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0286 COMPASS CIRCLE
�� �� �a o� ass �%�e d� __- _— _-- __ - -- t S� oFt�r, Town of Barnstable �7 , . *Permit# ; -Regulatory Sehvices 4Fee s 6 „rns „r �s„r � ggRVSrrIBI.E. # r SS. Thomas'F.`Geiler, Director H Building Division Tom Perry, CBO; Building Commissioner i `200 Main Street;-Hyannis, MA02601 www.town.barnstable.ma.us, Office: 508-862-4038 _ � �'x= • Fax: 508-790-6230 EXPRESS PERMIT APPLICATION ="'RESIDENTIAL ONLY Not VaIN without Red X-Press Imprint. a Map/parcel Number Property Address ❑'`Zesidential Value of Work. fd s 1Vlinimum,fee of$35.00 for work,unde'r$600i0.60 x �`Owner's Name Address -to lCf ! AC g s _ . . Contractor's Name s ���,ll' f) !�_ Telephone Number, Home Improvement Contractor License#(if applicable) d Construction Supervisor's License# ifa licable p � PP. ) - ❑Workman's Compensation Insurance aPRESS P A � . Cheo one: . I am a sole proprietor. S.Ep , 9 .IQ�� ❑ I arm the Homeowner '` ❑ .I have Wdrker°s Compensation Insurance TOWN OF,BAR14STA5LE i Insurance Company Name Workman's Comp. Policy# x Copy of Insurance Compliance-Certificateamust accompany each,permit 1 h Permit Request (check box) ❑ Re-roof(hurricane nailed),(sfripping old shingles) All construction debris will°be taken to ❑ Re-roof(hurricane'hailed)(noi'strippitT Gotng'over existing"layers of roof) , ,ER/Re-side, a. 4 #'of doors 1 YReplacement Windows/doors/sliders. U-Value 3 „'A } ' . r (maximum 5) #�of windows' *Wher`e required Issuance of this permit does not exempt compliance wuh other town dep•utment'regulanons i.e. Historic Coriservauonsetc. '***,Note: t'Property Owner must sign Property Owner Letter of Permissron,- A copy of the Home Improvement Contractors License& Consfruetion Supervisors License is required: SIGNATURE; JJA ZAWPFILESTORMS\buildi emut forms\ PRESS.doc Zevised 072110 The Covin rorrweahla ofMassachuselts . - -- - Deparbnent of Indr(strinl Accidents Ogce of. nvestigaWons 600 Washington Street , =l Boston, 2V4 02111 rtNIR rrrass go111dia 1Vorkers' Compensation Insurance Affida,,Zt: $uilders/Contractars/Ele-driciaus/Pl,umbers Applicant Information r Please Print Legibbi Name (B•tisiiness)70rgauizationUdividtml): —:3 '-f' e� �(� �oae L to Address: 15 -'44 11 5T_ - City/State-/Zip: Wr M o PlioFie AtT you an employer?Check the appropriate box.: Type of,project(i equired): l..❑ I am a employer with. 4. ❑ I am a general contractor and I ,�/�aiployees(full and/or part-time)..* have hired the sub-contractors 6 ❑.New cotrstnrc.tiou I L 1 I am a sole proprietor or partnea-- listed on the attached,sh.eet- 7- ❑.Remodeling shipand have no employees These;sub-contractors have E- ❑ 17euwlitiota working :for me in any capacity. employees and have workers' [No workers' comp.insurance insurauce..1 �. ❑ Building addition required:] 5 ❑ We.are a corporation and:its 10.❑Electrical repairs or additions 3.❑ :I air a.homeowner doing.all.work offi.cers have exercised their 11❑Plumbing repa:U'S or additions myself [No workers' camp. right of exemption per MGL 12.❑Roof repairs ins-urance.required.]t c- 152, §1(4).,and.we have no /D/�� . employees.[No workers' 13-LP ether comp.insurance required.] •Any appticaut that checks box#1.must also fill ow the section below sho--wing their workers'compausa:tiou policy infonmtioa f Homeowners who submit this affidavit indiiatutg they are doing all seark and then hire outside contractors must submit a ssew affidavit indicating suclL FC'out actors that check this b=must attached as sddition.sl:sh,e.et showing the:nsm-e of the sub-con'tractars and state whether or not those entities have employees. Ifthe sub-conttactors:hsve—ployees,they.umst provide their workers'comp.policy number. I alit err errtplo ,�r tltnt is prat i'.dirtg rtrork�rs'cotrrpertsrtr t7n irrsarm.rrce for rfty'ertrplaJ ees. Betotr is the policy,and,job site inforrnrrfiott Insurance Company Name: Policy#or Self--ins_Lic.#: Expiration Date: Job Site Address: CitydState/Zip; Attach a copy of the workers'compensation policy declaration page(shoaidng the policy number and expiration date). � Failure to secure coverage as required under Section 2.5r1,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 penal.ti.es in the forte 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 hem y ciertify rtatder the pains and penalties of, airy fleet fife ii forrrtRtiort prm�iderf abo' .is trtt.a 7aicorrect, Si tore: Date: Phone#: ' 4�p O -c:ial Ilse oath-. Do not write in this area, to be co►tipteted by city or totnn ofc7'aL City or Tm n: Permit/License issuing Authority(ch-cleone): 1.Board of Health 2.Building.Department 3.,C1ty T-own Clerk 4,Electrical Inspector 5.Plumbing Inspec or 6.Other Contact Person: Phone#. 6 OF THE ■ HARNgrmmE, " i6J9•. Town of Barnstable �� prFD MA'I A Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using .A. Builder as Owner of the subject property hereby authorize ��1m(��r� �(N6 to act on my behalf, in all matters relative to work'authorized by this buildirig permit application for: tO Y sI1 S�` (Address of Job) a Signature of Owner Date Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side: QAWPFILESIFOR Muilding permit formsT-XPRESS.doc Revised 072110 P�0(HE Town of Barnstable Regulatory Services . sa (ASS. Thomas F. Geiler, Director o;9,, Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 98-862-4038 Fax: 508-790-6230 ----------------------- HOMEOWNER LICENSE EXEMPTION Please Print DATE: tt JOB LOCATION: number street village "HOMEOWNER" name home phone N work phone N CURRENT MAILNG 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 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 suchtwork performed under the,buildingpermit (Section 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 Bud in'g 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.]27.0 Construction Control. HOMEOWNER'S EXEMPTION The Code stales 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 ofa 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 . �la.�achu.ett. Drlr;riTntcnl ''t Public `:I[A., 1 Board of Buildin_ Rcuulation. :u1r1 �1t:ultl:u• 1N Construction Supervisor License License: CS 70077 Restricted to: 00 JOSEPH C DUARTE a5 FALL ST `VVAREHAM, MA 02571 Expiration: 12/30/2010 ( nuni.<i,nrr Tr-: 7662. `,`•.,, . �" '�`'�: p� ✓fe �ana�nayu�aalC>li r��lla��cct.•luael,Ja ' `a tul aurSt"�l'� n l tY. l Board of Buildir-Regula tions mid St uaards dt nvnit a i stration va ccnse or d rutu HOME Ih9PROVENIENT CONTRAGION t �}itc :,yhnur�ain tiif .d ate 11 010 r tanitheex ttons and S Registration: 13234'9 ofBttl,ti� 2 Expiration: 1/11/2011 7rt 39!8t§nti,t Piaccn13 } oston,Tvta:132iOfi . Type: ,Partnership J&J Remodeling G `� Joseph Duarte` - 15 Fall St, �6id without suture .�,r„ Wareham. a ham,m '" -- . 025 71 I 041HE rqy, Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee , * RARNVSTABLE, ► - � Thomas F.Geiler,Director IT �fD MAI A Building Division Tom Perry,CBO, Building Commissioner APR 2 3 2010 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us TOWN OF BARNSTABLE Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint D Map/parcel Number 3 I 0 — 3 l (c ` l f Property Address C9 S QaSS Residential Value of Worl Minimum fee of$25.00 for work under$6000.00 t , Owner's Name&Address 1 oct r C � r A5 Contractor's Name — /CETelephone Number 8Go -7 9Z 'O 4 GJ Home Improvement Contractor License#(if applicable) / 4 R 6 0.7 Construction Supervisor's License#(if applicable) l XWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name A a eA vlyle r', Workman's Comp.Policy# yy L P 0 4 5 l O 1 ; O `7 ` Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) PARe-roof(stripping old shingles) All construction debris will be taken to ►d! Re-roof(not stripping. Going over existing layers of rood )PVRe-side #of doors Replacement Window oors/sliders.U-Value 0.3 a (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 Impro ement Contractors License&Construction Supervisors License is it SIGNATURE: ------------- C:\Users\decollik ocal\Microsoft\Windows\Temporary Internet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 jI1 t� i s * BARN3rABLE, Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, I, EM; / Q Soft Ir c s ,as Owner of the subjectproperty -� Jg hereby authoriz C i12 eo to act on my behalf, in all matters relative to work authorized by this building permit application for: a , r1r- P- (Address ofjob) 141�2 C,/10 aG r 3 Ol D Signature of Owner bate M I 1 ! Q "QM V- Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 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/Electiricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL. 32750 Phone #: 860-753-0452 Are you an employer.?Check the appropriate bog: Type of project(require_d)- 1.❑ I am a employer with 4. ❑ I am a general contractor and l 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. t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working forme.in any capacity. workers' comp..insurance. 9. ❑Building addition [No workers' comp. insurance 5. We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner,doing_all work right of exemption per MGL 11.❑Plumbing repairs or additions ,152 4 ,and we have no myself. [No workers'-comp. c. §1O 12.El Roof rcYs:.a insurance required.]t employees.'[No workers' 13.M Other qe (OL C we 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 dieck this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Ace American Insurance Company / Phone:866-283-7122 Policy#or Self-ins.Lic. #: WLRC45701207 Expiration Date: 08/01/2010 Job Site Address: City/State/Zip 1 Oa 6 O Attach a copy of the;workers'compensation policy declarationpage:(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of:a STOP WORK ORDER and a fine of up to$250.00 a.day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby ce un the pains an enalties of perjury that the.information provi d above is true and correct. Si atur : {Sears Auth.Agent} Date O Phone#. Home:860-315-7468 / Cell:860-753-0452 Official use only. Do not write in:this area,to be completed bycityor town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.,Ikj lding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing.Inspector 6.Other Contact Person: Phone M II CERTIFICATE OF LIABILITY INSURANCE DATE07/17/20 9 PRODUCER - Aon Risk services Central, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Chicago IL Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 200 East Randolph CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE Chicago IL 60601 USA COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC 8 PHONE-f866 283-7122 FAX- 847 953-5390 INSURED INSURER A- ACE American Insurance Company 22667 Sears Holdings corporation INSURERS: Indemnity Insurance Co of North America 43575 w dba Sears Home Improvement Products, Inc w Attn: Risk Management E3-219A INSURERC: v 3333 Beverly Road, a Hoffman'Estates,IL 60179 USA INSURERD: s. ^o INSURER E: p COVERAGES SIR applies per terms and conditions of the policy THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS F H POLICIES.O SUC AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED INSR ADD' LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ATE(MM/DD DATE(MM/DDIVYYY) A GENERAL LIABILITY HDOG24933398 09/01/2009 08/01/2010 EACH OCCURRENCE $5,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $S,000,000 PREMISES(Ea occurrence) CLAIMS MADE © OCCUR MED EXP(Any one person ExCludeU O PERSONAL&ADV INJURY $5,O00,000El n GENERAL AGGREGATE $5,000,OOO � GENT,AGGREGATE LIMIT APPLIES PER: �^ PRODUCTS-COMP/OP AGG $5,000,000 rn ❑X POLICY ❑ PRO- ❑ LOC O O JECT A AUTOMOBILE LIABILITY ISAH0857957A 08/01/2009 08/01/2010 COMBINED SINGLE LIMIT O A ANY AUTO ISAH08579568 08/01/2009 08/01/2010 (Ea accident) $5,000,000 Z ALL OWNED AUTOS ; BODILY INJURY u SCHEDULED AUTOS Per person) 4+ X HIRED AUTOS BODILY INJURY V X NON OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY AGO EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE ❑OCCUR ❑ CLAIMS MADE AGGREGATE H DEDUCTIBLE i 1 RETENTION A WLRC 0 X C STATU- OTH- WORKERS COMPENSATION AND 'ORY LIMITS ER EMPLOYERS'LL&BILITY Y/N CA A SCFc45701220 08/01/2009 08/01/2010 E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? WI E.L.DISEASE-EA EMPLOYEE $1,000,000 B (MandatoryinNH) WLRC4S701207 08/01/2009 08/01/2010 All Other States E.L.DISEASE-POLICY LIMIT $1,000,000 If•es,describe under SPECIAL PROVISIONS below � OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Sears Home Improvement Products, Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1024 Florida Central Parkway DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Longwood FL 32750 USA 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE � �� �� ACORD 25(2009/01) 01988-2009 ACORD CORPORATION.All rights reserved= The ACORD name and logo are registered marks of ACORD i r}� � '" - V i�i [j"O'!i/:dl�fL''!l��it+t-�Y" r � a,'` 'li.•ri"84.r/�='£•�.. 51f./-oiT„4..F C rl° Board of Building Regulations and Standards y,��� r1i One Ashburton Place.- Room 1301 Boston, Massachusetts 02108 Construction Supervisor License License CS: 97519 4- Restriction: 00 Birthdate: 8/31/1963 .` Expiration: 8/31/2010 Tr# 97519 LUBOS SVEC - 827 THOMPSON ROAD _.- THOMPSON, CT 06277 Update Address and return card.Mark reason for change. Address . Renewal Lost Card Awl— -,_ -k 0r°lN y.ri:Mru•r!/ff :�`f r'rr4t.nfrtr%!r(3fYf! a t;. •• Board of Building Regulations and:Standards A. Construction Supervisor License Qs Q Rear'U- Enewrli 7 . License: CS 97519 1l1ke¢1! 5 tit EyQt HAZ t 25�2LtU7 *° '. , Birthdate: 813111963 SVEC,{ sj x f{ �" t '•� i. M Expiration: 8/31/2010 Tr# 97519 BOS, .d Restriction: 00 lTHomps wCT w y LUBOS SVEC 400'* 827 THOMPSON ROAD THOMPSON,CT 06277 Commissioner 09I30/2009 10:49 4077678536 SHIP PERMIITSSLICENSE PAGE 01/01 &ce o on'nsu eer mars an usiness a at1<on 10 Park Plaza- Suite 5170 i Boston, Massachusetts 02116 ' Home,Improvement C©attactor Registration Registration: 148607 Type: Public Corporation Expiration: 10/11/2011 Tr# 28820 SEARS HOME IMPROVEMENT P b40J,, " ALFRED NYMAN JR, . - - 1024 FLORIDA CENTRAL PKWY: -- LONGWOOD, FL 32750 - - - Update Address and return card.Mark reason for change. Address (_] Renewal Employment Lost Card --CAI a solo-04roe.G14121e office of Camomer Affairs& mduess Regularloa License or registration valid for ind-widul use only HOME IMPROVEMENT CON'rftACTOR before the expiration date. If found return to: Rsgfstratiori°\749807 Office of Consumer Airs and Business Regulation Expiration:"' R Park Plaza.1m.1112011 ` Tr# 288268 Typer Aii511cCkcrpot�tton � aa FAA DZi16 Suite 5170 SEARS HOME WFR0VZWEI.f'PRODUCTS INC. ALFRED NYKW JR.' 1024 FLORIDA CE.'P.R�N1' '�r 4D • —: LONGWOOD,FL Undersecretary Not valid without signature 4 91te Oft ce o onsumer �A(aJkusi�nesseguon 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improve kerit,Contractor Registration k Registration: 148607 Type: Supplement Card Expiration: 10/11/2011 SEARS HOME IMPROVEMENT PRODUCT_ ` LUBOS SVEC 1024 FLORIDA CENTRAL PKWY ,, a — LONGWOOD, FL 32750 ` Update Address and return card.Mark reason for change. Address Fj Renewal Employment ❑ Lost Card 0PS-CA1 0 SOM-04104-6101216 1. - 1_\ Office of Consumer Affairs&B mess Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: •, Office of Consumer Affairs and Business Regulation Registrati0n: 148607 10 Park Plaza-Suite 5170 Expiratiorr_10/11/2011 Boston,MA 02116 Type ?Supplement Card SEARS HOME IMPROVEMENT PRODUCTS INC. LUBOS SVEC c {` 1024 FLORIDA CENTRAL PkM LONGWOOD,FL 33750 Undersecretary Not valid without signature Proposal Date Job Sears Home Improvement Products,Inc. Customer Name P.O.Box 522290 ;;LAII [A Sears 1024 Florida Central Parkway Customers ome Phone Customer's work Phone Longwood,FL 32752 2290 Home Improvement Products Phone (800)469-4663 treet ddress ESTIMATE AND PROPOSAL Contractor License/Registration Number 2VO QPM94% C.Iiz Windows HIC 1148607;all plumbing and electrical city State Zip code services performed by licensed subcontractors pad) Is installation within city limits? FEIN 25-1698591 Installation Address Coun ❑Yes ❑No Billing Address(it different from above) City State Zip Code Project Consultant Name 8 License No.(it applicable) a:b Description of the Project and Description of the Significant Materials to be Used and Equipment to be Installed 1. Remove existing units to be replaced.(PLEASE NOTE:The removed units are likely to be damaged.) 2. Prepare openings as necessary to receive replacement units.(No finish work other than normal installation is to be done unless otherwise noted below.) 3. Installation includes the clean up of all job- Iated debris upon completion of the job. 4. Install Sears Weatherbeater 'PLu-, f Vw,ut- 1_ Windows in the openings described below according to the following specifications: COLOR: 5Khite ❑Tan ❑Clay ❑White/Light Woodgrain Interior ❑White/Dark Woodgrain Interior TYPE: ❑DH Oty— Eaft Oty-2, ❑Casement Qty Type ❑SH Oty— (swo Qty—I ❑Bay ❑1-LR Oty ❑Garden Door Oty ❑Bow: ❑3 lite ❑4 lite ❑5 lite ❑2-LR Oty_ ❑Garden Window ❑3-LR Oty_ ❑Other Qty GLASS: ❑Tempered` Qty. ❑OBS Half City. SCREENS:Check if other than FIBERGLASS 'PLEASE NOTE:Tempered glass will be installed to ❑OBS Full Oty._ (on sashes only) ❑Aluminum meet building codes. ❑Laminated Oty. GRIDS: Type Color: Placement: Existing units NOT to be replaced. -- ------- ....... ------------ ---------------------------- R'fes ❑Col Flat 0 hite ❑Woodgrain ❑Top ❑No 2tol Sculp/Contour ❑Tan Crull L ❑Other(Specify:) ❑Brass ❑Bottom ❑Clay ❑Flankers Only 5. (If applicable)After the completion of the project,the customer will be responsible for the application and removal(storage)of shutter panels.In the event that the project requires the installation of storm shutters or egress windows,Sears Home Improvement Products, Inc.('Sears')will not re-install any affected security bars. 6. (If applicable) In the event Sears is unable for whatever reason to obtain the proper permits prior to the commencement of any work, Sears will refund any previous payment and this contract will be automatically cancelled. Additional work to be done. L L L Work NOT to be done: t SPECIAL INSTRUCTIONS: 5wotm, 'pan,2'-t7oaFz if`1 rui5 All of the above check boxes and the"Work NOT to be done"section have been reviewed and explained to me. Customer(s)initials APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 2—S VJF_E (Approximate Start Date)and will be substantially completed by approximately St&A(Approximate Completion Date).These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products,Inc.("Sears")or at any other time by mutual written agreement.Customer understands that the Approximate Start Date is only an estimated date and the Customer will be contacted pdDr to this date to schedule the actual start date. The TOTAL PRICE including all labor,material,taxes and any applicable discount is $ — Contract Price $ 00.aO Initial Payment(not to exceed 30%of Total Price unless Special Order) $ If- State Sales Tax( %) $ p Final Payment(balance payable upon completion of job} $ 00 Local Sales Tax( %) $Ki a The Initial Payment is due prior to Sears ordering products. Total Amount Due I$ 4Off, The form and method by which the Customer(s)will pay is described in a separate Cash/Credit Card Payment Addendum made a part of and incorporated into this contract by reference. Customers)initials , NOTICE TO BUYER:YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA,FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER)AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Additional provisions of this contract are slated on the pages fallowing Customer(s)initials SW7-Ma Rev 04le9 IIIIlII I II III III t. . ADDITIONAL PROVISIONS Proposal ad r oval. Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown.This offer must be approved by the Installation Department.If this is a credit sale or a payment on completion sale,it must be approved by the Credit Sales Department.If this proposal is not approved or the installation cannot be made in accordance with the law,this offer will be withdrawn and any payments you have made will be refunded to you. Any materials left over after the installation has been completed are Sears property and will be removed by Sears. Installation. I understand that Sears will not install the materials but will arrange for the installation.Sears is not responsible for materials or installation NOT furnished or arranged by Sears.Sears agrees to procure all permits required by local law. Authorization. I authorize Sears to:(1)arrange for a contractor(licensed where required by law)to make the installation of materials;(2)issue a work order for this installation to a contractor:(3)inspect the installation;and(4)pay the contractor when the installation is complete if I have signed a certificate that the installation has been completed to my satisfaction. Delays in Installation. I agree that Sears is not responsible for delays in delivery or installation due to weather,fire,strikes,war,government regulations or any causes beyond Sears'control. Oral Agreements and Changes in Contract. I understand that there are no oral agreements between Sears and me.Everything I expect Sears to do has been included in writing in this contract.Nothing can be changed in this contract unless it is in writing on a separate form accepted by me and Sears. Responsibility of Buyer. I agree that any information or measurements that I give to Sears are correct and complete.I am responsible for any special work described in this contract. Electrical&Plumbing Service. I will provide adequate electrical and/or plumbing service(s)to run any newly installed appliances or other furnishings. If the electrical and/or plumbing service(s)do not meet the standards of the utility company or electrical and/or plumbing codes, I will make the necessary changes at my expense unless Sears has agreed in this contract to make the changes. moment. I will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warran Information. Appropriate product warranty documents will be given to me by Sears.Sears'Warranty on Installation is: SEARS'LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s)used(which warranty becomes effective the date the merchandise is installed),if the workmanship(or application)of any Sears'arranged installation proves faulty within(i)one year for Weatherbeater Value Line,(ii) two years for Weatherbeater Plus,or(iii)three years for Weatherbeater Max,and Weatherbeater Stormbeater,then upon notice from you Sears will cause such faults to be corrected by repair at no additional cost to you.If Sears determines that repair is not commercially practicable or cannot be timely made,then,at Sears'sole discretion,Sears may elect to provide replacement or refund.Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1-800-222-5030,Option 4.This warranty gives you specific legal rights,and you may also have other rights that vary from Slate to State. NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT.KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME,AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY[FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER]AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT.FAILURE TO EXERCISE THIS OPTION, HOWEVER,WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS.IF YOU WISH,YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING"I HEREBY RESCIND"AND ADDING YOUR NAME AND ADDRESS.A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY In addition to the Notice to Buyer shown above,Massachusetts law requires that contracts for home improvement work state that all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration P.O.Box 871 Taunton,MA 02780-0871 Telephone:(508)821-9375 Please note that owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Notwithstanding any.other language in the contract or associated documents, Sears will not remove, replace, or install any heating or air conditioning system,or any portion thereof, if asbestos or asbestos-containing material is known or likely to be present in that heating or air conditioning system, or any portion thereof. If it is determined or reasonably suspected that asbestos is present,either before commencement or during performance of the work,it shall be the cus- tomer's responsibility to select, retain and pay all costs of a Division of Occupational Safety("DOS") licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determina- tion or reasonable suspicion of the presence of asbestos arises after Sears has started the work,Sears will immediately cease performing the work until a DOS licensed Asbestos Contractor,hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R. 7.00 and 453 C.M.R.6.00 or veri- fies that none is present. By signing the contract the customer agrees that it understands the above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES - � r Ina Customer's signature -D(te ; Customer 'gnature Oat' Accepted by Sears Home Improvement Products,Inc.("Sears")on ( 0 by: ate anageme epresentative 8W-MA Rdu 94/99 ' i 777, - NFRC Natl0naf Fenestration Via" ja Ilisiz <- 0 s Rating Councile N 3�-6. -V'�p as.29, mu ;a illo; ENERGY PERFORMANCE RATINGS EVALUACION DE RENDIMIENTO ENERGET100 U=Factor Solar Heat Gain Coefficient Factor-U Coeficlente:Ganancia de Energia Solar .: f a (USA-P) Wetrico$I) ADDITIONAL PERFORMANCE RATINGS EVALUACION SUPLEMENTARIA DE RENDIMIEMTO Visible Transmittance Transmision de Luz Vjsible Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a fixed set of environmental condi ions and a specific product size..NFRC does not recommend any product and does not warrant the suitability of any product for any speciffc use.Consult manufacturer's literature for other product performance Informa.fion_vP,vvr;nfrc.org - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Este fabricante estipula que estos valores cumplen con los procedimier>tos aplicabie<s de NFRC para de-terminar el rendimiento total del producto.Eras valores usados por NFRC son determinados por un conjunto fijo de condiciones ambientales y un tamano de producto especifico.NFRC no reoomienda ningun producto y no garantiza que el producto sea adecuado para un use especifico.Consulte con el folleto,del fahricante para el use apropiado de este producto.wwwArc.org z g }r- T -vegi6nfes) ButRGY STAR,. worts, Rein 49;1H- G Wasted 4- e: 3 . X > .g MID; Refue r`zo A -R65 f g Y "'}`"it x r., � €tY. 9 _ - _ Keep this label for possible ENERGY STARO rebates.To loam more tff-NvUenerystar.gov Guorde este etiqueto paro posibles reembolsos ENERGY START Para conocer As acerca de esto,visite www.eriergystargov E Tyra.;AT7, V f� cf oFt�E> Town of Barnstable Regulatory Services 0 Thomas F.Geller,Director MAM 8. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 -PERMIT# y FEE: $ P 0 SHED REGISTRATION 120 square feet or less Location of she (ad ss) illage . 6o I Pr erty owner's name Telephone number -a/ o 396 Size of Shed Map/Parcel# Signs J �' Date Hyannis Main Street Waterfront Historic District? Old Ring's Highway Historic District Commission jurisdiction? -------------- Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. -THIS FORM MUST BE ACCOMPANIED BY' A PLOT PLAN i i� 1 . - a L GAT 0,'4'. �_ear' a,0 5r. POP, AT lor c� s tt R 3Y ►T TmIS NVAT f ri J-w. SETt +t A essor's map and lot number C31Q��,�1 t d••••• SEPTIC SYSTEIV! ��U of�NeT�r► INSTAI_LE V' ~ Se ge Permit number ........................................................ D IN COMPI. WITH N ARTICLE II STA BAHBSTSDLE, SANITARY CODE A House number .................................. .................................. REGULATIONS. `90'a NAG& ULATIONS. 639- D yaY a`e�� TOWN OF 'BARNSTABLE BULDIHG 11SPECT0R APPLICATION FOR PERMIT TO � r.......... ?fir.. ............................ ................................ ......... . ..... .... TYPE OF CONSTRUCTION �o ..................................................................................................................................... ...............G.............19..7 . TO THE INSPECTOR OF BUILDINGS- The undersigned hereby applies for a permit according to the following information: Location .../A.f....ZA.!3 �'Ccy,�flss....�!.C<<c ...l lnri!./A........y95S ProposedUse .... .. ..................... ...................................... ................................................................. Zoning District ....91............................................................Fire District ... ................. Name of Owner .. ..{...�..:Ce..s-IPv�i. °.!............................Address .6rP�.7......zob;A... . . ............... .... Nameof Builder .. .M. '.......................................................Address .................................................................................... Name of Architect ..Address Number of Rooms ..... .........................................................Foundation .�`€N.�tee .Q....................................................... Exierior ..gdm� ..... .�.! 5.� .).............................................Roofing .... ?f��IR.4?......S..f..MI.1E5................................... :.. Floors .tuA��...T.��`�'..!�5:�..................................... ................... .................................................................................... Heating .......... ..... .................................Plumbing ...,p! .................................................... Fireplace .On!1F........................................................................Approximate Cost .... .............................................. Definitive Plan Approved by Planning Board -----------_-------------------19_______. Area " ' ......, 4— ...a• Diagram of Lot and Building with Dimensions Fee /9 .............. .... ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 30 � �� � poi $d ! ao t .Sa I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........................ .. ... ...................................... / F Theo Construction Co. A=310-396 �213 +.... Permit for ..Single..L=ily...... .......dwelling...................................................... Location ... 0�1....2$6..Cbtgass...Ci.rcje HxaS......................................................... Owner .......Z' Q.Q..QQnS>tXllctiM..Co............... Type of Construction frame.......................... Plot ........................ Lot ................................ Permit Granted 19 79 Date of Inspection f Date Completed ......... .........19 PERMIT REFUSED ................................................................ 19 ............................................................................... r ............................................................................... ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's map and lot number ............................................r' tP�oF Ta a Tod Sewage Permit number ........................................................ Z BAWSTAXE, i House number ......... .......................................................♦ NAG& p 1639. \0� YPY p TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........P�..... r?? !...... �.............................................................:.. TYPE OF CONSTRUCTION (A l o o ......................................................................................... ............................................. ................................................19.:�R. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...�...!....L!?.. .... '.*:•.!'.1`.....�:.• �e�........... ..a.:: : ....... f�S.S..............:........:... /. .. ProposedUse ...I-o :.:r+/i,.., f................................................................................................................................................. Zoning District ... ..P,............................................................Fire District ... r N tJ..'.. ............................................ Name of Owner ...... n..(... .,s-fruc f........?......'.................Address ..(-.. f2�::...... / � Name of Builder !? ! .. ..............Address ... .. ... y .. Nameof Architect .....���.` ..................................................Address .................................................................................... Number of Rooms ..... .........................................................Foundation . '! >!t.r. ....................................................... Exterior Qr'.....<.(.: ;'-.i" N............................................Roofing ....f7�nf��c7......S.f. �lo< ....... ............................................ Floors (.�;�� c„�, f........................................................Interior .................................................................................... ................ Heating 4�-1 . ...Plumbing .... T>ti Fireplace r'9hr ..........................................Approximate Cost ... '70:74�, ........................................ .................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area ""'" 4........ f Diagram of Lot and Building with Dimensions Fee J f.`.r"'"�' r . ............... SUBJECT TO APPROVAL OF BOARD OF HEALTH O 3G � uo , �014P13 SS . 7 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....:................................................................................... Theo CooGczzuc--~^- �� �� ' ` n" , A=3lO-q96 ' � No �D�.-.. Permit for ..... . .. dwell ~ ------.'`�------------------. Location lnt �7O4 �l��..._=~.~.^~-'' _-�'^=wug?aoS-'C-zrc1-e ' --'~-'---'-------------------' Owner --.�hea. .6���---- ' Type o. Co. s./vc"v.. - ' ncx ............................/L 0 t ............ Permit" Granted 4........June.,4............1979 Date of lnspectio�nl...................................19 __- Completed_ -------. PERMIT REFUSED , .. lV ' - � _.��---.. .... `�.'�------------.- . ° --^~^'~-- ^^^^-'-~--^'-''^^'--'` � m� ----.-..~........--~...----....----.. Approved ---------------- lg -------.-.----.~.-~.--------. � ----------~--.-----,--~....... TOWN OF BARNSTABLE permit No. ___-21344 Building Inspector - -- swrrn, q / Cash OCCUPANCY PERMIT sons No buildingshall be erected and no land buildingor structure shall be used for a new,d nor ifferent, changed, or enlarged-use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Theo Construdi.on GO-JnC, Address South Yarmouth lot #1€3A 286 Compass Circle, Hyannis Wiring Inspector � y � �r' Inspection date -� Plumbing Easpector j�. / Inspection date Gas Inspector Inspection date Engineering Department r Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON •SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. r Building Inspector r.� F.�?d F 1� '� '+i};w"7#(+ f � r 'fin= ,� ^* ; f}.••r c �� � - a • r ,_ 'S y"t .�. ;t,,,. ps"fc. .r XS 4�i.a"` i ���� ,rl»". :♦ 'e1 fi trF_'Y .'a ir� r � 'I � '�° +`cl y+''. ... .+..-' �` x.� �x��,"'z•u'�.�tvT:s " :�'� .�' '1 ; - . 1 s - • T �' `�` {' - � 3A� 4 � #. fir: �,.., i �9. , �'s s ,�. .#"`5v{�a/"al Kl• ��� h�'+a. 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