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Home My WebLink About0223 ARROWHEAD DRIVE c�-2607 f ��M Citizen Web Request Page 1 of 1 rSHIM ...Gz._.c.... -s TI . r 1�" E& .G € isra�rri `5 � Citizen Request Management Request ID: 70462 Created: 2/10/2020 2:59:40 PM Desmarais Donald Status: Assigned To Staff Assigned To: Health Department Article X- Food :Illegal Anonymous: Yes Category: Operations E.C. Date: 2/25/2020 Created By: Soto, Kathryn Citations: Health Department Time Worked: U0 Response Time: , 0.00 sue. Request Location: 223 ARROWHEAD DRIVE Hyannis, Ma 02601 Parcel Number: Map: 270 Block: 075 Lot: 000 Request: r Caller reports a hairdresser named Ana is making and selling food.in the basement: pastries,,cheese, chicken,'ground beef,etc... Request Work History: � https://itsgldb.town.barnstable.ma.us/CitizenRequest/WRequestPrintPub.aspx?ID=70462 1/10/2020 A IP 2 7 ? i j'C)V.,, �Ni3w T�gLE UCENSiNG AUTHORITY 26 July 2002 Licensing Department Town of Barnstable To Whom it may Concern: I am writing to your department in order to register a complaint regarding the operation of illegal, unsanitary and unlicensed beauty salon services here in Hyannis. I, myself, own and operate a beauty salon at 720 Main Street, Lina's House of Beauty. My salon is registered and approved by the town of Barnstable, and I am licensed by the state of Massachusetts. I am from Brazil, and the majority of my clients are Brazilian men and women living here on Cape Cod. Lately, I have learned that a number of Brazilian women are not only offering beauty salon services out of their residences, but that they are inducing my clients to make use of their services and offering rates for service that are below mine. They can do so because they have no professional equipment, they have no costs associated with the ownership or rental of salon space, compliance with municipal requirements for the use and disposal of chemicals, the provision of a sanitary environment or the state licensing process. I feel that this is improper, both from the standpoint of professionalism and of unfair competition. I have invested a great deal of time and money in establishing what I consider to be a first-rate beauty salon environment, while these others have invested nothing. 1 am also concerned that, while I have been scrupulous with regard to hygienic practice and the proper observance of environmental safeguards, these women pay not the slightest attention to such factors. I have listed below the addresses at which these illegal salon services are being offered, without mentioning names. I hope that the town of Barnstable will take steps to curtail the continued operation of these illicit, unsanitary and unlicensed salon operations. 5 Hiramar Road 170 Winter Street Hyannis Hyannis 411 W. Main Street 223 Arrowhead Drive Hyannis Hyannis I trust that you will look into this problem, and thank you for your attention to this matter. ry ly yours, f ` C Li rina Pinheiro 720 Main Street Hyannis, MA 02601 Town of Barnstable Regulatory .Services P�pf THE tO�y� Thomas F.Geiler,Director Building Division BARNSfABLE, Tom Perry,Building Commissioner 9 MASS. g 1639. 200 Main Street, Hyannis,MA 02601 �ATED MA'1 A Office: 508-862-4038 Fax: 508-790-6230 Notice of Zoning Ordinances Violation(s) and Order to Cease, Desist and Abate: Ana Boaventura and all persons having notice of this order. As owner/occupant of the premises/structure located at 223 Arrowhead Drive, Hyannis; Map 270, Parce1075- ,you are hereby notified that you are in violation of the Town of Barnstable Zoning Ordinances and are ORDERED this date,April 27, 2007, to: 1. CEASE AND DESIST IMMEDIATELY,all functions connected with this violation on or at the above mentioned premises. SUMMARY OF VIOLATION: Violation of Town of Barnstable Zoning Ordinances: Zoning Code Chapter 240-11 Illegal operation of a beauty salon In RB residential zone. 2. COMMENCE immediately,action to abate this violation. SUMMARY OF ACTION TO ABATE: Cease all professional beauty services. And,if aggrieved by this notice and order,to show cause as to why you should not be required to do so,by filing an appeal with the Town Clerk of Barnstable, a Notice of Appeal(specifying the ground thereof) within thirty(30)days of the receipt of this order(in accordance with Chapter 40A Section 15 of the Massachusetts General Laws). If,at the expiration of the time allowed,.action to abate this violation has not conunenced,further action as the law requires will be taken. By order, Robin.C. Giangregono Zoning Enforcement Officer Q/FORMS/viozonel Ice pTi1E l°� Town.of Barnstable #1• , 01 b Expires 6 months from issue dote Regulatory Services Fee ,��, snxxsrnst.e. # k 9� MASS. $ Richard V.Scali,Director A i6g9. rf0 MA'I a Building.Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL. ONLY �'ot Valid without Red X-Press Imprint Map/parcel Number 0 1 Property Address Qd3 Q [Residential Value of Work$ 20 i ,71-cJ0.00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address hgAak ��AjQt}cl�nTc/�� Contractor's Name '�5RCtO 1DAMASC�-N3 Telephone Number- ��'�•��'� 3�y� Home Improvement Contractor License#(if applicable) t(� g Email: ? 0 /-01 Construction Supervisor's License#(if applicable) 4Workman's Compensation Insurance PERMIT Check one: ❑ I am a sole proprietor MAR AR D O 4 2015 I am the Homeowner 1• I have Worker's Compensation Insurance TOWN OF BARNS-1-ABLE Insurance Company Name Workman's Comp. Policy# i H( i� '412 11 �- Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value maximum.35)#of windows #of doors: o� Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy oft the Home Improvement Contractors License&Construction Supervisors License is requir SIGNATURE: Q:\WPFILES\FOR S\building pe onns\EXPRESS.doc Revised 06131 ,j Depiw-anent of bulusind Accidents - fie a 'frzesfr �tiQ�u 60.0 Wash-&igton Street astali,MA 02.H1 YVFGfi?mass-gaiVdiii 'workers' Compensafi€anInsnrance davit:BiiildersICantraactors/E-.ectriciauMumbers ApWic-ant Information Please Print Legibly Flame akiwI- Addr - 21 A1t(-c ems- City/Statejzip_ C �� .6 Phone 9- Are you an employer Check the appropriatebax: Type, C of.project r _ atii ar gener�1 contractor and I am' � ��= 4 LX I am a employer with 3 ❑ I 6- ❑New mnsEi oa employees{full an ]lavehaired.the sub-conffacfors. dlorgatf-#ime�'� 'j_ �c,delia 2_El rin a sole proprietor or partner iste Id on the attached sheet g stip and have no employees 1�Se s-ub-coatractors have a_ Demolition . rc r;n�_ rrme in an ci r_ employees and have.workers' Y capes � 9_ '❑Building addition ?? o wc+lre�' ccsuip_t*��I are ccnTp_insurance.l ;.mired 5-❑ We arc a corporation and its IO_❑Electrical repMM or additions cofficers batim exercised ter I l_.❑Plubinm ?. M or additions 3.❑ I am.a hflmeo-�n�doing all wow g� . n7ysel£ [do worS-M'comp- right-of exetionper MGL 12-.❑Roof repairs a4a� -once regnired_�F c_152, §1(4} and we fiskTe no employees_(No worms' 13-❑other comp-msara-cerequrred-j !Any app6ocf&-it checks hayflamstslsofm out the section hcJ—sho-nngTheirwosk¢s'conpessadio:npolicyiufzmzfkS 9 ffnmecwn�s ct ub2L it this�,�itisv t ira taey as2 rl�iag rS1 r��3c aL�then hire osiL co�tcacros mast sr banes a ur a V d�rit n��_ sorSi =GGuntcac tars trot cj,--A this bar mast#ruched sn addirinnrI sheet sbvcrffia�n�o�die srk mks�m3 staff zhe�scant thflse�if�es fiave c-umltlyers_ If the Fob-Contactors h-re empIo}-ees,the),must piu ice ih r workers'comp.policy ntmmbex_ ;ranarr�mpZvyerthatisores�idiltgtEorders'corczpRrurrtiunaru�trarcce�arrah emp7i�ee� I�e�rrisStepr�Tic}and}obai1� _ irifotmaf�a.;*1. hasurance GomgangrName: ` AA (/E 4-- �SJAA^- Cc for ry'or Self inn Lim 1 NU 3 2 L( Expiration Date: Job Site Ad,&= old, hgmw 4c -D -P�? him City,StaW7,p Hv,a..lyItl(s 11A CO,ej,o f Attaclt a copy of the zsvrkers'compemation polio-declaration page(showing the policy n-azaber and expi aation date). Failure,5o se-care eoLvitrage as requin4under Sectioa 25.+,of MGL c, 152 can lead to the imposihog ofcriminal penalties of a fine up to S 1,500.0Q andlor ore-year imprisoS as well as civil pe ta16Es in the form of a STOP'�QrORK ORDER and a f= of up.to$250_00 a-day against the violator_ Be advised that a ctTy of this statement maybe far warded to-the Gice of la estigations of the DIA for it surance coverage vedfication- Ida hLzreby C f3'r . 8 pea-ns alidpsna Lffgs ofpitdgry that the infarmadian prcnzZs d abm,,-Ls.bwa and carruct Simatuz : Date: 0 3 Phone 3 y Official use ores[}. Do rrat write in this area,:a bs campleted by city ar town official City or Town: _PerrtritlLicense ff Issuing Authority(drde one); 1.Board of HeAth 2.Bnd'd n.g Department "3.Cityfavm Clerk 4,Electncal Inspector 5.Plumbing Inspector 6.0ther Cosf;kct-Persan.- 6 r S . Infar afion and Instruefions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 Iegal 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 sues employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold Jte issuance or renewal of a license or permit to operate a business or to construct build.vzgs 'in the commonwealth for- applicant who has not produced acceptable evidence of compliance tlz the insurance-coverage required." Additionally, MGL chapter 152, §25C(7)sates"Neither the cornmonwea la nor any of its political subdivision shall enter into any contract for the per-o_Tmance of public work until acceptable evidence of compliance,pith the insur-dnct requirements of this chapter have been presented to the contracting auth(mty." Applicants — — — Please fill out the workers' compensation aff davit completely,by checki-rjg the boxes that apply to your situation and,i.f / _ necessary,supply sub-coatractor-(s)name(s), addresses) and phone rs,,nrbe,.(s)along with heir cet,: �rcalc-(s) o rf insurance. Limited Liability Compa:its(LLC)or Limited Liability Pai-T-Dersl ys(_.LP)veitHl no employ�ts other than the members or partners,are not requi_ed to cagy workers' compensation it rr ince_ if an LLC or LLP does have employees, a policy is required, Be advised that this affidavit maybe sT_bmiited to he Department of induslaial Accidents for confirmation of i��u7--ante nve_age. Also be sure to sign and date the affidavit "I1e affida,,it shciEd be returned to the city or town that he application for the permit or license is being requested,aot the Department of Industrial Accidents_ Should you have a--.ay questions regarding the lava or if you a-re required to obtain a workers' compensation policy,please ca_i1;'-he Departanent at the number listed bolo,,. Self:innr<-ed companies sa.oald enter their self-insurance license number on the appropriate at, City or Town Otia—cials ---�_ Please be sure that the affidavit is c--raplete and printed legibly, The Department has proFZded a space at the bottom of the affidavit for you to ill out is tie event the Off-ice of Investigations has to contact you reg-ardirg the applicant Please be sure to fill.in the permit/Ecense number which will be used as a refe,-c:nce number. in addition,an applicant that must submit multiple pti-DaWhu--se applications in any given year;need only submit one aflddavit mdicai]2g c ,.,1 ent policy information (if necessary) and under"Job Site Address'the applicant should vmte"all locatio-s in_____(city or town)."A copy of the affidavit that has been officially stamped or marked by he city or town may be provided to-It applicant as proof that avalid affidavit is on file for fhtmc permits or licenses_ A new affidavit m,.?st be tilled out each year_Where a home owner or citizen is obtaining a license or permit not related to any business or co- ercial ,,enture (i.e.a dog license or permit to burn leaves etc.)said person is NTOT required to complete this of ida:-it. The Office of Investigations would like to thank you in advance for your coope-,ration and should you have any questions, please do not hesitate to give us a call_ The Department's address,telephone and fix number n�Coa m aaweatth of Massach:asafts Depart meat cif Industaal AQCidents 5 MCI-- of jayesti tiaxis (500 Washingtau Ste, Boston_MA 02111 Ttl.W 617-127--4g00 W 406 or Revised 4-24-07 Fax r 6I7-727- Tt91 a ©® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03/04/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Finnerty Insurance Agency PHONE , (781)337-1009 NC No: (781)337-1171 1598 Main Street E-MAILADDRESSm bdan@rinnertyinsurance.com Weymouth,MA 02190 INSURERS AFFORDING COVERAGE NAIC# Phone (781)337-1009 Fax (781)337-1171 INSURERA: UTICA FIRST INSURANCE - INSURED INSURERB: COMMERCE INSURANCE PD Remodeling,Inc. INSURER C: TRAVELERS INSURANCE 28'Miller Street Apt#9 INSURER D: Quincy,MA 02169- 781 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. ILTR TYPE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LIMBS INSR WVD POLICY NUMBER MM/DD MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000.00 ❑ ❑ CLAIMS-MADE OCCUR #ART 5030514-01 MED EXP(Any one person $ 5,000.00 A ❑ 09/032014 09/032015 PERSONAL 8 ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 El ❑ PRO-JECT ElLOC - - $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident . $ ❑ ANY AUTO BODILY INJURY(Per person) $ 100 000.00 ALL OWNED SCHEDULED #14MMBBZK40 BODILY INJURY(Per accident) $ 300,000.00 B AUTOS ❑ AUTOS 07272014 07/272015 HIRED AUTOS NON-OWNED AUTOS N-0WNED - (PR PgERTYDAMAGE $ IOO,000OO ❑ ❑ Per accident ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ C ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY y/N TORY LIM S ❑ R ANY PROPRIETOR/PARTNER/EXECUTIVE #IHUB 7324P79 E.L-EACH ACCIDENT $ 100,000.00 OFFICER/MEMBER EXCLUDED? N/A 02/242015. 02242016 (Mandatory in NH) ❑ E.L.DISEASE-EA EMPLOYE $ 100,000.00 If yyes,describe under DESCRIP ION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE - Town of Hyannis THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 200 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction supervisor SpecialtN License: CSSL-099846 PERCIO G DAMOCE "9 28 MILLER STREET; QUINCY MA 02169 1 Expiration 0911612015 Commissioner . ee or�vir,zo�ruuea z as accaelld Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 147959 Type: Office of Consumer Affairs and Business Regulation Expiration 8/23/2015' Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 PERCIO G DAMACENO }r 3 - PERCIO DAMASCEN,O ` Y 28 MILLER ST,UNIT QUINCY,MA 02169 r� Undersecretaar ' Y No�t tout signature CONTRACT PD REMODELING INC TO: JOB TO BE DONE: 28 Miller St, Unit 9 Ana Boaventura 223 Arrowhead Dr Quincy, MA 02169 223 Arrowhead Dr Hyannis MA 02601 (617)778 3448 Hyannis MA 02601 Percio Damasceno - Install 3/8 insulation board on flat walls to be sided; - Install certainteed mainstreet vinyl siding: Granite Gray - Install vented vinyl soffit:white; - Cover all fascia and rake boards with PVC white coil; - Install white regular corner posts; - Install new aluminum seamless gutters white; - Install white downspouts; - Install gutter screen leaf protection; - Wrap all window and doors that have an exterior wood casing on it,with PVC white coil; - Replace all rotted wood; - Remove all debris from job site related; - No painting included; Permit fee is not included; - Electrician not included { by town codes ); TOTAL= 13,500.00 DOWN PAYMENT=$7,000.00 .(By signing date) FINAL PAYM NT= ,500.00 hen job completed)+ Permit fee DATE: PD REMI INC C Percio�D asceno (pdre odeling@gmail.com) a DATE: (_ 4na Boaventura f CONTRACT PD REMODELING INC TO: JOB TO BE DONE: 28 Miller St, Unit 9 ANA BOAVENTURA 223 Arrowhead Dr Quincy, MA 02169 .223 Arrowhead Dr Hyannis, MA 02601 (617)778 3448 Hyannis, MA 02601 Percio Damasceno - Install 1 bow window$3,000.00 - Install 2 windows$1,100.00 - Install 1 entry door(front) $1,600.00 - Install 1 storm door(front)$350.00 - Install 1 door and 1 storm door(side door) -$1,200.00 TOTAL=7,250.00 DOWN PAYMENT= $4,1100.00 (By signing date) FINAL P ENT= $2-7-5&80 en job completed) 3,d 54_a/J V DATE: %s REMODE G ercio Da sceno (pdremodeling@gmail.com) DATE: a Boaventura . t r Town of Barnstable #� 6 L U3�— oF �. „y� 0 Expires 6 m nths r m is a date Regulatory Services Fee . + BARNSTABLE, " 9Q i MASS.. ,0� Richard V.Scali,Interim Director �OArfD N1A'�A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 2 M �C� Not Valid without Red X-Press Imprint Map/parcel Number � Property Address 2`23Arrolj)kea� r Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address_A hQ' - n L.r7Q. Contractor's Narr&m ' SVX!�eIephone Number='7S3 ' 0492 Home Improvement Contractor License#(if applicable) Email:4V ECO83 10-6 W10 I''GOW7 Construction Supervisor's License•#(if applicable) {�7 1 — _ XWorkman's Compensation Insurance Check one: ❑ T am a sole proprietor JlL 2 _ cv t4 ❑ I am the Homeowner 1 have Worker's Compensation Insurance Insurance Company Name e � �r� 4� ,�TA�LE � Workman's Comp. Policy# tVL R "'1 1 3 Z Z 534-- ' Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) JA ---❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to IJA --❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) �"i ❑ Re-side XReplacement Windows/doors/sliders. U-Value U& (maximum .35)#of window s r #of doors: NA --❑ 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. r ***-Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re ed. SIGNATURE:44 5 T:\KEVIN D\Bi s\EXI'RESS PERM IT\EXPR. oc Revised 061313' { i a' The Commoszwealth-of Massachusetts Department;of Industrial Accidents Office of Investigations 600 Washngton.Street Boston, MA 02111 www mass.gov/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/E.leetrieians/Plumbers Applicant Information Please Prim Legibly Name. (Business/Organization/lndividual): 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 theappropriate boa: Type of.project(required): 1.❑ I am a employer with_ 4. ❑ I ani a general contractor and T 6. New construction - employees(full'and/or part-tune).* have hired the sub contractors--- -- 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # 17 ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition work-in for me in an. capacity, workers' comp. insurance.. g Y p Y 9.. ❑Building addition [No workers' comp. insurance 5. We are a.corporation and its required.] officers have exercised their 10 ❑Electrical repairs or additions 3.❑ I am a homeowner doing..all work right of exemption per MGL 111❑Plumbing repairs or,additions myself. [No workers' comp. e. 152, §1(4),and we have no 12.❑ Roof r, sirs insurance required.] t employees. [No workers' 13.� Other �Q,C� 4 �1 comp. insurance required.] dd S 2 C *Any.,applicant that checks box#1 must also fill out the section below showing their workers'comp.ensation,policy informal n. t Homeowners who submit this affidavit indicatingthey 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 ofthe sub-contractors and theirworkers'comp..policy information.. I am an employer that is providing workers'compensation insurance for my employees. Below is.1he policy and job site information. Insurance Company Name: Ace American Insurance Company / Phone:866-283-712.2 Policy 4 or Self--ins. Lic.. #: WLRC47322534 Expiration Date;; - 08/01/2014 Job Site.Address: Zz3 r"r o(A) 69 City/State/Zip nn is OU0I Attach a copy of the workers' compensation,;policy declaration,page(Aowing;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:civi.l penalties-inthe..form of a:STOP WORK ORDEPcand a fine- of up to$250.00 a:day against the violator. Be advised,that a.copy of`this statement'inay be:forwarded to the Office;of Investigations of the VIA for insurance:coverage verification. I do hereby certi nd the.pains an nalties of perjury that the information provided above is true and correct. Si natur {Sears Auth.Agent} Date: ZZO ZO Phone ft: Home-Fax : 860-935-0346 / Cell: 860-753-0452 Official use only. Do-not write in this area, to be completed by city or town official. City=+or Town: Permit/Liceme# Issuing Authority(cirele:one)' 1. Board of Health 2.BuildingD'epartmeni'3:C.ity/Town"'Clerk, 4.Electrical.Inspector 5.Plumbing Inspector 6.Other ,. Contact Person`: Phone#: Al DATE(MM/DDNYYY) A �® CERTIFICATE OF LIABILITY INSURANCE 07/19/2013 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 0 00 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 3 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. J IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT d PRODUCER NAME: '� Aon Risk Services Central, Inc. PHONE (g66) 283-7122 FAX (800) 363-0105 y Chicago IL office (AIC.No.Ext): aCX.No.: fl 200 East Randolph E-MAIL p Chicago IL 60601 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE, NAIC# INSURED - INSURER A: ACE American Insurance Company 22667 Sears Holdings Corporation INSURERB: Indemnity Insurance Co Of North America 43575 dba Sears Home Improvement Products, Inc Attn: Risk Management E3-219A INSURER C: 3333 Beverly Road Hoffman Estates IL 60179 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570050796993 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 LTR TYPE OF INSURANCE INSR WVD BRI POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS '�' GENERAL LIABILITY HDOG O 0 20 1 EACH OCCURRENCE S5,000,00DAMAGE T_O_RMTrE5__ X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence $5,000,0O0 CLAIMS-MADE X❑OCCUR MED EXP(Any one person) EXCl tided PERSONAL B ADV INJURY $5,000,000 rn GENERAL AGGREGATE $5,000,000 'So GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $5,000,000 X POLICY PRO- LOC o n A AUTOMOBILE LIABILITY ISAH08719780 08/01/2013 08/01/2014 COMBINED SINGLE LIMIT A ISAH08719792 08/01/2013 08/01/2014 Ea accident) $5,000,000 A ANY AUTO ISAH08719809 08/01/2013 08/01/2014 BODILY INJURY(Per person) Z X ALL OWNED SCHEDULED BODILY INJURY(Per accident) 41 AUTOS AUTOS X HIRED AUTOS X 'NON-OWNED PROPERTY DAMAGE V AUTOS Per accident) t= QI UMBRELLA LIAB OCCUR EACH OCCURRENCE L) EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION ' ' A WORKERS COMPENSATION AND WLRC47322534 68/5726131]8/Ol/2014 X I C LIMITS ERH EMPLOYERS'LIABILITY Y I N CA MA AZ ANY PROPRIETOR I PARTNER/EXECUTIVE E.L.EACH ACCIDENT $2,OOO,OOO B OFFICER/MEMBER EXCLUDED? NIA WLRC47319122 08/01/2013 08/01/2014 (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(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE MATH THE .. - POLICY PROVISIONS. - Sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1540 American way Longwood FL 32750 USA / ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I N .fi%J= Y %s''li ( C' Office of Consumer Affairs and Business Regulation 1.0 Park Plaza - Su e. 5170 Boston, Massachusetts 0211;6 Home Improvement_ ontractor Regi tration . g Registration: 148607 , =t Type: Supplement Card 1 Expiration ' TOM 1f2015 SEARS HQME,IMPROVEMENT PRODUCT s 3 LUBOS SVEC 1024 FLORIDA CENTRAL PKWY ':; _. _.__ _. ___ .: _: _ ... LONGWOOD, FL32750 ...._ »r s . ...."' '' lipdate`lddress and'return card.Mark reason for change. Address Renewal . 1 Employment r,Gost Card € SeAi ura.o n� _. ._......... %() . ....-.,.__ _...: �� , ;, - '�.e.—f iffice of Consumer Affairs h Business;. egufahon License or>registration valid for individul use.only` Ji " before the expiration date. If found return to: f DME IMPROVEMENT CONTRACTOR Office o.f Consumer.Affairs.and`Business.Regulation Y �E Registration 148607. > Type: IO Y1rk Plaza_-Suite 5170 ExpEratEori 10111l2015 . m Suppleent Card Boston,1A 0211E SEARS HOME IMPROVEMENT PROOUC,TS ING' LUBOS SVEC , 1024 FLORIDA CENTRAL PKWY rs a G — � :.. Mw LONGWOOD,FL 32750 _ } T.indersecrctary - va I .w►t lout signa ur . f rt y 4 I r f en se CS-09 513.: N' .. .. g pry, c Via` .. � #.�� •z,d.. 3 � Thonnoson CT 06277 � � r 6641 f O ' e. A IIIII IIIII III III Office Location: BOSTON Proposal Date 07/16/2014 Job Number 17277406 Sears Home Improvement Products,Inc. � Customer Name P.O.Box 522290 ANA BOAVENTURA ar� 1024 Florida Central Parkway Customer's Home Phone Customer's Work Phone Home Improvement Products Longwood,FL 32750-7579 rovemen (S08) 771-2896 p Phone(800)469-4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 223 ARROWHEAD DR MA(148607) City State JZip Code Windows 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) MUHAMMAD NAEEM 32130 Description of the Project and Description of the Significant Materials totbe Used'and Equipment to be installed 1. Remove existing units to be replaced.(PLEASE NOTE:The removed units are likely to be damaged.) 2. Prepare openings as necessary to receive replacement units.(No finish work other than normal installation is to be done unless otherwise noted below.) 3. Installation includes the clean-up of all job-related debris upon completion of the job. 4. (If applicable)After the completion of the project,the customer will be responsible for the application and removal(storage)of shutter panels. In the event that the project requires the installation of storm shutters or egress windows, Sears Home Improvement Products, Inc. ("Sears") will not re-install any affected security bars. 5. (If applicable)In the event Sears is unable for whatever reason to obtain the proper permits prior to the commencement of any work,Sears will refund any previous payment and this contract will be automatically cancelled. Summary of Window Order Addendum(see detailed Window Order Addendum for more information): Type: WB PLUS (WINCORE) Quantity: 4 Type: Quantity: Type: Quantity: Type: Quantity: Type: Quantity: The Window Order Addendum is made a part of and incorporated into this contract by Customer(s)initials reference. Additional Work to be done:REMOVING & REINSTALLING AIR CONDITIONAR ON THE FRONT WINDOW. Work NOT to be done: NA SPECIAL INSTRUCTIONS:AS PER CUSTOMER REQUIREMENT, WINDOWS ARE WITHOUT GRIDS. WINDOWS EXTERIOR WRAP COLOR IS G. WHITE All of the above check boxes, "Work NOT to be done," "Additional work to be done," and Customer(s)initials "Special Instructions"sections have been reviewed and explained to me. ' SW1-MA (Dig.) Rev 08/13/12 Page 1 of 3 1 Job Number: 17277406 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 3-4 WEEKS (Approximate Start Date) It will be substantially completed by approximately 1-2 WEEKS (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 written notice to Customer. I IF The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 3,685.53 Contract Price $3,685.53 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 1,105.66 State Sales Tax( 0.00 %) $ 0.00 Final Payment(balance payable upon completion of job)$ 2,579.87 Local Sales Tax( 0.00 %) $ 0.00 The Initial Payment is due prior to Sears ordering products. Total Amount Due $3,685.53 The form and method by which the Customer(s)will pay is described in a separate Cash/Credit Customer(s)initials Card Payment Addendum made a part of and incorporated into this contract by reference. 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,fumishings. 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(i)one year for Weatherbeater Value Line,(ii)two years for Weatherbeater Plus,or(iii)three years for Weatherbeater Max,and Weatherbeater Stormbeater,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. SW1-MA (Dig.) Rev 08/13/12 Page 2 of 3 w ' ' 1 IIIII II II IIII III Job Number: 17277406 NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE 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 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. 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 contractors 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 . 07 1 2/ 6/ 014 _ 07/16/2014 Customer's signature Date Customer's signature Date Accepted by Sears Home Improvement Products, Inc.("Sears")on 07/16/2014 by. Mw.M�owEEM Date Management Representative SWl-MA (Dig.) Rev 08/13/12 Page 3 of 3 JOB NUMBER: 17277406-0001-B PROPOSAL DATE: 7/16/2014 WINDOW ORDER ADDENDUM 1 WP-DOUBLE HUNG 2 24 W X 36 H , - WHITE ,...._...._.._.... LOWE/ARGON/CLEAR FULL SCREEN TWO CAM LOCK MAX CLEARANCE DIMENSIONS=[18.75 X 10.56251 2 WP-SLIDER 1 37 W X 27 H WHITE LOWE/ARGON/CLEAR FULL SCREEN MAX CLEARANCE DIMENSIONS=[13 X 21.751 3 WP-DOUBLE HUNG 1 36 W X 48 H WHITE LOWE/ARGO N/C LEAR FULL SCREEN TWO CAM LOCK MAX CLEARANCE DIMENSIONS=[30.75 X 16.56251 TOTALS: 4 COMMENT: o ' 1 of 2 : a f = t i ` F {... . .. .. . } � 1 j, I { i i L y l { { I t 2 ! i ............. _ { ... } # .. t k. . i # # l' i W # .. 3 t s -..- _.: { 1 S£S£ 3 1st Floor �ID�ri�9uUGf�UZ_ 07/16/2014 F/16/2014 Customer Signature Date Customer Signature Date 2of2 II11111111 III III Office Location: BOSTON Proposal Date 07/16/2014 IJobNumber 17277406 Sears Home Improvement Products,Inc. Customer Name `��1�� P.O.Box 522290 ANA BOAVENTURA 1024 Florida Central Parkway Customer's Home Phone Customer's Work Phone Longwood, FL 32750-7579 (S08) 771-2896 Home Improvement Products Phone(800)469-4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 223 ARROWHEAD DR MA(148607) City State JZip Code Doors All plumbing and electrical services performed by HYANNIS MA 02601 Is installation within city.limits? licensed subcontractors Installation Address County BARNSTABLE I (Yes,/No): YES FEIN 25-1698591 Billing Address(if different from above) City State Zip Code Project Consultant Name 8 License No.(if applicable) MUHAMMAD NAEEM 32130 Description of the Project and Description of the Si nificant Materials to'be Used and Equipment to be installed Entry Door 1 Location:RIGHT SIDE Entry Door 2 Location:BASEMENT Style:430 Style:6 PANNEL EMBOSSED Jamb(Full/L Frame): FULL Material(Steel/Fiberglass):STEEL Jamb(Full/L Frame): FULL Material(Steel/Fiberglass):STEEL Configuration(Single/Double/Patio):SINGLE Configuration(Single/Double/Patio):SINGLE Slab Type(Grain ed/Smooth/VL Smooth):yL SMOOTH Slab Type(Grain ed/Smooth/VL Smooth):VL SMOOTH Colors Ext S.M.WHITE Int S.M.WHITE Colors Ext CAFE CREAM Int CAFE CREAM Grid/Blind Colors Grid/Blind Colors Ext Int Ext Int 0 Glass Style:CLEAR ❑ Glass Style: Finish (Bright Brass/Antique Brass/Satin Nickel/Aged Bronze):BRIGHT BRASS Finish (Bright Brass/Antique Brass/Satin Nickel/Aged Bronze):BRIGHT BRASS 0 Standard Hardware Package ❑ Door Cutdown ❑ Standard Hardware Package ❑ Door Cutdown Additional Options: Additional Options: ❑ INSWING(LH/RH): 0 OUTSWING(LH/RH):RH 0 INSWING(LH/RH): LH ❑ OUTSWING(LH/RH): Casing (Modern-Ranch/Colonial/3.5 Colonial): 3.5 COLONIAL Casing (Modern-Ran ch/Colonial/3.5 Colonial): 3.S COLONIAL Casing Color:WHITE Casing Color:WHITE ❑ Door Cutdown Patio Door Screen Color ❑ Door Cutdown Patio Door Screen Color Jamb (Standard/Extended): . Jamb (Standard/Extended): Jamb Cladding Color:G.WHITE Jamb Cladding Color:G.WHITE Door 1 SIDELITES STORM DOORS Location: Model: Model: Jamb(Full/L Frame): Material(Steel/Fiberglass): Colors Ext Int Configuration(Single/Double/Patio): ❑ Tinted Glass (Bronze/Gray/Green/Low'E'): Slab Type(GrainedlSmoothlVL Smooth): ❑ Standard Hardware Package (Black/White): Colors Ext Int ❑ Specialty Hardware: Grid/Blind Colors Ext Int ❑ Glass Style: Finish (Bright Brass/Antique Brass/Satin Nickel/Aged Bronze): Door 1 TRANSOMS Model Number: PLEASE NOTE:Contractor is not liable for the condition or Grid Colors Ext Int operation of rehung storm doors. ❑ Glass Style: Additional work to be done:SOME ROTTEN,WOOD ON THE BASEMENT DOOR NEEDS REPLACEMENT. DISPOSING OFF STORM DOOR Work NOT to be done: 4, NA SPECIAL INSTRUCTIONS:AS PER CUSTOMER'S REQUIREMENT THE DOOR 1 (RIGHT SIDE DOOR) HAS RIGHT HAND OUT SWING. AND BASEMENT DOOR.HAS LEFT HAND IN SWING. All of the above check boxes, "Work NOT to be done," "Additional work to be done," and Customer(s)initials "Special Instructions"sections have been reviewed and explained to me. SD1-MA (Dig.) Rev 08/13/12 Page 1 of 3 �II I�III III'll Job Number: 17277406 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 4-5 WEEKS (Approximate Start Date) It will be substantially completed by approximately 1-2 WEEKS (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 written notice to Customer. The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 4,500.00 Contract Price $4,500.00 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 1,350.00 State Sales Tax( 0.00 %) $ 0.00 Final Payment(balance payable upon completion of job)$ 3,150.00 Local Sales Tax( 0.00 %) $ 0.00 The Initial Payment is due prior to Sears ordering products. Total Amount Due $4,500.00 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 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 three years on Custom Craft products and one year on all other products, 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. SDI-MA (Dig.) Rev 08/13/12 Page 2 of 3 Job Number: 17277406 NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IFANY OFTHE SPACES INTENDED FOR THE AGREED TERMS TOTHE 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 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. 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 contractors 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 v 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. j 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 r� 07/16/2014 07/16/2014 Customer's signature Date Customer's signature Date Accepted by Sears Home Improvement Products,Inc.("Sears")on 07/16/2014 by: Date Management Representative SDI-MA (Dig.) Rev 08/13/12 Page 3 of 3 ,..._....:_.... .._..,............ ..... ..., 1,011,8/2012 12:56 1781471.2WB BOSTON SALES PAGE 01/61 �111 WCW i 540DS Set€es Viq Double lio gW1edaw 9,fCnM F,nsgPUiac.. Iay .?..m .ow.f 1.9.E - Varne>d Slider vtindv:v -- - a , CPO:.WCJd—M-:f7-0002E—.a1760i ENERGY PERFORMANCE RATINGS U_-hctor(U S.A—P)` S*Heat GaIn Gaelticjer"t ` ADDITIONAL PERFORMANCE.RATINGS r— Visible TmismiQltanse " � e!3AYaattuttl 9alpUlLM 1pa(SRea ra0A9g PPNsfm to apP$pAiFi�AC�ploeedursa let.Petammmp rakaia .. - ' pratiPd a(oamande$FM rfil.at a=saeraml9aa Iat a ltl4P aei"pt e�rRptmtAlal`tPnaltMudd a uanclNC Pr¢autl Y2/.-NFRCJisa+'rPr tatEmAit1P t&Y Pr=daft IAa'•Aeel 201,Wwa d1Pa W4Chlhi of i -.. Ipreaum'm,any soIft uee.togrtfl On no140'.UY l w von lAi ohs,p oni"Pdlrnrnce in ArmAi(9n. t +wrr,n,.rnra I DesagnPtessure:+35' 35 - Maximum Saxe:40 x 88 TWIq 8taedard!AAMANtUMAlCSA iClll$21A44D—D5 Tog1ab:ARCHITECTURAL TeSTINQ INC:. i -70 X-P --PERMIT Town..'of Barnstable *.Permit# GExpires onths from issue date 1 R_ egulato' 8 ry Services 1Nee 2012 v� Thomas F.Geiler,Director 039. Building Division " 'OWN OF BARNSTABLE Tom Perry;CBO, Building Commissioner m 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION_ - RESIDENTIAL ONLY y t—� Not Valid without Red X-Press Imprint Map/parcel Number 0 .l O r l ^ A Property Address p�pL 3 Arrow U Residential Value of Worl,0'T O I O Minimum fee'of$35.00 for work under$6000.00 - AnaOwner's Name&*Address - i J Dr -14 -606cQ L vS v 2G ors P.v Contractor's Name Telephone Number8�0'Z� 'dos Z Home Improvement Contractor License,#(if applicable) Construction Supervisor's License#(if applicable) ( l S c VWorkman's Compensation Insurance Check one: : ❑ I am a sole proprietor . F I am the Homeowner £ I have Worker's Compensation Insurance Insurance Company Nam A' Workman's Comp.Policy Q C Copy of Insurance Compliance Certificate must accompany each permit. . - Permit Request(check box) Re-roof(hurricane nailed).(stripping old'shi.ngles) All construction debris will be taken to —�Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) �JA --El Re-side .#ofdo'ors Replacement Windows/doors/sliders;U Value r ^y (maximum .35)`4 of windows NA - Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and'inspections required ,;. Separate Electrical&Fire Permits required. *Vh'ere 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 ome Improvement Contractors License&.Construction Supervisors License is r Uired` _ __. SIG NATUR C'\Users\decolhk\A' a ocal\Microsoft\w.indows\Temporary lntemet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 oF�rod , anxtvsrna�,e, MASS. A Town of Barnstable �f0 MAC Regulatory Services 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,A nQ 1V)DCt.Ve'Ob I-D,- , as Owner of the subject property hereby authoriz PS �T �- JV act on my behalf, in all matters relative to work authorized by this building permit application for: r"aa3 A �►�iv�ke � (Address of Job) 7 4CAC/� N Signature of Owner Date no- 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 Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 wj of Tw,, Town of Barnstable saiwsrasi.e, Regulatory Services * Mass. �, Thomas F.Geiler,Director ot39;. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ina.us 508-862-4038 /791 -6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to in ude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not ossess a license,provided that the owner acts as supervisor. DEFT TION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she re ides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures two- ,cc ory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a omeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she sh be responsible for all such work performed under the building ermit. (Section 109.1.1) The undersigned"homeowner"assumes resp risibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies at he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that /she will comply with said procedures and requirements. Signature of Homeowner Approval of Building.Official Note: Three-family ellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction ntrol. HOMEOWNER'S EXEMPTION The Code states t,at: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of t s section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for ire to do such work,that such Homeowner shall act as supervisor." Many homeo ners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rul s& Regulations for Licensing Construction Supervisors,Section 2.15) This.lack of awareness often results in serious pr lems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the nlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsi le. To ensure hat the homeowner is fully aware of his/her responsibilities,many communities require,as part.of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 The C'onitriornvealth of Massachusetts Deparnnent€rf lindustrial Accidents Office of lnvestigat nns " 600 Wasltiiigton Street BostonA 02111 �nVW.ma gm�/dire Workers' Compensafion Insurance Affidavit: BuilderslContr:.ictors/ElectriciansfPhu�nbers Applicant Information. Please Print 'h N (BaisiuesslorganiiationtIadividna Address_ 4 �b Cep rcA.; r City/stste/Z a 6 �L-3Z1- `U one �'6b•-7 C3 -.�Q 4 7 Are-you an,employer',4Neck the appropriate box.: Type of project(required): 1_❑ I am a employes with 4.,❑ I am a general contractor and I employees{full andlor part-time). s have hired the sub-contractors 6.-❑New construction. 2_❑ I am a sole proprietor or partner- listed on the attached sheet_ 7. ❑Remodeling. ship p and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance I 4_ Building addition required] 5- We are a corporation and its 10.❑Electrical repairs or additions 3.❑ .1 am a homeowner doing all work off€cers have exercised'their. 11.Q Plumbing,repairs or additions MP- myself{No workers'Comp. right of exemption per 1VIGL i2-O Roof repairs insurance regarired.]a C. 152,§1(4),and we have no employees. a workers' 13:0 Other "' ire �Cl e G�ti►'� mp .[N comp_insurance required.] P, 4-L ;Any applicant ihatchec9cs boa#1 must also fill out the secuoa helow showing their work Iers'compensauonpolicy.k4onnatiasl Homeowners who submit this:affidavit indicating:they are doing all wmt and then mire outside ceutractors mast submit a nIeu 1.affidavit indicating such. ; fCoutractors tbar cbeck this box must attache an additional sheet ribmi tg the amine of the sub-ccmiractors and:state whether or not those entities have employees. If the strl-contractors have employees;,they rMIst provide their warkers'comp.policy number. I am an employer that is pmiding wvorkers'compensation insaaraaace for iray employees. Below is the polio and lob site inforinatioaa ` Insurance Company lame: r-i C a !rl Policy#. or Self-ills.Inc,9. Expiration Date. Job Site Addresszzs A r V )ecA DYIt ✓e— Cit-y/Stat jz4gV h✓) 1 Attach a copy of:the workers'compensation policy declaration page(sheaving the pommy number and expiration date). Failure to secure coverage as required under,Section 25A of MGL c_ 152 can lead tD the imposition of criminal penalties of a fine up to$1,500.00 odlor one-year imprisoninent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.40'a day,against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DU for imurmce coverage-wenifrcaticn. Idohere.4-.cetv. rift er.the pain id pen zltiei of peduh,that f 40 inforin ation provided Wife is true and correct Si ...lure• .Date: U - �� . r, Phone#a. G C2 s b QQs�ouDo! otvrie in this or rr, n - va offlcial City;orTown: Permit/L cease° Issnstg Authority(circle one.., 1.Board of Health 2:B Min evartne.nt,'3..City/Town'Cluk 4-Electrical Insp�tar'SrPlrimb ng Inspector 6.f#ther Contact Person: Phone#: :. 6 r r• � The CominonYdealth of 1YI assachusetts Department<of Industrial Accidents Off of Investigations 600 Washington Street Boston;_MA 0211.1 wwry maS$.gov/dia; Workers' Compensation Insurance Affdavit; Build`ersContractors/Eleetni-ians/Plumbers Applicant Information Please"Print Legibly Name(Business/organ zation/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?Check1he appropriate box: Type_of project(required): 1.❑ .I am a.em,lo er with: 4. ;❑ I am a general contractonand I p' Y 6, ❑New constriction; employees.(full and/or part time1.).' have hired the sub, contractors 2.❑ ham a sole proprietor or;:partner-i listed on the:attaq.e. sheet; # ❑Remodeling ship andhave`no employees These sub-contractors have 8. ElDemohtori working for mein.any capacity: workers' comp. insurance. 9. Building addition [No workers' comp. insurance 5. We:are a,c.,orporation and its .] officers have exercised their 10 ❑Electrical repairs or additions required 3.,❑ I am a homeowner:doing;all work -right of exemption..per MGL 1 L:,❑,Plumbing repairs or:additions T 4,and we have no myself. [No workers com c. 152p. § ,O 12.❑Roof airs insurance required, employees.employees. [N `w oorkers' 13.� Other �� comp insurance.reIquired] *Anyapplicantthat,checks box;#1 must,alsofill outthe,sectionbelow showing4heirworkers'compensation,policy information.. Q. D r- t Homeowners who submit this affidavit indicating,they are'doing:all.work and'then:hire outside contractors must submit a new amdavit-indrratmgsuch. !Contractors that check this;box.must attached an:additaonal'she6t showing the name.ofthe sub-contractors and their workers'comp.policy information. I am an.employer thatis:providing workers',compensation insurance for my employees. Below.is-th,e policy.:and job site information.. Insurance-Company Name: Ace American Insurance Company / Phone: 866-283-7122 Policy#pr Self;:ns...1ic. #,: WLRC47123033 Expiration"Date; 08/01/2013 Job Site Address: 9,93 Arnoik)'� JY'( V(T.;City/State/Zi VO ki 4lik S, Attach a copy of the workers'<xompensation polity declaration page.(showing the policy number,and expiration dat"e). Failure to secure coverage as required under Section 25A,of.1v1GL c.,152can.,lead to-the impositionof criminal penalties of a, fine up to$1,5*00 and/or one=year imprisonment;as well.as.,civil,penalties.inthe4orm of a.STOPWORK ORDER;anda fine of up to.$250M a,day against the violator. Be advised'thata copy,of this statement may::: forwarded tc the Office of Investigations of the DIA for insurance coverage verification,. I'do hereby certi nde..the-pains a penalties of perjury that the information provided bov.e is true and correct. Si afore: (Sears Auth.Agent) Date: Phone:#ii —Fax : 860-315-7468 / Cell: 860-753-0452 OfftciaCuse only "Do...not write in Phis area;to be.comple?ed by.city`or.town official. City or Town: Permit/License Issuing.Authority(circle one.) 1.Board of Health 2 Building Department 3:Cityfr ownClerk 4 .Eiectrical.Inspector 5.Pluni ingInspeetor 6 Other:. Contact Person: Phone#: /YYYY)CERTIFICATE OF LIABILITY INSURANCEF7p(8"/om6//D2D612 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 NAME: AOn Risk Services Central, Inc. PHONE FAX Chicago IL Office (A/C.No.Ext): (866) 283-7122 glc.No.: (847) 953-5390 4) 200 East Randolph E-MAIL 2 Chicago IL 60601 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC p INSURED INSURER A: ACE American insurance Company 22667 Sears Holdings Corporation INSURERB: indemnity insurance Co of North America 43575 dba sears Home Improvement Products, Inc ' At Risk Management E3-219A INSURER C: 3333 Beverly Road Hoffman Estates IL 60179 USA INSURERD: INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER:570047225444 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 LTR TYPE OF INSURANCE INSR WVD - POLICY NUMBER (MMIDDNYYYI IMMIDDIYYYYILIMITS A GENERAL LIABILJTY HDOG EACH OCCURRENCE $S,000,000 X ENTED COMMERCIAL GENERAL LIABILITY A M TOR PREMISES E a ocwrrence $5,000,000 CLAIMS-MADE ❑X OCCUR MED EXP(Any one person) EXcI uded PERSONAL B ADV INJURY $5,000,005 GENERAL AGGREGATE $5,000,000 N GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $5,000,000 v CD X .POLICY PRO- LOC - r A AUTOMOBILE LIABILITY ISAH08710132 08/01/2012 08/01/2013 COMBINED SINGLE LIMIT A ISAH08710120 08/01/2012 08/01/2013 Ea accident) $5,000,000 ANY AUTO BODILY INJURY(Per person) 2 ALL OWNED SCHEDULED BODILY INJURY(Per accident) W JXX AUTOS AUTOSNON-OWNEDPROPERTY DAMAGEHIRED AUTOS X AUTOS (Pere ccident w t: d JjBREL LA LIAR OCCUR EACH OCCURRENCE V CESSLIABCLAIMS-MADE _ AGGREGATE RETENTION A WORKERS COMPENSATION AND WLRC47123021 08/01/2012 08/01/2013 X WC STATS ORH. EMPLOYERS'LIABILITY ANY PROPRIETOR I PARTNER I EXECUTIVE YIN CA MA AZ E.L.EACH ACCIDENT $2,OOO,OOO B OFFICERIMEMBER EXCLUDED, a NIA WLRC47123033 08/01/2012 08/01/2013 (Mandatory in NH) All other States E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS bc!onE.L.CtSEA£E-?OLICY LNdIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) �y - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE MATH THE POLICY PROVISIONS. Sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1024 Florida Central Parkway Longwood FL 32750 USA c � WIM A114JL ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD , rx � Office of Consumer Affai and Business Regulation 10 Park Plaza - Suite 5170 " Boston,.Massachusetts 02116 HomeiImprovernent.Contractor Registration 4 Registration: W 148607 Type: Supplement Card :` Expiration: 10/1112013 SEARS HOME IMPROVEMENT PRODUCT . - LUBOS SVEC tet` 4024 FLORIDA CENTRAL PKWY�. LONGWOOD, FL 32750 Update Address and return card.Mark reason for change.. Address `' Renewal ;, Employment 7— Lost Card OPSLAi 0 WW"''04-Gf01216 _ Office of Consumer AfTair5&Business,Regulalion License or.registration valid for individul use only. ^HOME IMPROVEMENT CONTRACTOR before theespiration date. if found return tot R istration:.148607 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 *� Expiration: 1011112013', Supplement Card Boston,MA 0211.E SEARS HOME IMPROVEMENT PRODUCTS INC, /' LUBOS SVEC ' 1024 FLORIDA CENTRAL PKWY` LONGWOOD,FL 3V60 ; ""' lindersecrctary Not v ilid`1r1ithout signature r ; !. Massachusetts -Department of Public Safety �V'IfJ Board of Building,Regulations"and Standards , $ Crin+truct on Supervisor = License:CS-097519 4 ' LUBOS SVEC _ �- t 1 827 THOMPSON20 ►� t Thompson CT OQ-77 f ' f" �# >t lit Expiration Commissioner 08/31/2014 t Lw J. r� z .: ` w Office Location:BOSTON Proposal Date 11102120I Job Number 14586392 Sears Home Improvement Products,Inc. Customer Name rrs P.O.Box 522290ANA BOAVENTURA SO1� 1024 Florida Central Parkway Customer's Home Phone Customer's Work Phone LongW00d,FL 32750 7579 Home Improvement(508) n1-2896 Products Phone(800)469 4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 223 ARROWHEAD DR MA(148607) City State Zi Code Windows p 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) TODD SARGENT 29247 De"scri tlon of the Pro ect and;Descri ton of the St nificant Materlals.16 Used.and,nE ul merit to ell nsta led 1. Remove existing units to be replaced.(PLEASE NOTE:The removed units are likely to be damaged.) 2. Prepare openings as necessary to receive replacement units.(No finish work other than normal installation is to be done unless otherwise noted below.) 3. Installation includes the clean-up of all job-related debris upon completion of the job. 4. (If applicable)After the completion of the project,the customer will be responsible for the application and removal(storage)of shutter panels. In the event that the project requires the installation of storm shutters or egress windows, Sears Home Improvement Products, Inc. ("Sears") will not re-install any affected security bars. 5. (If applicable)In the event Sears is unable for whatever reason to obtain the proper permits prior to the commencement of any work,Sears will refund'any previous payment and this contract will be automatically cancelled. Summary of Window Order Addendum(see detailed Window OrderAddendum for more information): Type: WB MAX (WINCORE) Quantity: 1 Type: Quantity: Type` Quantity: Type: Quantity: Type: Quantity: The Window Order Addendum is made a part of and incorporated into this contract by reference. Customer(s)initials Additional work to be done:NONE Work NOT to be done: 9 NONE SPECIAL INSTRUCTIONS:NONE All of the above check boxes, "Work NOT to be done," "Additional work to be done," and "Special Instructions"sections have been reviewed and explained to me. Customer(s)initials SWl-MA (Dig.) Rev 08/13/12 Page 1 of 3 (IIII III I I III'll Job Number: 14586392 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 1-2 WEEKS (Approximate Start Date) It will be substantially completed by approximately 4-5 WEEKS (Approximate Completion Date) These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products, Inca("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 written notice to Customer. Customer(s)initials The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 4,010.83 Contract Price - m$4,010.83 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 1,203.25 State Sales Tax( 0.00 %) $o.oo Final Payment(balance payable upon completion of job)$ 2,807.58 Local Sales Tax( 0.00 %) $o.oo The Initial Payment is due prior to Sears ordering products. Total Amount Due $4,010.83 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 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(i)one year for Weatherbeater Value Line,(ii)two years for Weatherbeater Plus,or(iii)three years for Weatherbeater Max,and Weatherbeater Stormbeater,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. SWi-MA (Dig.).Rev 08/13/12 Page 20 3 II�IIIII��I�'I� Job Number: 14586392 NOTICE TO BUYER 1. DO NOT SIGN THEAGREEMENT IFANYOF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE 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 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. 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 with unregistered contractors 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 11 02 2012 / / 11/02/2012 Customer's signature Date Customer's signature Date Accepted by Sears Home Improvement Products,Inc.("Sears")on 11/02/2012 by: Date Management Representative SW1-MA, (Dig.) Rev 08/13/12 Page 3 of 3 JOB NUMBER: 14586392-0001 PROPOSAL DATE: 11/2/2012 WINDOW ORDER ADDENDUM m 1 WM-PATIO DOOR 1 72 W X 80 H WHITE LEFT OPENING LOWE/ARGON/LAMI TOTALS: 1 COMMENT: 1 of 2 f`ys ®. ... ... _. '` i ( t�}.. . ..... E t 1 �� KIT�CHEN� � E ... € BEDROOMS .-� .. L.. ..r..... t { e ...e... ..... yy 7 { .. .. .. 3�. 4.. -. _ ' _ LIVING ROOM € i - �- .€.. . I t �... _I € € _ .. . € 1 } l FIRST FLOOR ✓�( " - 11/02/2012 11/02/2012 Customer Signature Date Customer Signature Date 2of2 i 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7t Parcel i� 7,Sa Application# Health Division Conservation Division Permit# Tax Collector Date Issued d Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address oZ�J C-r t`n t_,:1 c Village u Owner D�u°�rr�yh Address 3 j Telephone 01) Permit Request - — CA Square feet: 1 st floor:existing proposed 2nd floor:existing proposed lm'fial neu Zoning District Flood Plain Groundwater Overlay Project Valuatio n - -£onstruction 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 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 BUILDER INFORMATION Name &��. � U� V Telephone Number Address o?a3T d w h�a 1?1K License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE JUAYL DATE CS �� 9 - FOR OFFICIAL USE ONLY F �•> i PERMIT NO. r Y DATE ISSUED MAP/PARCEL NO. • J I ADDRESS VILLAGE - OWNER r } 1 I DATE OF INSPECTION: , FOUNDATION FRAME INSULATION i i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' -O DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d ° 600 Washington Street Boston,MA 02111' www.mass.govldia ' workers} Compensation Insurance.4 ffidavit: Builders/Contractors/Electricians/Plumbers Applicant ImfOMation Please Print Legibly Name(Business/Organization/Individual): •Address:�`�� "' '� : , City/State/Zip:" Phone.#: aC Are you an employe ? Check the appropriate bog: :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' [No workers' comp,insurance comp,insurance,$' 9. ❑Building addition required.] 5• ❑ we area corporation and its 10.❑Electrical repairs or additions '3..&l am a homeowner doing ill-work . t 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' 13.7 Other comp,insurance required,] *Any applicant that checks boi#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 anew affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the dub-contractors and state whether 6rnotthose 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: Policy#or Self-ins.Lic.# Expiration Date: ?ob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiratirn date). Failure,to secure coverage as reganed under Section 25A of MGL c. 152 can lead to the imposition of aEminal penalties of a ne up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP 7"'ORK,ORDER and e tine of-up,to$250.00 a day against the violator. Be advised that a copy of this statemerit maybe forwarded to the.Office of Lvesticatiow of the DL&for instiance coverage verification. " 7do hereby certify under the pains and penalties of perjury that the in fartnatian provided above is true and correct. Simature: Date: ' P=one ; I OfjZcial use only. Do not write in this area, to,be completed by,ctr or town official or Town: —C>_y � .Perm:.t/TJicense�r � Issuing Authority(circle one): :1,Board ofHealth 2.BuildingDepartment 3, City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6.Other i IContact Person: Phone#: 1 Ivlassachuset`�s General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to t'�s.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,asso6iaLLoA corporation or other legal entity,or any two or more Of the foregoing engaged in joint enterpr din a ise, and inclug 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 owmr of a d,neling 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 hereto shall notbecause of such employment be deemed to be an employer." MI GL 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 producedtacceptable evidence of compliance with the insurance coverage required." AdditionaIly,MGL chapter-152, §25C(7)states`Neither rite commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evi:dense•af-compliance.VPA the in a^-ce' requirements of this chapter have been presenteddto the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contiactor(s)name(s),address(es)and phone numbers)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 ibis affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign arld 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 appropriateline. 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:Whare a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to bairn 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 tc give us a call. The Department's address,telephone-and fax number;. The C0.MM0 V Wth of Mas Whores tts Dt pa (mt of h tdal Acddenits ' of 6..00 Washington S.tred Bo4on,.,MM G2111 - TO.#617-7-27-494-0 ext 406 0r 1,-377 MASSAFE Fax A 6-17-727-774.9 Revised 11-22-06 W .maS1q.gQv1dia °pTHE, Town of Barnstable ti yP °^ Regulatory Services s t sARNSCAELE, MASS. Thomas F.Geiler, .Director 9 $ �'plEn w►p� Bu11d1Ilg Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-403 8 Fax: 508-790-6230 Permit no. f Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c:142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion, -improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost ° Address of Woik:Q VoW a Owner's Name: 4in U e 1 Date of Application: - 1 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑lob Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWli'ERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR , D to Owner's Name . ,t i pF T E�p� �.� Town of Barnstable Regulatory Services + BARNSTABLE, = Thomas F.Geiler,Director. y MASS. Building Division rED � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEONNINER LICENSE EXEMPTION Please Print DATE: ..— lV JOB LOCATION: number street village "HOMEOWNTER name j) ome phone# work phone# CURRENT MAILING ADDRESS: P city/totem state zip code The current exemption for"homeowners".was extended to include o-pier-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeo,,vrier. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned."homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and req cements. Si ature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the proNrisions of this section(Section 109.1.1 -Licensing of construction Supervisors);prm ided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner.shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction-Supenrisors,Section 2.15) This lack of awareness often results in serioui problems,particula-ly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would Huth a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require;as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several tovns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt TOWN OF BAR.NSTABLE BARNSTABLE, i KABIL 0 039. BUILDING INSPECTOR e m a' APPLICATION FOR PERMIT TO J.Cte.C17......!.. /O TYPE OF CONSTRUCTION ....&VA.....F0.07.�.....i.Al..l�d1.....,�7.�.�.�.�1�....................................:.............. .....jo ae. ........9z..............1922.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �z...3....../.�..f?��P.(t.C.h ProposedUse ...........� :G i.l................................................................................................................................................ ZoningDistrict ............1. .................................................._..........Fire District .............................................................................. Name of Owner .. 2.T/.e.1eerl.... .J.V.t.. . p.111..5�...�:L.a .Address ..��,.��.... f�i'/Wfi�PGr:�C ....��:4 ....... Nameof Builder ........�A!?2 ....... ... b�✓ ...................Address .................................................................................... Name of Architect .......5.q"!e.......a 5....A:e.lo....................Address ..........................................................,......................... Number of Rooms ....................r............................................Foundation .........�G'?a<Y..�'.�P..........................,..........:....... Exterior ................1?.C..t.G:Pr. ................................................Roofing ........1C.14.e .-kS.5................................................ Floors ................COi'?f= .,Fle................................................Interior ..................................................................................... Heating ✓W7.e......................................................Plumbing ............f„v,N ........................................................ 0, v Fireplace ............... .??.. .....................................................Approximate Cost ..............Z.0............................. ........ ...... Definitive Plan Approved by Planning Board -------------------_---_-------19 Diagram of Lot and Building with Dimensions d. SUBJECT TO APPROVAL OF BOARD OF HEALTH p �Q Sc y zya t ( Z DO© C�. �� / Qroraz c��.l C00 MC 4D/7 ,ye lbnc J L ro M S v '' O .� 1z r4. Pro rvaecy Cnr��1 Gc��on - Scicei71 44,0 0Z50 Nz < o, qok w 0 0 O m -- ILL7' ��rJ�n� : // / 8a�� 0 t l D.� O i l rtC'I, ocn�¢ zo o _ :. _._a Area G4�e�- ,= a{ Ism _ {` - - h- G1?,, ,fie(Irot,n 46ec4r00 G-1 vti2(¢ �i�,3 yyi W j'�[P �y o 1r =2 Ld o 16� W I- a = z © I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r Name ... .. . &404� . �...... .. . Morris, l��bIeen ��urrio - - ' . No ...I5]22_ Permit for __sczamo..operz__ porch --..—.—.---.---.--.-----~^..—.— � . '— } ' Location --.223. . ____.. / ......................g.Vnqs.----.—.`----.---.. ` C)wm�r ............Kathleen M. Morri � ..—.----...---.'^—'.--. � Typo of Construction ...................fram.e............. � -----^—'~-'----`^-----^-----'- PERMIT REFUSED Approved - - � . � ................................................. lg ' ------.------~—.—..—.--...--.. , - ................-----------'`^^`—^^~—'—~'- . ' | � L--� f Barnstable Assessing Search Results Page 1 of 2 s Home: Departments:Assessors Division: Property Assessment Search Results New Search = New Interactive Maps >>�t Owner: 2007 Assessed Values: BOAVENTURA,ANA BENEDITA 223 ARROWHEAD DRIVE (� lJ Appraised Value Assessed Value Map/Parcel/Parcel Extension 2�\ Building Value: $ 127,900 $ 127,900 270 /075/ \ Extra Features: $5,000 $5,000 Outbuildings: $5,700 $5,700 Mailing Address Land Value: $ 192,100 $ 192,100 BOAVENTURA,ANA BENEDITA eTotals $330,700 $330,700 223 ARROWHEAD DR HYANNIS, MA. 02601 Zo n Tax Information: Tax information is currently not available for 2007 Construction Details Building Property SketcVM rty -2Ketch & ASI Building value $ 127,900 Interior Floors Carpet Style Ranch Interior Walls Drywall Model Residential Heat Fuel Oil Grade Average Minus Heat Type Hot Water Y Stories 1 Story AC Type None y Exterior Walls Vertical Sidin Bedrooms 3 Bedrooms •• tea. 'f � .*� �� _, Roof Structure Gable/Hip Bathrooms 1 Full+ 1 H p 4. Roof Cover Asph/F GIs/Cmp living area 1104 y off Replacement Cost $152243 Year Built 1968 Depreciation 16 Total Rooms 5 Rooms Land http://www.town.bamstable.ma.us/assessing/assess06/displayparcel07map.asp?mappar=27... 4/27/2007 I Barnstable Assessing Search Results Page 2 of 2 CODE 1010 Lot Size(Acres) 0.47 AsBuilt Card N/A Appraised Value $ 192,100 iView Interactive Maps > Assessed Value $ 192,100 I3 x + Sales History: Owner: Sale Date Book/Page: Sale Price: BOAVENTURA,ANA BENEDITA Jun 29 2004 12:OOAM 18772/158 $55,000 MORRIS, KATHLEEN M ET AL Dec 30 1999 12:OOAM 12756/221 $ 100 MORRIS, KATHLEEN M 1581/240 $0 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value BRR Bsmt Rec Room 600 $2,500 $2,500 FPL1 Fireplace 1 $2,500 $2,500 SPL2 Pool Vinyl 352 $5,700 $5,700 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area UST Utility Area(Unfinished) (Finished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story (Unfinished) FCP Carport . GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/assessing/assessO6/displayparcelO7map.asp?mappar=27... 4/27/2007 I Town of Barnstable ti Regulatou,,S.eriyl e- �ABLE �. Thomas F.�Geiler,Director * fARNSTABLE, 9� MASS.16 fob. �•�q Buildi t ZD Zvi i9n0 9: 5 '°lEn nw� Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 DIVISION Office: 508-862-4038 Fax: 508-790-6230 COMPLAINT/INQUIRY REPORT Date: 'off -Oa Rec'd by: Complaint NameZ� Map/Parcel 7a —d 7 Location. Address: ' Originator Name: - Street: �® 9 7i11,o-, L� Village: State: Zip: eg Telephone: Complaint Description: coor FOR OFFICE USE ONLY Inspector's Action/Comments Date: '7-,7-( —G?i Inspector: [-.t CPi -7 — ac=�Q dC i a..S Additional Info.Attached Q:forms:complaint I . 26 July 2002 Building Inspector Town of Barnstable To Whom it may Concem: I am writing to your department in order to register a complaint regarding the operation of illegal, unsanitary and unlicensed beauty salon services here in Hyannis. I, myself, own and operate a beauty salon at 720 Main Street, Lina's House of Beauty. My salon is registered and approved by the town of Barnstable, and I am licensed by the state of Massachusetts. I am from Brazil, and the majority of my clients are Brazilian men and women living here on Cape Cod. Lately, I have learned that a number of Brazilian women are not only offering beauty salon services out of their residences, but that they are inducing my clients to make use of their services and offering rates for service that are below mine. They can do so because they have no professional equipment, they have no costs associated with the ownership or rental of salon space, compliance with municipal'requirements for the use and disposal of chemicals, the provision of a sanitary environment or the state licensing process. I feel that this is improper, both from the standpoint of professionalism and of unfair competition. I have invested a great deal of time and money in establishing what I consider to be a first-rate beauty salon environment, while these others have invested nothing. I am also concerned that, while I have been scrupulous with regard to hygienic practice and the proper observance of environmental safeguards, these women pay not the slightest attention to such factors. I have listed below the addresses at which these illegal salon services are being offered, without mentioning names. I hope that the town of Barnstable will take steps to curtail the continued operation of these illicit, unsanitary and unlicensed salon operations. 5 Hiramar Road 110 Winter Street Hyannis Hyannis 411 W. Main Street 223 Arrowhead Drive Hyannis Hyannis I trust that you will look into this problem, and thank you for your attention to this matter. ery ly yours, Liberina Pinheiro 720 Main Street Hyannis, MA 02601 Assessor!' map and lot 'number :.:./... ....... ............. .... sM SE CYO ' INSTALLED IM WNUAVI CE Sewage Permit number :... .. g LQ...... WITH 'ARTICLE iI STATE............................... SAMITAI Y COX AND VM y�FTNEt�� TOWN. OF BARNSTABL ro�Q y O� Z E9HB9TODLE, i "6 9 BUILDING INSPECTOR op�DM a APPLICATION FOR PERMIT TO. ..... ..... .................................................................. TYPE OF CONSTRUCTION .......... �.l�.lM.!.ti..t/. ......d�....lF.�..!V. .L.............................................. ....... �?!L .......................:?/.. ........19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location q� 3 A I-tro W tieA � YA v / 5 ......................................................�....!.....�.'�.............� .. .......�........................................................... ProposedUse ...... .............................................................................................................. p Zoning District '......: ......................................................Fire District .................................................................... /)t...� Name of Owner ./fei�. .T0.!'7j j.. !� ... .Ir.-±1s.Address .....!��.�Z.. ... 1/Qk4?.Kl.` !1 ...... . ^.!..V ...... l Name of Builder ... : tt0 i"C a /9 . ws Rlwy / ................... Nameof Architect ..................................................................Address ................. ........................................................... Numberof Rooms .......... ..................................................Foundation ................................................................. -Exierior -t- ....................................................................................Roofing .................................................................................... Floors .............................................................Interior r--� Heating ............ ....................................................Plumbing .................................................................................. ....... Fireplace .......................................................................::.........Approximate Cost .........................................................:.......... Definitive Plan Approved by Planning Board -------------------__----------19________. Area ........ .............. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF H LTH di {h boo IY toOq � I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. NameA.! .. .Y.l:'q/�lLP �c � Ford, Kathy & Kathy Morris Private s i ng ....��855.. Permit for .................... ..... .. .... No- ....... Pool .............................................................. Location .........2.2.3..Arrowhead. owh.e.a d..Drive. .............. . . .. .. . ........ . .... .. ........ %. .......................Hyannis ............................................ Owner ...........Kathy Ford &..Kathy...Mor.r.i.s........................... ........... ...... . . . Type.of,Construction .......................................... . ................................................................................ ' Plot t . Lot ................................ 010 , July 29 75$ 4 Permit Granted ........................................19 Date of Inspection .....I........ ......................19 4 Date Completed 19 ............ PERMIT REFUSED ..... 19 A'A............................................................................... . ................................................................................ ......................!......................................................... .. ............................................................................... 4 . Approved ................................................. 19 ............................................................................... ................................................................................ M' a --5? 70 4,7,S' 6 + Assessor's map and lot number .......................................... a Sewage Permit number ..... .l� .�............................................ TNETd�yo� TOWN OF BAR.NSTABLE Z BABBSTADLE, i "6 9 BUILDING INSPECTOR a MPS a r�I,�c:1 S'w�44 ,�, � C APPLICATION FOR PERMIT TO ...................................................... ..................................................................... TYPE OF CONSTRUCTION ..........AJ.!:!.!*?!.! rt, t/.. c'..... +rti J l/ .............................................. ..... ............ 45 `2 � a ........................�!...................19. .-?- TO THE INSPECTOR OF BUILDINGS: a The undersigned hereby applies for /Ia permit according to the following information: Location ..... .?v lr va w ti�C-,?ii .... *-' �' ("F„ ." .�.{"r.................................................................................... ..... ........................................ ProposedUse ....... .........!.: d.o ............................................................................................................. ZoningDistrict .......9...�,--�9-6..................................................... District .................................................................... Name of Owner .,44-A Z.T-ht!^dt, 6!61.. Address ..... ;, !;� 3 ,I vI a ,6t`Pkd...�b ...V�-p..... pp `_ r Name of Builder ....Y.? .I�.....`.�?. ex.fMkIs .... `' Address .......�. 46N F""S Y ..... ............ .�. .................................. ........................ Nameof Architect ..............' ....................................Address .................................................................................... Number of Rooms ........... ..................................Foundation ....... ...................................................... Exterior ..............::"".'_. ........................................................Roofing .................................................................................... Floors ...J............................................................Interior .................................................................................... ---- .--------�----- Heating ..................................................................................Plumbing .................................................................................. Fireplace """_...... ...................................................Approximate Cost ............................... Q (.. a , � Definitive Plan Approved by Planning Board ________________________________19________. Area ...........t ...�?4............. Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH �7,ci ty7 .' \�odlr 1 � SUP I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. XIJA�Alvhzop f`�Name . iZd... t.3 , Z;; <)C � �17..�.. f Ford, Kathy & Kathy Morris A=270-75 No .:. ,.17855. . . ... Permit for ....p.rivat. . .e swi. .mming . . .... . .. . ...... . ........ . ....... pool ...................................................................... Location 223 Arrowhead Drive ................................................................ .......................Hyann i s . . ......... . . ............................... Owner ................................Kathy Ford & Ka thy Morris .................................. Type of Construction .....,./..................................... Plot ....................... . Lot ................................ ^ Permit Granted ......... ?..Y... . .................19 75 Date of Inspection ................. ..................19 Date Completed .....................................19 PERMIT REUSED ...................................... ..................... 19 .................................... . ...................................... ..................................... ............................................................................... ............. Approved .................................. ............. 19 ............................................................................... ...............................................................................