Hyannis, Massachusetts 02601 Tel. (508) 771-3232 FAX (508) 790-2344 TO: ( ) Building Commissioner or Inspector of Buildings ( ) Board of Health or Board of Selectmen ( ) Fire Department TOWN OF Barnstable TOWN HALL MA RE: Insured: KOTWAS, J. Richard &Judith Property Address: 505 Old Kingshighway /�1#;Al S� W. Barnstable, MA / - Policy Number: 1­109811178 Type of Loss: Water Date of Loss: 9/18/2002 File#: 94521 Claim has been made involving loss, damage or destruction-of the above captioned property, which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail N. LAGUE Adjuster 9/25/2002 _,2 Assessor's map and lot number ...... ..Ba >, a SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Sewage Permit number ........ WITH ARTICLE 11 STATE SANITARY CODE AND TOWN QofTHE .T TOWN OF BARNSW °i SARESTAMM - "6 BUILDING INSPECTOR ss ,/ APPLICATION FOR PERMIT TO ......... �f/, if ......�' ..tl... � ...... Kll.. 'J.L.c ..... ............ TYPE OF CONSTRUCTION ....../A L.V.04..... .... YA/^ ...........................:.............:.................................. ...... ............ ..................19...7 JO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ►^ 5 Proposed Use ... 4.,`�� ..... ............................................................................................................................... ZoningDistrict ........................................................................Fire District ............................`................................................... i' Gl�l A �f t . r��v A 5 � 0 S* ,•04c1 /`!Y ,$ �/ �t w/1. Name of Owner .............. ..1..........k'�d......�1..Q..(......................Address ................... .................. ........:... y Name of Builder ...!..1. .... ...&..- !V'�Address ....�.R. IQ.Y:! S M. ..;�....!Y:�............... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior ....................................................................:................ Heating ......................................................................:...........Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost `�3v. . !..®0 ................................... .. ....... Definitive Plan Approved by Planning Board -----------_______-----------19________. Area ..........--.�v......4........... Id Diagram of Lot and Building with Dimensions Fee �— SUBJECT TO APPROVAL OF BOARD OF HEALTH Al Lj0 Q C L � -No U5le a . Q . W A y I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name A.�.��'I.:..no!FZ:!.....`c....-- .!......1".�. Kwtmmm» Dr. Richard ' ' ' 1869*1 ^ private e�umu���No —.��.�.—.. . . Pe .... . ' pool -----------------^--------' ' . . ' ' Kings Highway ' Location ----50�----�1d �����--. . . West Barnstable --------------------------. ` . ` . ' Owner ---- Dr. Richard Kw%~�xm ------------------ ' Type �mpl �~ ~..^.`~. -----. = '' ' --'� ----- --------------------------. `^ . ' N� Plot --------_� �t ................................ ' . + / * � �� Perm � -� �l Permit -= /� ' ---------��`--.` ~' ^ � Dote of Inspection .......................... ---lA ` 'Dote Como��e6 ........................... ~ lg ^ . ---- -, / �����@� ������� ^ ^~ � ' ^-----.—..---.—..--.. ' lV —..--. .~—~--------.---. — � .---~—_--.. . �* ' ,—.—.--.—....----.—.-----~.---.. .—.-'^-------~-------^'�—'----- ---------.--------.—.':.---.��.. � . Approved ------------.!--.. Yg � '. ' ' �--------.--------.—..--.'—.---. ' v ------------------------....�. ' ' ' . 9,2 2 - 7, Assessor's map and lot' number i ...l.. ......�.....�.°� Sewage Permit number .........2?.,ov T"ET°�o TOWN OF BARNSTABLE BARNSTABLE. i 9` oaELAV BUILDING INSPECTOR ,/ APPLICATION FOR PERMIT TO ........ .......�.=`....X 3.�..'. f�...... � TYPE OF CC+NSTRUCTION ...... y, yex....�....�1t„���C......................... ............0 ->L.............19...` r TO THE INSPECTOR OF BUILDINGS: The undersigned 'hereby applies for a permit according to the following information: .........W Location r , �) ............................................................................................................:................................ ...... .... aQ,Y'..... Proposed Use ��1 AML4:�g D Zoning District ..........................................Fire District ...D.....�........4......�...............�.. Name of Owner )).' .....RC.. . Ab /,.,,,/ D.rvF... .........Address ... N 5 � yy Y�A r�%��a✓� 'w� l �. �b rtis �/ Nameof Builder .............a........../�..........................................Address .......... .....::.................................;........... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms '...............Foundation i Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .............................................................................. .... Heating ..................................................................................Plumbing .................................................................................. Fireplace ........................Approximate Cost � 6.0.0.1.0.0 Definitive Plan Approved by Planning Board -------------------_-----------19________. t Area .........:..`. ..f ..... ........... Diagram of Lot and Building with Dimensions ��": Fee ............................................. 9 g SUBJECT TO APPROVAL OF BOARD OF HEALTH Yi d , 4,10 U a �J e i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. (� Name J� V�!s�. L.�.~....C .... NC•(•• � � ... Kotwas, Dr.. Richard A=133-32 No ... .... permit ?or.......pri tn!� .'s coming ...........R00.1.............................. M&in Location .........5PLAL.A-"ft".-449hw4y........ .......................... ................... Owner ...............................Rich.ard..Kotwa.s........... .. ...... ........... . Type of Construction s Aming-pool .............................. .............................. Plot ............................ Lot Permit .............................. - Granted ...22.........19 76 Date of Inspection ....... ...........................19 Date Completed ....... ............................19 ........................... PERMIT"REFUSED ............................................ .... .. ........ 19 I ........................................ ... ...................... .r, LAO ...........................P/7 1111p)-ii l..........:................... ............ .................................. ............................... ...... ........ ... ...... .. ... ........ Approved .............................................. 19 .............. ............... ................................................ ............... ............................................................. Assessor's map and lot number ... ... - .. 'THE Sewage T� Sewage Permit number 'fad...�l.�rx�._.yr! SEPTIC SYSTEM MUST 8 . e House number !� 'INSTALLED IN CC�MPLIAi� BaEMAS& E, ONi WITH TITLE ��5qq �O,o�t6,9. BARN s l �1f1 YU19T 0 E AN �E�MpY a TOWN 'OF BARN �z IQ�S BUILDING 4INSPECTOR APPLICATION FOR PERMIT TO .......�' ,,?!T. . ..........................:.........................:..............:.................: TYPE OF CONSTRUCTION ........ .rV�.d4 ............................................................:................... ................... .......�..............I9.2..1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....5.-�?.....1 .i .. .. .............. ?. .. �o .r..................................................... ProposedUse ................................................................................�.................................................................. ZoningDistrict ........................................................................Fire District ..................................................................................... v Name of Owner ...` C`:... `.0 '@'� r ...:... ... ....PSIddress ...........:: ... C l. ............................................ F Name of Builder1�1�'11 ,.... �.'... . Address ...�J ... ��-'� �. .:. ....... Name of Architect ...........1�`C>1� .'................................Address .................................................................................... Number of Rooms �- ....................Foundation s.C��. . ..................................................... Exterior .... r�r^D Y..,,.....................................................Roofing ......i :!4:1? —a�_ ... .......... .. ............................................... Floors ........ .................................................Interior �. Heating .. Q...........................Plumbing ..... vac...... ..... ....... ...................................... Fireplace .......... C? .....................................................Approximate Cost . ....1. .................................... Definitive Plan Approved by Planning Board -----------_------_-----------19_______. Area ...... ....................... Diagram of Lot and Building with Dimensions Fee i. " SUBJECT TO APPROVAL OF BOARD OF HEALTH J J � 0 n i57O --�- too I I hereby agree to conform to all the Rules and Regulations of the Town of arnstable reg'ardi the ab ve construction. , Na . . .... ... ... .............. K,,DTWAS,. DR. RICHARD 41d Addition No ... Permit for ... ......................... Dwelling ............................ ................ Location ...5'05 Main Street ......................................... West Barnstable *. ..................................................................... .......... Owner .....D.r......Ri.ch.a.rd...Kotwa.s.................. .... .. ..... .... ....... .. Type of Cons'tructr6n ..Frame ............................... .................................. ............................ Plot .............................. Lot ........................ ........ Nov. 12 N , Permit Granted' ..�...... —............................19 81 Date of Inspection ....................................119 /V Date Completed ....... 19 PERMIT REFUSED ............... .......................................... 19 ..................... ......................................................... ................................................................................ ............ .................................................................. ............. ............................................................ Approved ................................................. 19 .......................................................................... . ............................................................................... p .G� /e Assessor's map and lot `number ... .. ..... cF THE ro Sewage Permit number i B9B.BSTLDLE, + House number. .....:.................................. y� rues i639• `e0 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........... k���.1.�`............................................ TYPE OF CONSTRUCTION .........�! .................................:..................................................:................... ...................n ZA.�..............19.2.A TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... ." .....1 Zf � ..�\..�.............Q.,. eZ� � � ���.� .�....................................................... ProposedUse .... ..........................................................................................:..................................................:...... Zoning District •..Fire District Name of Owner ..... ��:... � ;?'\.�� ��"�.. Address ............ , ........................................... w A l ` .. Name of Builder � ......��>.....�\ mac, J�'fl ��� �� Pa� ,��,,�� ............ — ..... ....... ..........: Address ................... ......... ......:.................�,......;.1�......... Name of Architect ...........: ......................Addiess ......Foundation 0.��+C. ...................................................... Number of Rooms .... Exlerior _ ' 'a4�, _ ......................Roofing .....'? * � " .�. .c.............. . ................................................. Floors ................................................Interior ....� ..... :................................... Heating --jt.,l.. . .r/,,: C '..�`.-a CQ...........................Plumbing .... 19 ll, , ...................................... Fireplace ............ C? ................. ............................Approximate Cost . ............................... Definitive Plan Approved by Planning Board ______________________________19________. Area /.. ............................ Diagram of Lot and Building with Dimensions Fee ........ SUBJECT TO APPROVAL OF BOARD OF HEALTH 20 r � � J � too l I hereby agree to conform to all the Rules.and Regulations of the Town of.,Barnsta_ble regarding'the above construction. Name -� i / ......... KOTWAS, DR. RICHARD =1:3:3:-3�2 23633 Build Addition No ..............:.. Permit for .................................... Single Family Dwelling ............................................................................... 505 Main Street Location ............................................. .................. West Barnstable . ............................................................................... Dr. Richard Kotwas Owner ................... ............................................... Type of Construction .....Fr me......... .................. ................................................................................ Plot ............................ Lot ................................. • November 12! 19 81 Permit Granted ......... ................. Date of Inspection ............. ......................19 Date Completed .......................................19 PERMIT REFUSED ....... . ............. ...... ............ 19 ......LAIV. .........?1�114*�-*--z..................... ................................................................................ ............................................................................... ............................................................................... Approved ........................................................................................ 19 ............................................................................... ................................................................................