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HomeMy WebLinkAbout0024 BROOKSHIRE ROAD &eooxshwte- o&Az,, YftlAIIS /u P ' Sze — 0570 i i I 'I J IJI/30/2009 10:14 5089937877 SERVICEP9ASTER FHUN PAGE 01/02 L - 'own of Barnstable *Permit r regulatory Services EVirer 6 mwrrhvfrrptr&-ve daft Fee NAM 6YO. k Thomas F.Geiler,Director _ �g� Building Division IWI Tom pe rry,CBO, Building Commissioner MAY 2 i 2009 200 Main Strcct,Hyannis,MA 02601 www.town.barnstable.ma us Ow PRMYT APPLICATION - RESIDENTL ONLY Fax: S08-790-6230 IA NOI Valid without RedX-Prew r#V ivtt Map/parcel Number Property Address &0 Residential Value of Work yo _ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor`s Name pp Telephone Number ' 7(0 Dome improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Ckwbrkman's COmppnSatlon InsuranWe Check one: ❑ I am a solr proprietor ❑ 1 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Naihe Workman's Comp.Poli�_v#__� Copy of insurance Compliance Certificate must be on file. Permit Rejuest(check box) ® Re-roof(stripping old shingles) All construction debris will be taken to ' ❑Re-roof(not stripping, Going over existing layers of roof) © Re-side / �n7trY + S {orv►� © Replacement Windowsidoors/sliders.U-Value (maximum,44). "whet a rtquirod: Isgoance Of this permit does not exempt ccmpliancc with other town department r6gulations,i.e.Historic,Consarvstion,etc. ***Note: Property Owner must sign property Owner Letter of Permission. A copy of the Home improvement Contmetors License h;required, SIGNATURE: OUMMIdecolliklA felt, w11%MicrmfhWindowslTempomry temd I cskCoMnt-OullooklMY7NB4n,\BXPRESS.doc Revised 100608 i 09-05-27 14:07 » P 1/1 ConEftomweafth of Afimsch ��ae act a�jif�edusVid Accfdews 600 Wayh*won urges - y Bastb a,MA 02111 sargarxa.�a rt5��5a/ '}' ralica�:� a�an � I'llease Print A.e 'bk ��ar(�usis�ess°�;z�o�n!¢r�ivi�n6); •� z , ifLi Axe rorl�e;r-p�o�eai Check the xpparoFussE&dogs ~ �. Z a geacas¢ fps of giaject{reQui�)_ etas aad i ticmel._ tsawe lid flee m cvu ss Newcoast ctiou 0,part=-' IBB�04 the z5tad�sbe,-t %, V�j.R=wdcjjng siupand ano=003-= Th=st-Goner have I, Q'ar� for i$any scrs.�n�- cap�Y- �mym nd a ti wwk s, ❑D=olion comp. 3 � iA5U1�,� o di -. 5• �e;e t�®eaeporRtioa a its10-o E3mctic4 repairs or a�ho:� MY �. L 11.0 Flu _ df&XeID( Qu�e(A I�4�. �2sz�n q e.1S2,§1(4j,aadv%re eve tsa 12® ofrepaiss oployeau.[go wpri=, 13-� 7�-17y�1rcc�,f�:��`•��1 Wa.,se also fe'If�c,t�seed ft whodie$ri v,�di51-m trey w de'bdwg th*w,:km°wr4mcidm➢atcYialo�tt46oa. °�°�=••:.:oni tS�ZY - s � aRQ 4hmh�O,uSiQ�mp®,�'y�,fi ttrauss48�ie't.a,w.r al3tdardv,dicr�u+�¢ ��L�{ im tfdidAW Am Eft a 4,1 have�����mUd�v;de of the ti Od'asax whc$rer yr ao:�a,�Sa�e JrRfIL Rt��! CDa$�-Po�Y wee. • ��' Fl.�� ��P'�S'l�'Jl�190Y�7�`F®OL •�J'�Ti7ffi[!I fQ�.P1CB �r @i9 P .�'cps �e1o�es tree po7ir�y�dJao sate A3 ch a�cpx of the s�csa s coaegae�sat�n pC1lg degiam�t�aaa pie�s ffie r a:::a= ,setter� 8 as25A, PO�C�saes e�pt.ati®3a �a&e), z5Vh--d nudes Sedon 25 A,of MGL r-152 rate ls�d E0 dke jMpasit[!oft of t 1 pr,�sIti as of a e g1,SG{`,CJ a�?r�ar aae G�: �SEt.Ji; t Y ss'011's ciyg p�sxhk3 in tf c f=ofi,S70?WORK ORDER snd a Same Y$fit�Viakto r. at air ed t ass yIA %�P at s s May fm�to the Office of - aaRLs tang fiiiiybrMfdo a provided rabm if mw¢Rd wr?wL ae ' ' ! 1 use��zs. Des�Ci write: 2Jafs�JrIA� e e o y rrty or tbev�fl,�Sc faE j' Cis or iawr: • { y w .al:UQtsft(ci.eie one,, I/ T, card���a Z.�nzH� aeast• �>�t�f]°o�sa�ler� �. �I Doi .�,Pinmblse �x gflr h • I� tc�E�CStaY:: PIAER:f istration valid for individul use only License or reg►ration date. If found return to: before the expiration and Standards �p Board of Building 11 k One Ashburton Place Rm 1301 02108 Boston,Ma. •_ pa tur clot valid w►th,out s►g WC I Board of]3 wl - HOME tMP dinQo� . 9 s � ROVEMEN C aad Standards Re t try Toni T ONTf�q pT0 if Exptrati 14 8688 R ,: + 1. -T 1812009 CO WE f I t n Ype S f"7t S HOME f �Pplemer7t oYMl RppR1GVEFNTERS DIY Card 00 2 COW MppR ESVtCC E.NC28117 .: ` �r4. naministrator 600 W' ' .� aasf�uag#an street Boston,hA 02IIl �uei:mrgssgov� Workers,' COMgeP OLdOU InW uce davf�Buf�ea fCoia rSXWtTicI asfP]uazbers . tslacaszt lima Prxnt Legibly Name 'r r Phone.t Chesk(he-appropriate —"—+ ropris�bm�s 7Y pe of pa°oj�(wired): .� sgitI a�a g=ers@ Qr and 1 i.5-a zacly:part-lSII3Cl.s hs�hixeci 11 sub-crab as Q Few coa5t=k= ; sprnr or pax isd on the ate t$stet 7. - R"oodeling ra toyees Tsa Sub-co�is have Dmolition u=Y capacity. cnpiayew a d have wMk=J I a 0eke%� rotes.sns rn oaaap<insuaumt 9. ❑Building addict= s _ 5. 0 ate are a coap0awdon and its '10.11 nerical repairs ar at dau:►s _ . hcs Gov off l I I.[]Fi=ibmg rcpe ter. b irk gig bf t1 va addiriow t �ave s i2.®Rmf repairs �{4�,and tive eve sao 11 IAyeea o>�' 13-El Oda rAnv appl .t 't�srar�scc requu�,j �.•'•�x- t indiea . € � i Y WC60ft an W4 then�am*- naw snT�a mw aPBdnrit s�di �xh fitse�as rotdid�s9 €Sep t#anmof the sub�oaaa�oas aad'ss vctha aa:ilio�cares have S s 6"f the ai cOtq nay€ th-'Y-'-f¢,.wide nir worf�s' is vmasBss rrr� rani rag worken`co u :4s+ acs�ar � reapPaytx� ze&w is twpolaey asajab site job S to Addr sz-- C4/5'�&4p : l c p r e 1vr s•° *MPa daa p�alficy dad (fm I =e(s the Wficy umber and expiaati®a date): �^ se""'� zNuhmd uRAIM Sect=25A of MGL e. 152 lead ib tile ig6/, msifm ttf e..,a o f WORK U2 Y �S � G pen4im in th.:f=of 8 SM? vc VRK ORDER and a fine day sg st EDe viAmr. Be adviged tit a c Vy oftbb sWxMgj6 may be foiwstded to the-Office of y r tt�zaf g �aasS g to a tw and corr ((44 s ; lFrtq, �i1D8��tB�A�E1.P 8Cf � =- I5 I3 ,� ase,Pef. ga��t asr,ite e'�.iJbts aore�,fb a e� tits or IMM gj)kja Ir .:.FLY or 6u`wa.. , I � 'ciree one); Ej I!Board of!Rn-W& 2.RatIditiDeparbAeat 3°ChylTows Clerk 4. mczl Znpftfor 5,PIumbing Iaasgec�or intact ems; phone#. SERVICEMASTER FHVN PAGE 02/02 • � vnmater.�oe� '" Town of Barnstable Regulatory Services Thomas F.Geilcr,Director Building Division Thomas Perry,CRO Building CommissiOReY 200 Main Street, Hyannis,MA 02601 w"w.town.ba rnstable.ma.us Of-ce' 508-862-4038 Fax: 509-790.6230 Property Owner Must Complete at'd Sign This Section If Using A Builder A T. 9 as ()W"Q of dic subjer Propel' heretic•authorize • �� � __l act nrt my behalf, in ali matterE rea��ve to svork authorized by this building pernut application hP n for: (Address of Job) St ile turd f Owner Date ptuit**iafPe 1 T4roPert}`Owner is applying for permit,please complete the floaaeowners License reVerse aide. Exemption Form on the C:`:U'u"" "ik'Apppa'\Loealmirro�OftNwindowslTcm Revised 100608 fMrAr}'Intemct FilesiCotttent.fhttlookiMY7N341t,1LJ{ppESS•dm F t 2008-09-26 06:41 - INSTALLS:_ !Y.!p _ P 1/1 NIMS'Achusettx-Department of Public tiuFet% \ Board Of Buildin" Ret;ulationr and 4�tawfaf"I, Construction Supervisor Specialty License License: CS SL 101046 ,\ Restricted to: RF,WS MICHAEL PURPURA 239 CHURCH STREET ` MARSHFIELD,MA 02050 4 y -yam Expiration:.419W2 t �ainN.rviner Tr#. 1 0104 1 200$=04-11:. 1-�1.�...... _ - 'INSTALLS : !.ytp P,2/2 Board o u.il in egula ons an an a s One Ashburton Fface Room 13Q X Bolton, Massachueits 02,108 ome Improvement Coaitracto'Rep stritlon Ristratlari 141531 Type, . DBA Exq " i6goIn 4/2712010 Tr# 26W46 NAIL QN'THE HEAD MICHAEL PURPl1RA - 239 CHURCH STREET - :MARSH FIELO, MA 02060 _ Update Address and return card Mark reastiafor clhdnge DP&Cat.0 9DM-07107 PG84 „' I I Address I fte�israf Employment ( Lo:atCsrd rho ; 777 - — BoAtd df")gnildtag RegulAtians and 5ta®dard9 l.leeuse or re*stratlon valid for."Wividul use only iHOIYIE'nAPR4YEMEIff CONTRACTOR beilore the eapiratlott date: Bo If found return to:`4; Regeatrattott. 141q and of Bu[1dL Regnlatioins and Standards -One Ashburton . 412712010 : Trli 266D46 Place Rm 1301 Type b.&4 BO$tOQ,Ma:"o21o6 NA1L'•ON THE'NEAD t MICR ZL,r PURP(JRA f 239 CHURCH$TREC=T: c ' MAfiSNFIELD;MA 02050 �' J4dnItr118tPaiAr of vaUd W1tlt6nt sigq&}ArE r 09-05-27 13:54 » P 1/1 1 b16 � °F1HE r Town of Barnstable *Permit# 'b Expires 6 nron s from issue dat Regulatory Services Fee c BAMSrABLE, : Thomas F. Geiler,Director 9 MASS 9, 039 .� Building Division �OjFp�.lA 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 Not Valid without Red X-Press Imprint Map/parcel Number J�r Property Address `'d e V t L Residential Value of Work >00 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Addressc�0�J r �j ✓Nl / '/ U o Contractor's Name /6,/V A.�Or .L,/{/ L Telephone Number 40/ Home Improvement Contractor License#(if applicable) ❑Workman's Compensation.Insurance r mI" RESS PERMIT Check one: X I"" V❑ I a a sole proprietor MAR j 8 2009 ❑ am the Homeowner I have Worker's Compensation Insurance 1 .� �owN OF BARNsTABLE Insurance Company Name' Workman's Comp.Policy# 9 to Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re- tde Replacement Windows/doors/sliders.U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 E The Cont.o, nwealth of Massachusetts Department of Industrial Accidents Of ce of Investigations k1i 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ,typilcant Information Please Print UPON Name(Business/OrganizatioNlndividual): �nonzS Address: City/St e/Zip: D��. -� d -���� Phone#: Z{f/ �'C, �'-Co Are ou an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 2(// 4• ❑ 1 am a general contractor and I - • have hired the sub-contractors 6. ❑New construction � employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.$ required.] 5• ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof airs, insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other C ell/ comp. insurance required.] J n*U� ' '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. 1Contractor 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 worker'comp.policy number. I am an employer that Is providing workers'compensati n Insurance for my employees. Below is the policy and Job site information. Insurance Company Name: e.i AA//� ✓V< Co l Policy#or Self-ins. Lic. #: j g� Expiration Date: I D J l Job Site Address: City/State/Zip:1` Ja_ o xo J �-T 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 ce fy under the pains and penalties of perjury that the information provided above is true and correct. Phone #• 7V/ —C21— C lor) Offlc al use only. Do not write in this area,to be completed by city,or town offlclaL City or Town: Permit/License# r issuing Authority(circle one): t. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i d Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than threeapartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall noil, ecause 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 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 pemtitilicense 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. When 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 t 1-22-06 www.mass.gov/dia Fr um-,Sfra canna Robin on,Hunter Insttrance At;Hurter fr#surance.Inc: F3><DI To-QeNse Glode Date:or"291015 I 1.1b IATO ila e: cv OP ID � 0AIE4MP4tt3I3tY1t>'Yj A�'f.?R,L CERTIFICATE OF LIABILITY INSURANCE MOOR 09,29/08 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc, HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 399 Old River Road, P.O. Sox 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Manville RI 02838--0001 Phone; 401-769-9500 Irax:401-769-9502 INSURERS AFFORDING COV15RAGE NAICMSURED � €tdm1. ',Er{f4: >3t.at taaxxrl 6cattg'+ nsxxx rxxcM c*a Moan Associates Inc, �.0 D9A Gutter Helmet {Pq ,AEe7E3• 8saaas�f>Xx�tatxA xnnurxn�� cxa.. DBA Renewal b Andersen of RI N DBA Gutter Heyxn,et Roofing iPg6 Cit4.: 1137 Park East Drive Woonsocket RI 02895 PJstixLa. �_ COVERAGES .wtzY G�'It.SI,#IPrltil';WT.TEI?e.l f3ia e;OtgG?ITini<'d tiv ArJY Crard#�ACT s:SP q'rHER Ctt;DCU�ti;PYI'�.w,"i Y2i raEEeFT•Eq WNlt:i�#TI'#€$CrRTtfit.ATE taAY EIE t`"3"SE.t��7 C"�t. P,%Y PE,PTAIN,T14Z€E,7^j''1VWJ�X Ar-f- #)CO BY'I"ham TERMS, 0i,!-�I!i #�'�€.W E�'v tx��"'=�2f::a'�TC�€.tfv<!"Y;j i{bsFr'!J 0.4�cY YtA:E fs•i:t€(t�(„1,#�•EG7 tfl�{•"'R€='�Ct..Ic#P�#"a. .....�,.................. -P#3L7G"Y"EF'FEt"P '„"P�TT�°S'">rX6�E#'�TiCtlt,>.,.,�,,w�.,�.�...: LTr? HSY3 T"'FPFS OF#tlil.tRArdCEx POLICY HtJMQJFJ? PATE �1M1Opiw"r t3f`iTEM1RStTsrSlYVS LttAlT3 GENERAL LIABILITY F.,.ACH000,11,7L"-NCE $1000000 rscx �•-lia r°e T A X CORMt-RCIAL GE14'RAL 4 IADILIrf MA'S-06619 09)16108 09/16/09 Frt�atei tP��cc�� w �500000 AIMS#errX 11Aa t< eaE atrrnar«3 €t§ t 10000 Ssx:Ta ta�aAa. Ary dt,a,.itzv #* 10 0 0 0 0 0 4"RWfAL,Aar&(W'Tr $2000000 �. � r #iEThi#I r• k,i5 � cs.� I�Az� 12000000 PC ICY E] t�- 'r AUTOMOBILE LIABILITY A X Er�P�r. lrti 1u26619 09/16/013 09/1f0/ 9 e tztrr� dad ixPnr $1000000 1 fi Fu p sNtPl f)�i£TO t3 iL 0q.fx4 I,1FE":tA E0 A JTOS 4F�ar a r'asi,1 t E #!Er¢E•€"�AffO.S nOErl.Yirq.Aa?V � i�tfEr Ea 2 I#>cY tl�ci�tearstf GARAGE LIABILITY {A,;TO tiMLY.LA cc`,;£,IUL, 'i• S A"'r A?rts� . kAA,,LC S i1T}ICR 7}f�N AAfrO 00-T EXCESS"10RELLALIABILITY EA I#€a CtJkk CJwd $ 100n000 w.zre t � CUS26r 19 09/16/08 09/16/09 A XI oc X �TckiFs�r4� t 10000"� �,...,„��. ,._.._ .,... �....._,,,.d..�,,_..��.... WOWIwR<"x CCPrsrErAT€CSNAKta # [rxiP#.OYERS"L#At"flLTYY —E LR __ B 28586 10/01/08 10/01/09 t t LN-Ii rCffkNT 5t10000 .aAtY f�#fWR€E-I'(* 31R'"1'P11r'1;ff.3OVE ..,,"...._....,,,,,,�___.. _,. ,...�.,«..«,. .......�- _.,._:;.._-..,.wx,....,.-....-., QF' CE'l�I-)ABL-P C rvLt f'CSC €f`l ,S� zsta rtuu EC C EASE EAkdI IT7YE nQO00 i S00000 OTHER T#E�CE't#PT1r�P1 q�G31�E#tAT#C`itJ�`f LgcATlarJf3 t VEtI1CLE.�x f E%CLL�:.1pPt5 atapET}�°C INOORSEPtENT r sPaEc#k!.PROV# #t?Nfl CERTIFICATE HOLDER CANCELLATION . - BUILAIN SHOULD ANY OF THE ABOVE DESCRIBED PO•UCIES BE CANCELLED BEFORE THE EXPIRATION t?ATE T}IERIEOF,THE tSSUlt4 t!#d URER VALL Er40CAVOR TO#AJL 10 DAYs WFjTT&j Building Cont. Reg. Board NOTICE TO THE CERT#FICATE HOLOER NAMED TO THE LEFT",OUT FAILURE TO 00 SO SHALL Dept. of Administration IMPOSE H0 OBLIGATION OR LABILITY OF ANY#etNO UP THE INSURER,#Ta AGENTS OR' One Capitol Nils. Providence RI 62908 REPRHSE#TTATtVP fi, ACORD 25 12001(08} 0 ACORO CORPORATION 1989 License or registration valid.for individul use only Board of Building Regulations and Standards before the expiration date.,If found return to: HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards Registration: 119535 One Ashburton Place Rm 1301 Boston,Ma.02108 Expiration: 7124l2009 Tr# 130185 ; Type: Private Corporation MOON ASSOC INC JAMES MOON 1137 PARK EAST DR. 7 Not valid ithout signature WOONSOCKET,RI 02895 Administrator I .+:tcirtt�c tt� Del)ar'itne nt ill' Ptritiit; `:tip 4> Restricted to: RF,WS 1 Bo.ts-rf <if 13ttildirv-, Rk:--,id tt+frr:, and �srtttt9a�tl� Construcmn Supervisor Soecc a t y License Ir1.- Masonry only R"F- Roof'Covering License: GS.Si. 998A0 WS-Windows and Sitting Re5m,cted to: RF,WS SF- Solid Fuel Burning Devices DM-Demolition only JAMES MOON 48 PAINE ROAD Failure to possess a current edition of the CUMBERLAND, RI 02864 Mtzssachusetts State Building Code is cause for revocation of this license;. Refer.to: WWW,Mass.Gov/DPS ,.. _ czprrr+rxn: 312312012 t r Customer Name: 7 Year Built: /�S Penewal by Andersen of RI&*Cape Cod Renewal - Sales Agreement Address' YJ �' Customer ID#: 1337 park East Ilrive �yAndersen. City,State,Zip: O Q Order Number. ��iopusorlte4 RI 02595 Phone-Home: C�{)27-02- 5eFT r license#RI 12259-IVA 119353- WINDOW REPLACEMENT —Ad—C—pany P hone Wort: �i Pager of Date: CT0562725 Email: UNITS Technical Measure GRILLES Dimensions ggg 4��8d�¢a o Room s i ,� pR ate• rna ssxb �Z •e3 `—"a Y9 odt �g��i`-c �° n �'� dik m_ '�^Y S $PRICES E� 6a t x Description ¢en o P uK W rti qz ut; � -3 11 flw - w w' r - - - - - - - aU �M ( ev I, 35 a - w IV, Cu c. 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Pr oe irrcluda labor,rnater aLs,insellaciort spololryralsd abwe aminst-➢ell. athenvisenotrd. atlMenOC.d,ejoballcoium tim bend willhe removal,and disposal ofproduc[s replamd. .re ed andv+e wlldwn yoarnew vrindaruatl White-Renewal by Andersen Wflow-lnstallatimn Pink-Homeowner Cvstomer C astomer Gnsamer wY inralari3n a.T+. Initla///1,: Initials_ Initials: _ - [ •'• /�� �� '4n-.J!.l..:h �vl J..e.....�ln.�•n�•••hen.�m.�......in...4.+.t'::n,�:...•.f.W+nara.ni vinnnw M,yu.x,ao t.rrlviein:1.3r4•n i ✓ pI