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HomeMy WebLinkAbout0129 ARROWHEAD DRIVE /4� , tHE r Town of Barnstable *Permit#16 Expires 6 n:o hs from issue date Regulatory Services Fee BARNSPA6 'rLY 9� Richard V.-Scali,Director r� ATF 0 �o D / 0 Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us� Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 2_1 I G I ^e Not Valid without Red X-Press Imprint YV Map/parcel Number n Property Address 1 Zq t'1 rrow tQ Q r v(f— Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address r IZ9 Arr Dr . 1- M . O26 a 1 C Contractor's Nam���'�TMQ� 2 n`CTelephone Numberg6y'7J�3 ' SZ Home Improvement Contractor License#(if applicable)149�l.J 1 EmaiIkSVE,O'W I @Gwa I I' COS Construction Supervisor's License#(if applicable) / )CWorkman's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ .1 am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Ace— Awie('i rn in 5L(r ee- 0-00, Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) S uh jve AV e X Re-roof(hurricane nailed)-(stripping old shingles) All construction debris will be taken to " AOA Re-roof ourricane.nailed)(not stripping. Going over existing Mayers of roof)` ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .32)#of windows #_of doors: ❑ .Smoke/Carbon Monoxide detectors 4 floor plans marked With red S and inspections required. Separate Electrical& Fire Permits required. *Where required:' Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letier of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is re fired. SIGNATURE: —' �cars n C:\Users\Dccollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\2PI0IDHR\EXPRESS.doc Revised 040215 t �-( ' �T% C��i',�>?/��L'C.i'r G�'L�(.<'C.t:Y/��i�/i'' tJ•/..'"J'�� �l�C.�:A'i.�'Y..i��:/�C/�t'L,���`0• r Office of Consumer Affai';rs az�c1 i3ilslz�c ss R:egulat an Y ! 10 Park-Plaza,- Spite 5170 dston,Nlassachu;Sens 02116 fl:t�ixz.f Zm x ove ent C ozatz<t toz Registration. R-'gistr tioti: 14860:7 Type. Public Corporation ' Expiration. 1 011 11201 7 Tr# 270727 SEARS HOME IMPROVEMENT'PRC7DUCT ` - A( FREO NYMAN 1024 FLOR10A CENTRAL PK11 Y LONGWOOD, FL 32750 'Update Address and return card.Mark reason for change. SC„f Cj 2f)M-0,,V 4 ( ,Address � _ Itenew 11 ( k:nysloutnetif I_� [ost'L'atrd ? 3rx i OfHtt orconsumer Affairs& 1311n6ness Ilegulation Ulu gnfy 1 NOME IMPROVEMENT CONTRAC1OR before the expiration flap. Iffound return to: 'rR e§Ntratlan 186t37 Type- Office Of COnsunierrkffairs arrd Busing 12e�ulation •j Expiration 10(11/2017 Public Carl�of tion. 10 Park Plaza Suite 51?I} a s✓ i oston,MA 02116 SEARS!i(}IVIF IM17R6�1I [DI NT-.KROt3UCTS INC. AiFRED NYMAN 1024 FLORIDA CENTRAL f V 1�t7Y . —� _mow �„�•�:. .�... -- LONGWOOG,Fl-32750 l!nfieryecrciarF i\tatjwa)id withc�u si natt ire Colistriicv:O i Gr Lk-,en'e�' 5 097�a19..a• - . t.i LC)BOS SYNC °821 THOMPSON Rd�k Y Thotnpspn'CT UG277 f I. 4m r/ $ Cq mis, e;` 48t31l20'.1fi S-6ars 1024 Florida Central Parkway,Longwood,FL 32750 PH:407-551-6000 October 2015 LETTER OF AUTHORIZATION I, Alfred W. Nyman, Jr.,Assistant Secretary and Massachusetts State Qualifier for Sears Home Improvement Products, Inc., grant permission to Lubos Svec to submit permits and licenses, pick up permits and licenses, make changes to permits, licenses and plans and initial changes made by the building department on behalf of Sears Home Improvement Products,Inc. I also grant permission to Lubos Svec to purchase permits and/or licenses with a company check,personal check,personal credit card or cash. I certifiy that the above information is true and correct. -- -- -.. T �� Alfred W.Nyman, r� 3s �,eiary arid Massachusetts State Qualifier (148607,C S't"1-001$3.. Sears Home Improvement Products,Inc. STATE of Florida COUNTY of Seminole SWORN TO AND SUBSCRIBED BEFORE ME THIS day of October 2015,by Alfred W. Nyman,Jr.,Assistant Secretary for Sears Home Improvement Products,Inc.and who is X personally know to me or has produced a valid Drivers License. Seal: Print Name: Deborah P.Ph' s � ""'' Notary Public,State of Florida DEBORAH P.PHtt.UPS MY COMMIssiOH FF ztsee5 Commission 4: FF 219986 t XPiREs;August ts,2ots. My COMMISSION EXPIP.ES:Aug.13,2019 Bonded Thiu Notary Pubric Undo i 4 r - 'A YYY CERTIFICATE OF LIABILITY INSURANCE °ATE`MM,07/25/20, ' 015 5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the w certificate holder in lieu of such endorsement(s). PRODUCER CONTACT d) Aon Risk Services Central, Inc. NAME: 'fl Chicago IL Office (A/C No.El): (866) 283-7122 aX.No.: (800) 363-010S `) fl 200 East Randolph E-MAIL o Chicago IL 60601 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED - INSURER A: ACE American Insurance Company 22667 .. Sears Holdings Corporation - INSURERB: ACE Fire Underwriters Insurance Co. 20702 dba Sears Home Improvement Products, Inc Attn: Risk Management E3-219A - - - INSURER C: - - 3333 Beverly Road INSURER D: Hoffman Estates IL 60179 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570058793162 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE DUL UBRI POLICY NUMBER POLICY YYYY POLIO EXP LIMITS A X COMMERCIAL GENERAL LIABILITY HDOG 8 0 0 EACH OCCURRENCE $S,000,000 CLAIMS-MADE X❑OCCUR G O $S,OOO,OOO PREMISES Ea occurrence 4 MED EXP(Any one person) Excluded PERSONAL&ADV INJURY $5,000,000 to GEN'L AGGREGATE LIMIT APPLIES PER: - - GENERAL AGGREGATE $5,000,000 M on X POLICY El PRO- JECT LOC - PRODUCTS-COMP/OP AGG $5,000,O00 co 0 OTHER: - o n A AUTOMOBILE LIABILITY ISAH08859000 08/01/201S 08/01/2016 COMBINED SINGLE LIMIT $S,000,000 A ISAH08859012 08/01/2015 08/01/2016 Ea accident A ANY AUTO - ISAH08859024 08/01/2015 08/01/2616 BODILY INJURY(Per person) O ALL OWNED SCHEDULED Z BODILY INJURY(Per accident) N X AUTOS AUTOS - � i X HIRED AUTOS X NON-OWNED. PROPERTY DAMAGE O , AUTOS Per accident — d) UMBRELLA LIAB HOCCUR - EACH OCCURRENCE L) EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION - A WORKERS COMPENSATION AND WCUC48589662- 08/01/2015 O8/01/2016 X PER OTH- EMPLOYERS'LIABILITY YIN OH, WA, WV STATUTE . ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $2,OOO,OOO A OFFICERIMEMBEREXCLUDED? N NIA WLRC48S89650 08/01/201S 08/01/2016 (Mandatory in NH) All other States - E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000— DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) - - Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE -EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE.WITH THE POLICY PROVISIONS. Sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1024 Florida Central Parkway Longwood FL 32750 USA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000034159 , LOC#: ACORD® ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk services Central, Inc. Sears Holdings Corporation POLICY NUMBER See Certificate Number: 570058793162 CARRIER NAIC CODE See Certificate Number: 570058793162 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. INSR ADDL SUBR POLICY POLICY EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER DATE DATE LIMITS MM/DD/YYYY MM/DD/YYYY WORKERS COMPENSATION B N/A SCFC48589674 08/01/2015 08/01/2016 WI ACORD 101(2008101) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD I The Commonwealth of Massachusetts a Department of Industrial Accidents a 1 Congress Street, Suite 100 Boston,MA 02114-2017 w„ Svey'e� www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL 32750` Phone#: 860-753-0452 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in $, ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.❑:Plumbing repairs or additions 5.�1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 1 ,3)•❑Roof re airs 6.❑✓ We are a corporation and its officers Have exercised their right of exemption per MGL c. 14. ✓❑Other — 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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: Ace Ar-herican"insurance Company / Phone.: 866-283-:7122 Policy#or Self-ins.Lic.#:. VVLRC48589650 Expiration Date: 08/01/2016: Job Site Address:I2C1 City/State/Zip n/71.5 0 Z19c" Attach a copy of the workers' compensation policy declaration page(showing the policy nu(nber and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert' un r the pains an penalties of perjury that the information provided above i true and correct. Si natur YC W Date: Phone#: - n-452 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: W E E4 FORM f . 1.� IIIIIIIIII III III Office Location: BOSTON Proposal Date 03/03/2016 JJobNumber -1 Sears Home Improvement Products,Inc. Customer Name rrs P.O.Box 522290 CANUTE TAYLOR 1024 Florida Central Parkway Customer's H stom r e s Home Phone Customer's Work Phone Home Improvement Products Longwood,FL 32750-7579 (347) 430-1714 P Phone(800)469-4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 129 ARROWHEAD DR MA(148607) City State Zip code Roofing All plumbing and electrical services performed by HYANNIS MA 02601 Is installation within city limits? licensed subcontractors Installation Address County BARNSTABLE. (Yes/No):.YES FEIN 25-1698591 Billing Address(if different from above) City State Zip Code Project Consultant Name&License No.(if applicable) DAVID ROGERS 34603 Description of'the Project and Descri tion of the Si "nificant Materials to,be Used and Equipment to be installed The work to be done under this contract includes the following(where checked): Specifications(0=Included❑=Not Included) Preparation 1. [0 Tear off existing roof shingles down to wood deck on entire house. 2. Z Inspect wood deck for rotten wood. 3. © Replace any rotten wood found in the deck area at a rate of$ 3.30 per square foot. PLEASE NOTE:this amount is not included in the TOTAL PRICE shown below. Customer and Sears agree that the TOTAL PRICE will be amended via a Contract Change Authorization form to add the costs of replacing rotten wood in the deck area discovered after existing roofing materials are removed. Customer(s)initials �'�"''_ < Installation 4. 0 Furnish and install Exterior Shingle: TYPE: OAKRIDGE COLOR: ONYX BLACK 5. ® Furnish and install PLYWOOD underlayment over roof decking. 6. 0 Furnish and install ice&water eave&valley protector. 7. Z Furnish and install starter shingle on all eaves. 8. 0 Furnish and install/replace any deteriorated 1"flashing. 9. Z Furnish and install metal drip edge along rake edges and eaves. 10. ❑ Furnish and install skylight systems. ❑ Reuse existing 11. Z Furnish and install new vent covers on all vent pipes. 12. 0 Furnish and install attic ventilation system(Check all applicable): . ❑Turbines ❑ Power vents 0 Shingle-over ridge vents ❑Off-ridge vents ❑ Soffit vents 13. ❑ Furnish and install new flat roof Exterior Protection System: COLOR: Gutters 14. ❑ Furnish and install guttering: COLOR: 15. ❑ Dispose of old guttering. Clean-up 16. 0 Clean-up and removal of all job-related debris including excess materials. (Extra materials are shipped with each job to avoid delays).Manufacturer warranty will be sent upon completion of installation. Sears recommends that Customers have their chimney siding or mortar between brick,stone,or blocks inspected periodical) b a arofessional and tuck nointed and/or waterproofed as needed. Sears shall not be responsible for chimney integrity other than Customer(s)initials replacing the,flashing in conjunction with the installation of the roofing materials described above. Additional work t0 be done:CHIMNEY FLASHING, REMOVE SAT DISH Work NOT to be done: Repairs and replacement of any damaged existing structural members. Interior repair to walls or ceilings including sealing, painting, and/or drywall repair. Removal and/or re-installation of items that may otherwise impede Sears'ability to install a new roofing system prior to installation. Examples include, but are not limited to, satellite dishes,solar panels, pool heating panels, gutter protection systems,TV antennas,HVAC systems,and weather equipment. NA SPECIAL INSTRUCTIONS:DUMPSTER IN DRIVE All of the above check boxes, "Work NOT to be done," "Additional work to be done," and Customer(s)initials e—A,-C7.,,t( "Special Instructions"sections have been reviewed and explained to me. SRl-MA (Dig.) Rev 08/13/12 Page 1 of 3 II III III I I III III Job Number: -1 y APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 3/14/16 (Approximate Start Date) It will be substantially completed by approximately 3/15/16 (Approximate Completion Date) These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products, Inc. ("Sears")or at any other time by mutual written agreement.Customer understands that the Approximate Start Date is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. ASBESTOS ABATEMENT: This Estimate and Proposal assumes that there are no asbestos containing materials ("ACMs") that would be disturbed in the performance of the installation work. If upon further inspection by the contractor or others it is learned that ACMs have to be disturbed to perform work,then Customer must arrange and pay for abatement of asbestos by a qualified person prior to the start or continuation of work. If Customer fails to arrange for necessary asbestos abatement within thirty (30) days, Sears may cancel this contract upon Customer(s)initials ��F written notice to Customer. The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 13,250.98 Contract Price $13,250.98 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 3,975.29 State Sales Tax( 0.00 %) $ 0.00 Final Payment(balance payable upon completion of job)$ 6,024.71 Local Sales Tax( 0.00 %) $0.00 The Initial Payment is due prior to Sears ordering products. r Total Amount Due $-13,250.98 The form and method by which the Customer(s)will pay is described in a separate Cash/Credit Card Payment Addendum made a part of and incorporated into this contract by reference. Customer(s)initials �"'�` ?.144 NOTICE TO BUYER: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER)AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ADDITIONAL PROVISIONS Proposal and Approval.Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown.This offer must be approved by the Installation Department. If this is a credit sale or a payment on completion sale,it must be approved by the Credit Sales Department. If this proposal is not approved or the installation cannot be made in accordance with the law,this offer will be withdrawn and any payments you have made will be refunded to you.Any materials left over after the installation has been completed are Sears property and will be removed by Sears. Installation. I understand that Sears will not install the materials but will arrange for the installation. Sears is not responsible for materials or installation NOT furnished or arranged by Sears. Sears'installation contractor(s)will obtain all building permits required by local law. For homes located in historic or landmark zoning districts,Customer will be responsible for obtaining required approvals and related permits prior to the commencement of work on this contract. Authorization. I authorize Sears to: (1)arrange for a contractor(licensed where required by law)to make the installation of materials; (2)issue a work order for this installation to a contractor; (3)inspect the installation; and(4)pay the contractor when the installation is complete if I have signed a certificate that the installation has been completed to my satisfaction. Delays in Installation.I agree that Sears is not responsible for delays in delivery or installation due to weather,fire,strikes,war,government regulations or any causes beyond Sears'control. Oral Agreements and Changes in Contract.I understand that there are no oral agreements between Sears and me.Everything I expect Sears to do has been included in writing in this contract.Nothing can be changed in this contract unless it is in writing on a separate form accepted by me and Sears. Responsibility of Buyer. I agree that any information or measurements that I give to Sears are correct and complete. I am responsible for any special work described in this contract. Electrical&Plumbing Service. I will provide adequate electrical and/or plumbing service(s)to run any newly installed appliances or other furnishings. If the electrical and/or plumbing service(s)do not meet the standards of the utility company or electrical and/or plumbing codes, I will make the necessary changes at my expense unless Sears has agreed in this contract to make the changes. Payment.I will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warranty Information.Appropriate product warranty documents will be given to me by Sears.Sears'Warranty on Installation is: SEARS'LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s)used(which warranty becomes effective the date the merchandise is installed),if the workmanship(or application)of any Sears'arranged installation proves faulty within five years(Best),three years(Better),two years(Good)or one year(Limited) after products are installed,then upon notice from you Sears will cause such faults to be corrected by repair at no additional cost to you.If Sears determines that repair is not commercially practicable or cannot be timely made then,at Sears'sole discretion,Sears may elect to provide replacement or refund.Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1-800-222-5030,Option 4.This warranty gives you specific legal rights, and you may also have other rights that vary from State to State. SR1-MA (Dig.) Rev 08/13/12 Page 2 of 3 ,�' + IIIIIIIIIIIIIIII Job Number: -1 NOTICE TO BUYER 1. DO NOT SIGN THEAGREEMENT IFANY OFTHE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OFTHEAVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT.KEEP IT TO PROTECT YOUR LEGAL RIGHTS, 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME,AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TOWIDNIGHT OF THE THIRD BUSINESS DAY[FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER]AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH, YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING"I HEREBY RESCIND"AND ADDING YOUR NAME AND ADDRESS.A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY In addition to the Notice to Buyer shown above, Massachusetts law requires that contracts for home improvement work state that all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration P.O.Box 871 Taunton,MA 02780-0871 Telephone:(508)821-9375 Please note that owners who secure their own construction-related permits or deal with unregistered contractor's shall be excluded from access to the Guarantee Fund. Notwithstanding any other language in the contract or associated documents, Sears will not remove, replace, or install any heating or air conditioning system, or any portion thereof, if asbestos or asbestos-containing material is known or likely to be present in that heating or air conditioning system,or any portion thereof. If it is determined or reasonably suspected that asbestos is present,either before commencement or during performance of the work, it shall be the customer's responsibility to select, retain and pay all costs of a Division of Occupational Safety ("DOS") licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determination or reasonable suspicion of the presence of asbestos arises after Sears has started the work,Sears will immediately cease performing the work until a DOS licensed Asbestos Contractor, hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R.7.00 and 453 C.M.R. 6.00 or verifies that none is present. By signing the contract the customer agrees that it understands the above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 03/03/2016 03/03/2016 Customer's signature Date Customer's signature Date Accepted by Sears Home Improvement Products,Inc.("Sears")on 03/03/2016 by: Date Management Representative SR1-MA (Dig.) Rev 08/13/12 Page 3 of 3 OF IME TQ� * r r * BARNSTABLE, MASS*9: r Town of Barnstable Regulatory Services Richard V. Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, , as Owner of the subject property hereby authorlz&ar5 Ham —IiAb0 5 to act on my behalf, -Seat r5 AC Qn ZF in all matters relative to work authorized by this building permit application for: 2 v1(:-1 III (Address of Job) Signature of Owner Date Y)uc 7Q— fC) r- Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Fi1es\Content.0ut1ook\2PI0IDWEXPRESS.doc Revised 040215 Cape Save InI1WIN OF BARN TAD 7-D Huntington Avenue South Yarmouth, A&0, 6632 4 # : 57 Tel: 508-398-0398 Fax: 508-398-0399 QIVT: ! � 4/17/12 `1 F Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 129 Arrowhead Drive,Hyannis has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-19 cellulose Walls: R-13 dense pack cellulose All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 ; Map P 1 Parcel` I Application # C. 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 _ Urfovih91o„J 'D rie Village -- Owner C 11 rest j t1e 5a,v� ^0 Address SOLrnC Telephone_ 501 — 10 3540 Permit Request _ R ' g cc &14 5 e. -Jrhe A i G. ^crCaze, 0 A to caa�° W11 .�&.R Iit y�n`� r seA.l A li c. Plane �gsf, p dX, 48 wo,lls W'th I�• 13 CelliabSe. Square feet: 1 st floor: existing proposed — 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4415' ® Construction Type__ Lot Size_ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .)9 Two Family ❑ Multi-Family (# units) Age of Existing Structure 11 9,4 0 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: 14 Gas ❑ Oil ❑ Electric ❑ Other `v Central Air: ❑Yes TX No Fireplaces: Existing New Existing wood/coattlove: 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 21 No If yes, site plan review# Current Use _ Proposed Use APPLICANT INFORMATION — (BUILDER OR HOMEOWNER) _ _ �o Name �gllvara C�0. Col 5 _ Telephone Number 5 0 �Z� — fod� p 03 Address 4-C n 0tlAfkia License # 1—C. l 0SOWA b Yo.cmoifi �� 1 fI �b0 l Home Improvement Contractor# J,L � Worker's Compensation # _ t ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE --- DATE ` � w i 5 FOR OFFICIAL USE ONLY APPLICATION# 4 a ' DATE'ISSUED MAP./PARCEL NO.,- r ADDRESS, VILLAGE;_ ' OWNER- DATE OF INSPECTION: ' r;,FOUNDATION FRAME 'INSULATION'-A FT4,!, FIREPLACE s , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS--- _:• ROUGH FINAL .:FINAL BUILDING!L7; —DATE CLOSED OUT ASSOCIATION PLAN NO. S 460 West Main Street HOUSING Hyannis, MA 02601-3698 S S I S T NCB , ENERGY & HOME REPAIR Mr T (508) 771-5400 F (508) 790- ORPORATION 2425 HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE: P1 Fad � nr IT n ar_nt ruIcG9R�tA-?�Y�1<� Ali€ THE APPLICANT-HOME OWNER. . Il`� �� � j' i� C� hereby consent to and agree that w�therization work may be done by the Weatherization Program of H ousing Assistance Corporation (herein after referred as jAT } n theproperty to at: = Theweatherization work'donewill be based on programmatic priorities and availability of funding and it may i ncl ude all or some of the following Measures:. WeEdher-stripping& caulking of windows and doorsy insulation of attics sidewalis& basements; attic and other ventilation measuresand possibly replacement of badly deteriorated window§. In ' consideration of the weatherization work to be done at my home I•agreeto thefoliowing 'I. I give permission to the"Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be nary to perform weatherization work on said property. 2. The Housing Assistance Corporation resavesthe right to inspect thefud or utility bill for the weatherized unit on an ongoing basisfor no morethan five(5)years after the weatherization work is completed. §. . I have read the provisions of thi�/a'7, kt li redy give my consent. l/ Home Owner: (Signature) Date: Agent: (signature) , . k D ate M i HAC approved We1herization Company Caliber Building&Rein odeling Cape`Cod Insulation Save Creswell Construction Frontier Energy Solutions °'z Lohr&Sons Peter Smith R.esoMon Energy _ r Rock Solid Construction Sprinkle Home Improvement C:Il xaments and petit rcladse do .doe CAPE SAVE Weatherization' 548-38-0398 August Up 2010 To Whom It May Coaeern: William J. McCiuskey is an employee Of Cape Save. He as authorized to negotiate contracts and building permits for our.company. Michael McCluskey . a Cape Save—Owner 919-593-5939 cell 7C Huntington.Avenup,youth Yarmouth,MA 02664 The Commonwealth of Massachusetts:, Department of Industrial Accidents Office of Investigations, 600 Washington Street Bostom AM 02111 www mass gov/dia. Workers' Compensation Insurance_Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Let=iblw, Name(BusineWorganization/Individual): D131k SAU Address: I-L ' ( u n� I of ca't Av City/State/Zip: fir ou /�f1t 2,�Wone#'. - 3 ' Are you an employer?Check the appropriate box: Type of.projecC(required.): 1.El.I am a employer with. ] S 4: Q.I am a_general contractor-mid 1 6. ❑New construction, employees(full and/or part-time).* r have Hired the sub-contractors listed on the attached sheet. `7. ❑Remodeling 2.❑ 1.am a sole proprietor or partner ship and have no employees These.sub-contractors have 8. Q.Demolition - working for Y acme in any ea employees and have workers' capacity. 9.. ❑ Building addition [No workers' cotilp. insurance, comp.insurance;; required.] 5: ❑ We are a corporation and.its: 1.0.0 Electrical,repairs or additions 3.Q 1 am a homeowner doing all work officers:have exercised their 1.1.D.Plumbing repairs or additions myself. No workers'comp. right of exemption,per MGL Y [ + p c. 1.52, I(4},and we have no 1.2.Q Roof repair••�� 1 insurance required.] 13.®OtherT11 1 afi'�' M employees.-[No workers' - comp. insurance.required,], *Any applicant that checks box#1 must also fill'out the section below showing their`workeis'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all wozk and then hire outside contractor;must submit anew affidavit.indicating such.. . tGontractors that check this box must attached an additional sheet showing:the name of the"sub-contiactots and state whether or not those entities have employees. If the.sub-contractors have employees„they.must provide their workers'comp.policy number. I an an employer.fhauis,providing workers'compensation insurance for my-employees. Below is the policy and job site information. T . Insurance Company Name: P G n o o a V �J�nS U�r0.�C� C c m Q an Y Policy#or Self-ins:Lic:..# T W C,_3� 9 �' I "r d� -Expiration Date:. 0 a I a O o�, Job Site Address: - City/State/Zip a.tn.T+rk� Attach a copy of the workers'compensation policy declaration page(showngatie 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 V,500.00 and/or one-year imprisonment;as w.e11 as civil penalties in the form of a STOP WORK-ORDER and a fine!' of up to$250.00 a day against theviolator. 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 d Wallies erjuty that the information provided above is true and correct Si Date: afore:.. . ... Phone#s F5 Official use onlp. Do hat'irrite in.this area,to be-completed by city or town.o�ciaL ,_ City or.Town: Permit/License Issuing Authority(circle one): i.Board of Health 2.:Suilding:Department. 3.Cityll'own Clerk. 4.Electrical Inspector 5.Plumbing.Inspector 6:Other Contact Person: - Phone# _ .. ATE j ACOO F LIABILITY INSURANCE °0/20 2011' �. CERTIFICATE O 10/20/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUPROGATION 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 NAMTACT Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 FA C No: X (781)963-4420 15 Pacella Park Drive aoARILSS:ssperrazza@risk-strategies.com Suite 240 INSURERS AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:SeleCtiVe Insurance INSURED -INSURER B:Safet Insurance Company- 33618 Michael McCluskey, DBA: Cape Save INSURER C Technolo'civ Insurance Company 7 C Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL11102041451 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 ADDLSUSR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MM/DDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE15- X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE Y OCCUR CPPS1994480 0/16/2011 0/16/2012 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: `�. PRODUCTS-COMP/OP AGG $ 2,000, 000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY T ° Ea acccidEentSINGLE LIMIT $ 1,000,000 ANY AUTO } BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 6208200 1/6/2011 1/6/2012 BODILY INJURY(Per accident) $ AUTOS NUTOS ON-OWNED ` PROPERTY DAMAGE t $ X HIRED AUTOS X AUTOS Per acc dent X Undednsured motorist Bl split $100000 300000 X UMBRELLA LIAB X OCCUR PPS1994480 0/16/2011 0/16/2012 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ . $ C WORKERS COMPENSATION t ecutive excluded X UVC STATU- OER TH- AND EMPLOYERS'LIABILITY , ANY PROPRIETOR/PARTNER/EXECUTIVE YIN roID coverage E.L EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? NIA 3297972 0/21/2011 0/21/2012 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes escr be under E.L.DISEASE-POLICY LIMIT $ End500 000 DRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc. , and Housing Assistance Corporation are listed as additional insureds as respects'General Liability as required by written contract. - CERTIFICATE HOLDER'* CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE •• THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN w ACCORDANCE WITH THE POLICY PROVISIONS. Housing Assistance Corp 484 Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601-3698 Michael Christian/SMS 'vr�- ����4_� ACORD 26(2010/05) 01988-2010 ACORD CORPORATION. All rights reserved. INSn25r2ninnsini Tho e(OPn nnmo nnr1 innn urn runicfcrad martrc of arnpil O ice o"onsu�vner Af air and Business Regulation 10 Park-Plaza - Suite 5170 `a Boston Massachusetts 02.116 Home Improve ment;Contractor Registration _ —= Registration: 164432 - Type: Supplement Card CAPE SAVE Expiration: 10/6/2013 WILLIAM MCCLUSKEY 8201 S. HOURD CT ` CHAPEL HILL, NC 27616 - Update Address and return card.Mark reason for change. ' Address ❑.Renewal. Employment ❑ Lost Card DPS-CAI 0 5OM-04/04-G101216 92. aa\ Office or Consumer Affairs&Business Regulation License or registration valid for individul use only aiOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration 164432 Type: 10 Park Plaza-Suite 5170 ` Ex pi t0/6/2013 Supplement Card 'Boston,MA 02116 CAPE SAVE WILLIAM McCLU$KEY 7C HUNTING AVE - S.YARMOUTH,MA"02664,', Undersecretary Not valid without ; nature , � r \;! ta<tchusctt� - l3i'Itartntnt art Pul31t� '�aEi:f.� '� Boar tl ot'.Stiilclin: 12e��11,ttiittt, and 1tI111tl.tt NW COjjSttpiction Supervisor Speciatty Ucsense License. CS Si. 102776 µ " Restricted to:. IC WILLIAM.MC CLUSKY 7 NAUSET ROAD A 3 D ,. WEST YARMOUTH,NIA 02673 Expiration: 6/2612013 Tf 102776 -4 /36 ,� t! � _..y L� L� e•- / A;. �,. �err \. 1 . � � �• _'� f' �..� �- fir.{�,,;} L•- -•.�;� ,�^— r � '. � / 5 - t � \ � : �K _ f?2 92 \� ¥ ( ) .\ . 2 . oFn+e rp� . f. : The Town of Barnstable • sasxsrABM • 9� 1639. m� Department of Health Safety and Environmental Services AlFD Mai" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner December 9, 1997 Mr. Walter Neale 129 Arrowhead Drive Hyannis,MA 02601 Dear Mr.Neale: Please find enclosed and highlighted a copy of 780 CMR Section 3408.3.2.6 regarding the termination height of masonry chimneys. These regulations come from the 5th edition of Massachusetts State Building code which was adopted in 1972. All single family dwellings constructed after 1972 were required to comply with the code in effect at that time. I hope this has enlightened you. If this office can assist you further,please do not hesitate to contact us. Sincerely, LC Richard G. Stevens Building Inspector RGS:lb enclosure g971209a n y ti >'e AV J 0 2 N >>0 33axAv qj lk 1 l + V �• 32�. U ^ 9 0 y t": 19 r S � 3 i2 0 ^• � '9 0 e >0 `7£ Jo 9' w /of /4 ✓p � (�•. •6 �R >� k' For ro a 4, Fir , g .' � /2, b• �� GY �U Sa s6�lq ^ N h 88 Op 4 ryp 'O.O. 40 //q Ail . p pe- , :� O e 71 r� .. �• AOv Y �I T Q ww �y