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0080 CROCKER DRIVE
� � 7 `^� - �) 1 1� �, � �'�� i :.Application number ..... i Fee... . ...... ............... *iS�H$TASLB„ s KAss. APR 2 5 205 s Building Inspectors- � ,. ' i� f(���I�9:°A tJAKNS�� D Date Issued .... ............................. , ' MP .. .. �a� as a /Parcel............ ......... -TOWN OF. BAR.NSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project e0 C IG IZ . a n 0'/rS. NUMBER STREET- vnLAkE Owner's Name:ire r k e 0.s Jr Phone Number 15165 `6 g G(o J Email Address: Cell Phone Number Project cost $ l / Check one Residential l/ Commercial OWNER'S AUTHORIZATION e Asowner of the above property I hereby authorize to make application for building permit in accordance with 780 CMR Owner.Signature: Date: ' TYPE OF WORK Siding O Windows (no header change)# Q Insulation/Weatherization Doors (no header change)# _ Commercial Doors require an inspector's review Q Roof(not applying more than.1 laver of shingles) ; Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name C L)I Home Improvement Contractors Registration(if applicable)# f j �yT (attach copy) 'Construction Supervisor's License# V J (attach copy) Email of Contractor ,S "DI (_.IIJSDY) cr O F",CO3-'Phone number 560 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................ t *For.. Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes --No — - - — Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required.. Natural Gas Yes No if yes, a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION t , Homeowner's Name:. Telephone Number - Cellror Work number I understand my,responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 180 CAM the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date '. APPLICANT'S SIGNATURE l �5 Signa2 Date L All permit applications are subject to a bui ing official's approval prior to issuance. Esc ;,a The Commonwealth ofMassachusetts RDepartment of Industrial Accidents Office of Investigations . 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit. guilders/Contractors/ElectriciansiPlumbers Applicant Information Please Print Le 'bl O Name (Business/Organization/Individual): ' U j ) 6n Address: % 3,�j rnA o_l • City/State/Zip:. . ��;� ,�tJu-'- MA 79-6 Phone.#: 5 Are you an employer?Check the appropriate box: Type of project(required): 1IM4 am a employer with `5 � 4. 0 I am a general'contractor"and I ployees(full and/or part-time).* have hired the sub-contractors 6' New construction 2.0,I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling ship and have no employees These sub-contractors have g, .0 Demolition y working for me in any capacity. ;employees and have workers' 9. ❑Building addition [No workers' comp:insurance comp.,insurance.# . required:] 5. E] We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11:0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,..§1(4),and we have no employees,[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#l must also fill out the section below showing their workers'compensation:policyinformation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or,not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Tam an employer that is providing workers'compensation insurance for my employees. Below is the policy,and job site information.Insurance Company Name: S�r kvl—G,,,{�). ka�: IS J /e Policy#or Self-ins.Lie,#: Expiration Date: l I Job Site Address: J�C) Ct�C City/State/Zip:� G.h n i_s � oa o i Attach a copy of the workers' compensation policy declaration page(showing the policy nuAir 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 here y cerh under the p ins and p alties of perjury tha.the information provided aba.a is tru and correct: Si afore:~ Date: Phone* 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#: Information -and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers',compensation for their,employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,.§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage.required." -. . Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been,presented to the contracting authority:" Applicants Please•fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with theircertificate(s)of r insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with.no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"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. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4400 ext 406 or I-877-MASSAFB Fax#617-727-7749 Revised 4-24-07 www.mass.govfdaa -� Contract - Detailed Sales - ® Rep Name. Harrison,Gene Sales Rep Phone: 508-962-2021 Phone: Fax: Sales Rep Fax: Sales Rep E-Mail: gharrsson@gopella.com Customer Information Pro'ectl J Delivery Address Order Information Irma Senkovsky Senkovsky,inna,2240162 80 Crocker Dr Quote Name: Patio Door 80 Crocker Dr HYANNIS,MA 02601-4410 Lot# Order Number: 738ZW9GIC Primary Phone:{508}9046634 Hyannis,MA 02601-4410 Quote Number: 11129462 Mobile Phone: County: Barnstable Order Type: Installed Sales Fax Number: Wall Depth: P @gmail.com Irma Senkovsky E-Mail: ca edacha Owner Name: Payment Terms: Contact Name: Tax Code: MASS Owner Phone:(508)9046634 Cust DeliveryDate: None e Great Plains#: Quoted Date: 3/14/2019 Customer Number. 1009064046 Contracted Date: 3/17/2019 Customer Account: 1005108396 Booked Date: Customer PO#: Customer Notes: Paint intrerior trim Pella white Lifetime war ranty on products and 10 year warranty on labor Lock box#0113 Line# . Location: 10 Rear patio door Attributes Lifestyle, Double Sliding Y � Door Contemporary,ntemporary, Vent Right 1 Fixed White Item pace Q 9 ty ExYa Price $5,123.95 1 $5,123.95 t* 1:Vent Right/Fixed Double Sliding Door General Information: Performance Package,With Hinged Glass Panel,Clad.Pine,5 7/8",4 9/16,Oak Threshold PK# Exterior Color/Finish: Standard Enduraalad Whit e to Interior Color!Finish: Bright White Paint interior 2030 Glass: Insulated Tempered Low-E Advanced - - L - ow E Insulating Glass Hinge Panel: Clear,Tempered 9 Arg Non High Altitude Viewed From Exterior Hardware Options: Black,Standard Handle Included,Handle Includ Satin Nioke�fte,No Integrated Sensor Screen: Roiscreen®,Bright Whitn — _. 07 Unit Accessories: Snap-in Between-The-Glass Blind Bottom-Up,White,Manual Performance lnformatlon: CPD Not Rated,Performance Class LC,PG 40,Calculated Positive OP Rating 40,Calculated Negative DP Rating 40,Year Rated 08111 Grille: No Grille, 1000020-Double Door Installation For more Information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 3/17/2019 Contract-Detailed Page 1 of 6 .......................................................................................................................................... ... Customer.Inna Senkovsky Project Name: Senkovsky,Inna,2240162 Order Number. 7382W9GIC Quote Number. 11129462 1000041-Exterior Trim PVC Q, 1 1802-Prefinish interior Trim per Unit oy 1 Line# Location: Attributes 15 rear entrance Pella Brand, Entry Door Inswing, White, 6 9116 Item Price Qty Ext'a Price - $2,784.45 1 $2,784.45 1: Entry Door Unit Type::Right Inswing,Standard Sig,No Fire Rating,No Fire Rating PK# Dimension Options: No Cut Down x General Information: 7 7/8",1 5/16',6 91-16" 2030 Panel Style: Full light Glass: Tempered Blinds-Between-The-Glass Air Filled Viewed From Exterior Panel Selection: Smooth,Painted,White,Painted,White Frame Selection: Clad,Pine,Oak Threshold,No Panel Reinforcement,Standard Enduraclad,White,Wood,White Hardware Options: latch Bore with Deadbolt,2 3/8",2 1/8",No Integrated Sensor,No Handle Set,Standard Steel,Satin Nickel,Mill Finish Sill Unit Accessories: No Bang Panel. Performance Information: U-Factor 0.31,SHGC 0.21,VLT 0,23,CPD PEL-M-174-02607-00001,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,Year Rated 08 1000027-Entry Door Single Installation Q y 1 1000041-Exterior Trim PVC Q y 1 1802-Prefinish Interior Trim per Unit oty 1 Line# Location: Attributes 20 Rear entrance Entry Systems, Stone Door Fullview Roiscreen Unhanded, White(P390052331) Item Price Q ty Exrd Price $830.60 1 $830.60 -- 1:to 81 Unhanded Storm Door General Information: Clad PK# Exterior Color/Finish: Standard Enduraclad,White Sash I Panel: 1 3/8"Extruded 2030 Glass: Clear Viewed From Exterior Hardware Options: Standard,Satin Nickel Model. 3900 1000033-Storm Door Installation Qty 1 For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 3/17/2019 Contract-Detailed Page 2 of 6 Customer.Inna Senkovsky Project Name: Senkovsky,Inna,2240162 Order Number. 738ZW9GIC Quote Number. 11129462 Attributes, Line# Location:• � , 25 Front Entrance Pella Brand, Entry Door Inswing, White, 6 9116" Item Price Qty F_xt'd Price i - $3,277.97 1 $3,277.97 El >: 1: Entry Door �:. Unit Type: Right Inswing,Standard Sill,No Fire Rating,No Fire Rating PK# Dimension Options: No Cut Down General Information: 7 7/8",1 5/16,6 9/16" 2030 Panel Style: 3 Panel Oval Glass: Tempered Decorative Castile Nickel Air Filled Viewed From Exterior Panel Selection: Smooth,Painted,Lively Blue,Painted,White Frame Selection: Clad,Pine,Oak Threshold,No Panel Reinforcement,Standard Enduraclad,White,wood,White Hardware Options: Latch Bore with Deadbolt,2 3/8",21/8",No Integrated Sensor,No Handle Set,Standard Steel,Satin Nickel,Mill Finish Sill Unit Accessories: No Bang Panel Performance Information: U-Factor 0.21,SHGC 0.15,VLT 0.16,CPD PEL-M-174-02395-00001,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,Year Rated 08 1000027-Entry Door Single Installation city 1 ! 1000041-Exterior Trim PVC city 1 1802-Prefinish Interior Trim per Unit city 1 I tl For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 3/17/2019 Contract-Detailed Page 3 of 6 Customer. Inna Senkovsky Project Name: Senkovsky,Inna,2240162 Order Number. 738ZW9GIC Quote Number. 11129462 Thank You For Purchasing Pella@ Products PELLA WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale.All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details,taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wall system.Neither Pella Corporation nor the Seller will be bound by any other warranty unless specifically set out in this contract. However,Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening(egress)information does not take into consideration the addition of a Rolscreen[or any other accessory]to the product.-You should consult your local building code to ensure your Pella products meet local egress requirements. Per the manufacturer's I imited warranty,unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually,thereafter. Variations in wood grain,color,texture or natural characteristics are not covered under the limited warranty. INSYNCTIVE PRODUCTS:In addition,Pella Insynctive Products are covered by the Pella Insynctive Products Software License Agreement and Pella Insynctive Products Privacy Policy in effect at the time of sale,which can be found at Insynetive.pella com. By installing or using Your Insynctive Products you are acknowledging the Insynctive Software Agreement and Privacy Policy are part of the terms of sale. ARBITRATION AND CLASS ACTION WAIVER("ARBITRATION AGREEMENT") YOU and Pella and its subsidiaries and the Pella Branded Distributor AGREE TO ARBITRATE DISPUTES ARISING OUT OF OR RELATING TO YOUR PELLA PRODUCTS(INCLUDES PELLA GOODS AND PELLA SERVICES)AND WAIVE THE RIGHT TO HAVE A COURT OR JURY DECIDE DISPUTES.YOU WAIVE ALL RIGHTS TO PROCEED AS A MEMBER OR REPRESENTATIVE OF A CLASS ACTION,INCLUDING CLASS ARBITRATION,REGARDING DISPUTES ARISING OUT OF OR RELATING TO YOUR PELLA PRODUCTS.You may opt out of this Arbitration Agreement by providing notice to Pella no later than ninety(90)calendar days from the date You purchased or otherwise took ownership of Your Pella Goods.To opt out,You must send notice by e-mail to pel lawebsupport_0pella.com,with the subject line:"Arbitration Opt Out"or by calling(877)473-5527.Opting out of the Arbitration Agreement will not affect the coverage provided by any applicable limited warranty pertaining to Your Pella Products.For complete information,including the full terms and conditions of this Arbitration Agreement, which are incorporated herein by reference,please visit www.gelia.com/arbitration.or e-mail to pellawebsupportna pella.com,with the subject line:"Arbitration Details"or call (877)473-5527.D'ARBITRAGE ET RENONCIATION AU RECOURS COLLECTIF("convention d'arbitrage")EN FRANCAIS SEE PELLA.COM/ARBITRATION.DE ARBITRATE Y RENUNCIA COLECTIVA("acuerdo de arbitraje")EN ESPANOL VER PELLA.COM/ARBITRATION. Product Performance Information: U-Factor,Solar Heat Gain Coefficient(SHGC),and Visible Light Transmittance(VLT)are certified by the National Fenestration Rating Council(NFRC).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 conditions and a specific product size.NFRC does not recommend any products and does not warrant the suitability of any product for any specific use. Design Pressure(DP),Performance Class,and Performance Grade(PG)are certified by a third party organization,in many cases the Window and Door Manufacturers Association (WDMA).The certification requires the performance of at least one product of the product line to be tested in accordance with the applicable performance standards and verified by an independent party.The certification indicates that the product(s)of the product line passed the applicable tests.The certification does not apply to mulled and/or product combinations unless noted.Actual product results Will vary and cliahge over the products life. For more performance information along with information on Florida Product Approval System(FPAS)Number and Texas Dept.of Insurance(TDI)number go to www.pe]la.com/performance. For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelle.com Printed on 3/17/2019 Contract-Detailed Page 4 of 6 i Customer. Inna Senkovsky Project Name: Senkovsky,Inn a,2240162 Order Number: 738ZW9GIC Quote Number. 11129462 Notice:You may cancel this agreement if it has been signed by a party thereto at a place other than the address of the seller,which may be his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of the agreement. >>FOR REPLACEMENT PART ORDERS PAYMENT IS REQUIRED IN FULL AT TIME OF ORDER<< Federal iD#71-0986135 Rhode Island HIC Registration#21210 Massachusetts HIC Registration#149840 Massachusetts CS License#CS81843 1.Work to be performed and materials used: Pella agrees to perform the following work for the homeowner: a.Remove existing window(sydoor(s) b.Install new window(s)/door(s) c.Dispose of old windows)/door(s) d.Clean up work area The materials to be used in completing the work described above are a part of this contract and are listed on this contract. 2.Wananty and Limitations Seller warrants the installation services only as set forth in the Seller's Installation Limited Warranty and Service Agreement,which is made part of this Contract.The Seller's Installation Limited Warranty and Service Agreement,is available from Seller upon request and may(but need not)be attached hereto or enclosed herewith.All product warranties for products manufactured by Pella or others are direct from Pella or others,respectively.Seller also agrees to service the Pella Products purchased by the Buyer for an 8 year period starting from the date of the expiration of the Installation Limited Warranty pursuant to the conditions and limitations set forth in the Service Agreement,which is made part of this contract.Pella warrants its products only as set forth in Pella's separate product limited warranties,which are made part of this Contract.The product limited warranties for Pella products are available from Pella upon request and at pella.com/warranty,and may(but need not)be attached hereto or enclosed herewith.Other manufacturer warranties can be obtained directly from such manufacturer.Certain Pella Products contain a factory finish.If the products purchased by the Buyer(s)contain a factory finish,this finishing will be warranted as part of Pella's Product Warranties.These warranties are available at pelia.com/warranty.if the Buyer(s)elects finishing by the Seller,Seller warrants the finishing only as set forth in the separate 2-Year Finishing Warranty.The 2-Year Finishing Warranty is available from Seller upon request and may(but need not)be attached hereto or enclosed herewith.Where applicable,all terms and limitations of the 2-Year Finishing Warranty are made part of this Contract as if expressly set forth herein.If finishing is not selected from the Seller or from the factory,Buyer(s)is responsible for finishin .THERE ARE NO OTHER WARRANTIES,EXPRESS OR IMPLIED,INCLUDING BUT NOT LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.IN NO EVENT SHALL SELLER OR PELLA OR ITS SUBSIDIARIES BE LIABLE FOR ANY INDIRECT,SPECIAL,CONSEQUENTIAL,OR INCIDENTAL DAMAGES ARISING OUT OF OR RELATED TO THE PRODUCT OR WORK. 3.insurance Pella certifies that it maintains adequate liability insurance. 4.Arbitration Any controversy or claim arising out of or relating to this contract or breach thereof,shall be settled by mediation under the Contruction Industry Mediation Procedures of the American Arbitration Association.If within 30 days after service of written demand for mediation,the mediation does not result in settlement of the dispute,then the unresolved controversy or claim arising from or relating to this Contract or breach thereof shall be finally settled by arbitration administered by the American Arbitration Association in accordance with its Construction Industry Arbitration Rules and judgement on the award rendered by the arbitrator(s)may be entered in any court having jurisdiction thereof.The costs of such proceedings shall be bome equally by both parties. 5.Incorporation of Other Documents The following documents are incorporated and made part of this contract:Pella Limited Warranty and Pre Installation Checklist. 6.Other Provisions a.Pella is not responsible for any existing security systems. - b.Please remove all shades,blinds,curtains,drapes or window mounted air-conditioners,prior to the installation of your new windows or doors.The installers are not repsonsible for the removal or installation of these types of items. c.Structural damage(eg,rotting or damaged wood or frame of rough opening)may not be determined until the old window or door has been removed.If the installer determines that structural repairs are required there will be additional charges.The additional work will require a separate contract or change order and the additional charges shall be payable upon completion of work. d.Pella will use reasonable efforts to return the areas affected by the work,performed under this contract,to a state approximating its original condition:however,Homeowner understands For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 3/17/2019 Contract-Detailed Page 5 of 6 ......................- ..............__......................._................................................................................................................................................................_......................... Customer. Inna Senkovsky Project Name: Senkovsky,lnna,2240162 Order Number: 738ZW9GIC Quote Number. 11129462 and agrees that this may not result in the affected areas being restored to their original condition. e.This contract shall be governed by the State of Rhode Island or Massachusetts depending on the location of the work to be performed. -vev Order Totals Customer Name (Please print) Pella Sales Rep Name (Please print) Taxable Subtotal $9,541.97 �ev— /Cd� Sales Tax @ 6.25% $596.37 Customer Signafure Pella Sales Rep Signature Non-taxable Subtotal $2,475.00 0/'le-il 7 _- _—_---- Total $12,613.34 Date Date Deposit Received Amount Due $12,613.3 Credit Card Approval Signature For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 3/17/2019 Contract-Detailed Page 6 of 6 Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvemerrt.Contractor Registration Type: Supplement Card PFR ACQUISITION,LLC ' Registration: 149840 1325 AIRPORT ROAD „� 8 ; Expiration: 02/12/2020 FALL RIVER,MA 02720 .. Update Address and Return Card. SCA 1 15 20M-05/17 - _._. ............. -.__.._ ------ ._ .._... -._..... Vhe (�arr�i»aa�zuea�f�a�C?r�/laaa�r�uue/lt Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Suoglement Card before the expiration date. If found return to: Registration, Expiration Office of Consumer Affairs and Business Regulation 149840.-: 02/12/2020 10 Park Plaza-Suite 5170 PFR ACQUISITION, LLC' Boston,MA 02116 STEPHEN T.DICKINSON A�m ,Q 1325 AIRPORT ROAD FALL RIVER,MA 02720` ry Undersecreta Not valid without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const\ Ctl6t f 4Spprvisor J. CS-081843 t ��ires 02/06/2020 ; STEPHEN T DICK-ii -IR' . S AZALEA LAft y � PLYMOUTH MA.9z360 s , r t 1 ,. Commissioner CIL E' I , -- .... _. i I ' Client#: 73461 PELLAWINI ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/30/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS j CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Melissa Tanguay Starkweather&Shepley PHONE 401435-3600 FAX 401431-9658 PO Box 549 (AC-No Ext: A/C,No): EMAIL y@ ua p. Providence,RI 02901-0549 ADDRESS: mtan 9 starshe com 401 435-3600 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Employers Mutual Ins 21415 INSURED PFR Acquisition LLC INSURER B: DBA: Pella Windows&Doors INSURER C: 1325 Airport Rd INSURER D Fall River, MA 02720 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE SR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 51D67408 5/01/2018 05/01/2019 EACH OCCURRENCE $1000000 CLAIMS-MADE a OCCUR PREMISES Ea occurrence $500 000 MED EXP(Any one person) $10 000 PERSONAL SADVINJURY $1,000000 GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $2,000,000 PRO-POLICY❑JECT F-1 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 5Z67408 5/01/2018 05/01/201 E M11CINeDtSINGLELIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED_ AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OAUTOSWNED PROPERTY DAMAGE $ Per accident X Drive Oth Car $ A X LA X OCCUR EXCESS LIARB 5J6740818 05/01/2018 05/01/201 EACH OCCURRENCE $10000000 EXCESS CLAIMS-MADE AGGREGATE $1 O 000 000 DED I X RETENTION$10000 $ A WORKERS COMPENSATION 5H6740818 05/01/2018 05/01/201 X STEARTUTE OTH- i AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N [ N/A OOO - E.L.EACH ACCIDENT $1OOO (Mandatory In If yes,describe a under E.L.DISEASE-EA EMPLOYEE $1 000 000 under � � ' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) t , CERTIFICATE HOLDER CANCELLATION PFR Acquisition LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE'CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DBA:Pella Windows&Doors ACCORDANCE WITH THE POLICY PROVISIONS. 1325 Airport Road Fall River, MA 02720 AUTHORIZED REPRESENTATIVE I I (c�19RR-2014 ACORD CORPORATION.All rights reserved. The Town of Barnstable Conservation Department t63 �+ 367 Main Street; Hyannis, MA 02601 Y � Office 508-790-6245 Robert W. Gatewood FAX 508-775-3344 Conservation Administrator TOe Joseph Daluz, Building Commissioner FROM: Robert Gatewood RE: Occ ancy Permit/Final inspection DATE: Q The following project has been granted an Order of Conditions by the Conservation Commission. Applicant: Project: St Location: U Map/Parcel: Our Permit #: SE 3- We would kindly ask that no Occupancy Permit or Final Inspection (as may apply) be granted by your department until a Certificate of Compliance for the project has issued from the Conservation Commission. Your assistance is very much appzeciGS:ea. 8 fir ill"MIN, Y n ..(,- .•L--^,fe,. Avg''.,+. RK., ir,•.,:t .f.-:5., .�..�:`A ,,�.'.. yy ,:r:. YO a 2 S, 1., fr.,,... 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Mv,Yi, ..� 4.. .;3 ,w-..+'.:._. ,.,J -,i... „ 'll:..:. �i�.M1 ti� Ol,t,.;:.,YK ., ;• - -•t _ i.,. / * Assess h office(1st Floor): Assessor's map and lot number (' (O ^'/ed SEPTIC.Sy' -tMf t .:; STEM MU 11-�Board of,Health(3rd floor): / /_ INSTALLED IN COMP ' 6 Sewage Permit number (� Engineering Department rd flRON ��nTLE Z D��a LL House number( ENIALCO Definitive Plan Approved by PI g Board 19 TOWN REGULaATIO DNA APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only APPROVE10 s n OF ' BARNSTABLE B st bl� Cyr ^rvation II " G INSPECTOR igned Date APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION _ 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies a perm accordin to he followin information: t ' Location i Proposed Use Lxwy--m - f Zoning District Fire District Name of Owner Address , Name of Builder Address Name of Architect r Address M WOQ Number of Rooms Foundation Exterior Roofing l Floors Interior G CA -- Heating Plumbing Fireplace Approximate Cost ©r Area �a Diagram of Lot and Building with Dimensions Fee I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the.above constructio Name' Construction Supervisor's License KAPISH., RITA & STEVEN - "NO ' 3 4 2'2 6: Permit For R i�pvate Single Family Dwe�llihq Location 8'0 Cro_cker Street - i fill, lannzs Rita &-�Steve� Ka ish �« ' Owne { , Type of Construction Frame! a Plot Lot r March 2`6 , 19 91 Permit Granted Date of Inspection 19 Date Completed 1 19 � I , Cr CC i !x ® Z.. I J M CIL del �. m ems. kt a`�• � ten}� - _ r � - r I ....,. �.. r_,ya's•-..�'r.Y.. :ir+,dY"x;,,.K'✓'4.'R K:.� !fib 7-"t r:,4 �«a ,t,..,. _. „-,sr„t.7).-'i,-L•Y ;�`,�.'� a , f �� � �„^r.r,. "N �� ,Lrs. .;,rq^7',:z"�' p":4.¢rr-�n.-�':ra wr"-t..sr..i3^s^*�tv�.u'R'^ R.,„ rt.,�•,i�,p;...ci . Assessor's office(1st Floor): � Assessor's map and1ot number �l0 OC L7U ;+ o`TNc To Board of Health(3rd-floor): .W WQy `e Sewage Permit number En ineerin9 De a_rtment r8 f lrr JCJ� �ri9uTa - 0 039°•House number nti Definitive PIan.Approved yPi g Board 19 � APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00 2:00 P.M.only T WN OF BARNSTABLE - ,BUIL G INSPECTOR F APPLICATION.FOR PERMIT TO V TYPE OF CONSTRUCTION �r 2_9a 19 (, / TO THE INSPECTOR OF BUILDINGS: .rk The undersigned hereby applies rya perm' accordin to he followin information: 1 t Location Proposed Use /"JA 1 A Zoning District Fire District Name of Owner Y Address G Name of Builder J)A k Address AY") A, Name of Architect �, Ad�ress Q41h Number of Rooms Foundation / Exterior Roofing -/,4�a Floors lq� Interiors (r Heating Plumbing Fireplace Approximate Cost ec� ©l 7" ` Area - Diagram of Lot and Building with Dimensions Fee ©' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations.of the Town of Barnstable regarding the above construction. Name ' 4 r Construction Supervisor's.License KAPISH, RITA & STEVEN A=306-028-002 3 J6-0 ff-=-(10 j— No 34226 permit For Renovate Single Family Dwelling Location 80 Crocker -&-6 — � Hyannis Owner Rita & Steven K.apish Type of Construction Frame Plot Lot Permit Granted March 26 , 19 91 Date of Inspection 19 Date Completed 19 5 PERMl i" PLETE® _ TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE / -- a�? JOB LOCATION Number Street Address Section Of Town HOMEOWNER" S % �� �� Jl0�'/7� � c�',� © � S Name Home Phone Work Phone PRESENT MAILING ADDRESS �$�/ 141dL - 1140 — Al 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 such 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 to six 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, by-laws, rules and regulations. The undersigned ,'homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE .� APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127 .0, Construction Control. MISC5 r y. HOME OWNER'S EXEMPTION � The code states that: "Any Home Owner Performing permit is required shall be exempt fromtheprovisions ofrthiscsectionlding (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such. work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor for Licensing Construction SupervisorsSeSectiond2. 15) .RuThises a lack eoflations awareness often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the unlicensed person as it would with licensed supervisor. The Home Owner acting as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, many communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. u . Assessor's office(1st Floor): �j Assessor's map and Iqt nu er ,w��i (n _ ©�6 , 000z" E zin�g u Q? �,a f-flit r Conservation _ _Gt� ��� �*C0 �d��Av Board of Health rd floor): wiTH TITLE 5 •� w Sewage Permit number — t,�VIR®14 E{VTAL CO :sai�Inc Engineering Department(3rd floor): TO M REGULATIONS �° 1639• House number FCl Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TOitp�, ✓ i TYPE OF CONSTRUCTION LY(�/ 19 ..._ . . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use�lsi P Zoning District Fire District r-�,c/ S Name of Owner / e-211V °"Act 1� OPKV)f Address Name of Builder Address Name of Architect Address /�^ Number of Rooms Foundation 's- r( / Exterior Roofing Roofing Floors i Z�_ Interior Heating '7� Plumbing c9--CJ Fireplace 'Approximate Cost -- fC 41U b�� AreaOQ Diagram of Lot and Building with Dimensions Fee G=� "J/S 01! d`N/Fa I 7P Ito t�tq u if i/ i - it tr 14 • , cr 4,� 1t Li b_j Coil S S OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License w v e.l- KAPISH, STEPHEN & RITA 2 N r t \ No— T5= Permit For BUILD DICK. s Single Family Dwelling Location 80 Crocker Street Hyannis + Stephen & Rita K.a ish i Owner P P Type of Construptidn Frame Plot - Lot i Permit Granted October 5, 19 92 J + Date of Inspection 19 Date Completed 19 W, _ t 6