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0044 CHASE STREET
Nq.s�e- S'7r _ .tl tl t_#, r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION (49 Map �w Parcel � Application# ���� 3 Health Division Date Issued . Io 11 Conservation Division Application Fee m � Tax Collector Permit Fee Treasurer PIZ— Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address- Village (,(,n ft S Owner lit.ham J"0y5V_W Address 21 I WAsk sr, Telephone D�" 1 " �N.3 d IU�'A,I.YI ro Z� U Permit Request Cob,SfinALt 19 X I pT. de_e� r (a,u Z d on rS Square feet: 1 st floor:existing proposed U 2nd floor:existing proposed U Total new -- Zoning District Flood Plain Groundwater Overlay — Project Valuation �rd�• Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Ko + — Historic House: ❑Yes O-ft On Old King's Highway: ❑Yes ❑-M Basement Type: 3-Ftff ❑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 d-DI Total Room Count(not including baths):existing new zff�- First Floor Room'count Heat Type and Fuel: J-das '❑Oil ❑ Electric ❑Other Central Air: ❑Yes Q-Ne—IF-ireplaces: Existing New Existing wood/coal stove: c;0 Yes:: Detached garage:❑existing ❑new size — Pool:❑existing ❑new size- Barn:Lk e sting 0 new _size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Yw 5�J Zoning Board of Appeals Authorization- ❑ Appeal`# -Recorded❑ Commercial ❑Yes ®'No If yes, site plan review# Current Use 11 ( Proposed Use � ►'1') �L �� � ,µ- BUILDER INFORMATION O6!Name r WL� 1'N.IYA S 1110— Telephone Number 5Dg'gL�j • d . � 1 ( License# �S �(g500 ktydress 0� f kf. A44 D2&3_S"_ Home Improvement Contractor# l S� � Worker's Compensation# M (D U 17'"1 L44 y 2. ALL CONSTRUCTION DEBRIS RESULTINAFROM THIS PROJECT WILL BETAKEN TO SIGNATURE AU I l DATE FOR OFFICIAL USE ONLY 'APPLICATION# DATE ISSUED MAP/PARCEL N0. - ADDRESS VILLAGE OWNER DATE OF INSPECTION: F 5 , FOUNDATION FRAME f (a _ 7 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f DATE CLOSED OUT r ASSOCIATION PLAN NO. yFp 1 OCT-05-2007 FRI 11 :53 AM JANOVSKY APPRAISAL FAX NO. 17818431789 P. 02 OUt 05 07 12310p SCOTT PERCOCK BUILDING 6 506 4P8 7625 p.2 Town of Barnstable. Regulatory Services mma T4.omsr P.Geller,(Director _ `''A�• Building Division Tons?=TY, Mudding Cd=ukdoner 200 Mom Streak $yaaate,MA 026D1 www.town.barwtab1Lr=.us Offico: 508-862-4038 Fax: 50&790-6230 Property Owner Must Complete and Sign This Section If Using A Builder -M • �ANd V s K, `. ,u Ow=r of the subject property h=byauthorizeSwraw,-L. 4, ioactonmybeh4 in all=acts relative to.work amhorized b) t b&14ermit application for. , . ( �s of job • S o Qwa m s' Dace IN N&Name .Q'FOF{M9:QR+PIP.RFEAKS310N The Commonwealth ofMassachusetts Department of Industrial Accidents Offzce of Investigations 600 Washington Street Boston, M4 02111 , ww.mass.gov/dia Workers' Compensation Insurance.Affidavit;.Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Le 'bl Name (Business/Organization/Individual):, �i Ino- Address: .+ City/State/Zip: V S V 1 07-'I' hone.#: .00-142,83 "7 Are you an employer? Check the appropriate box: Type of project(required):. 1. I am a employer with�_ 4. ❑ I am a general contractor and I employees(full and/orpart.time). have hired the sub-contractors 6. El New construction . 2.❑ I am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp, insurance comp.insurance.$• required.] 5• ❑ We are a corporation and its 10.0 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 12.0 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#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must providb their workers'comp,policy nurnbcr. ; Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. //�� Rome— /►� Insurance Company Name: li sJop) �,(,�� � W, Policy#or Self-ins.Lic.#:_ l00 /_`'iq'q Z - Expiration Date: Job Site Address: 44 (.ale J � City/State/Zip: hwu S , Mn V21001 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 bIA for insurance coverage verification, I do hereb certi :ender the p 'P sand p/eenalties of perjury that the information provided above is true and correct: Sienature: �(/ ' Date: Phone 4: O — "t 2 5 —r7(P OO Official use only. Do not write in this area,Yo be completed by city or town ofj7claL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.BuildingDepariment 3. City/Town CIerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: Town of Barnstable Regulatory Services snxNsznHi.� Thomas F.Geiler,Director y Mass. g, . Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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. 10 , &M Type of Work: ly.U'r6i7iwct Ua �� Estimated Cost Address of Work: 4A UI xk /1,(S Owner's Name: Date of Application: 0 — 14 "� Q I hereby certify that: Registration is not required for the following reason(s): F]Work excluded by law ❑Job 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 IMPROVEMENT 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 agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav v I V V, I i(POwl 7 I� x 1 11 all 4/2007 4! --fH—ISCERTIFICAT E IS ISSUED AS A MATTER OF . . ............. 3T JAN,, INFORMATION PRODUCER ONLY AND CONFERS 140 RIGHTS UPON THE CERTIFICATE GERMANI INSURANCE AGENCY HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 908 MAIN STREET ALTER THE -RAGE AFFORDED By THE POLICIES BELOW __COMPANIES AFFORDING COVERAGE OSTERVILLE, MA 02655 COMPANY SAFETY,INSURANCE A INSURED COMPANY AIG AMI:-RICAN HOME ASSURANCE CO. SCOTT PEACOCK BUILDING&REMODELING —.8 . .... PO BOX 171 COMPANY OSTERVILLE, MA 02656 c COMPANY D 'IT -T 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 6 Y THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDMONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. co POUCY EFFECTIVE POLICY EXPIRATION LIMITS E O TYPE INSURANCE POLICY NUMBER LTR DATE tMMMD") DATE jMM/DOfYYI GENERAL AGGREGATE $ L900,000 GENERAL LIABILITY j A — CP00001 152 07105/07 07105/08 -PROCLICT8-COMPIOP AGG $ X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR PERSONAL&ADV)NJVRY 17 OWNERS&CONTRACTOR'S PROT EACH OCCURRENCE ----1,000,000 FIRE DAMAGE (Any one Ike) MED EXP (Anyone person) AUTOMOBILE LIAIBIUTY COMBINED SINGLE LIMIT ANY AUTO ALL OWNED AUTOS BODILY INJURY (Pa parson) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Pgr accident) NON-OWNED AUTOS PROPERTY DAMAGE 5 GARAGE LIABILITY TO ONLY-EA ACCIDENT OTHER THAN AUTO ONLY: ANYAUTO EACHACCI�ENT S AGGREGATETS EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND WC 6117-44-42 06122/07 O'i'221011 ;Ov� D J. B I _L EACH ACCI CNT 100,000 EMPLOYERS'LIABILITY I— EL DiSe"12-POLICY LIMIT60 0 ."-90 TKOE PROPRIETOW INC 5 0 PARTNERSIEXECUTIVE EXCL EL DISEASE-V 100,000 OPF"IRS ARE: OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS SHOULD ANY Or T14E ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL TOWN OF BARNSTABLE 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, FAX#,.508-429-7625 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENT$ OR REPRESENTATIVES. _I -AuTHo REPRESENTAT:1Z 70 rll.M101,111111-1 11,64106LIM611 ON a i 4 ✓�B��i�ii"� ��i�n�r¢ ,4�`Ffi` License: CONSTRUCTION SUPERVISOR ;N E. Number: CS 094500 'Expires: 07/22/2010 Tr.no: 94500 Restricted: 00 JAMES S PEACOCK OSTEVILLE, MA 02632 Commissioner ,} < 4'. 1 L y.✓ i J'� I,•".+x 'A%st�"Y 3.�� v � S �'!'� �..%e%V.'�rL v.Ji+ir'4 Board. of Building Regulations and. Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Hoine f nproVemellt Contractor Regrlstratioll Reqistration: 151853 Type: Private Corporation Expiration: 7/7/2008 SCOT PEACOCK BUILDING & REMODELI JAMES PEACOCK PO BO/"( 171 OS-(ERVILLE, IVIA 02655 Update Address and return cart). I�'iarl:rcaso,, lili ia;ut:%,:. I ...1 Address Renewal Elliployntcnt ..-.. _:-,1 ,. :ilidl-t1:Vl1i;-I'':%;i-I':Ill ..4111 e•s„ t{uanl of l;uildu,, Itc,ulalions and Standards Lieense or rc�istralion valid for iudividul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If fount) return to: i "i i i(�✓ RecJ Istration: Board of Buildin-Regulations nd StamlardsIiIF53 b ��`= Expiration: 7/7/2008 One Ashburton Place Rm 1301 -;•.• ± hype: Private Corporation Boston,Ma.02108 SCO fT Pf ACOCK 13UILDING & REMODELING INC � ^� PI-ACOCK 4 Ua6 N;AIN S',RL-PT SUI TE 7 1• S I E;'VII_LE, NIA 02655 Deputy \dministralor i��j Not valid without stguahn e. PY is C' 16" oc. . Ml ' 7{ ma \ ol \ \ \ 30e266 \ s ` \\ g � 308225 ` #4 308189 l \t #33 \ :� 9. "r t A '{ r I L ifs 308224 = \ All i x_-X08 IS #2 , r3J8228 t \� #54 \l #51 i Town of Barnstable Geographic Information System February 28, 2011 308223 #30 I � `��t t � 308266 ¥ `k r $ #38 308189 ¢ #33 308225 a Pam' -4 308226 ' R+ 308224 N� #44 Vv 308188 PC,*. -} 308228 � 1 #64 .. 308229 308187 #58 0 13 Feet _ 7 Ma 308 Parcel:224 Selected Parcel Q DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal - P� ft! boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:KAHLER,HEATHER J Total Assessed Value:$226200 1"=1Go'may not meet established map accuracy standards. The parcel lines on this map ' - are only graphic representations of Assessor Co-Owner: Acreage:0.10 acres Abutterss tax parcels.They are not true property 9 . . boundaries and do not represent accurate relationships to physical features on the map Location:44 CHASE STREET such as building locations. Buffer • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# b� Health Division Date Issued: b 11 6 Conservation Division Application Fee S-0 Tax Collector Permit Fee o Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village �Ygplq:m II'' Owner ZVAII_SA0OVs(cy Address �', � 5T RID, Telephone,5'0 I I S-4 3a Permit Request cam- S,r 9 5 65T F mo P, Arti -tt0 0vN.NA'iT0nd V J C� Square feet: 1 st floor:existing r72- proposed -S"S' 2nd floor:existing S72- proposed Total new rS— Zoning District Flood Plain Groundwater Overlay Project Valuation 000 Construction Type 141600 iM F' Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family &-- Two Family ❑ Multi-Family(#units) Age of Existing Structure 6o + — Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: UX-r(t' ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) 5-2Z- Number of Baths: Full:existing / new D Half:existing o new f Number of Bedrooms: existing 3 new 0 , Total Room Count(not including baths):existing 6 new D First Floor Room CountCD Heat Type and Fuel: a-,Gs ❑Oil ❑ Electric ❑Other 7 1 _ Central Air: ❑Yes U4K' Fireplaces: Existing New Existing wood/coal stove: ❑Y.,es ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:L existing-J❑new, size-- Attached garage:❑existing ❑new size Shed:❑existing ❑new size '— Other: Zoning Board of Appeals Authorization ❑ Appeal# -' Recorded❑ _ Commercial '0 Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name,O!' VXV— CAD, C' KPIQ4FIMAJ6 Telephone Number Sad'—yak`? 0� Adress AOY6 /1617N Sfi� License# Oq NS'o 0 ACT M ly Home Improvement Contractor# 82-65'9— Worker's Compensation# 6F7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO RA10✓T W SIGNATUR DATE f� _��_d7 i FOR OFFICIAL USE ONLY APPLICATION# k' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE i f, OWNER J f. r DATE OF INSPECTION: ' FOUNDATION FRAME "4L INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ¢� DATE CLOSED OUT ASSOCIATION PLAN NO. t 1 OCT-09-2007 TUE 02:30 PM JANOVSKY APPRAISAL FAX NO. 17818431789 P. 01 ilep SCOTT PERCOCK BUILDING 6 508 428 7r,25 p.2 Town of BaMStable Regulatory Services RAM a'y Thown F.Geger,Aircdor Building Division Tom perry. Ra wft CMMS51"er 200 Maio Strut, HYMP!s,MA 02003 Office: 508-862-4038 Fax: 508-7W6230 Property er Must Complete and kgn This Section If Us' A BWldcr ` .as 0wncr of the subject prop" P" hereby authorize n C to act on my behalf, is all matters rckewc to work authorized by building permit application for. <. r (Address of Job) 5 atac of 0w Dar �vru� M A AJ o v 5 it Print Name Q:FGttMs�WNER1tW RMtSS�ON � License: CONSTRUCTION SUPERVISOR ' Number: CS 094500 1 Ewes '07/2212010 Tr.no: 94500 Restricted: .00 JAMES S PEACOCK PO c JX 171 / OSTEVILLE, MA 02632. Commissioner k Tame as-S-10 tcUU UNQ pmeriptive Pseksget for dal and Txo-Family Raldenthl B�iIdiaga Srstsd yrit�'F '�PR1s ' � 11'YAiCfh'NM . 11'IITIIMUNi Glaring Gluing Ceiling Ws1I Hoar Baxm=at Slab 'FIesting/Coolir�� Air(`le) U-values R-v4ug' ' R-vsluo' R.yslucf A'all •Ya�rnd�x F 1Fmrnt Blfidcnrr' Pic 5701 to 6500 Hcaticg Ilegm D ` B ' 1Z°la. 0.40 33 13 19 10 b Normal 1ZJa 0.3? 30 i9 (9 10. 6 Nomad I2°le 0.30 38 13 I9 10 Isle 03B 38 13 ?5 PIIA NlA. Normal' T e 1+IcrmaI U ISve 0.46 31 I9 19 10 6. y 15% 0.44 38 13 23 NIA N[A U mut jy 13% 0.31 30 19 19 10 3 U�►FtIE 11% 032 38 • 13 2. NlA NIA N0� �• Isy. 0.42 39 19 25 NIA NIA- Nontial 3: live 0.47 311. 13 19 10 •6 90 AFUE 1 o'le ff 50 34 19 19 10 i AFTTz I. ADDRESS OF PROMTY: l SQUARE FOOTAGE OF ALL BXTERIOR WAS: 3, SQUARE FOOTAGE OF ALL GLAZING: 6 �� 4, Aro GLAZING ARRA403 DWIDED BY'02): too S7F' ' S, 5EL-ECT PACKAGE(Q--AA-sea ahazt above), � -�— NOTE; OTHER MORE Rq-VOLYm IVIETRODS OF DE 1ZF1YMNING ENERGY REQUIREN.I "NTS ARE AVAILABLE, AM.TJS FOR THIS INFORMATION6 BtJI I)ING•INSPECTOR APPROVAL: YES:. NO: q-Ivris-pi;0303a . 1117AA A 4/2007 A :cQR ' J ISU D AS A MATTER OF INFOt7, il RMATIO N HIS CERTIFICATE IS PRODUCER ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE GERMANI INSURANCE AGENCY HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 908 MAIN STREET ALTER-THE COVERAGE AFFORDED BY THE POLICIES BELOW. OSTERVILLE,MA 02655 COMPANIES AFFORDING COVERAGE COMPANY SAF ETYINSURANCE A INSURED COMPANY AIG AMERICAN HOME ASSURANCE CO SCOTT PEACOCK BUILDING&REMODELING —.8 . PO BOX 171 COMPANY OSTERVILLE, MA 02655 c COMPANY D ------------ Mill 151 It A-v A THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, ANY REQUIREMENT.TERM OR ITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO E T CERTIFICATE MAY BENOTWITHSTANDING ISSUED OR MAY PERTAIN,THE INSURANCE CON AFFDORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT To ALL TH WHICH THISERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAAO CLAINIS.-... co POLICY EFFECTIVE POL!Z;KPIRATION LIMITS LTR TYPE Of INSURANCE POLICY DATE(MMIDD(YY) OA mmf") I GENERAL AGGREGATE a. 2,000,000 GENERAL LIABILITY A CP00001 152 07/05/07 07105/08 -PRODUCTS-COMPIOP AG-0 COMMERCIAL GENERAL LIABILITY PERSONAL&ADV INJURY CLAIMS MADE I OCCUR EACH OCCURRENCE $ OWNERS It CONTRACTOR'S PROT FIRE DAMAGE (Any One two) 3 MED EXP (Any one parson) AUTOMOBILE LIABIUTY' COMBINED SINGLE LIMIT s ANY AUTO I ALL OWNED AUTOS BODILY INJURY (Pw person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY S (Per a=ldenit) NON-OWNED AUTOS PROPERTY DAMAGE 5 9ARAGE LIABIL-ITY AUTO ONLY-EA ACCIDENT OTHER THAN AUTO ONLY! ANY AUTO —;�NT ACI�ACCII AGGREGATE $ EXCESS LIABILITY .EACH OCCURRE-NCE UMBRELLA FORM —AGGREGATE. :s OTHER THAN UMBRELLA FORM WC VATU- WORKER'S COMPENSATION AND WC 687-44-42 06/22/07 06/mO8 �—j T0R.yjLhkfr8 J. .1%,-. _• •- B I EL EACH ACCIDENT 100,000 EMPLOYERS'LIABILITY ......... i.... THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMLT. 5 PARTNERSIRXEC'LaIVE FL DISEASE-EA EMPLOYEE f S 100,000 EXCL OPP"Rg ARE H OTHER DESCRIPTION OF OPERA IONS/LOCATIONSIVEHICLFSISPECIAL ITEMS IC 77-2., ............ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED UEFORE THP 9XPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL TOWN OF BARNSTABLE 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, FAX#:508-428-7625 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHOAW REPRESENTATIVfl , 16 I—k A Zql I P�°p THE r, Town of Barnstable Regulatory Services 9 saFwna Thomas F.Geiler,Director IN Building Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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. Q p Type of Work: r�b y�K S ST Estimated Cost o2 00 / Address of Work: H Owner's Name:SV-,9 Date of Application: 0 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply.for a permit as a agent of the owner: to--to -an /r/?S' Date Contractor Name Registration No. OR Date Owner's Name Q:formslomeaffidav I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 , www.mass.g ov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leebly Name (Business/Orgaaization)lndividual): � Racna— :6ultdim, Address: oto, main 33" 71 . Q. BQ 1M I City/State/Zip: !"� e M 14- ®?fQ5-phone.#: Are you an employer? Check the appropriate bog: Type of project(required):. 1. I am a employer with - 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp. insurance comp, insurance.$ 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 m sel£ o work ' co right of exemption per MGL y � workers' �• I2.❑ Roof repairs • insurance required.] t c. 152, §1(4), and we have no employees, o 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 employers,they must provide their workers'comp.policy number. lam an employer that isproviding workers'compensation insurancefor my employees. Below isthe policy andjob site information. Insurance Company Name: Policy##or Self-ins.Lic.M • [081 "4`'1—`9 2 Expiration Date: ZZ Joh Site Address: qN 1- City/State/Zip: VON kmS Attach, a copy of the workers' compensation policy declaration page(showing the policy nu er and expiration date),., Failure,to secure coverage as required under Section 25A of MGL e. 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ido hereby rti .ender thep n .andpenalties ofperjury that the information provided above is true and correct: Sienature; Date: IO— l ' 0/) Phone#: Official use only. Do not write in this area,'t6 be completed by city or town of' tciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: I 9 - I `i J r�-E �.�, � y✓'i�iJ�•'!.".,y �-d.='::d.lid.'�;�� S 1� �,,• � v..w.�.,,$�.gt� >^v 1��,..^� ,,, u..�v 13o A of Building Regulations and Standards One Ashburton. Place - Room. 1301 Boston, Massachusetts 02108 1.1.011le Improvement Contractor Registration Reqistration: 151853 l ype: Private Corporation Expiration: 7/7/2008 SCOTT PEACOCK BUILDING & RENIODELI JAMES PEACOCK PO BOX 171 OSTERVILLE, 1VIA 02655 Update Address and return card. R,1;1,-k rcasult i Adch•ess Renewal ts'III ploymenl ,. 1 ..,.r ,IJ/;;"r•, „'YJJ['J OItJe:�f'1 uuard ur l;uildul" Itc"111:11ione and Standards License or rcuisti-ation valid for inilividul use uuly I ' HOME IMPROVEMENT CONTRACTOR before the expiration date. It'found return to: Registration: I Iti�3 Board ol'Buildingi Regulations and Standards / Expiration: Ouc Ashburton Place Rill 1301 7/7/200u Type: Private Corporation Boston,Ma.02108 TPEACOCK BUILDING & REMODELING INC PEACOCK li'^u M/ S RLI_T SUITE 7 Iv / cr C �151 ISTE"NIECE, MLA 02655 Deputy Administrator ! f Not valid without signature. r. Y� r a 1 ,.. t I � F ell , --� NT J.. vy 1 tv IV Vill Mb� g 1 '".Far F xx5 1N(I 4 G c--,r a IT \ 3082 \` \ # 8 \\ \ , \ a 308225 \ #4 . '" \ , l �4 \ r ♦ -yi' 75 ♦ ,3 � � � ����` tea. El x ' 8 s i v� g 401 , , r" F r NOTE:PARCEL LINES MAY NOT BE ACCURATE. The DISCLAIMER:Thls map a for planning purposes only It �',,y r �` r parcel lines on this rnaD are only graphic representations of may not be adequate for legal boundary determination or < "7� 0 2.5 5 10 Feel Assessor's tax parcels. They are not true',property regulatory interpretation. T his map does not represent . . boundaries and do not represent accurate relationships to on-the-ground survey physical objects on the map such as,building locations. - 1 inch equals 10 feet - Town of Barnstable *Permit# � S29' Expires 6 months from issue date Regulatory Services Fe(A!z, q P � Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 1 Not Valid without Red X-Press Imprint Map/parcel Number r�S�zp)o7 '1 / /I Property Address -T`� �-n CL - Y`�a i 1 ❑Residential Value of Work 0 0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address lJ tv Contractor's Name k42 `,c Telephone Number % Home Improvement Contractor License#(if applicable) kS .3 Construction Supervisor's License#(if applicable) Oq 41 GU ❑Workman's Compensation Insurance Check one: ❑ I am sole proprietor -PRESS PERD411T ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance S E P 2 4 2007 Insurance Company Name n 6"✓ Workman's Comp.Policy# t t/C Copy of Insurance Compliance Certificate must be on file. Permit Request check box) Re-roof(stripping old shingles) All construction debris will be taken to u ❑Re-roof(not stripping. Going over existing layers of roof) D e-side ❑ eplacement Windows/doors/sliders. U-Value 3 (maximum.44) *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A .opy of the me Improvement Contractors License is required. G URE• SI NAT �(';'� � Q:Forms:expmtrg Revise061306 f ` The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 12: ' d 600 Washington Street Boston,MA 02111 , www.mass.gov/dia Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):. 61 -Address: ele©YA City/State/Zip: gqX— Vx-,L�_ Phone.#:_ ' ��T7K6 VY0ean employer? Check the appropriate bog: •Type of project(required):• 1m a employer with `f 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction . 2.❑ I am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. . employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.[1 I am ahomeowner 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. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must providb their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and fob site information. Insurance Company Name: , Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: -( t C 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 iip 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. Id hereby ce D ander th ins•a d penalties of perjury that the information provided above is true and correct: Sienature: Date: Phone 4: C5 T Official use only. Do not write in this area,'ib be completed by city or town oj1j`1ciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: IN 9/14/9007 A C-Q-R-D, THIS CERTIFICATE IS ISSUED A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE GERMANI INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 908 MAIN STREET ALTER THE CgVjl'm—RAGFAFFORDED BY THE POLICIES BELOW. OSTERVILLE, MA 02655 COMPANIES AFFORDING COVERAGE . COMPANY A SAFETY INSURANCE INSURED COMPANY AIG AMI-iRICAN HOME ASSURANCE CO. SCOTT PEACOCK BUILDING&REMODELING -.8 -- . ...- .. - PO BOX 171 COMPANY OSTERVILLE, MA 02655 C COMPANY D 2 F THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD CT OR 13TMER WITH RESPECT TO TH INDICATED,N ANY REQUIREMENT.TERM OR OF ANY CONTRA CERTIFICATE MAY OTW BEITHSTANDING ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDCONDITION ED 6 Y THE POLICIES DESCRIBED HEREINDOCUMENT E T 15 SUBJECT TO ALL THE IS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS...... — POLICY EFFECTIVE POLICY 1EXPIRATION LIMITS LT co TYPE OF INSURANCE POLICY NUMBER DATE(MMIDINTY) DATEtMMlOOfYyI I R GENERAL AGGREGATE 3 2,000,000 GENERAL LIABILITY A CP00001 152 07/05/07 07105/08 PRODUCTS-COMP/OP AGG $ X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR PERSONAL a ADV INJURY OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE S ....11000,000 FIRE DAMAGE (Any one fire) IVIED EXP (Any one parson) AUTOMOBILE COMBINED SINGLE L11 ANY AUTO L r LIABILITY COMBINED SINGLE LIMIT S AUTOMOBILE ANY AUTO BODILY INJURY ALL OWNED AUTOS (Par person) S SC CHEDULEDAUTOS HIRED AUTOS BODILY INJURY (Por accident) NON-OWNED AUTOS HPROPERTY DAMAGE 5 TO ONLY-EA ACCIDENT 3 L�u ACCIDENT LIABILITY '�Ly.!T3 _OTHER THAN AUTO ONLY! T. ANY AUTO !ACH ACCIDENT _S AGGREGATET$ EACH OCCURRENCE EXCESS LIABILITY UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM I-. —10 WORKER'S COMPENSATION AND WC 687-44-42 06/22/07 06/22/08 OR -.1. '-J—PTA" EMPLOYERS!LIABILITY EL EACH ACCIDENT 100,000 THE PROPRIETOW INCL EL DISEASE-POLICY LIMIT 5 60q'.090 PARTTIERS/EXEC,UTIVE ELDISEASE-LA EMPLOYEE $ 100,000 0011"R9 ARE H EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLFSISPECIAL ITEMS -:3 L'r- X 2 g 71,17,�T. .......... IF ..PPA SHOULD ANYOr T14E ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE EXPIRATMIN DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL TOWN OF BARNSTABLE 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, FAX#:508-428-7625 BAIT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE COMPANY ITS AGENTS_081REPRESENTATIVES. AUTHO REPRESE game. !11P I .,I .;-v .'! dL /.✓:��J i� �' .v/� ,4 �i. i JV ',r `� / V.4.L:.'✓�.�L t�%�r i'°fY14�V.,...c...t`v.J' 13ow. of Building Regulat oils and. Standards One Ashburton Place - Room. 1301 Boston. Massachusetts 02108 L-loui.e Improvement Contractor Registration Registration: 151853 Type: Private Cu poration Expiration: 7/7/2008 SCOTT PEACOCK BUILDING & REMODELI JAMES PEACOCK F'O 130>< 171 OSTERVILLE, IVIA 02655 Update Address and return Carl. Mark rc:dso Yd rid+ ridask;,ii. I Address Renewal lsYupluyndcYdl :,i}>l. ';•:i '7";•x.daa:-rr-tcdc17.5 l{u:drd ul huildin, lie"ulalions and Standards License or Y-egistralion valid fot indrvidul use duly IId ! I HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: 1 Registration: I:i 1853 Board of Building Regulations and standards Expiration. One Ashburton Place Rm 1301 I 7/7/200Ei � Type: Private Corporation Boston,Ma.lIZ I0t3 COi i PEACOCK BUILDING & REMODELING INC vl! PEACOCK I \_f M� . i i N;A�N;,REEI SUITE 7 � � •,. ;, '1 ` . 'Sl CI'VII_LE. MA 02655 � Not valid without signature. Deputy Administrator ! � � lJ; C License: CONSTRUCTION SUPERVISOR Number. CS 094500 I � t 5, x ° Expires 07/2212010 Tr. no: 94500 Restricted DAMES S PEACOCK PO;_,J1 OSTEVILLE, MA 02632 Commissioner SEP-21-2007 FRI 04: 16 PM JANOVSKY APPRAISAL FAX NO. 17818431789 P. 01 Sep 21 07 02t42p SCOTT PERCOCK BUILDIMG 6 5O8 428 7625 p•z Town'of Barnstable Regulatory Services • o nrs►ma• = Thomas F.Gener,Director Building Division to Torn Pal, Building Commissioner 200 Main Street, Hyannis,MA.02W1 Office: $08-862-4038 Fax: 509-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I 1jtjc M . ./ N O V5,k ,as Ownct of the subject property hereby authorize ?Adt to act on my behalf; in all mattcts zelntive to work authorized by this buildtag peen it application f0Z 6N& &-��nj4 (Address of lob) $' atatc of Ov6ir Date `June M 13imt Nauae Q:F0RMS:OWN0JSWWSI0N i PERMIT PAYMENT RECEIPT j\1 _TOWN OF BARNSTABLE BUILDING DEPARTMENT ` 200 MAIN STREET \ HYANNIS, MA .,02601 DATE: 09/24/07 TIME: 10:06 -----------------TOTALS----_- ---------- PERMIT $ PAID ` 369.00 AMT TENDERED: \ 369.00 AMT APPLIED: 369.00 ' CHANGE: .00 APPLICATION NUMBER: 200705997 PAYMENT METH: CHECK PAYMENT REF: 3284 f i TOWN OF BARNSTABLE CHECK REQUEST E DATE: 9/7/2007 REASON FOR CHECK: Refund DEPARTMENT: Regulartory Services/Building Department MAIL CHECK: X Pay To Vendor No. Account No. Amount Steven R. Swoszowski 35886 16301433150 $492.00 TOTAL CHECK AMOUNT: $492.00 APPROVED BY: Debi Barrows Town of Barnstable *Permit#p60%41q ` Expires 6 months from issue date Regulatory Services Fee 4 4 Thomas F.Geiler,Director Building Division Tom.Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bsm table.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY c Not Valid without Red X-Press Imprint Map/parcel Number Ed O Property Address q44 CHASE -S eyS Wi5 mA -00-661 Vj Residential Value of Work��o��6VO. va Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address SfEVE/V (Z. St jov ot,6 L t � G-R�CC-t40� DuR� �IYAAiNis Contractor's Name Telephone Number��l Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance ESS PER9� Check one: �°� ELjam_a�e4irqp=r 2007 I am the Homeowner JUL r s ompensation Insurance BARNSTASLE .� F Insurance Company Name azk�41Z j� 1,10 OWN p Workman's Comp..Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) LL / [�Re-roof(stripping old shingles) All construction debris will be taken to J 1175 ❑Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders. U-Value J (maximum•44) :,r �._• *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. C 7 n A c e Home Improvement Contractors License is required. rJ� SIGNATURE: ' Q:Forms:expmtrg Revise061306 Form w 9 3 Request for Taxpayer Give form to the (Rev.March 1994) Identification Number and Certification requester. Do NOT Department of the Treasury send to the IRS. Internal Revenue Service Name ft loint names,list first and ircle the name of the person or entity whose number you enter in Part I below.See instructions on page 2 If your name has changed.) 7�S 'JC' L QS ln�St-CI Business name(Sole proprietors see instructions on page 2.) 0 r c = Please check appropriate box Individual/Sole proprietor Corporation Partnership Other IN d Address(numb street,and apt.or suite n ) Requester's name.and address(optional) N ACFA9N Cif. a cod /'XV� /')ljl� Taxpayer Identification Number IN List account number(s)here(optional) Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). For sole proprietors, see the instructions on page 2. For other entities, it is your employer identification number(EIN). If you do not have a OR For Payees Exempt From Backup number, see How To Get a TIN below. Withholding(See Part 11 Note:If the account is in more than one name, Employer identification number instructions on page 2) see the chart on page 2 for guidelines on whose number to enter. FUMIMIF-Cerlification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am wafting for a number to be issued to me),and 2. 1 am not subject to backup withholding because:(a) I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding. Certification Instructions.—You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because of underreporting interest or dividends on your tax return. For real estate transactions, Rem 2 does not apply.For mortgage interest paid,the acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement (IRA),and generally payments other than interest and dividends,you are not required to sign the Certification, but you must provide your correct TIN.(Also see Part III instructions on Sign 16 r Here Signature IN- Do-Date Section references are to f payments under certain conditions.This is interest and dividend accounts opened Revenue Code. called "backup withholding." Payments after 1983 only), or Purpose of Form.—A person who is that could be subject to backup rP P 5. You do not certify your TIN. See the required to file an information return with withholding include interest, dividends, Part III instructions for exceptions. the IRS must get your correct TIN to report broker and barter exchange transactions, income paid to you,real estate rents, royalties, nonemployee pay, and Certain payees and payments are transactions,mortgage interest you paid, certain payments from fishing boat exempt from backup withholding and the acquisition or abandonment of secured operators. Real estate transactions are not information-reporting. See the Part II property, cancellation of debt, or subject to backup withholding. instructions and the separate Instructions contributions you made to an IRA. Use If you give the requester your correct for the Requester of Form W-9. Form W-9 to give your correct TIN to the TIN, make the proper certifications, and How To Get a TIN.—If you do not have a requester(the person requesting your TIN) report all your taxable interest and TIN, apply for one immediately.To apply, and,when applicable, (1)to certify the TIN dividends on your tax return,your get Form SS-5,Application for a Social you are giving is correct(or you are waiting payments will not be subject to backup Security Number Card (for individuals), for a number.to be issued), (2) to certify withholding. Payments you receive will be from your local office of the Social Security. you are not subject to backup withholding, subject to backup withholding if: Administration, or Form SS-4,Application or(3)to claim exemption from backup 1.You do not furnish your TIN to the for Employer Identification Number(for withholding if you are an exempt payee. requester,or businesses and all other entities), from 3iving your correct TIN and making the your local IRS office. appropriate certifications will prevent 2.The IRS tells the requester that you If you do not have a TIN, write"Applied ;ertain payments from being subject to furnished an Incorrect TIN, or For" in the space for the TIN in Part I, sign 3ackup withholding. 3.The IRS tells you that you are subject and date the form, and give it to the Vote:If a requester gives you a form other to backup withholding because you did not requester. Generally, you will then have 60 ban a W-9 to request your TIN, you must report all your interest and dividends on days to get a TIN and give it to the ise the requester's form if it is substantially your tax return(for reportable interest and requester. If the requester does not receive similar to this Form W-9. dividends only),or your TIN within 60 days, backup Nhat Is Backup Withholding?—Persons 4.You do not certify to the requester withholding, if applicable,will begin and naking certain payments to you must that you are not subject to backup continue until you furnish your TIN. vithhold and pay to the IRS 31% of such withholding under 3 above(for reportable 17 Form W-9 (Rev.3-94) f . Aug 08 2007 12: 07PM RHLEMRN & LENDER 2039297022 p. 2 {♦♦�� Aog. 8. 2007E 8�56AMFM J�J;��Ch,�;s,o,p,h,t [SAL FAX N0, 178184317B9 No. 1379 P,„2 01 MUTUAL RELME 2007 by and between June RE.. Purchase and Sale AgreemRe Swosao � and Evelyn O. Swoszowski, M. ]anovsky, Seller, and at Chase Street,in the Village of Hyannis. Buyers, regarding the property Town of Barnstable, Barnstable County, Massachusetts In consideration of One and 001100 ($1.00) D°f[ar a ents set nd other good and,valuabie consideration, and the mutual considerations an ced Parches- a d SaleoAgreement� the undersigned part►es to the above refer enSp here agree to release each Other frorn any aindanll waay r relating to r of action t* have against each other arising cut of a y ;use that �rp - concMing the above referenced Purchase and Sale Agent, and ag said Purchase and gale Agreement is null and void. Ci ned parties hereby direct the escrow agent, , sto check shall The and return pDO.Oo deposit to the Buyers and agree that ft P.C, to return the$ be payable to Steven R. SwQ�oyvski,who paid the original deposits. be considered an original signature. The parties agree that a faired signature will > day of August, 2007. Signed and sealed this J e M.Jano. day of Augur 2oO7. Signed and sealed this. � awsla SP. 1ed this day of August, 2007. Signed and Buyer; Evely . swoszowskl r a Aug 08 2007 12: 07PM RBLEMRN & LENDER 203929'7022 p. 1 Aug;, 8, 2007 8:56AM J. Chrisopher No. W9 P. i J.CMUSTOPHER AMRfiE1N,P.C. ATTORNEY AT LAW 20 DOWNER AVENUE, SUITE FOUR m NGgAM,MASSACHUSETTS 02043 J.CgRIBTOPHER AMRHEIIY TELEPHONE(781)749-8844 FAX(781)749-1350 Of Counsel: www.amrheWbw.ccm JOSEPH P.GAUGHAN BRENDA L.BOWEN August 8, 2007 :ia E-mall: C� srsconstructionmsn.com ViaE-ai , eswDszowsldosbcQlobal.net &srscnnstruction a0comcastnet &Via Fax No.: 203-929-7022 Steven R. Swoszowskl Evelyn a. Swoszowskl 2 Graceada Court 345 Shelton Avenue Hyannis, MA 02601 Shelton, CT 06484 RE: lanovsky to Swoszowskl 44 Chase Street, Hyannis, Barnstable, MA Dear Mr, & Ms, Swoszowski: With regard to the above entitled matter, attached please find. the revised Mutual Release,which has been signed by Ms. ]anovsky. Note that the amount,of the deposit in paragraph 3 has been changed from $2.,500.00 to$3,000.00. Kindly sign said release and return It via facsimile. i Upon receipt of the signed release, the deposit will be mailed to 7Wo Graceada Court, ; Hyannis, MA,and the check will be made payable to Steven R, Swoszowskl. Very truly yours, Maureen T. Golden Real Estate Paralegal Enc. a Town of Barnstable *Permit#4�60%qq Expires 6 months from issue date Regulatory Services Fee �[ Z a) Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 4144 CHASE -ST /7WAIMS , MO. -00661 Residential Value of Worl/a0.DOO• dG Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address S+FyE/y �. SwUS2OW5 eft Co ntractor's s Name -'Yn &.1 QS ow Cv�6-17 I- Telephone Number 7. Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance � I Check one: )(.PRESS e pri_etor 1 ZQ07 I am the Homeowner JUL 8 r s To Len. Insurance TOWN 0V BARNSTAgLE Insurance Company Name ��Ii'i Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) (stripping Re-roof old shingles) All construction debris will be taken to V-5 kJb/o fly [� ❑Re-roof(not stripping. Going over existing layers of roof) Re-side 2 Replacement Windows/doors/sliders. U-Value . �) (maximum.44) r- *Where required: Issuance of this pernvt does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. _. ***Note: Property Owner must sign Property Owner Letter of Permission. 7 ;' A c e Home Improvement Contractors License is required. Jy _j 16li: SIGNATURE: Q:Fomis:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents = - d Office of Investigations ' d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lepibiy Name(Business/Organization/Individual): f*Qen 1C S�US2UWSL(t -Address: &2 CPaj? CT� City/State/Zip: S IYI R , Phone.#: S0� q00-g 1 Q 1 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 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. ORemodeling ship and have no employees These sub-contractors have g• Demolition workingfor me in an capacity. employees and have workers' Y P tY• $. 9. 0 Building addition [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.J4 Electrical repairs or additions 3.6 I am a homeowner doing all work officers have exercised their 11.t[Plumbing repairs or additions myself [No workers' comp- right of exemption per MGL 12.EK 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. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-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.#: 'ClIf Expiration Date: lob Site Address: `-� H��E S-� City/State/Zip yZ/I n�S r /V?l7 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under, enalties ofperjury that the information provided above is true and correct ,� Si afore: Date: Phone#• yao Y/9/ 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#: 1 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 in employer." MCTL 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 iaust.subniitmultiple permit/license applications in any given year,need only submit one,affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo 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 ofMassachizsetts , Department of Industrial Accidents Office of Investigations 600 Washingtofi Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia I f oFTHE Town of Barnstable Regulatory Services BAM917ABLE. : Thomas F.Geiler, Director �pT i639' Building Division _ FD AAA'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: //`� C h zSC' T 0 n n / S number street / c village "HOMEOWNER": S�-�✓en _ 51.1 US 20 W.S"C name home phone# work phone# CURRENT MAILING ADDRESS: CS WIP004 (f k T . aZ/717d /✓l19, Dam 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 accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a 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 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable..Building Department minimum inspection cedures and requirements and that he/she will comply with said procedures and requirem Sig Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the 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 person as 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 STANDARD FORM ° PURCHASE AND SALE AGREEMENT From the Office of: J. Christopher Amrhein, P.C. 20 Downer Avenue, Suite 4 Hingham, MA 02043 This 5s' day of June, 2007 1. PARTIES June M. Janovsky of 271 Washington Street, Braintree, MA 02184, hereinafter called AND MAILING SELLER,agrees to SELL and Steven R. Swoszowski of 2 Graceada Cart, Hyannis, MA ADDRESSES 02601,hereinafter called the BUYER OR PURCHASER, agrees to BUY, upon the terms hereinafter set forth,the following described premises: 44 Chase Street, in the Village of Hyannis, in the Town of Barnstable, Barnstable County, Massachusetts 2. DESCRIPTION Single Family Dwelling known and numbered as 44 Chase Street, Hyannis, MA, further referenced in a Deed recorded with the Barnstable County Registry of Deeds in Book 4896, Page 015. 3. BUILDINGS, Included in the sale as a part of said premises are the buildings,structures,'and improvements now thereon, STRUCTURES, and the fixtures belonging to the SELLER and used in connection therewith including, if any, all wall-to-wall IMPROVEMENTS, carpeting,.drapery rods, automatic garage door openers,venetian blinds, window shades, screens, screen FIXTURES doors, storm windows and doors, awnings, shutters, fumaces, heaters, heating equipment, stoves, ranges, oil and gas burners and fixtures appurtenant thereto, hot water heaters, plumbing and bathroom fixtures, garbage disposers, electric and other lighting fixtures, mantels, outside television antennas, fences, gates, trees, shrubs, plants, and, ONLY IF BUILT IN, refrigerators, air conditioning equipment, ventilators, dishwashers,washing machines and dryers;and but excluding 4. TITLE DEED Said premises are to be conveyed by a good and sufficient quitclaim deed running to the BUYER, or to the nominee designated by the BUYER by written notice to the SELLER at least seven days before the deed is to be delivered as herein provided, and said deed shall convey a good and clear record and marketable title thereto,free from encumbrances,except (a)Provisions of existing building and zoning laws; (b)Existing rights and obligations in party walls which are not the subject of written agreement; (c)Such taxes for the then current year as are not due and payable on the date of the delivery of such deed; (d)Any liens or municipal betterments assessed after the date of this agreement; (e) Easements, restrictions and reservations of record, if any, so long as the same do not prohibit or materially interfere with the current use of said premises: *(f) 5. PLANS If said deed refers to a plan necessary to be recorded therewith the SELLER shall deliver such plan with the deed in form adequate for recording or registration. 6. REGISTERED In addition to the foregoing, if the title to said premises is registered, said deed shall be in form sufficient to TITLE entitle the BUYER to a Certificate of Title of said premises, and the SELLER shall deliver with said deed all instruments,if any, necessary to enable the BUYER to obtain such Certificate of Title. 7. PURCHASE PRICE The agreed purchase price for said premises is one Hundred Sixty-two Thousand and 00/100 ($162,o00.00)dollars,of which $ Soo.oo have been paid as a deposit this day and $ 2,500.00 was paid to bind offer $ 159,000.oo are to be paid at the time of delivery of the deed in cash,or by certified, cashier's,treasurer's or bank check(s) $ 162,000.00 TOTAL 8. TIME FOR Such deed is to be delivered at 12:00 o'clock P.M.on the 3ot'day of June 2007,at the Barnstable PERFORMANCE; county Registry of Deeds or at the Buyer's lender's attorney'a office, unless otherwise DELIVERY OF • agreed upon in writing. It is agreed that time is of the essence or this agreement. DEED 9. POSSESSION AND Full possession of said premises free of all tenants and occupants, in pFevided, is to be CONDITION OF delivered at the time of the delivery of the deed, said premises to be then(a)in the same condition as they PREMISE now are, reasonable use and wear thereof excepted, and (b) not in violation of said building and zoning laws, and (c) in compliance with provisions or any instrument referred to in clause 4 hereof. The BUYER shall be entitled personally to enter said premises prior to the delivery of the deed In order to determine whether the condition thereof complies with the terms of this clause. At the time of delivery of deed, the premises shall be free of all personal property not purchased by the buyer and shall be in broom-clean condition. 10. EXTENSION TO If the SELLER shall be unable to give title or to make conveyance, or to deliver possession of the premises, PERFECT TITLE OR all as herein stipulated, or if at the time of the delivery of the deed the premises do not conform with the MAKE PREMISES provisions hereof, then any payments Fnade UAder this agFeerne nt shall -he fa�yAth refunded and all Gthef CONFORM abligations of the pa#les harete shall nease and this agreement shall he VGid 4111100 F9GGuFSe tG thO PaFtier:, he, 1prA the SELLER shall use reasonable efforts to remove any defects In title, such reasonable efforts shall not exceed Fifteen Hundred and 00/100 ($1,500..00) Dollars, exclusive of the payment of any mortgages or liens which have been affirmatively granted or assumed by Seller, or to deliver possession as provided herein, or to make.the said premises conform to the provisions hereof, as the case may be, in which event the SELLER shall give written notice thereof to the BUYER at or before the time For performance hereunder, and thereupon the time for performance hereof shall be extended for a period_ of thirty days. 11, FAILURE TO If at the expiration of the extended time the SELLER shall have failed so to remove any defects in title, PERFECT TITLE deliver possession or make the premises conform, as the case may be, all as herein agreed, or if at any OR MAKE time during the period of this agreement or any extension thereof, the holder of a mortgage on said PREMISES premises shall refuse to permit the insurance proceeds, if any, to be used for such purposes, then any CONFORM,etc. payments made under this agreement shall be forthwith refunded and all other obligations of the parties hereto shall cease and this agreement shall be void without recourse to the parties hereto. 12. BUYER'S The BUYER shall have the election, at either the original or any extended time for performance, to accept ELECTION TO such title as the SELLER can deliver to the said premises Ira their then condition and to pay therefor the ACCEPT TITLE purchase price without deduction, in which case the SELLER shall convey such title, except that in the event of such conveyance in accord with the provisions of this clause, if the said premises shall have been damaged by fire or casualty insured against, then the SELLER shall, unless the SELLER has previously restored the premises to their former condition,either (a) pay over or assign to the BUYER, on delivery of the deed, all amounts recovered or recoverable on account of such insurance, less any amounts reasonably expended by the SELLER.for any partial restoration,or (b)if a holder of a mortgage on said premises shall not permit line insurance proceeds or a part thereof to be used to,restore the said premises to their former condition or to be so paid over or assigned, give to the.BUYER a credit against the purchase price, on delivery of the deed, equal to said amounts so recovered or recoverable and retained by the holder of the said mortgage less any amounts reasonably expended by the SELLER for any partial restoration. 13. ACCEPTANCE OF The acceptance of a deed by the BUYER or his nominee as the case may be,shall be deemed to be a full DEED performance and discharge of every agreement and obligation herein contained or expressed, except such as are, by the terms hereof,to be performed after the delivery of said deed. 14. USE OF To enable the SELLER to make conveyance as herein provided,the SELLER may,at the time of delivery or MONEY TO the deed, use the purchase money or any portion thereof to clear the title of any or all encumbrances or CLEAR TITLE interests,provided that all instruments so procured are recorded simultaneously with the delivery of said deed. or within a reasonable time thereafter, according to local standard conveyancing practices. 15. INSURANCE Until the delivery of the deed,the SELLER shall maintain insurance on said premises as follows: Type of Insurance Amount of Coverage (a)Fire and Extended Coverage $as presently insured (b) 16. ADJUSTMENTS G0IIeGt8d FeRtS, me4gage ist water and sewer use charges, opeFating expenses (if any) a and taxes for the then current fiscal year shall be apportioned and fuel value shall be adjusted, as of the day of performance of this agreement and the net amount thereof shall be added to or deducted from, as the case may be,the purchase price payable by the BUYER at the time of delivery of the deed. 17. ADJUSTMENT if the amount of said taxes is not known at the time of the delivery of the deed,they shall be apportioned on OF UNASSESSED the basis of the taxes assessed for the preceding fiscal year,with a reapportionment as soon as the new tax AND rate and valuation can be ascertained; and, if the taxes which are to be apportioned shall thereafter be ABATED TAXES reduced by abatement, the amount of such abatement, less the reasonable cost of obtaining the same, shall be apportioned between the parties, provided that neither party shall be obligated to institute or prosecute proceedings for an abatement unless herein otherwise agreed. 18. BROKER's FEE A.orm-keel foe f.,.n.nf L Err f., ���.�o,o�Qo- ��� �essienal servises of S is+#ue frem-the-S��� but only if, as and when the deed is delivered -nd title r - reee;ved by Sailer, not andethexw&ae. NIA,there are no brokers involved in this transaction. 19. BROKER(S) The grakw(s)named herein WARRANTY NIA,there are no brokers Involved In this transaction. 20. DEPOSIT All deposits made hereunder shall be held in escrow by J. Christopher Amrheiri, P.C. as escrow agent subject to the terms of this agreement and shall be duly accounted for at the.time for performance of this agreement. In the event or any disagreement between the parties,the escrow agent may retain all deposits made under this agreement pending instructions mutually given by the SELLER and the BUYER or Order of a.court of competent jurisdiction. Said deposit shall behold in a non-interest bearing escrow account 21. BUYER's If the BUYER shall fail to fulfill the BUYER's agreements herein, all deposits made hereunder by the DEFAULT; BUYER shall be retained by the SELLER as liquidated damages DAMAGES peFf49FmanGe of this agreement or a ereef, the SELLER otherwise.notifies the 131 IYI=7R writing and this shall be the Seller's sole remedy at law and in equity. 22. RELEASE BY The SELLER's spouse hereby agrees to join in said deed and to release and convey all statutory and other HUSBAND OR rights and interests in said premises. WIFE 23. BROKER AS , PARTY PFQVi8iGR6 OF this agreement expFessly apply le the lgrakei:(s), and to any arnapdm6pts oF FnedifiGations Of NIA,there are no brokers involved In this transaction. 24. LIABILITY OF If the SELLER or BUYER executes this agreement in a representative or fiduciary capacity, only the TRUSTEE, principal or the estate represented shall be bound, and neither the SELLER or BUYER so executing, nor SHAREHOLDER, any shareholder or beneficiary of any trust, shall be personally liable for any obligation, express or implied, BENEFICIARY,etc. hereunder. 25. WARRANTIES The BUYER acknowledges that the BUYER has not been influenced to enter into this transaction nor has AND he relied upon any warranties or representations not set forth or incorporated in this agreement or REPRESENTA- previously made in writing,except the following additional warranties and representations.if any,made by TIONS either the SELLER or the Broker(s): None. 26. MORTGAGE In order to help finance the acquisition of said premises, the BUYER shall apply for a conventional bank or CONTINGENCY other institutional mortgage loan of.$300,000.00 at prevailing rates, terms and conditions. If despite the CLAD BUYER's diligent efforts a commitment for such loan cannot be obtained on or before June Is, 2007 i the BUYER may terminate this agreement by written notice to the SELLER and/or the Broker(s),as agent(s) for the SELLER, prior to the expiration or such time,whereupon any payments made under this agreement shall be forthwith refunded and all other obligations of the parties hereto shall cease and this agreement shall be void without recourse to the parties hereto. In no event will the BUYER be deemed to have used diligent efforts to obtain such commitment unless the BUYER submits a complete mortgage loan application conforming to the foregoing provisions, on or before three days after the execution of this Agreement. 27. CONSTRUCTION This instrument executed in multiple counterparts,is to be construed as a Massachusetts contract,is to take AGREEMENT effect as a sealed instrument, sets forth the entire contract between the parties, is binding upon and enures to the benefit of the parties hereto and their respective heirs, devisees; executors, administrators, successors and assigns,and may be cancelled,modified or amended only by a written instrument executed by both the SELLER and the BUYER. If two or more persons are named herein as BUYER their obligations hereunder shall be joint and several. The captions and marginal notes are used only as a matter or convenience and are not to be considered a part of this agreement or to be used in determining the intent or the parties to it. 28. LEAD PAINT . The parties acknowledge that,under Massachusetts law,whenever a child or children under six years of LAW age resides in any residential premises in which any paint,plaster or other accessible material dangerous levels of read,the owner of said premises must remove or cover said paint,plaster or other material so as to make it inaccessible to children under six years of age. 29. SMOKE The SELLER shall,at the time of the delivery of the deed,deliver a certificate from the fire department of DETECTORS the city or town in which said premises are located stating that said premises have been equipped with approved smoke and carbon monoxide detectors in conformity with applicable law. 30. ADDITIONAL The initiated riders,i#-emy,attached hereto,are incorporated herein by reference. PROVISIONS See Rider A attached hereto and incorporated herein. FOR RESIDENTIAL PROPERTY CONSTRUCTED PRIOR TO 1978,BUYER MUST ALSO HAVE SIGNED LEAD PAINT"PROPERTY TRANSFER NOTIFICATION CERTIFICATION" NOTICE:This is a legal document that creates binding obligations. If not understood,consult an attorney. 4C ' Broker(s)NIA,there are no brokers involved In this transaction. EXTENSION OF TIME FOR PERFORMANCE Date The time for the performance of the foregoing agreement is extended until o'clock M.on The day of ,time still being of the essence of this agreement as extended. This extension,executed in multiple counterparts, is intended to take effect as a sealed instrument. SELLER(or spouse) SELLER BUYER BUYER Broker(s) NIA,there are no brokers involved in this transaction. i d RIDER A TO PURCHASE AND SALE AGREEMENT BETWEEN JUNE M. JANOVSKY, SELLER(S)AND STEVEN R. SWOSZOWSKI, BUYER(S) RE: PROPERTY AT 44 CHASE STREET, HYANNIS, MASSACHUSETTS CONTINUATION OF NO. 10 Reasonable efforts shall not require the Seller to expend more than $2,000.00 exclusive of voluntary mortgages, liens and encumbrances. CONTINUATION OF NO. 14 or within a reasonable period of time thereafter if arrangements are made for the same by the bank attorney in accordance with the customary conveyancing practices. 31. The Buyer acknowledges that he has been informed by the Broker(s) and/or the Seller that there may be lead paint on the property and that he has been ' informed that there is a lead paint law in Massachusetts. The Buyer hereby agrees to accept the property with lead paint if there is lead paint on the property, and furthermore, hereby agrees to indemnify and hold harmless the Seller from any and all liability as a result of lead paint being on the property. Lead Paint Law. Buyer and Seller acknowledge that (a) Buyer has been informed. by Seller of the provisions of the lead paint statute and regulations (105 CMR 460, et seq.) (the "Lead Paint Law"); (b) Seller has made the disclosure to Buyer with respect to lead paint in the premises required by the Lead Paint Law; and (c) Buyer has received the notification forms required by the Lead Paint Law. Buyer acknowledges that Seller has notified Buyer of Buyer's right to perform a lead paint inspection of the premises if Buyer so chooses. Buyer agrees that if the premises contain lead paint, Seller shall have no duty to remove same or to otherwise make the premises comply with the lead paint law, and upon closing, Buyer shall assume all responsibility with respect to lead, paint in the premises. The provisions of this paragraph shall survive the delivery of the deed. 32. Unless otherwise specified herein, any notice to be given hereunder shall be in writing and signed by the party or the party's attorney and shall be deemed to have been given (a) when delivered by hand or by a nationally recognized overnight delivery company; (b) when mailed by registered or certified mail, return receipt requested; or (c) by faxing notice to the party's attorney, all charges prepaid in any case, addressed: In the case of Seller to: June M. Janovsky 271 Washington Street Braintree, MA 02184 1 � " With copy to Seller's Attorney: J. Christopher Amrhein, Esq. 20 Downer Avenue, Suite 4 Hingham, MA 02043 Phone: 781-749-8844 Fax: 781-749-1350 In the case of the Buyer to: Steven R. Swoszowski 2 Graceada Court Hyannis, MA 02601 With a copy to.Buyer's Attorney: Joseph V. Maruca, Esquire Sykes & Cole 420 South Street Hyannis, MA 02601 Phone: 508-775-9147 Fax: 508-775-5682 By such notice, either party or such party's attorney may notify the other of a new address, in which case such new address shall be employed for all subsequent deliveries and mailings. 33. Buyer and Seller warrant and represent each to the other that neither has dealt with any Broker or Finder in connection with the purchase of the premises covered by this Agreement or in connection with this Agreement other than any real estate broker referred to in Paragraph No. 18, and each agrees to hold harmless and indemnify the other from any loss, cost, damage and expense, including reasonable attorney's fees, incurred by reason of their own breach of this paragraph. The provisions of this paragraph shall survive the closing and the delivery of the deed. 34. Extensions of Performance. In order to facilitate the execution of such documents extending the time for the performance of any event that may occur under this Agreement, each of the undersigned hereby authorizes his or her respective attorney to assent and execute on his or her behalf any agreements extending the time for the performance of any event or of any notice that may be given under this Agreement. 35. Buyer hereby acknowledges that he has been given the right to home inspection and in consideration thereof, Buyer releases Seller from any and all liability relative to the condition of the premises, and acknowledges that the premises is being sold to him "as is"without any warranties and representations made by the Seller in the purchase of the within described premises, except any warranties and representations 2 f F d Specifically stated in writing in this agreement; the Buyer acknowledges that Buyer accepts the results of the home inspection and is relying solely on the results of the same in purchasing the premises with the exception of any warranties and representations in writing in this agreement. 36. Seller hereby discloses to Buyer that she is a licensed real estate broker. SELLEK June M. Janovsky e e Swoszowski 3