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0029 DELTA STREET
0 5y _r oo�� � 1 Application number...R......�....1........... � QaFee.............. ............ NAM Building Inspectors Initials............. ................ Ak APR 22 2011 TOWN Date Issued....................... ?/�.r ...................... T1.J�1� N 0� bAHNSIAB�� Map/Parcel..(-qaa....�.....�I TOWN OF BARNSTABLE , --- - -- EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS BENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: '2 g 9 C LT)"'I s T IQ l:C-T HYA N N is NUMBE STREET VILLAGE Owner's Name: Gj U R M UR \ �S I NCc 1-j Phone Number_ ,5 b$ -776- '�-926 EmailAddress:6ypmyk SuNNX& PV7" tiR11'--&n-ell Phone Number Sob` *3?0/- 9J2--6' Project cost $ 1 S 40 - 4° Check one Residenti Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Siding ❑ Windows (no header change)#.' ❑ Insulation/Weatherization ❑ Doors (no header•change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles), Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) {Construction Supervisor's License# y (attach copy) - Email of Contractor Phone number 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............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total 4 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 x No , if yes, a gas permit is required., r 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-d: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 r HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: GU A ni y Telephone Number Cell or Work number 50$ I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barn table. Signature < Date Z 2— APPLICANT'S SIGNATURE Signature C."t^^'r Date - ZZ— All permit applications are subject to a building official's approval prior to issuance. 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/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/Individual): J�j y kQM(y A^ �/rvoq kj Address: 29 DC-7 rt4 STP-LET city/State/Zip: jjyHfv/V f S M f} OZ-6 01 ` Phone#: -5 1)8 ^ j 3 61"^ 83 2-6/ 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 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 workingfor me in an capacity. employees and have workers' Y P t3'• $ 9. ❑Building addition. [No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. �.We are a corporation and its ❑ P 3'K I am a homeowner doing all work" officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other } comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address:" 29 L f!.Tiq Q E_4�T Hrgh s7� City/State/Zip:— Hylj-fy Vs M,4 0 Z,�a j Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or`one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER-and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenayes of perjury that the information provided above is true and correct GSi�ature Date: t ZZ— i9 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 their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"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 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 42111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www,mass.gov/dia (3-6 7 7�, r -- ----_-- -- - - - --- --1 r �� f r� �� �e� � � . , Town of Barnstable Building i o ;x.:, T'. ^` ' §ti,. ^'� v�'�'`h, a,.> sty; x„ss<r;s' 'i�^•'. x�.. ,: xs; r Xc. '"u9 �.:u nr, e x?� 3 >.Ps � tThisCardSoThat t�is Visible From the Street A roved PlansMust,be Retained on Job and this Card Mustbe Kepts ,, 1Al2HliGBt.E, f � pxz,,;�'�^.._�.. �:s�.�„-.'�,tr ; .i a ,..s v �� ._�q���� �;•, pp\��5,.u�+. a: ' s y 3.:# i �tia s� ��•r� � �.. �.r. M" PostedUntilFinallns ectlonHasBeei%INlacle '� g4 E � ` . 16 9. N re + �n ' Whe :a Certificate ofOecu anc =is Re uiredsuchBuildm shall Not,be Occu`ied until a,Flnal Ins ection.has,beenjmade Permit "-.�... ..mx s,, ; �"�.x....,«.,�a«»G�«p< ._�y�,,:��..Q.•.:,�r'.w.' ;.��.:a:.+a..,�. �..»eg...�,�'a�F::,..S:.a,�?. ...f.�. .-�p�.i,.� �..&", �r......�.,.,.&.,S'�o ,». >..-a;:x... .._,...:u.:.tsaz<..�.:..-s..:,:R Permit No. B-18-2200 Applicant Name: SINGH,GURMAKH Approvals Date Issued: 07/10/2018 Current Use: Structure Permit Type: Building-Restore to Single Family Expiration Date: 01/10/2019 Foundation: Location: ,,29 DELTA STREET, HYANNIS Map/Lot: 292 212 Zoning District: RB Sheathing: Owner on Record: SINGH,GURMAKH ntractor Name Framing: 1 Address: 29 DELTA ST Contractor License 2 HYANNIS, MA 02601 'y t .A Est;Project Cost: $200.00 Chimney: Description: REMOVE DOORS TO OPEN V OPENING AND RESTORE TO SINGLE Permit Fee: $85.00 FAMILY. BASEMENT TO BE FINISHED REPLACE-KITCHEN SINK WITH Insulation: Fee;Pai.d.• $85.00 BAR SINK. ELIMINATE TWO BEDROOMS IN LOWER LEVEL create Final: Date 7/10/2018 gym and temple prayer room u° - ?ar~�- Project Review Req: PLUMBING AND ELECTRIC PERMITS REClUIRED Plumbing/GasvT Rou h Plumbin : g g Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized,by this permit is commenced within six,months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the.:approved construction documents for whichahis permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws,and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspegtion for the entire duration ofthe work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are,provided`on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work s q 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection - 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of.the APPLICANT-ISSUED RECIPIENT r.' F �,/- �.� � Barnstable Bldg.Dept. r Approved by.,ew Permit#: 120 6 C,)4 v 4406 IT (5�fq C9 L) IV J�� � �- S-7 r IV QQ . (90 t=-C-7T .--- a ` z r n o o g J vzz� 1 i c AppIicafion xumber.......... ..1. ... ........ • BAMME&BM ' �P-Q'r Permit Fee........:........ :. .. ; OiF ........................ ..J - J�� p 2010 Total Fee Paid................................................... .....:............ TOWN OF BARN®T.A-pLE�� ��L Pwl by... ........................on............./. BUILDING PERMIT --- .............. ..... � .. ....Map, ..Parr&. APPLICATION,,, . s Section I — Owner's Information and Project.Location r ` Project Address 2-3 .1b ELI -5 j Q 9-� P Y/2 N ,4S Vflkge--&12ZVS i [� Owners Name CU Owners Legal Address 23 -D E0-19 S'Ta 2E-C c State !yl zip 62.4 '0 7 d rJ O E-mailUh'^'►1/ �1 h��� Owners Cell# S � K a 7,M Section 2—Use of.Structure Use Group ❑ Commercial Structure over 35,000 cubic feet Commercial Structure tinder 35,000 cubic feet 9, Single/Two Family Dwelling Section 3 Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structare) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation Other—Specify Section 4-Work Description Q � rA�r,m�v92ots r 'Application Number.................................................... ' r Section 5—Detail . F Cost of Proposed Construction_ 20 0 Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing ' - Total#Of Bedrooms(proposed) 110 MPH wind Zone Compliance Method ❑ MA Checklist ❑ wFCM Checklist ❑ Design r r i Section 6—Project Specifics ❑.wince ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas .❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom a Water supply ❑ Public El Private — - Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: C b �� � �"'''� I am using a crane ❑ Yes El No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No Section S—Zoning Information Zoning District R Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed 1 Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No 3 i i LastmixtM-2/9/2019 Application Number. Section 9-.Construction Supervisor Name Telephone Number w Address City State zip k: License Number License Type. Expiration Date Contractors Email Cell# I understand my responsibilities under the rules and regulations for Licensed Constucfion Supervisor in accordance with 780 is CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and r. documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section-10-Home Improvement Contractor Name Telephone Number Address City State zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.LC... Signature Date Section 11-Home Owners License Exemption Home Owners Name: C0 ICT-\ Telephone Number_ 9 0 24 Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation by 780 CMR and the Town of B le. Q Signature Date APPLICANT SIGNATURE Signature Date - g p Print Name C1111k1\ �/hlCc l� Telephone Number E-mail permit to: �i t��►M v�e�S��h y {'I o r/LioJ-C©11" T e*.....i..a-.t. mnn�o Section 12—Department Sign-Offs Health Department © _Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire deparftent for approval Section 13—Owner's Authorization L , as Owner of the-subject property hereby authorize to act on my behal4 in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name a i t t J 3 3 3 f f 3 1 3 Lest undated:2/92018 The Commonwealth of Massachusetts Department Industrial Accidents eP ment of Office of Investigations ' 600 Washington Street • Boston,MA 02111 www.mass.govh9a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LedblY Jl Name(Business/or��onandMdual): G UAM Ulan Address: 29 E L•/ /� / / City/State/Zip: N�ANiJl S -M)}- D 2&) Phone#: SO 99 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. ❑Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers'comp.insurance ' comp.insurance.t e-cp=ed-] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.Lv1 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myselt[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#1 must also fill out the section below showing their workers'compensation policy information. 1 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-contactors and state tyhetber 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 pokcy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: CftY/stawzip. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required trader Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine , of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p ' andpenahUY of erjury that the inf ormation provided above is true and correct Si afore: Date: Phone#: t� n g 7 r (' 2.6 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.Pluimbing lnspector 6.Other Contact Person: Phone#: Barnstable Bldg.Dept. Approved by: Permit#: / -2AQ �pAe vj v � rJCA oM (9 u 7v I--) G tv I Ac � � \� f � _ a - Q22 1 1 ,� (9 d Al) CL,�f 19TA 1 CIE* 2-9 1 � a _--_/ } oill L 1 � t q+ , , sl 7 AP -74 Date: June 21, 2018 To: Building File RE: Basement apartment Address: 29 Delta St, Hyannis Originator: Electrical Inspector Complaint: Performed solar inspection and noted basement apartment with deficient egress Enforcement Process Steps ® 1. Initiate local investigation: RA ® 2. Document/enter into system Yes ® 3. Contact ® 4. Property Owner Gurmakh Singh 5. Seek access to subject property 6. Seek administrative warrant(if necessary) NA ® 7. Notify state authorities of findings NA ® 8. Document conclusion OPEN 13 9. Referred Building/Jeff Property—292-212 Property is developed with a 1 story ranch (1930) containing 3 bedrooms and 1 1/2 baths on 0.25 acre in the RB district. 06/21/2018 Electrical inspector noted apartment with deficient egress/emergency escape. Photos attached. 17r's P E� v,•� P.42-rn. ire 3hs 'T- 2 �PC c'T2CAE V O Town of Barnstable Building Department Services Brian Florence, CBO Building Commissioner BARNSTABLE. 200 Main Street Hyannis,MA 02601 !ll SONS N2i5•IYaM1P'W1.M6i NAhSiMtl Y 2639-201e www.town.barnstable.ma.us 575 Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Gurmakh Singh and all persons having notice of this order: ; As property owner or tenant of the property located at 29 Delta Street,Assessors Map 292 Parcel 212 and known as residential structure,you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section(s)R105.1,R310.2.1 and are ORDERED this date 5/7/2018 to: CEASE AND DESIST all functions associated with the following violation(s)on or at the above mentioned premises: Summary of Violation: On 6/21/2018the Building Department observed violation(s)of 780 CMR of the Massachusetts State Building Code Chapter 1 Section(s)R105.1,and Chapter 1 Section R310.2.I Specifically, basement finished without the benefit of proper permits and consisting of a two bedroom apartment. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office,commence immediately upon receipt of this notice the following action: cease use of the basement for sleeping and commence with obtaining the proper approvals and permits to either: 1) remove all unpermitted work or;2) finish the space in the basement to that of an approved use. And, if aggrieved by this notice and order;to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof) with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143 § 100. If, at the expiration of the time allowed,action to abate this violation has not commenced,further action as the law requires may be taken. By Order, &eVyL/. Lauzon Chief Local Inspector (508) 862-4034 Jeffrey.lauzon@town.barnstable.ma.us , Parcel Detail Page 1 of 2 -THE E . ] f V y1 ( `tT3 o FF':ARN5TAPi1L '� I1 M.i' •� - e s e77 Logged In As: Parcel D'eta i l Monday, December 6 2010 Parcel Lookup Parcel Info Parcel ID,292-212 I 'Develop LOT 4 _ I Location 12 DELTA STREET Pri Frontage 100 I Sec Road Sec I Frontage 3 I Village,HYA NIN S Fire District HYANNIS I Sewer Acct I Road Index0435 _ I Asbuilt Septic Scan: ' P �. Interactive 292212_1 p ' Owner Info Owner`SINGHGURMAKH Co-Owner _._._. I Streetl 29 DELTA ST Street2 _ _f City�HYANNIS I State jMA Zip�02601- Country Land Info Acres 10.25— --�j use Single Fam MDL-01 Tj € Zoning FRB Nghbd 0 4Ll Topography Level —._ ._ � ,. Road [PaVed�____.__ Utilities 1PUblic Water,Gas,Septic �.' Location Construction Info Building 1 of 1 Yea r(19772 Roof Gable/Hi Ext W Shin le Built f y �Struct i p �� Wall 1 g Living 1152 �, Roof Asph/F GIs/Cmp AC one: T � Area Cover Type Style Ranch ~�� Int D wall Bed rooms . Wall Rooms I �� Int i Bath l (1 Full + 1 H ModelReSldential Floor: Rooms Heat Totaled` Grade IAverage Type lHot Water Rooms 16 Rooms t Heat Found- ' stories Story Gas Poured Conc: Fuel ation 9 �` Gross Area 2448 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=23064 12/6/2010 Parcel Detail Page 2 of 2 Permit History Issue Date Purpose IPermit# Amount Insp Date IComments Visit History Date Who Purpose 3/16/2004 12:00:00 AM Paul Talbot Meas/Est 2/21/2001 12:00:00 AM SM Meas/Listed-Interior Access 9/15/1987 12:00:00 AM ME Sales History Line Sale Date Owner Book/Page Sale Price 1 9/1/2006 SINGH, GURMAKH 21320/163 $300,000 2 11/10/2003 THIND, NARIENDER S & PARAMGIT K 17911/072 $245,000 3 7/15/1982 GOSS, WILLIAM P 3521/350 $0 - Assessment History Save# Year Building Value XF Value a OB Value Land Value Total Parcel Value 1 2010 $112,700 $3,200 $0 $102,100 $218,000 2 2009 $112,300 $2,600 $0 $138,600 $253,500 3 2008 $130,800 $2,600 $0 $144,400 $277,800 5 2007 $130,000 $2,600 $0 $144,400 $277,000 6 2006 $115,100 $2,600 $0 $143,000 $260,700 7 2005 $108,200 $2,600 $0 $129,300 $240,100 8 2004 $87,800 $2,600 $0 $97,000 $187,400 9 .2003 $79,800 $2,600 $0 $29,300 $111,700 10 2002 $79,800 $2,600 $0 $29,300 $111,700 11 2001 $80,100 $2,600 $0 $29,300 $112,000 12 2000 $56,600 $2,300 $0 $18,800 $77,700 13 1999 $56,600 $2,300 $0 $18,800 $77,700 14 1998 $56,600 $2,300 $0 $18,800 $77,700 15 1997 $52,200 $0 $0 $18,800 $71,000 16 1996 $52,200 $0 $0 $18,800 $71,000 17 1995 $52,200 $0 $0 $18,800 $71,000 18 1994 $50,200 $0 $0 $22,600 $72,800 19 1993 $50,200 $0 $0 $22,600 $72,800 20 1992 $57,100 $0 $0 $25,100 $82,200 21 1991 $71,100 $0 $0 $40,800 $111,900 .22 1990 $71,100 $0 $0 $40,800 $111,900 23 1989 $71,100 $0 $0 $40,800 $111,900 24 1988 $47,500 $0 $0 $18,200 - $65,700 25 1987 $47,500 $0 $0 $18,200 $65,700 26 1986 $47,500 $0 $0 $18,200 $65,700 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=23064 12/6/2010 Town of Barnstable Building Post This"Card So That itsis:Uis�bleFrom,the Street Approved Plans"Must be Retam'ed on J;ob antlthis Ca,r,",d#IVlust be Kept ,. M" Posted Until`£Final Ins action Has:Been Made .- .' `� = e IL Where a Certificate of Occu ancisRe wired such Bu�ld�ng shall Not be Occup�eduntil a Final Inspection,has been made r ;i Permit Permit No. B-18-1027 Applicant Name: Paul Eaton Approvals Date Issued: 05/08/2018 Current Use:. Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 11/08/2018 Foundation: Location: 29 DELTA STREET, HYANNIS Map/Lot 292-212 Zoning District: RB Sheathing: . Owner on Record: Gurmukh Singh Gontractor Name``: ,TRINITY HEATING &AIR, INC. Framing: T Address: 29 DELTA ST y Contractor License: 170355 2 HYANNIS, MA 02601 i = Este Project Cost: $30,000.00 Chimney: Description: Install 7.375kw solar panels on roof.Will not exceed roof panel,buts Permit Fee: $203.00 a Insulation: will add 6"to roof height. 25 total panels. Fee Paid $203.00 s Project Review Req: Date 5/8/2018 Final Z/ /S Plumbing/Gas vJ L j y v Rough Plumbing: -,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced with Insix months afterrissuance. All work authorized by this permit shall conform to the approved application andthe;approved construction documenrts fo which this permit has been granted, Rough Gas: All construction,alterations and changes of use of any building and structutes shall be in compliance with the local zoning by laws;and codes. This permit shall be displayed in a location clearly visible from access street or i•oadand shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. t Electrical The Certificate of Occupancy will not be issued until all applicable signaturesby the Building amend F e Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work. id r Service: 1.Foundation or FootingW. Y r F 2.Sheathing Inspection 'I> Roug h: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department. Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: F. �u s G CF THE Tp� " Town of Barnstable HARNSTABLE. .i Regulator Services 9� z6 �0� 1°re039. Thomas F. Geiler,Director Building Division Thomas Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 December 13, 2010 Mr. Gurmakh Singh 29 Delta Street Hyannis MA 02601 Illegal Apartment: 29 Delta Street Hyannis,MA 02601 Map: 292 Parcel: 212 Our records indicate that your house at the above-referenced location is currently being used a something other than'a single family"home, which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which . results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a single-family home • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. _ Linda Edson r a Amnesty Apartment Investigator Building Department gforms:zoning3 SEN.DER: COMPLETE THIS SECTIO N , T COMPLETE THIS SECTION ON DELIVERY N Complete items 1,2,and 3. A. Sign ■ Print your name and address on the reverse ❑`Agent I so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. ,--- 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,etiter delivery address below: p No 10T, 3. II I iillll Ilil I!I I I I I II I I II I I I I I I I I IIII III III ❑AduMail ExpresisO lt Service gnat ree Restricted Delivery ❑Reeg Registered Mail Restricted 9590 9402 3615 7305 6411 48 rtified Mail® Delivery Certified Mail Restricted Delivery �l Return Receipt for ❑Collect on Delivery Merchandise a,...._..__.:__-,_,-, i^-^r^-'-on Delivery Restricted Delivery n Signature ConfirmationTA° 7 017 1000 0000 6759 6 7 8 . M' ail ❑Signature Confirmation Mail Restricted Delivery Restricted Delivery IT(over$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic,Return Receipt USPS TRACKING# _ First-Class Mail Postage,&Fees Paid USPS Permit No.G-10 I 9590 9402 3615 7305 6411 48 I United States •Sender:Please print your name,address,and ZIP+4®.in this box° Postal Service a` WN OIL BARNSTABLE BUILDING DIVISION 200 MAIN ST � I HYANNIS, MA 02601 I I I I I I i I � li CO r- -0 Ir I ,,� NI. LP) Certified Mail Fee yUil $Extra Services&Fees(check box,add fee as appropdatey❑Return Receipt(hardcopy)❑Return Receipt(electronic) $ t 'O ❑Cert�ed Mall Restricted Delivery $a ❑Adult Signature Required $❑Aduk'Signature Restricted Delivery$O Postage O $ rq rq Total Postage and Fees Imo- Se o %.4 --O Stree ------------------G'i te, :rr r r rrr•r Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(Including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Wile,First-Class Package Service®, available at retail). ' or Priority Maile service. t,i 4 Adult signature restricted delivery service,which ■Certified Mail service'is notavailable for requires the signee to be at least 21 years of age international mail.kYl" and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent. with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a+ certain Priority Mail items. USPS postmark.If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.if you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return i Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. PS Forth 3800,April 2015(Reverse)PSN 7530-02-000-9047 _ .:, _.. _ Mt + I ,rr �,,�, .r ,� �. _. _ 3. .. _ .. � ti. ,: ;�r �d. y `. ,�. TOWN OF BARNSTABLE 1018 ."jM 2 j AM 7. 53 ?TvT's d Date: June 21, 2018 To: Building File RE: Basement apartment Address: 29 Delta St, Hyannis Originator: Electrical Inspector Complaint: Performed solar inspection and noted basement apartment with deficient egress Enforcement Process Steps Q1. Initiate local investigation: RA D2. Document/enter into system Yes 0 3. Contact ® 4. Property Owner Gurmakh Singh 8 5. Seek access to subject property 6. Seek administrative warrant (if necessary) NA 7. Notify state authorities of findings NA D 8. Document conclusion OPEN D 9. Referred Building/Jeff Property—292-212 Property is developed with a 1 story ranch (1930) containing 3 bedrooms and 1 1/2 baths on 0.25 acre in the RB district. 06/21/2018 Electrical inspector noted apartment with deficient egress/emergency escape. Photos attached. �. F'. I CI ,y t. T TOWN OF BARNSTABLE 1018 ..It9Ad 21 AM 7: S3 f Iv Q �o*Its, Town of Barnstable *Permit# OExpires 6 monthsfrone USI date Regulatory'Services Fee * anartsTABLE, ` v K^SS- $ Thomas F. Geiler,Director/ i6g9. �0 plE�MA't A Building Division -PRESS PERMIT Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 DEC 2 3 2009 www.town.bamstable.ma.us Office: 508-862-4038TOWN OF BA�'af�x1ERAME-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number lVg. /7 Property Address 0 r [Residential Value of Work_ 19'. Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 1 J n. Contractor's Name T 9A 0 T lephone Number Home Improvement Contractor License#(if applicable) �d Construction Supervisor's License#(if applicable) / ❑Workman's Compensation Insurance Check one: ❑. I a sole proprietor ❑ am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# �! Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over. existing layers of roof) ❑ Re-s' e: #of doors eplacement Windows/doors/sliders.U-Value 3, (maximum.44)#of window *Where required: Issuance of this permit does not exempt compliance with other town department.regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re SIGNATURE: QAWPFILES\FORMS\building permit foims\EXPR.ESS.doc Revised 090809 l '? The Commonwealth of IYlassac'iusetts Department of Industrial Accidents Office of Investigations 600 ) 'ashinalon Street Poston, 4 0 111 v%di:t Wimpensation Insurance AM BlllldYrs;Contractors,El Phase Print L aiblti' A licant Information f Ar(�'' , N11Tle(Business/Orgarization/Individual): c 1l1.v l �- � ( Gc�L�.-L• Address: City/State/Zip: C��L t - 3��5 j Phone#:_______� you an employer? Check the appropriate bo Type of project(required): 4, am a general contractor and I6 Ne onstruction [Are . I am a employer with _ have hired the sub-contractors employees(full and/or part-time).* 7. Remodeling listed on the attached sheet. 2.❑ 1 am a sole proprietor or partner- These sub=contractors have g 0 Demolition . .... ...... ship and have no employees employees and have workers 9 Building addition working for me in any capacity. comp. insurance.t - [No workers' comp.insurance 5 We are a corporation and its 10.❑Electrical repairs or.additions required.] officers have exercised their 1 I.[]Plumbing repairs or additions 3.[] 1 am a homeowner doing all work right of exemption per MGL 12•Q Roof repairs myself.[No workers' comp. c. 152,§1(4),and we have no 13.[�Other insurance required.]t employees. [No.workers' 1. comp.insurance required.] icy 'Any applicant that checks box#1 musttaln�t fill catinutthey the aretidoion nglow showing their workers'all wok and then hire outside ctontractors mast submitanew affidavit indicating such- *Any Homeowners who submit this affidavit g tContractors that check this box must attached ees an additional sheet Showing thethe name oo e sub-contractors policy nactors and state whether or not those entities have ide employees. If the sub-contractors have employ y em l0 ees. Below is the policy and job site I am an employer that is providing workers'compensation insurance for, my ploy information. P�C — l S Insurance Company Name: � 3 Z Expiration Date: { Q Policy#or Self-ins.Lic. 4: City/State/Zip: Nil/ Job Site Address: -_/__ a owing the policy nu er and expiration date). Attach a copy of the workers' compensation policy deciarationpat c(showing b sition of criminal penalties of a Failure to secure coverage as required under Section 25A of iv1GV I p enalties in the form can lead to the i aoSTOP WORK ORDER and a fine fine up to$1,500.00 and/or one-year imprisonment,as well as c of this statement may be forwarded to the Office of of up to$250.00 a day against the violator. Be advised that a copy tnvestiaations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalti of perjury that Lmation provided above�isDate: SiQnature C} Phone Official use only. Da riot write in this area, to be completed by city or town official. Permit/License# ------------ City or Town: Issuing Authority (circle one): 1.Board of Health 2.'Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone 9. Contact Person: The Commonwealth of Massachusetts Department of lndustrlal Accidents Office of Investigations UT 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/OrganindonMdividual): erVh c-6 Address: G l-P4 City/StateMp:T(�ZAJCWD , Phone#: Are,,vdu an employer?Check the appropriate box: Type of project(required): LEI I am a employer with_q 4. ❑ I am a general contractor and I employees(full and/or part-time). s have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Q'"ling ship and have no employees These sub-contractors have g, (]Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp. insurance.= - 9. C1 Building addition required.] 5..0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner do' all work officers have exercised their I L Plumb' r � right of ex - ❑ m8 repairs or additions myself.[No workers'comp. ght 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.] J . •My applicant that checks box 01 mist also fill out the action below showing their worken'compamdon policy information. t Homeowners who submit this affidavit indicating they am doing all work and then him outside contractors must submit a new affidavit indicating such. tConouton that check this box mast attached an additional sheet showing the name of the subcontractors and state whether or not thoa entities have employees. If the subcontractors have employees,they must provide their workm'comp.policy number. I am an employer that Is providing workers'compensation 1Wnsuranee or my employees Below Is the polky and Job site injormadon. n Insurance Company Name: Policy#or Self-ins. Lic.#: V A S 2 Expiration Date: Job Site Addrc9s: LIAe City/State/Zip: , TIJ ox, Attach a copy of the workers'compensation policy declaration page(showing the policy nur�iber 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 S1,500.00 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 fol insurance coverage verificatio I do hereby ce the n ojperjury that the information provided above is in and con Signature: Phon — QfftcFal use only. Do not write in thk a_re_a,_t0_Fe comp etc y c or town oJflclaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#' Information and Instructions Massachusetts General Laws chapter 152 requires all employees 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,par<Ztership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three'ap'srtments and who resides therein,or the occupant of the dwelling house of another who employs persona 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 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 aftldavit. 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 legibly. The D Department has provided a ace at the bottom Please be sure that the affidavit is complete and puntedep p space 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 permitilicense number which will be used as.a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,needonly submit oni 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 to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please_do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax #617-727-7749 Revised 11-22-06 www.mass.gov/dia ' r -------"4—t`lit- !},•I :!t'trnit,t ,:; 1't!!',ii� ;al�'!; CS 51899 ?_striae t tc,: 00 i TIMOTHY M THOMAS ,tom 740 GLEBE ST TAUNTON, MA 02780 Exntration! 212172011 — Tr 12144; e , �f r. f a�n,•rnr cct`ia orf,i l�a trcn c�.y'r ; llo,cd of�r•'�e tg ktz"'i1 lions r.:,. License or regi�t!anon valid for individul use only y before the expiration date. If found rclarn to: �y HG,:'E 111r1PkJVEIUi Board of Buildin�Regulatiors and Standards t +�' d Rc9ist ration: 152121 One Ashburton Place Rm ]301 Expiration: 8/1/2010 i 272597 Boston,Ma.F4108 Type', Private Cc; ,n R&R DEUVERY SERVICE,INC. r TIMOTHY i HOM;%S 1009 POST RO�.0 t Y Not valid without signature WARWICK.P;.'-1;L288 TxWjrDATE z E o ' �' l' 1L1�1 _ _ il�LXiT4 ';. _ 3: 06.19-09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM.kTION ONLY PRODUCER AND CONFERSNO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT A_MEND,EXTEND OR ALTER THE($)VERACiE _ AFFOR1lFD RY THF.POI.TCTF.3 RRF I)W. FARRELL.BACKLUND INS AGCY COMPANIES AFFORDING COVERAGE PO BOX 509 TAUNTON NZA 02750 lnlr:a+Y . YAMERICAN ZURIC:H INSURANCE COMPANY C ETTIiF. CONF.A,lY LL•.1'fliR. _•_ -_ INK-RED cva;EA r; C - LLITIiF'. R&R DELIVERY SERVICE INC: OWF'A`I` ll L ETTI:F 740 GLEBE ST TAUNTON Nik 02780 vmknrlr 'E l LITIiN. 4 ►►rr��1g@��,ap h811Hf if f4 X4PHt LB@!@F9gIH1M 91PM H4f14HMfIBElMfl11hNf 3YH4f41H14 i4 MQN6161RI�P6P8H$MNYY4±I FHIHIA�#91��{BY)IM1Hit#YN1 NH M1N9EMIIn!!I"II�tBYEf91117PHIWW 411 PoIfl 41A.IflIH@9RiBf tihlfb6 s:A ..u"IT�_.LFP�T-- �._,.Mlv I •�. . .. .,�_;E an z_:. .... .. ...e�E .�. _.. _ .•,a�aE__,_ ----°.-�" THIS M TO M-. r[T--�"THAT THF.PCIIJOT,-S OF11JS1)RANCF T.I.S1T?D RFf OW IiAVF.RFF.K ISSIIFD TO THF.INSi1RT?D NAMET)ARDVF FOR THE PO1.iCY PFRIDD INDICATED.NOTVTTHSTANDIKC1 ANY RF.OI-IRT-VT-W. r,TFRA9 OR CO NDfTT()N Or,ANY('.I)NTRA(-rOR 0114FR T)M.JMTFN'T WITH RFSPr-T TO WHICH TH1S CERTTTT(-.ATF MAY RC mm IED OR MAY PERTAIN,TIIF.TNSI.RANCF ATT•T)RDFT)TlY TIFF f`OI.TC1fS LQ5CR11TR1)IIFRr1N IS SuRIECT TO All.TTfE TFRTviS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CO TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LIMITS LTR E:FFECI'IVEDATE EXFIKATION DATE (rlViDD:YY) -MM/DDlYY) GENERAL LIABILITY 0L;NL_xA1:A�idKL:0AIlb $ rxvuu(a�-cvnlP/vP.Anv. 5 Q COMMERCIAL,CUIEIRAI.LLADILITY PIRS•ONAL @ ADV.INJURY $ U CLA[NfS 6fADE UOCCUR. - - - ... ... fi:iCH UC<71RKINI:I' $ • Q OWNERS&CONTRACTOP,'S?ROT. GIRL RALI:AOL(Any Or,.'Fvc) $ U MLA.EXPENSE iAlr met vlion AUTON441RD.RIJARIITTY -- CCQIB1NZDSINGLE•UMIT % Q .ANY ALF16 ` RODII.Y 1N11TRY F Q ALL OWNED AUTOi - !Per P,r,mll - O 5CH60ULtU:AV"1'US t BODILY]NJ URY Q 171N.tJ)AL'1'Oi - •Woi>ccwcu11 Q NON OW`:III AUTOS CROPE•RTY DAMAGE y (JARAOF T.I ARII.IT-Y - EXCESS LIABILITI' -- 1 F.ACH OCOJP.RFNCF f, Q L,M1I1:R::1,l.AFL�RM . Q OTHLHTHAN UML•RL.LLA 16l h1 . .. - STATUTORY U&BTS A WURKER'SCJODiPENS.AT[UN 3100,000 AND 0655N48509' 06/19/69 061:9/10 DI.S----ASE-POL£CYUMIT $500,00(l EV1PL01'EK'SLIABILLTY DES ASEEAL74E:,TLOYLL �IUO,UC'll OTHER --— DEYI'RIFTLUNUFOP(7LITIVNS/LUI•aTIUNSiVLEi1'L3-V/&rSL'1A1.IIEMS --- - 711E INSUHLD':SN1A t1.ORhEHS COMPENSA I-ION VOLIC) ANLI L'1S L1A71!'EU DTIILH 57 ATlS NSVXANCL t(NUOKJ'EhlENI'1:1U"1'110NIZL5'I ILE YATNSEN I"Ok'll>;NG}'ITS YOH CLAINIS MADE BY THE INRLR WIS NIS EMPLOYEES IN STATES OTHER THAN MA.NO.ALMHOR14.T1ONAS CIVEN TO PAN CLAIRS('OR BHNEFITS IN ANY STATE OTHER THAN\LA IF THL - INSURED HIRES,OR HAS HIRED,EMPLOYEES OUTSIDE OF MA,TIl LS POLICY DOES NOT FROV7DE COVERAGE FOR ANY STATE OTUER TITAN MA. - - MASSACHUSETTS COVERAGE ONLY THIS REPLACES.ANY PRIOR CERTIFICATE ISSUED'IC-THE'_i-ERTIF'ICATE HOLDER AFFECTING WORKERS CO(AIP Qav RA.E CFFIC h 1_ EIOLQE_t __ ._ yCL13 #TICT`f _ '11-11)AT ROME SERVICES LNC uBA'I'm HOME DEPW,A1,llomp-,'. ' SHOULD Am,OF HE ABOVE DU- CRIBCD PIJLICIG BECANCGLLCDbrF1iRLTHr E\Y:KA'IJON IJA E,IlilSE01,111E ISSLINGCONIPAN)li.LLE'NDLAVOR'IONIML - .Itvtr.r . - 1oIIA1_Sri'1i1C1b:\IA0 11C1.10'1I!E CbRl lllC.il E 1101,lltx NAittta70'171t!I:HEI:• 690 Cc:R-MER LAND PKWY M,.300 Bln r'A1un<E 10 mnlL SuCII NO nCr SH.tLL IMrOat NO 01:I ICA n-V,,OR ATLAN TA GA 30339 il `.LIABLU I%Ox ANY LIND LYON I'HE COMYAN)',II'S AGEWIS OR Kk;PKLSEY I AI IVES - A171HORIZ ED REPRLSEKTA71VE KERRY MAY pA('C7TM.- RPORAT1nT�194ff Beard of 33aiiditm Rrgaiatioss aed">saad2rds s HOME IMPROVEMENT.CON,RACT.OR Registration_ tS• Expiration., &3;2010 Type: Suopr -- seri i;:a= Q 1-+0,ne Depot At-Home Service BARREN'0-EMERS 3=�)o COBB GALLERIA Pl A'Y#20 �--- �._. u,NTA_-A 3J339 zi�insstrsetQr g License or registration valid for indi``idut use.aeh . before the expiration date if found return t6: , Board of Building Regulations and Standards, one Ashburton Place Rsn 1301 { . Boston,via.02108 'Not valid Without signature ACOR CERTIFICATE OF LIABILITY INSURANCE D 02/20/20 IDINYYYY>. /09 PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE r HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certrequest@marsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 948-0902 INSURERS AFFORDING COVERAGE INAIC# INSURED INSURERA:Steadfast Ins Co 26387 THD At-Home Services, Inc. INSURERB:Zurich American ins Cc 16535 2690 Cumberland Parkway INSURER C:NATIONAL UNION FIRE INS CO OF PITTS 19445 Suite 300 Atlanta , GA 30339 INSURERD:New Hampshire Ins Co 23841 INSURERE:Illinois Natl Ins Co 23817 COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR OD' - POLICY EFFECTIVE POLICY EXPIRATION - - TR N POLICYNUMBER DATE MMDD DATE(MM1DDfYYI. LIMITS A GENERALUABILITY IPR 3757 608-02 63/01/09 03/01/10 EACH OCCURRENCE $4,000,000 X COMMERCIAL GENERAL LIABILITY LIMITS OF POLICY ARE EXC SS _ PREMISES Eaoccurence DAMAGE TO RENTED $1,000,000 CLAIMS MADE OCCUR "OF SIR: $1,000,000 PER )CC" MED EXP(Any oneperson) $EXCLUDED PERSONAL B ADV INJURY $4,000,000 GENERALAGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OPAGG $4,000,000 X POLICY PRO. 0LOGJECT - B AUTOMOBILE LIABILITY BAP 2938863-06 03/01/09 03/01/1.0 COMBINED SINGLE LIMIT X ANYAUTO (Ea accident) $1,000,000 ALLOWNEDAUTOS - BODILYINJURY - $ SCHEDULED AUTOS (Per person) HIREOAUTOS BODILYINJURY - a. - (Peraccidenl) - $ NON-OWNED AUTOS - X SELF INSURED AUTO PROPERTY DAMAGE $ PHYSICAL DAMAGE r (Peraccident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - I - , - OTHERTHAN EAACC $ AUTO ONLY: I 'AGG $ - A EXCESS/UMBRELLA LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE $5,000,000 X OCCUR CLAIMS MADE - AGGREGATE $5,000,000 t $ DEDUCTIBLE - $ RETENTION $ t $ STATU- OTH- C WORKERS COMPENSATION AND 3566916 (CA) 03/01/09 03/01/10 X 11 WC ORY IMIT R D EMPLOYERS'LIABILITY 3566915(AOS) 03/01/09 03/01/10 E.L.EACH ACCIDENT $,1,000,000.. ANY PROPRIETORIPARTNER/EXECUTIVE E OFFICERIMEMBEREXCLUDED? 3566917 (FL) 03/01/09 03/01/10 EL.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONSbelaw E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER D Workers Compensation 3566918 (KY, MO, NY, WI, ) 03/01/09 03/01/10 F TX Employers Excess TNSC45694422 (TX) 03/01/09 03/01/10" ccurrence/SIR 25M/2M C Workers Compensation 4801323(QSI) 03/01/09 03/01/10 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: EVIDENCE OF INSURANCE - - - d CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THD AT-HOME SERVICES, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN I NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL 2690 CUMBERLAND PARKWAY IMPOSE NO OBLIGATION OR LIABILTY OF ANY KIND UPON THE INSURER.ITS AGENTS OR SUITE 300 REPRESENTATIVES. ATLANTA, GA 30339 AUTHORIZED REPRESENTATIVE - USA ACORD 25(2001/08)ckomraus_hd ©ACORD CORPORATION 1988 11172180 1:f0,Mk1WROvEmENT c0N7'RAGT PLEASE-BEAD TWS, . O - Sold,FuznishG l and dnstalled.by--. �"� Bi�anchName.-Boston ::'mate G�7 /: .: , y.. -:, a�F13:At-IF�meServices,JnG � . - - _ d/b/aaFhc Hors Depot;kt-Home:Stnices... • 345A Greenwood Saco i7ruE'2,:Wor•estc,•MA'Ud6a7. Branch Numbcr..31 Toll Free(809)657 5182; F,uc{508)756-8823 FedcsaLID Ef_7S 269&}l�0;ME L.ic#C 02439; U Cont Lio+.16427 - C C Lie#565522;vfA Home l/mppmycm.aot Goni I etpr Rcg.#1268§3 Installation Address: vi 'ry.,.. : ..• ., ;. State ,: �• p,:..� Parchaser(s): WorkPHoiiet' HomrPhoneE. ; cellPhonc ` 7777777 Home Address_ `T (If different iron 7nstallahon:Add[csv}_ _: :.'r City. ;,State i Zip _ E-mail Address(to iedeive project'comiiiun' ations and Home=Depotupdates): - R f DO,NOT wish to rcxcive anv7riarlccting snails from The Home.Depot Prniect 1'nformadon:`Undersigned("Customer);the oWnemof the'propercl^located`titthe'above mstallatiori Ai dzess,agrees to buy, and THD At-Home Services,Inc.("The Home Depot")agrees to furiiuh'delrGer"and'a gc for the instFtllutio a{"i,rstuea►tion'}of all:toaterial .described.:on;3be..bclow and:,on.the-refercaceti_Spec-Sheet(s),al),of,.whichf amjncorporated=into.,iii Contract by-:this -• colTecOvet refcrcnce,:along•With,ny,applicable State.Supplement and,PkY-iriegt.Stuumaiy:aetuehedhereta and??ny()s3ttge �zders,(, y, „Contract"Y. , ! lob=#: (cni�.�tktwr�a) Pr nets. _S is Shcct(4):u:' P v,'octAmounr oofittg' Siding' indowE" ' losulahon ' 6 QGuttcrs/Coveis`QEiitiY Doors`Q R6o .. Siding Wipdo�i�.. Ins,diil,on . QGutteJ Goycrs•[]l Wiry Doors Q. f;; d Roofing: Sidins' .Windows; , ;Insulation _ '�' "QGuttesa 7.Covecc,QEntry`Doors[�.. .. - :' . Roofing Siding ViSndows ' Tnsulatiori• v . �-CJCntttcr��coocrs'C]E'ntry Doors-D" _ - _ -.Minininm 25%ncpostoof Contract,Ij nntdueupon't%cP ion of,this conaxM Tocnl ContractAulouuC '.S Ntune Purelmsers may not deposit more than one•third of the Contract Amount U•� �.:,., Customer a ees;tba iinrisodiatel upQii eon letton oFthc work for each l'toduet,Customer will excciitc a C mprebotr Ccrtrricxtc (one for,eah I'rodii iis:defined by,:an uidty dual Spce''Sheet).and pay any,baltince""due As xpp,t a,e,each Custutner�inder ibis Contract.a m be jointly,aAdsGxCrally obligated and iAble hereunder _ The Home Depot reservcsahe xight to issue AChange Order.or ternihWe_BI"contraet:or aqy ipdivtduxl.ProducU�)included herein ,it itti discretion,if The Home Depot or its authorized setviec ptovid9 determines that it cannot.per£ortri 1ts,0bl�gatic ns due to a shuchtral probimwith the.home,environment l hazards such:as.tuold asbestos or_lead pOnt,,other safety... . ps one Ong enon or because «ork requiic d tp.completc the job was not included w tlie,Con c. n 1 ;.included avpait of this -Ontrae seus forth-the total Pavmcnt•4ummarv: •The Payrnent:'Stunmtty- �'' Contractamountand*yments required for the deposits and final paYmc at,by_Product(asapplicabie) NOTICE TO CUSTOMER < k... You arc entitled to a completely filled-in copy ofthe Contract atthe hme'you sift%Do nat sign a Complee>a Gerti'ficate Bate: there is one Completion Ccrtiflcate for'cach listed Pr`u_ct'as•:defincd'by,iudlvidtral Spvc� eets)'before�arts ori#hatProduct is complete. - - Customer agrees to pay The Home Depot the costs of mates lain,1plu.a In the event of termination of this Contract, y other t and services provided by The Home Depot or Authorized Service Provider through the date of terming lion, amounts set forth in this Agreement-or allowed under applicable law. THE ROME DEPOT MAY WIT)iHOLD AMOUNTS OWED TO TI•IE HOME DEPOT FROM THE DEPOSIT pAy\•LF,NT OR OTHER PAYMENTS ;MADE, WITELOUT LINUTING TIE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Aeceptance and Authorization: Customer agrees and understands that this Agreement is the entire discussions at between ts,cimcr and The Homo Depot with regard to the Products and In, services and supersedes all prior discussions.nd agreements,citb4r to said Products and Installation.This Agreement cannot be assigned or amended exec,,t by a writing signed oral or written,relating by Customer and The to saDepot,Customer acknowledges and agrees that Customer has'ead,understands,)oluntarily accepts the terms of and has received a copy of tl' Agreement. Sub d by: Accept y: �a Date Sales o suitant's Signature ink Customer's Signature �.6.46 Y © TelephoneNo. — ' Customer's Signature Date Sales Consultant 1 iccuce No. (Z's:Palia,l 1 CANCELLATION_.: CUSTOMER MAY CANCEL THIS - AGREEMENT WITHOUT PEN•4LTY OR OBLIGATION . By DELIVERING WRITTEN NOTICE TO THE HOME' DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY ALPTER SIGNING THIS AGREEMENT-. THE - STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO .USE iF ONE IS SPECERCALLY PRESCRIBED BY LANV IN CUSTOMER'S STATE. NOTICE:ADDITIONAL•►•RRMS AND CONDMONS ARP-STATRri ON�R�V�E SiD&�xD AisE PART OF 7 MS CONTRACT . r.•�....r,or Pink-Ralgc Cnnsuliant - ,n„ SIKNV,IH soaaa 314011L9 Zi GOOz-eo,321a