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0021 BLUE JAY DRIVE
- - _ __V � �' �' � ` _ ____ - l k� Town of Barnstable *.Permit# Regulatory Services gee 6 m h� m issue • BARNSTABLE, « MASS. Richard V.Scali,Director PERMIT Building Division Tom Perry,CBO,Building Commissioner 17 W5 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us TOWN pF.BARNSTABLE. Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY -� j � Not Valid without Red X-Press Imprint Map/parcel Number G kj vtJ Property Address / �eAL noll Z 6LhO., :5- Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addressf Contractor's Name` / he�,e, // Telephone Number 3j�©� Home Improvement Contractor License#(if applicable) 10 �I f mail: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ lam the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 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 Replacetnent,Windows/doors/sliders.U-Value 1�11 (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections required. Separate Electrical&Fire Permits required.. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Impirovement ntractors License&Construction Supervisors License is re e SIGNATURE: Q:\WPFILES\FORMS\building permit forms\E)PRESS.doc Revised 040215 AC40R o CERTIFICATE OF LIABILITY INSURANCE DATE /YYY1� 03/31/2015 2015 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. H 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 CO ACT Marsh USA Inc. NAME: 100 North Tryon Street,Suite 3600 PHONE FAX Charlotte,NC 28202 E-MAIL AIc No): ADDRESS: INSURERS AFFORDING COVERAGE NAIC iF 47095 CASUA ONLY•1516 INSURER A: National Union Fire Ins Co Pittsburgh PA 1gg45 INSURED New Hampshire Insurance COm Lowe's Companies,Inc.and subsidiaries INSURER B: P PAY 23841 including Lowe's Home Centers,LLC INSURER c:Steadfast Insurance Company 26387 1000 Lowe's Blvd. Mooresville,NC 28117 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-002939185-31 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. ADD SUBR LLTTRR TYPE OF INSURANCE I POLICY NUMBER P CY EFF P�O'U�CY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY Self Insured-See Below DAMAG O R D PREMISES Ea occunence $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMrr APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC A AUTOMOBILE LIABILITY CA5260749 (AOS) 04/01/2015 04/01/2516 COMBINED SINGLE LIMIT B X Ea accident 5,000,000 ANY AUTO CA5260748 (MA) 04/01/2015 04/01/2016 BODILY INJURY Per ) ALL OWNED; ( person $ A AUTOS AUTOS CA5260760(VA) 04/01/2015 04/01/2016 BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ Per accident C X UMBRELLA LIAR X $ OCCUR IPR3792301-01 04/01/2014 04/01/2017 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ B WORKERS COMPENSATION WC017731584 AOS $ B AND EMPLOYERStiLIABlIrry ( ) 04/01/2015 04/01/2016 WC STATU- OTH- ANY PROPRIETOR12PARTNERIEXECUTIVE Y/N WC039901583 (WI) 04/01/2015 04/01/2016 I B OFFICER/MEMBEREEXCLUDED? N/A E.L.EACH ACCIDENT $ 2000000 (Mandatory in NH); WC017731585 MN If y ( ) 04/01/2015 04/01/2016 E.L.DISEASE-EA EMPLOYE $ 2,000,000 B DESCRIPTION OF OPERATIONS below WC039901584 AK,AZ, NH, ( VT) 04/01/2015 04/01/2016 E.L.DISEASE-POLICY LIMIT $ 2,000,000 A WC XWC9883959 (AOS) 04/01/2015 (Zi/2016 WC:Stat/EL:$3mil;xs$2mil SIR A Excess WC XWC988M(FL) 04/01/2015 04/01/2016 WC:StaUEL:$3mil;xs$2mil SIR DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insured is self insured for General Liability for the period of 4/01/2015 to 4/ lmlis. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc.; and subsidiaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 1000 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mooresville,NC 28115 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Paula Stapleton p q.. ACORD 25 2010/05 01988-2010 ACORD CORPORATION. All rights reserved. ( ) The ACORD name and logo are registered marks of ACORD cJ�ie 1pomamoncaeal�i o�C�a�tuGe�6 ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: istration: 168027 Type: Office of Consumer Affairs and Business Regulation piration: 12fM616 DBA 10 Park Plaza-Suite 5170 KENNETH KENDALL Boston,MA 02116 KENNETH KENDALL 5 WELDEN PL. 4 � � - FAIRHAVEN,MA 02719 Undersecretary Not valid without signature � II 1 Massachusetts -Department of Public Safety Board of Building Regulations and St y' s a,,,.Standards $ii��Fii i iiiii _ License: CS-075153 Kenneth D Kendall` 5 Weeden Place * Fairhaven MA Orig — - Expiration Commissioner 01/1212017 I f The Commonwealth of Massachusetts DPwftent gflndus&WA ts I Con g-ress Skreet,,Sake Too Boston,MA 02114-2017. www.massgov/dia Workers"Compensation Insurance Affidavit:Bm'iders/Contractors/Electri TO BE FILEp ctansMlumbers. Aunlic2nt Information R' TEE PER ffrfING AUTHORITY. Name(Bosmesslomao,zation/Ind,viduai): L acQ . �� / Please Print Le�ly !A'h �- Address, City/State/Zip: ./� Phone#:�6 S( 3 13 tlW G` Are you an employer'.Cb0ck Me appropriate bo=: 1.Q 1 am a employer with_employees( and/or s Type of project(regained): part-Fiore). [2-0 I awn a sole proprietor or partnembip and have 7. ❑New construction �'capacity[No workers'comp ��) working for in S. Q Remodeling abomemier do* an work myself[No workers'comp.insurance re4d]t 9. ❑Demolition 4.01 am a bomeowner and WM be hang oohs to conduct an work on 10 Q Building addition assure that an ncmiactors either have workers' �'�°�' I w>71 Proprietors with no employees. ° inaa�a a or are sole I LEI Electrical repairs or additions 5 am a general comnictor and have hired the ors listed.the a sheet i2.❑Plumbing repairs or additions These sub-ooahactors}��Icees and bave workers'comp.msumme,s 13.❑Roof rep ' 6.Q We are a corporation and its officers lave 14.0 l� 152,§1(4),and we have no employees.[No workers trglrtof perM(3L c. �P.insurance required.) *Any applicaffi brat checks box#1 must also fill our the section below mf t who submit thisareall > ammbm moors that check this box must attae&d an g�g doing showingthe�dien hue nw.,ofthe�e co >� affidavit indicating such employees. Ifthe ns have��Y subco�sand state whether or not those entities have E law an proviWag workers ®nployer that is , information. ce irsation insurmtcefor my entployeec. Below.rs McPah y and job site Instnance Company Name: klety ems" Policy#or Self-ins.Lic. 7 <%,e q Expiration Date: J Job Site Address: Q �dftb�raUown Attach a copy of the workers'coinCity/State/Zip: k pensation page(showing the policy num r and Failure to secure coverageaspire n dated and/or one- ear' as��under MGL c:152,§25A is a criminal violation punishable by a fine up to$1,500.00 Y imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fin up to$250.d0 a coverage verification.day against the violator.A copy of this statement may be forwarded to the Office of Investi e of gations of the a Of for verification. Pdo hereby caitiff th - o that the formation provided a is and correct S` e Date: Phone# Ojfusal use only. Do not write inthis meq to be Completed by�or town offroial City or Town- Permit/License# Issuing Authority(circle one): i L Board of Health 2 Building Department 3.City/fown Clerk 4.Electrical Insp ector pector 5.Plumbing Inspector i Contact Person: Phone#- ' I rt7lP ((v+1717/!n/Ill+PR�I�f+.n'E'[llJJffl�llJP��J ffire of Consumer Affairs&Business Regulation License or registration valid for individul use only a ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 14868 Office of Consumer Affairs and Business Regulation r 8 a Type: 10 Park Plaza-Suite 5170 Expiration:P • 10/18/2015 Supplement':ard Boston,MA 02116 LOWE'S HOMES CENTERS INC 4Z?7— ROBERT ABBOTT 136 TURNPIKE RD.SUITE 100 SOUTHBOROUGH,MA 01772 -. Undersecretary. Not valid without signature i * BARN Tnsi.e. 9� 1639. ,. Town of Barnstable , - �FD MA'1 A Regulatory Services Richard V.Scali,Interim 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 P Ow ner wner of the subject property // J P �' hereby authorize _ ye-z�y f, to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of J b) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN_D\Building Changes\EXPRESS PERMIT\EXPRESS.doc Revised 061313 The Commonwealth of Massachusetts Department of Ind=Wd Accidents Office of Invesfigations 600 Washilrgton Street Boston,MA 02111 Workers' Compensation Insurance Affidavit:Buildels/C A licant Information onh-actorslElectticians/p]umbers Please Print 'bl NaIIle(Business/Organization/tndividual): � G� Address- City/State/Zip: one Are you an employer?Check the appropriate box: 1-❑ I am a employer with 4. ❑ I am a Type of project(required): employees(full and/or---* general cofactor and I 2 I am sole �time) have hired the sub-contractors 6• ❑New construction Proprietor or partner listed on the ship and have no employees a1ta�sheet.t 7. ❑Remodeling work' These sub-contractors have mg for me in any capacity. workers'com .• 8• Demolition eequiwreod.workers,comp.insurance 5. ❑ we are a corporation and its 9• ❑BmZ ding addition 3.❑ I am a homeownerofficers have exercised their doing all work 10.0 EICCUiW repairs or additions myse� right of exemptiOn per MGL I I.❑Plumbing insurance o workers.comp, c.152,§1(41 and we have no �s or additions reytiiredJ t 12.[]Roof repairs employees.[No waalcers' •Any comp.insuramce ) 13.0 Other fi -neo"ems who su aho fill am the section Wow showing gicil. �Coatr thaz chock this twx anac �g they are doingshON/m8�name tf� 'nust saa�tlavQ mdtc�ag sock addtional sheet I am an employer that is ro �s ana their wortoas'comp-�, mfornratio� p '?ding workers= compensation i�csur ancefor ary enpioyee� Belota is the policy and job site Insurance Company Name: Policy#or Self-ins-Lic.#: Job Site Address. Expiration Date: Attach a copy of the workers'compensation Policy declaration page(showinthe y as her andT Failure to secure coverage required under Section 25A of MGL c. 152 can lead to the imposition of and expiration ai date). fine up to$1,500.00 and/or one-year'imprisonment,as well as civil Penalties of a of up to$250,00 a day age the violator. Be advised that a Penalties m the form of a STOP WORK ORDER and a fine Investigations of the DIA for' cePY of this statement may be forwarded to the Office of insurance coverage verification. I do hereby ce under the paircr and penauies ofPe1lury that the in o f nn&fon provided above is tare and correct Si store: 1 f Phone#: Date: Official use only. Do not write in this area,to be completed by djy or town offuial City or Town Issuing AuthorityPermit/License# 1. Board of Health(ZrBuilding Department 3.Ci - 6.Other ty/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector' Contact Person: Mine#: sum-2376- pp 47 i i Al '. ka bl-I 71 le-4-1 41- STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK - INT/EXT/PATIO DOOR LOWE'S OF WAREHAM, MA, STORE#2376 STORE PHONE: (774)678-6000 2421 CRANBERRY HWY, STE. 100 SALESPERSON:JOSEPH SANTOS JR WAREHAM, MA 02571 5022 SALESPERSON ID: 1850062 Y/ Document Print Date : 08/06/2015 This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any other addenda or attachments hereto, shall be referred to herein as this "Contract." PLEASE READ THIS ENTIRE DOCUMENT INCLUDING THE "TERMS AND CONDITIONS." BEFORE SIGNING. Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers, LLC's MA HIC NO.: 148688 Lowe's Home Centers, LLC's FEIN: 56-0748358 Customer Name Home Phone i S BRENNA QUINN 310-986-4747 OCustomer Address Other Phone 21 BLUE JAY DR L City State/Province Zip/Postal Code p HYANNIS MA 02601 Installation Address T 21 BLUE JAY DR O Installation City Installation State/Province Installation Zip/Postal Code HYANNIS MA 02601 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 231061 : NA : SOS : SOS ATRIUM VINYL PATIO DOORS : 332 2 LITE PATIO (58 3/4-IN W X 79 1/2-IN H) 15%OFF SOS RELIABILT WINDOWS & DOORS 08/05/2015-08/18/2015 : ATRIUM WINDOWS -QTY 1 1155 : 1155 : STK : 1-4-8 SELECT PINE : 1-4-8 SELECT PINE : PRECISION LUMBER -QTY 3 130222 : 358730AKSL : STK : OAK SDLE 358 3-5/8 X 5/8 X 73 : OAK SDLE 358 3-5/8 X 5/8 X 73 : EMPIRE COMPANY, INC. (THE) - QTY 1 193569 : 35170FJPMD : STK : PFJ CASE 351 2-1/2X1 1/16X7 : PFJ CASE 351 2-1/2X1 1/1 6X7 : EMPIRE COMPANY, INC. (THE) - QTY 3 238343 : 2826-8 : STK : 3/4X3.5X8 RF EMBOSD PVC TRM BOARD : 3/4X3.5X8 RF EMBOSD PVC TRM BOARD : ROYAL MOULDINGS LIMITED - QTY 1 Materials Price $ 712.00 Store 2376 Project No. 449519118 for BRENNA QUINN Page 1 of 8. STORE COPY INSTALLATION DESCRIPTION Stock or SOS : SOS Door Type : Patio Select Location : Back Door Select New Door : Sliding Side Lights or Transoms : No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door : Yes Customer Understands Scope of the Project : Yes Permit Required : Yes Who Will Obtain Permit : Lowe's Permit Fee : No ` Additional Miles Traveled over 20 : 10 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed : None Comments : No Comment Lead Safe Practices : No Labor Charges $ 519.00 Detail Deduction -$ 35.00 Additional Specifications: Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop- erty is governed by Historic District Regulations. Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where In- stallation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title, interest in and to the photographs for use in all markets and media, worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including, but not limited to, marketing, advertising, publi- city, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. [Customer to initial to the left]. NOTICE TO CUSTOMER-PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of the estimated Goods required to fulfill the Contract (including waste), which may exceed the actual square footage of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the contract (including waste). By signing this Con- tract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Store 2376 Project No. 449519118 for BRENNA QUINN Page 2 of 8 STORE COPY Installation Services are performed.. TOTAL CHARGES OF ALL MERCHANDISE AND.SERVICES where applicable SUB-TOTAL $ 1196.0 *TAX $ 0.0 ? DELIVERY $ 0.0 ORDER TOTAL $ 1196.0 BALANCE DUE Work is to commence upon reasonablle��avvailaablity of Contractor which is anticipated to bedZ [fill in date]. Estimated completion date is 01rL�--�f f [fill in date]. NOTICE TO CUSTOMER ` > r All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom- er. IF THE CONTRACT TOTAL IS$1 000 00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00: r_1 Customer to Pay in Full; OR Customer to use the following payment schedule: (1) Deposit of $ to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3) of the contract price; and (2) Payment of $ to be collected upon or after the commencement of work. I/We authorize Lowe's to do one of the following (check ap- propriate box.below): [_] Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or [_] Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and Store 2376 Project No. 449519118 for BRENNA QUINN Page 3 of 8 STORE COPY (3) Final payment of$100.00, to be paid upon completion of the installation to both parties' satisfaction. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c.142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON- TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OF THE EXE LITIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT TO UCH A �TRATION AS PROVIDED IN M.G.L. c.142A. By: Date: _ Lo 's Home C nters LLC By: � — Date: Owner By: Date: Co-owner or Witness THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L. c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES. WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS tO DAY OF S� Lowe's Home Centers, LC By: (Seal) Print Name: ��5 P � �, 11 (c) e--:2 L \ C_ � , rt' D ( Seal Address Owner We�le\00011 AI City State/Province Zip/Postal Code Print Name Store 2376 Project No. 449519118 for BRENNA QUINN Page 4 of 8 .I STORE COPY Co-Owner or Witness (Seal) Print Name Customer acknowledges receipt of a true copy which was completely filled in prior to Customer's execution hereof. You the customer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. See the attached Notice of Right to Cancel for an explanation of this right. Store 2376 Project No. 449519118 for BRENNA QUINN Page 5 of 8 Back to Quote LOWE'S HOME CENTERS,LLC#2376 a tk� 2421 CRANBERRY HWY,STE. 100 0 WAREHAM,MA 02571-5022 USA Date: 08/12/2015 (774)678-6000 Project#: 448826728 Description: door for install Customer Name: BRENNA QUINN Customer Phone: (310)986-4747 Customer Address: 21 BLUE JAY DR HYANNIS,MA 02601 USA Line Item Product Code Frame Size Description Unit Price Quantity Total Price . 0002 Manufacturer:Reliabilt by Atrium Size=58 3/4-in W x 79 1/2-in 15%off SOS Reliabilt Windows&Doors 08/05/2015-08 H 18/2015 Energy Star Requirements for Northern/North-Central/South- Central/Southern Regions***U-Value:0.30 SHGC:0.22 DP50: Size Tested 70 3/4-in x 79 1/2-in ***DP Code and Florida Approval Code only valid up to indow size tested*** Division:Millwork Product:Doors Type:Patio Manufacturer: Reliabilt by Atrium roduct Line:New Construction eries: 332 Best ctual Width: 58 3/4-in Actual Height: 79 1/2-in Fits Opening Width: 59 1/2-in Fits Opening Height: 80-in onfiguration:2 Lite 'Color: White **See in-store displays for exact color samples for both interior and exterior color.*** nterior Laminate: None .Opening Direction: OX Glass Energy Efficiency: Ultra Low-E w/Argon lass Color: Clear ***The graphics present an estimation of the color and are not completely accurate representation.*** lass Strength/Safety:Tempered Grid Type:No Grids Grid Style: No Grids $615.69 1 $615.69 Hardware Color:Brushed Nickel ootbolt: Yes ` Green: Screen ***Lead Time: 18 Days*** tem Number: 231061 Project Total: $615.69 Salesperson: JOE SANTOS (52376JS6) Accepted by: Date: 08/12/2015 Print this Page This Millwork Quote is valid until 9/4/2015.This is an estimate only.This estimate does not include tax or delivery charges.Delivery of all materials contained in this estimate are subject to availability from the manufacturer or supplier.All the above quantities, dimensions,specifications and accessories have been verified and accepted. t a i hsso map and lot number .............. ......... .......: V SEPTIC SYSTEM MUQfFMML VACCINATIoN INSTALLED IN CflMPLI Sewage Permit number ..... @&CHUSETTS .. .: °..... ,. ... WITH ARTICLE II STAT�o I R E O1 8120 THE To�o TOWN OF BAPR S. Z HJHH9TSDLE, i i 1639. .. BUILDING INSPECTOR' APPLICATION FOR PERMIT TO ............................t �.f P0 :-T..........................................:........................................ TYPE OF CONSTRUCTION ..........w 1:.......lr[ t'1-r�.:�.......................................... ..................Z. .J,--z............192 . -,TO THE INSPECTOR OF BUILDINGS: The undersigned hereby'applies for a permit according to the following information: Location i - f Proposed .Use !-`t'o o vn 9 2. E-�-2 i,T�!�................ ................................................ ....... Zoriing District ......... ..........................................'...........Fire District ........ � , ` n II Name of Owner .....V„ -L�Yfi'�� O{� C,{-I- Ec��C- . ...................... ...........................Address .................................................................................... Name of Builder V)rl . �.!... KL ( 0 .Address ......�'.C� .ST( t P....!�.rl .................................................... ... .. Nameof Architect +�`� .. .................. .................................................Address ...........................................:........................................ Number of Rooms ............ .()... .........................................Foundation .. •CaNCJT(J ......!��?v i i:v�� Exlerior ................................... ..............Roofing .... .... .................................Interior ............... _' Floors ..................:.......:.......................................... ..................................................... � Heating � .........................Plumbing ........................................... .�........................................................... .......................... ...... Fireplace .............................Approximate Cost 1 © l'..................................................... ........... ... .................................................. Definitive Plan Approved by Planning Board ________________________________19_______. Area ...... ............... Diagram of Lot and Building with Dimensions Fee !.�.. ....................... . ........ SUBJECT TO APPROVAL OF BOARD OF HEALTH 50 Joo J z-z- 3b 2O 1�L U G ;� cl �. 10 r r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the abo construction. Name ........................... l'` ..................................... Walter Roach, K / � [ 2I652 ` add carport ' l No ................. Permit for .................................... \�o dwelling ' . . ----'----^'----'---�J%�����'--''' < ~' ` ' Location ___.2l_Blue..Jo�.�wmms�______ � . Hyannis ` � ------.--.���������------.------.. - [ ` . - ' ' Walter Roach F - � Owner ����� � —...-----,--... —.-----.—.. frame Type of Construction .......................................... � ----.----^~---..-------,—_.--.. _ . / l 'Plot ............................ Lot ................................ ! ~ / - P-ernitGronte6 --.Fehxnuary..23........ g ?9 � - � Date of Inspection lV . . . 19 ' ~ 14r | ' � ' . -PERMIT REFUSED . - . . - / ' l� '—.---'--,..—.................................... . � ^ ' ^ . ' --^-------''^^^^—~^'^`---^'''—'----' . � ^ ` —...—.—...._...-----.-.....~.~..—,..... � --�--...--.—.—....—,—�—.--,.---~.. Approved. , . ................................................ lA ----------.---~......--~~..--, | -------`---.------------.—... . ^ | �; | TOWN - OF BARNSTABLE me ,639-&. BUILDING INSPECTOR - '\`, APPLICATION FOR PERMIT TO -----.��C��:��[�=�'-----------------------.---.. � \ � ' TYPE OF CONSTRUCTION --- ....... --------.---------------... � �� ����� --------+."�-----. ".^.�.. � TO THE INSPECTOR OF BU|LD|NG6 ' � The undersigned 6ero6v applies for o permit according to the following information: Location ..-'. "J \ -''. �~����-��.����_~-��|�..___./ \.4014xJ|s......................................................................... Proposed Use ........../4^ --�.����L�./.��--.���.�4������/�~-----------.-------'------------ ` \ | Zoning Dio��� ---�����.----..---.--------Fina Diu��� --����8/J/���--------~------_. � ' \ .� ' Name of Owner ...................Address .......A.eqv1e"°......................................................... Name of 8vi|6e, -------.A6Jeax ............ ^ Nome of Architect ............./l.qP*'*�...................................Address -------------------------___ Non6e, of Rooms ........... � 0._-------------.Foun6o�on N�-------.' Ex|o,ior ----------------'-------------.Roofing - ��\47----------_______,_ ~~ _- Floors ----------------------------JnKsicv ..................................................... Heating ------:77TT........................................................... ... .................................................................. �� _- Fireplace --------------------------_Appvoximo^eCox .----%�[����---____..^______. Definitive Plan Approved by Planning 8uor6 --------------------------------1g--------. Area -- .............��� Diagram of Lot and Building with Dimensions Fee ............. ................... _ SUBJECT TO APPROVAL OF BOARD OF HEALTH 106 20 � - � � � ~- �� . ~�� | ~ -- - .~ ~^ . . ` . ' { / | ` / | hon»6y agree ^o conform all Rubs and Regulations of ��eTovvn ofBonn�o6� regarding ��e o6o�e construction. Name ............................... .4..*..r........-------.--' ' Roach, Waltar, � , . A=268~9 . ' . . �dd No �����_- Permit ---..��������--- \ _. .to..dwelliu�__.._____ Location ...........2l..Blua..J�v.����______ - is -.-.--.--.~ ........................................... ^ Owner ............ . --.------- Type of Construction . ' ` ' } / o .......... , Permit ' Granted ""'= of Inspectirn ....................................19 \ . - ' ' ~ ' . _ PERMIT- -_U ED ' . r ' .-..-..-,--_.--.-_ ................... ' ` ................ ............. -.. ` ~ / ----- '- --- ' '��-�-'-'' \ / K / / -----t�`'`-'—^`�.............. -''r^^^~'--'-^ ` - . ..................-'_.-,......~...,..-.._-.---~.- . . . . \ ~ Approved ---------------- lg ' _ -----------------^^-^^-'----' � - -----------^-----~--^^-^^^^^`' ' lam Parcel �26 � ermit# rf Date Issued Fee .�`s: Engineering Dept. (3rd floor) House# j BARNSTABLE. 19 +eMABB.s91 .� . �f0 MAC► TOWN OF BARNSTABLE Building Permit Application Proj l�c� t Addressal/ J Village C Owner Address Telephone Permit Request First Floor square feet Second Floor square feet Estimated Project Cost $ gStn. Zoning District o Flood Plain A--bWC_ Water Protection Lot Size ecln Grandfathered ? Zoning Board of Appeals Authorization — Recorded Current Use Proposed Use Construction Type („ Commercial r Residential �� S Dwelling Type: Single Family ��S Two Family Multi-Family --- Age of Existing Structure 3 Z Y5_B sement Type: F,i�n* he.d �O rG�� Historic House �� n m*shed �S Old King's Highway 4,)O Number of Baths Cam" No.of Bedrooms 3 Total Room Count(not including baths) First Floor �$ Heat Type and Fuel �`\�ZI /b d-e� entral Air Fireplaces 4'-17'C C Garage: Detached Other Detached Structures: Pool /00 Attached Barn �6 None Sheds erot-o Other Builder Information Name ��,(JiV C S' lV S.c� Telephone Number � Address 3 Z 3 �Z1 '� � ! i License# 0 5- 1 —S b r Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRU ION DEBRIS RESULTING M THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY 3' PDRMI +N - D TE ISUED MIAP/ RG•,{EL NO. 11, 'j � . � •r^1, � i Y,� ,'Ir a � i, f , r , '4 j A ADDR SS €3 VILLAGE f f OWNER F-1 I DATE F INSPECTION: FOUNDATION FRAME' . •� � ;" , s• .. ` INSULATION ° w FIREPLACE ELECTRICAL: ROUGH s. FINAL PLUMBING:; ROUGH .'FINAL GAS: ROUGH {FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i t f jj t f o f i ;r r - a v a a _ The Conunonivealth of Atassachusetts _ ---� " ' Department of Industrial Accidents , 011lce8/1BVOS9121loas 6001i uchurgtun Street ='f Boston.111ass. 02111 `Zr W rizers' Compensation Insurance Atftdavit 00 10C.1 ion, Z �9 P a2�d iAnne 0 I am a ho eowner performing all wo myself. I am a x6le proprietor and have no one working in any capacity 07. r-- -.. . . 1 am an emplover providing workers' compensation for employees working on this job. snmpIny flame• - address• •• nhone#• incur•tnce�� o,Rlicy# 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name• address: city: !shone#- incur ince co policy# i.:��i.- �-��!:_-•_-�:.:�ncnrur..c:..:a[was-?+e�'v„?'T'T•�'"fr..',�;sgv=' - '"rJVE ?OtraR::�w; 7►•y.^_+R'n•_' .8R1329"+�"" ynmpan•name: - address- city: phone#h insur•tnee co- policy# Attach additideal'sheetifneeessa �7: :•r% :�i j-�±"":N*ram; :���'' "� - ,;�,a, Failure to secure coverage as required under Section 25A of 51GL 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me: 1 understand that a copy of this statement mad'be forwarded to the Otrice estigations of the D1A for coverage verification I do lierehr rtifj•u der the pains and penal ies of perjury that the information prottided above is trae and correct Stsnature' ate Print name Phone# cal use only do not write in this area to be completed by city or town ofrtcial city;or town: permit/license# riguilding Department Licensing Board• ` 17 check if immediate response is required QSeteetmen's Office OHealth Department contact person: phone#; rtOther.�_ Information and Instructions Massachusetts Gencral Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law",an empli{ree is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An emp1over,is defined as an individual, partnership,association, corporation or other ;cgal entity, or any two or more of the fore,_oing engaged'in�a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual -partnership. association or other legal entity, employing employees. However the owner of a dwelling= house having not more than three apartments and who resides therein, or the occupant of tite dwcllin�_ house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 1*52 section 25 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 common-wealth for any applicant,%%•ho has not produced acceptable evidence of compliance with the in coverage required. Additionaliv. 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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying-company names, address and phone numbers as all affidavits 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. . '�,;.r: ,'y.,i. '...i..i r _t..�J,{Yy,•..)W' f�� .-. �+s'�tae'%��% �'v•. _. ., City or Towns 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. The affidavits may be returned to the.;Department by mail or FAX unless other arrangements have been made. ti The Office of.liivestigations�would Iike,to thank you in advance four you.cooperation and should you have any questions, please do not hesitate to give us a call. *^li•frl�AMrw..,.+l.[I�S�••�- - -/ `.•!fv �w.Y t Of •+�.+tr•�.L _ t �:.� _T.�Tq �i►1f/fM'sO. 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 fax#: (617) 727-7749 •. phone#: (617) 7274900 ext. 406, 409 or 375 i - lit _7 7 The Town of Barnstable . NAM 1es Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crcs= Off ca: 508 790-6227 Building Commis Fast: 508 775-33" For office use only Permit no. Date AFFIDAVIT HOME nMROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. I42A requires that the"reconstruction,alterations,.renovation,repair,inod 013�C0II�0n' improvement,.mmo%al, demolitian, or construction of an addition to any pre-existing ed building containing at least one but not more than four dwelling waits or tosMucMres which are adjaccnt to such residence or building be done by registered c01ft1 errs,with certain aoceptietts, along with other rcquiremcu . Type of Work: Address of Worst: 2 ecQ Ocrner.Name: Date of Permit Appli Z,,: I hereby certify that: Registration is not required for the following trason(s): Work ccciuded by law Job under SI,000 Building not owner-oocupied Owner pulling own permit Notice is hereby gh*=that: CONTRACTORS OWNERS PULLING THEER OWN PEUXTROVI:i ORT ALINGWORK DO N HAVE .ACCESS TO THE WrrH FOR APPLICABLE HOME ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. I42A SIGNED UNDER PENALTIES OF PE&MY I hcrcby apply for a permit as the agent of the owner: Contractor frame Registration No. Date OR ' TOWN OF BARNSTABLE BUILDING PERNqT j PPLICATION Map O; d" Parcel ® Permit# Health Division ] C �/% Date Issued J�/r • "/ Conservation Division .�`�� Feei/,G� Tax Collector Treasurers *SE (C SYSTE NfiUST BE �'-'—�— INSTALLED IN COAPIPLIANCE Planning.Dept. %UITH TITLE.5 Date Definitive Plan Approved by Planning Board EIRONMENTAL0ND Historic-OKH Preservation/Hyannis Project Street Address Village f /1` 4A-)AJ1 S , Owner �l�S 6 T 'L ���� Address 9) 7G�T64T�c% ✓�9k)(I��s'. Telephone Permit Request ee -)14 7r Gt-)000 gNJ %,£3U%LD Ol T�1 i�/ E,5SuA. 7_eC OM Z) 4✓.L()L4'13Ce L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type ' Lot Size l4 00� ,� �`� Grandfathered: Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ,!R Two Family ❑ Multi-Family(#units) Age of Existing Structure 3� Y�'Q'e`� Historic House: ❑Yes �dNo On Old King's Highway: ❑Yes d�No Basement Type: O 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 d 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 `1 -'-iAJfS LJl&)suN Telephone Number Address 3 Z; r �'�/ �'e��£ License# C`O S/ 3 ��Y�•t�'y��S' �`��SS �ZCoD Home Improvement Contractor# 40 3 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Tf1 Td SIGNATURE Z-Al DATE 2 .�� FOR OFFICIAL USE ONLY PERMIT NO. ' DATE ISSUED ` • { - ' .� ; •� _ -. ,.k • EL'NO: . . MAP/rARC - , P Rt r I f �* ADDRESS , VILLAG_ Er 1 OWNER'. DATE OF INSPECTION FOUNDATION ' 4 i 'FRAME INSULATION ) FIREPLACE LTA T. ,, � ,; .� " .. -, •_ t ELECTRICAL: ROUGH- FINAL ' y PLUMBING: ROUGH- �'+ FINAL GAS: _ ROUGH FINAL •r. FINAL BUILDINGt DATE CLOSED OUT ASSOCIATION PLAN NO. E 8 i -- - 7 N � STANDARD LEGEND / A P 247 � ! I note:not all symbols will appear an n mop I' i ;"-T-1 GOLF COURSE FAIRWAY ((/ �1{ 10268 A P 2 6 8 DECIDUOUS TREES J i I E5" EDGE OF BRUSH J i i OR OR NURSERY f, I ; Q CONIFEROUS TREES 1R 1 ! ' �•..I�••.,,•,� # 1 V j\ ^l/l� _-_----__ ___'�-- i`•1: I ` r, r' L...-._.- #� ...._.. i..i., MARSH AREA . # J 3 32 EDGE OF WATER •- I I l: DIRT ROAD _ \ / - _.... AI. i oftwfwars 44 . 6 1 L POF AVED RA HISOAD •'•••.,,• DITCHES /.,,,\ ._...._...._..._....._...._....._._._..._...._... ....:�\.... i �- PATH iRML h $$ j ! _ ._..__._._.. _ '1 I. : ......__................._._........_........_......_ - ....._....._..�_.._.._._' _ _�:�' PROPERTY TINES ..__......_....._._........_....._y""�.- ! ,} \\ _ ..--........ - ....-...._._.._-_ -_ I ! � MAP f/ 1��PARCEL NUMBER 1 A , Y 43 . 9 "�E�HOUSE NUMBER i / t 1j\ 2 FOOT i ❑ i }- `—'"'""! f - CONTOUR E _. .,- -�. 10 FOOT CONTOURLI LINE E P (---------- `...•`\ .....,..-.._..._..^.... _. _ .. SPOT ELEVATION I ' / - f l _...... _....._._..... ..___ STONEWALL i 'I Q 1 I FENCE �-- ------- _ ............._.._._...._. ^...- _... 1 1 RETAINING WALL ` RAIL ROAD rftatxs K}7J� i ') I Jrr I I�r. I / \ ❑ STONE JETTY ,r SWIMMING POOL ! .............. 1 PORCH DECK i J I ' ILDIN / L-.1 BUDOCKG5P1 RTIIY ES/IE # L.. 1 ASSESSOR'S MAP BOUNDARY L`{jh _.. p 9 VALVE ® MANHOLES Jrr 7 i f I i i o POST OR FLAGPOLE > z SIGN n AORAI GRAINS 12 TOWER 0 POLE ________ # '4 LIGHT O ELE(ABOY # 285 �\ IE ......_.........__.._..._....__ �__......_.._......___....... l _._..._.... ._ I SITE MAP T.O.B.GEOGRAPHIC INFORMATION SYSTEMS UNIT SCALE:in feet MAP 268 20�.. 40 1 INCH 0 FEET 4 _ r r ! t I I '❑ I W E i f S NOIf:THE PARCEL LINES Of OIILY GRAPHIC REPRESNRAIIONS Of \ F-1 2b8NO, BOUNDARIES,THEY ARF POT TROF IOCAlI0X5 rmh 8-3-9A \ C- A 2 VE6OAOON ANB TOPOGRAPHY.LANIjUjC ETEDBATAFROM 198ED FROM 1995. PHOTOGRAPHY AI 7'=ADD'.At PUXIMIIN(DAIA IXIERPPElEO FROM 1995 { MR PHOTOS,PHOTOGRAPHY Al I'm A00'.AOIN MAPPED AI I'=I W'. I PAROLOAEA DIGIiIlED FROM I'=IWNGINEERING ASSESSORS MAPS 1997. C I \ ., *DATA All 100', CUACYOF P0.1N7EO AT MINI NG S(Ai MAY . `. `.. 1 //, Off f p i ;,a•e� ..M �, 1�.by ���/fS � �,fgj'. V V{, r 1 NO r' 't _ sASKsrdffis = 9 & �o� Department of Health Safety and Environmental Services Fo ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230' Building'Commissione: Permit no. 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. 1 Type of Work: /��/��� �AiT d F S'aKJ Cfe Estimated cost 9 �� Address of Work: Owner's Name: /-//Z �'� ��T- er 4-4 q4?� Date of Application: '-/2 �f 9 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law JJob Under$1,000 Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MIPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the age o 1 the owner. 1^ Date Contractor Name Registration No. OR Date Owner's Name q:fomns:Affidav • G. -�n=�`� '� '��✓Ae. gyp., i. ONE MPROvM, NiQNRA0 �^ ��. fiti e straj, Rik R Expiration 07/19/99s r NNI .7 NSUN- ml I H � IFIE LAY R g�'�+ nADMINI$jRATOR � 7x ` s �-ta 'P�kt{�� ���t•k h t4�,.s - „rF,� .:va.+r" �. ✓fLC'U�O'I!�/IYL0�721(�B2LGiL l4�✓�j�a�k1�GG�iLGJ�L�j .• i M^-• DEPARTMENT OF PUBLIC SAFETY E CONS;TRU:C,TION SUPERVISOR LICENSE Nueber Expires: 4 Res3ricted To:: 00 OENNI� VINSUN�, �_ 32' LUE"JAY DRIVE �} °"'"'� HYANNIS, NA 02601 ' + „« Department of Industrial Accidents - �''=— Offrce nflosestlgatlons s= R 600 Washington Street Boston Mass. 02111 ` Workers' Comyensadon Insurance Affidavit ow OEM name: 'OC AJk)/ S (/lkl. CIA) location: 2— M- -3w y //et o�- citV / y�'�ti1 i S /y �7 Z-� hone# 7--"-7s^ ` ❑ I am a homeowner perform g all work myself. /❑///�%//O%///sole vtor and Aave no one �%%g in any ca acity //%/��./////////////�///�''�,�,���i,���%r/,% % ❑ I am an employer provi ng workers' compensation for my employees working on this job. comnnnv name: address: ;:•.. : : ::: •<;:.: ::.::.::.;•:::;:::. city: phone#: in'surnnce cn. 2011CV# %L(�G%�'�///�/i%l0/////G%lll/.�///G''�///ll� ///.e'�l/////// •�7�i... I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who ha�e the folloi%ing«prkc' compensation polices: comnanv name•. addresir dtv: phone insarnnce co. comnanv name: address• citF- phone ituvrancc co. cv# .:. ..:.:.:::..::;;::�•:;M..:.. ,�.. .::. .x:: ............ . aai��it Fadure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Me up to S1,500Ae and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigation?of the DIA for coverage veritkation. 1 do hereby certi 'rtnder the puss and penalties ojper/nry that the injorma:don provided above it&ae and correct Sig<sature � ��L��l� Date Print name Phone lY official use only do not write in this area to be completed by city or town official city or town: peeittit/llcense tk LC,3BuddinDepartment Board❑ check if IxTbnediate response is required 's Oinceparttaeat�� (mvwm 9,95 P1A1 Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for Th. employees. As quoted from the "law", an employee is defined as every person in the service of another under any car 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 the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the recce i•e: 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&"grouaris c: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew, 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,neitherthe 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 cotnncnng authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insur nce as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation ofmsnrancir 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 a�questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Departm=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. The affidavits may be rcturaed io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Imlestlpallons 600 Washington Street Boston; Ma. 02111 • fax#: (617) 727-7749 phone#: (617) 7274900 ext 406, 409 or 375 TOWN OF BARNSTABLE Zoning Board of Appeals Petition for a Variance file z-appva.doc 071994 Procedure: Petition applications are available at the office of the Planning Department,First Floor,School Administration Building,230 South Street,Hyannis,MA. Three(3)completed applications along with five(5)copies of a certified property survey and if applicable,five(5)copies of an improvements plan must be submitted with your application for a petition. Failure to supply required information is sufficient reason for a denial by the Board of your request. The three(3)completed applications must be filed with the Town of Barnstable,Town Clerk's Office,to be time and date stamped. One(1)shall remain with the Clerk's Office,and the others shall immediately be filed with the Zoning Board of Appeals Office,along with all other supporting documents and plans. A filing fee of(See Fee Schedule)payable by a check to the Town of Barnstable, is required at the time of filing. The Zoning Board of Appeals shall hold a Public Hearing on the petition within 65 days of your application and shall render its decision within 100 days after the close of the Hearing. Both the petitioner and the abutters will be notified by mail of the date of the Public Hearing. The petitioner and/or their representative should attend the Public Hearing to explain the request for the Variance and to address those conditions which justify the granting of a Variance. The decision is processed within 14 days and is filed with the Town clerk. There is a public appeal period of 20 days from the date the decision is filed. After the public appeal period has elapsed,and if no appeal has been taken,the Town Clerk shall certify the decision and a copy shall be mailed to the petitioner. That certified decision must be recorded by the petitioner,at the Barnstable County Registry of Deeds to take effect. The rights granted under a Variance shall lapse unless they are exercised within one(1)year of the date of the certified decision. Additional Notes: The Petitioner Name is the name you wish the Variance to be issued to. Variances and any conditions are fixed to real property,land and/or structures,and are permanent to that property. If applicant differs from owner,the applicant will be required to submit one original notarized letter,copy of a proposed purchase&sale agreement or lease,or other documents with the application to prove standing and interest in the parcel or structure. Site Plan Review is required for all proposed development activities or for changes in use, except single or two-family dwellings. TOWN OF BARNSTABLE Zoning Board of Appeals Application to Petition for a variance Date Received For Office Use only: Town Clerk Office Appeal # Hearing Date Decision Due The undersigned hereby applies to the Zoning Board of Appeals for a variance from the Zoning ordinance, in the manner and for the reasons hereinafter set forth: Petitioner Name: , Phone Petitioner Address: Property Location: Property Owner: , Phone Address of owner: If petitioner differs from owner, state nature of interest: Number of Years Owned: Assessor's Map/Parcel Number: Zoning District: Groundwater overlay District: Variance Requested: Cite Section & Title of the Zoning ordinance Description of Variance Requested: Description of the Reason and/or Need for the variance: Discription of Construction Activity (if applicable) : Existing Level of Development of the Property - Number of Buildings: Present Use(s) : , Gross Floor Area: sq.ft. Proposed Gross Floor Area to be Added: Altered: Is this property subject to any other relief (variance or Special Permit) from the Zoning Board of Appeals? Yes [ ] No [] If Yes, please list appeal numbers or applicant's name Application to Petition for a variance Is the property within a Historic District? Yes [) No [] Is the property a Designated Landmark? Yes [ ] No [] For Historic Department Use Only: Not Applicable . .. . . . . . . . . . . . . [] OKH Plan Review Number Date Approved Signature: Have you applied for a building permit? Yes [] No [J Has the Building Inspector refused a permit? Yes [] No [] All applications for a variance which proposes a change in use, new construction, reconstruction, alterations or expansion, except for single or two-family dwellings, will require an approved Site Plan (see Section 4- 7.3 of the Zoning ordinance) . That process should be completed prior to submitting this application to the Zoning Board of Appeals. For Building Department Use Only: Not Required [] Site Plan Review Number Date Approved Signature: The followings information must be submitted with the Petition at the time of filing, without such information the Board of Appeals may deny your request: Three (3) copies of the completed Application Form, each with original signatures. Five (5) copies of a certified property sALrvep (plot plan) showing the dimensions of the land, all wetlands, water bodies, surrounding roadways and the location of the existing improvements on the land. All proposed development activities, except single and two-family housing development, will require five (5) copies of a proposed site improvements plan approved by the site Plan Review Committee. This plan must show the exact location of all proposed improvements and alterations on the land and to structures. see "Contents of Site Plan:" section 4-7.5 of the Zoning ordinance, for detail requirements. The petitioner may submit any additional supporting documents to assist the Board in making its determination. signature: Date: Petitioner or Agents signature Agent's Address: Phone: Fax No. Notice For Public Hearing The following are the most recent names, mailing addresses and corresponding Assessor's Map & Parcel Numbers of the abutting property owners, the owners of land directly opposite on any public or private street or way, and all abutters to the abutters within three hundred (300) feet of the property lines of the subject property. Assessor's Map a Parcel Number Owner's Name Address * Notice upon submission of application, it is required that all facts and documentation necessary to support the relief being sought by presented by the applicant. The failure of which may result in the denial of the application at the scheduled hearing V` Town of Barnstable .. . Zoning Board r*? eals New Fee Sc ie u e To all persons interested or affected by the Board of Appeals: You are hereby notied of a new fee schedule- r for all applications to the Zoning Board of Appeals. Z13A Fee Structure: Single and Two Family Special Permit-Home Occupation 5200.00 Special Permit-Family Apartment S 75.00 Varianc. - Bulk Dimensional Variance to Structure S100.00/per lot minimum set backs,front yard setback Variance- Lot Dimensional Variance SI00.00/per lot minimum lot arca,frontage, lot width &upland requirement All Other Special Permits& Variances SI00.00 accessory lots, non-conforming two structures, Commercial D sinrss and industrial All Dimensional Variances 5200.00 all Lot and structural dimensions, groundwater, etc. All Special Permits (parking reduction, conditional, non-conforming, and including Modi.Scation of existing Special Permits) under 4,999 gross sq.1 of structure 5200.00' 5,000 to 9,999 gross sq.ft of structure 5300.00• above 10,000 gross sq.ft. of structure 5400.00` plus SI00.00 for each addition:I 10,000 sq.ft. above • In addition. lots and developments fronting on to Routes 132, 28, and GA, and west Main Streit Hyannis add 5100.00 for location and traffic ruview. O!hers Use Variances & Modification of Existing Use Variance Same as Special Permits Commercial Business&Industry Appeal of Administrative Olfcials No Charge Comprehensive Permits (CH. 40B) 5100.00/unit By order of Barnstable Patriot Gail Nightingale. Chairman 12122194 and 12129/94 Zoning Board of Appeals