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0039 PERCHERON WAY
J G� �Ilyhv Oxford® NO. 1521/3 ORA MAMN U" ESSEL E 4 °F Town of Barnstable *Permitt(z_ J21? Etprres 6 mo /rs ronyissc r e Regulatory Services Fee HAHNSTAHLE, 9� mAss'16g9. Richard V.Scali,Director ♦0 QED NIA� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www-town.bamstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press bupriut fviap/parcel Number 17'1- CO.l G S 2- Property Address rd,ego r1 I,Ja X 310/_I ❑ Residential Value of Work$ �,'711 / L Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1,o i A x 3c! Pr�G,er'o.n iJay W. terns- ble tiA 026 R Contractor's Name is "lldc / ljrso/( Telephone Number q0f 2 Horne Improvement Contractor License#(if applicable) l 7 =32 L/ s Email: Construction Supervisor's License#(if applicable) 7 0 7 (L�Workman's�Compensation Insurance Check one: ❑ I am a sole proprietor ❑ m the Homeowner I have Worker's Compensation Insurance 0 9 2 E I Insurance Company Name F=, C aMe n,5 Loser ac,C p�fz. A �j Workman's Comp.Policy# W C 8 31 S 8 7 2 9 — 2 0 TOWN N O� 8A R�i'y S I AB L E Copy of Insurance Compliance Certificate must accompany each permit. I 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) ❑ De-side eplacement Windows/doors/sliders.U-Value 3(maximum.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 t6th other town department regulations,i.e.Historic.Conservation,etc. ***Note: Property weer must sign Property Owner Letter of Permission. A copy the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: a C:\Users\Decdllik\AppData\Local\ivticrosoft\Windows\Temporary Internet FilesTontent.0utlook\2P101 DHR\EXPRESS.doc Revised 040215 Renewal _ — - -- R1 License#3607, bY/�tldersen. RENEWAL BY ANDERSEN Licensecr License 063455-' WINDOW REPLACEMENT m,VdenmC.impaq 26 Albion Road • Lincoln,RI 02865 Lend Firm#1231 Phone 866.563.2235•T tx 401.633.6602 Federal Tax ID#46.0566630 Southern New England Windows,LLC d/b/a t Renewal by Andersen of Southern New England n �/ CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name: N fL-hW r .3 c O T Z:// A , Du /e ofAgreemenc 7� 7 / / i Buyers)Sweet Address.Cty State,and Zlp Code/P.O-Be. V t �"- ��� W'/ a"•' E-Ma1lAddress: y 2 Home Telephone Number19� y'-y Y yyorkTelephone Number:V 'o 2/Z%ffZ 1 Buyer(s)herebyjoindy and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal by Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheets)(collectively,this`Agreement"). O Historic O Condo ❑ HOA? ��Gj til.S/�rr l oTo I�)o�Amount✓ / Estimated Sprung Date:S Method of Payment O Check O Cash ❑Financed psitdcbrved(33%). � �_ i Credit Cards are accepted for deposit only-maximum 1/3 of the Balance at Start of Job(33%): Estimated Completion Dace: project cost.(Please see Credit Card Payment Form.)By signing this, 1 O 6 O Agreemen t,you acknowledge that the Balance at Start of Job and the Balance on Substantial 7-2L-It5 Balance on Substantial Completion of Job cannot be made by credit Completion of Job(33%} card and must be made by personal check bank check or cash. 1 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 I 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 be 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 1 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. Buyer(s)received the consumer education materials provided by the Rhode Island Contractors Registration Board. (Blyer's Initials) Renew y Andersen of Southern New England Buyers Bu e s) Y r( g. Signature o roduct Manager Signature I � Signature `� �S oTT Print Name of Product Manager� Print Name Print Name 4 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- - - - - - - - - - - - - -�`- - - - - - ae Date of Transaction �����/ 7 NOTICE OF CANCELLATION - this transaction,without an You may cancel I Date of Transaction .You may cancel three business days from the penalty a date.If loutcancel,any I three business this days without from he above date.If y or outcancel,within y ou under the erty traded in,any payments made b Y y Contract or Sale,and any negotiable instrumentuexecuted I e I Contra ora Sale,ded yand ay payments got ab eanstrde ument executed by you will be returned within ten business days following I by you will be returned within ten business days following receipt by the Seller of your cancellation notice and an receipt b he Seller of our cancellation notice,and any ice a iliLercst arising out of the at vau -I YOu cc-a^cel•Y4u must transaction will be I securityinterest arisingyour of the transaction will be yoU'aressdencezi'n`' ub make available to the Seller i cancele .If you cancel you must make available co the Seller r•ctvW �tialty as oo�odi d'alive *-.X+8_. d condition I �y z ;t�yin �yyou under when at our residence,in substantially as good condieJon as when tr Set►e`rt�"s`�i d►^g`th� �'~ Y wiih gib°^tract Or I received,any goods delivered to you ur+de i,ttiis Contract or tO eXPense�and reh"'^ships,ento �estrue4 Sale;or ou may,it you wish,comply w�Eh.the'instructions of ti1e Seller'aQ the sk.If,YOU do Make �oO at the�l Y P g Men Sellernot tite oo ds the Seller regarding the return-shipment ment of the oods at the dispose°a the the date o/cancellatio Pick Ahern pp�� in 'to Seller's Seller and the l Seller does of pick them p within r °f fol to m /e goods8 goods y fur 'You may retain or i twain days of the date of cancellation,you may retain or to return there available° her obligation.If you I dispose of the goods without any further obligation.If you 'amain liable 80►ds to the Seller the Seller,or if ycu agee i fail to make th goods available to the Seller,or If you agree perfor and fail to do and di et!cancel this m�Ce Of all obli so.then You I to return the goods to the Seller and fail to do so,then you tra►tsactien, gations.undo r'the remain liable for performance of all obligations under the written n°utePy of this mail or deliver,a signed 1 ContraetTo cancel this transaction,mail or deliver a signed the ersendatelengtetlati°^ ^°tiCe or;;ny other' l and dated copy of this cancellation notice or any other NOT Lq ER T ^Bland at 2ti rem CO Renewal bygnd�;San of I .written notice,or send a telegram to Renewal byAndenen of (Date HAN MID Albion Road;Lincoln¢R I HEREBY C NIGHT OF _ 0286s, I Southern New England at 26Albion Road,Lincoln,RI0286S, ANCELTHIST 1 NOT LATER THAN MIDNIGHT OF RANSACTION. i Date) j. (HEREBYCANCELTHISTRANSACTION. suy„y flt,yt,,,,� X FZ; assachusetts Department of Public Safet] oarcl of Building Regulations and Standards License: CS-095707 BRIAN D DENNISON ; 7 LAMBS POND CIRCLE f9 . CHARLTON MA 01507. ' .tom �-1 =Ypir3tiQn: Co mmissioner 09i08/2018 o;�;r .C.. ':9 :_�r:'-.•ciic�i::y,+.�i��rri(.r"'. J� •"'/:;.r;:at b���;Cr'.i�'i IO'tiice of Consumer Affairs and Business Regulator. 10 Park Plaza -Suite 5 L70 .2116 Boston,7Ntassacnusetts 0Z Home Improvement f-ontractor Registration Regfstradon: 173245 Type: SupplementCard - E:tpiraftn: 9/19/2018 SOUTHERN NVI E ENGLAND VVINDOW-.",L- BRIAN DENNISON 26 Al BION RD LINCOLN, RI 92865 Uuduwe xddr^ss and return For,:han6e. address _Renewal _Employment ;_Lust Card Rce of Cnasumer.VFairs Y BusineSS RE903110u Rryistration-valid for individual use only uefi re the � __ expiration date. if found return to: • jOA7E IMPROVEMENT CONTRACTOR OtLc of caoslrmer mTair..and 3usinss 2ev!adon %=5r•- r 'z 9_3::_Registration: Tree: 10 c'ar!:Pl:rra•Suite 5110 e5 1 S _- E:.piradon:;;9l19%1D13 Supplement card 3oston.bC\02116 SOUTHERN,NEN ENGIrAND WINDOWS LLC. !'• RENEWAL 3Y ANDERSON': l' BRIAN DENNISON - ' UNCOLN.RI 02865 '-Undersecreury n Lure ! Y ` The Commonwealth of Massachusetts "I� Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, JL4 02114-2017 www-mass-gov/dia '"'orkers' Compensation Insurance Affidavit:Builders/Contractors/Electriciaus/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): E LA.) fwaW ow Address: .z& ALzloo _ City/State/Zip: p Phone#: Are you an employer?Check the appropriate box: Type of project(required): I�I am a employer with Zo femployees(full and/or part-time).` 7. New construction 2.F�I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'camp.insurance required.] 9. ❑Demolition 3.R I am a homeowner doing all work myself INo workers'camp.insurance required.) 10 Q Building addition 4. [am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.71 I am a general contractor and I have hired the sub-contractors listed on he attached sheet. 13.RRoof repairs These sub-contractors have employees and have workers'comp.insurance. / 5.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,6 1(a),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 1,1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Lf the sub-contractors have employees,they must provide their workers'tamp.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: 1l hIQ $ (39 fit Policy#or Self-ins.Lic.#: �,(�O A,3ls�V 7 z T — Z- Expiration Date: / l Job Site Address: 3 � G lk•e r-o✓1 City/State/Zip: //. t"-zrrn s /a A Attach a copy of the workers' compensation policy decl ration 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 th gins and penalties of perjury that the information provided above U true and correct � e Signature: 14 Date: — Phone#• 10 ZZ.e— lT 9c;V > Official use only. Do not write in this area, to be completed by city or town ofjiciaL 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#: , ESLERCO-01 SANDERSO AIC400M® CERTIFICATE OF LIABILITY INSURANCE. °0 107120 7 os/o7�2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMECT CoBiz Insurance,Inc.-CO PHONE FAX 1401 Lawrence St,Ste.1200 AIc,No,Ext:(303)988-0446 (AIC,No):(303)988-0804 Denver,CO 80202 aURILEss:COMail@cobizinsurance.com INSURERS AFFORDING COVERAGE NAIC 0 INSURERA:Acadia Insurance Company 31325 INSURED Southern New England Windows,LLC.dba Renewal by INSURER B:Firemens Insurance Company of WA D.C. 21784 Andersen of Southern New England INSURER C:LibertySurplus Insurance 10725 26 Albion Road,Suite 1 INSURERD: Lincoln,RI 02865 INSURERE: 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR INSD yJ1/D POLICY NUMBER MMIDO M DNYYYl LIMITS A X COMMERCIAL GENERAL LIABILITY EACHCURRENG 1,000,000 CLAIMS-MADE ®OCCUR DAMAGE TO RENTED S CPA3158728 0110112017 0110112018 PREMISES E.amu'rence S 300,000 MED EXP(Any oneperson) S 5,000 PERSONAL S ADV INJURY S 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY a JECT to 2,000,006 PRODUCTS-COMPIOPAGG S OTHER: EBL AGGREGATE S 2,000,000 A AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT Ea accidentl S 1,000,000 X ANY AUTO SCHEDULED CPA31SB728 01/0112017 01/01/2018 BODILY INJURY Per person) S OWNED AUTOS ONLY AUTOS BODILY INJURY Per accident S HIRED NON WNED PROPERTY DAMAGE AUTOS ONLY AUTO ONLY (per accident S S A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 EXCESS LIAB CLAIMS-MADE CPA3158728 01/0112017 01/01/2018 AGGREGATE S DED X RETENTIONS 0 Aggregate s 1,000,000 B WORKERS COMPENSATION PER OTH AND EMPLOYERS LABILITY YIN X STATUTE ER ANY PROPRIETORIPARTNERlEXECtmvE WCA3158129-20 01/0112017 0110112018 ELEA@HACCIDENT S (M 1,000,000 OFFICERIM�MBER EXCLUDED? ❑ N I A andatory m NH) E.L.DISEASE-EA EMPLOY S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS belav ,000,000 E.L.DISEASE-POLICY LIMIT S B Worker's Compensatio WCA3158730-20 01/0112017 01/01/2018 1,000,000 C Pollution Liability EDE654299117 0110112017 01/01/2018 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is requ-1 17-18 Workers Compesnation Includes-All states except ND,OH,WA,WV,WY ` 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 PQL--IGY PROVISIONS. AUTHORIZED REPRESENTATIVE IF OR Informational Purposes ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PPE INT own of Barnstable *Permit# Expires 6 mo is om date 3 2015 Regulatory Services Fee • tutuvsrner g, • „MAM 'r: BAPNSW1Pjehard V.Scali,Interim Director 6 Building Division (j Tom Perry,CBO,Building Commissioner I' 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY _ Not Valid without Red X-Press Imprint Mao �/parcel Number 7 �O/ L� Property Address Residential Value of Work$ Z Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /V y �7wT Contractor's Name S o 6A- e-'N0-E. v J t�1 ,P)S NN/ O Telephone Number Home Improvement Contractor License#(if applicable) q/732`f.IC Email: Construction Supervisor's License#(if applicable) 0 /'/70 7 XWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation )l Insurance n Insurance Company Name ll� ��^^ niv b Ql1P Workman's Comp.Policy# WC. 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 tJ (maximum.35)#of wind ws�, #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 Owner Letter of Permission. A copy of the Home Improvement.Contractors License&Construction Supervisors License is required. l e SIGNATURE: TAKEVIN MBuilding Changes\EXPRESS PERNUDEXPRFSS.doc Revised 061313 ' Renewal �• Ill License dW-07:� i RENEWf1L BY ANDERSEN "Nu""�rr1732^1 1 byAndersen ' un WINDOW REPLACEMENT 26 Albion Road • Lincoln,RI 02865 f(��� U n J,l lad firm#1237 ' I Phone 86G.563.2235•Fax 401.633.6602 1 I'Wcrel Tax ID 046-056G630 f Southern New England Windows,ILC d/b/a 1 Renewal by Andersen of Southern New England D 1 III"'iii��� n CUSTOM WINDOW /AND DOOR REMODELING AGREEMENT / U Buyer(s)Name: - �.f��J/. --J°\... / Date ofAgeement: Buyer(s)StreetAddrea•City Sate,and Zia Code I P.0-Sax: 5 � .I'^' y VV �� ob I O�� E•Matl Address: Nome Telephone Number:3 ZU-Iftl- Work Telephone Number:.4a!e 3(jt_%LT Buye1(s)hereby jointlyJand severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal by Andenen of Southern New Frngland("Contractor"),in accordance with the terms mid conditions described on the Runt and the reverse of this agrecmeut and on the,attached specification sliect(s)(collectively,Ilik'Agreement")• ❑Historic ❑Condo ❑HOA? ATr�= Total Job Amount:17LY2k Estimated Starting //Date ,, Method of payment O Check O Cash G Financed Deposit Received(33%): � � � 2 LON G Credit Cards are accepted for deposit only—maximum 113 of the Balance at Start of Job(33%):-1,[��-- 13 project cost.(Please see Credit Cord Payment Form)By signing this Estimated Completion Date: Agreement.you acknowledge that the Balance at Start of Job and the Balance on Substantial c Balance on Substantial Completion of Job cannot be made by credit Completion of fob(33%): S� 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 Soles 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)receivrd the consumer education materials provided by the Rhode Island Contractors Registration Board. (BtgtirslnitiaLe) Renewal by Andersen of Southern New England Buyers) Buyer(s) By: SignatureofProductManager Sigl tun: Signature �I�l?V .9C07-T Print Maine of Product Manager Print Name Print Nantc 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. - - — — — — — — — — — — — — —3�-C- - - - - - - - — — — — — — �— - - - — — — — — — — — � NOTICE OF CANCELLATION NOTICE—OF— —CANCELLATION Date of Transaction S—.20— ) IT .You 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 three business days from the above date.If you cancel,any property traded on,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 I by you will be returned within ten business days following receipt by the Seller of your cancellation notice,and any l receipt by the Seller of your cancellation notice,and any security interest arising out of the transaction will be security interest arising out of the transaction will be canceled.If you cancel you must make available to the Seller l 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 the Seller regardingthe return shipment of the goods at the the Seller regarding the return shipment of the goods at the; Seller's expense and risk.If yoiu 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 I to the Seller and the Seller does not pick them up within twenty days of the date of cancellation,you may retain or l twenty days of the date of cancellation,you may retain or dispose of the goods without any further obligation.If you I dispose of the goods without any further obligation.If you fail to make the goods available to the Seller,or if you agree I 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 remain liable for performance of all obligations under the Contract.To cancel this transaction,mail or deliver a signed l Contract.To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other and dated copy of this cancellation notice or any other written notice,or send a telegram to Renewal byAndersen of I written notice,or send a telegram to Renewal byAndetsen of Southern New England at 26 Albion Road,Lin n..RI 0286S, I Southern New England at 26 Albion Road,Lincoln,11102865, NOT LATER THAN MIDNIGHT OF — l NOT LATER THAN MIDNIGHT OF (Date) (Date) 1 HEREBY CANCEL THIS TRANSACTION. I I HEREBY CANCELTHIS TRANSACTION. X atsyer's Signature Print Name Dots tuyr's signawn print Nuns Dab RbA Copy:White Buyer Copy:Yellow Buyer Copy:Pink Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction supervisor License: CS-095707 BRIAN D DEMOSbN - :r 7 I A14BS POND Charlton rAA 01507 EApiration Commissioner 0910=016 uS2oan�re:o�ru�ea�� Office of Consumer Affairs find Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9119/2016 _ - DENNISON BRIAN 26 ALBION RD == — LINCOLN,RI 02865 _ _. Update Address and return card iNark reason for change.-- SCA 1 0 20&&05M1 Q Address j::Renewal FI Employment Lost Card Iflce of Comnmar Afhirs&gusi—Re4alation License or registration valid for individul use only E IMPROVEMENT CONTRACTOR before the expiration date. Irfound return to: .Office of Consumer Affairs and Business Regulation V gistration'. 173245 Type 10 Park Plana-Suite s170 Expiration: 9n912016 Supplemerd:and Boston.MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. '` RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD LINCOLN.RI 02865 lladcrsrcmary Not valid without signature _ Ii L CERTIFICATE OF LIABILITY INSURANCE �"M�"�"at oe/2s/2ena THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CMFER a 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),AVMORRED 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 condi#lons of the policy,certain policies may require an endorsement. A shtentent on this certificate does not confer rights to the cerUfkate holder In 1[eu of such endorsemangs). PROOUCPRpillis of New JAy o=seY. Inc-tac- ACT C/O 26 C'aatttsy*Blvd ['HONE 1-877- 4s-7378 FAX -8es-467-237e P.O. Bos 305192 Heahville, TO 372305291 WM AAnvRE AIL •cart•ifieate.eviliia-cm 0ISIfflEIWAFRXtDM CWJBtAS£ FIAIC 6 INSUPMA:Baloctive T^ffaran» Cbmpscy of 8Y 39926 RSSUREDgouthaza Sev England uiadv= LLC WSURR6:7ha Beaten Matua1 Insuranca Ca=V=y 24017 D/B/A Rnaevnl by Aa's-aaa 26 Albion Road Ue3IlRRC_ ZweL 19801 Lincoln, RS 02865 WSURERD: DiS1RER E MURER F: COVERAGES CERTIFICATE NUAMSER.-29160 REVISION NUMBER:- THIS IS TO CEMZTIFY 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 LYSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOV/N MMAY HAVE BEEN REDUCED BY PAID CLAIMS. LILT R TYPE OF INSURANCE POLICY KUl0352 MMONYM POLICY EFF POLICY I7IP LMM AX C CIAtGENRALtustuiY I10811012014 EACH OCCURRENCE 5 1,000,000 CIAL64tADEaOCCUR DAMAGE TO Rawfo— PREUMM 200,000 LIED EtP(Any�P�N lo, 0o N S 2029459 0011012M PSRSO-M&ADVWURY` S 1,000.000 GAGCREGATEUARTAPPLMS PER: G13a61ALAGGREGATE S 3,000,000 POLICY JPECT a LOC PRD6UCtS-COAWIOPA`6G S 3,000,000 OTHER $ AUTOMOBILE LIABILITY C Ol'87 SINCdELMdIT S 1,000,000 X ANYAUTO I BODILY KIURY(Perpmsan) $ A A T OWNFO SCHEDULED 8 ao294s9 08120/201S 800ILYBiAW(Per $ X H�AurOS X � 11,08/20/2024 FRnPi327Y OAMAGe 5 n L A $: UMBRELLAIdAB X OCCUR EActfoticilraiENCE S s,cbo,bbn IEIMMLIAB CLAWS-MADE S 2029459 08/10/2014 08/10/2015 SATE $ 5,000,000 OID RETENTIONS S WORKERSCOEFERSATION X PERM OTit- B AND EMPLOYtRSLUOLrrY YinATuf R ANY PROPRIETOWPARTNEREKEt CUnYE EL EACH ACCpgh $ 1,000,000 OFFICEMMEMOEREKCLUOED7 Q NIA 0000066028 08l2112014 08/21l2015 IIIE.L.DISEASE-EA EMPLOYEE S 2,800,000 ❑yy8e55.�de=M UWer D£Bi iIPTIONOFOPERATIONSbdm FLr)#.,;r SE_PDLICYtJ40T S I,000,000 C ork Cmg/6L Covgt W092793835Y394 08/22/2014 08/21/2015 .L Ia. Accident = $2,000,000 rotatory Limits - irc .L. Disease Policy rot - $1,000,000 -L Dieeaae Ea. 1ibp107se - $2,000,000 OEBCRIPTRNd OF OPERATLONS I LOCAT#M I VBRMM(ACORD IDI,AddMonsl R4maft Sdmidwv,nW be a03d70d ff emta apau!s m arl 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 South—BE LLC 26 Albi=Road [14 Jincoln, RI 92865-0000 ©7588-20W ACORD CORPORATION. A8 rights HMIWd. ACORD 25(201001) The ACORD name and logo are registered In aft- of ACORD SR ID:6629625 BASCHiBateh 8: 79627 The Commonwealth of Massachusetts Department oflndusiddAccidents Offwe oflnva gations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electiiciam/Plumbers Applicant Information - Please Print LeLnbla Name (Business/Ownization&&vidual)• / n I Address: City/State/Zip: Lf"""'-c IIJ Phone#: Are you an employer?Check the appropriate box: Type of project(required): .L Van a employer with ?-C 4. [] I am a general co&actor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees • These sub-contractors have S. 0 Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp.insurance �P•ins'urance. �] 5. We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work 1 L[J 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 employees.[No workers' 13.�Other U)1"tV comp.insurance required.] «Any applicant that checks box#1 must also fill out the section belaw showing their workers'compensation policy 'on t Homeowners who submit this affidavit indicating they are doing all work and then hire outside ccntrdcbors must submit a ni*affidavit indicating mach. TCont actors that check this box must attached an additional sheet showing fie name of the sob-ca ntractots and state whether or not those entities have employees. If the sub-contractors have employees,they provide their wxd=,comp.policy number. I am an employer that is providing workers compensation insurance for my ennployeem Below is the policy and job site information, /Y Insurance Company Name: Policy#or Self-ins.Lic.#: W ' ; ,j 9 3 S -3 `j Expiration Dom: 8 f I Job Site Address: v lr�lUZy VN City/StatelZip: U),&IA5, 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 criin nal.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 MeT pains and penalties of perjury that the information provided a true_ and correct Signature: Date: 6 J Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Perm Meense# Issuing Authority(circle one): I.Board of Health 2.Building(Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector &Other i Town of Barnstable *Permit e- 12012 Expires 6 the fr m' to ������- Regulatory Services Fee - �z Thomas F.Geiler,Director Building Division �t Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis;MA 02601 TOWN OF BARNSTABLE www.town.bamstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work 0 -D V\1 •� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name f t CMk Telephone Number Lj�5 3 1 Home Improvement Contractor License#(if applicable) I 3 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance . Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [3�1 have Worker's Compensation Insurance Insurance Company Name WVVt � Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) a-Ke-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 #of doors ❑ Replacement Windows/doors/sliders..U-Value (maximum .35)#of windows ❑ 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: P 4r,yProperty Owner Letter of Permission. provement Contractors License&Construction Supervisors License is re SIGNATURE: C:\Users\decollik\AppDa Local\Miry nternet Files\Content.Outlook\QRE6ZUBMEXPRESS.doc Revised 053012 i PI-ea a Jc_`,t,, David Sawyer Construction 318 Meiggs Backus Road Sandwich,MA 02563 508-539-1992 Proposal Submitted To: Work Address: Jack&Penny Scott 508-420-1887 Po Box 786 West Barnstable,MA 02668 39 Percheron Way,W Barnstable Worked to be Performed: *Strip old roof shingles and replace with new CertainTeed Architect Landmark Shingles Color: *Nail Plywood as needed *Clean Gutters as needed *Install: Vented drip edge as needed Ice&water barrier on all edges of roof,valleys,chimney Underlayment Paper System Ridge Vent Pipe Flange Hurricane nail roof *Clean &Remove all debris from workplace,take to landfill. *Please note when installing ridge vent sawdust may fall into attic. Please cover items. Total Investment& Labor: $8,800 eight thousand eight hundred dollars Payment is due at time of job completion. All materials guaranteed to be as specific,and work to be performed as stated above in a workmanlike manner. Please remove and secure any fragile household items. Not responsible for broken or damage to household items. Five year Labor Warranty/PI Manufactures warranty. Contract may be withdrawn if not accepted within 30 days lease/see back f additional terms. Respectfully Submitted IL Date/6' Acceptance Of Proposal The above prices,specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work. Pay ent is due in full at job completion. Owner signatdii:; -. 4 Date i I i The Commonwealth of Massachusetts Department of Industrial_Accidents Office of Investigations 600 Washington Street Boston,MA 02111 titmm:ntass.gm.,ldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elechicians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizaatiioonlindividual): . !/ Address: /1/ a-ct G(J_ yn/�, City/State/Zip: #41(A—Phone# Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I p 3''� 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.Nj7im a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demolition w for me in capacity. employees and have workers' working �y � tY• 9. ❑Building addition [No workers'comp.insurance comp-insurance i 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.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.PO ther comp.insurance required.] •Any applicant that checks boa#1 must also fill out.the section below showing their workers'compensation policy information. Z Homeowners who submit this affidavit indicating they are doing all wank and then hue outside contractors must submit a new affidavit indicating,such. 3Contractors that check this boat must attached an additional sheet showing the name of the sub-conaxMrs and state whether or not those entities have employees. If the sub-contractors have employees,they mast provide their workers'comp.polity number. I am an employer that is providing ivorirers'compensation insurance for my eniployees. Below is the policy and job site information, Insurance Company Name: Tills E2::�4 Policy#or Self-ins.Lic.#: Expiration Date: ,� J Job Site Address: City/StatdZip: ✓ Attach a copy of the.workers'compensation policy declarati 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the viol or- Be advised that a copy of this statement may be forwarded to the Office of Investigations of a DIA for instuan coverage verification. I do hereby ce ender hepains nd penalties of petjrtry that the information provided above is trite and correct 0S' tore: Date: / " J Phone#: Official use only. Do not write in this area,to be completed by city or town of cial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.City/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: -� -Cammvwwe� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5 170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 134313 Type: DBA Expiration: 10/24/2013 Tr# 216645 DAVID SAWYER CONSTRUCTIONf: DAVID SAWYER 318 MEIGGS BACKUS RD. SANDWICH, MA 02563 Update Address and return card.Mark reason for change. Address Renewal Employment F I Lost Card S-CA1 0 SOM-04/04-GIO1216 921- -e.-1zoqzawa.1d& Offlee of Consumer Affairs&Business Regulation License or registration valid for individul use only CONTRACTOR before the expiration date. If found return to: HOME IMPROVEMENT CONTRA Type: Office of Consumer Affairs and Business Regulation Registration::,:134313..: 10 Park Plaza-Suite 5170 Expiration: -10124/2013 DBA Boston,M 02116 DAVID SAWYER.tQNSTRUCTI0N'!*. DAVID SAWYER..- 318 MEIGGS SANDWICH,MA 02563......."'- ithifnture Undersecretary Not valri, out s ----- .... .. ........ ...... ........... VAlassachil-Setts-'Del);ti-Inient Or Pub.iit: Boar(l Buil(ling Re'110 C0 iistruct; 111tiolls on supervisor Specjallty License: CS SL 98859 Restricted to: RF,WS DAVID SAWYER A 318 MEIGGS BACKUS ROAD SANDWICH, MA 02563 Expiration: 1/27/2013 Tr#: 9053 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY' INFORMATION PAGE AGENT NO 3020 . OFFICE NO 3020 MARK SYLVIA INSURANCE AGENCY LLC 771 MAIN ST OSTERVILLE MA 02655-1903 FARM FAMILY CASUALTY INSURANCE COMPANY 508-428-0440 NCCI COMPANY NO. 16721 POLICY NO 2001 W6406 < n< « ? INSURED AND MAILING ADDRESS: RENEWAL OF NO. 206IW6406 EFFECTIVE 3/05/12 DAVID SAWYER DBA SAWYER CONSTRUCTION 318 MEIGGS BACKUS RD SANDWICH, MA 02563-3131 THE INSURED IS INDIVIDUAL Workplaces covered by this.policy: ST WP NO. 'ADDRESS OF WORKPLACE RTG.BUR NO. - INTRASTATE N.O. 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A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the state listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bod11V Injury BY Accident Bodily Injury By Disease Bodily Injury BY Disease $ 100,000 each accident $ 500,000 policy limit $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except the states designated in item 3-A. of the information page and ND, OH, WA, and .WY D. This policy includes these endorsements and schedules:. WC 00 00 COB WC 00 00 01A WC 00 03 15 WC 00 04 14 WC 00 04 22A WC 20 03 01 WC 20 03 02A WC 20 03 03D WC 20 04 05 WC 20 06 01A Copyright 1997 National Council INSURED COPY PROCESSED 01/30/12 on Compensation Insurance WC 00 00 01 A AI MAKIN/ KIMAI vnr21/ 'Innn4 nCr= � 1 Town of Barnstable �Permit l 10 (c (4' Regulatory Services F-F1e'h nio t/J.e fro t fs.,ne �• BARNSTABLE, MASS. i679 `m� Thomas F. Geiler, Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number / 7V_ Properly Address esidential Value of Work Minimum- - Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Namc 2liaAe_r_ _ ('elephonr Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 9 G/ `�Workman's Compensation Insurance NOV' � IS2G11 '�� Check one: J - ❑ I am a sole proprietor l`l�N,f.<,( �' �� BLF �A ❑ I am the. Homeowner have Worker's Compensation Insurance Insurance Company Name/L ev _ 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 #of doors [Replacement Windows/doors/sliders. U-Value_ ( _(maximum .35)#of windows *Wherc required: ISSnanCe of1his permit does not exempt compliance with other(own department regulations.i.e.I lis(oric.cowen•ation.e(c. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is r uired. SIGNATURE: (.':\Ucrs�decullik\,�pht):n;t\Loca11A•Iicro,ulilWindows�l•emporary tlernel riles\('ontenl.OuUoak\I)I)VR7�A7\I�\I'RIitiC.doc Revised 072110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kv 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Lellibly Name(Business/Organization/Individual): Q, Address: Mc� 1jj �✓ City/State/Zip: Phone#: Ar eu an employer?Check the appropriate box: Type of project(required): 1. a employer with / 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance.: 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers'have exercised their 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 13.[y'Other employees. [No workers' comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t'Homeowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name:4,55oC/d A?I AVIOI/I AA Policy#or Self-ins.Lic.#:16)tf,�(�� Q`1ZJ-3 — 7/p�401 t Expiration Date: Job Site Address:0V wau City/State/Zip Attach a copy of the workers' compensation po icy 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 under the pains and penalties of perjury that the information provided above is true and correct Signature- p. Date: Phone#: 0 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#: Client#:9742 2BAKERAS ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)o5/0212011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil Insurance PHONE 508 775-1620 --raC,Ne: 5087781218 A/C No,Ext: 1_�--)------- Agency E-MAIL DRESS: 9731 annou h Rd., PO Box 1990 — — -------- ---- ----� � - - ---- -- y g INSURER(S)AFFORDING COVERAGE j NAIC N Hyannis,MA 02601 INSURER A:National Grange Mutual Insuranc INSURED INSURER B:Associated Employers Insurance Baker&Associates,lnc. —-----_ ------"" INSURER C: P O Box 923 Centerville,MA 02632-0071 INSURER D --` -- —"-- - ---i — —" 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 ADDL SUBR POLICY NUMBER POLICY IYYYI' POLI YYYY - LIMITS - LTR WVD ---.--- ------_.__ _. A GENERAL LIABILITY i MPJ7223M 04119/2011 04/19/201 EACH OCCURRENCE _ _ S 1i000,O00 ' DAMAGE TO RENTED S SOO,000 _XIr_COMMERCIAL GENERAL LIABILITY i_PREMISES CEa occurrence) I I CLAIMS-MADE [ X I OCCUR I I MED EXP(Any one person) S 10,000 - PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCT S-COMP/OP AGG 32,000,000 I PRO- S LPOLICY _ JECT LOC _ _. ------------ - i--- i AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 (,Ea accident) - $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS _ AUTOS f I RTY NON-OWNED I I PROPE DAMAGE S HIRED AUTOS AUTOS I Per accidanp I UMBRELLA LIAB EACH OCCURRENCE $ __ OCCUR �-------. -- ---------_ . r EXCESS LIAB L AGGREGATE - L. CLAIMS-MADE I__---'---- --- - --- _ i_ j DED-IIRETENTION S $ i_. -_ -_—._....__.--_.'----- ---- ------- IyYCSTATU- OTH- ) WORKERS COMPENSATION B I WCCSO02454012011 4/23/2011 04/231201 X LTgRv LIMIT$I._LER _ AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y I N I E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? l N 1 NIA - , - �EMPLOYEEI s500,OOO (Mandatory in NH) E.L.DISEASE-E _ It yes,describe under r LDESCRIPTION OF OPERATIONS below -,- -__ _- -- j E.L.DISEASE--POLICY LIMIT 5500,000 _— I I I a I j DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) t Insurance coverage is limited to the terms,conditions,exclusions,other I limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the j coverage provided by the policy provisions. ! 1 a 1 I CERTIFICATE HOLDER CANCELLATION I r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Thomas Perry ACCORDANCE WITH THE POLICY PROVISIONS. P 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE t ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S80402/M80401 LS1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR . QUALITY ORIGINALS) m A I DA T- A •*;� Nlassachusctts Dcparuncnt ill, Public safcU B(►ard of Builtlin�„ Rc�-,tilations and Standards l Construction Supervisor License License: CS 9714 Restricted to: 00 RICHARD P GARNEAU JR 251 WOODSIDE RD W BARNSTABLE, MA 02668 Expiration: 4/4/2012 ('Irnuni•.iuncr Tr#: 25310 C2,�j�l?� Office of Consumer Affalirs And Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 162600 Type: Supplement Card BAKER & ASSOCIATES INC. Expiration: 3/26/2013 RICHARD GARNEAU 521 SHOOTFLYING HILL RD - - - - - - CENTERVILLE, MA 02632 Update Address and return card.Mark reason for change. 1 t111,,i'; l( n11 ❑lll l'r \tlalr '\ n11,mos Re1t111atio1l I,ICFIKF Or registration %:r 1f11 1111 Intl1\'Id 111 II'.1'Nrlli HOME. IMPROVEMENT CONTRACTOR befol'F the expiration dale. If Inun�l rrtnrn In. i...l. Uftice of .a Consurner Affairn(t tSu.iul•�. kr.111:ftmi. IQltgistratlt>n' 111162600 TYpe Ill Park Plaza—Suite t 1711 1 1.:xplra110n: 3/26/2013 Supplement Card Boston,MA Ol 116 I ;I:1 rF-S INC I ndrra'errlar�' Not kalid withuul �ilLnalurF I I �Autlto--jT-at i I jo�h I�C,, , as owner of the subject property, hereby authorize Baker & Associates to act on my behalf, in all matters relative to work authorized by this building permit application for Address of property: 39 Percheron Way W. Barnstable, MA Signature of owner:' I ZHE Town.of Barnstable *Permit# OE TaY Expires 6 nr nt6s from issue dale Regulatory Services Fee r • BARNSTABLE, 039. ��� Thomas F. Geiler, Director DM Building Division Tom Perry,CBO, Building Commissioner 200 Main*Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Prope ty Address _ t� y Residential Value of Wort. ! ®c,0.---- Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address ao VIAWYN GCO' Pe_rC� eIPAI ��✓ ic_ W 66-9 Contractor's Name (,�(�/V ftc, Telephone Numbed�t� '� fJ qyo I Ionic Improvement Contractor License#(if applicable) Construction Supervisor's License # (if applicable) Y 6n 't® .,PRESS PERMIT ❑Workman's Compensation Insurance JUL 2 2 2009 Check one: ❑ 1 am a.sole proprietor I-OWN OF BARNSTABLE I./Kiave Ihe Homeowner Worker's Compensation ; � Insura ce Insurance Company Name tfC0/-L/ /OL)J�lu/n7 Workman's Comp. Policy Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-VAlue0t 3S_ (maximum .44) ;�/9^!✓ayw_s *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 is required. SIGNATL'12E: II.I:SU'ORMS\building permit forms\EXPRESS.doc \ Revised.100608 f w �A aJJ .S 7/-n63 v Customer Name: KnS Year Bulk: Renewal by Andersen of Renewal by Andtrsen 3 ��r r1/Q� Sales A ment Ads: Customer(Dr: of R1 P Cape cod Ci Stacy 4p:!P r b olt3�3Y,toA g ,((t&4m Number: 1 bo sod Drive by Ci'SC[l. `'� � wort.acltet,RI o2s9s Phandt atwaor ek�uatsawr anAt�ereComPP/ phone-Wodt: Page: of 1 D. 6crax a RI 12259-MA 119535-Cr 0%2725 tabakMhrrt a WNIIIS Ulm 'c ! • e 'fi �3j ti a 1 �� oil all I nuus ifRom Descriptionit Ipill', ! j r ��It 1 l � d �. A, r (. way 1s•� 7 l is COL 64b ST s- E 1 + v F n A T7 n pr Sol"anon b Reyment meow we —�, M Nm fix .a,aem.me.cpopae-by. ear"` :` Cbr�donlNar $prioc s�sitidDow" I � �ONdc .v 3 e st brS l UvAT} L/ D sera s ROC*@Mar boesses �Gaad fee Revicnee Side �bytd�C�ondi 0 of Srtle.-lfthe buq L Q C/C/E I y ..—— thisdie dtuentosf m TLaa% eoateT� ee ad�> 5w rya Ie'O rr st �V ujl salastra can rw.+r tb0n of Ala _-.-� Toed MWxUant w Oman or Expam Work omit can �Ywt l orr rs.+�awtw/ ® �'�+.�� _ (pa wn a+iw�Ye aa4t/apm�e mlotm�adj tl ONAMOM.iaat 900 SUMOM SpeaialOedecNa.a TutdAn uOtdA�aaaaM b hMaow reta.r iara.a fn aeet.a �_ ,,,..,,bp�mfu.v,ot.o�..s�awa `r _ ¢Tt E4-d1ly nPh& G doao«ne.tl,b.i air/ ta.utd,rana.. a,tp erg �t.raxr+�ean r..�r. r..euom.t.rtowayM. ;y` N&O&aAt 'YO.Or14itlf' r-4,CC- embscs aaote.■pletlaa (p 1�e� tawMl'ifnNAd4��qpdrdd PA¢i 24 �w�1n�t a ry arr xow..ax rru�a.rgr —r e.ti�Yrl[nattMMdd Mday..t.amw �yplpa apnYNyat Edm1��f Itaa111an reMr.4atdN edodu i.bor.foaoaWr.IslwMadoo. J� �.Ir a.r i.w ere mt..r.tdr. a.a Orot• utr aana>i.tO.a tn►� nmor.l.aad rD.po..t o(vtot7ua+reVfned- M• , q` .,.' mIi1.a. e.�.ta..m. sirriEpoda+u�mo.mem.m b. SUM Oar t.r ea►'M.E���eO Nfik.•tetwwd Oyu �Ns-ImYllitiwl Mt•1t7i9...wMt �� Gantotner GIa101t1Q •aaw.11r Mom•d dv bsl4Mws.t.P uwYn.M1{Man.(.I...Wa O m0..el.wn fatleaR Na/1ss.a.UY.sN.r�1.OM I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information y� n' Please Print Legibly Name (Business/organization/Individual): a-w w /�"�S a G t a 4—S L Address:-It -5 `7 -y-C Eo-s Pir - City/State/Zip: �N�/US�'G' �� o a��Phone#: y°/ - 6 7/ - b 1/0 Are you an employer? Check the appropriate box: Type of project(required): 1.9l am a employer with 4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ErRernodeling 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.❑ Roof repairs insurance required.]T c.152, j 1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providuig workers'compensation insurance for my employees. Below is the policy and job site information. /j� / Q Insurance Company Name: 0_,_- l 'l U TU01- Policy#or Self-ins.Lic. #: �"S J Expiration Date: c / Job Site Address: poo ,,omv nn City/State/Zip: 9) UPS aUe Attach a copy of the workers'compensation policy dec aration 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 under the pains and penalties of perjury that the information provided above is true and correct !• q Signature �_�- ate Phone#: Official nse onhl. Do not write in this area,to be conipleted.by_cifh qr toiv_n 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#: Restricted to: RF.WS Ai;taoarhu�ea -.Department d1 IA- Masonry only fi;4ard of Building Re;ulations and Standard` RF- hoof Covering Construmiion Supervisor Specialty License WS_Windows ortrl Siding License: CS St MW SF- Solid Fuel Burning(3dtvity, DM-Demolition Only restricted lo;,�ij�if9, Failure to poaxess a current Witiwj Of III@ Massachusetts State Ralldift- Co" 46 PAM is cause for revocation Vf thl-51IM4% &--gMbfR4PW' Refer to: WWW.Ma%a.C;dtv/DPS Expiration: 3/23 12 =,iani irm.t Tr#: 29W l � K � Board of wilding Regulations and Standards . :.r One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration.: 119635 Type. R'HV810 G91`001` 0 Expiration- 7/24/2000 TFO IN105 MOON ASSOC INC JAMES MOON 1137 PARK EAST OR, WOONSOCKET, RI 02895 Update Address and return card.Mafk ro-4MM ti1F 09110f: Address Rettewat E>'tnhlr.�'t11s?lit 1:p3I - fEl •� ,�fRI: �fiM ln.artUwr+!t.6th' G B�ft,�:l(% [f..ltlGi �.:.. •- r' _ I►HNfd of hbtliiiaq"'MNidilNd9 and Standards license or cegictration vas►d for Inlilviduf Itar YIt 3 " t before the expiration dale, If found raliffit fil€fMPf>lOVf Ml tdT CONYRACTOR lui Board of Ikdiding Xegltlatllrt"Roli'itNftlfNflfb l �f li�Rt 9i0(95t3 one Asbhurion koce Rin l @i €0106.00*1-712412000 TrA 130185 Boston,MR.OR too fiypi ftoto Cdrpmoon madN Ali 6§INN JAW§ WON Vt16dN§0§K@T;Pi 6290 Adir inktratnr Not veitd�11h0uf 9iilltill�ICc From;Sttttunne Rob}nson,Mtln#er tnzumr= At:Mt,7ltCr IttwMme.bta. FOAM To.Denise C3todet Wate:'dt^v)uts 1 1:u*^M 114901 h w. OP ID S DAM(t7hVDQNYYY} C" .TIF1 A�'E F LIAR LIB INSURANCE MOOI�� 09 29/08 pRObUG»R TtftS GtgR'tn.FjaTE TS tSSUP-0 AS A M4TTER OF EftPORMATtON 014LYAND CONMMS NO RIGHTS Upag THE;CERTISCATE uixtcr xaL tt nc�, Inc. HotogR.THIS Cet2T RCATE DOES NOTAMEND,EXTEtdt)OR A 2139 old River Road, P.O. Box � f�Tf;R"TtiECQ�JERACE 1 CtREJEa BY TEdt POLICIES Bel BELOW. nviijo RX .q�+02838n-p�t000�+1 r�r �1 %��3rcde.'..402-769°-9SOO H4+cXi.:�-01— 69-$S02 MURERS AFFORDING COVERAGEx0on tJAtC(Y 'R..-(1 tP +�t�t�R t1: j�iF�.Ahtx Qki, x �l1IDf[=aA6w CD DB21 &ter Halmot tAISLA�ttB: »�xcotf lsutva►1 xrtsaxaaoc co. f3iEttox Heyml gdao> rkq VTOpnsCca't RX 02� 8 13451k^Ei R fi; COVERAGE$ tT$+POt.tCIE.B OP 11•:9tlttrlhlGL'LtBYi�BEt.�PlAVtz ta'�ETt Iafit�R TOTF4E IAtSiJFtc"'O NA�$"iD R9i7VB FOR Tt�'PQ1.iCV PG'Ril3AlitDICA7ED.t�lWiRi31'Ata4l3 Am R@Ouwa�herT,TOU OR CWDtlM OF AW C ORMAa OR OTHM Ci00ATM Wn"FC'WeCT TO VftCPI TMCEWnFiCKM WAY ee 9MLW OR mAY PERTAK IM mpAmx OFOROED©Y W FRi,.tt^.tCS DE5CMMD FesW IS 4MM ECT MALL TM WW VMtMOM r'XM CMOMONS OF WCH POLiccea Room:8.`rm LtYC m 6tiC wN 1,KY PAVE SM REDt.tCQt?9Y PAID Cam. � L iI2 "Sac rfm Of O&ILFrW4tce POLICY NUMER { h 0 U��D1YY1 L GZNERALLIAMMY EACHOCCL=UCE $1000000 A % CO1 tCiAd.GEAILRALLiABtLITY i�3'3 6819 09116/08 09/:L6/09 F h1i$E�S mmtuoneo $ Oap0i7 CLAYS ®OCCII¢2 L4m oto oiy a o Aomcm s 10000 _ PERSOWL&A0V IN462Y $3.000000 �*M 2o0t]0ao oEM AWREGAYE LfM f ice,rM PER. PRODLIM-COt~AOG $2 0 00 0 00 PLILICY LOC Atn7ftriOMSUAt1UN t YWEDstyI.L4ttY s i000000 A X ANY AM os/16/08 09/16/09 ;Eoouiciartt► ALL OvOSD AUrM SM4.Y tlAtY SCt4EAtJf.GYJwJrO3 {PvV 0$tvbn} 19dFit AttfAS OILY WAY y NOWOWN20 ALFlA7as ERor Oactblar�} GARACS A.XUfUTY AMMY•EAACCiD7 W S AW A= AAJTiI�� EAAOC } AW S CxM2ltthlt3R Lt.l'�LFAMITY EACH at i:Ixx $l000000 x ..c>ccx¢t cLAi§�ivJ+Th Ct392&61J 09/16/08 09/16/09 W MATE ff a10000- 22" s i^tORltt�COfSt�E�I:.JiTtON AFFO ER EitpLQYE!'.flx 1IABfLTPY � �0sas 10/01l08 Ja/0.J100 E!t_. Euxl Accttmur 0500000 At PR0PFM7T0"ART*-WMC1J11Ve WteMOSMEKCLUo E.L otsEAse-eat P10Yk"E s_500000 tIy tAL pltOviC,t dMMMt7vJss> tmla�v E.L,D 'SE-POLICYLIMIT S S 0 0 0 0 0 6R G o ROSCR pN OF o ti I wCAMONG I QWCML—r-C 1 ENGIMOMI 735—W MEMMOFEMCHrl SPEan PROWSIONO C fMFICATE HOWER CANCELLA otl BUT-LD114 ZrKO PW Any OP nC-AnOV13 DESCRIBED POUCM-8 On CAOCULLeD QeFORS nM eXPMATtON RATE TtMFMOP,WC-18sW4a WVW vnLL etDaAVOR TO MAR. 10 RAY-.WRM 0 Building COnt.. #'tog. BQaXd t*71Ct3 TO ttts c� r=- ATE H*%.D-:R Wh1ED Ta Ttr LEFT.DVr FAkUF TO oa 60 GMr L Dept, of Administration I.APOSEMQSU"MON OR UALtnm OF AWJOND UPON TOO WSVREP' (MAGkMFFl OR One Capltal Hill 1 r*videnco RX 02908 piEPrtEatrliPAFIV �REs ACt t*t 26 S2ttdYt{t8} 0 ACORD CORPORATION 1988 TO ALL NEW BUSINESS OWNERS DATE: C, o CrLIf/ .rt " . ,� sct—le- APPLICANTSFill in please: �� � '� /•cow 'f YOUR NAME: " YOUR HO E ADD.RESS:, BUSINESS - 4' '; ;eMe Call! ,BEEN. file 1 TELEPHONE + 1M Telephone Number Home Z2—YaU— 08� NAME OF NEW BUSINESS+ / �� - TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YESNO Have you been given approval from the building division? YE NO MAP PARCEL NUMBER ADDRESS OF BUSINESSES Qd C Per When starting a new business there re several things you mus do in order to be in compliance with the rules and regulatio a ns of the Town of ainedthe. requ red signatures, Barnstable. This form is intended to certificate at the Town Clerk'sssist you.in obtainin the rmation you m Office (Ist floor-Town Hall). You MUST goy need. One you have t to the following office to make.sure below,you may apply for a business cyou have all the required permits and licenses.. GO TO 200 Main St. - (co r of Yarmouth Rd &Main Street) and you will find the following offices: 1. BUILDING MI SID ER'S This individual as b inf ed a it re irements that pertain to this type of business. ho a gnat r COMMENTS: 2. BOARD OF HEA This individual has ee informed th permit nts that pertain to this type of business. A orized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h n inform oft a licensing requirements that pertain to this type of business. Authorize Signature* COMMENTS: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. -it does not give you per to operate-you must get that through completion of the processes from the various departments involved.' **SIGNIFIES APPRO VAL FORA BUSINESS CERTIFICATE ONL Y. i Town of Barnstable OFTME 1p� Regulatory.Services Thomas F.Geiler,Director sarttvs�rABM Building Division 1639. Tom Perry,Building.Commissioner �0 '•�fp Mp'l a 200 Main Street, .Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-7.90-6230 Approved: Fee: _ Permit#: HOME OCCUPATION REGISTRATION Date: G r,2po Name: 'Phh ti sco T T Phone 9�(_) /10 Address:39 Acke(nl Village:_&I" r- Name of Business:l�l o r(J , ao , Type of Business: �d Uf�9�i�w/ �Oy� U/�j�ci Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of.space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with a above restrictions for my home occupation I am registering. Applicant: Date:O(,�L Q Homeoc.doc Rev.5/30/03 Sk- a - ate- sue 0- -IS - �� Assessors office(1st Floor); y/f , �e Assessor's map and lot num K/?`G - `7 y ":S"o E� o%tN t to Conservation Board of Health(3rd floor): CC z cy' i Sewage Permit number_T?, Sr�/'�.� -� NALIST Ut Engineering Department(3rd floor): �? �• y �° t610' House;number 3� �oasr� Definitive Plan-Approved by.Planning Board APPLICATIONS PROCESSED 8:30-9:30 A.Wand 1:00-2:00 P.M.only t P TOWN " OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO f a t TYPE OF CONSTRUCTION /N'b`yTi t`/ZED L to Y 193 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use Zoning District v� Fire District Z-6 - / �9 Name of Owner�Z!5t� Address Name of Builder Address Name of Architect Address Number of Rooms Foundation Exteri Roofing (li Floors v Interior l Y- Heating G Plumbing '�/9 /1�1 3 Fireplace / ?���"�D� y` e Approximate Cost lip Area Diagram of Lot and Building with Dimensions 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. ti Name lgze I Construction Supervisor's License O.S6 yY �BAYSIDE BUILDING INC. No 45 Permit For 1 z Story Single Family Dwelling Location Lot #14 4 , 39 Percheron Way W. Barnstable ,.Owner Bayside Building Inc. Type of Construction Frame Plot Lot Permit Granted December 2 , 19 93 Date of Inspection/M\4v IkI94 19 D f C,ompl te 19 . r III _ s , COMMONWEALTH OF MASSACHUSETTS DEFAIMMEN OF L�IDUSTRIALACCID.Er S L 600 WASHINGTON STRE T BOSTON, MASSACHUSEM 02111 WORKERS' COMPENSATION INSURANCE AFFIDAVIT nsm/pcfminec) _ principal place of business/residence at: (Cuy/Smte0p) -eby certify, under the pains and penalties of perjury,Char. m an cmplover providing the following workers' compensation.eoveragc for my employees working on this G�/G j 3i zL7 17V D/ nce Company Policy Number m,a sole proprietor and have no one working for me_ m a sole proprietor, ncnl contnaor r homeowner (circle one)and have hired the eontracrors listed below vc the following war as compensation insurance policies: of Contnaor Insurance Company/Policy Number .. of Contnaor Insurance Company/Policy Number f Contnaor Insurance Company/Policy Number a homeowner performing all the work myself. NOTE .Please 6c aware test while borneo-men ..ono emniov persons to do mai.ntetsamer. eonstructioc or repair.00rK oa a of not more Inzx taree unto r0 wnrci foci nomcowllcr 1iLo restiors or on the rmunds appurtenaDt thereto arc not[tneraiJ►' .d.to be er_movcn under tic Woriccn' Comprivauon Act (GL C 152.sect,. 1(5)), application by a homeowner for a liccnsc t may ertceoce 6c iro sums of an employer under the Woricen' Compenutioo Act and usat : coo••of this sutt-:rnt will be fonrarced to the Dcoarrnent of Indun ial Accidents' OF cr of butirancr for cove—arr �n In :n .2iiure to secure m•erazc as rteuirec undo Seenol.5A'of.MGL 15: can Ieac to the imposition of C"S.�33j D=2j. of: fine of ue to S1500.00 and/or impnso=cr.t of up to one yea anc aw per:ajues in the form of a Stop wore Ordc sne a 00.C.v a day a€a:ns-. mt. .. ..... ,:.,,. .,. •... .._� y..w ti,.:. ti„ •'._� - ,, r..-.• ,�Y-L,y,n.r✓v+.....^ .._ .r._...-r'.- _y.�,.+.._ n.,,J-..•- .. ..y �lDl3�l TOWN OF BARNSTABLEF1 PermitNo. ......:......... BUILDING DEPARTMENT I """ TOWN OFFICE BUILDING Cash HYANNIS.MASS.02601 Bond X CERTIFICATE OF USE AND OCCUPANCY Issued to Bayside Building Co. Inc. i Address Lot #14 4, 39 Percheron Way West Barnstable, MA 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. April15, 19•....9.4....... ....................................... Building Inspector I .-_-�=-'OF BARNSTABLE, MASSACHUSETTS BUILDING PERMIT DATE 19' ' PERMITNO. �• •• APPLICANT ADDRESS (NO.1 (STREET) ICONTB'S LICENSE) NUMBER OF PERMIT TO �_) STORY DWELLING UNITS (7Yp OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) DISTRICT ( .) 5 BETWEEN AN • (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT, LONG BY FT, IN HEIGHT AND SHALL*CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: - AREA OR ; PERMIT VOLUME ESTIMATED COST $ FEE (CUBIC/S E EET) 4 OWNER BUILDING DEPT. ADDRESS I BY THIS PERMIT CONVEYS NO RIGHT TO OCCUP.--ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBI OPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET O :', E GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED . FROM THE DEPARTMENT OF PUBLIC WORKS ISSY UANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS I OF ANY APPLICABLE SUBDIVISION RESTRIC'...;NS. MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMIT$ ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS Li HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT c) r1 La c7 BO RD OF HEALTH OTHER �- V C: ' '(( ) SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'N!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT iS ISSUED AS NOTED ABOVE. NOTIFICATION. ( ' 145 :: ,�►^ 13q zo c 2it otl 1-17•So CPSN tPA44A. WCHARD ' 36 BAXTER v' + ft"o-W 9tel lArp �E►J S�p� S�rna�v�s,o,J ��,a,v f ,27 D- 7 41A7- 7A- ,� -vP.4z4r.,v- , OC,4T/O.V -5"4/OWN h�E.2E0.!/COiilf?L YS L,c I �0 pATE 7`•�•���$"/OE-C/i�/� ANO SETBA Ck .rc'EQU/,�E�1E�t/lS O� T.4/,C-' Tow�t/ac �•C�4it! .2E.�E,2Ei(/C'E 8i e Aj IrA B« Lo7' Ids- .COCA TE'L> 41o" ,�/�t/ T�Y25 .�,Coaac�G4/�f! H L)4TVL 14U.. 4e4. OATS: ll•2¢,� �I /iv BASSO O//,4i(/ �2EG/STE.e�� /,�q,�% SU,eliEyat� D� S'FTS SyaLt/y 5.�,�v[a -V07-49,C-- U.SEQ 7"O OETE,�--/Lf/�E X-OT /NHS. �Oi��./C,C{/✓7" q,151b� �(�IGbI� L-O COMMONWEALTH DEPARTMENT OF PUBLIC SAFETYNaQMfl�laf OF ONE ASHBORTOKPLACE- 5 MASSACHUSETTS LICENSE CAUTION EXPIRATION DATE CONSTR. SUPERVISOR 04/19/1 9 96 EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST RESTRICTIONS THEFT, PUT RIGHT THUMB NONE I CC'54 T 06/30/1993. 005645 PRINT IN APPROPRIATE ��° `° ° �BRIAN T DACEY , BOX ON LICENSE. � 62 FERBROOK LANE ° BLASTING OPERATORS m CENTERVILL MA 02632 MUST INCLUDE PHOTO. PHOTO(BLASTING OFF!ONLY) Ff 7V7 V o•0 O _ PAID VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: STAMPED-OR-SIGNATURE OF OMMISSIONERf ' 2 2��- ;�I THIS DOCUMENT MUST BE « SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIEDONTHEPERSONOF IGNATURE OF LICENSEE THE HOLDER WHEN EN. I!%i� �I•�,�o .. OTHERS-RIGHT THUMB PRINT GAGED INTHIS OCCUPATION. '�I�� ER ,* COMMONWEALTH OF MASSACHUSETTS `=P DEFAIMMMN'T OF LND USTRIAL ACCIDENT S W 600 WASHINGTON STREET GanDOel BOSTON, MASSACHUSETTS 02111 "i-sstone, WORKERS' COMPENSATION INSURANCE AFFIDAVIT iccn=1permiac0 z principal place of business/residence ac 6 3 a (GtylSmtt mp) creby certify, under the pains and penalties of perjury,that. I am an employer providing the foll owing workers' compensation coverage for my employ=.working on this l 7 Y D/ S rang Company Policy Number- l am a sole proprietor and have no one working.for_rne.. 1 am a sole proprietor, ncral eons actor r homeowner(circle one)and have hired the eontraaors listed below have the following wor c:s compensation insurance policies: c of Contractor Insurance Company/Policy Number r... c of Contractor Insurance Company/Policy Number c of Contractor Insurance Company/Policy Numb= am a homeowner performing all the work myself. NOTE_ .Tlcasr be awuc teat wbilc bomeo-men who emaiov persotu to do taainteaaaec, eoastrURlon or rtFatr wort on a nc of not more that three units to -,b,6 the horncowner Liao ruiacs or on the Frouacs appurunaat thereto err not it lrice-c 'erto to be cr_oiorers uaarr the a'oriccn' Cornvctuauoo Act (CL C IS'_.sea. IM), application by a horneowoer for a lnse mtt M3.Y enaracc for ico sums of an employer unacr the Workers' Cornpensuloo Act. it and :eat ; env•-o..ms stat=cnt will be forwuced to cite Deoaratent of Indusmal Accidents' Ofnee of lnsurana ror aovc—w.r :lion anc :ice: faiiurc to secure ca•�erauc as rtccuircc unou Seenon=5A of.MC;L 15: an lead to the imaosiuon of cri=i3L LDa one of;,fine of ur to Sl 500.00 anchor imprtson=.t:.t of up to one�n and aw penaiues in the Corm of a Stop dote Or= In a S100.w a day a€a:ns: me. c;%, o f ____�—��� 1 TJS l6�J -VATA 511,16L E FAMIL`( 3 $EDR40W ; : - Oo 605AC,E GIzIIJDEK PAIL`S FLOW 3)(Ito-1w &PD �4S 5EF-Ic TMNV—= 3�0vl-&)y0s4,qS9t> W4*-1 :U4G 1000 6AL- D117FMAL PIT 1-I000�-Ac./2sraNf i 51DEWALL AID % la$ 5F ) o� t� 03 f�5FX 2'r = 4�v&P'� 10 o lbTAL t)&516N = S 4-15 1G 1 \ TOTAL. 'DAILY PE2601-ATIOW A'tF- =I°t� ���i \`� 't� `''I^� °' � ` N Pjk% OFMS •' BAXiEW ca � �y ` � � �;� � � PETER - ff SULLIdAN t No. 29733 'SPA- "Ca FSS�p ENG�� NAL I-%r P 60"lZq TF=1�,s t}o1� to 5-el 176=ISO �T -- --�,Rvr.1�—rn-�� �l 130 p V.c. Svr�ot(r a $�, � Ivov 11Jv. 133 IN✓- 3 t►1✓ +.b PKT ter i4v- SEAL t3z'S 13CK t• 4 3 TANZ GAL W Mm - _ Sau� s waSaa� �: Au._5TZtCNvEs sr.T so 1r. 13� T s7ouE tito¢tE 7tu� 4.vr�P @ 12 YRCES SMALL. Me A-Zo OF 210 Ir-I® PLOT RAO "P�VEIopE� 'P1��1 Ll�-- L.OG�STIDN : u f. STaZc.E tJ o EL=11A- SGA LS- � �� r t DATI=; I C) ilo WAT2L 0se > PLAN yarsrzaicz- 1 (-GMFY 'T} AT TqE 'I JWal.l.l kt %owN He=t4 -C-o44r� 5 wrrµ 'ME '5(PEUgE LoT 144 ' 5ET'�vx mo. � ql1: lbwq OF BtSIZ41T-A 3 t,& l Vv t rs-2- ' A+tD 15 I�ri" Lot,& M 11U E rLoo > t�:.AIU, tt� SP�C3$e�xYE¢ NYE 1NC, QZqFm551oQ4L. LAUD SueVeycaS 70K FBI.] IS Not" $AMID c>W AN 1q4'TwAEvr r�..r t L 4 E061 N EIS Sugvty My TO : OFFSe'rs 4 4out,• > L1vr BE o 5Te2v►we MA44 . u51� To ESTQ'Bt-i5r�} Pr�p�lztY la uE5 APPLIC.AN'['; A�(SID�, �vrLbtnl� SEn.'L-.TA.a�'-: � rl4c..T S�Ftu:.iC:c.6SJ' = D ® ® D - D - IUD - _ D u z k. 49p 5ELLIVATIOWS T I. I � I I I I �pU9L.E'-0006 R4C>E Apr� rf��Ei.11JG_. TU.LL. I I I I r_ourstoe suo'werz pL'AC P- 'Ac-o ru,-ji-C Go wc1Z E-r::--,&-c. �tGHT SINE CGAR.AC E�.,. i i i -'-------. ..._� .TREATED CVO Op MEGK ♦ RA.I L. 14'• o' MoxC�,oN I Mo aiJ 4e 40. 3� . I ITGU.EN- , :-A/A I IJ`f ROo/n pASL Vl-,L O n.wc Ferri V O 3 � r r I W ...1a c A va i ; t,: I _.;0.i cPAM'.f7�Y:,., _ _._. GOt•+LR Sl_A�. Ss(e, a _ dn14 I -rL. .GPfd.O tJ _... • 9 . 24._0.. -15•- in, I . I • I to-o.. 24 •o -' -- -- i ' C.Lr' S9 °ie 49 Tn,P. na... 2 ,97 b7 Cl- WO t Na.1Q+.i V T F,1AMaD• ! 31}t.,�ce . I. A P�v asap ' : I N Pu�C.6 �• Doses, � i CAfL9GT N n CALO _ Ampct - i —7 0 i I �• I �3CGL�.' � I �S: � I I I r r� .: � -+*�=-�-b�••-•-�.a�auo-Gaut.. -. I I ; t I I ; a i i =@"+c4tiG�-:cott�rcuvzuJ}_ I 9:�2".Car_t�n...ctsp�l I 1 1 I I I I i t I I Qi'•4' (n'. !o•• G' -rAIId'G:�__C:G'/1�P/�GS. .Ill. " t ri I r r r .�<! 2.k 9 1 X 1 O 3 .'- 1 L J L J N 11 I I I r � �'-OeAt•�.:Col_'3�.': _0 vin PocICET I i I I i N j III L�e►Co".Y..10-_�J7O T..1_LI 15)-,Cr t Co' cr L . kV Stove Permit _ ry �yo�THir Date TOWN OF BARNSTABEEseej�G. �. t BAHa9TAEL 0 'oo sAM 6 q. �P MASSACHUSETTS Solid Fuel Stove Permit DATE OF APPLICATION ...................:............ ................, FIRE DEPT: ISSUING PERMIT .............................. . % 6 1 'ss S. ` ..... Hw:.....: .:.........SCUT J................................. NAME. Installer %o .../,/.,X...S-*,, o s vl6-V,'.d NAME (owner) (Installer) .............................................................. ADDRESS , CV, J/ . otw �............w.. fADDRESS. ..1E 1a� ..:.... ..................:.................... STOVE TYPE ........... `� ..�...`..: ............................................................. CHIMNEY: NEW .......:...✓........... EXISTING .....`.................. (D S d.,5 S .. . t/ Manufacturer .............le ^-'-� CHIMNEY: .Masonr Mass. Approval ..........: 11:..... ............a...........: CHIMNEY: Metal This is to certify that the above installer has permission to install a solid fuel burning appliance 'at the listed address in accordance L dance with an application on file with the �............................................. p •-- , .................................................. Fire--De�arlment 'and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made under the authority thereof. IssuedBy ...................Title .................................................................................... Date .......................................... Permit to install expires 60 days after, issue date Stove .............. .......... . ..... .........................................:.,..............................................................................................................................:..................................................... lze Stove Clearance ............ .. o-)oe ..................................... ................................... ..... ...... Floor ...............a61.........../ .k ..............:... .............. .................................... / ......... SmokePipe .............................................................................................................................................................................................................................................................................................. SmokePipe Clearance ............`.10.................. .1.. ......-..............:..1.. :. . ........'�fltirl.3............... .�r��..................................... ....................................... . Chimney (1.,f Qn....r` .......:..:........................................................:............................................................................................................................................................... Smoke.Detector ................L./...............................................................................:............................................................................................................................:......................................... . The undersigned hereby certifies that the installation of solid fuel .burning" stove and equipment made under au- thority of permit dated ...................:.................................. has been made in accordance with provisions, of the/C°xnmo wealth of Massachusetts State Building Code now currently in effect and pertaining thereto .. ..:!...:.` Installer goo>y7 INSTALLATION APPROVED ......�.:I... ... .. ... .�,....:........... By:.......... .... . ......11 ' ....................................: Title: ...... ....... ..... d�e WHITE: FIRE DEPARTMENT — CANARY: BUILDING INSPECTOR — PINK: APPLICANT *Mr TOWN OF BARNSTABLE permit No. . 36361 ` BUILDING DEPARTMENT I ""� I TOWN OFFICE BUILDING Cash ,6}0• HYANNIS.MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Bayside Building Co. Inc. Address Lot #144, 39 Percheron Way Test Barnstable, MA 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. c � � =- ... . P,p r i.. 15, 9 4 19................. ....... ............................. Building Inspector