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HomeMy WebLinkAbout0054 CHASE STREET s��i� ����- 1 �� The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth,Corporations Division IN �Z"y One Ashburton Place, 17th floor Boston,MA 02108-1512 r Telephone: (617)727-9640 BAYRIDGE REALTY LLC Summary Screen D Help with this form F* Request a Certificate`s r The exact name of the Domestic Limited Liability Company(LLC): BAYRIDGE REALTY LLC Entity Type: Domestic Limited Liability Company(LLC) Identification Number: 453929643 Date of Organization in Massachusetts: 11/29/2011 Last Date Certain: 11/30/2030 The location of its principal office: No. and Street: 96 SUMMIT ROAD City or Town: PLYMOUTH State: MA Zip: 02360 Country:USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No.and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: e11 � 3� Name: DENNIS KERKADO �~ 7 No. and Street: 96 SUMMIT ROAD City or Town: PLYMOUTH State: MA Zip: 02360 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER JENNIFER CAMPBELL 96 SUMMIT ROAD PLYMOUTH,MA 02360 USA MANAGER SUSAN MASCI .�j DRIVE21 HAYDEN FOXBORO,MA 20355 USA The name and business address of the person in addition to the manager,who is authorized to execute documents to be filed with the Corporations Division. Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY DENNIS KERKADO 96 SUMMIT ROAD PLYMOUTH,MA 02360 USA SOC SIGNATORY FRANK MASCI 21 HAYDEN DRIVE FOXBORO,MA 02035 USA http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 10/9/2012 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 2 of 2 The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY SUSAN MASCI 21 HAYDEN DRIVE FOXBORO,MA 02035 USA REAL PROPERTY DENNIS KERKADO 96 SUMMIT ROAD PLYMOUTH,MA 02360 USA REAL PROPERTY FRANK MASCI 21 HAYDEN DRIVE FOXBORO,MA 02035 USA REAL PROPERTY JENNIFER CAMPBELL 96 SUMMIT ROAD PLYMOUTH,MA 02360 USA Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership X Resident Agent _ For Profit _ Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS Annual Report Its Annual Report-Professional Articles of Entity Conversion 4� Certificate of Amendment ICE �� HVlew Fllmgs �I `New S a chi Comments O 2001-2012 Commonwealth of Massachusetts All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 10/9/2012 r t of Massachusetts for a full four months in a calendar year. alth club agreement/contract Benefit Year TOTAL AMOUNT SUBMITTED: $ signed and dated below.) eld of Massachusetts, Inc.,about my health club membership. complete and correct and that I have not previously submitted Date: QUESTIONS? To verify this benefit is within your plan or for further information, call the Member Service number on the front of your ID card. ,J L� �.,Inc.. - MASSADHUSET ®T S (3/09) .r d Parcel Detail Page 1 of 3 Logged In As: Tuesday,October 9 2012 Debi_Barrows. Parcel Detail Parcel Lookup Parcel Info Lot Parcel ID j 28 308-2 Developer ii LOT 5 _ I I Location 154 CHASE"STREET �I Pri Frontage 157 Sec Sec Road Il7RACEADA COURT Frontage 170 Village IHYA S O Fire District HYANNIS ^� Town sewer exists at this address Fjes � Road Index�0287 Interactive - Map Owner Info OwnerFNOVICKI, MARY L co-Owner;%BAYRIDGE REALTY, LLC Streetl 196 SUMMIT ROAD _ I Street2 j f city jPLYMO.UTH - State l�A zip 02360 Country Land Info Acres 0.10 Use(Single Fam MDL-01 � Zoning jRB _NuM� I Nghbd lF0106��'T Topography Level Road Paved Utilities{AII Public _ Location Construction Info Building 1 of 1 Yea ri�927, m Root Gable/Hip T ExICia board Built I Struct Walll p � Living�1095 - � Roof Asph/F GIs/Cmp Ac,IIkNone Area Cover Type wnt all Plastered Rooms 4 Bedrooms Style'Cape Cod ( Bec mm.__.:._. ..—. _---_. Int Bath Model Residential Floor(Pine/Soft Wood Rooms 1 Full Heat I Total Grade jAverage Type IHot Water �I Rooms i7 Rooms jp Heat Found-�� Stories 11 Story F A FuelOII e ation#Cons. Block TIfi+ Gross 2944 Area I http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=25094 10/9/2012 f Parcel Detail Page 2 of 3 Permit History Issue Date Purpose I Permit# Amount I Insp Date I Comments Visit History Date Who Purpose 04/04/2012 00:00:00 Denise Radley Change of Address 03/20/2002 00:00:00 Paul Talbot Meas/Listed-Interior Access 05/15/1988 00:00:00 ML - Sales History Line Sale Date Owner Book/Page Sale Price 1 09/15/1995 NOVICKI, MARY L 9865/088 $68,500 2 10/15/1993 CHASE, MARY B 8834/028 $1 3 02/15/1991 CHASE, MALCOLM P JR TR 7436/298 $1 4 07/15/1983 CHASE, MARY B 3798/044 $0 5 05/24/2012 BAYRIDGE REALTY, LLC 26358/149 $1 6 01/20/2012 KREC, LLC 26018/29 $125,000 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2012 $84,500 $21,800 $0 $116,300 $222,600 2 2011 $109,400 $0 $0 $116,300 $225,700 3 2010 $109,000 $0 $0 $118,100 $227,100 4 2009 $120,500 $0 $0 $142,800 $263,300 5 2008 $125,200 $0 $0 $152,800 $278,000 7 2007 $124,700 $0 $0 $152,800 $277,500 8 2006 $119,800 $0 $0 $158,700 $278,500 9 2005 $105,900 $0 $0 $102,000 $207,900 10 2004 $97,900 $0 $0 $102,000 $199,900 11 2003 $77,600 $0 $0 $29,000 $106,600 12 2002 $82,800 $0 $0 $29,000 $111,800 13 2001 $82,800 $0 $0 $29,000 $111,800 14 2000 $56,300 $0 $0 $20,600 $76,900 15 1999 $56,300 $0 $0 $20,600 $76,900 16 1998 $64,600 $0 $0 $20,600 $85,200 17 1997 $56,600 $0 $0 $18,200 $74,800 18 1996 $56,600 $0 $0 $18,200 $74,800 19 1995 $56,600 $0 $0 $18,200 $74,800 20 1994 $58,100 $0 $0 $21,000 $79,100 21 1993 $58,100 $0 $0 $21,000 $79,100 22 1992 $66,200 $0 $0 $23,400 $89,600 23 1991 $76,100 $0 $0 $33,800 $109,900 24 1990 $76,100 $0 $0 $33,800 $109,900 25 1989 $76,100 $0 $0 $33,800 $109,900 26 1988 $44,600 $0 $0 $18,500 $63,100 27 1987 $44,600 $0 $0 $18,500 $63,100 11 28 1 1986 1 $44,600 $0 $0 $18,500 $63,100 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=25094 10/9/2012 Parcel Detail ' ' ` "` 'Page 3 of 3 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=25094 10/9/2012 Home Energy Raters LLC BTorrey @EnergyCodeHelp.com Box 989,E. Sandwich, Ma 02537 888-503-2233 Duct Leakage Test Address4 CBase St=Hyannis-,-Ma---Date---April_26,_2012 Test Type — Post Construction — Leakage to Outside Conditioned floor area =1254 Sq FT. To comply with Section 403.2.2 Of the 2009 IECC Code in this home the Maximum duct leakage CFM = 100 CFM (1254/100 x8 = 100) Duct leakage tested = 53 CFM This Home complies with Section 403.2.2 Of the 2009 IECC Code Date of Test: 4.26.12 Technician: Larkum Test File: Untitled Customer: Carrigan Heating and Cooling Building Address: 54 Chase St Hyannis, MA Phone: Fax: Test Results 1. Measured Duct Leakage: 53.0 CFM 110.0 sq. in. (+1-0.0 %) 2. Duct Leakage as a Percent of System Airflow: 3. Duct Leakage as a Percent of Building Floor Area: 4.2% 4. Leakage Split: Supply Side: Return Side: 5. Duct Leakage Curve:. Flow Coefficient (C): 7.7 Exponent(n): 0.600 (Assumed) 6 Test Settings: Test Mode: Pressurization Test Pressure: 25.0 Pa. Equipment: Series B Minneapolis'duct Blaster Test Type: Outside'Leakage (Combined Duct Blaster and Blower Door Test) Contact our office with any questions, Bruce Torrey, , Certified HERS Rater Home Energy Raters LLC Commonwealth of Massachusetts Sheet Metal Permit Map Parcel f Date: 3 u i 'Z Permit# 0 ' Q Estimated Job Cost: $ Permit Fee:'r`$ Plans Submitted; YES NO '° Plans Reviewed.:-YES NO Business License# Applicant License# 31 M o Business Information:M Property Owner/Job Location Information: Name:• C A Name: X P tCr L L_ �Z. ' o Street: a P�►^r\.\JeA s ��-j- .,_ `Street: Ci /Town:ty r-M tro�1�. A gity/Town: Telephone: g `3 �d 3 Z � ", Telephone: 0 S 71 7 2 59 Photo I.D. required/Copy of Photo I.D. attached: YES JL NO staff lnitial J-1 /M-17unrestricted license1 v " J-2/M-2-restricted to dwellings 37stories or less and>cornmercial up to 10,000 sq.ft: /2-stories or less ` Residential:'1-2 family ' Multi=family 'Condo/Townhouses Other y Commercial: Office Retail Industrial Educational Fire Dept. Approval Institutional Other Square Footage-.sunder 10,000 sq.-ft. over 10,000 sq. ft. Number of Stones: �_5 rD 4 At Sheet metal work to be completed: New Work: Renovation. , HVAC Metal Watershed Roofing Kitchen Exhaust System L_-, Metal Chimney/Vents Air Balancing --� Provide,detailed description of work to be done: ­0 C10401r r 1;N NSURANCE COVERAGE: have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 YeOhNo ❑ f you have checked , indicate the type of coverage by checking the appropriate box below: % liability insurance policy Other type of indemnity ❑ Bond '❑ )WNEWS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Aassachusetts General taws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent ly checking this box[],I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and ccurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be i compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Y Progress Inspections Date Comments Final Inspection s Date Comments .- Type of License: y y ❑ Master itle , ❑ Master-Restricted I ityfrown ❑Journeyperson Signature of Licensee ermit# ❑Journeyperson-Restricted License Number: :e$ Check at www.mass.govIdol ispector Signature of Permit Approval sr ,M The Commonwealth of Massachusetts Department of Industrial Accidents Off ce 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):�- I� g�� Al) 0 .eA7(,'n R Address: (7 .)-2 P717 L,,A �1, V� City/State/Zip: f r Phone #: ' �. ® " 3 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 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction . 2.. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 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.❑ 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 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' 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: ,� Date: Phone#: b 7- �5 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#: t _ LT WR- IS Z A TSSUES f�EFAB�,VE-LI E,NSEi TO a I �PAl1 A ,CtArRRkIGAtJ C�RR. E'A4tT3I,N�G y ;30 'AM`UET i 30 AMUET AYE f a -.r THEr Town of Barnstable ` Regulatory Services t r r $ Thomas F.Geiler,Director ", BuRding Division Tam Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us - Off cc: 508-862-4038 Fax: 508-790-6230 Property Owner Mus t Complete and Sign This Section If Using A Builder . ; as Owner of tlh.e svbject.property . bemby authorize P(• V L C4 to act on my beha}f, in all matters'relative to work authorized by this binding permit application for. C - - (t4dd ess of Job) of Owner Date V ' 6 i1Gtwy - � L Cs Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on'the reverse side. .Q:FoxMs:owrrErz�E�rrss�ox Town of Barnstable TKE r ti tiw o Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main-Street,_Hyaffiis,MA_02601 www.to wn.b arnstabl a-ma.us Office: 509-862-403 8 Fax: 509-790-6230 HOh'IEOWNER LIMM,EXEMPTION Please Print DATE J C7, 1 JOB LOCATION: � { number street C village "HOMEOV7NER': K RE:C- IrLC, name home phone# work phone# p�/� l � CUR MA RENT ILING ADDRESS: CV SUM✓LI t T R MA c)a CRY/town statr zip code T7ie current exemption for"homeowners"was extended to include owner-occupied dwt-Uinzs of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner arts as supervisor. DEMON OF HOMMOWNTR Persons)who awns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than tine home'in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Budding Official on a form acceptable to the Building Official. that he/she shall be responsible for all such work performed under the building permit (Section'109.1.1) 71,c undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner?'certifies thatht/she understands the Town of Barnstable Building Department Mspecfion., mc-dures and requirements and that he/she will comply with said procedures and tints. Y Si omeowna ' Approval of BuildingOfncial d Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control Hohmoyv QEws FJ mmbN .The Code states that "Any bomeowner prrfomung work for which a building permit is required shaD be exempt from the provisions of this section.(Seetion 1D9.1.1 -Licensing of caarau6tion Supenisors);provided that if the homeowner engages a persons)for hint to do such work,that sCuch Homeowner shall act as supa-visor." 1ri-any homeowners who use this cxcmptioa are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Ru)cs&Regulations for Licensing Construction Supervisors,Section 2.1.) This lack of awareness often results in serious problems,particular)y when the homeowner hires unlicensed persons. In.this case,our Board cannot proceed against the unlicensed person as it wrou)d with a licensed Supervisor. The homcowncr acting as Supervisor is ultimately responsible. To ensure that the bamcowner is fitIly¢ware of hisihcr n spo=bilitics,many communities require,as part of the permit application, that the homoovmcr certify that bmishe understmids the nspmm'bt7i6rs of a Supervisor. On the last page of this issue is a form curnart)y used by several towns. You may care t amend and adopt such a formfcerti5r_ation for use in your community. Q:formt:homeea:empt Tyr ToBarnstable ' F � wn of Permit# OExpires rtt/ts from is die ' Regulatory Services Fee: 9cb 16 S. Thomas F. Geiler,Director m Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 0260.1 www.town.bamstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY _ Not Valid without Red X-Preys Imprint Map/parcel Number Property Address-_s'4 C-hli St es,-f- I LjG4;�1 a1 lI A Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address AWE( GL� Contractor's Name JC nnlf� Telephone Number Home Improvement Contractor License#(if applicable) �'� 4-$RE_SSPERMIT Construction Supervisor's License#(if applicable) 093 L L XWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor TOWN OF BARNSTAB� XI am the Homeowner I have-Worker's Compensation Insurance Insurance Company Name i✓1Gb9► `` 1 i T � Uu 0ku� (N3'l­�,6 Workman's Comp. Policy# h (✓ -1 1`3)A Copy of Insurance Compliance Certificate must accompany each permit 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-side #of doors ] Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows _.*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 Improvement Contractors License& Construction Supervisors License is tired. 1 IGNA 1WPMESTORMSUilding permit fnrmslEXPRESS.doe :wised 070110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 .°� • ""W www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): Den Ais Keykadv Address: ( 1'�OoMV"I City/State/Zip: y jvtiwVk hA,Pr 04�(.0 Phone.#: 5V S Are you an employer?Check the appropriate box: Type of project(required):,.- 1.�I am a em to -r with 4. ❑ I am a general contractor and I p Y 6. ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity, employees and have workers' Y P tY 9. ❑Building addition [No workers' comp.insurance comp.insurance.t 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 fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ) `� Insurance Company Name: Policy#or Self-ins.Lic.#: ';bij 7�_3�A Expiration Date: !� /) 3 Job Site.Address: ( � � City/State/Zip: A e i1t/vl'4), _ 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'nswance ca.era a verification. I do hereby cer,' n the pains and penalties o, erjury that the information provided above Iis true and correct. Signature:_ Date: Phone#• SZE 57722 7e7 !ST 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#: E 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 three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of 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-contiactor(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 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"I:he 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 fo any business or commercial venture (i.e. a dog license or permit to bum 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:. Tho Con=onwoalth of Massa chusotts Department of Industrial Accidents Office, of Investigations 604 Washington Street Boston,MA 02111 Tel. ##617-727-4900 ext.406 or 1-977- ASSAFE Revised 11-22-06 Fax##617-727-774 www.mass..govMia Town of Barnstable Regulatory Services • a+aivsresrs, Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner i 200 Main Street,Hyannis,MA 02601 www.town.barnstoble.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder P yt'nt as Owner of the subject property hereby authorize 1J&VA&C's to act on my behalf, in all matters relative to work authorized by this building permit r l C4 5 -� (Address of Job) **Pool fences and alarms are the responsibility of the applicant.' Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner SigAae of Applicant . d(.Is I'� Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS EVE Town of Barnstable Regulatory Services i► RA STABLE. « Thomas F.Geiler,Director Ar 16. . A•�� Building Division ED MA'1 Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS:. city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling, attached or detached structures accessoryto such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable'to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section l09.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The� Code states that: "An homeowner e y performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems;particularly' when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas it would with'a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt I i RightFax NI-2 2/24/2012 7:09:08 AM PAGE 3/003 Fax Server (F 11� CE. E DATE ISSUE TE 2/2d/2012 THIS CERTIFICATE IS LSSUED AS A MATTER OF INFORMATION ONLY A.YD CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTMCATE DOES NOT AFFMIATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY TEL 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 pollcy(les)must be endorsed,9 SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement s� PRODUCER CONTACT DOWLING&O'NEIL INSURANCE AGENCY INC NAME P.O.BOX 1990 PHONE FAX (AA:,No,Est): - (A/C,No): HYANNIS MA 02601 EaIAIL ADDRESS: PRODUCER CUSTOMER ID t INSURED INSURERS AFFORDING COVERAGE NAIC# KREC LLC INSURER A HARTFORD UNDERWRITERS INSURANCE 945 CONCORD STREET COMPANY FRAMINGHAM,MA 01701 INSURER B INSURER C INSURER D INSURER 1E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TTIE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITU 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LUVDTS LTR I'NSR W VD GENERAL L1ABR.TTY (MIv1IDD/YY'YY) (hIM/DD/YI. . EACH OCCURRENCE S 0 0010AMC1AL,GENERAL LIABILITY DAMAGE TO RENTED S PREMISES(Ea - occurrence) 0 CLAIMS MADE 0 OCCUR 1 ED EXPENSE(Any me S ersm 0 FEF-MNAL&ADV S INJURY 0 GENERALAGGREGATE S GEN'L AGGREGATE 12M APPLIES PER 0 POLICY 0 PROJECT 0 LOC PRODUCTS-CONIP/OP I AGO AUTOMOBR.E LIABB:dTV CONBINEO SINGLE S - (E&a CiderR) 0 ANY AUTO EODR.Y 114FJRY S - (Per Perzon) 0 ALL O'.VNED AUTOS BODII YINPIAY S er ACadmt) 0 SCHEDULED AUTOS PROPERTYDAMAGE S eracaded) 0 HIRE7:ADIOS _ - S 0 NON-OWNED AUTOS .. - S 0 0 UMERELI ALV$ 0 OCCUR EACH OCCURRENCE S 0 EXCESS LIAR 0 CLAIMS-MADE AGGREGATE - s 0 DEDUCTIBLE s 0 RELEIMON S S WORKERS'COMPENSATION - A AND EMPLOYERS LIABILITY NIASWCTATUTORY YIN L.iN11.:J ANY PROPRMTOR/PARTNER/ - - EXECUIIVEOFTICERAaMER IN Y NIA 5047F30A 02115/2012 02l15/2013 EL EACH ACCIDENT s1,000,000 EXCUJDIA� (MANDATORYI� - .L DL�'F?.SE-EACH SI,000,000 LOYEE [ryes,des:nbe under DESCRIPTION OF L DISEASE-POLICY 51,000,000 OP73'iATTONS below LMw DESCRIPTION OF OPERATIONSILOCATIONSIVEMCLES(Attach ACORD 101.Add3bonal Rertuaas Schedule,,(more space,s required) - THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFEC WG W ORI[ERS COMP COVERAGE C£12LTFr�'ATE.HQEK CANCEr.LA l ION•: TOWN OF BARNSTABLE 200 MAIN STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE HYANNIS MA 02601 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUIHORIM PJ393DEWATFVE 8r%cwvMatiLecuv ACCORD 25a009/09) 0 19W2009 ACORD CORPORATION.All is reserved. Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Suhcrtisur License: CS-093445 DENNIS KERIFADO i 96 SUMIVIIT ZID , Plymouth M,9 02360 ` Commissioner 14Ln Expiration 02/26/2014 0 M c e k4 mer a�sVBAis:i ess egul`ahi n License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: r171230 Type: Office of Consumer Affairs and Business Regulation Expiration: `:3(1/2.014 LLC 10 Park Plaza-Suite 5170 r Boston,MA 02116 LLC. c- ------------ DE NIS KERKAgO' x� 96 SUMMIT RD ` .+ PLYMOUTH, MA 02360 Undersecretary Not valid.without signature 1 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth,Corporations Division J One Ashburton Place, 17th floor_ Boston, MA 02108-1512 .�1 Telephone: (617)727-9640 KREC LLC Summary Screen Help with this form -;�„a „Request:a��ertlficate � The exact name of the Domestic Limited Liability Company(LLC): KREC.LLC Entity Type: Domestic Limited Liability Company(LLC) Identification Number: 270274855 Old Federal Employer Identification Number(Old FEIN): Date of Organization in Massachusetts: 05/28/2009 The location of its principal office: No. and Street: 10 ATLANTIC AVE City or Town: YARMOUTH State:MA Zip: 02664 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: DENNIS KERKADO No. and Street: 945 CONCORD STREET City or Town: FRAMINGHAM State:*MA Zip: 01701 Country:USA The name and business address of each manager: Title Individual Name Address (no PO Box) t First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER FRANK MASCI 21 HAYDEN DRIVE FOXBORO,MA 02035 USA MANAGER DENNIS KERKADO 10 ATLANTIC AVE YARMOUTH,MA 02664 USA The name and business address of the person in addition to the manager,who is authorized to execute documents to be filed with the Corporations Division. Title Individual Name Address ono Po Box) y _ First,Middle,Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY FRANK MASCI 21 HAYDEN DRIVE fOXBORO,MA 02035 USA SOC SIGNATORY DENNIS KERKADO 10 ATLANTIC AVE YARMOUTH,MA 02664 USA http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True&... 3/5/2012 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 2 of 2 iV The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY FRANK MASCI 21 HAYDEN DRIVE FOXBORO,MA 02035 USA REAL PROPERTY DENNIS KERKADO 10 ATLANTIC AVE YARMOUTH,MA 02664 USA Consent _ Manufacturer Confidential Data _ Does Not Require Annual Report Partnership Resident Agent For Profit _ Merger Allowed Select—tYpe of f filing from below to view this business entity filings: -- -- - - --- —----— -------- ALL FILINGS Annual Report 3 Annual Report-Professional Articles of Entity Conversion Certificate of Amendment I gtVlew Film s N� Se...arch 9_x r Comments ©2001-2012 Commonwealth of Massachusetts. All Rights Reserved Help 4 http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True&... 3/5/2012 FIRE r Town of Barnstable *Permit#200g037� Reulatorervices Expires g y S f�r�ssue Y Y fj7 dl f sAaxsrASL$, Thomas F. Geiler, Director y MASW, g t639. Building Division �rFb �pl rti �. 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 Not Valid without Red X-Press Imprint Map/parcel Number Property Address 4 AS A 5 k/Residential Value of Work �8©,`'`3 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name 6/) G ti/ t✓ Telephone Number 38-71 Home Improvement Contractor License# (if applicable) f�/6�S' V7 f""/s ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor X-P ESS PERMIT ❑" I am the Homeowner I'" h/J I have Worker's Compensation Insurance � J JUL 15 2008 Insurance Company Name IILpS>L�� � 5t1l�A��� Workman's Comp. Policy# 0,96 o 5/,Q TOWN OF BARNSTABLE 06py of Insurance Compliance Certificate must.be on file. Permit Requ st(check box) Re-roof(stripping old shingles) All construction debris will be taken to LJiS,QoS /�'�✓oi,��///,Q ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum..44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. E Z :6 W'1 S I ]Ar JIM SIC,NATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 k� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El Pl icease bers Print lumnt Led A Rcant Information Plbl Name(Business/Orianizadon/IndMiivan: jr !�✓ d/1/ Fq Address: VO LIAJCt City/State/Zip: ll✓ ne.#: / ` SB-S--�3� Are you an employer? Che a appropriate box: Type of project(required): L[ ] I am a employer.with--�' 4. I am a general contractor and I 6. ❑New constnmtion employees(full and/or part time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling These sub-contractors have g• Demolition ship and have no employees working for me in any capacity. employees and have workers' 9 Building addition com [No workers' comP.' surancc p.insurance.$ in required.] 5, We arc a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 ❑Roof repairs ir,cmance required]t e. 152, §1(4), and we have no employees. [No workers' 13.❑Other comp,insurance mg ed j *Any applicant that chmim box#1 must also fill out the section below showing their workers'mrnpanstion policy information. t Hcamownut who submit this affidavit indicating they ara doing all work and thrn hire outside contractors must rub nit ants affidavit indicating such. tCantraetnre that check this box amst attached an additiana]sheet showing the name of tbo sub-contractors and stain whether or not those cntitics have employees. if the sub-contractors have ernploycrs,they n=d providt their wmimn'mTnp.policy mmnba. I am an employer that is providing workers'compensation insurance for my employee.. Below is the policy and job vile information. Iasuiance Company Nam e: Policy#or Self-ins.Lic.#: O062i6 oExpiration Date: z t) rob Site Addiess:--,S—q C AX1SP— l / City/StatelZip: s Attach a copy of the workers' compensation policy declaration page(showing the policy num er and expiration date). Failure to secure coverage as required under Section 2 5A of MGL c. 152 can lead to the imposition of criminal penalties of a fins dp to$1,500.00 and/or one-year mi 1prisonmcnt, 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 fliat a copy of this statcmcrit may be forwarded to the Office of Investi Lions of the DIA for insurance Mv=R0 verification. I do hereby certr;&u ' the pains aloes of perjury that the information provided above is true and correct. Si c Date: Phone#: ��✓�S Official use only. Do not write in this area,tb be completed by City or town offtciaL City or Town: Permit/License# IsstungAuthority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk .4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Persorr• Phone#: A IO* �, ' p, THO CEMF 6 As J1 MATTER of IFlFO111ATM Y 1io UPON WE CEflT1 GATE tpla",W nt tN0tnF1�dITE ooEs ilaT aaeat aA AITHi T11E oave�lsl; mr�Ba+Orl1►. CWMEB Orden MA QMS4 mIvw A TNmw f mnm dam WWAW Ibvh&M affftdkq 10L 29 Aatad M MIR VA CM C � taltuxr �CNW THU TW POLICIES OF NSWAHM LOW WM WIVE H(MW TO THE 26M WNW ABOVE FOR THE FCUC r t�E3800 ,ryDTVItTI�TMQttI[i AMY Rom',TE W OR CONgTM OF ANY COMti Wr CA OTHO OOCUI RH VM T TO VDGM THIS CtOtTiF7d►TE tQ�[Y t3E s GR MAY 1+WUt THE ffWANZ Ate BY THE POtJ M(»D WEN IS f TO AIL THE TEHta E>O US=AND COIOWW OF MW FUJUM LWM SHt7WH MY NAVE OEM!gl=BY_MD CLAW Kup EiNOM EWRATW LAM T716 OF fOIAlYYAE �OuGT tAi1®91 ommm am offimm A 096M Y I-ED36L013 03121107 06 f 21108 . a8ML Q itBNTE s 2, 00,000 x uatutr tRoou M•WWW AM s 2 000,000 W,W Q� psw 11 m►mwW s 1,000,000 000 OWNW►COWFACi0t1EROT MR OCCLOFiam 1,coo.coo Fft UWAN tsar a* $0,000 am flip wa palm s 6,000 A mmm=u►stttlr BA G036LG45 06121107 08121108ammm 6111m tam I m auto �m ALL t>TM AtAD6 x'Salffi OAM "FmAt1TU8 1 S 5D,00O AUH>8 Pf4PUOY DAWaE i 100,000 WID CKY-FA ACMW i AM MM anER TIUUf AM 019Y- EAOt r i A9GI�tiATE i Emcm EALtt OCUMENM i tMA FM AaomwE i tltHM tM UMEUA MiW > t1A%S Ala X EMKDMW9 00671G0 D812►l0= 08f24108 g Maur o Sa0,C00 PROMEMFLRTWStSVCCWA >E om Dam offs �►e txtz E1016E+14E-t l t tEe f 100,000 isttel MN OF OMTOMMO om OPt71Atlaa tl UX TO TW S5110S OF I* INSM. SFR=ALIT CE IM AM=RW paim so oiuimuEo omm 71E EoWi w his MEW%tm mom aflo fNV Hilt OO vot TO WA Tom 01'a"m A S alTs omT9e t�0tlCf TO 1IlE tE yOt06i IwsEO TO ifE tW. ear mm to Tim!aonrs SWL WOW W Cl MTW OR L=W trti► OF ANY IW10 GWW6 Rs MWas AGM 2M tl�tT� Kevin reen's Contracting Inc. Residential & Commercial Roofing 24 Round Hill Road Kingston, MA 02364 Ph/one: (781) 585-3378 Fax: (781) 585-6780 SUBMITTED TO PHONE DATE ADDRESS07 JOB NAME r ' JOB LOCATION &s 4/ ��i�� 6, 34A n DATE F PLANS JOB PHONE WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR 40 / ` f J • �x WE PROPOSE HEREBY TO FURNISH MATERIAL AND LABOR-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR THE SUM OF e e y� 41�e, _ DOLLARS ($ ���Gl.` 4 ' PAYMENT TO BE MADE AS FOLLOWS inn fibb I � %� �� (.-� j-r7aA/ri Of' !'d.kk- ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED. ALL WORK TO. BE COMPLETED IN A WORKMAN LIKE MANNER ACCORDING TO STANDARD AUTHORIZED PRACTICES.ANY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS SIGNATURE INVOLVING EXTRA COSTS WILL BE EXECUTED ONLY UPON WRITTEN ORDERS, AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.ALL AGREEMENTS CONTINGENT UPON STRIKES,ACCIDENTS OR DELAYS BEYOND NOTE:THIS PROPOSAL MA BE OUR CONTROL.OWNER TO CARRY FIRE,TORNADO AND OTHER NECESSARY WITHDRAWN BY US IF NOT ACCEPTED WITHIN DAYS INSURANCE. OUR WORKERS ARE FULLY COVERED BY WORKMEN'S COMPENSATION INSURANCE. ACCEPTANCE OF PROPOSAL — THE ABOVE PRICES, SIGNATURE SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED OVE. % SIGNATURE DATE OF ACCEPTANCE t /zeo ''O�"` ��z �`✓ j License or registration valid for ind-------------- ividul use only iration date. If found return to: Ba.4ru of Gdildin ;R�gUlations and Standards before the exp' u►ations and Standards tfOME`MPROVEPJIENT CONTRACTOR- Board of Building Reg l One Ashburton place Rm 1301 tn1di237 I a.02108registra Tr# 129441 Boston, Expiration 4I712009 Type Rrivate COrpbrafio KEVIN GREEN'S CONTRACTING I�1C. KEVIN GREEN SR x '° .. Not valid wi out signatu }ROUND HALL RD ---� 2 Administrator F, ` KINGSTON,,MA 02364 ' e