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0052 POINT HILL ROAD
a 'I 1 o i c o ?y ;I �,.ty1T•b9 ��NIW•�� I: i ® MM Z �o NJ N IQULO . v �Z = 9 4 E 1 r 9 IH� . } 7706-,=' L9�►/� Aj Q Lp7- 0 0 Lv7''s`i3 J � 0 N .S3 78-j v . I / Z07- /s- CERTI FIED PLOT PLAN LOCATION: .W�3T. 4 !- BGG M/�ss. SCALE PLAN REFERENCE S,406Wn/ Z49 aX,%OF PAGE. . !. . . . . . . . . . . . . . . . : . . . . . ... . ?� EDWfRD A LLEY U ' Na 26100 y OISTS 1 CERTIFY THAT THE .�ovti!�!. .. ...... q*0SUR40 SHOWN ON THIS PLAN IS LOCATED ON THE GROUND ` v�ae:r AS SHOWN HEREON AND THAT IT CONFORMS TO THE : . SETBACK REQUIREMENTS OF THE TOWN OF Q -^!s??�Q�.E7. . . .. . . WHEN CONSTRUCTED. % DATE' /��-Ti7/vN6� G4.LS 74� REGISTERED LAND SURVfz OR Town of Barnstable Building , Post This Card So That rt is Visible From the.Street A roved Plans Mustbe Retained on Job and his Card Must be Kept ; PP M Posted Until Final'Inspection Has Been Made IF b R Where a Certificate of Occupancy is`Required,such Building shall Not be Occupied until a Final Inspection has been made t' JliJl Permit NO. B-17-970 Applicant Name: CAPE COD INSULATION, INC Approvals Date Issued: 04/10/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 10/10/2017 Foundation: Location: 52 POINT HILL ROAD,WEST BARNSTABLE Map/Lot: 136-029 Zoning District: RF Sheathing: Owner on Record: STEIGER,ALBERT E III&DEBORAH J Contractor Name: CAPE COD INSULATION, INC Framing: 1 Address: 253 W 73RD ST UNIT 12D Contractor License: 153567 2 NEW YORK,NY 10002 - - ..rt_ Est. Project F Cost: $1,100.00 Chimney: Description: insulation/weatherization Permit e: $85.00 Insulation: Project Review Req: insulation/weatherization Fee Paid: S 85.00 Date:�`/ 4/10/2017 Final: wC Plumbing/Gas Rough Plumbing: \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after?issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. --- Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building.and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:) 1.Foundation or Footing �_.• Rough: 2.Sheathing Inspection - 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel "" ' O Application # CD Health Division �O Date Issued Conservation Division 0 Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board OD �' � Historic - OKH Preservation/ Hyannis Project Street Address 2 Village OwnerV, &bV-0fA �J,6[Lq& Address Telephone l7 1`J Permit Request C 21b Zu V' 5)&[wJW Wd l . Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District: Flood Plain Groundwater Overlay Project Valuation ©� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �a Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes �No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address L" qavd,&�, License# o Home Improvement Contractor# (�-2---) b Email 11046 Worker's Compensation # 4xt00 0z ALL CONSTRUCTION DEBRIS RESU FROM THIS PROJE T WILL BE TAKEN TO , wg &.0 SIGNATURE DATE 4/1/o FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: .ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r Town of Barnstable Regulatory Services g"RWAM ' RiehardV.Scali,Director IL Building DivisiorL 'Tom Perry,Building Commissioner 200 Main.Street,Hyannis,MA 02601 whvv.town.barnstable rna.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete-and Sign This Section. if Us.in„g A Buijde r I, b e h o r al 5 f e.i je[ _,as Own&of the silbJect property hereby authorize_ C to act on my behalf, in all matters relative to work authorized"by this building permit application for: Sa Po,ni Vii gowj ►-.,e5f RaL. St abjQ {Adddlress of;j6b) Pool fences and alarms are the responsibilky of the-applicant. Pools :are not.to be.filled or utilized before fence is igstall�d and all final itlspecbo are performed and accepted. VA s Signature of er Signature of Applicant Print Name Print Name Date. Q:FOnIS:O%V?.*F-RPER-IISS10NPOOLS The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 1 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/OrganizwiorOndividual): Cape Cod Insulation Address:18 Reardon Circle City/State/Zip:South Yarmouth, MA 02664 Phone#:508-775-1214 Are you an employer?Check the appropriate box: Type of project(required): 1.K I am a employer with 48 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' 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 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 13.0 Other Weatherization employees. [No workers' comp. insurance required] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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:Atlantic Charter Policy#or Self-ins.Lic.#:WCCE00431902 Expiration Da'te,:I6/30/2017 Job Site Address: . 452 pdlq�_4tk City/State/Zip:Vy 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 under the pains and penalties of perjury that the information provided a ov is true and correct: Si afore: Henry Cassidy Date: Phone#: 508-775-1214 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#: r _-1-1 CAPECOD-27 KD YLE o3r3or�o17 , 6ft .�R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2017Y) ` 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 CONTACT Rogers&Gray Insurance Agency,Inc. PHONE Ext: Fagc,No:(877)816-2156 So Rte Dennis, EMAIL 9 9 Y South enn MA 02660 mail@ro ers ra .com INSURERS AFFORDING COVERAGE NAIC F INSURER A:Peerless Insurance Company 24198 INSURED INSURER B:Safety Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Com an 44326 South Yarmouth,MA 02664 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 EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR R/O CBP8263063 04/01/2017 04/01/2018 DAMAGE TO RENTED occurrence) $ 100,000 MED EXP(Any one rsoh) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PEST LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO 6232707 COM 01 04/01/2017 04/01/2018 BODILY INJURY Perperson) $ OWNED X SCHEDULED 1,000,000 AUTOS ONLY AUTOS yyN D BODILY INJURY Per accident $ X AUTOS ONLY X AUTOS ONLY Per a E.. ^t AMAGE $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAR CLAIMS-MADE R/O EXCl 0006635001 04/01/2017 04/01/2018 AGGREGATE $ DED I I RETENTION$ Aggregate $ 2,000,000 D WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ CE00431902 O6/30/2016 06J30/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached it more space is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Informational Purposes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD •y �--- >.Ri. Massachusetts Oepartment of Public Safety It. i� Board of Building Regulatlons and Standards License: 08-100966 Constructlon Supervlaor.. " HENRY E CAS-810YNO • . 0 SHED ROW WEST YARMOU;-fhi I`yy9� 2' I r � 5 • ' , ', •••:nil/F10 �` . n'I5 >I'15111 , Expiration: Commissioner 11/11/2017 a . I , o Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston,' Ma '��iutsetts 02116 Home Imp roveme.: ..•.e..t ractor Registration Type: Corporation l X. Registration: 153567 Cape Cod Insulation, Inc � =T':t,,i ;, _- r Expiration 12/14/2018 18 Reardon Circle _ --_ So. Yarmouth, MA 02664 • _ ru , `b --r Update Address and return card. Mark reason for change, 1 45 20M•06/11 ._____.._._-_-'_-- ....------•--•--._._._�__.__.._.__._...__.___�-A�1�'«a�a-!�11�nrzu:a4_!�F..s^a!a��mert_17�.ns�C�+.r�i.... &.2/te TonmtomaeaN olbAwaac/uaem Office of.Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only i jy'09, Corporatlon before the expiration date. If found return to; etretion Office of Consumer Affairs and Business Regulation � 10 Park Plaza•Suite 5170 1 ggJ 12/14/2018 Boston,MA 02115 ,C Cape Cod Insu Henry Cassidy , =` 18 Reardon Clrc' i"': /,!I CC. So,Yarmouth,MIX;. 2 ¢ J''' Undersecretary Not v d w g'tt/rIr L 1 Town of Barnstable Regulato Sea vices s Maud V.Scary Director Building Division Tom PeM,Bu&rmg Commissioner 200 Maa►Street-Hyannis,MA 02661 www.town barnstable ma.us Off= 508-862-4038 Fax: 508-790-6230 Property Omme7r Must Complete and Sign This Section If Usiugg_A.Builder I, ,.as Omer of the subject property hereby authorize_ " ro act on my behalf, in Z man=rckfmae to work authorized by this building permit application for (Address of job) *"-Pool fences and alarms are the responsliiity,of the applicant.Pools :axe not to be filled or utflized'before fence.is installed and all final -ons are performed and.accepted. lam% ture of er Sipnatnre of AtVRcurt Name � Print Name 3Ap, / QTORMS:OWNWERM=IONPaoLs TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parci) Application #a Q! _1¢� ?6. Health.Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address rL 'J;t, `ti iA Village g,A_ZfS I 2� . Owner LDG7FF Address 5 f o�'�� /�i<l ��. A#94U. Telephone '7 +q: IM A-oA.(oC�' Permit Request NnPDC�c �- i X ` -ID2!5c Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District y Flood Plain Groundwater Overlay Project Valuatior4 e Construction Type ,sae r� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure _ SyiZ% Historic House: ❑Yes E No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing _ new Half: existing new N Number of Bedrooms: existing D new q o Total Room Count (not including baths): existing new First Floor Room Counfr Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑ Yes ❑ No Fireplaces: Existing New Existing wood/coal stow ❑Y,'s ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing O newer size_ rrti Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use f�'l `' Proposed-Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name W( d I on 1MLAL10 Telephone Number 5_0:R-_24 --70flLb Address _ -9 a-)^ (/J1110 1A,1 S I (j).R icense # C 5 " 0 0 .¢ `7 3 o�b L�r' Home Improvement Contractor# Worker's Compensation # 0 i�NL�C1r-1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE z FOR OFFICIAL USE ONLY APPLICATION# Y -DAITE ISS.UED�,s.!=i_ -, MAP/PARCEL NO. ADDRESS, VILLAGE . . OWNER" DATE OF INSPECTION: FOUNDATION ��� " r FRAME FIREPLACE s ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 1 -GAS: ROUGH a: FINAL ,FINAL BUILDING'i — { DATE-CLOSED OUT, ASSOCIATION PLAN NO. . The Commonwealth ofMassachusetis Department ofIndustrial A dents rA Office of Investigations 600 Washington Street _ Boston,MA 02111 --- - - — - www.mass gov%dig ' - Workers' Compensation Insmmnce Affidavit.Builders/Contractors/Elee'tricians/.Plumbers Applicant Information Please Print Le�ibl� Name(Busmess/organizafionandivid4:. U1111/!}N, YkOLL/`✓ Address: G`ity/State/Zip: W N IMA. Phone.t ,bP-744-V,2,o C6,ef_ �Lo7-38-0i,�7' / Are you an employer? Check the appropriate bow a of ro ect(required):., I am a .TYP P .1 (r q ' �:. 1.❑ I am a employer with ❑ general contractor and I 5. ❑New conetr„et;�.n loyees(full and/or part-time).*. h ve�d the gab-contractors ` 2. am a•sole proprietor or partner- listed on the'attached sheet. 7. 2,&inodelmg slip and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.iii ance comp.insmm ce,# 9. ❑Budding addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions niysel£ [No workers' comp. riglit of exemption per MGL insurance required,]t c. 152, §1(4),and we have no 12.❑Roof repairs employees. [No workers' . 13•❑ CM= Pomp.insurance regtred_] *Any applicant that checks box#1 must also fill out the section below showing their wmi=s'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then his outside contractors most submit a new affidavit indicating such. kbntractors that check this box mist attached an additional sheet showing the mane of the sub c utractms and state whether or not those entities have employees If fts sub-contractors have employees,they mustpron ide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.# ExpirationDate: lob Site Address:--City/State/zip: Attach a copy of the workers' compensation policy declaration page'(shovr ing the policy number and expiration date). Failure,to secure coverage as reqaired.under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 tbq violator. Be advised that a copy of this statnmerit maybe forwarded to the Office of hrmstigations of the DIA for insurance coverage verification. I do hereby certify wdff the pain penalties of perj that the information provided above is true arid correc4 S' iztce: Data: Phone#: S^d�' `�'��—fi n G6zL t J7 —3YjD'9 7 Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense# -Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector I C. Other Contact Person: Phone#: 5088984650 north tax EMC-Prooel508-998-4660 11:08:30a.m. 05-14-2012 1/1 r Town of.Barnstable • Regnlatory Services KM Thom F.Gciler,DhwW Building Division 200 Mat Sttwk Hymen*MA 02601 �nvw.towa.barnstableml�.w ......._ Ofce: 508-862-4038 Fw 508-790-6230 Property Owner Must Complete and Sign 11is Section sin Builde as Owner of the sabject property hereby authorize ! to att on my bed is alI mamess relative to ZVOrkharized by d= petit (Address of Job) ! 1. . **Pool fences and alarms are the responsibility of.the applicant. Pools are not-to be filled before fence is installed and pools are not-to be utilized until all final inspections are Performed.an_ d accepted. Signature of Signature of Apphcwt Pant Name Print Name . Date • Q:FOR&-'OWNE LvMtM WOMPOMS I - License or registration valid;_for individul use only Office of Consumer Affairs&Business Regulation i before the expiration date: If found return to: ulgHOME IMPRQVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registratiop�w'-1$4831 1 10 Park Plaza-Suite 5170 Expiratiot I7`L_197?011 Tr# 290710 Boston,MA 02116 Type -4[1_:Indiwduak_ 1i WILLIAM D.MULLI.N-JR`. �_-__=Vi WILLIAM MULLIN -a:, ._ r art., - 325 WILLOW ST ;t> {r ._, WEST BARNSTABLE-MA-02668 Undersecretary Not valid without s.. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-004173 WILLIAM D 11LLIN,JR % r 325 WILLOWST ? W BARNST.4BLE MA.026 i Expiration j commissioner 03111412014 J I .. ,I i i i I - n I I C I CA,4 k6 �I cc Q cn r oLa1-1 �~ d NORTHSIDE DESIGN ASSOCIATES DISTINCTIVE RESIDENTIAL&COMMERCIAL DESIGN 141 MAIN STREET•YARMOUTHPORT•MA 02675 (508) 362-2210 • (508) 362-9802 APPROVED Fax:(508)362-5269 www.northsidedesign.com SEP 2 8 2011 E-MAIL:northsidei ftomcast.net Town of Barnstable Old King's Highway Committee 16 September 2011 Old King's Highway Regional Historic District Committee . Town of Barnstable 200 Main Street Hyannis,MA 02601 Re: Kathleen C.Kilduff 52 Point Hill Road, West Barnstable Map 136,Parcel 29 Gentlemen: We would like to make the following minor modification to our application which was heard and approved on 13 October 2011 with a time extension requested and granted on 10 August 2011: • On the rear elevation, due to structural issues, it was necessary to add a post under either side of the balcony and the 45'supports have been slightly enlarged. This is not visible from any street. Please see the attached plan; I have indicated these changes by"clouds" on the plan. If you have any questions or require additional information, please do not hesitate to contact me. Thank you for considering our request. Yourst�ulY, NQRTHSIDE�,. SSOCIATES I . Gordon Clark III cc: K.C.Kilduff I • 8� a 0 3 R e i 0 I =3= N N N aaaaa z0� \------------- n2c -------------- mp rcr II v i..( 11 m 'n D ° DQ �a v'U) (n °'D 'I.......... 34............ ............... ...... .... 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DATE: 70peOMCMAL RESIDENCE ASSOCIATES DRAWN a sTlwctwu EvwrNCTEs N CHANCED OR COPIED M ANY FORD OR(CANNER WHATSOEVER 8/09 Il * ��at M V"Lam oa WITHOUT FIRST OBTAINING THE A.1 / oaAVTlblr�oro+„�,,, P INT WILL ROAD DI41 MANE STREERESIDT VAL O C01ORT-WL DESIGN EXPRESS WRITTEN PERMISSION 0A 1 AO p0R0 s�'10 T HARNSTABLE MA. ut 'W'(s2REEY'YARu°tmt (NOj M ue80 AND CONSENT OF NORTHSDE CHECKED p6(n!y[IIQi N snunw,4 (00a)sal-T7f0 DESIGN. 1 I A.3 � c ' m PROPM D FRCNW DOOR M4 WINDOW/DOOR CASING p MAT"EXISTING Zillill III WWrr9 CEDAR I MATW EXISTING1 1111111 IMP 11 zi 11 1 11 1 1 11 1'. 1."... 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"' MAIN snTETY'rARI/wmFORr'W Dxe7e AND CONSENT OF NORTHSIDE CHECKED olsawm9n IN eTRLKTJ AL I (eoe)302-221O (me)ee�-oem DESIGN. JOB TAYLOR DESIGN ASSOC., INC. SHEET NO. OF- P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY- DATE Z"57 Tel./Fax: (508) 790-4686 CHECKED BY DATE j-r I I.L- Q_JC>. Q. 't3AAW3r~CALE ............. ........................ 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JOB TAYLOR DESIGN ASSOC., INC. SHEET NO. OF ` xl P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY � T DATE Tel./Fax: (508) 790-4686 ` CHECKED BY DATE I�' fin- 3 A•G c� i ........................................:............._._.._ . -:...- ..__ ...... _....._ ..... ..... ..... _._ ...... - - ---- ..... ..._ _...... _ ...... , ....... ...:.... ....:.. ..:.... .... ... . i :..............:..................................._...:.......... ..... ..... ..... 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Z�x... ..k.�t.., ..........1,s. ..A-c.. ...............'........................ ..... _ .......:. ........ — .... ..... ..... _... ...... ...... .._. ..... ...... ..._ ..... ...... ...... ...."� - - - . i i ' i .i.........._�........ ..... ...... ...... ..... ...... ...... ._.. ..... ...... .. ...... ..... .__ ..... ; n.............>...................................... ...........; ....y.... ....:.... A� L Q �`- ...............................................[..........................'..... ...... .... ...... ..... ..... ...... ..... ..... ..... ...... ..... ..... ...... .... ..... ...... ................................ .. . _ ... ....... C - ..............i..............i...........................i..............;..............i.............:.............�... .. ..... .... ..... ..... ...... ..... ..... ..... ...... ..... ..... ...... ...... .... ...... ...... ..... .... .... ... . .........._i.... ....b......... ... ...5.... .....:.... 0 3.: 8 ...... .............._..... c l: ...... ...... ..._ ... k c� X 8 .._......... ..... ...... ...... ..... ...... ...... ..... ...... ...... ......_.................................... ... ......... .._.... r ..Q 11 .. ! , i t° l W Co _... ..... .. T. R- 'TS,... G1-......_ o ...... 0...._.... ..... ...... . ..... ..............:.............................._..........:.........................................>.........'qrq.. .. 1?L�. . ....... 'T Srr_....` rt4- .... ....:.... �Nc . � l oFtKE T Tows of Barnstable ermtt ti0 Expires 6 mor the•e� Expi from issue date Regulatory Services Fee anxxszwElm 9 16 9. ,0� Thomas F. Geiler,Director �p�FO MAy A Building Division 1� Tom Perry,CBO, Building Commissioner XTP ES 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us �:j jl l' Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - 'RESIDENAA"A6 LSD AR,N,S?A€3L Not Valid without Red X-Press Imprint Map/parcel Number Property Address,5_Q P, A l L Rol W . 1us&�ke- I.q e2 a(4&9 residential Value of Wor Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address r Contractor's Name�pa Q f,J� u Telephone Number ���1�, Home Improvement Contractor License#(if applicable) Zt*on Supervisor's License#(if applicable) I? T3 an's Compensation Insuran ce nce Check one: ❑ lam a sole proprietor ❑-am the Homeowner [ I have Worker's Compensation Insurance Insurance Company Name t9 / �T, _ Workman's Comp. Policy# ���. 9 7 B �5 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors . D Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required; Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc: ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: Q:IWPFILESIFORMSIbuilding permit formsEXPRESS.doc Revised 070110 f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): i( deuu C Address: City/State/Zip: l Al 4 p d Phone #: 5p���7(�• ��a1y Are y an employer? Check the appro rate box: Type of project(required): 1. I am a employer with(- 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the.sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' comp.insurance.$ 9. ❑Building addition [No workers' comp. insurance P� required.] 5. ❑ We are a corporation and its ME]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.❑ oof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13. Other C h comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: daa s eri Policy#or,Self-ins.Lic.#: /,(, �,/ ��� ���ad Expiration Date: Job Site Address:.2o2 City/State/Zip: • G� G� 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 D1A for insurance coverage verification. I do her certify under the pains and penalties ofperjury that the information provided above is true and correct l Si afore: Date: /0 6 /, Phone#: ra 74; 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#: OP ID: 31 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) �.. 04/29/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CONTACT PRODUCER 401-8$6-$OOO NAME: The Preston AgenC ,Inc. PHONE FAX 1350 Division Rd Suite 303 401-885-1700 AIC No Ext: Alc No PO BOX 810 A o acc. East Greenwich,RI 02818-0810 PRODUCER FELLA-1 Patrick Meacham,AAI,CIC CUSTOMER ID#: INSURERS AFFORDING COVERAGE NAIC# INSURED PFR Acquisition LLC INSURER A:Hanover Insurance Co. dba: Pella Windows&Doors; INSURER B: Atlantic Millwork,LLC INSURERC: 1325 Airport Rd Fall River,MA 02720 INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP LIMITS ILTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY ZBE 8151344 05101N 1 05/01112 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- Emp Ben. $ 1,000,000 POLICY LOC � A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ 1,000,000 (Ea accident) A ANY AUTO AWE 8714919 05101111 05101112 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEOULEDAUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS L - $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS-MADE UHE 8714781 05/01/11 05101112 AGGREGATE $ 10,000,000 $ DEDUCTIBLE X RETENTION $ WC STATU- OTH- WORKERS COMPENSATION X T RY LIMIT AND EMPLOYERS'LIABILITY 05/01N 1 05/01/12 E.L.EACH ACCIDENT $ 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A WDE 8716568 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 1,000,000 (Mandatory In NH) 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION PROOFRI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Proof of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. Only AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ;. Barnstable.Old Kings .. } 200 Win:s� . _ way H�stoM.l'aftict Cdrrimi "`"� Yanrus,MA 02601',TEL. 508-862=4787 ft.508-802::47- aPPL1CA:-77ON. . 4. �P avian r made;.with fbtw(4)�ot:►rl DER tTIFIChe A TE OF.APPROPRU TEMU 470;Acts and Itosolves of Massachusetts; Din .far of a.C"frcate.of..A Y�g tma li ation.foi- �°p°�work as described below ai d:oil '�'p'' under Sec7inirlG'�f t'tiaptu: . c kas;drawings; Ph�bgtnpbs Cha*cll cWegoria•t d 1, Btu din' Qppl'; _.1.—�c°nshuctio� ;' ❑New ❑Addido� 2. .T a of Bt2ildin . 12Alteradon ( � ❑� eib a c uv,ettle"r� • Hou 3. EzteriotPaintin roof �' g etn ❑;Sllect Q.C6nitne�cil ®� new:roof ❑cojdnl na ° 4. sue: teirial change,.of trim; — _ C] ' 8indow doo rN . x{P .ewSig Exist l :5. Q Repainting:F t3hrgSlg1 ^ture. Fence ❑PIagl e< Reti6 ❑Svin ni ❑ ning wall ecout per,r-- 13 l Other man-made.pool. ❑ Solaz parcel Type or Prim Leg'blY' Date, c ❑ alter NOTE,tam wstttir �!'uectmrwlow,w Cwrarr(print).:. a Address of Proposed.Work:. Teleplaaa#::. 0 { Mailing Address(if di village �. �1 owner's Slgria DemiPtfoti of Ptopd VYor1c;>(iivti. p 1`. .:of work to be do Ido .c TR KTUOAC C 0"�t9 Agent or.Contraetor(print); ,n �,. � / Address: .l ) aTacphone.*. CIT ee J"OP-(o7(o-6Pda Coairutor/Agenf signatwe:: �2// mop 91i1-0 7 ,10 Tor conunittee. J�® �ha CertfEjca :sherebY�Yite be i . �ovEnr,� J �wN OF BPS RV 0011 H,S-�OR1G PRE I►a, GcZl oti - p`S7M _ td xLeda tngbw�Ro,�{►n ��7 OP dauWKH D 'V�I p P nsen DRAFTda j Town of Barnstable —j-� Old King's Highway ` , 1 (� ,�n V3)V\A� Committee w f W. .- ' CERTIFICATE OF APPROMATENESS SPEC SHEET Please sv6.. 5 Copia Fotrizdatbn TYPE(Ma:i: 12"exposed)(material-brick/cemen4 other S:ding TYPe: .Clapboard shingle:-_._ other . Materials red cedar.. .white cedar �Py Material•. —=-- other. Color. — ---_.: Color. Root Material: '(Makedt style) . Root Ptbch(s): (7/12 mhlimum) Color. . (speedy on PImu fbr..eery brr'.. WIM&W and door �8�.majorQddltio>r r) nQateiialt wood Other material.specify. N A 2Xis�•� .Size ofc 4 r'i u � o rboards _ c esiu:of casings(1 X.4 ,) Raked 1st.mem color .. pet a Ar + � --�--.niber Dept[t of overhang Window (makelrn d l�}Ser�e,f (Provide winddw scheduleVim. Trial' WOO d color C 140t Pivir foX ne►it biiildiitga:M P addition$) . 'andl� e Window Brills(Please check all that. true divided tights exterior&W griUs- _...grills between lass. RP'n'ovabteWcodCrr;IIS g —.removable.ititerior✓N�e.Door.style and make:. . ��maten'�al Ae exislcl tternajej People Garage .Color: �1 �Door,Style, Size of opening ---_Material Sh°WrTYWSt3 W?&terial:. .. Color: GnUer TypetMaW iW: !material: wood: Color: other materia(,,specify.. Skylight,t Color. ®� B OV E YPe%ke/model/:: . 'material----__Color. sign size: Type/Maceriats: Feriae j`ype( .6+).Style Color: wn of Barnstable mate nal• ReWaIng.w dL. ' Color:; Old Committeeway . Material; ��5:trees�nding on.building. dT EX MFORMA ION, it un g,$ign. A AC-MD C L T'MUST BE CO 1?1e. MPLE D ANDS . Mr P�de samp�:of -. xt�$ taxers b ��h� a�,�,,_ . rnchnra ot"wia4owa;.,� % � Slgneds (pladpiep�, ) ft W) �r/.G<-- dam,° �1rP .:etc `-'.80 r&=d CcmrklufanjW d Cingt H,,;hwa)4jX!!.4 i -J'Od�'tdo�.i10XNDIP4fT70/1 C'art.lpp^yP�int,rtas w Z d7, ae License or registration valid for individul use only y l ug Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration149840 10 Park Plaza-Suite 5170 Expirat o`ni,,"%Q 3_l2012 Tr# 293041 Boston,MA 02116 Yp 1� � ,. 7 T e:_�L"-td-Liability,Corpor PELLA WINDOWSFAND D, S"' STEPHEN DICKINSON. 1325 AIRPORT R©AD`; � fmi s" ANot valid without signature FALL RIVER,MA 02720'.,�t Undersecretary Massachusetts- Department of Public Safetc Board of Building Regulations and Standards Construction Supervisor License License: CS 81843 j Restricted to: 00 s STEPHEN T DICKINSON p12 BURNSIDE LANE ; MERRIMAC, MA 01860 Expiration: 2/6/2012 commissioner Tr#: 18033 i Contract Detailed Pella Window and Door Showroom of Fall River 1325 Airport Road Fall River Industrial Park Sales Rep Name: (508)Conc 962- Kevin ® Sales Rep Phone: �(508) 962-0766 Fall River, MA 02720-1309 Sales Rep Fax: Phone: 5086766820 Fax: 5086766823 Sales Rep E-Mail: kconchinha@gopella.com Customer Information Project/Delivery Address Order Information Kathy Kilduff Kilduff,Kathy-West Barnstable,MA Quote Name: 12 final order 52 Point Hill Rd 52 Point Hill Rd Order Number: 738221MF3 WEST BARNSTABLE,MA 02668-1014 Lot# Quote Number: 2994752 Day Phone: (508)596-8458 West Barnstable,MA 02668-1014 Order Type: Installed Sales Mobile Phone: County: Barnstable Wall Depth: Fax Number: Owner Name: Payment Terms: Deposit/C.O.D. E-Mail: Kathy Kilduff Tax Code: MASS Contact Name: Owner Phone: (508)596-8458 Cust Delivery Date: 10/13/2011 Kilduff Kathy Quoted Date: 8/12/2011 Great Plains#: KILKAT Contracted Date: 9/6/2011 Booked Date: Customer PO#: Line# Location: Attributes 15 main size Architect, Precision Hung Double Hung,27.5 X 52.5,Sand Dune Item Price Qty Ext'd Price 1 $1,397.89 8 $11,183.12 1:27.552.5 Double Hung,Equal Split Frame Size: 27 1/2 X 52 1/2 General Information: Style Edition,Clad PK# Exterior Color/Finish: Standard EnduraClad,Sand Dune - Interior Color/Finish: Unfinished Interior 479 Glass: Insulated Low E Advanced Argon Gas Viewed From Exterior Hardware Options: Spoon Lock, Champagne,No Sash Lift Screen: Full Screen,InView Grille: ILT,No,7/8",Traditional(4W3H/4W3H) Wrapping Information: Perimeter Length=160",Glazing Pressure=115. i Rough Opening:28'X 53' 1000008-Wood Pocket Replacement Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 9/6/2011 Contract-Detailed Page 1 of 6 Customer: Kathy Kilduff Project Name: Kilduff,Kathy-West Barnstable,MA Order Number: 738221MF3 Quote Number: 2994752 Line# Location; Y_ ., 77 - y Attributes 20 master bath-front Architect, Precision Hung Double Hung,.27.5 X 52.5, Sand Dune Item Price Qty ExVd Price- $1,469.00 1 $1,469.00 1:27.552.5 Double Hung,Equal Split Frame Size: 27 1/2 X 52 1/2 General Information: Style Edition,Clad PK# Exterior Color/Finish: Standard EnduraClad,Sand Dune I 479 Interior Color/Finish: Unfinished Interior Glass: Insulated Tempered Low E Advanced Argon Gas Viewed From Exterior Hardware Options: Spoon Lock, Champagne,No Sash Lift Screen: Full Screen,InView Grille: ILT,No,7/8",Traditional(4W3H/4W3H) Wrapping Information: Perimeter Length= 160",Glazing Pressure=205. Rough Opening:28"X 53" 1000008-Wood Pocket Replacement Qty 1 "Line# Location: Attributes 25 kitchen sink Architect, Precision Hung Double Hung, 27.5 X 36.5, Sand Dune Item Price Qty ExVd Price r $1,178.96 1 $1,178.96 1:27.536.5 Double Hung,Equal Split Frame Size: 27 1/2 X 36 1/2 General Information: Style Edition,Clad PK# Exterior Color-/Finish: Standard EnduraClad,Sand Dune 479 Interior Color/Finish: Unfinished Interior �— Glass: Insulated Low E Advanced Argon Gas Viewed From Exterior Hardware Options: Spoon Lock, Champagne,No Sash Lift Screen: Full Screen,InView Grille: ILT,No,7/8",Traditional(4W2H/4W2H) Wrapping Information: Perimeter Length=128",Glazing Pressure=145. Rough Opening:28"X 37" 1000008-Wood Pocket Replacement Qty 1 For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 9/6/2011 Contract-Detailed Page 2 of 6 Customer: Kathy Kilduff Project Name: Kilduff,Kathy-West Bamstable,MA Order Number: 738221MF3 Quote Number: 2994752 Line# Location: Attributes 30 fixed unit-side Architect, Double Hung Fixed, 50.25 X 50.75, Sand Dune, 3.11/16" Item Price Qty ExVd Prrce- f $2,076.85 1 $2,076.85 1:Non-Standard Size Fixed Double Hung Frame Size: 50 1/4 X 50 3/4 General Information: Standard,'Clad,Pine ' PK# Exterior Color/Finish: Standard EnduraClad,Sand Dune Interior Color/Finish: Unfinished Interior !_ 479 Glass: Insulated Low E Advanced Argon Gas Viewed From Exterior Grille: ILT,No,7/8",Traditional(7W6H) Wrapping Information: 3-11/16"Factory Applied, Perimeter Length=202",Glazing Pressure=50. Final Wall Depth: 3-11116" Rough Opening:51'X 51.5' 1000010-Wood Pocket Replacement Fixed or Composite Qty 1 Line# Location: Attributes 35 daughters bedrm Architect, Precision Hung Double Hung,21.25 X 44.5, Sand Dune Item Price Qty Ext'd Price j - $1,237.52 1 $1,237.52 q 1:Non-Standard Size Double Hung,Cottage Split " Frame Size: 21 1/4 X 44 1/2 General Information: Style Edition,Clad PK# Exterior Color/Finish: Standard EnduraClad,Sand Dune 479 Interior Color/Finish: Unfinished Interior Glass: Insulated Low E Advanced Argon Gas Viewed From Exterior Hardware Options: Spoon Lock, Champagne,No Sash Lift Screen: Full Screen, InView Grille: ILT,No,7/8",Traditional(3W2H/3W3H) Wrapping Information: Perimeter Length=132",Glazing Pressure=140. Rough Opening:21 -3/4'X 45' 1000008-Wood Pocket Replacement Qty 1 Line# Location: Attributes 40 CREDIT CREDIT Item Price Qty Ext'd Price ($318.65) 1 ($318.65) For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 9/6/2011 Contract-Detailed Page 3 of 6 ."ustomer: Kathy Kilduff Project Name: Kilduff,Kathy-West Barnstable,MA Order Number: 738221MF3 Quote Number: 2994752 Line# Location: Attributes , 45 Thank you Item Price Qty Ext'd Price- $0.43 $0.43 I i For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 9/6/2011 Contract-Detailed Page 4 of 6 Customer: Kathy Kilduff Project Name: Kilduff,Kathy-West Barnstable,MA Order Number: 738221MF3 Quote Number: 2994752 Thank You For Purchasing Pella® Products PELLA WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale.All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details,taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wall system.Neither Pella Corporation nor Pella Windows Inc.will be bound by any other warranty unless specifically set out in this contract. However,Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening(egress)information does not take into consideration the addition of a Rolscreen[or any other accessory]to the product. You should consult your local building code to ensure your Pella products meet local egress requirements. Per the manufacturer's limited warranty,unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually,thereafter. Variations in wood grain,color,texture or natural characteristics are not covered under the limited warranty. Notice:You may cancel this agreement if it has been signed by a party thereto at a place other than the address of the seller,which may be his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery,not later than midnight of the third business day following the signing of the agreement. Federal ID#71-0986135 Rhode Island HIC Registration#21210 Massachusetts HIC Registration#149840 Massachusetts CS License#CS81843 1.Work to be performed and materials used: Pella agrees to perform the following work for the homeowner: a. Remove existing window(s)/door(s) b. Install new window(s)/door(s) c. Dispose of old window(s)/door(s) d.Clean up work area The materials to be used in completing the work described above are a part of this contract and are listed on this contract. 2.Pella Limited and Exclusive Warranty. The attached limited warranty is the sole and exclusive warranty given by Pella with respect to this agreement.Salesperson has no authorization to make any representations other than contained in this agreement and homeowner represents that none have been made or relied upon by the homeowner. 3. Insurance Pella certifies that it maintains adequate liability insurance. 4.Arbitration Any controversy or claim arising out of or relating to this contract or breach thereof,shall be settled by mediation under the Contruction Industry Mediation Procedures of the American Arbitration Association. If within 30 days after service of written demand for mediation,the mediation does not result in settlement of the dispute,then the unresolved controversy or claim arising from or relating to this Contract or breach thereof shall be finally settled by arbitration administered by the American Arbitration Association in accordance with its Construction Industry Arbitration Rules and judgement on the award rendered by the arbitrator(s)may be entered in any court having jurisdiction thereof.The costs of such proceedings shall be borne equally by both parties. 5. Incorporation of Other Documents The following documents are incorporated and made part of this contract: Pella Limited Warranty and Pre-Installation Checklist. 6.Other Provisions a. Pella is not responsible for any existing security systems. For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 9/6/2011 Contract-Detailed Page 5 of 6 Customer: Kathy Kilduff Project Name: Kilduff,Kathy-West Barnstable,MA Order Number: 738221MF3 Quote Number: 2994752 • b. Please remove all shades,blinds,curtains,drapes or window mounted air-conditioners,prior to the installation of your new windows or doors.The installers are not repsonsible for the r removal or installation of these types of items. c.Structural damage(eg.rotting or damaged wood or frame of rough opening)may not be determined until the old window or door has been removed. If the installer determines that structural repairs are required there will be additional charges.The additional work will require a separate contract or change order and the additional charges shall be payable upon completion of work. d.Pella will use reasonable efforts to return the areas affected by the work,performed under this contract,to a state approximating its original condition:however, Homeowner understands and agrees that this may not result in the affected areas being restored to their original condition. e.This contract shall be governed by the State of Rhode Island or Massachusetts depending on the location of the work to be performed. Project Checklist has been reviewed Order Totals Taxable Subtotal $14,909.34 Credit Card Approval Signature Sales Tax @ 6.25% $931.83 Non-taxable Subtotal $1,917.89 Total $ Customer Name (Please print) Pella Sales Rep Name (Please print) $8, . Deposit Received $8,662662.6767 Amount Due $9,096.39 Customer Signature Pella Sales Rep Signature Date Date For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 9/6/2011 Contract-Detailed Page 6 of 6 N TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION TQ'wn Or SARNSTAPLE Map Parcel Application # o Health Division 21 $ p 2 } )'Date Issued CIt Conservation Division Application F ( Planning Dept. Dj1 �---Rermit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner Address s.rh Telephone _S?c- Permit Request Wr-JU,.n.�_ r; (ell.-).. P-44,� i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count i Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: I Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mike McCarthy Construction Telephone Number PO Box 52 Address west Dennis. MA 02670 License # Cell (508) 280-6964 ^816 586a3 UIC-169393 Home Improvement Contractor# i Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO J J SIGNATURE DATE T/y i FOR OFFICIAL USE ONLY APPLICATION# bATE ISSUED ,MAP/PARCEL NO. ADDRESS VILLAGE ' + OWNER . r DATE OF INSPECTION: c, FO.IJNDATION� ., ;x� ti FRAME --INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT { ASSOCIATION PLAN NO. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Super isor License: CS-058633�, _ MICHAEL J MCCAR PO BOX 52 f ' W DENMS MA 62670 1 y Expiration Commissioner 04/10/2016 CT Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2015 Tray 238121 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 WEST DEN NI 0267 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 C? 20M-05/11 r 4 ,ac©fF0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 07/10/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 Ileu of such endorsement(s). PRODUCER 01962-001 �RMJACT Bryden&Sullivan Ins Agcy of Dennis IncPO Box 8 c.Ext; (508)398-6060 ,No.: (508)394-2267 So Dennis,MA sd MA 02660 igShss: I RE )AF BDIN C VERGE NAIC# INSURED NS RE A: A.I.M.Mutual Insurance Company 26158 i ----_ Michael McCarthy Construction Inc -INSURER B: P 0 BOX 52 INSURERC, West Dennis,MA 02670 INSURER D: N RER 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. N0 i WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DCCUMENT WITH RESPECT TO IAI-ITCH 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. IC1s TYPE OF INSURANCE POLICY NUMBER Ms MNI/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ a e CLAIMS-MADE OCCUR MED EXP(Any one person) $ -- PERSONAL&ADV INJURY $ __ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ �OLICY I UECT F-LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO a accident $ ALL OWNED CHEDULED BODILY INJURY(Per person) $ AUTOS AUTOSS BODILY INJURY(Per accident) $ *HIRED NON-OWNEDPROPERTY DAMAGE AUTOS accident $ OCCUREACH OCCURRENCE $ CLAIMS MADE AGGREGATE $ NTION $ giN�y��R�l��p�l�o�>E9TpesR��CpigsiR�T�NQERr N X T�4>al-S A OFFICER/MEMBER EXCLUDED9 ECUTNE N/A VVVC-100-6017666-2014A 7/17/2014 7/17/2015 LL .EACH ACCIDENT $ 600,000.00 (Mandatory In NH) �/ fl d b���dgr L DISEASE-EA EMPLOYEE $ 500,000.00 D SgCR ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace Is required) Workers Compensation Coverage applies to MA employees only. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering 195 Francis Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cranston,RI 02910 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i The Commonwealth of Massachusetts Department oflndustrurlAccidents Office of Investigations 600 Washington Street Boston,MA 02111 lviinp.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers `. Applicant Information Please Print Le ' I Mike McCarthy Construction Name(Business(Organizationtlndividual): PO Box 52 Address: West Dennis, N11A 02670 City/State/Zip: CSIph%§# 3 HIC-169393 Are u an employer?Check the appropriate box: Type of project(required): 1.&I am a employer with 4. ❑ I am a general contractor and I _�— 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole propridtor 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. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We arc a corporation and its required.] officers have exercised their l0.❑Electrical repairs or additions 3.111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. e.152,§I(4),'and we have no 12.❑R f repairs insurance required.]t employees.[No workers' 13.ther COMP.Insurance required.] *Any applicant that checla box#1 must also fill out the section below showing their wodmW compensation policy hdbmtadon. t Homeowners who submit this aBdavft indicating they are doing all work and then hire outside contractors must submit a new afdava indicating such. !Contractors that check this box must attached an additional sheet showing the name tithe sub.contractom and their wozkore comp.policy ir6rrnation, lam an employer that Is providing workers'compensaflon Insurance for my employees. Below✓s the policy and job she Informatlon, Insurance Company Name: b.1 .P. Policy#or Self-ins.Lic.M nVW(- IGo-(�d��G�- A Expiration Date: Job Site Address: ��— R'�^�-a' hl 1 City/State/Zip: 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 ofMGL c.152 can lead to the impositfon ofcriminal 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 tho'Office of Investigations of the DIA for fnsu ance coverage verification. I do hereby ceHt&r! d e pa a enables ofpedury that the Informadon provided above fs true and correcA Si tore• 54 /y . Phone P Offlcial use on y. Do not write In this area,to be coigleted by chy or town oJ7k1aL lI PermitUcense 0. `Cite or Town; i Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/1•own Clerk 4.Electrical Inspector 5.Plumbing Inspector j 6,Other - Contact Person: Phone#: r - 7"y`1-7 OWNER AUTHORIZATION FORM I, (Owners Name) owner of the property located at PO -� i26c-L roperty Address) r ) a-�� (Property Address) hereby e e eby authorize (Subcontractor) an authorized subcontractor for RISE Engineers g,to act on my behalf to obtain a building permit and to perform work on my property. xOwner's Signature Date Town. of Barnstable Perm Expires 6 months .•. Regulatory Services Fee * 1AENSTABLE, ;' ' M Thomas F.Geiler,Director.. .1639. 11/ Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,M.A.02601 www.town.bar-nstable.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 1 p (23,9- n Property.Address �,�1 't�111A) gt ❑Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owners Name&Address Telephone Number Contractor's Name ll) i I l ��',- �(, p c6iL 2,C,' Home Improvement Contractor License#(if applicable) /'cr,4' 9,31 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Cher one: am a sole proprietor N0V. ❑ I am the Homeowner 42012 ❑ I have Worker's Compensation Insurance ?O VV/V OF B Insurance Company Name ARN Workman's Comp.Policy# STge`� 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) 0"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.reguMons;i.e:Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License 8i Construction Supervisors License is requirep. . SIGNATURE: 771e iCrrminonivealth a.f Massachrrse lls DeparMent o,f Industrial Accidents Ofik of Investigations 690 Washingtm Street Boston,MA 92111 . tir»Minass-govIdia V,orkers' Compensation Insurance Affidavit~ Bidders/Contractors/EtecEric ans/Pl�mbers. Applicant Information Please Print Leg��I]` Name lj: t� lll��v� ►��c�CjL��✓ wiz �c��U�. Address: 3 a-5 t low S7 b Cit3rfStatel2ip: Phone## Are you an employer?Check the apprepnatt'box: Type of project(required): I-❑ I am a employer with 4. ❑ I am a general cmt ractar and i 6- ❑Drew constatrction loyees(full and/or part-time).* ha°EIrked the iub-con s 2.L� I am a sole pmpriet&or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition -,,.&ng for Mein airy capacity. employees and have worms' 9. ❑Building addition (No woricets' comp.insurance comp.insurance Z required.] 5. ❑ We are a corporation and its 1 a•❑Electrical repairs or additions 3_❑ I am a homeowner doing.all work officers have exercised 92esr 1l.❑Plumbing repairs or additions myself [No workers'camp- right of exemption per MGL 12❑Roof repairs ' insurance required.]T c. 152,§1(4),and we have no employees.(No workers' 13.❑Other SI D�W!{LL comp.insurance required:]: *Any appfics3rt that check box trl:mast also fill out the section below shua g their woalies'co®Pensatiaa policy informstimn. 7 Homeomrners wbe submit this af5dsvit im&cating they aaedoiog Salted and,then hue outside con rRCMTs mast submit a new affidavit indicating satb. FConttacmrs that check this boat must attached as sMfSEM sheet showing the mime of the siib cautract and stop whether or not ease entities have employees. If the sub-contmc[oa h2ve employees,theynntscpxnvide their aiurkers'romp.policy number. I am ati employer that is pmiWng workers conrpertsattsrt insurance}br grey awgA7yees. Bdtow is the psiicy and jab site. inftm ation. Insurance Company Name: Policy-cr Sel€ins.Lit.# Expiration Date: Job Site Address': city/State/zip- Attach a cirpy 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. L52 can lead to the imposition of ciiniinal penalties of a fine up to$1,500_©a andlor tine-year imprisOmnen,as wren•as civil penalties in.the form of a STOP WORK ORDER and a fine of up to$250-bO a day against the violator.. Be advised that a copy of this statement may be forwarded to the Office of Investigations of 1hgDIA for insmance cooperage verifffiatio L ' Ida kereby card y airdar thep� s and pe tibias v�I`;perjwy t�?rattJie information provided nfaotne is true and correct Bate: Phone.#_ d -� '7l? oL a - elm t>Z o 7 , 3 6rp. --9 .©jgkial irse only: Do not unite in this argil,to be comphdrd by city or totm o,,iciat City or Town: PermitUcense#' Issuing Authority,(circle one): 1..Board:of Health 2.Building Department 3.Cityt /I'o�trn Clerk 4.electrical Inspector rs:Ph�mbirg InsQec#©r .. =t:,•: i MEMABIA ASS Town of Barnstable Regulatory Se'mces Thomas F:-Geiler,Director Building Division Thomas Perry,CBO. Building Commissioner 200 Main Street,'Hyannis,MA 02601 www.town.barnstable.ma.us ' Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign.This Section If Using A Builder , I,_�1 �1f���n� '�:' �l`7U fit' ; as Owner of the subject'property hereby authorize 122 11 h! ko- 6-1 l)LL 1 n) to act on, my behalf, in all matters relative to work authorized by this building permit application for: 13 4i'll 12 N-/� L5)-'�2-104P (Address of Job) Signature of Owner Da/to ern• �- , �. . . : .: . . : .' � ' '. Print Name If Property Owner is applying for.permit,please complete the*Homeowners License Exemption Form on,the reverse-side. ' � ✓!ze -t�d7z7zrnzaiealC/ o�✓�aeaac/,.uaelza �---�'.__....._._, -- . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only u,p HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:! 164831 Type: Office of Consumer Affairs and Business Regulation .11 10 Park Plaza-Suite 51.70 Expiration;--__1:1,"/"/-1912013 Individual -= Boston,MA 02116 WILLIAM D. MUU411--JR�:,'>.F=-_=_(� - 4' WILLIAM MULLIN`' �t1 325 WILLOW ST WEST BARNSTABLE MAt02668. Undersecretary Not valid without signature # Mas` achus�etts -D rt epament of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-004173 .v �..r I WILLIAM IN JR i�� 325 WILLOVK ST W BARNSTBLF 02668 = �" i Commissioner Expiration 03/14/2014 j _--MCCARTHY RUCTI0 1 CO. ' d "`dal and Commercial Builder ; k-, �.1 PEel+ I`•y r I FAQ IZATTON SPECIALISE QUA " " _ �;,•ti �. -o�. dJ �. MCCAR7HYC G �{ ,k 1 f P YJW. October 21, 2014 Town of Barnstable Thomas Perry CBO _ Building Commissioner 200 Main Stret �� Hyannis, MA 02601 .� 7- RE: Insulation Permits Un C'3 y yy Dear Mr. Perry, a. This affidavit is to certify that all work completed for permit application#201405793 at 52 POINT HILL ROAD has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction `�� '°•.e. TOWN OF BARNSTABLE BUILDING DEPARTMENT t sseaar : TOWN OFFICE BUILDING rua HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authoriz'ed'by Building Permit' issued .to -r-! s / ? o Please release the performance bond. ` TOWN OF BARNSTABLE Permit No. 266117 ------------------- Building Inspector ""�'°L Cash OCCUPANCY PERMIT Bond Issued to Address Wiring Inspector % f6�i. r Inspection date Plumbing Inspector 1 � Inspection date Gas Inspector a Inspection date Engineering Department _�{,� R � Inspection date Board of Health r' ,. Inspection date z� 1 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 I11T ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. i ................. ' ' 19........... v ...............»» »..» .... ✓ Buildm Inspector � u«..- .s a� ems:.".� .,^, ..;� w;. r w; �v. A,ti� a «, t• ... _. _ �-r�-_ ..-, ,;,r��.�.K-. 7. ;'r+— �r';.,��, y^�.� ,i+.�r4�-•t �"'('Tti" �'7t►f�j„,J Y•.- ���A•f�-'.`,,�`.•j'y,:\n }rr''��' ,.•_ �"� �_�'r..ttt�'y--ra•-'r.c4�,.e,`i�;jv••.a,,�.'Y�`'''uar.r... c �• f { number. I �STHET�� Assessors map 'and lot nu Sewage Permit` number . ' r, l if Z BAHB9TAD LE, i L C'yL�.............. .... M MAB& House number, ........................ ..:...... .:.... 1 . 1639 00 y _ w - TOWN OF_ BARN STAB LE•� ,' . ,. - BUILDIN ,71 G INSPECTOR 'ems, • . _ . . � . + . �. APPLICATION FOR PERMIT TO . 'TYPE !C e� lr�.. t' Y. OF CONSTRUCTION'..� .................... ......... . .. .................................................. + t / ........... 19:+ TO THE INSPECTOR OF BUILDINGS: -The undersigned hereby applies for a permit according to the followings information: Location .... �.... .�.�"'.... J! h/ l ////� . •> ' ...fit "-j„/� 6:Ji`�` ,_<lti � .Proposed Use .......... 1 d� - . ` - Zoning District '.................... ..:................................ ..............Fire District .................................................... { •Name of Owner ;� � I�✓/,,�C/J�`►, .. ......................Address �rl �U �IQy • /J� l�, lfi1 �Y�37�{j /S ''J i, s �.(�i,/r im l ../ U �J � c: 2 , cY 4. Vt . . . Name.of Builder .. .....................................Address .... ..... . . .. ...... . . ......... i'Yed'�,... Name of Architect .. ..... .........................................Address . Number of Rooms .....9..........................................................Foundation t a ......................... Exterior ...................... ....................... �.. 4..............................Roofing ................ :......:............... FlooFloors 1 � _ _. J ....�<"�®D:t.�1. �:�.�'ism..............................................lntenor .. .f.:.�`.�':...!...................................................... r�. r J t ., Heating `............ .. 1 .. fr " ...... ..................�......PJumbing i ,s'1 / ............. `.....................:.. . , Approximate. Cost Fireplace .........�. .................... ................. �/,5U e. d, ..t .I................................... V1411 7/ Definitive Plan Approved by Planning Board _________ ___________________19____°'_'. Area .... 16 4•J t i Diagram of Lot and Building with Dimensions' Fee ...... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS" REQUIRED FOR NEW DWELLINGS hereby agree to conform to all the Rules and Regulations.of the Town of Barnstable regarding the above Z. construction. y Name .. `7 Construction Supervisor's License _ . t ROBERTS, WILLIAM M.D. A=136-29 26687 1�- story No ................. Permit for .................................... Single Farmi�y ................................ .. ...................... Location .....Lot 14, 52 Point Hill-Road ........................................................... West Barnstable ............................................................................. Owner ....William- -Roberts, M.D. .. Type of Construction .................. .......... . ............................. ............................................. Plot ............................ Lot ................................ Permit Granted ....Jljly..U....................19 84 Date of Inspection ....................................19 Date Completed .......................................19. 7o • SH�Z� / of L S'�C87�. 139.t, P�zoposern ~ � � Lo T I.5e- =w h 3� /Zo --Sip, f-T_ t \ 7 3 j N�l ► TZsr- PRoposrn c �' 3v Z-,T W/3 7140 '• l , tia - 79 �.0 J sect' .� Ajee)q Lo7- Ivor,-- ru�..�,o s ��s� o ti S/7'G q P�� By B.gysioE LOCATION W6T BA72/vsTq/3L Sc�/Lv�y, DA-i3� HAN /`j8/ SCALE •. . . bATE PLAN REFERENCE . .. . . . . . . N OFF,,,'. /07. EDV'Yf RD E. N KELLEY No.26100 h aISTEA�O I CERTIFY THAT THE .. .... .. .... . �yosoA�E SHOWN ON THIS.PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO rHE SET9ACK REQUIREMENTS OF THE TOWN OF WHEN CONSTRUCTED. DATE . : . . . . . . . . . . D,2. WILL/A" 10o,e&7z73 - P&Tl770 A/t-;P- REGISTERED LAND SURVEYOR r •SHOT Z of Z Sr°�G�� � L. .4�-.�.�. .. ... . TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 3,49' 's a 4"CAST IRON ' 12 MAX. 12"MAX. F3/4" OR SCHEDULE 40 4"SCHEDULE 40 P.V.C.(ONLY)P.V.C. PIPE PIPE - .MIN. LEACH PITCH I/4"PER.FT PITCH 1/4"PER.FT. PIT TINVERT • G\-INVERT INVERT v� W SEPTIC TANK EL.:37 os DIST.. EL36.7o �_ .INVERT BOX 's730 . oQ. . GAL. (INERT �� ' 0'EL....-..... .. INVERT v a 0: /w w EL u- �:w PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE P_ Z// SOIL LOG WITNESSED BY : DATE .'`� . 3 1.98!.. TIME. . . . . . . . . . . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 C. 2 S/�/ZT =r/C. ENGINEER ELEV. - ,&, Bo. . ELEV. Z-41, � DESIGN DATA E2.31`80 , S�B-Sa.L \ czgy -'a- 38•zo NUMBER OF BEDROOMS `3 330 . . . . . . EZ. .ss' go TOTAL ESTIMATED FLO1k . . GALLONS/DAY B¢„ ni+cT ,c' - BOTTOM LEACHING AREA �S3 9 . , SQ.FT. /PIT/iZ7.7 G,P.D. Jl?+ D Bo . SQ.FT./ PIT/ 7 P SIDE -LEACHING AREA . . zG•3 9 . Sz •gc, p, D GARBAGE DISPOSAL .•ye'•5. . . (50 % AREA INCREASE LoasG .SA+uo TOTAL LEACHING AREA . 4/7,.8 0 . SQ.FT, PERCOLATION RATE ZB,8o /68" .... . .WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE A. S-:�SQ.FT/Gp•D, NUMBER OF LEACHING PITS W122l. . APPROVED . . . . BOARD OF HEALTH �v2 �EZ'T OT S7vNc' D/+� •92L S/a�5. DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. AGENT OR INSPECTOV.cri,R �H OF R4 2- + l o .0/¢ 7 J[/ K m �t R. L ELLEY Poi.v? Nib /M4� / Na 26100 Z O ABC NQ/STEP De Nrt p� PETITIONER 7�2. W/GG1.g" 2oB�rzrS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION #....Applicaticifi Map- Parceiv., Health-Division Date Iss66d Conservation Division '-A piliciati6b '-,Application Fee Planning-Dept, Permit Fee; Date Definitive,Plan Approved by Planning Board Historic - OKH Preservation Hyannis Project Street Address 44 i Village Owner t ) Address-ib:Y-So 29 Telephone "I4 — 13?Q: Permit Request . -�ea\AC.Q* E41•4i ; L_• Sq uare feet: 1 st floor: existing 13(oi proposed 2nd floor: 'existing p roposed Total new Z6, hing District Flood Plain Groundwater.Overlay ISOO. Project Valuation 'DO Construction Type 1_61 t Size &,,1 65_ A aAe) Grandfathered: Ll Yes � No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family 0 Multi-Family(# units) Age of Existing Structure S Historic House: Q Yes 0 No On Old King's Highway: XYes L1 No Basement Type: U Full Ll Crawl Walkout 0 Other Basement Finished Area (sq.ft.) q00 Basement Unfinished Area (sq.ft) (o & Number of Baths: Full: existing new Half: existing inew C Number of Bedrooms: -3. existing —new =1 3 7n Total Room Count (not including baths): existing Co new First Floor Room County ZE Heat Type and Fuel: L1 Gas U Oil XElectric L1 Other (n Central Air: AYes U No Fireplaces: Existing New Existing wood/coal stm/ce? L1 � No Detached garage: U existing Unew size—Pool: U existing U new size Barn: Llexisting Unew size Attached garage: existing U new size2- Shed: existing u new size W Other: Zoning Board of Appeals Authorization U Appeal # Recorded L3 Commerdal Ll Yes No - If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name'lAut'nI 10- _ Telephone NumberJr- 6 A Address License # (is ftO Z g ,N CkA M Home Improvement Contractor# 1 qq 1,9T Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY :APPLICATION# «� !� DATE ISSUED IVAP/PARCEL N0. ' ADDRESS VILLAGE OWNER 'r DATE OF INSPECTION: ti IF FOUNDATION FRAMEFiZt'h r _ ; INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: _ ROUGH FINAL FINAL BUILDING b, a ' DATE CLOSED OUT ASSOCIATION PLAN NO. a Y w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations- IM 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual)N,ji'A h • K,,bq§tn2_G ALA lamt IS Address: AMQ,Y�-, City/State/Zip: tiAonza ONO- e(Q Phone.#: 5dzz6_ Are you an employer? Check the appropriate box: Type of project(required): 1. I am a with employer . 4. 0 I am a general contractor and I �— 6. Q New construction employees(full and/or part-time).* have hired the sub-contractors ..2.El I am'a sole proprietor or partner listed on the'attached sheet. T.° Remodeling ship and have no employees These sub-contractors have g• Demolition workingfor me in an capacity. employees and have workers' • Y P tY• � 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, §1(4),and we have no employees. [No workers' 13.❑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. 1Contractors 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. /y Insurance Company Name: l l 1�L .1C►2� � l�' — Policy#or Self-ins. Lic.#: w�-��-O�I� Expiration Date: Job Site Address: s.Z \ O�1-\ 1�111 City/State/Zip: VIJ I�ILNS� ? �� 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 tip 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 ce fy un r the pains and penalties of perjury that the information provided above is true and correct. Signature: G Date: tk Iso V010 _ Phone#: Official use.only. Do not write in this area,to be completed by city or town officiat City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 1.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, it necessary,supply sub-con6actor(s)name(s),-address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies.(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in - (city or town).".A copy of the affidavit.that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Deputment of Industrial Accidents Office of Investigations, 600 Washington Street Boston, MA 021.11 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia r /"�-T)P 11/10/2010 11 : 10 AM PAGE 2/003 Fax Server rf DAVIOWE-02 ENKE ACORR. CERTIFICATE OF LIABILITY INSURANCE T °1111 i0°o PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Automatic Data Processing Insurance Agency,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1 ADP Boulevard HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER.THE COVERAGE AFFORDED BY THE POLICIES BELOW. Roseland,NJ 07068 INSURERS AFFORDING COVERAGE NAIC Nll . INSURED David Or Nordberg INSURER A.NorGuard Insurance Company P.0 BOX 660 INSURER 8: Yarmouth,MA 02664 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVETOR 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. kDDL tNSR BRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE UPMDn-n DATE(MMODrM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ . COMMERCIAL G ny ENERAL LIABILITY PREMISES Ee occurence $ CLAIMS MADE OCCUR MED EXP(Anyone person) $ PERSONAL 6 ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATELMIIT APPLIES PER: PRODUCTS-CCMP/OP AGG $ POLICY PRO- 7LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Es sodden) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) . HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per ecddent) $ PROPERTY DAMAGE $ (Per ecddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESSAMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMSMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ ' WORKERS COMPENSATION AND X TO Y LIIMIT ER A EMPLOYERS'LIABIUTY DAWC120210 6112010 61112011 E.L.EACH ACCIDENT $ 106,00 ANY PROPRIETOR/PARTNERIEXECUTNE OFFICERfMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 100,000 rtyes,describe under SPECIAL PROVISIONS beloH E.L.DISEASE-POLICY LIMIT $ '500,0 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Job Description:Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 200 Main Street Town Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Hyannis,MA 02801- NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SQ SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _ ACORD 25'(2001108) ©ACORD CORPORATION 1988 r i f Town of Barnstable Regulatory Services Thomas F.Geiler,Director �'�� •`0� Building Division Tom Perry,Building Commissioner i 200 Main Street,Hyannis,MA 026oi i www.town.barnstable.ma.us i i - Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Iarci ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work a ' orized by this building peniut application for- ' dress of Job)tj , ��--- i IL0/!c7 siinklire of Owner Date ffi�t K u Q *, U_k Print Name If Propea Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORM&OWNERPEMILSSION i Massachusetts- Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 90682 . Restricted to: 00 DAVIDO NORDBERG PO BOX 660 SO YARMOUTH, MA 02664 c�G_ �y�y� Expiration: 4/23/2012 ('unnnissimer Tr#: 23587 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR T y� Registi,taCt=6: 144905 ExpN twn'11118/2010 Tr# 277370 r J7Pe 013A .. 0 NORDY'S :.�g DAVID NORDBERG _ 1196 RT 134 C"�Q E.DENNIS.MA 02641 Administrator r a+ 5x�ja i i Barnstable Old Kings Highway Historic District Committee 200 Main Street,Hyannis,MA 02601,TEL.: 508-862-4787 Fax 508-862-4784 APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for. Check aU categories that apply: 1. Building Construction: []New ❑Addition OAlteration 2. Ty_pe of Building: OHouse ❑GarageBarn ❑Shed ❑Commercial ❑Other 3. Exterior Painting,Roof. ❑New Roof ❑Color/material,change of trim,siding,window,door 4. Sign: ❑New Sign ❑Existing Sign ❑Repainting Existing Sign 5. Structure: ❑Fence ❑Wall ❑Flagpole ❑Retaining Wall ❑Tennis Court ❑Other 6. Pool: ❑Swimming ❑Other Manmade Pool Type or Print Legibly: Date: 9/23/2010 Address of Proposed Work: House: #52 Street: Point Hill Road Village: West Barnstable Assessors Map Lot: #136/29 Description of Proposed Work: Give particulars of work to be done: Removal of existing triple casement windows on rear of house. Installation of new French door in same location on first floor. Installation of new French door on second floor with a 51-0" cantilevered balcony. Aged Contractor(print): David Nordberg,Nordy's Construction Telephonne: #508-737-9141 Address: POB 660,So.Yarmouth 02664 APPROVED Contractor/Agent's Signature: 0 C T 2 7 2010 Town of Barnstable Old King's Highway NOTE. AU applications must be signed by the current owner Committee Owner(print): Kathleen C Kild Telephone#508-744-7321 Owner's Mailing Ad s: 9 est Ba stable,MA 02668 Owner's Signature: For Commi ee se only. This Certificate is hereby APPRO D 7- ^r Date Members' Signatures a 4 N W IX 0 2W I a Any o titon approve . , A, v-4* C� 09/22/2010 10:09 5083625269 NORTHSIDE DESIGN PAGE 01 Town of Barnstable Old IGng's Highway Regional Historic District Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please sabmit 4 copies Foundation Type(max. 18"exposed)(material—brick/cermcnt/other) Siding Type Material Color Chimney Material D D color Roof(make&style) Material Color SEP 13 1410 Trim Material Color TOWN OF BARNSTABLE M HISTORIC PRESERVATION Roof Pitch(7/12 min.) Window(make&model) Material Color Sizes) French Doors(make&style) Material: Atrium Doors,aluminum clad exterior Color: Sandstone Garage Door(style) Material Color Size Shutter Type Material Color Gutter Type Material Color Decks Material Tuscan chen7 PVC 5%"x611;Color: match existing Railing crystal white composite Skylight Type(make dt model) Material Color ' APPROVE Sign Type Material Color Size .n A Fence Type(max.6')(style) Material Color OCT 2 7 2010 Im Town of Barnstable Retaining Wall Material Old committeeway Lighting Freestanding On Building 111uminating Sign please provide samples of paint colors and manufacturers brochure of style of windows,doors,garage door,fences, lamp posts,etc. ADDITIONAL 130D tMATION: Signed: (plan Prep r) Print Name: David Nordberg,Nordy's Construction Tel.No.: SM737-9141 Location of Application: Street No.:' 52 Street: Point Hill Road Village: West Barnstable Plans shall include the following: Name of applicant,street location,map and parcel. _Name of Builder Designer,or architect;original signature of plan preparer and stamp;plan date,and all revision dates. ALL NEW HOUSE OR COMMERCIAL BUILDING PLANS MUST HAVE AN ORIGINAL SIGNATURE AND STAMP,IF ANY,BY A REGISTERED ARCHITECT,MEMBER OF AIBD,OR A LICENSED MASSACHUSETTS HOME IMPROVEMENT CONTRACTOR,UNLESS THIS REQUIREMENT IS WANED BY THE OKH DISTRICT COIVIIVIITTEE. A written and drawn scale. _Elevations of all(affected)sides of the building,with dimensions including height from the natural grade adjacent to the building to the top of the ridge; location and elevation of finished grade,roof pitch(s), dormer setbacks;trim style,window and door styles. Changes to existing buildings must be clouded on drawings. Landscaping plan,4 copies drawn on a certified perimeter plan containing the following information: Name of applicant, street address, assessor's map and parcel number. Name,address and telephone number of the plan preparer;plan date and dates of revisions. The location of existing and proposed buildings and structures, and lot lines. Natural features of site (e.g.rock outcroppings, streams,wetlands, etc.). _Existing buffer areas to remain. _Location and species of trees outside of buffer areas greater than 12"caliper to be retained or removed. _The location,number,size and name of proposed new trees and plants. Driveway,parking areas, walkways,and patios indicating materials to be used. Existing stone walls,and proposed walls including retaining walls for slope retention or septic systems. (for removal of stone walls, file Demolition Form). All proposed exterior lighting and signs. Sketch or photos of adjacent properties, (1 copy only) A sketch(s)to scale or photographs of nearby adjacent buildings,where present, along both sides of the street frontage,showing the proposed new house or commercial building in scale and in relationship to the existing buildings. Please discuss with staff if you do not think this is relevant to your application. Photographs of all sides of existing buildings to remain,or being added11-TOWN o. [� d Fee according to schedule.Please complete the following: SEP 13 1010 Existing building, foot print: OF BARNSTABI�EBuilding 1 1 , 944 sq. ft. Building 2 STORIC PRESERVATION Existing Building, gross floor area, including area of finished basement: Building 1 1 , 944 sq. ft. Building 2 New building or addition, foot print: Building 1 1 , 944 sq. ft. Building 2 New Building or addition, gross floor area, including area of finished basement: Building 1 1 , 944 sq. ft. Building 2 4 Q:I GMD-Groups101d Kings HighwayIOKH New AppIOKH Cent Appropriateness 07.doc I 09/21/2010 15:27 5083625269 NORTHSIDE DESIGN PAGE 01 4. SIGNS Diagram of Sign,showing gmpbics,sloe,design and height of post,color and materials- Spec sboet. Site Plan on a Gals map or mortgage Mirvey,OR photographs OR to-scale slmtch of buwldivag elevation showing location of proposed sign;and any tree to be removed near a freestanding sign- Pee according to schedule. S. FOR LIST OF ABUT TRRS: PLEASE SEE OKH STAFF SIGNED (pisnprepnorer) Print_ David Nordberg, Nordy's Construction Date:_ 9/21/10 _ Tel.Phone no's: S0 8 7 3 7-9141 NOTE ALL appheawns MUST BE ACCOMPANIED by the CERTIFICATE OF UNDEBSTANDINO Tice Old Kings Highway Historic District Committee MAX DEW INCOMPLM APPLICATTONS ATTENDANCE AT MEETINGS: If the applicant or h&1her reprasentati"is not,anent during the hearing 1s scheduled& a,pp licadon be either CONT7 =OR DAN= APPEAL PERIOD APPROVED PLANS PLAN PICKUP There is a fourteen(14)day appeal prod for approved plans. This is necessary for each Certificate of Appropriateness and/or Certificate for]Demolition issued by the Old P.,it<rg's Highway Committee. Plans approved by the Old King's Highway Regional Historic District Committee may be picked up at Growth Management,Regulatory Division,200 Main Street,Hyannis,agar Wi ation of the 14 day appeal period. if the le day falls on a Saturday, your plans will be available the afhernoon of the following business day. DENIALS Applications that are denied way be appealed to the Old Kings Highway Regional Historic District Commission within 10 days of the filing of the decision with the Town Cleric. For more information,see the Bulletins of the Old Kings Highway District Commission. BVMI)JNG PERMITS,OTHER AGENCY CONTACTS In most instances,before commencing work,a Building Permit is required. The Building Division will require a certified plot plan for new construction and/or demolition Commmial work may require Site Plan approval. Demolitions: the applicant should check with the Building Division as to conftwumce with Zoning requirements. Other Regulatory Agencies at 200 Main St,Hyannis MA 02601: Building Division 508-862-4038 Conservation Division 508-862-4093 Health Division 508-862-4644 QUESTIONS ABOUT HOUR APPLICATION? PLEASE CALL THE BARNSTABLE OLD KINGS HIGHWAY OFFICE AT 508 8624787 D19 @ [9aV 5 Q:{GA/D-G'rvnps101d 1Cbgr Xig!►+wrylOR7l Nsw ApptOAY Oat AOPP+oI�t�+07doe SEP 13 1410 TOWN OF BARNSTABLE HISTORIC PRESERVATION q v - r r wuu rma w H � r�.i� Sift. QIyRY� Y � l 1 •• 1' - �, 52 Point Hill Road, West Barnstab*fir P- . 0 0 � I .. I II PTMN II g II N II II 'm 8 • I . r�--- -----1� II O II Tm II I II II I II ' II I II II � II II � II II la II II II J L II II I II - --------- II II �S� II II II II N I I II 11 II I O II II II �I adz II I II I I ' I 1 I I I I I I I I I I I ldmm11 �.®o covrwartDAU MOMS PROPOSED FLOOR PLANS NORTHMDE DMa. ❑DESIGNf N0. ppA}{NKILDUFF RESIDENCE ASSOCIATES °" uwm�rn.,xro A.2 p 52 POINT HILL ROAD e6'INCfM R®O(eY Comm o®1 a m mna�ma �� �.�WN nlmf•uobYneplfl•W @n0 um G ImN O NWII®( �Q®_._._. ..__._ BARNATARLP .. LIM q ____.___.__._.____--------------------------------------------------_.___.__ ___ k -----------'-'-''-'-'--'-'-'-'--'- - - -'-'-'-'-'-'-'-'-'-'-'-'-'-'-'-'-'-'-'-'-'-'-'-'-'--'-'-'-'-- --' de I Mill w cn '-'-'� � -.-'-'-'--'-'--'--'--'-'-' --' -''-'- ---'--.-.-'-'-'-' RIGHT ELEVATION REAR ELEVATION l � �� wr.. OTHER ELEVATIONS TYPICAL !n Z Z 0 Q wed p J w?0 w � � p pia tL O J R' Y EXISTING TO 0. m ° T� REMAIN P1 t.T.CfG[ANQ q 6 -._._._._._. a LEFT ELEVATION _ °_ (Y EQOTHER ELEVATIONS TYPICAL Assessor'lilmap and lot nu /�(- t639- MAX TOWN OF BARNSTABLE BUILDING..' INSPECITOR APPLICATION FOR PERMIT TO ....... Al -'TO,-THE INSPECTOR OF BUILDINGIS: The undersigned hereby applies for a permif. according-to the following information: Zoning District ..............TV..FP ..............................I.............Fire District .....V41��7-4?30................. womo or Builder --_--'*oon�x ro°�.^r°~^�~ . ' ! Name of Architect .....777777777=......................................Address.-- _^ ---'�--------------.. � w^ ` Number of Rooms —� ........................................... .=—'.�--- ..................................... ' . ^ . _ Ex|e,ior '1�'»���.� ------'*oonng — --------,------------' »��/��/� Interior' Floors —^������° .—.������---'-----------.. n^e,o, _A4.Lrwr���' -----------' . . ` ' . Heatingh,4 --------.—P1vm6ing —. ....................................................... Fireplace 0 Approximate � aN�^ �� � --'^------------------------ '^�~�" =--------...--.---. Definitive Plan Approved 6v Planning Board " 19....w�'' Area -------' _ Diagram of Lot and Building with Dimensions . Fee _1.0-91/ 0............. ' -SUBJECT TO APPROVAL OF BOARD Of HEALTH Z^ / 19? ' \ ' . . . . . ~' o .. ^ � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS | hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name 64r/:—"�.n+���.u�~~«------------. Construction Supervisor's License .3----. j�� ROBERTS, WILLIAM M. D. 140 r- 2UU.... Permit for ... ................ ...................... Location Lot..14. .,.....5.2...Point..Hill. . ..Road.. <= ....... .. . . .. . ........... .... . .. ......... West Barnstable ............................................................................... William RobertsM.D. Owner .................................................................. Type of Construction ..F. :r Plot ............................ Lot .....................:.......... ° Permit Granted ...July 12,..........;..........19 , 84 Date of Inspection . `/R//-/..................19 Date Completed ..... ...............19 -'S / a t �•�;' TOWN OF BARNSTABLE Permit No. -_-26687 O� ----- ---------- i 1.,, 16 Building Inspector "w� � Cash OCCUPANCY PERMIT Bond _—. Issued to rt Address tI Q0 4&;J 0-(Ai. .J-k:-- Wiring Inspector _ — Inspection date Plumbing Inspector i Inspection date Gas Inspector Inspection date f Engineering Department . l� K �,� e.)� Inspection date - _ Board of Health r Inspection date A 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. _ 19 �tr r, __ ................................................. C....!................. BuildingInspector - t-1 Town f Barnstable�� � _ o a astable Permit#_db6j66Sqo IFxpires 6 m ont! oni issue date Regulatory Services . Fee 5 2•d B 4 Z007 Thomas F.Geiler,Director �F �A�NSA Building Division O� I S d7. .TO) ,N 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 Property Addressc i Residential Value of Work 7 d Minimum fee o4$25.00 for work under.$6000.00 Owner's Name&Address Contractor's Name Telephone Number' >'tl'ac2 5 o Horne Improvement Contractor License#(if applicable) 6 Construction Supervisor's License#(if applicable) aWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# ?q YX 6 (9 tt 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 n Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *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. y of the me Improvement Contractors License is required. SIGNATURE. Q:Forms:expmtrg Revise061306 i The Commonwealth oj'Massachusetts -` Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 �,M syeso www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers plicant Information Please Print Legibly Jame(Business/Organization/ludividual): kddress: O o X L/ Ss �ity/State/Zip: C'�-�-w�i� V14 yk Phone#: a ,re you an employer? Check the-appropriate box:. Type of project(required): Ej�-I am a employer with -3 . 4. ❑ I am a general.contractor and I 6. ❑New construction employees full and/or part-time).* have hired the sub-contractors � yees ( listed on the attached sheet. $ 7• ❑ Remodeling El I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or.additions required.] officers have exercised their ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.' :omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such mtractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. im an employer that is providing workers compensation insurance for my employees. Below is the policy and job site Formation. ;urance Company Name: licy#or Self-ins.Lic. #: 7 �] I Expiration Date: 10 O b Site Address: a 'QGI ' /ICl/ City/State/Zip: tach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a to up to$1,50Q.00 and/or one-year imprisonment, as well as.civil penalties in the form of a STOP WORD ORDER and a fine up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of vestigations of the DIA for insurance coverage verification. fo hereby ceOWVn the ins and p ti f perjury that the information provided above is true and correct. a Dater (/nn tone# 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#: r — -�- � ." % �� ��• ������� l �,'� 5 � ��j TffiS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY PRODt7CER AND CONFERS NO RIGHTS UPON THE.CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT NJ),EXTEND OR ALTER THE COVERAGE WISE&QUINN INSURANCE AGENCY AFFORDED BY zM POLICIES BELow. 449 PLEASANT ST BROCKTON,MA 02301 . COMPANIES AFFORDING COVERAGE COMPANY LETTER A HARTFORD UNDERWRITERS INS CO COMPANY B LETTER' INSURED COMPANY C. FRASER•CONSTRUCTION LETTER PO BOX.1845- GOTUIT,MA 02635 iE� D COMPANY E LETTER ski'.•'' :uui �.u ¢i *1ax,.'` '�,.- ` .s .. � `" z's�z"'�ya� {�ak..� �.ki 1,.5,-.�s.. _ txa r, . THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LLSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIM POLICY PER�IOD � INDICATED.NOTWITHSTANDING ANY REQUIRE[v1EI4T,TERM OR CONDITION OF ANY CONTRACT CERTIFICATEOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN,THE'INSURANCE AFFORDED BYTHE AND CONDITIONS PpLIC1ES-DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS OP SUCH POLICIES..LIMTTS SHOWN MAY HAVE BEIN RIDUCED BY PA1D CLAIMS CO ' TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LIHHT S .. LTR EFFECTIVE DATE EXPIRATION DATE ' ' GENERAL LIABL►STY D D COM4vffRCLSL GENERAI;LiABII1TY GENERAL AGGREGATE $ PRODUCTS-COMIP/OP AGG. $ CLAIMS MADE OCCUR PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any One Fue) $ AUTOMOBILE LIABILITY MED.EXPENSE(Any one person $ COMBINED SINGLE Luar $ ' ANY AUTO ' ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per Person) HIRED AUTOS BODII Y INJURY $ T76N-OWNED AUTOS (Pc Accide t) GARAGE LIABILITY' PROPERTY DAMAGE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE OTHER THAN UMBRELLA FORM $ AGGREGATE $ A WJRKER'S'CdfvPEN A-fiON STATUTORYIBUTS EACH.kc=ENT• AND 660UB-794X619 $100,000 1 09/26/06 09/26/07 DISEASE POI ICYLDvIIT EMPLOYER'S LIABILITY $500,000 OTHER DISEASE-EACHEMPLOyEE $100,000 DESCRIPTION OF OPERATIONS/LOCATIONSMMICLES/SPECIAL ITEMS TETS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE LNI SHOULD ANY OB TEE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ERASER CONSTRUCTION EXPIIIATION DATE TBEREOF,THE ISSUING COMPANY WIIy ENDEAVOR TO MAII 10 PO BOX 1845 DAYS WRITTET*NOTICE TO TIIE CERTIFICATE HOLDER NAMED TO THE LEFT, �_OTUIT,MA 02635 Li�ABII ITY OFOF ANY KIND UPON THE COMPANY,TTS AGNENTS OR REPRESENTATIVES ADTHORIM REPRESP.NTATIVE /yam 1'`Wr �f3 =F`u:iitz �� ra�A„'` .� `•i.r7�l� �S�� �r..,s'a ,,,.fir..- f.+ -syR• —�" C� '4� a a-�i_%',t*�iA��.v� ua��3>�j�2�•4 ���°��p����er���lg.�o�'� 5 L3 TOTAL INVESTMENT: LANDMARK ULTIMATE - (with opened Red copper valleys) $12,710 Copper Ridge Roll - $750 *4 Star.Warranty Upgrade will be applied if proposal is signed and returned within 10 days. (see enclosed brochure) 2% discount if paid by check Payable immediately upon completion NO MONEY DOWN- NO Payment at the start or part way thru Payments accepted are: . CASH—CHECK— MASTERCARD—VISA—AMERICAN EXPRESS *Any payments not made within 30 days of completion will be charged 1 %z%for every 30 days the payment is late. Possible Extra-After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation is not up against the plywood sheathing preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then re-installing the plywood. If needed, this would be charged for as an extra at the rate of$4.00 per panel including Materials & Labor. There are 6 Panels per sheet of plywood. Possible Extra -Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$50.00 per hour, plus materials, plus 20% overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the labor for 10 years FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. CERTAINTEED Warranties the shingles and labor 100% through the Sure Start Warranty duration. CERTAINTEED Warranties'the shingles to be ALGAE resistant for the duration of the Sure Start Warranty depending on the shingle that was purchased. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: 4Z6)7-7-- i omeowner Fraser Construction Board of Building Regulations.and Standards License or registration valid for individul use only HOME IM `OOVEMENT CONTRACTOR befot i the expiration date. If found return to: Registriore?� 12536 Beat of Building Regulations and Standards One.Ashburton Place Rm 1301 XP 2 f2007 BostRn,Ma.02108 FRASER CONST� DEAN FRASER _ 71 TARRAGON CIR°•4 5�°`0` •r COTUIT,MA 02635 Administrator Not valid without signature _ /..