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0142 BISHOPS TERRACE
I Town of Barnstable *Permitoo l� Expires b ntont issare d x Regulatory Services Fee snxrrsrnate. NAM Richard V.Scali,Interim Director 059 M� • Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION. RESIDENTIAL ONLY J� Not Valid without Red X-Press Imprint Map/parcel Numb�t�t�J I _ Property Address NZ l'tl s S TeNL Residential Value of Work$ ` Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 56:P{.RA lYZ R lSw_s 7aR—R- InA Contractor's Name Telephone Number 'lot-7141-6 3 g 9 Home Improvement Contra for License#(if applicable) JZ6 FFS Email: Sue Lcr)qmqd. Construction Supervisor's License#(if applicable) . O 700 7 ❑ � I�''Workman's Compensation Insurance 0 ' ' Check one: ❑ I am a sole proprietor APR❑ I am the Homeowner 4 2014 1 have Worker's Compensation Insurance . Insurance Company Name� QST/ (/ ft1 ® TA ALE Workman's Comp,.Policy# Copy of Insurance Compliance Certific a 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 3C) (maximum.35)#of windovu(D #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections required. Separate Electrical&lire Permits required. *Where required: Lssuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope ne must sign Property Owner Letter of Permission. A cop of ome Improvement.Contractors License&Construction Supervisors License is requ dd. , SIGNATURE: TAKEVIN_MIluilding Changes\E iux TTLRESS.doc Revised 061313 HOME ,CONTRAr—r PLEASIy READ THIS ��✓✓ Sold,Furnished and Installed by: Branch Name:Boston North&South Date:3 f 5v—a ' TEAT At-Home.Services,InF. d/b/a The Home Depot At-Hoipc Services Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 'foil Free 977-903-3768 Federal ID#75-2699460,ME Lle#C 02439;Ri Cont..UL4 16427 Ac tr Lis-#mc,0565522; #_12a93 Installatlon Address: �isho s CO 6;7,6 0 City State Zip Purchaser(s): Work Phone: Hamm Phone: Cx11 Phone: rot [ ] [ l [ ] Home Address: (Ifdifferent from Installation Address) City State: Zip E-mail Address(to receive project communications and home Depot updates): ❑T.DO NOT wish to receive any marketing cmails from The Horne Depot Proiect Information: Undersigned("Customer"),the owners of the property located at the above installation addrms,agrees to buy.. and TKD At-Home Services,Inc_("The Home Depot)agrees to furnish,deliver and arrange for the installation("nstallation")of all materials described on the below and on the rcfcrcncW Spec Sheet(s), all of which arc incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Changc Orders(Collectively, "Contract"}: Job#c fuwffa kmr=e P oats S Sheet(s)#. Project Amount Roofing Siding indows LJ insulation y>!o. o Yl ❑Gntte,s/Cowers Otlatry Doers'El ill d Roofing USiding LJ Windows LJ Insulation - ❑Guttan/Covers ❑Entry Doors ❑._,,._ Roofing LISiding Ll Rrrndaws LJ Insulation OGurten/Covers CEntry DoorsEJ ❑ItooSng osiding Windows U insulation $ -- ❑Gutterx/Covers ❑Entry Dtwrs Q h inim m 25%Dept of Corntmd Amami due apm owcuilon erthm contract. Total Contract Amount Mtaiure PurrAasers may not deposit more than o w hdod orthe Contract AmotmL e7 C7 Customer agrees that,immediately upon completion of the wort;for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable, each Customer under this Contract agrees to be jointly and severally obligated and liable Hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(i)included herein,at its discretion,if The Hume Depot or its authorized service provider determines that it cannot perform its obligations duo to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or because w&k required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# O�b included as part of this Contract. sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE:T0CUS1W ER You are entitled to a completely Mled-in copy-of the Contract at the time your sign.-Do not sign a Completion Certitica(e(note- there 1s one Completion Certtflcate for each listed Product as deMud by individual,Spec Sheets)berore work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the can-t5 or materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE.ROME DEPOT MAY WiTRAOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT.PAYMENT OR OTHER PAYMENTS MADE, W1TtlOUT LIMITING THE HOME DEPOT'S OTHER REMEDM FOR RECOVERY OF SUCH AMOUNTS. and Asther-igation. -Ca eragrees and-tmdcrstands--that-thm-Agreeme nt]A.IIK:-CiStir�-a$�CeP..trAent-betwEErr�'�llclettr,clr "and he.l-Eome Depot with regard to the Products and hnstallation services and supersedmi all prior discussions and agreements,ciltnx oral or written,relating to said Products and Installaton.This Agreement cannot be assigned or amc nded except by a writing signal by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreem nt_ Acc pted by / Su by: 3 - Customer':1 Signature Datc Sales C nsultant's Signature !?ate X Telephone No. �og !?tom Customer's Signature Date Sales Consultant License No. " CANCELLATION: CUSTOMER MAY CANCEL THIS ("s tppliwbla) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRrrMN NOTICE TO THE,HOME DEPOT BY,M1DN1Gtl'T ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO._ CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON TIM REVERSE SIDE:AND ARE PART OF TBIS CONTRACT 11-08-13 White—BranchFle Yellow—Customer . Td Wd80:t7 0T0Z £ -ioo TLZZZ92e0S:. 'ON XHJ Pe6wiet: WOi' The Commonwealth of Massachusetts Department of Industrial Accidents office-of Investigations 600 Washington Street Boston,MA 02111 www.Mass.gov/dia Workers'.Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): e, V/ _Aa�5 f Address: S ��, City/State/Zip: t y b�. 3033f Phone#:rr � 3 Are you an employer?Check the appropriat�e °z: Type of project(required): 1. I am a e to.er with 4. u 1 am a general contractor and I ❑ Y 6. New construction, employees(-full and/or:ppt-time).* have hired the sub-contractors 2.❑ r am a sole proprietor or partner- listed on the attached sheet. 7: Remodeling ship::and have no employees. These sub-contractors have g. Demofition workingfor me in an capacity. employees arid have workers' Y P tY - $ 9. ❑Building addition ' [No workers' comp 'insurance comp.'insurance. required.) " "` `"" `"5. We are a corporation and its 10..❑ Electrical repairs or additions 3.0 I am a homeowner doing all work officers have.exercised their I LEI Plumbing repairs or additions myself[No.workers' comp. right of exemption per MGL 12.E Roof repairs insurance required:)-1 c. 152, §1(4),;,and me have no employees..[No workers' 13.(g[OthermOU�p�J comp.insurance required.] *Any applicant that checks-box#1 must also fill out the section below showing their'workers'compensation policy i formation. t Homeowners who subrnit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance=Company Name: / w Policy#or Self-ins.Lic.#: kA 0 10. / 942 vZ' Expiration Date: 3 ` EJ� Job Site Address: YZ l SW s > �• City/State/Zip: ge&LVIS. fm Attach-a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1 5500.00 and/or ene-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against 01 e violator. Be advised that a copy of this statement may,be forwarded to the Office of Investigations of the DIA for • ante coverage verification: I do hereby certify under t ins a d pe ies of perjury that the informations provided abo a is rue and correct. Signature: Date: _ p Phone#: Official use.only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other �. Contact Person :. Phone#: w. I - The Commonwealth of Massachusetts Mr Department of Industrial Accidents Office Investigations r_ ff of - r I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly l Name (Business/Organization/Individual): �T/rjd JCL/I�o Address:_ City/State/Zip: f kborv(/ d ye Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I —* have hired the sub-contractors 6. El New construction employees(full andior part-time). 2.0I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance. 9. ❑ Building addition [No workers comp. insurance p• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions' 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.]. *Any applicant that checks box#1 must also till out the section below showing their workers'compensation.policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. . :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information: Insuranrie Company Name: t � � rJ 1 A) C - Policy#or Self-.ins.Lic.-#:. Expiration Date: Job Site Address: _ City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead.to the imposition of criminal penalties of a fine up to $1,500.00 and/or one--year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify nder the a'is and en _ ies of erjury that the information provided above is true and correct. i .5ilgigure Z.. -_.../ _.___ --j Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official Cite or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: u � � a rt ry ..: `xto Public t Boar 0and Iding Regulatioris ancl St �. -07007 _ 7 JOSE �:,C DUAR is FALL $T ^' WARE114M- M-A , ,0257r � F Expf' ratior, 1213012014 , k C mi ner ; � rV4 '9a f 5 r x NOW, a } A, &, J Re.mw,, T � 3 • ran • t „t i W- e4ii, q kyvxx r z rr ` � � ........... . yipSt - )� r �XlF1 i �' � �6 ����� �• all3g su ex y i:f' "�pia.- are] ham, .yy phi q 4 Y F t U^}S�t Sye 7 i�;� L 6 y RNA n x '.F' � d�� �-� �'�. e r Y°'''a•°'dart 'r 4� '"•r' ,,:�• .."�.. >,�' .,�, ;��a:af. r-y.:} �' ,.�y ..;�r-"s� ,y� {., �j,,'t .:yf 1"k 'S . ,'4,.'S' ** �,9 '.3'�• 3°iF `up,,� , yx y� n. i' '� _ `' �" +. I.' s ,':M U>x,* a. ,. „xe r �- .,::.�. $ k 4Y, -�`�q•-�„py- yypp a*"aix. ,,�5 .'�C � i ��•� '".+a' �.. � !ws�{ 'a" F i•'av`k�. �{ Y'�i"'mil •9 .� _wS�x.:."y(:{d "k :s.. a h. 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Supplement Card Expiratbn. 8=014 The Home De t-At-Home Senftj& ANDREW SWEET , -.>V 2690 CUMBERLAND PARKWAY� I; Q ; l -- ATLANTA, GA 30339 g. Update Address and return card.Mark reason for change. F1 Address E] Renewal [1 Employment ❑ Lost Card OP8-CAI O °. 44104410121,8v�,_ omet oT al ii f' a �� a� License or registration,valid for individul use only ME IMPROVEMENT CONTRACTOR > , before the expiration date. If found return to; Office of Consumer Affairs and Business Regulation Registration:'' = 10 Park Plaza-Suite 5170 Expir # Supp4*meM Card Boston,MA 02116 APIgREMI $WE 2690 CUMBERLANI P Y$ �?•+•• . -- � ,GA3033g Uddwoteretarq a signature May 11, 2013 Barnstable Building Dept. '-The following is aylist of our approved sub-contractors for The Home Depot: f Ericsson Torres—CSSL# 100546 HIC # 163528 s . Michael Viola — CSSL# 099403 HIC# 140993 Vincent Smith - CS # 106837' HIC # 165927 Timothy Thomas— CS# 51899 HIC# 152121 Ronaldo Solano — CSSL# 101027 HIC# 152206 Joseph Duarte - CS # 70077 HIC# 132349 Douglas Szynal — CSSL# 103950 HIC# 146142 Brian Laroche-CSSL# 100478 HIC # 152612 Joseph McKeon — CSSL#98863 HIC# 132614 If you have any questions please contact Mike Bedard our permit coordinator at 508-962-6942 or myself at 617-438-9017. S' erel uss one Bra installation Manager THD At-Home Services,Inc. ` 908 Boston Turnpike- Unit 1•Shrewsbury,MA 01545 Phone:774-275-2139•Fax:508-845-6076•Toil Free:800-657-5182 Town of BarnstableExp*Perm d� 7 jate, Regulatory Services Fee 6 ■�srtscs 639. Richard V.Scali,Interim Director w M1� 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 I Not Valid without Red X-Press Ir Frint Map/parcel Number Property Address Residential Value of Work$3 7"/ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address c> 4. Contractor's Name lne- LeAgZ // rl f/ e Telephone Number I-01—vy—— �2 6 8'Q3 Home Improvement Contractor License#(if applicable) I jZ 13 y Email: Construction Supervisor's License#(if applicable) 0 I�Workman's Compensation Insurance i" Check one: El am a sole proprietor MAR 1 2014 ❑ I am the Homeowner RI have Worker's Compensation Insurance T0wN®F 13RRN8T Insurance Company Name) y ��f��� /ems . CID „BL� Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side a Replacement Windows/doors/sliders.U-Value , 3 O (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. , Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of th H Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: T:\KEVIIY D\Building Changes\EXPRE SS. oc Revised 061313 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ., Boston,MA 02111 wM www.mass.gov/dia Workers' Compensation Insurance.Aftidawit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgdhization/Individual): / � J/Ei '� � L9Z�d� �l�/C� C✓ Address: k0hp City/State/Zip: 441"Va, 0,303g Phone#: Are you an,employer? Check the appropriate x: Type of project(required): 1.❑ I am a employer with 4 I am a general contractor and I employees(full-and/or part-time).* H1.ave hired the sub contractors _6. ❑New construction - listed on the attached sleet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- shi and have no employees These sub=contractors have g• ❑Demoliltion P:. working for mein any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance.$ 5. We are a corporation and its 10.❑ Electrical repairs or additions required:].. - ❑ officers have exercised their I L Plumbing repairs or additions 3.❑' I am a homeowner doing all work ❑ g .eP • 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.Z Other LD 10A Q U) comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractor's 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. �' / /3 Insurance Company Name: //��/ Policy#..or.Self:ins. Lic.#: W C, 0 Ll q 10: 12 2 a Expiration Date: Job Site Address: 1,57qn4s_ City/State/Zip: u Attach.a-copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ins0lince coverage verification. I do hereby certify under th p 'is and penalties of perjury that the information provided abo a is rue and correct. Si ature: Date: b Phone#: ( ✓ / 3 — Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License#- Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: G/ Ltl1P � ess Re ulation O ice o�sumerAd�d+o" i g 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 ome Improveth Contractor Registration / k Registration., 126893 ° Type_ Supplement Card ° Expiration: 8/3/2014 The Home Depot At-Home Servit3's: „ ; 1;•c� ANDREW SWEET 2690 CUMBERLAND PARKWAYf` UI " -- ATLANTA, GA 30339 Update Address and return card.Mark reason for change. (� Address n Renew+al [] Employment [] Lost Card OPS-GAi 0 °AM••04/04-GIM76 �/ ,,,( Otltee OAS �i'r re no reegu`at�� on License or registration valid for individul use only OME IMP QVEMEtd7 CONTRACTOR before the expiration date. If found return to; Office of Consumer Affairs and Business Regulation RegiaLratlow,,�, %93 Type. 10 Park Plaza-Suite 5170 Expirt�an; .pl1g Supplement Card Boston,MA 02116 e orVDepol°•4. i { h • ANDREW SWEF' ,",,r) 2690 CUMBER LANi PAok-w lap �► AI1,©A 30339 Undersecretary at t ou signature I ' 2014-02-19 11:01 2612EXPDTR.PHONE 5089574714 >> Home Depot AHS P 1/8 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,FumishW and Installed by: Branch Name:Bosh North&Swth 'Date:a/61`� THD Al.Home Services,Inc. d/tda The Home Depot At.Horne Services Branch Number:31 and33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903 3768 Federal lD#75-20)WA);ME Lie#C 02439;R I Cont.Licit 16427 L ( 17 Lie#HIC.0565522;MA Home In'quomucnt Ctntraotir Rey,It 126893 Installation Address: I 1'5110 0:5 J C I 1 K 4. ! G� -Oak,o City I State Zip Pur'd'aset'(s): work Phone: Home Phone: Cell Phone: Home Addrem: (If different.from Installation Address) City State. Zip E-mall Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive,any marketing emails from The Htmne Depot ?iect Information: Undersigned("Cnvtomer"),the owners of the property lomted ai the above installation address,agrees to buy. andTHA At-.omc Services, inc.("The Home DepoY')agrees to furnish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Shect(s),all of which are in agxrraLM into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: am—a ate ) Products: ' Sheet S1# Prgirct Amount Rixfitng LjSiding A2J.Windows LJ Insulation I r 1 L) ❑Gutters/Covers ❑Entry amrx ❑ 65 I(C( I I i Ruut�ng Siding❑Wtndnws Insulation I I $ I ❑Gutrers/C:nvers ❑Entry Duurs ❑ I Rmdiui i g❑Siding�Windows insulation I I ❑GRtcrs/Covers Or Doors❑_.. 1 Roofing LJSiding U Win:&)ws' hwufIItion ©(inners I Covers []Entry Duots ❑ i $ j MinimuM25%a Deposit ofCanh rtAntnmttdueuponemmilianoflhhtcunirwl Total Contract Amount $ Maine Pro m m may not delxtdt nitre than one tbtrd of the ConUFAAmotmt �{ Customer agrees that,immodiatcfy upon completion of the work for each Product,Customer will execute a Completion Certificate (cure fur each Product as defined by an individual Spec Shecl)and pay any balance.due. As applicable,each C'.umtmer under tf+is C rmtract agrees to be jointly and severally obligated and liable hereunder. The Howe Ih:punt reserves the right to Issue a Change Or(V or umninate this Contract of any individual Product(s)included hercin,at its discretitm,if The Hamm Depot or its authorized service provider deix.rmincs that it cannot perform its obligallous due to a structural problem with the home:,envimmitental hazards such as mold,wtx:sum or lead paint,other safety concerns.pricing errors or txcausc work required ut complew the job was not included In the onto ct. Pavntdent Summary: The Payment Summary A�Y/ included as part of this Contract, sets forth doe inlal Contract amount mid paymenCs required for the deposit);end final payntwis by Product(am.applicable). NOTICE TO CUST()MI:R You are entitled to a completely filled-in copy rrf the Contract at the time you sign- Do not sign a Completion Certificate.!note: there is one Completion Certificate for each listed Product as defined by Individual Spec Sheets)Wore work on that Product is imniplete. In the event of termination ttf this Contract,Customer agrees to pay The Hume Depot the costa td'materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date or termination,plies any other amounts set forth in this Agreement or allowed under app)imble law. THE HOME DEPOT MAY W ITIIII0I,D AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR Irt'HF.R PAYMENTS MADE WITHOUT LIMITING THK HOME DKPOT'S OTHER REMEDIES FOR RhCOVERY OF SUCH AMOUNTS. Acceptance and Atrthuriratiun; Cusunner agrees and understands that.ibis Agreement is the cnfirc agreement txitwccn Cusnuuler and The Home Depot.with regard to the Products and Installation services and supersedes all prior discussions and a frecu:cnts.either oral ttr written,relating to said Products and Installation.This Agreement cannot be acxigncxl or amended except by a writing sinned by C;URtdneer and'1'lie!dome Depot.C.ustomLr acknowledges and agrees that.Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Ac ed hy: I Sttb 'ttcd by; - / C omen's 5ignatur Date Sales onsu tant's Sigmature . Dttte X Telephone No. Inn Customer's 5igatature bete Sales Consultant License No. CANCELLATION: CUb'TOMF,R MAY CANCEL THIS (axupplicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE, HOME DL+PCYl' BY MIDNIGHT ON THF. THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMPNT ATTACHED HERETO) CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED RV LAW A CUSTOMER'S STATF, NOTICg:ADAi9TONAL T7:RMS AND CONDITIONS ARE STATED ON THE REVF.RSR SIDE AND ARE PART OF THUS CONTRACT ONTRACT 11_W13 White—Branch Fite Yellow• Customer • y � � � �u• X".w .. e a r. x .. R4 ':�` rNs• ,•G 7vL':`4 �,y i'�„ t+��rL r'!. '�,",Q' w l ' ,�. "._.' ,� �, , r .... _��:..::. .. rc"c`. 'r"we � 'T �'� � �' � i � ,,.s x��':p rf:1•a� �� s �',. #Y.ap,' ' r.fiat`:` � .s 0—m' � ' r ,, .,t ::�5'.•. s .�-�. .. .y'f .,;:'.',- ,, �, r,. iS;.�� �k ,�:"rrr's°. � 'r' .�';rE:_'Sv. n 5�.:..'r.-.. m,. ,.�,.,,;R�n,S >b �:. x >r '"rn.'"'p,•t'...�,s�i-`,� I �.-,- `-:: � ..y; ....• "`•s r �' A ,',�. f•h� '' �,.��'. .i. i �;, , M:1.' "4*v.... •'!5+ .C4�. r-`,. .,: ....ag^ `. % !� .ryV a,fi, - ��,rqy, ��a..- w .m ,J W- � L.; *.k.. ..-t� '9;:•- '.r r:`�"' ,c ,=,crsy^y s'''}"'�`1".r+. o'�'� 4i.: ''�F", ��:, u• Ql""7 :$.' 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'� rC a .a,,...wa..+.+°— ,.r�Leo i!`�'V s f .w e: .vs� y + i 4 ' Y i� �• �R ,ems - ���� 6 � "'? }PX. - �p�s � � .� F, �°h. r • - l + w , v { dA � a ` r n • ; Y^ v 4 S A - n C + r 3a Mel � x � _�'� � z�€ � �`.?... ,���`rz+ �( -sue t x _ z�"�'�,, -_ � "<�� i; � �' _ �.g•. �;y;., t „�J'�5,.'� 1 �.lf'�r✓.-11X': i-5S?�� _.Z �'� -a � • . Y f 5 - ,F K o t ' the Commamvealth of Massachusetts Deparhnent of Industrial Accidents - - O, rwe of Investigadons 600 Washington Street A� Boston,M4 02111 n ms,.mass gvvv/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Naive U: �i�lfay Address: /� /�Sri 1U W A-c� 77-7G.� City/State/Zip:/1( 44) d L3 6 Phone Are you an employer?Check the appropriate box: T of project 4. I am a era)contractor and I YI#e p J £ ��� 1.K I am a employer with� ❑ 6_ ❑New construction employees(full and/or part-time)-* have hired the sub-contractms 2.❑ I am a sale proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition w for me in an t employees and have workers' �g y capacity. Y 9. ❑Building addition [No workers' comp.insurance comp.insurance. required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance required.]S c. 152, §1(4.) and we have no employees-[No workers' 13.aOther W/k o CJ comp.insurance required.) l B *Any applicant that decks boa#1 must also fill out the section below showing:th&workers'compensation policy information I Homeowners who submit this affidavit indicating they are doing all wal and then hire outside contactors most submit a new affidavit indicating such. IContmctors dhat check:this boat must attached au additional sheet showing the name of the sub-coun3am and state whether or not those entities have employees.If the sub-cantradtors have employees;they must provide their workers'romp.policy number. I air an employer that is providing workers'congwnsation insalrance for my engAoj ees. Below is the policy arrd job site information. / M _ Insurance Company Flame: L-. /' I �W 5 UVA1-re Policy it or Self-ins.Lic.4: --3'9'y 800 "6[4 Expuat on Date: � 2 �J Job Site Address: t.5t City/State/Zip: ) AtA Arttach a copy of the workers'compensate n policy declaration page(showing the policy mum er 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby G aaaatler tlaepaiaas Adpenalties<peduty that the information Arad aM hove is orate andtxirrect Si flue: Date: Phone#: -7 7 - 766 ( oZ Official arse only. Do not write in dais area,to be completed by city or town official City or Town: P'ermet.Ucense# Inning Authority(tdrcle one): 1.Board of Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector 5.Plumbing btspector 6.Other Contact Person: Phone#: ' I 3/3/2014 10:44:07 AM PST (GMT-8) FROM: 100005-TO: 15097302086 Page: 2 of 2 CERTIFICATE OF LIABILITY INSURANCE D"----ETE° *Go`Yr'"1 3r"M4 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 INURED,the pdicy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endonament s. PRODUCER PAUL B SULLIVAN INS AGCY INC CONITACT 1467 S MAIN ST PMONE FAl E•I1As. FALL RIVER, MA 02724 AI`N° ACCRIEft INSURERS AFFORDING COVERAGE NAIL 9 NSURERA: LM Insurance C lion 33WO INSURED INSURER B: JOSEPH DUARTE&JOHN DALEY DBA J&J REMODELING NSURERC: 15 WILSON WAY "SURERD: MIDDLEBOROUGH MA 02346 INSURERE: INS RER f: COVERAGES CERTIFICATE NUMBER: 19398310 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR Pau EFF PO ICY P TYPE OF INSURANCE aR POLICY NUMSIER #MM1I)D1YM1 IMMJDDIYMiLIMITS LTR COMMERCIAL GENERAL LIAOLITY EACH OCCURRENCE S CLAMS4AADE OCCUR PREMISES fEa ac MEDeutraneeV �e S MED EXP(Any one person) S PERSONAL S ADV INJURY S GEN't AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S JECT POLICY ElLOC PRODUCTS-COMPtOP AGG S OTHER: CADMINErD SINGLE LIMIT S AUtOMOHR.E LtASLITY a etc' $ ANY AUTO ` BODILY INJURY(Par parw) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS - HIRED AUTOS NNON-OWNED _ � � ROA aderA PER DAMAGES $ UMBRELLA LtAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLANS-MADE S DED I RFTENTiow A WORKERS COMPENSATION WC5-31S-384800-014 2P1/2014 2/2/2015 SPER TATUTE ER ANC EMPLOYERS'LIABILITY YIN s' ANY PROPRIETORIPARTNER£XECUnYE EJ_.EACH ACCIDENT S 1o0D00 OFFICERIMEMKR EXCLUDE? N IA (Mandatory inNN) E.L.DISEASE•EA EMPLOY $ 100000 ]Iy sa As,dabe under DESCRIPTION OF OPERATIONS bAbw E.L.DISEASE-POLICY LIMIT S 500000 OESCRIPTION OF OPERATIONS(LOCATIONS I VOKLE-S tACORD 101,Additional Remarks Schedule,maybe a0echsd It mate space Is required) Workers compensation insurance coverage applies only to the workers Compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers Compensation Coverage. NO PARTNERS ARE COVERED BY THE WORKERS COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION THD AT HOME SERVICES, INC.AND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT ACCORDANNCCEWM4T(HEPOLLICYPROY ONSE YNLL BE DELIVERED IN 2690 CUMBERLAND PARKWAY SUITE 300 ATLANTA GA 30339 M AUTROIUZEC11tEPREE6NTATNE. LM Insurance Corporation i 01988-2014 ACORD CORPORATION, Ail rights reserved. ACORD 25(201401) The ACORD name and logo are registered marks of ACORD CERT n0.1 19399110 CLIENT CODE: 15051C: Didi Dangea 3/3/2014 10:21s27 An Page 1/gr 1 - f r I May 11, 2013 Barnstable Building Dept. The following is a list of our approved sub-contractors for The Home Depot: R Ericsson Torres—CSSL# 100546 HIC # 163528 i Michael Viola — CSSL#099403 HIC # 140993 Vincent Smith - CS # 106837 HIC # 165927 Timothy Thomas- CS# 51899 HIC # 152121 Ronaldo Solano — CSSL# 101027 HIC# 152206 Joseph Duarte - CS # 70077 HIC# 132349 Douglas SzynaI -CSSL# 103950 HIC# 146142 Brian Laroche —CSSL# 100478 HIC # 152612 Joseph McKeon - CSSL# 98863 HIC # 132614 If you have any questions please contact Mike Bedard our permit. coordinator at 508-962-6942 or myself at 617-438-9017. uss ne Bra Installation Manager THO At-Home Services,Inc. 908 Boston Tumpike- Unit 1•Shrewsbury,MA 01546 Phone:774-276.2139•Fax:508-845.6076•Toll Free:$00-657-5182 TOWN OF"BARNS ASLE ZM9 SEP 1 I AN fl: 46 511°25746W DIVISioN - 133.00' F I -0ECK I ell •' -PATIO ' Ul — — — tD 0ECK - Z J 01 o m INo. 142 ` I 1/2 5TY.WD.FR. APN 25 1 - 1 77 15, 1 G2±51' N 1 1*25AIST 133.00' j q0L 15151101`5 TERRACE I HEREBY CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE, AND IN MY PROFESSIONAL OPINION, THE SWIMMING POOL'15 LOCATED ON THE GROUND A5 5HOWN HEREON,AND IT5 LOCATION 15 IN CONFORMANCE WITH THE HORIZONTAL SETBACK REQUIREMENTS OF THE TOWN OF BARN5TABLE ZONING BY-LAW. mft A5-13UILT PLAN JoB No.: 09178 IN DATE: 025EP09 • ri , MA55ACfIUHTT5 SCALE: 1" = 30' PREPARED FOR 5ANDRA MCGEE r.j: hood son,'Inc. t Land surveyors - englneer5 s 18 route GA, 5andwich, ma 025G3 Ph: (505) 888-1090 Fax: (50(5) 633-62 1 2 • 0 3SE.t� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map.. Parcel Application # 9aoqp3Yw Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee f ' Date Definitive Plan Approved by Planning Board Historic- OKH _ Preservation/Hyannis Project Street Address Village t lh nJ/\J Owner Address SG — Telephone Permit Request AJ (2,Aoy N� �C,cJ t/V1 14 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new 280 � Zoning District Flood Plain Groundwater Overlay Project Valuation 1 OO Construction Type ��o�nJ�S� �/�-� Pop IlV Q/__ Lot Size 1 15i I 60 O� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .tl:� Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: kull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(soft E o Number of Baths: Full: existing new Half: existing net Number of Bedrooms: existing _new ; Total Room Count (not including baths): existing new First Floor RoorT Count "n Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes X No Fireplaces: Existing New Existing wood/coal stove*YE,❑ No a X-d4 Detached garage: ❑existing ❑ new size_Pool:Xexisting Xnew size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name . ' �— Telephone Number Address > C� C�,A p;:�,-Je,' License# 130 6 �_6 Home Improvement Contractor# 30 6 Worker's Compensation # 2 17 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �-- ���. SIGNATURE ATE o�� t. FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. T ADDRESS VILLAGE OWNER DATE OF INSPECTION: eo �- �2Uu� FOUNDATION FRAME f INSULATION L1` FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING l DATE CLOSED OUT _ ' 4 ASSOCIATION PLAN NO. ` z PROPOSED 4' POOL-RATED CHAIN-LINK FENCE ;TYP.) 51 1°25'4G"W 133.00' 91 PROP05ED PROPOSED IN-GROUND 2)NPG-OUT POOL 0 F — 7 I DECK I ' DOOR < ALARM — z 4.5 GAT '�•---0 �;• PATIO z 1 PROPOSED m o . 5WI NG-OUT DECK J N � W1 b -t�! lNo. 142/ _1 I 1/2 5TY.WD.FP.'. - 4 m DECK,-- ---� o rAP N 25 1 — L 7 7 BIT.DPoVE 15, 1 52±5F N I I°25'4G" 133.00' EDGE OF PAVEMENT !_ • EDGE OF PAVEMENT BISHOPS TERRACE r I HEREBY CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE, AND IN MY PROFESSIONAL OPINION, THE LOCATION OF THE PROPOSED SWIMMING POOL, A5 SHOWN HEREON, CONFORMS WITH THE HORIZONTAL SETBACK REQUIREMENTS OF THE ZONING BY-LAW OF THE TOWN Of 5ARN5TABLE 51TE PLAN JOB No.: 09 178 IN DATE: 24AUG09 HYAN N 15 , MA55ACH U5ETT5 SCALE: = 30' PREPARED FOR `. 5ANDRA MCGEE r.j. hood * 5on, Inc. land surveyors - englneer5 p.o. box 1724 ma5hpee, ma 02G49 Ph: (508) 539-7799 Fax: (508) 539-7789 pf rTown of Barnstable °-� Regulatory Services saat SMBL . = Thomas F,Geller,Director Mass. a Building Division Tom Perry, 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 >as of the,subject property i b authorize `Y11 S/ act on my behalf, hereby in all matters relative to work authorized by this building perrrdt application for: ls� S Y %'!�•-�`_ Off/( d� (Address of Job) Signature of Owner ate Print Nariie Q.F ORM&OWNERPERMISSION I The Commonwealth of Massachusetts Department of Industrial Accidents ro Office of Investigations r 600 Washington Street w+� ry Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information D Please Print Le ibl Name (Business/Organization/Individual): ��M 6 t�� � Lem ?_ Address: .l 1 �2 ' City/State/Zip. p�A)/� L -S Phone # 4 7 7 Are you an employer? Checkf the appropriate box: Type of project(required): 1.VJ I am a employer with �I 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 These sub-contractors have ship and have no employees T .. 8. 0 Demolition workingfor me in an capacity. employees and have workers' y p y• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10•❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of thersub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n • Insurance Company Name:"�l of l Policy#or Self-ins. Lie.#: 19 1 0 —72, Expiration Date: 0 City/State/Zip:���Job Site Address: L V� G�IJAVI ����_. � Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil'penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties o perjury that the information provided above is true and correct. Signature: Phone#: ( 50 g) Official use only.'Do not write in this area,to be completed by city or town official City or Town: Per # Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5:Plumbing Inspector 6. Other Contact Person: Phone#: ;-t Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having riot more than three apartments and who.resides therein,or the occupant of the dwelling house of anothei who employs persons to do maintenance,constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 4 x Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only,submit one affidavit indicating current ' policy information(if necessary)and under"Job Site'Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number::- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia l P11 ALBERTO W ANCE R.E. FAX NO. SM6730734 P. 05 6i:t2on 1 rem-At& 4n 331 6594 7-5?S P.005/t114 F-231 PRODUCER TNS tr-AcT(F(C.ATE IS 1=90 AS A E 'F"t'ER Of INFORMA'iRON ONLY AND�W RIGWS U€M THE CERT(F#CATE Antmb f!Reno Ism Agency H�3 -m THIS C 'S1 CATS DOES NOT AMEtw.EXTEND OR 420 Sta(inM Rd ALm THIS'CovamnE ABED 9Y THE POLICIES BELOW Fell River,MA 02721 555�- 00WA A GRA TE STATE uRANcr:CEmPAwY INSURED Steven Sennm 4fIA SwWmming Pao(R Spa ONIP 105 Et�riutsa Bid . 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BR,aCg •-.• l LL oiY d Y NttSI.M:b AMO U:fN P+I�ItT NnCKVIlI tO VPv1NM.P.M L�2 x R 2'-0'f#X 6�/ya 61/2•aH(fA. 4N /4ra`v tlF+,aA I+ h�'°}MMYA .i4vkY MSV Tnl 4• T 2=d 6' I aB1[i ANOLP �� �� t a ""'js°""�'I;' r(;iru"�nG�`ilrlt wT RGYIAI°RA a41L iv an 1rr Ulr Lnx�. . TYPICAL Wl.1Li_ SECTKNV. :TYPICAL-.:YI(ALI,- STIFFENER �z=a�•Ovo�x�,na;rwro :....... .. ... . ....... .. ,. rr ice.;,.,. s ....... .................,,. .. ... .... ... ..... ....... .IW... .MIA9 r .tR. .. .. In. fl..rw.+rol .n•r^ .n. . •r. ,.. ,.,,,. ., ,.. ,. ,..... �r�w...:i;�!�i..w.....�?L•�...a�'�:u4G': �n?,..k, t;?t t,. . , �.r:u,u.:Tt.,7.:.rannreri . `•iiv. ,;/1•Y'.':AAII"t':C,YA'Alfa .+x�. +rhrrb�ronv. u - = BiToW uWg Veta. o tj� s One Ashburton Ply rh 1301 Boston. Massachusetts 02108 Home Improver_nerLf, r Registration ---- �-% Regg s�on; 130666 Type: DBA —- =- - ExOration: 4/a 010 Tr# 266242 The ern € od Spa Sale & Ser, w@ Steven Sena r.-- P.O. lox 3512 E. Falmouth, MA 02536 fly Ad&ew aid mare card,Mark reason for change. f j Addreu Of Renewsl I—, EmpWynmt F� Lmt Card Dot � sr�-ffrrs��saso �lre-tt�ioav�urt��c�.1�,cr:�aa�c Board of BmW g Rep fa#'am and Standards I.: Se or registration valid for individul use only gwwv� HOME ill RovEmENT CONTRAC OR before tlae expir d� If d aetar$s W: -4,1 Board of emiding Re a s and S ►lards � 13D Onel�ae IMI _ 910 Tr# 2 42 _ .��_-_. Via,Na.02109 The SvAm Pad S sbid�r cetGrp Stevens 103A tense E_Fa1rr ft,MA 0253a ^` Rdm?aistmtor Not -ad without sig s ture �4 32 31 00/AME WARDlA►ARE Buyliine 5862' Ameristat®Deadbolt Lock --- Eliminates need for weld-on lock boxes Ferrule gy p ` Pin Hinge .;) - Self-latching bolt and a dead bolt can both be Indusbial- ® adjusted over 3/8'with Magna- Double Drive Cane Bolt an Allen wrench" Latch latch 0 y>3 z:. •Keyed tadcAom Sides r ° ,�''' Mate 'Completely Rustproof Pin Fringe ® •Easy lnstallaum + i7 •No Welding ° 0 / Adjustable Bo t tergm Tru-Close Box / Hinge Hinge R For single gates / Easy-mount striker plate 180 Hinge Fork Latch T_ SECTION 32, 3100 - GATE SYSTEMS Architectural Metal Swing Gates PART 1-GENERAL ' 1.01 WORK INCLUDED such a manner as to ensure proper ventilation and e. Gates shalt be fabricated in a manner that ensures The contractor shall provide all labor,materials drainage and to protect against damage.weather, each upright and rail intersection is joined by and appurtenances necessary for installation vandalism and thaft. welding. Each pale or picket and rail intersection of the architectural metal swing gate system defined shall be!dried by welkfmg or by the same process herein at(specifyroiect sitel. P�2-MA�� used for fence panel assembly. 2-01 MANUFACTURER C. Completed gates shall be capable of suponrttrrg a 1.02 RELATED WORK The architectural metal swing gate system shall (specify 600lb for Impasse®Aegis 110oi echelon conform to the Ameristare(specify material as II®gates or 200 lb.for Aegis Plusr3 Montage Section 022__-Earthwork aluminum or galvanized steel),(sper&fence lvoe Pius@)or Echelon Plus®)load applied at midspan Section 030__-Concrete as_Impasse@ Security.Aegis It®or Echelon II® without permanent deformation(prior to mounting Industrial Ornamental or Aegis Plums Montane gates to posts) Phis@ or Echelon Plus@ Commercial Ornamental) 1.03 SYSTEM DESCRIPTION design,(specify the style from those listed in the The manufacturer shall supply.a total ciiv manufacturer's literature for the applicable fence D. sage pretreatment/wash /wteel gates shall( ith zinc phosto a phate)as aluminum or galvanized steep swing Ue)style. stage prby anmectrost ti(with zinc phosphate) , gate system of Ameristare,(sMity fence type as_ followed by an electrostatic spray application of a Imoas_see ce_�Aegis 119 or Echelon 11®Industrial two coat powder system. The base coat is a Ornamental.or Aegis Plus®. Montage Plus®or 2.02 MATERIAL REQUIREMENTS thermosetting epoxy powder coating(gray incolot) Echelon P mmerci l Ornamental)design and A- If material for gate framework CLe.tubular pickets, with a minimum thickness of2-4mills.The top coat - (speft the sWe from those listed in the manufacturer's rails and gate ends)is steel that is galvanized prior is a"no-mar"TGIC polyester powder coat finish literature for the applicable fence types We defined to forming,it shall conform to the requinnents of with a minimum thickness of 2.4 mils.The color herein. The system shall Include all components(i.e., ASTM A924,with aminimum yield strength Of50,000 shaltbe(specify Black Bronze White or Desert pickets or pales,rails,gate uprights and hardware) psi(344 MPa).The steel shall be hotdip galvanized Sand for Imp-ssoO.Aegis Plus@ and Aegi Is Is i®or required to meet the requirements of ASTM A653 with a Black Bronze or Desert Sand for Montage Plus). minmum zinecoating weight of 0.90 oz/ftr(276 g/ml, Coated galvanized framework shall be capable of Coating Designation G-90. salt spray resistance for 3,500 hours without loss O 1"04 QUALITY ASSURANCE of adhesion on parts scribed per ASTM D1654 and The contractor shall provide laborers and supervisors B. If material for gate framework(Le.tubular pickets, tested in accordance with ASTM Test Method who are thoroughly farniltar with the type of construction rails and gate ends)is steel that is galvanized after B117.Falure is considered to have occurred when involved and the materials and techniques specified. forming,it shall conform to the requirmenls of ASTM there is either I1W coating loss trumthe scribed mark LW A1011]A1011M.with a mi;amrnn ytaM_=r'sgh of or an accumulation of medium @8 blisters.Coated 50000 (3A4E£ �k k b•� galvanized framework shall also be capable of psi1.05 QUALITY ASSURANCE g t=0 o 1-e360ifIl k•�ffilmzmc meeting the performance requirements for each ASTM A653/A653M-Standard SpecfiCa?epn for S_J Ttl--i€ st i star be coated with a quality characteristic shown in Table 1- Sheet,Zinc-Coated(Galvanized)or Zinc-lron AKW. gtk_.�a!at-nominalzinc pigment Ong E. Aluminum gates shall be subjected to a six-stage Coated(Galvannealed)by the Hot-Dip Pnmass ASTM 03 r�(®-�mm)minimum thickness. pretreatmerilfwash(with zinc phosphate)followed by • A924/A924M- Standard Specification for Genera an electrostatic spray application of a polyester Requirements for steel Sheet.Melanie-Co K C ff for gate framework(.e.tubular pickets. finish. The finish coat shall be a'no-mat TGIC Hot-Di Process. ASTM A10111AI011M-Sold rails and g�ends)is aluminum,it shall conform to P the requirements of ASTM B221.The aluminum polyester powder coat finish with a minimum Specification for Steel,Sheet arid Sbila,Hot�L"�ii.3, thickness of 2 mils(0.0508mm). The odor shall Carbon,Structural,High-Strength arid F3�h extrusions for posts and rails shall be All andLow-A be(stJech Blade Bronze White or Desert Sand Temper Designation 6005-T5. The aluminum ASTM BI with Improved Fminab y. for Echelon II®or Black Bronze or White for ASTM B117_Practice for Ope SaR Spin)(Fog) sextrusionshef be A for pickets and rail inner slide channels fl Apparatus. ASTM B221-Standard Specification for shall be Alby and Temper Designation 6063 T5. Echelon Plus©). Coated aluminum framework shall capable of sat spray resistance for Aluminum and Aluminum, Extruded Bars.Rods, hours w , Wue,ProNes andTubes.ASTM D523-Test Method for D. Material,dimensions and spacings for gate pales without loss of adhesion on parts centredder Per Specular Gloss ASTM D822-Practice for Conducting pickets and for gate rails shall be the same ASTM of 654 and tested in accordance with ASTM Tests on Paint and Related Coatings and Materials as that used for fence panels of the ecify fence Test Method Bi 17. Failure is considered to have using Filtered Open-Flame Carbon-Arc Light and Ime as Impasse®Security Aegis 1 or Echelon occurred when there is either t/8"coating loss from Water Exposure Apparatus. ASTM D1654-Test II®Industrial Ornamental or Aegis Ptus_c.Montage the scribed mark or an accumulation of medium Method for Evaluation of Painted or Coated Specimens Pi's@ or Echelon Plus@ Commercial Ornamental) t8 blisters. Coated aluminum framework shall to Corrosive Environments. ASTM D2244 type and(specify the style from the listed in the also be capable of meeting the performance Subjected-Test Method for Calculations of Color Differences manufacturer's literature for the applicable fence requirements for each quality characteristic shown from instrumentally Measured Color Coordinates. type)style-Gate uprights dull be(5Pp1y2"syuare in Tablet. ASTM D2794-Test Method for Resistance of Organic x 16 gill galvanized -steel for lmpasseTM Security. PART 3-EXECUTIONCoatings to The Effects of Rapid Deformation(impact). 1 7. 5'square x 16 ga,galvanized steel-fo Aegia 3.01 PREPARATION ASTM D3359-Test Method for Measuring Adhesion Ib and AegisPI O roar all Sipe'. q All new u tallafiDn shall be laid out by the C intracor by Tape Test. x 0,250'aluminum for Echelon 110 Ornamental Aluminum or 1-1/4"spuam x 0125"aluminum for in accordance with the construction plarLs C 1.06 SUBMITTAL Echelon Plums). 3.02 INSTALLATION The manufacturerssubmita package shall be provided Gate post(s)shall be spaced according to the prior to installation. 2.03 FABRICATION gate openings specified in the construction plans- The'Earthwork'and"Concrete"sections of this A. Pickets or pales,rails and uprights shall be precut specification shall govern post base placement 1.07 PRODUCT HANDLING AND STORAGE to specified lengths and prepunched or predriied 9 Po P Upon receipt at the job site,all materials shall be as necessary to accept ipalted components,torts or and material requirements. checked to ensure that no damages occurred during fasteners. 3.03 CLEANING shipping or handling. Materials shall be stored in The Contractor shall dean the jobsite of excess materials. Post hole excevatics shall be scattered t uniformly away from post(s). Table 1 -Coating Performance Requirements Quality Characteristics ASTM Test Method Performance Aequirments Adhesion . D3359-Method B Adhesion(Retention of Coating)over 9tP/of test area(Tape and knife lest). impact Resistance D2794 impact Resistance over 60 inch lb.(Forward impact using 0.625"ball). Resistance Dom•�44• Weathering Resistance over 1,000 hours(Failure mode is 60%loss of Weathering D523(60°Method) gloss or color variance of more than 3 delta-E color units). e Page 39 CONSTRUCTUON SPECJF#C/`11II U®N 3231 00/AME B5 ine 5862 j SECTION 32 31 00 - COLOR CHAIN LINK FENCE SYSTEM Utilizing PermaCoat® PC-40'""(Industrial) or PC-20'(Commercial) Fence Pipe L' (MEETS"BUY AMERIC&E nna,MES7•IC PROC(IR eAEMM o PART 1-GENERAL 1.01 WORK PART 2-MATERIALS { r INCLUDED 2.01 MANUFACTURER Fence Pipe shall conform to the requirements OfASTM e The contractor shall provide all tabor,materials and F1043;the mtnuman weight shall not be less than g� appurtenances necessary for installation of the color Framework for color chain link fence systems shall of the nominal weight(see Table 1).The strength of chain link fencingconformtoAmenstarOPermaCoat®(sned _0- Q system defined herein at(spg Irtdeestrial WPi ht or MTM P�i line,end,comer and Pull posts shall be detemtmad aroject c g)• Fence Pi 9 yuu the use of 4'w 6'canilevered beam test.The top rat 1.02 RELATED WORK Pe,as manufactured by Amerislare Fence shall be determined by a 10 free-supported beam test Products vh Tulsa,Oklahoma (see Table 1). An altematirre method of determining o Section 03300-Paving and Suris Co ng pipe strength is by the calculation of bending moment Section 03 i00-Case-in-Place Concrete 202 MATERIAL-STEEL FRAMEWORK f Sermon 04200-Unit Masonry A The steel material used to manufacture Ameristare (see Table 1). Conformance with this specification PermaCoaP 1115am fv PC-4 Ind1 rce' r Can demonstrated by measuring the yield strength 1.03 SYSTEM DESCRIPTION PC-2oTM .r,.�.,,or...er tar �,, of a randomly selected piece of pipe from each Fence Pipe shall be lot and then calculating the section modulus. The a t Theconbactorstnallsu zinc-coated steel strip,galvanized p supply by the hot-dip yield strength shall then be determined acco^firng to system of the design.style and strength defined herein. Process conforming to the criteria of ASTM A6531 the methods described in ASTM E8. For materials Thesysfamshapincludeapcorrnpprrents(Le.framework A653M and the general requirements of ASTM under this specification,the 02 chain fink offset method shall O fabric,gates and fillings)required A924/A924M' be used in determining yield slue line posts and to ngth.Terminal posts, 1. 1.04.OUALITY ASSURANCE S. The zinc used in the galvanizing process shall specified lengths•p/bottom rails shall be precut to !i The contractor shall provide Laborers and supervisers conform to ASTM 86. Weight of zinc shall be cat } who are thoroughly famifiarwithlharypeofconsUnuMore determined using the test method described in 203 MATERIAL-FENCE FABRIC involr�and materials and tedmiques specified. ASTM A90 and shell cordons to the weight range A. The material for chain link fence fabric shall be allowance for ASTM A653,Isoecih Dac =rm� manufactured from 1.05 REFERENCES G210 for P enr a Ind ter^l Weight or Dec galvanized steel wire.The weigh G-90 for PG20TM Weight)., � of zinc shall meet the requirements of ASTM F668, . A. American Society for Testing and Materials(ASTM) Table 4. Galvanized wire shall be PVCcoated to Standards: A90/A90M-Test Method for Weight C. 1Tnefrarrnevwrkshallbe meet the requirements of ASTM F668 The class of a (Mass)Of Coating on Iron and Steel Ar6des with Znc manufactured in accordance the fence fabric shall be(seed Class t. an a t.or Zinc-Alloy Coatings A653/A653M- with commercial standards to meet the strength Class 2A_Extruded and Bonded or Cl eu for Steel Sheet,Zinc-Coated Specification (50,000 Psi minimum yield strength)and coats Alloy-Coated(Galvannealed)py� or Znc Iron 9 and Bordwi). a I requirements of the following standards:t.)ASTM _ A924/A924M-Specification for Ge General Pry F1043,Group IC,Electrical Resistance Welded B. Selvage:T edge Process. 9 op ge 5par h k MkIg for Steel Sheet,Metallic-Coated bythe Hot-Dip process Round Steel Pipe,(soeaN he J +. f v m a d o_ twhgW and for_PC-40 or i edg (;r&€�(y-knudded or hv'et Salt SpeaflcationtorZnc.B117-Practicelipr --�9ht mdu�* ".w fgy hlr PC" V -iSP4• Operating 2) M181,Type I,Grade 2 Bectrcal O f Prat (Poll)Apparatus. D1499-Practice for Welded Steal Pipe.3.i RR-F-1 ect Ck�ResiGr� C. (Cosoaci Bla��g Color(or the fence fabric shall be a Operating Light-and Water-Exposure pa�9 g,E(ra�pl Resistance Welded Steel Pyle. (SParVW and la F934•or Bra m). Reference ASTM { (Carbon-Arc Type)for Test Methods for Measuring Acheson by Tape Test D. The exterior surface of the electricalresistancet . E8/E8M-Test Methods for Tension Testing of Metallic ereld D. Wire Size: The size of the steel wire core shop be Materials.F567-Practice for Irestapatiorh of Chain Link shall be recoated with the same type of material and ($oecti(v a e) f Fence. F6F5-Specificationrlicefor for thickness as the basic zinc �t g-gauge (See Table 2);the finished POSY(Vinyl Chloride) 9• size Of the coated wire shell be(soecity aait"gauge (PVC)-Coated Steel ChaurL'mk Fence Fabric. F900- E. The manufactured framework shall be subjected (See Table 2). Q Specification for Industrial and Commercial F934-Specification for Standard Colors fSw�PgbGntse' to the P9rmaCoatm Process,a complete thermal E. Height and Mesh Size: The fabric height shall be o Coated Chain Link Fence Materials.'F969-Practice for temstraper anon coating Process(multi stage,high- (6 (y heieht)feet high with a mesh size Of( r Construction of Chan Link Tennis Court Fence.F1043 thre,multi-layer)inducing:as a mi mnunt,a mesh size)inches.(See Table 2). f-Specification for Strength and protective ge Pretreatmenthvash(with zhtc phosphate). Metal industrial Chain Link Fence From ��on an electrostatic spray application of an epoxy base. 204 MATERIAL-GATES + ework F7184 and a separate electrostatic spray appf�m of a Specification for Industrial and Commercial Horizontal Swung gates stall be manufactured and coated to meet Slide Gates, polyester finish. the requirements of ASTM F900. Slide gates shall B. American Association of State Highway and F The material used for the base coat shall be a be ma The urr Ill o mall gam shall re tents of ASTM Transportation��1s(AASHTO)Standards:M181 zinc-rich(gray color)thermosetting epoxy;the Greenlr Bran)Bra n)in Rea 9 4. d minimum ihidmess of the base coat shall be two a with ASTM F934. Standard Specification for Chain Lirdc Fence. (2)mils. The material used for the finish coat PART 3-EXECUTION C. United States Federal Supply Service General Services shall be a thermosetting"no-mar'TGIC Polyester 3.01 PREPARATION i Administration Specifications:RR-F-191/3-Federal powderthe minimum thickness of the finish coat All new installation shall be laid out by the contractor Specification Sheet for Fencing.Wire and Post.Metal shall be two(2)mils.The stratification coated pipe in accordance with the construction plan.(Chain-Link Fence Posts,Top Rails and Braces-Detail shall demonstrate the ability to endure a salt spray �. Specification. ) resistance test in accordance with ASTM B117 3.02 INSTALLATION without loss of adhesion for a minimum exposure Install chain link fence in accordance with ASTM 1.06 SUBMITTAL time of 3,500 hours. Adcfflionally,the coated pipe F567. For chain link tennis court fences,install in The r�suitimim paCkageshall p d� shall demonstrate the ability to withstand exposure accordance with AST�q Prig toyro1-2ya in a weatherometer apparatus for 1,000 hours at spacings � p�set .without failure in accordance with ASTM D1499 be spaced according r t the gate open nspecified j 1.07 PRO0_C-i;y .9 _ and to show satisfactory adhesion when subjected in the construction Upon;e- a c�"" to h:cross tc�l1 test Method��ASTM g y ,_ plans The`Paving and Surfacing,," 0 f� `' T�pax ,etast s +•«Concrete'and`UnitMasonry'sections checked ib erc-1r,?t;rm� a cc Es s in post base placement sStiPPin9orh=rdat9 a shabe -ism s e�2gove mannerto ensure pmpervan`�- ,� r Ekrr ments. Install fabric on Sacurtty : r€ft �and attxlh with wire ties or dip to line posts ffi Protect against damage,weather vat ward } 15 kxtL'-O c.and to ta ,.�rc� y raid braces and tension wire 25 ksdces 0.c HE r" rcg a v1'( Sll3 CiEMING ° *•c41Af3ev#trnr ax The contractor Shall dean the jobsite of excess 0 W materials. Post hole excavations shall be scattered uniformly away from posts. TABLE.1 -FiRAMEWORK Structural AGplicarion lFence - Decmral O.o. -..Pipe wz0 -. .. dent Section Thidmess- yr-:eta Mop Yw - Max.Bending - calculated l)ad(0r Q ModUllls - *x• (Strength --Moment ,: 1 p CanOlever 327 inches- mm lurches (mm ti1R m fm<rres) 1-SIB' 1.660 4218 .111 2.82 1.84' � _ )� a• ' 1.900` r .981 z _ per- T 4828" 120 :. 3.05 2.74 1 50,000 g,agy (intuStr41 2.1,7 2.375 2.28 3.39 .2810,. x 204 136 80.33 ,130 3.30 312 4.84 50 14050 3' 2.875 73.03• .160 •4881 z 50,0pp 24,405 814 4.64 6.901 x 'SOA00 50e 3391 4' - •4.000 01.60 .160 4.06 43,890 1,463'__ 914::. 610 1-3'3' 7.315. + 33:40 6.56 9.76 - . ..080. 2.03: 1.08 1.7819 z 50,000 = 89,095 2.970 - 1,8.56 1 1 1.660 157., .0900., ..• z 50.000 _ x:.. 4,500 PC-W-(Cammertiag 448Y68 ell 216 1.43 113 T574 x '" 150-.' ;WA._- WA.:- 1-. t 3 -.090 229 1.74 50.000 7.870 262 164 tog x 2•it2' ) 2 60.33 2^+9` 2208 x 50.000 _ 11,040 -WA., ..2W - 154 d J f e% 241 232 345 326 d:86 .973d z 50,000 = 18,670 WA -389 259- - `..6385 x ..50.000 ',.31.825 WA »-}-60 TABLE 2-FABRIC 'Al �S6uetural Application Finished - ; � " e <- GauPVC ge Thidmess�. `§ a" Mesh Sims:. ;i Fabric k6nhw" ,6 .102(433 rs� 1�(3.ra _ ,• AVaOeMe�_E PG40"(Indk� ( � IMS 02a`0.38.0.64 rum) _ Ex<+usion:Typa .Breaking sher1g11;_ 4 -8. - .162 4.11 "a ,..(:•,' y 0.64 mm) " �'^- 2 50 inn t-3/4 44 mm ill) CLASS 2A 128 O s ta6(3romr) ..20(3.M rs:�-ins{ate-o64mm) z(5omm):1. ( ) (25mmj CLAss:1;,2A ; BSOa PG2D"(Cmnmerk 8 -162(4.11 ( :,33�y�,,) iia-s ( 3.l3;�4 ( ) 3l4(C4 mm);t(25mm) CLASSI,2A I 2 .. BSOB 9 .14e(3.7s rum) .Q„a7 f2-46:.s:a D:5-.lhri(.y33-ab4 rcc �"3k(SOrxrx:i(ti rum) CLAS$:1,2A - 2(5)naa);:-3r4(44 mm):1.1l4(32 rum):1(15 rum •f CLASS 1,2A 6500 Page 35 F 1 .... 1....-... .` Assessor's map and, lot number �. /2 rsySTEM FTHE,,Sewage Permit number o........ .......... SE MUST S - House number ......... ��. /�.�.�� IN COMPUAtd BaaasTanis, y ..... ........... ..........-.............. WITH TITLE 5 o°i°'�cYaYa�e� TOWN OF BAR `' - ®®� � BUILDING 1AS�PECT0R APPLICATION FOR PERMIT TO C.Alfg ...... ?... .1./.. lV.. ....................... TYPE OF CONSTRUCTION ....... .n.�J ..:....: cT. ..Gy R: tT�-�`.` . ti ..-.. .....................19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: • LL �� , Location ............. J /JQ� �.?.....1..!4 �l� C ...�................................................=T" 1 � �/)15S .... Proposed Use ., /4 ....-......... 1.....? ..M .....(.l. .G ........ .................................................................... Zoning District .... . .... . . .............................................Fire District ...•17;. . 1. 5...................................... Name of Owner s S C# � 4 �:Address ....d S G S i .. . :...................................... ... . /.. .: 1. �...................... Name of Builder � �...... �1.. �s..l........................Address Ef....5:KIT: ..� ..................................... Nameof Architect ............ .. ..'L................:.............Address ..........................................................:........................... Pp.!?r!!��4CoPTkef�Number of Rooms ,....1............................................................Foundation ................................................... Exierior l �.4� .GJ• ll:J/.: :1:'.v.V/�g:�.Roofi g ..............zts,. T................................ Floors W f' , drJL. Interior ..........S�....eP.�.vc.......... .......................................... Heating ....Plumbin Fireplace ..:................ .............................................................Approximate Cost ... :.... ............................................. , ....... Definitive Plan Approved by Planning Board --------------------------------19--------. Area S. ' Diagram of Lot and Building with Dimensions Fee ......... . ./ -......7...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH � `� ''� - IP A- � ?,2 •5 f u (43 i /Sf7o is cC, �7 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... .. .........e....: .................................. CHANDLER, CHARLES S . No .... Permit for TwoCar...................... Garage & Room ................I.............................................................. Location #142 Blishop Terrace- ................................................................. Hyannis 011 101, Owner rles S. Chandler ............... ............................................I Ty0016f Construction ......ra.m.e..... ........................ .. A ................................................................................ Plot ... ...... Lot................................... June ;3 81 Permit ................................. .........19 r Date of, Inspection .............................M.......19 Date Completed ..................21 1,9 rt V ev 4 PERMIT REFUSED M g! ............. .19 r .......... ...................... .. ............. ............. fz �('j ................................................I ............. .......................................... ar tc- Aoll ........... .paws ........ ............................................. in Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's map and lot number ,....;.... _ �F7HE'TQ� Sewage Permit number . :-/ �Ac„/Cer�1M.chl.�� / d BAH AG IL E, i House number ......... .... ...............00..��... .......... .......................�.. 9 Maes 1639. \00 '`ram ti. 0 MPY a' TOWN OF BARNSTABLE BUILDING INSPECTOR M APPLICATION FOR PERMIT TO, .1 ./.!.. .. 5 �. �`1 �/ Z �......................... ....................... ...... ................. .......... TYPE OF CONSTRUCTION ........Gl. C! ..,....:. �� ..( !�....��� r2/IA/F ..�!cl� ........... ....................19.. ./ TO THE INSPECTOR OF BtiUILDINGS:• 'e The undersigned hereby applies 11f--or a permit`according to the following information: Location ........................... .61. Gl�`�. o 1 ::�......... ................................................ /�/ ....................... ProposedUse ... (?.. .... ........1..... .Au V.....1 ...........a...............................................................:.................. Zoning District ......A-C....?i...............................................Fire District ....#...Y14- W S Name of Owner .5.....:J!.. U.??„k�1�,/J 4L. Address ..12.�.2......! .............. Name of Builders ��s� // .....Address E, �� w�c� Nameof Architect ................. ...►:�.. ...............................Address ...................................................................................... Number o�fp Rooms ......................,.........,.... ......./.j./..�.... f—(.'..Fo�u�nd�ation l 0 611 ( d' cc,k7c G(2 /(' Exterior .1. .eD. .. �.�1..(�... !..1..�!Y( FJ..Roovf g ............ ..4:S./0/- ' :.T............................... Floors �./ dc•dL .................................................Interior Heating ............... .. ...5.............................................:'......"Plumbing",............... ..:::.............:............................................ Fireplace 7 -......................... 1..............................Approximate Cost O fr Definitive Plan Approved by Planning Board -------------------_____--------19________. Area ........ y. 1- , . ....... Diagram of Lot and Building with Dimensions Fee �' 7 SUBJECT TO APPROVAL OF BOARD OF HEALTH ( / `�� f27' 1l7 ,31 i 1 hereby agree to conform to all the Rules and Regulations of the Towr%of Barnstable regarding the above construction. 6. Name �� ,c. !........ F ....... � CHANDLER, CHARLES S A=251-1D77 No Permit for .,IWp --- ' ' (������ �� l�j���..............� ' ----'' - '' ��----' ' Location ................ ' � ........................ ..................................... s ^ ' Owner -..�h...4��l.e-�..�."-��jjaXjdjp_f.......... � Type of [ons/ruciop' .....F-razoe........................ --------------------------. - Plot ...................... Lot ----------' ` � Permit Granted ..... Juoe.],----]p 81 _ � . . Dote of Inspection ----------'-.lg bate Completed ...................................... .� � ` "E=M=" -------. ------. 19 ^ ' . ' ^ --------^' ----------------' , ' ................--..^y..—...------.-~.---.- �.. ' ... .. ---~.---...-----~.-.---.-- . .. � ' � ApprovedT . ................................................ lg . � � -------------^---^---------^ ` -----------------.---.--~..-' | � .