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0110 DOLPHIN LANE
�i� � -,�/-� �� i A i i 1 �I 1 � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map,-'?; �c�� `"� Parcel Application # CXIVA Health Division Date Issued ����—� ( Pp— Conservation Division Application Fee Planning Dept. . Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner Address Telephone �(c VBZ_l % Permit,Request aia'LL 4hLd-4 4,tf� _Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay' Project Valuation Construction Type h,71"'f Lot Size / � f1� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type:` Single Family Two Family ❑ • . Multi-Family (# units) ~ Age of Existing StZFull re Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: 0 Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) �� Basement Unfinished Area (sq.ft) Number of Baths: Full: existing ; new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 Gas ❑ Oil ❑ Electric ❑ Other1-4 Central Air: O Yes ❑ No Fireplaces: Existing New Existing wood/coal sfove: O-)Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn:0 existing'.-:)❑ neW -sizes Attached garage: ❑ existing ` ❑ new size _Shed: ❑ existing ❑ new size _ Other: co Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ r ►al Commercial ❑Yes Ndr No If yes, site plan review# f Current Use -- ' - --Proposed Use T APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name t'✓1 cei Telephone Number Vt 71 3 , Address License # Home Improvement Contractor# Email Worker's Compensation # ��- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE v FOR OFFICIAL USE ONLY F APPLICATION# DATE ISSUED MAR/PARCEL NO. I ADDRESS VILLAGE t OWNER r x DATE OF INSPECTION: ,.r y FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 'x D 4T&CLOSED OUT A A'SSQaffION PLAN NO. 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 f Please Print Legibly Name(Business/Organization/Individual): 11aa ad XL) v7 �/ L Address: 101 �IIEj 1012 City/State/Zip:(?e41 /116t, 00 Phone#: Z 77 S— 3 7!J k Are you an employer?Check the appropriate box: Type of project(required): 1.0 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. ❑Demolition workin for me in an capacity. employees and have workers' g Y aP tS'• ' � 9.'❑Building addition [No workers'comp. insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13. Other hQ G 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 aiidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: D 4-4,_0 Policy#or Self-ins.Lic.#:&Idg ) T6 3 e2 o l Expiration Date:. /T9 l a-p Job Site Address:lI D � � ter:+'1 �v'I_` City/State/Zip: ! Q r 1� Attach a copy of the workers'compensation policy declaration page(showing the policy nunt er and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under thepains andpen ofperjury that the information provided above is true and correct Signature Date: l 1,;�o Phone#: �� -7? 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permittlicense 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 Aocidents Office of Investigations 600 Washington Street. Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-817-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia Client#: 3860 2DANGELOMI ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE,MM/°°YYYY) 01/21/201 a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 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 NAME: __ Dowling&O'Neil PHONE 5 -- -- ?FAx ---- - AIc No E:t): 08 775 1620 (ac,No): 5087781218 Insurance Agency E-MAIL_ -"-- ADDRESS:---------'---------------'---------'-- -•-- -- 973 lyannough Rd., PO BOX 1990 INSURERS)AFFORDING COVERAGE NAIL as Hyannis, MA 02601 — - ------ :— INSURER A:Associated Employers Insurance INSURED Michael J. Dangelo Building INSURER B: ---"- - INSURER C & Remodeling, Inc. - INSURER 0: 105 Horseshoe Lane ---- ---- ---- -------- ____ INSURER E: Centerville, MA 02632 INSURER F 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 MAN' HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBRJ POLICY EFF POLICY LTR TYPE OF INSURANCE INS D -_ POLICY NUMBER POLIO YYYY MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE ^$ COMMERCIAL GENERAL LIABILITY DAMAGE REM SES(ERENTED occu ante !$ CLAIMS MADE L OCCUR MED EXP(Any one person). !s J -'PERSONAL&ADV INJURY 1SI -------...—--------------------- - GENERALAGGREGATE is _--I---------- .--------- -------- - i GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG I S f POLICI'I PRO- LOC-- - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - _. _ 'ANY AUTO BODILY INJURY(Per person) - ALLOWNEU SCHEDULED - - i - _ AUTOS _ AUTOS BODILY INJURY(Per accitlemj.;S PROPERTY DAMAGE ;HIRED AUTOS t s, ' I- AUTOS NON-OWNED Per accident j _ —� - — - ---.-.---- UMBRELLA LIAB EACH OCCURRENCE-_ -5 - __`UCCUR __ _-.._ ._ EXCESS LIA _ s LAIMS-MADE AGGREGATE -- - _ - I DED. JB [RETENTION A WORKERS COMPENSATION WCC50050067332013A 12/19/2013 12/19/201 X �wc sraru I oTH �. AND EMPLOYERS'LIABILITY -_ 79RY L(ML7S tEf� YIN ANY PROPRIE FOR/PARTNER/EXECUTIVE� E L EACH ACCIDENT- ;y100 000. OFFICER/MEMBER EXCLUDED? l ' 1 N I A - j(Mandatory in NH) E L DISEASE.EA EMPLOYEE!S1 OO,0004.A �it yes.describe under 1 DESCRIPTION OF OPERATIONS below_ -I}- I _. - E L DISEASE POLICY LIMIT_s500,000 - -_ l - ' DESCRIPTION OF OPERATIONS]LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Michael and Debra D'Angelo are excluded under the worker's compensation policy._ Insurance coverage is limited to the terms, conditions, exclusions,other limitations and endorsements. - Nothing contained in the certificate of insurance shall be deemed to have altered,waived, or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER . CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVES ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25( ame and logo are registered marks of ACORD #S 12; EAM d f r i Vhe 1poaruaivauvecc�C�i a�C�lcr��ccc�icr�elt� •' �. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only e(YOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: 112977 Type: j Office of Consumer Affairs and Business Regulation Expiration -5M2015 Individual . 10 Park Plaza-Suite 5170 ' - Boston,MA 02116 MICHAEL J DANGELO._. =..T_. MICHAEL DANGELO 105 HORSESHOE LN632{ CENTERVILLE, MA 02 ..- Undersecretary Not valid w out signature U Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor 1 &2 Family °" License: CSFA-048338 MICHAEL J DANOELO 105 HORSESHOE LANE CENTERVILLE MA 02632, �J 6G�c..)rva Expiration' Commissioner 01/22/2016 I ofEti Town of Barnstable Regulatory Services 9 � Thomas F.Geiler,Director Building.Division Tom Perry,Building.Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barustable.ma.us Office: 508-862-4038 Fax: .508-790-6230 } Property Owner Must -Complete and Sign This Section -if Using A Builder I, as Owner of the subject property hereby authorize k. to act on my behalf, in all matters relative to work authorized by this building permit. . Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized.before fence is installed and all'final inspections are performed and accepted. Signature of er Signature of plicant Print Name . Print Name.. A, , QTORMS:OWNERPERMISSIONPOOM 6/2012 THE r 'lown of Barnstable ; Regulatory Services MAIMST-42I,e, : Thomas F.Geiier,Director . a1Ass. 1639. ,�� B.pilding Division. Tom Perry,Building Commissioner 200 Maui Street, Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 'HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1013 LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILWG ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to'reside,on which there is, or is.intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she.shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code.Section 127.0 Construction.Control HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor. Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q., Rules&'Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a forn/certification for use in your community. . Q:forms:hom=' empt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map P6 f-o 3 V_ Parcel'. Application # SEPTIC SYSTEM MUST BE Health Division p0 ^PIV�ED IN COMPLIANCE Date Issue1. d _b1/1 hz� WITH TITLE Conservation Division �/7 �� ENVIRONMENTAL Cole AND', Application Fee TOWN REGULATIONS Planning Dept. ° ,; Permit Fee.. r Date Definitive Plan Approved by Planning Board Historic - OKH = Preservation / Hyannis Project Street Address &0 Y4r Village Owner & Address U e Ouaah / U Telephone P0AVIV70 Permit Request j �C�i,el� %Pin /1604 J 0/�- Square feet: 1 st floor: existing/ I proposed 2nd floor: existing 968proposed�' Total new Zoning District Flood Plain—n Groundwater Overlay 4-D Project Valuationl`f0 on Construction Type_4Z"_d__1g�&- Lot Size /U, 3�� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family' 9' Two Family ❑ Multi-Family (# (# units) Age of Existing Structure Historic House: ❑Yes CH'No On Old King's Highway: ❑Yes 9"No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) '� -Basement Unfinished Area(sq.ft) Number of Baths: Full: existing —_ new _ Half: existing new Number of Bedrooms: _ ' existing -new Total Room Count (not including baths): existing new _First Floor Room Count— _ Heat Type and Fuel: &r Gas ❑Oil ❑ Electric ❑ Other Central Air: E�'Yes ❑ No Fireplaces: Existing New Existing wood/coal stover Yew=< Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ Nw 99e_ *-, A- O Attached garage: ❑ existing ❑ new size —Shed:.Q(existing ❑ new size — Other: _ a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 7� Commercial ❑Yes ❑ No If yes, site plan review # 0 Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name X,da�e/ U; bam x0,16 Telephone Number &70) 77�- 374� Address /a6- &/-_: P S&e A,, License r // 10 Home Improvement Contractor# Worker's Compensation # �c1�57��0�33�0�Dlf ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO__6drtVa a,1le 'SIGNATURE DATE q1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED- MAP/PARCEL NO. . ADDRESS VILLAGE S OWNER DATE OF INSPECTION: FOUNDATIONO �- N'_ ' FRAME :F ,,INSULATION F it ,X FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: « : ROUGH _-.a FINAL ti. $jJfINAL B_.UILDING,' g DATE CLOSED.OUT 30 ASSOCIATION PLAN NO. loo Ok Me Commmnweakth of Massachusetts Deparbnew of fndus&W Accidentr' Q,f xe of 1meskgations 600 Washington SYreef ' Basto�s;: 02II1 WWW-mass gvv1k i¢ Workers Compensation Ias�rance Affdavit:`Sunders/Contrict6rs/IIA licant Information e tinb�rs` _ i ,'� Please Priint Le Name (Busincssorom/fndiv;civai): �� `:/ Address: City/St�te/Zip; et�i A-re yya an empluyer7 Check the spgrop�te bam. I• I em a=3PIoyer with �— 4. I am a TPA-tif project(requh'e Q general eoPhaetor and I . �:_- mploY= (M and/or part-til** have.wed the sub--contractors 6. E New constrvcdon 2.Q I am a sole proprietor or partner- listed on the attached sheet. 7. [f/Remodeling ship and have no employees These sub-conlractors have working fnr me in an c B. Q Demolition Y capacity.. emP yens and have wormers INC). workers'co n OMM omp,insurance.mP e c # 9:.L1 Ztrrlmgaddifion: 3.Qrequired.] 5. [] We are a corporation and its t1(J.[]Electrical repairs or additions I am a homeowner doing all work officers have exercised then " myself [No workers' camp, right of exemption per MOL I l.Q ph r g repass or additions insurance required.]t c. 152, 91(4),7 and we havb no 12.Q R.00frepairs employees. [No workers' 13.[]Other comp,insurance required.] ''mY aPPh=nt that cheers box#1 must also M out ft-section below showing then worloRs t Homeowners wbo mbmitffik en-davit in 'comPMq I on policy kb=ahoL tCaahactacs that deck ti.box mast at>Bch g arz"h., eIl wo*and tb=hire.oatidr contiaatan must submit a new nifdm t indi ead?t oael sheet showing the Ifnm�of thm ea( g Leh —PaYm If he so]-coalxacmn have emPloYy>ffist �.end sta>z whether or not those eotities have.. provide their.workers'romp.PDHCY cumber, I run an employer that is pravi�itg workers'caarpensatzon insurance err information, f my employeea Below is the policy and job site IN InsmMuce Company Name: le f r � a ' Policy#or Self-ins.Lic. ~. Expiration Data'J/d-4/ Job Site A dMSS:b/7 ) Ci�/Statev* API /f- Attach a copy of the workers' co�peasafion a& Failure to secure cov as re c decFarafion gage(showing the policy number and.expiration d.$te), . erag-e grured under Section 25A of MQ,c:152 can lead to the imposition of�mal fine UP to$1,500.00 and/or one year iap ommen� as well as civil Penatt es'of a Of rtp to$250.00 a der Peitatbes in the form of a STOP.-WORK ORDER and a fine y the violator. •Be advised that a copy of this stat$ment may be fIIr 'aidecI to the Office of Investigations of the DIA inr b1mr mne coverage vm-ficafion.. I do hereby certify under the pains and pe?=W=.a fPerj 3'aiat the information prapided above is true and.Correct ' Si Fardawath only, Do not grate in t3rss area fn be completed by city or town o LciaL n: PermitUcense# ority.(Circle one): earth 2.Building Department 3 City/Tgwn Clerk " IIect icaIFnsgectar 5 Plumb' Fnss ecfnr � Pon: . Phone#: Client#: 3860 2DANGELOMI DATE(MM/DDIYYYY) ACORD.. CERTIFICATE OF LIABI LIABILITY CONF INSURANRS NO RIGHTS oCEECERTIFICATE HOLDER./20/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOR 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!he 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). CONTACT PRODUCER NAME: Dowling & O'Neil PHONE 508 775-1620 FAX No: 5087781218 A/C No Ext Insurance Agency E-MAIL ADDRESS: 973 lyannough Rd., PO Box 1990 INSURER(S)AFFORDING COVERAGE _ NAIC# Hyannis, MA 02601 INSUFIERA:Associated Employers Insurance INSURED INSURER B Michael J. Dangelo Building INSURERC: & Remodeling, Inc. INSURER D 105 Horseshoe Lane INSURER E: --- Centerville, MA 02632 INSURER F 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 ED UCE Y EFD B P CID CLAIMS. ADDL SUBPOLF LIMITS INSR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LTR INSR WVD EACH OCCURRENCE $ GENERAL LIABILITY t DAMAGETO RENTED $ 1 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence MED EXP(Any one person) $ —�CLAIMS-MADE OCCUR PERSONAL 8 ADV INJURY $ --� --- GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: - $ PRO- POLICY JECT MLOC COMBINED SINGLE LIMIT — Ea accident .AUTOMOBILE LIABILITY _ BODILY INJURY(Per Person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED _AUTOS AUTOS PROPERTY DAMAGE S NON-OWNED Per accident I HIRED AUTOS AUTOS $ 1 ; I I UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB — -_.-- CLAIMS-MADE I DED I RETENTION$ WC STATU- OTH- A WORKERS COMPENSATION WCC5006733012011 12/19/2011 12/19/201 X AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT 100000 ANY PROPRIETOR/PARTNER/EXECUTIVE !OFFICER/MEMBER EXCLUDED? F N/p` E.L.DISEASE-EA EMPLOYEE $1 OO 000 !(Mandatory in NH) SOO,000 '"yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Michael Dangelo is excluded from the workers compensation policy. Insurance coverage is limited to the terms, conditions, exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered, waived, or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. a , ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD LS1 #S89392/M89391 To ry i mE,�,Y Regilato � k =�� sb+ea , Thomas F`Geiler,Director �►��� � �*' �:�Building Division' .� �- •�f x* °Taro Perry;Building Commissioner 200 Main Street,-Hyannis;MA'02601 www.tQWn.barnstable ma.us u Office: 508-862-4038 A Fax.`508 790-6230: PropeYtyQwner.Must y Complete,and 'I`his Sign Section j a Tf Us. g, r gA Builder< : oY e` Owner of the subject pro e f: P4. f N. hereby authorize ) to act on my behalf, izi all=atter5 relative to work authorized byth>s'buldug peTTT7t1 application for J///�/ Esc ?•hx_ - x} /y/� r� ; V (Address of job ` y Sty ire of Owners ' .tea IDa - ( Wit- //� �J V t 1 �" 4#4 Print Name k E �• F x If:Pro. er Owner l l � j _ �s"aPp,yrngi for permit pleas e c omplete yme Homeowners License Egemptton Form=on`s k therevers e s ide .' g} b k Q FORMS:OWNERPfiRMISSION �" TIM Town of Barnstable Regidatory, Services M Thomas F.Geiler,Director � WASS a``� Building'Division ' Tom Perry,Building Commissioner'` 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us. Office:. 508-862-4038 Fax; 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# , " �. work phone# CURRENT MAHJNG ADDRESS: city/town state zip code The current exemption for"homeowners".was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess anlicense,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel ofland on which he/she resides or,intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm:structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official;that he/she shall be responsible for all such work performed under the building permit.-.(Section%109.1.1) t The undersigned"homeowner"assumes'responsibility for compliance with-the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. F ; t � Signature of Homeowner - t , - Approval of Building Official M Note: Three-family dwellings containing 35,000 cubic feet or larger will be iequiredto comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the.homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." ' Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner ceriify.that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a farm/certification for use in your community. Q:forms:homeexempt MORTGAGE INSPECTION .PLAN BoSTON 11-07655 SURVEY, INC. P.O. Box 290220 ' Charlestown, MA 02129 (617) 242-1313 MAIN (617) 242-1616 FAX mpp@bostonsuryeyinc.com APPLICANT.' DEED/CERT: 24711-313 LOCATION: 110 DOLPHIN LANE PLAN REF: 139-11 SCALE: finch 20 feet CITY, STATE: YANNIS, MA = 'H PREPARED: 12-14-2011 CERTIFIED TO 100.00 LOT 36 10346+1-SF ✓! �,erlL s -— — --- ._ 231 #110 CD -,a 1:5 STORY . 100.00 DOLPHIN LANE 1994(c)Boston Survey Software j- ��I OF M The permanent structures are approximately located on the O� CyG According to Federal Emergency Management Agency g GEORGE ground as shown.They either conformed to the setback c� maps,the major improvements on thisproperty' fall in an o C. P J P requirements of the local zoning ordinances in effect at c� —+ the time of construction,or are exempt from violation COLLINS N a designated as Zone.PROPERTY NOT enforcement action under M.G.L.Title VII,Chapter 40A, •o No.41784 Community Panel No. LOCATED 9N Section 7,and that there are no encroachments of major <9�90F�SSt �Q' Effective Dat�L®®® HAZARD AREA improvements either way across property lines except as shown and noted hereon. S NOTE:Zone C is areas of minimal flooding(no shading). This designation is not based on an elevation certificate. NOTE:This is not a boundary or title insurance survey.This plan was pared in accordance to procedural and technical standards for Mortgage Loan Inspections as adopted by the Massachusetts Board of Registration of professional engineer nd land surveyors,250 CMR 6.05,and use for any other purpose is prohibited.This plan is not to be used for recording,preparing deed descriptions,or construction. A FCC Ga de to Wood Construction xrr4. Hc,;Ir t�tzd ftreds IIO ttcplr kYrnd Zone Massa*chusetts Checklfit for Comp ranGe pso ch7R.5301 A.,r , J � 1.1 SCOPE oa>pl;anct Wind Speed(3-sec gust)_. Wind Exposure Category- ..... _ 1. mph . 10.. Wind Exposure Category Engineers .R u •• t B 1 Z APPLICABILITY ng. e4 iced For Entire Pro)ect _. C a Number of Stories(a roof which ... ( exceeds 8 m�12 slope shall be considered a story) to. Roof Pitch.. _... s 2-stones .�.. Mean Roof �g 2) of Height _. ...:(Fg 2)`: Building Width,W_. .__. y`✓S ft5 3 2 Building Length, L ... [ ft BD' ... (Fig 3j Building Aspect Ratio(L/W) _ (Fig 4) ft-<BQ' , Nominal Height of Tallest OpenrngZ s 53 1 1.3 FRAMING CONNECTIONS Generals compilance with framin �., 9 r nnecttons � .(fable 2 2.1 FOUNDATION x x Foundation Walls meeting requirements of 78D CMR 54D4:1 Concrete. ...... r.,,. Concreta Miasonry -.; .- - 4 S 22 ANCHORAGE TO FOUNDAI"IOhlt : 5/8`Anchor Boltsfimbedded or 5/8 Proprietary Mechanical Anchors,as an aftemafrve in concrete only Bolt Spacing—genera! (Table 4): � Bolt Spacing from end Gfoint of plate - � • Bolt Embedment �roncrete (Fig 5) -= — —12-11 {Fig 5) - ..._ in c 6. Bolt Embedment-masonry 1L >7- Plate - ...,:(Fig 5) ::. ....... in. Washer..:_'._ _ in _t 1:5 ` (Fig 5) .1 FLOORS Floor framing member spans checked ; -• (per`7B0 CMR Chapter a5) Maximum Floor Opening Dimension Full Height Wall Studs,at Floor Operiin s)essah -" .. 9 an 2'from Exterior WaIL(Fig 6j.-..... Maximum Floor Joist 5efibacks. Supporting Loadbearing Waifs or Sheanvalf Maximum Cantilevered Floor Joists rt " ••---• Suppgrting Loadbeanng Walls or Shearwall FloorBracing at Endwalls (Fig 8) ./ <d` Floor Sheathing Type dig 9) Floor Sheathing Thickness , (per 780 CMR Chapter S5) Floor Sheathing Fastening (per 780 CMR Chapter 55) able 2 - - in:' R ) d nails m Edge/ in fte)d 4.1 WALLS 41 Wall Height LDadbearing walls ._.: (Fig'10 and Table 5) Non-LDadbeanng walls ._,' ' (Fig,1 D and--7able'S) c1Q� Wall Stud Spacing r- Wall.saxy Offsets. ' (Fi9�10 and Table 5) `" ...�� z0 in � 5 71£8)_ .., . - - !p {t c 4-2 EXTERIOR 1NALL S3 d f- Wood Studs i Loadf earing walls y ` ' ...I..... A (Table 5) ., ♦' Non-Loadbearing walls ...:..;(Table 5) x ro - in Gable End Wall Bracing i -` A. Full Height Fsdwall Studs ........ Fi WSP•At[ic Floor Length, .... ( g 1 D)` " .. ... 1 gypsum Ceifing Length,'(k W5P not used) ..(Fig 11) ft zW/3 d. and 2 x 4 Continuous Cetera!Brace! 6 ft.'o c (1711 11 j _ti'D9W _• or 1 x 3 ceil'mg furring strips;@ 16`spacin min w ,2 Double Top;?late 9 x 4 blocking @ 4 f spacing to end�o►st or truss bays Splice Length k , {Fg 13 and Table 6 e Spice Connection(no,of 16d cornmon nailsl "`rTahin�� �) ft ATVC Guide to FVood Construction irc High grid 1freas: 110 mph ff,7nd Zone Massachusetts CheClktist for compliance (790 CiA4R5301.2.1.1)i Loadbearing Wall Connections Lateral(no.of 16d common nails)............._..................(Tables 7).................................................... Non-l-nadbearing Wall Connections Lateral(no.of 16d common nails)................................(Table B)......................................................... Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ...................................................... able.(T 9)... ...... _ .......... ft in. <11, SIR Plate Spans ................................. .(Table 9)..................................�ft 1P in.911' Full Height Studs (no. of"studs)....................................(Table 9)............:....:---.._..._:....._......_.. -..... 022tje Non-Load Bearing Wall Openings.(record largest opening bUt check all openings for compliance to Table 9) HeaderSpans..............................................................(Table 9)..........._........._...........jft 10 in.512' SillPlate Spans-=-•,............_....................:....................(Table 9)..................................'... ft - in.s 12' Full Height Studs..l'no. of studs)...........................:........(fable 9)..................................-.................... � Exterior Wall Sheathing 10 Resist Uplift and Shear 5imuftaneousV Minimum Bulding.'Dimension, W Nominal Height of Tallest Dpenine ............................................................................... 67 SheathingType..............................................(note 4).............................._...................... Cam, Edge Nail Spacing (fable 10 or note 4 if less)......................I. fro in. Field Nail Spacing............................. ..........(Table 10)............._......_:.... ...._.. - - _�ii in. Shear Connection(no. of 16d common nails)(Table 10).............:. ..._-. b -•--• Percent Full-Height Sheathing...................:...(Table 10)..._...._........__.._.._.. ........................NO / 5%Additional Sheathing for Wall with Opening> S'S'(Design Concepts).............. Maximum Building Dimension, L "" Nominal Height of Tallest Opening?........................ Sheathing Type..............................................(note 4)................... ....... $)..--...._...._ ....................................... to in. Field Nail Spacing.......................................:..(Table 11)................,..........._.....:........•...... in. Shear Connection(no. of 16d common nails)(fable 11)..........................:..............:. ---....... is Percent FuI�Height Sheathing.......................(Table 11).........................-....:_................... 5%A di6onal Sheathing for Wall with'Opening> 6V(Design Concepts)..:........... Wall Cladding Rated for Wind Speed? ......................................................... ..... ...... ............................................... 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19)............. ft s smaller of 2'or L13 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift...................................••...._.... (Table 12)........._............... .._...... -..U= plf Lateral -•--------•-•--••----- (Table 12)......................... ......._.L= plf Shear............................:.................(Table 12)............................................ S= pit Ridge Strap Connections, if collar ties not>lsed per page 21... (Table 13)...............................T= plf Gable Rake.Oudooker................:.......... ...._...(Figure 20) ............. - . - .. :i ft s smaller of 2'or L/2 ' Truss or Rafter Connections at Non-Loadbearing Walls Propdetary Connectors Uplift._•...:................................_......(i'able 14)------------ --- ....................... U= lb. Lateral(no.of 16d common nails)...(Table 14).......................................L= . ib. Roof Sheathing Type...............:..................................(per 730 CMR Chapters 56 and 59) ............. Roof Sheathing Thickness................................-_...............•........_.................._..---.P in.?7/16'WSP r, Roof Sheathing Fastening. .................••...._.(Tabie.2)---*........... ........ . ........... Notes: .... -- 1. .'This checklist shall be met in its ehtirety, excluding the specific exception noted in 2, to comply with the requirements of 7130 CMR.5301.2.1.1 Item 1. if the checklist is met in its entirety then.the following metal straps and hold downs ara not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 2b Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1 Ba and Figure 18b Exception Opening heights of up to B fL shall be permitted when 5% is added to the percent full-height sheathing requirements shown in Tables 10 and 11. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade. . ii i 8pnsutger �� - - w 3 .= �firElfRO tton + 1rhTCTt�I 'fi' edistr " " 02s77 3 exultation 5 Cats - airs and$usmess Regulafon 0 3 Inoi=ndUW Park Plaza -Suite 51-70 EL J DANGELO r Eostom laIA 02Y-1 . r W. M1ICHAEL DANGEIO- i 105 HORSEShOE \ CEO 1TERVILLL MA0263€ �� �— - " `` �� Under�ecretacy - ' - T _ of va+ail w out signature, ivias,1chutittts- Utp Board of Bu�ld�n itf b Re�*ul tt�on ; nd S>in pnsfructi6 ,S: d-i {j Pervisor License,F .� L`�c ,e-tea 4833� R`zstr.�cfed to MICHAEL J DANGELO 105:HORSESHOE LANE CENTERVILLE, MA 02632 � # F« Expiration 1/22/2012 ('rnmri.�iureer . Tr#i 15301 ; t } 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map-AA Par elf `- Application # 62 Health Division Date Issued wtpe l f i9iff 6u Conservation Division 4_2� Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board I Historic - OKH _Preservation/ Hyannis Project Street Address 111) t Ad 'V9&g1P Village JA MAyIS�Q Old, Owner Address YVE11 r CJdeA-PI 1�1&i CIO Telephonegsv- q� -qf a cab-I t -a& - 70 l� 3�iU(��- Permit Request CCKg4-1cf 100 9 d®rniev �''lIf��r`2� ��d� �%�� = Square feet: 1 st floor: existing proposed 2nd floor: existing F2r4,�proposed8 Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiow` Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Struct e Historic House: ❑Yes @i"No On Old King's Highway: ❑Yes ❑ No Basement Type: lull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing new First Floor7'Fobm Coulit: Heat Type and F I: M'Gas ❑ Oil ❑ Electric ❑ Other g ` j s ; Central Air: Yes ❑ No Fireplaces: Existing New Existing wood%coal st`e: s ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing �U new size_ 59 Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: w zn M Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) l NarYie // e�- bagae- e Telephone Number(� � 77S 3 7tl0 CJ Address 10!�L A��p siepl N/C License # 7 Y13 3 d e D Home Improvement Contractor# Worker's Compensation #W--d& 5% :7.3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r. SIGNATURE DATE FOR'OFFICIAL USE ONLY t ?. r "•j APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER' DATE OF INSPECTION: FOUNDATION FRAME F , ,r INSULATION FIREPLACE ELECTRICAL: ROUGH ' FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL - 1 FINAL BUILDING f DATE CLOSED OUT"' . r ASSOCIATION PLAN NO. The.Commonwealth of Massachusetts I r Department of Industrial Accidents it Office of Investigations t 600 Washington-Street : Boston,MA 02111 wwwanask govldiQ Workers' Compensation tnsw-ance Affidavit:,Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leguibly �1 N3Il1e (Business/Organization/Tndividual):_./ Address: City/State/Zip: C rPh°one#: ZS Are A an employer?Check the appropriate box: Type of project(required): I,lYl I am a employer with 4. Q IYam a general contractor and I - employees(fuIl and/or part-time).* have hired the sub-contractors 6: 0 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 8. 0 Demolition working for me in any capacity. workers' comp. insurance. 9 Building'addrtion`` , [No workers' comp. insurance® 5:.❑ We are a corporation and its required.] 4: y officers have exercised their 10;❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL ., 1 l.❑ Plumbing repairs of additions myself. [No workers' comp. c. 152, §1(4), and we have no ; 12:0 Roof repairs ' insurance required.] 1. employees. [No.workers' comp.insurance required.] 13:0.Other *Arty applicant that checks box#I must also fill out the section below showing their workeis'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hiss outside contractors must submit a npw.affidavit indicating such., #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their,workers'.comp,policy information. ram an employer f6at is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: � _ l Expiration Date: Job Site Address: k City/State/Zi11 p r i a w7 Attach a copy of the workers' compensation policy declaration page(shoFving the policy nu er and expiration date). Failure to secure coverage as required under Section 25A of MGL c.'l]52 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 foie of up to$250.00 a day against the violator. Be advised'that a copy of this`statmI ent may be forwarded to the Office a Investigations of the DIA for insurance coverage verification I do hereb ertify under the p penaXes'of perjury that the infoi-madon provided above is true and correct S i ature: a Date. Phone# Official use only. Do not write in this area;to be completed by city,or town�fftcial City or Town: Permit/License#y }; Issuing Authority(circle one): ` I. Board of Health 2;Building I3epartm nt.3.City/Town Clerk 4. Electrical Inspector'5.yPlumbing 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()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 'V 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 thatthe 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 Ci.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hke 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 1-9.77-,MASSAFE Revised 5-26-05 Fax# 617-727-7749 wvW.mass..gov/dia P Client#:3860 2DANGELOMI ACOR CERTIFICATE OF LIABILITY INSURANCE 02/09/2011 rr) M PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling &O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 9 y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis, MA 02001 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Associated Employers Insurance Michael J.Dangelo Building INSURER 8: &Remodeling, Inc. INSURER C: 105 Horseshoe Lane INSURER D: Centerville, MA 02632 INSURER E: 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 OkDD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR N R DMMI GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE D OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROi El LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS - BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS, BODILY INJURY (Per accident) $ NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WCC5006733012010 12/19/10 12/19/11 X OR I IMIT FR EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1 OO OOO ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? YES E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT s500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Michael and Debra D'Angelo are excluded from the workers compensation policy. t, Insurance coverage is limited to the terms,conditions,exclusions, other '. limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived, or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED R�PRESENTAc I ACOR. _ �___..__, _ _. . 156/M75736 LS1 0 ACORD CORPORATION 1988 REScheck Software Version 4.4.1 Compliance Certificate Project Title: Glovinsky Residence Bathroom Addition Energy Code: 2009 IECC Location: Barnstable,Massachusetts Construction Type: Single Family Project Type: Addition/Alteration Heating Degree Days: 6137 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor 110 Dolphin Lane Daniel Lewis AIA,Architect Hyannis,MA 02601 332 Whitney Street Northborough,MA 01532 508-612-8771 danlewis@charter.net Compliance:0.0%Better Than Code Maximum UA:14 Your UA:14.•. The%Better or Worse Than Code index reflects how dose to compliance the house is based on code tradeoff rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Owe? maw Man Wall 1:Wood Frame,16"o.c. 176 19.0 0.0 10 Window 1:Wood Frame:Double Pane with Low-E 6 0.380 2 Ceiling 1:Flat Ceiling or Scissor Truss 60 38.0 0'0 2 i Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted With the permit application.The proposed build in een designe o meet the 2009 IECC requirements in REESccheck Version 4.4.1 and to comply with the mandatory requiremen fisted in e E ck Inspection Checklist. DA q Name-Title t Signature Date Project Title:Glovinsky Residence Bathroom Addition Report date:06/12/11 Data filename:C:\Users\Daniel Lewis\Documents\Architecture\2010\Glovinsky Residence\Glovinsky 110611.rck Page 1 of 4 ATYC Guide to 1'Yood Coiistructioir r'il Hi;Ji 1--rid ftreas: 110 fnpk I•Yilyd Zaue Massachusetts Checklist 'o Compliance (780 CMR53f)I:Z•►:l)' ... Check Compliance 1.1 SCOPE WindSpeed(3-sec. gust)............................................. .. .......... .. ......... ........ 110 mph Wind Exposure Category Wind Exposure Cat egory................Engineering Required For Entire Project ................•......................C ' 1.2 APPLICABILITY , Number of Stories (a roof which exceeds 8 in 12 slope shall be considered a story) 1 stories 5 2.stories Roof Pitch .......•............:..........:. .....:.............. (Fig 2) ...... .. ...... . .:.....: ...... ...:3 /?�Oe s 12:12 Mean Roof Height .... ......... (Fig 2)...............................................Z �t°`_<33' BuildingWidth W (Fig 3 �ft _<80, ( 9 )....... Building Length, L ...(Fig 3)........ .°... :. _... ft s`I30' Building Aspect Ratio (UW) ..... ............... (Fig 4).,.....: 5 3:1 Nominal Height of Tallest Opening2 ................I............:.....(Fig 4)........ ......... .I... .. ........: • ...... *1' .s 6'8" 1.3 FRAMING CONNECTIONS , General compliance with framing connections... ::............(Table 2)..::............ ......... ........ .:.... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete............................................................•...... .............................; ......... .......•• ConcreteMasonry..........:............. ................:,.............................................. ...................:..:................ 2.2 ANCHORAGE TO FOUNDATION"'. 5/8"Anchor Boltsimbedded or 5/8"Proprietary Mechanical Anchors as'an'a Item ative.in concrete only ' Bolt Spacing—general I.........:.(Table 4) • Bolt Spacing from end/joint of plate ..............................(Fig 5)..................:................. in.—<6"—12". Bolt Embedment—concrete...........................................(Fig 5)................................................... in. >7" Bolt Embedment—masonry.: ...I....•........... ............(Fig 5)............i......... ......... :.:;. in.>: 15" Plate Washer...................... ..........(Fig 5).....,......:..... :.....L 3"x 3"x'/." 3.1 FLOORS Floor-framing member spans checked ..........(per 780 CMR Chapter 55)... Maximum Floor Opening Dimension....:..............:: ..... ...•..(Fig 6) ..................... ......I............ ft 12 Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)..:....................... ........ Maximum Floor Joist Setbacks Supporting Loadbearing Wails or Shearwall... ...::..(Fig.7)..........:......................................... Maximum Cantilevered Floor Joists Supporting Loadbearing Walls qr Shearwall................(Fig 8)......................................... ............ ft <d Floor Bracing at Endwalls..............:.....................................(Fig 9)..................................................................... Floor Sheathing Type ..:...:.:•..:...... .(per 780.CMR.Chapter 55) ... Floor Sheathing Thickness ... (per 780 CMR Chapter 55 Floor Sheathing Fastening............. 2).. S at Ib in`edge IB in field 4.1 WALLS Wall Height I .... ....(Fig 10 and Table 5).... z ft.510, { Loadbearing walls......:....... .., .................. . . . ( 9 . � , . Non-Loadbearing walls..,,...;................. (Fig 10 and Table 5).... .......•........ ` ft 520' i Wall Stud Spacing ......... ..............:...... .. ....... .... ....(Fig 10 and Table;5).... ........jam in. 24 o,c. i Wall Story O_ffsets .(Figs 7 8:8)......, a 4.2 EXTERfOR-WALLS f Wood Studs Loadbearing walls. ..... ........: ••.... .. .......... (Table 5)............................... x�-�_ft in. Non-Loadbearing walls................................................(Table 5) / :......::.........2x- - ft in. Gable End Wall Bracing Full HeidhtEndwall Studs.............................................(Fig 10):. ..... .. WSP-Attic Floor Length... (Flg 1-1).: ft zW/3 'Gypsum Ceiling Length (if WSP not used)....:..............(Fig 11)•. .•. ...... ......... .............., ft?0.9W and 2•x 4 Continuous Lateral.Brace.@ 6 ft. o.c. .. (Fig 11)............................................................. or 1 z 3 ceiling furring strips @ 16'spacing min: with 2 x 4 blocking @ 4 ft. spacing in end joist or truss bays ,Double Top.Plate . Splice Length .......(Fig 13 and Table 6)....... .. . ..... ......... to ft .......... Splice Connection (no. of 16d common nails)..,..... .....(Table 6)........:......'..,.....•.................................. v APVC Guide to IYood Cofrstr,crctio» hi Higfl !'lurid firm--s: 110 t/cph I'Vilid Zoite Massachusetts _Checklist folr Compliance (780 Ci)11IZ5361.2.1.l)' Loadbearing Wall Connections Lateral (no.of 16d common nails).......................:........(Tables 7)..................:.................................. Non-Loadbearing Wall Connections . - Lateral (no.-of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) HeaderSpans ........................................................(Table 9).................................. a'• ft 2 in. 5 11, Sill Plate Spans ........................................................ Table 9 �-Q-ft /in.511' Full Height Studs (no. of studs)....................... (Table 9)............................,...................,...... It. Non-Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9)' Header Spans.............................................................(Table 9)..................................�ft --,in. 5 12' Sill Plate Spans.... .......................................................(Table 9)............:.....................4-a-ft in. 5 12' Full Height Studs(no.of studs)....................................(fable 9).............................................. Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously'i Minimum Building Dimension, W Nominal Height of Tallest Opening2 . Sheathing Type.............................................. note4,............."........................".-.,......!l�U Edge Nail Spacing.........................................(Table 10 or note 4 if less) in. Field Nail Spacing..........................................(Table 10)..............".................................. in. Shear Connection (no. of 16d common nails)(Table 10)....................................................... Percent Full-Height Sheathing...................:...(Table 10).....................................................t % 5%Additional Sheathing for Wall with Opening> 6V(Design Concepts).................... Maximum Building Dimension, L. < Nominal Height of Tallest OpeningZ.......... .........................................................� �,=6 8 SheathingType..............................................(note 4)....:........................................,.....� Edge Nail Spacing.........................................(Table 11 or note 4 If less)........................_.I In. FieldNail Spacing.......................................:..(Table 11)................"....................................j,0 in. Shear Connection (no. of 16d common nails)(Table 11)..................................I......,.............. '? Percent Full-Height Sheathing.................:.....(Table 11)..........I............_.................... .....�% 5%Additional Sheathing for Wall with•Opening> 68"(Design Concepts)..................:.. Wall Cladding Rated for Wind Speed?........................ 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool, see BBRS Webs!te) " Roof Overhang ................................:..................(Figure 19) ............. ft 5 smaller of 2'or L/3 ; Truss or Rafter Connections at Loadbearing Walls Proprietary•Connectors Uplift able 12 pif Lateral...................................... . ....(Table 12)............,................................L= pif Shear............................::.................(Table 12)............................................S= plf Ridge Strap Connections, if collar ties not used per page 21... (Table 13)............................".T= � plf Gable Rake Outlooker........................6.................(Figure 20) ......:,..... .� ft 5 smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary• Connectors Uplift....................:..:........................(Table 14)............................................U= lb. Lateral (no. of 16d common nails)...(Table 14)........:..............................L= . lb, Roof Sheathing Type................:...................................(per 780 CMR Chapters 58 and 59) ............ Roof Sheathing Thickness.....................................:..... In. _>7/16"W S P Roof Sheathing Fastening............................................(Table 2).....................:.............,....................... otes: This checklist shall be met in its entirety, excluding the specific exception noted in 2,'to comply with the requirements of 780 CMR.5301:2.1.1 Item 1, If the checklist is met in its entirety then the following metal straps and hold downs are not required per the-WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e, Comer Stud Hold Downs per Figure 18a and Figure 18b Exception: Opening heights of up to 8 ft. shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. The bottom sill plate In exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-gr6de.. . Nlas'sachusetts- Department`-O 1 Board.of Building Re�gulatiim, and Standards.: Construction Supervisor License .,, ••. 41 ; . r ,cPnsp«: 5 4833!? Rastricted to:. 1G E MICHAEL J DANGELO 105 HORSESHOE LANE ' CENTERVILLE, MA 02632 - s . Expiration: 1/2212012 ('unmsi'si„rtcr Tr : 15301 �. Cifice�t'Con m°"e .airs u�iness egu a"�ori� �� License or registration valid for mdividu' use only iI'riPROVEI4iENT CONTRACTOR before the expo:anon date If found zeturn fo _. Registration: ,1.12977 Type: i t Office of Consumer Affairs and Business Regulation Expiration: ._5/712013 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 EL J DANGEL  -; MICHAEL DANGELO 105 HORSESHOE QN� CENTERVILLE, MA 0263� Undersecretary y Not valid w out signature � i 4of THE ry Town of Barnstable Regulatory Services + tARNSTABLE, « - ,� $ Thomas F.:Geiler,Director rf1 ,19. A. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www:town.barnstable.ma.us Office: 508-862-4038 Fax:` 508-790-62' Prop erty.C►wner Must Complete and Sign This Section If Using A Builder I, S 6; O I S V J e:. ; as Owner of the subject property here by authorize /,I f h 9'(S \ to act on my behalf; in all matters relative to wo"k authorized by this building permit application for: (Address of job �l Te // Signature of.Owner' Date . �5T2ri Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the -reverse side. Q:FORMS:0 WNERPERMISSI0N { the own of Barnstable �oF ` ' o Regulatory Services BARNsrABLE, Thomas B. Geiler, Director v MASS. i6.19. ,m Building Division lFo n Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 t www.town.barnstable.ma.us r Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print 1 DATE: JOB LOCATION: CPS number street village "HOME_OWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/toNm state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures aocessory to such use and/or farm structures. A person who constructs more,than one home in a two-year period shall not be,considered a homeowner; Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations, The undersigned "homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note; Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1,1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supennsor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several mms. You may care I amend and adopt such a form/certification for use in your community. 601 oF'THE r Town of Barnstable e mit Expires 6 monl6 onr issue r r Regulatory Services Fee + BARNSfABLE, ► i639. ,0� Thomas F.Geiler, Director Arf�MP't A , Building Division Tom Perry, CBO, Building Commissioner 200 Main'Street, Hyannis, MA 02601 www.town.barnstable.ma.us 01'f ice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �� v Property Address Z/� esidential Value of Wort. �10 0`"' Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address S't` A 6/ ' )'AG Atj � .ifs - Contractor's Name b . Wit? � /�/i 1�,'''.S P./1/ '^ �N�iP7/s one Number f� � I tome Improvement Contractor License#(if applicable) M / F� zs > Q Construction Supervisor's License# (if applicable) Fa 0 ❑Workman's Compensation Insurance -PRESS PERMIT Check one: ❑ I a sole proprietor AUG 6 2009 ` ❑ airt the Homeowner TOWN OF BARNSTAB�,E have Worker's Compensation Insurance Insurance Company Name Aw�)�4 Workman's Comp. Policy Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will betaken to ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side_ �Zplacemen ~indow /doors/sliders: U-Value (maximum .44) vNAaw� *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 rovement Con tractors rs License is required.ed SIGNATURE: RESS.doc ).`WI'I II.I:SU ORMS\huilding permit forms\EXP Revised 100608 The Commonwealth of Massachusetts r Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibl Name (Business/Organization/Individual): - - Address: � � U � G� � - Cr�i'�-2-• - . �I �� E'T City/State/Zip: t%� 3�' j` Phone#: " �5 � ` 5— Are you an employer?Check the appropriate b Type of project(required): 1. I am a employer with _ 4. I am a general contractor and I 6 construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling . ship and have no employees - ~' : These•sub-contractors have g,'Q Demolition employees and have workers' working for me in any capacity. 9. ❑Building addition comp. insurance.$ [No workers comp. insurance 10.❑Electrical repairs or additions required.] 5. We are a corporation and its ' 3:❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per 1VIGL 12.0 Roof repairs insurance required.]t c. 152; §1(4),and we have no employees. [No workers' 13.❑Other . comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.- t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number: I am an employer that is providing workers'compensation insurance for my employees. Below'is the policy and job site information. p . U 4 Insurance Company Name: 5 S Policy#or Self-ins.Lic.#: J l l Expiration Date:::3 l 0 pL�Vt Job Site Address: /® . 411A1 City/State/Zip:Aium JV �, L Attach a copy of the workers' compensation policy declaration page(showing the policy leand 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 andpenalties of perjury that the information provided above is true and correct. Si naturer. 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): Inspector S.Plum bing Inspector a Ins P Clerk 4.Electrical b 1.Board of Health 2. Building Department 3. City/Town CI P . 6.Other' Contact Person: Phone#: 7 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 Leizibl Name (Bu iness/O g ationandividual): _ A Address: City/State/Zip: o," Phone#: Qcg-L" G Are you an employer? Check the apprdpriate boa: Type of project(required): 1.❑ I am a employer with 4• ❑ I am a general contractor and I 2.�tployees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction nam a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.T I required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I atn a homeowner doing all work officers have exercised their I i.❑ Plumbing repairs or additions myself. o workers' com right of exemption per MGL . Y [N P= 12.❑ Roof repairs insurance required.] c. 152, `1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compet6adoti insurance for my employees. Below is the policy and job site information. - Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date: Job Site Address: - City/State/Zip: Attach a copy of the workers'comknsation policy ydeclaration page(showing the policy number and expiration date). Failure to secure coverage as required underSection 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 u e p s and n perjury that the information provided above is true and correct. - Signature: 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(circleone): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: ' Phone#: ..flre yL:,a�r�ava�t •.��r�a�a.ut..��a•. y �. Board or ag s and S3�eeo-darda HOME lfAPft0VE111M CMMCTOR s ' RegistratHM: 126893 Expiration: &312010 Tyre: Supplement Card The Home Depot At-Home Service DARREN DEMERS 3200 COBB GALLERIA PKWY#20 ATLANTA,GA 30339 AdmizWeater r. f. r License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place RIG 1301 Boston,Ma.02108 . olz — . Not valid witho®t Signature • J ICi'//:.ieJ:/A Board of Buda IIg RCgulations and�tanc�ards ` HOMEIMPROJEMENT.CONTRACTOR Registration: 153140 Expiration: 0/31/2010 Tr# 278191 Type' DBA NU-VISION INSTALLATIONS STEPHEN RESTAINO 32 OVAL DRIVE WEST YARMOUTH, AAA 02673 Administrator' Y 1.icense-or registration valid'for individui use only before the expiration date. If found return to: . Board of Puilding Regulations and Standards One Ashburton Place Rm 1301 Boston, eta.02108 Not valid without signature ----------------- License CS SL. . 99560 t j°rs , r Restricted to:- WS � � � . > a 1,01 . -60 i . . 1 ^lg F a STEPHEN RESTAINO' 32 OVAL DRIVE WEST YARMOUTH, MA 42673 � -- - — Expiration: 1 /22/2012 "#�llli�Il1•i+#I3i°� v �� Try: 99560•. N� V, IJUL-15-2009 13:36 HOME DEPOT HYANK-1- P.001 t ) HOME IMPRO CONTRACT THIs. 5 _ Sold,Furnished alnd Installed by: Branch Name: 'Bog ton ...,.0tate• 1�.J Q-`-{7Ji iD At=l3ome Services:inc. d/b/a:Tbe-Homc•Depot At-home Services - .. .345A Cfeenwood:Street,Unit 2,Worcester.MA.0,1607 Braneh.Number.3]. ....Toll Free(900)•657-5182; fax t:508)756-8823 Federal ID#75-2698460:ME Lic#C 02439:RI Coat Lio#16427 CT L,c#565522;MA j�ome Improvement COotraetit Reg.#126893 i 1 Installation Address: Jma, i�l�hr•�=�t"ram• �n r �L-- ROM Ile, City State Ap Parcbusar(sY.•-•: work khone: Home Phone:: @ dl Phone: it Rome Address: (If different from Ins allatioA Address)..,- Gjty, : State ." Zip E-mail Addrevs(to i xeive projeacommueications smd:Home-Depot update) --- -- ❑I DO NOT wish t>receive any.mtuketing ernails from.TherHome Depot Project lfir rmatio Undersigned(-Customer-);tlii owners of'thc property Tocated at the above installation address,agrees to buy, and THD At-Home�ervices,Inc.("Tbe Home Depot")agrees-to;fartush,-'dellver and arrange for'the installation('17nsmilation7)of all matcrials.dcuxil j 4--on.the below and on the.referenced Spec;Sheet(s), all of.which are.jacorporated into,.this:Contract by•this reference;along.wid any.applicable,State Supplement and Payment Sum'mar hereto.and aay Cli;mge..M1iFis(collectively, "Contract")t job,-#: Products 5 5h '8 # Pro ert.Amount �Gr j Rooting Siding endows InNlation O ❑Gottcrf%COvet� �]&ntry Uoo!:•❑ t� . ' ;• " (� oofing. Siding Windows lnsulaaon :• $• f .❑Gutters/Covets[:]Entry.Doors.❑ t ._:,j:.E1RoqfLng. Siding. Windows Insolation.: j:❑Gutters.•/.Covers ❑Entry Doors,[]' c Roofing iding Windows Insulation $ �. 00uWS-1covers 0 fttryDoors•I]•` :. Mhiim=2S%Depa itofConft-atAmount. uponexecutionofthiscm&3CL,,r ';Total Contmet Amount Maine purchasers m y not deposit more than.one third orthe cow Amount; L !: Cus�tomer.agrees_Ol ,imm ott�ediately upon.cpletion`o�the',worl`for.each Product,CucYOmei'willCxccutc-a Comp•]etion CcrtificsCc (one for each.Pro&t'as'di.6ed by:an iadividual,Sp®c Sli�tO:and-pay any.balance due.• As applicable,'each Customer under this Contract agrees to be jointly amd;severally obligated.and liable hereunder The Home'Depot.res ,ves•tiae'righrto?ssue a Change Qrdec'Ot terminate this Contwt-ovany in dividualYroduct(s)included herein.-at its discretion,if Thel•tome Depot or its autho&.ed service,providerdetermines that it cannotperform its obligations clue to a structural Problem with the:ha ae,eavironmental.hazards such as.mold,;asbestos or,lead.paint,other safety concerns,,pricing terrors or because work required to con plete ,was not inc C luded.in the ontract the job Payment Smnma.H The Payment Summary #_, included as part.of.:thisContract sets forth the•total Contract amount-and payments required•for the;deposits and final payments by,Product(as applicable). NOTICE TO CUSTOMER You are cadticd`to.(,completely fille&iii copy'of the.Contract atthe ttme you sign Donot sign'a Completion Certificate(note: there is one Compli tion Certificate for each listed Product as defined by•indsviduaf.Spec Sheets)before worlron that Product is complete_ In the event of tern Ination of this Contract,Customer agrees to pay The Home Depot the costs of nmteriahs labor,expenses and services provid ed by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth h i this Agreement or allowed under applicable law..THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE -IOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE,,WITHOUT LIMITING THT✓H)ME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and AU thorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Dept:with regard to the Products and Installation services and supersedes all prior discussions and agreements,either r oral or written,rclati ag•to-said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed -by Customer and Th:.Home Depot:Customer acknowledges and agreecth tc Cmtamer-has=Ad,understands,voluntarily accepts.the terms of and has rerg,ived a copy of this Agreement. Ac •p Sub by: y X �' i 17ate Sales C ultant's Si ature /,� D�ate� X. Telephbnc No. '� 152 (tea Customer's Signatut: Date Sales Consultant License No. CANCF.LIX60N; CUSTOMER MAY CANCEL THIS (c appHGible) AGREEMENT Wk CHOUT,PENALTY OR OBLIGATION BY DELWERINCi WRITTEN N NOTICE TO THE HOME DEPOT BY MIDIIIGHT ON THE THIRD BUSINESS DAY AFTER SICNING THIS AGREEMENT. THE STATE SUPPLEMENT. ATTACHED HERETO CONTAINS A. ,'FORM TO USE W ONE IS SPECIFICAi,LY 1 PRESCRIBED BY LAW IN CUSTOMER°S STi ATE.. NOTICE:ADD M1 AL'TERMS AND CONDIT101.6 ARE STATM ON WE REVERSE SIDE AND ARE PART OF THIS CDNTRACr __ .. but,hrs_wsrrn'r�o»vatmr;:Casfoiner• `Pink--safes consultant ram. 1 Town of Barnstable *Permit# 0?NY6lO6a Expires 6 months from issue date Regulatory Services Fee �5 6 �) X-®RES P�� �� Thomas F.Geller,Director FEB 'V1' ?,,008 Building Division Tom Perry,CBO, Building Commissionee- TOWN OF BARNS` A13L 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY. Not Valid without Red X-Press Imprint Map/parcel Number a 6 d 3 t n7 Property Address 06 l Q 4 r n 14 Ll �tJ. 4XV i2 4, Residential Value of Work R,00 U Minimum fee of$25.60 for work under$6000.00 Owner's Name&Address S�LP a r 616 tI (PI I`L ZZ 000 4o1 IL 14 e Contractor's Name jkl a E/e vy P � f�� ,-�1�f Telephone Number •S��9 6 Home1mprovement Contractor License#(if applicable) 1 d 6 B y ? Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one:- ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name l 1/i W %I g rn rr s A r- Workman's Comp.Policy# i7a t a o a. Copy of Insurance Compliance Certificate must be on file. Pet°nut Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side MReplacement Windows/doors/sliders U-Value % 33 (maximum.44 0 +Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. "*Note: Property°Owner must sign Property Owner Letter of Permission. A copy of the ome 3inprovementContractors License is required. SIGNATURE.. zvlze:��. Q:Fotms:expmttg Revise%1306. The Commonwealth of Alassaehusetts Department of Industrial Accidents M W Office of Investigations . 600 M shington Street Boston, MA 02111 �e www. ass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ayuiicant Information Please Print Legibly Name(Business/Organization/Individual):_ b �a Address: t n City/State/Zip:�'I'�'� 44 G 4 10 3 `l Phone.#: 60 7 1 o? Are you an employer? Check the appropriate bozo general Type of project(required 1. I am a employer with /D 4. ): ❑ I am a ral g contractor and I. (]N s employees(full and/or.part-timel.* ` 'have hired the sub-contractors 6 New construction- listed on the attached sheet. 7. ` Remodel' 2.❑ I am a sole proprietor or partner- ❑ g" These sub-contractors have ship and have no employees 8. {]Demolition working for me in any capacity. employees and have workers' coin insurance.$ �- 9• ❑Building addition . [No workers' comp.insurance P• . required.] "..5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no. employees. (No workers' 13. Other_f� r`a c� ace f 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 mustsubmit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or.not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp:policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is,the policy and job site information. Ncw Insurance Company Name: AN t✓e h S• C a Policy k or Self ins.Lic #. f a 0 ExpirationDate: '`J- U g Job Site Address: fD1 4 4n r City/State/Zip: QJ fi. 7� Attach acopy 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.up/er th pains and p nalties of perjury that the information provided above is true and correct. Si afore: R. a,O . Date: Phone#: �+ 62' t�,l Official use only. To 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#: ions n formation and Instruct" 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 xeceive�ortLust�e Q n iizdividual��artnership association or other le al enti ,em 1p oying employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the to do maintenance,construction or repair work on such dwelling house dwelling house of another who employs personsshall not becaus . e of such employment be deemed to be an employer." or.on the grounds or building appurtenant thereto . MGL chapter 152, §25C(6)also, states that"every state or local licensing agency shall withhold the:issuance or operate a business or to construct buildings in the commonwealth for any renewal of a license or permit to applicant who has not produced acegotable.evidence of compliance with the insurance coverage required." Additionally,MGL chapmmonwealth nor any of its political subdivisions shall ter 152, §25C(7)states."Neither the co lic work until-acceptable evidence of compliance with the insurance enter into any contract for.the performance of pub requirements of this chapter have.been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and; if . necessary;supply sub-contiactor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance.-Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'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 peimit/license applications in any given year,need only submit one affidavit indicating current under"Job Site Address"the applicant should write"all locations in (city or policy information(if necessary)and 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 io 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 bivestigations 600 Washington' Street Boston,MA 0-2111 Tel.#617-727-4900 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia t ,. ce TU=ICATfi;NUMeER� rr PRODUCER_ "ATL Od F234410 Ol MARSH USA INC THIS'CERTIFICATE 19 15SU86 AS A MkTTfiR OF INFORMATION ONLY ANO CONFERS 'NO RIGHTS UPONSHE CERTIFICATE HOLDER OTHE h R THAN THOSE PROVIDED IN THE omedepot.certrequestQmarsh:cam r l PQLICY..THIS CERTIFICATE ODES,NOT AMEND,fiXTfiNO OR ALTER THE COVERAGE FAX(212)946-0902 AFFORDED BY THE POLICIES DESCRIBED HEREIN, 3475 A 30305 NT ROAD,SUITE 1200 ATLANTANTA,PIEDMONT COMPANIES AFFORDING COVERAGE C GA `. COMPANY'. . +00492-THD-IPUSA-07-08' IPUSA , A STEADFAST INSURANCE COMPANY INSURED COMPANY HOME DEPOT USA,INC. " 8, CE COMPANY 2455 PACES FERRY ROAD NW ZURICH AMERICAN INSURAN ' BUILDING C-8 COMPANY ATLANTA,GA 30339 C• AMERICAN HOME ASSURANCE COMPANY COMPANY' Q;. NEW HAMPSHIRE WS COMPANY s � 1 ettlR lit � c �e � . � 24 A THIS IS TO CERTIFY.THAT POLICIES OF.INSURANCE.,OESCRIBEp HEREIN HAVE.BEEN IS$UEt1aO THE;INSUREO,NAMED HEREIN FQRTHE.POLICY PERIOA' NOTWITHSTANOINGANY REQUIREMENT TERM OR CONOmON OF ANY CONTRACT QR OTHER DOCUMENT WITH RESPECT TO'WHICH THE CERTIFICATE MAY BE ISSUED OR MADY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL:THE TERMS,CONOITIONS AND EXCLUSIONS.OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R TMPE OP INSURANCE :' POLICY NUMBER " " PO UCY EFFECT E POLICY EXPIRATION ATE(Mwoo I DATE(MWDOIYY) LIMITS q . 99NERALLIABILITY . . . IPR3757.608-62 03/01/07 03/01/08 GENEAALAGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS: PRODUCTS.COMP/QPACG' $ 4.000,000 CLAIM$MAOE a OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL 8 ADV INJURY $ 4,000,000 OWNERS 3 CONTRACTORS PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE An one fire) $ 1,000,U00 3 AUTOMOBILE LIABWTY MEO EXP n one arson $ EXCLUDED BAP.2938883-04. .' 03/01/07 03/01/08 COMBINED SINGLE UMIr $ 1,000,000 . X ANY AUTCI ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Perpelaen) $ HIREOAUTDS. : BODILY INJURY NON-OWNED AUTOS (Paraceidenq $ ' X" ELF-INSURED AUTO HYSICAL DAMAGE PROPERTYDAMacE $ GARAGE LIABILITYw. . AUTO ONLY.EA ACCIDENT $ ANYAUTO OTHER THAN AUTO ONLY .... v EACH ACCIDENT $ . EXCESS LIAEILITY AGGREGATE $ aIPR 3757 608-02 03/01/07:'. . 03101/08 EACH OCCURRENCE ' ' $ 5,000,000 MBRELLA FORM AGGREGATEOTHER THAN S 5,000,000 ELLA RS COMPENSATTHER THAN RON AND FORM � , 2921209(CA) 03/01/O7 03/01ro8 X TH EMPLOYERS LIABILITY TORY LIMITS ER ?rsv*troc� , d c N 2921210(FL) 03/01/07 031008 ':: EL EACH ACCIDENT $ 1 000,000 THE NERSI E ECC ' X INCL 2921211(AZ;tD,MD,VA) 03/01/07 03/61/08 EL DISEASE-POLICY LIMIT $ 1,000;000" P.4RTNERSlEXECUTNE OFFICERS ARE EX�L 2921208(ADS) ' 03/01/07' 03/01/08 . EL DISEASE-EACH EMPLOYEE $ 1,000,000 o ►+ R 2921213(GSI) 03/01/07 ` 03/01/08 . WORKERS'COMPENSATIOf "2921212(KY,MO,NY,WI) 03/01/07 ' P3101168 TEXAS E.MPLOYERS., TNS-C44642086.(TX) 03/01/07 03/01/08 EACH OCCURENCE 25,000,000 EXCESS LWBILITY SIR BCRIPTION OF.OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS 2,000.000 a. t T FEET M�ytTCpE ��s -,� y.� a ,4> rr a '^ E,sr's r.; �( p, ;,_ aii2; °Sg11ai{l�"yyy.Ses :t•' •�S„'n ,,iic�•'"• "�F,�q�+"�'Y ..:,}3� ;r3 .14 ' 4� Q4\j •e%' �': r�k� 1 r.os.rv -•�'t', ,,&`�" • Pa•.s- "i il�s�"Ch-, ; irtCija�xiC L `{L..-,� �i. ]' • . r F ,�t+6 ;e 4-Y•l"? SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION GATE THEREOF THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MA4�tl DAYS WRITTEN NOTICE TO THE FOR EVIDENCE ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR - 10 } t ., L t.� a�' OAT i � "COMFANIE$AFFOat]INO EOVERAGE '� �"'^* PRCOUCER .: MARSH USA.IN� COMPANY homedepot.certrequest@marsh.cam E ILLINOIS NATIONAL INSURANCE COMPANY`': FAX(212)948-0902 3475 PIEDMONT ROAD SUITE 1200 ATLANTA,GA 30305 caMPANY F NATIONAL UNION FIRE INS CO 100492-TH0•IPUSA-07 08 IP.USA I . COMPANY NSURER , HOMEbEPOT USA'.INCr G iLLIN0IS UNION INSURANCE CO 2455 PACES FERRY ROAD NW BUILDING,C-8 ATLANTA,'GA 30339 COMPANY N , • .5 1 -Y t.G i� -F. 1 i fn+.w ,J'..:H,t .. �,xµ• h.3'F�v7. .. �,. r l HER WIN fi 1 F j y t f tit r �.. e Y, 2. : Y. t } v 14 - ., ; r'•� -•,e7" 'F�'i �:.` : a «y,, .....r�k'w.�•��t3'�yj;y,�.:�'4 -�R(,n,'�-`"f"'1,�1�' rt ..t�!; z�a�`.t r rr RF�'4 � ��� ..:heL4'LSS4���?f3.M..-".a•:�'eT�",�»+,::s GiERTI ICATSHQIMER�"r . "� a�N� � � �+ �s r« &fie •�� =��z*�.'�a,: . .�ec�.:�. �y " �,'X• F+- 2e^. d .wli�.�..Lz�iurt«::,.iv,...«w'k:,f" �..+h.. ::d'iitiw�.^+�:rt:-"�'s�u�.23i<t::,a..cw:L•s«+-�ti`r+�;stt.7�..r.�FOR EVIDENCE ONLY mi q. 1 .. t�Il ,.e�11 i 7 �' ,��i P{�,A`�' yM,�ARSHUSAINCBY 11I'. `�f,•;_,.,1a .;,. k t ! ': ,.•M.-:S'S"I;�ANW � ��711 L�i�'"}i . IjY IMF lUi. ..,»I�II"" } Fit: �•i'�1�� t{ ���� �:Yd.:f1lIS f �' a,�..,, „L.�.:e..I'� I,I,�..7..Mary:R �..��".��.r��� _,....:Y:, •>�- ;.1 I . NFRC The Home Depot 6500-Series Double Hung Vinyl Window National Fenestration Architectural-grade, Soft Coat Low E and i Raengcouncil® Argon Gas-filled Insulating Glass Unit ENERGY PERFORMANCE RATINGS U-Factor(U.SJI-P) Solar Heat Gain Coefficient Visible Transmittance • 0.33 , 0.29. . O A8 Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining y twle product performance.NFRC ratings are determined for a fixed set of environmental conditions and a specific product size.NFRC does not recommend any product and.does not warrant the suitability of any product for any specific use. ENERGY STAR(` Clualified in all 50 States i. Northern. South/Central Mostly Heating Heating&Cooling ] North/Central Southern" Heating&Coaling Mostly Coaling P -W. OP:25 Test Size:48 x 80 Test Number.05.30307.01 ��ie �aamnw�w�eall� Board of Building Regulations and Standards , License or registration valid for individul use only HOME IMP, OVEMENT CONTRACTOR before the expiration date. If found return to: Registrations I28893 Board of Building Regulations and Standards ' �xpiratlan r3/3l2008 One Ashburton Place Rm 1301 Affype . uP lement Card Boston,Ma.02108 THE Home Depot glroe e o DANIEL PELOQ�IIN"— 3200 COBB GALLERIA;�tZWY#20 Atlantic,GA 30339 �'J _ Administrator Not valid without signature r to . jHOME 0 WROVEimmr CONTRACT BmuhNuzw Data • bb"a iLe Home Depot AtliomO Seevloea� 343A Caeeaw+ood Setet;A'atoasltc,VIA Ut607 C Dranrhl�amAer: 3� „Job Pt ThIl Free IBM 657.5182;Fax.508.7S6-2M 0. L Fedoet 1D t 766xaela%55LIC A C 434M IN OWL U.N 3607 P Cr M 0 5 012%MA trams lmprueemmtdooarela•Rry e]xNi! IatWbtUrnAddrarrr `i�g�d1.�^. w.11unmisacst� mo, mumk, ' E— a. t21yJ N Some ZfP F ): &4 %1V of o�rtrt HeeaeAddrerc ,4'1��11'�,o_t�'1 �� S�•=Loti,►S 1�L1sL.4i3��t OfdiECuatfi mlmullrkaoAM=) J C1.4' Stele Zip B-mallAddette 00-,d%v updates wAproroobmfram noHec a Deep* ?lojeet to w LWe+Yoa f P�scpaaee'�,the aanaci ed the Am y bc&tW at Ate above inatefledoo edd:ese,off,w 000ftawd TM At-HOw Srar3oer,Inc.CNomeDep o CO[uenlsh,MIAM and fbe amlosulla'ficaOfall Material, . asdwerl6adoodteelFacBedSpooSheetP—>ji1{�e-f�� .�o:porated�relabYafermreandmadeape:theaeof. ` Name Deppf rasenu the dght to Rawl.lib ooatrad 1L upon reaatpeetioa 41be Jeh,Home bepet dtoermlica am It purnot perfoim tes oDBgatiama dte to a truwc4aral probteo Mlh the iomh prlelag errors or 6ectaae wor4 regotned to aaaptett the Job was not Ittdmded In the Spec Sheet or Contrut. DEP0S r8AYbM'TWnONS . .. usk4ed b hw"mcwm aobmaeat tpyravai) . J COMRACTAMOIINT 3 '3 t: 'a*&-.owuma- cavttwwS—keb&oq.obkt tiassmp0s 7 (1..00 `f°prymdrbnrsllaaxnmot} .. L GRdU Cend"aaa(x oaerpymvtcytios.Orde OorDdra• BAWNCBDUB v'sa muteGrt :DSmD+e r ONOO��LBTION S l5 'S.�� 1bex3oaoatkgaH�etm�eovemmtl.sin^a� p�1t 4Mldmm2s%ifantmttAmeiddenpaa: tl'kwAecow OTC,— Aamm p!¢,ettm't7ctMLV) .�1DLseaaAoi ddl.tcatrae. A"M**Ctle91%tM%3 'pQ(,h1IDOC CPdYJ _ Ib[etoePt}atettMNhodFor .per r/] $ALANCXVUZ.ONCQ.WLRnaN:. 1i Atoms 134atskgpeuem ma 'olilalCiQ4 +ry�1h 1ot�Iy 4torna •'Bx ourolpautktaw.Fwwe �OOrato dk poHek[adioated boieWYN ome i&L uD9 T+eUdkdaeamebw E TAQ Lateti erleekr Roee£oretaaeeale aE[1 atBrraaR stele O tics tokh.&=par Room v b ycooe4Y 4s PDaKer k a . f7r l2edt.aeorlceOa.RS�wuea Oohrau0oafaom ycnr ale&at '.. W lorlr mtie[c+oKe:Hoof Oroee1,60A am4egg be wMdm,4 hom !M OS II11CC @e . A �teapeomtu enoo as aie eUs�tL'eadie4 Wa pm ward - li'joa! 170ett , wxhsyomt3eeettaed�. - , OPlr cheeer agree dm4 laa ediarelp tamp of the w�,PaccUm trill eze¢ate a Caepletion QrCBceta and pay toy x Daleooedx.Putrb3sorilsoggteptobOJoEtoy�ae+era)tyo656aeedendNab6ehersmdee Thu rgremotet and its itfachmema,in bAuq ae0'floand%aget om%ooeaein&a campiero agreed m P+otaeen thePtr6w ad om Sot he amended at modiSed wtleta io af3tiag in a tepanoe asmmeal dped bybA Partks-. NOTICE TO pvitcmSER Do ant elgt Ms aochatt bebre for read IL You m dded ampkaty f1lled•tt eapq of the tostrw at at am* tyros dw Kcep h to protect fov•ittBMa Do not r Ce CCtaetlMiMp btPore tlda project L oomplfts 16W Co iot baste toabeetom how regreotlrg or accepoig a Cempletfor Certlficeb.$t ied by at avrrar paler to totati�hof the trOr$tO bt peKarmed mda the contract, .. YOa my toned this tramudor aq thine PAST to addakOt of the dit buftess dap tiler the date d Wi eoatratt.See Notice of CamedLeMon ibr as eaplaratlot d thh del. There%ill be it min tharge egad to 10%Of the oontrtet "mat Web hessoelledbyPttclnwAPMt6ddvdbodaaoday,htt$BPOREmObrbban0rdcraLTlKa+twM bt a siOke ehnge egtd to 2554 ef 1be contrut mawael if Job le csaeelled by Part:htaer AFYBR ma UWI afe•ar&le& 0 m BYSftMR SMAIMBEIAW.MEUYn6RSTAND THAT TMAGREEbi6VT MAY BESUWEGT71ORbVlEW OF gyibL'R CREDIT HISTORY AM DWE AUr1MRLZE HOME DEPOT TO VEMT AND RBVIEW-MYIOGR N Q=PLRbCORD WITH AN 1NDEY6,\'DiOT1'CR6If0:1'R6PORIMO AMCY AND R£LF.ASE THEM FROM jILL---. t LIABILITYINCURPM FROM LCADVBRTENTOMASSIONSORERROR$, ~ BY bSYIC)ltR&[GNAT=BUDW,YWE AGREE TO BE BOUSM SY TIM TERMS OF TIDS CONTRACT. MR (V AMIMEDOB RAPOF A COPY OF THIS CONTRACT AND TWO CMH -ED COPIES OF nM-N01HM tb OF:ANCEI.L11)Q,V. SL�.1ffT1ED Date:e2`21�0O -. AOCENEDDY. Date: er YA 33r� yts ,4 Town of Barnstable *Permit �4 7� XpPRE Expires 6 months fran issue date SS Pe �7. Regulatory Services Fee SEP ct Thomas F.Geiler,Direor T�wNF 2007 Building Division 0Bq Tom Perry,CBO, Building Commissioner R/V`S�'gBC� 200 Main.Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number C;&2 Property Address ) (/o t el pt [-Residential Value of Work /,` /w• Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address S /���� r '� / Y 1/0 0 /DP6 � co le 41/461K If rQ�r Contractor's NameLhf. Meywe DeigeT 41, deate Telephone Number 5��9'q6,�•�j�{.y ? Home Improvement Contractor License#(if applicable) f d 6 9 7? Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner. I have Worker's Compensation Insurance Insurance Company Name !U4zw . (�o Workman's Comp.Policy.# 1 ,3 o Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles).All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value 3 3 (maximum.44) 3 *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 tlr.,Home Improvement Contractors License is required. SIGNATURE: Liaf.A Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts - -- -- Department of Industrial Accidents Off ce of Investigations 600 Washington Street Boston, MA 62111. www.massgov/dia. Workers':Compensation Insurance Affidavit: Builders/Co.ntractors/Electricians/Plumbers . AP licant Information PIease Print Lesibly Name(Business/Organization/Individual): E� Address: Ce /Z. p City/State/Zip 4 B'33 Phone.#77 Are you an employers Check the appropriate box Type of project 1. I am•a:em to er with` d 4 0 Ham a general contractor and I P Y, 5 []New'construction " employees_(full and/or part=time)* have hired the sub-contractors 2.❑�.I am a sole proprietor orparther listed on the attached sheet.t : 7 0 Remodeling ship and have no employees ': These sub-contractors have 8. ❑Demolition workingfor in an ca aci -workers' comp.insurance. 9 Building addition' y 1? ty. [] $ [Nil workers'comp.insurance- 5 [].:We are a corporation and its required'.] officers have.exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work rtgtit of exemption'per MGL 11 Q Plumbing repairs or additions rri self. c:152, 1 4 and we have no: .: y [No,workers comp. § O Roof repairs insurance requited.]t, employees [No workers'. • : :: camp. insurance requued;r i3 Oth e.rH �Qc;, er 'Any applicant that Aecks box#l.must also fill out the section below showing tfieir walkers'compensation'pohcylnformation.' .. t Homeowners who submit this affidavit indicating they are doing all_work and,tiienhire outside contractors Must submit a new`a�davitindicating such:' -.—=Contcactors_thaf clieGk t}us box must attached an additional"sheet showingtho name ot'thosub-conhactors and their workers'comp:policy information -- -� - I•ane on nm 14er that is providcng'ivbrkers'compensation insurance for my employees..Below isahe policy and job site information. . Insurance Company Name. F. : - M S I r& �+'/"S Ca • Policy-Al 6r:Sel f ins.L, # Job Site Address ! 1/�I D�7{ I .P City/State/Zip: (�a� Attach a copy of the workers'compensation policy declaration page(showing the policy clamber and_expiration date): Failure.tosecure coverage as required under Section 25A of MGL c.a 52 can lead to the itnposifion of criminal penalties of a -fine.up.to:$IM0.00 and/or one-year:imprisonment,as well as civil penalties in the form of a STOP;WORKORDER and a fine of up to$250.60 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 airs and p aIties ofperjury that the information provided ab+o`ve is rue and correct; Signature:' Date: �r`� Phone#: ro�� c0 .OJ70141 use only.:Do not write in this area,to be eompleled by city or town ofcial s - 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 Instr notions . 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." 1 , . 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,o.the receiver or:irustee`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 dd.maintenance,construction or repair work on.such dwelling house or on the grounds'or building appurtenant thereto shall notbecause.of such employment be.deemed to be an employer." MGL chapter 152, §25C(6)also states.that"every state local licensing agency shall withhold fhe issuance or renewal of a license or permit to operates 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;<MGG.chapter 152, §25C(7)states"Neither the commonwealth nor any of tts 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." ApplicantsZ. ' 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),addresses)and phone numbers)along with their certificates)of msuraiice..:Limited.Liability.Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the`, members or partners,are not required to carry work ers'-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 �►cc'idents:.for conf rmation of insurance.coverage.. �#lso be sure to sign and date the affidavit. The affidavit should be returned to the city or toxin 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' cotzipe ah ptshoy'please-call the Departmentt tthe number listed below Self insured companies should enter thou t self insurance license number on th10. e appropriateline City or Town Officials Pleasg be sure-that the affidavit is complete and printed legibly. The.Department has provided a space at'the bottom of the:aflidavI't for you to fill out in.1he event,the Office of Investigations has to contact you regarding the applicant. ' Please be su're'to fill~in the petmit/license number which will be used as a referenee`number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only,submit one affidavit indicating current Ir policy}nformation(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).;'A copyof file affidavit that has been officially stamped or marked by the city or town may be provided to'the a ` rotas roof that a valid affidavit is on file:for future permits or licenses. A new.aff davit must be,f lled out each PP P.., year.`Where'a home owner o..citizen is obtaining a license or perm it not related to any business or.commercial venture _ (i.e:a'dog'license or pekihit to buiii 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 havQq 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 5-26-05 www,maSS.gov/dia " _ ER IFICATE NUMBER PRflouceR ATL.00t23441 0-01 TNIS CERTIFIQA ,18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE rll hOQdepOf.CEftfeGU25t(03R1af8h.COr1I POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE FAX (21 Z)948-0902 AFFORDED BY THE POLICIES DESCRIBED HEREIN.. 3475 PIEDMONT ROAD,SUITE 1200 ATLANTA,GA 30305 COMPANIES AFFORDING COVERAGE COMPANY 00492-THD-IPUSA-07-08 IPUSA A STEADFAST INSURANCE COMPANY INSURED COMPANY HOME DEPOT USA,INC. 8 2455 PACES FERRY ROAD NW ,. ZURICH AMERICAN INSURANCE COMPANY BUILDING C-8 COMPANY ATLANTA,GA 30339 C , AMERICAN HOME ASSURANCE COMPANY .`COMPANY nGOVERI�CsES � D� NEW HAMP E COMPANY _ SHIR INS CO AN .�4:�,sze,: ���� t1" xn.�."zxi,.�...-;M..,.t,.•fS ��.....:..�.��.��.��� �ri. �F� �GQ`� � � "�. � „� '.:,... +Km%1u :�,.: ���'.'?,;�•"� •.�."'t';� r � -`-..•:-�� .�. . �a�""��� FOR HEREIN,RD7iE�grrodxr�atec�befiQ THIS.IS..TO CERTIFY THAT POLICIES.OF INSURANCE DESCRIBED'HEREIN HAVE`BEEN 1S$UEO 1 THE INSURED NAMED THE.POLICY 0ER100 INDICATED NOTWITHSTANOINGRNY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER OCCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOW N MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO. TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDOIYY) LIMITS' A . GENERAL uAeaLTv IPR 3757 608-02 03/01/07 .. 03/01/08 GENERAL AGGREGATE $ 4,000.000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF.POLICY ARE EXCESS' PRODUCTS•COMP/OP AGG $ 4,000,000 CLAIMS MADE a OCCUR 'OF SIR:$1,000,000 PER OCC' .' PERSONAL S ADV INJURY $. 4,000,000 OWNER'S 3 CONTRACTOR'S PROT 1 EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one ere) $ 1,000,000 B AUTOMOBILE LIABILITY MED EXP(An one person) $ EXCLUDED BAP 2938863-04 . 03/01/07 03/01/08 X COMBINED SINGLE LIMIT' $ 1,000,000 ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS . .; ". BODILY INJURY NON-OWNEDAUTOS (Per accident) $ X ELF-INSURED AUTO HYSICAL DAMAGE PROPERTYDAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ , ANY AUTO OTHER THAN AUTO ONLY EACH ACCIDENT $ . EXCESS LIABILITY AGGREGATE $ A IPR 3757 608 02 63/01/07 . 03/01/08 EACH OCCURRENCE ... e 5000,000 X UMBRELLA FORM AGGREGATE $ 5,000,000 OTHER THAN UMBRELLA FORM $ C WORKERS COMPENSATIONANO 2921209(CA) O3/O7/O7 O3l01/O6 TA OTH� s EMPLOYERS'LIABILITY X TORY LIMBS ER s E 2921210(FL) 03/01/07 . 03/01/08 EL EACH ACCIDENT $ N 1.000,000 F THE PROPRIETOR! X INCL 2921211(AZ,ID,MD,VA) 03lOt/07 03/01J08 D PARTNERS/EXEC EL DISEASE-POLICY LIMIT $ 1,000,000' OFFICERS ARE: EXCL 2921208(AIDS) 03/01/07 03/01/08 C OT ER EL DISEASE-EACH EMPLOYEE $ 11000,000 2921213(QSI) 03/01/07, 03/01/08 E WORKERS'COMPENSATION 2921212(KY,MO,NY,WI) 03/01/07 03/01/08 G TEXAS EMPLOYERS. TNS-C44642086(TX) 03/01/07 03/01/08 EACH OCCURENCE 25,000,000 EXCESS LIABILITY SIR DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS 2,000,000 HfCOERy _; u R r.AIYfrE4.LA�IO s .�`-�'„nt9,.��:.�z.�� 3r:�.,au. .�m �::''" u•.s -- T� � � r .!�r�� a4����f '� � �„��.v° ���,�" �°44 - x�`dx.-.. �'w� r�da,.#a4:`�'.''T'1o`Kid.`�'..an,'.�:.Ya.2•��Y,;iYea.�3}�.�•3Y:.u«18�.':���i1`.�ka:.. s` .,a4e�cie•J, kE`��Aa'.`,.'ka.3#n sE.�F`4 "i xp r� - SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL�a DAYS WRITTEN NOTICE TO THE FOR EVIDENCE ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIFICATE. - - - ^-. MARSH USA INC. BY: Mary Radaszewski y` + fir. .�•_ � s-r z_`ct ^wx sr I,�! AS OF 02/28/07 �:-�• .�as�, r�""€.+MJ`•�:�,��`�".�*,���`°;`_-��.-! '���FSf�'�Z.':,„'�..�.. �Zr��w.z��'.aG,"Nt. s��� �'�i^����'� '��r��r3.�k���"��a,��'`y'iS�'.r' �.,��`��^a �• +c��. % � I• .1 DATE(MMIDDIYY) F� r au�w .02/28/ 07 i � � W�, .a COMPANIES AFFORDING COVERA E s e PRODUCER MARSH USA INC. COMPANY '. homedepot.certrequest@marsh.com, E ILLINOIS NATIONAL INSURANCE COMPANY. FAX(212)948-0902 3475 PIEDMONT ROAD,SUITE 1200 ATLANTA,GA 30305 COMPANY F NATIONAL UNION FIRE INS CO 100492-THD-IP USA-07-08 IP USA INSURED COMPANY HOME'DEPOT USA;INC. G ILLINOIS UNION INSURANCE CO 2455 PACES FERRY ROAD NW , BUILDING,C-8 ATLANTA,'GA 30339 COMPANY d. c z- :� `€'r=1r kl `1�. �`a"` '. �;}'�` -` �G� '3 t-x' •3..�` 'm"e"' 't `�"rr "CERTfFICATE FOR EVIDENCE ONLY �} m. ; MARSH USA INC.BY Mary'Radaszewskl OR p M .,.k 'h sic r`t'4'°a '� c ,rn"'xx� `q "..,�I� @' � n33u. 'rR�, (` ,'' .':, ` ,:-5, ��. °� . +� 3: .s�.,t �Rt The Home of De . p 6500-Series Double Hung Vinyl Window Architectural-grade,Soft Coat Low E and National Fenestration Rating Council® Argon Gas-filled Insulating Glass Unit : ENERGY PERFORMANCE RATINGS U-Factor(U.SJI-P) Solar Heat Gain Coefficient Visible Transmittance 0.33 0029 OA8 Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining Whole product performance.NFRC ratings are determined for a foced set of environmental conditions and a specific product size.NFRC does not recommend any product and does not warrant the suitability of any product for any specific use. STAR'ENERGY Oualified in all 50 States i ® Northern. South/Central" Mostly Heeling Heating&Cooling M North/Central Southern ®` Heating&Cooling Mostly Cooling o Dp:25 Test Size:48 x 80 Test Number:05-30307.01 � GTE Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Regstratrori _�26893 Board of Building Regulations and Standards Exprratlon 8/312008 One Ashburton Place Rm 1301 . Type :SFupplement Card Boston,Ma.02108 THE Home Depot A f tome Selvic MNIEL PELOQ'I 1 " 3200 00BB GALLERIA Atlantic,GA 30339 Administrator Not valid without signature P HOME IMPROVEMENT CONTRACT Sold,Fumishcd and Installed by: • Branch Name: 001.4 Date: Q• Ao THD At-Home Services,Inc. drb./a The Home Depot At-Home Services ell 345A Greenwood Street,Worcester,MA 01607 Branch Number: IM, Job Toll Free(800)657-5182, Fax: 508-756-2859 Federal ID'0 75-2699460 ME Lic#C 02439 RI Cont.Lick 16427 i C'I'Lick 565522;;- MA liome tmprrovvemcnt Contractor Rcb.k126893 Installation Address: 1�� �C��IN L RNf �/y. f�i i�i10� + v� City State Zip Last 4 Digits of Driver's Purchaser(s): Lic.k&E.• o/Yr: Work Phone: Home Phone: ( ) ( ) Home Address: A1 A _ (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): a�A Project Information: I/We/You("Purchaser"),the owners of the property located at the above installation address,offer to contract with THD At-Home Services,Inc.�"HQme,D of")to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet# U�� $�ly(; incorporated herein by reference and made a part hereof . Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home, pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS (Subject to fund verification andror credit approval.) ` Iy CONTRACT AMOUNT I. Chuck*,Cashiers Check or US Postal ServiceMoney Order t ll (Made payable to The Home Depot). s� -BLESS DEPOSIT S D�G 2. Credit Card"andlor othv payment options-Circle One Below BALANCE DUE Visa MasterCard Discover American Ex ON COMPLETION $ _ The Home Depot I lame Improvement Loan The Home Depot Credit Card tMinimum 25%of Contract Amount due upon ❑New Account xisting Account (}IIL&HDCC ONLY) execution of this contract. Available Credit:S 6 DLL- (HIE,&HD'CC ONLY) Indicate Payment Method For Acctk: Exp.Date:._. N��t BALANCE OMPLETION: Name as it appears on card: [y�1cT l7t'l�Vlttj/ By my/our signature below,I/We agree to allowJDa /It o charge t�abbovc, of ce t card for the de'When you provide a check as payment,you authorise us either ___ to use information from your check to make a one-time electronic G t c fund transfer from your account or to process the payment as a check transaction.When we use information from your check to HIL or HDCC Authorization Codes stake an electronic fund transfer,funds may be withdrawn from your account as soon as the payment is received,and you will not Deposit Final Payment receive your check back. # d— tcO # . Purchaser agrees that,immediately upon completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Atr-reement: This agreement and its attachments, including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time .you.sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project.is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 10% of the contract amount if job is cancelled by Purchaser AFTER the third business day,but BEFORE materials are ordered.There will be a service charge equal to 25%'of the contract amount if job is cancelled by Purchaser AFTER materials are ordered., BY MY/OUR SIGNATURE BELOW,]/WE UNDERSTAND THAT THIi_AGREEMENT MAY BE SUBJECT TO REVIEW OF 'MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DI"'POT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL I3ARILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. 1'urcllascr�s}:' Lic.#&Elp.Vo/Vr: Work Phone: Home Phone: UA*T av1L Home Address: N .A _ w (If different from Installation Address) �- City State Zip E-mail Address(to receive updates and promotions from The Horne Depot): �j.A' Project Information: I/We/You("Purchaser'),the owners of the property located at the above installation address,offer to . contract with THD At-Home Services, Inc PA me D ot")to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet 4 -1t b E ,incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract DEPOSIT PAYMENT OPTIONS G (Subject to fund verification and/or credit approval.) J,�MOS CONTRACT AMOUNT $ �� f�S 1• Cheeky,Cashiers Check or US Postal Service Money Order (Made payable to The Home Depot). . fiLESS DEPOSIT $ 6!a f 2. Credit Card**and/or other payment options-Circle One Below BALANCE DUE Visa MasterCard Discover American Lx ON COMPLETION $���_ The Home Depot Home Improvement Loan The Homc Dcpol Ctcdit Card j'Minimum 25%of Contract Amount due upon ❑New Account 2,0xis`ting Account (HIL&HDCC ONLY) execution of this contract. Available Credit:$f S i (H[L&HDCCfiONLY) Indicate Pavment Method For ncctu: Exp.Date: NIA BALANCE OMPLETION: e Name as it appears on card: **By my/our signature below,I/We agree to aIlow Horn o to charge a abov of ce card for the deposit' di t *When you provide a check as payment,you authorize us either Q to use information from your check to make a one-time electronic �' r rold"cr s S' nat c Da fund transfer from vour account or to process the payment as a check transaction.When we use information from your check to make an electronic fund transfer, funds may be withdrawn from HIL or HDCC Authorization Codes your account as soon as the payment is received,and you will not Deposit I Final Payment receive your check back. # CT[ # !'1 p 6 Purchaser agrees that, immediately upon completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement: This agreement and its attachments, including any financing agreement, contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely tilled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of'the work to be performed under the contract. You may cancel this transaction any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 10% of the contract amount if job is cancelled by Purchaser AFTER the third business day,but BEFORE materials are ordered.There will be a service charge equal to 25%of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW,l/WE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND 11WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDFPFNDEiNT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNATUR B I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. IIWE ACKNOWLEDGE RECEI A ,OPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATI SUBMITTED BY: Date: 17 }7 ACCEPTED B Date: -'Pun aser ---- _ --- Date: —- Purchaser • r NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THUS CONTRACT S 60-07 rev 4-2-07 C-SC t.6 0 0 6 2 D*hUd-Branch File Yellow-Customei 0 NN"SI11fitt9rQultant „ 1 a t ,t a 1 sx 3y lx I l I 5 Y' CIA MIMI Is- SRI, 3' < / t „ir d; K s a WOO�r r 3 r ' �r k k } k > e T M , y .. n <.h ,(of kfv.'.a;, »„�px�< '�. •�i« � `aP., •b z''• ��hh 3 �.' st •r1 y"� � Y z�-..: ,/ t. %kr A.- :y qfir, t' '.\4�£��� '.•Ty. lZE” "'�' f �p'.' .a` a€5 / �. the ' ." � � d .�: ✓' �' f ^W I II X sync. ( 4 n , , i f 6'rf , , '� �,'-.� � � sE: ��,,,'., � �,- �" �- h e.:- y �3�,z, ; ��R$•aiY���e� '(�j 9,�y: g.. �e ✓� ,^,• "u, � �\ „fir. � �+> -- a, c l ��., >, lG�',.�:.. a� l _ \ s. 3 x , 4x. 7 \ 2EY \Fr<. ITS 4 a a.. .a 1. k y 9 a� v f, a 3 E 1 _a 3a \ l \ 1 j3 \r P '�iy'ttx e I � 3 b I, �a a P t. �y y w , t y,s§�-•1.P ; dJ� '`r `.-, ::. � s � «r Sys �' � '�a'';. a� �".� F r� 5",iti `u z �£ti:s t K� '� � _x�� ��f al. 1 `"� � �g! y'. _"T€ ':� >`,-'• � r i ..x �,��' y'.` ,:�, ,�• ":t", p ,try r� i r� t'�"� :i"' -vie`-...' ,z^ .�. �a .�:.1' ::«, t 4, .w' f•n :M `: \ .- ,:. � fi ,� �' _.. '_\ � U it z k £ x *i� '� ,.� 33, .,L- k`a' r•^. -aaid' ^>L `.l� `?".�, P `w v, fih 5 f a, 3 F 't f3 Z ?ir b 1 x v a w, z 9 \ �s a,. n.. S r 5 R> \ 3 u'�r i \sL 7 17 Do h y,p a h x 3� a -s ,.F... p� :;ate .c ': .. ,•4, i i i- y "1 < ; < I < ^ l" 4 \ � f c.• f :fin; -...s-.r '�\. a '•«e � c. r Z �xxx, C 1 `s if 'ikx: H l y� t r: 1 3 \Y h s: a / a: `a r-j e . 3 i a: v r� \,u u r 3. x � �x E a .:w c , x 2 } �\ fir•,' \ i / 7„1 1a123.0 17»�D`ol, .,., s.•. .. <.a.a... _ ,,, ..tea.... .. < Z.,. '' „ xt:. -�.. a i a \ fit 'k sus' l N ; r: ^ _.. F&P YS e. ,u , a\ FaM f Y _ �r m ,� ,,,. � ... -.,' � \. ,.}.a x ,r...c _... a.. .gym .\" k H\• `\ "$" T A ,.. \ z a1�x Town of Barnstable Regulatory Services q% Thomas F.Geiler,Director f, sAmas=rnat.E. i Building Division v M S& �' Tom Perry,Building Commissioner ` .z639 �0 i°reo 39 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: 4:6- Permit#: 19 NO (p HOME OCCUPATION REGISTRATION Date: 1/ {6. 0// Name: .!A-CKy 1&-Z<_G Y i Phone#: w q Addre s //D D L f�f/I ,C./qNC Village: ��iQ/�jS7A�j ll' Name-ofBuLess: k/6-4L-r9 /V drA'J7/b ---------------------------- w tom_ Type of Business: AY-7 y� Ma ot: INTENT: 1- is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation withi 'single�family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shay—n t b discenu e from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would.,suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air'or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No persop shall be employed in the Customary Home Occupation who is not a permanent resident of the dwellin t. I„the undersigned, e read and agree with the ab estrictions for my home occupation I am registering. Applicant:_ Date: Homeoc.docVev.51 TO ALL NEW BUSINESS OWNERS DATE: // /�• d Fill in please: s APPLICANT'S YOUR NAME: J e-Ky BUSINESS �30�5. YOUR HOME ADDRESS: //o ,:�08"-asa TELEPHONE Tele hone Number(Home)— jw 8 - "/ �0 NA�AE 4F NW'BUSINSSLy �zr. ra I) t1S ,i�APfi7tc IS H rreQb Keen giver ap;provI fI'+al�rt the k��Uiltllllll' i�r(si�rn7 Alps = �xrslNl Ss � � .� When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St.- (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING CO STONE 'S OFF This individual h b nfor d of a p irem nts that pertain to this type of business. 'z Si ur , COMMENTS: 2. BOARD OF HEALTH This individual en 'nf r d he a uirem is th rtain to this type of business. COMMENTS: u honzed Signat I , 3. CONSUMER AFFAIRS. (LICENSING AUTHORITY) This individual oft ing e e requirements that pertain to this type of business. Affttorized Signature*'* J �6 JCOMMENTS: N0 moti f- � baAl/1-2. 6t.rQ,Q. & " .GC aA SO 00P- /lc S S Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. t 7 06/20/2000 09:31 5087715336 CRAIGVIL_E REALTY Cat PAGE 02 CRAIGVILLE REALTY CO. W CR UGVft.I,E 73EAQ1..IRd) BOX 216 R£A LT O R S SST HYAIINNISPORT,MASS.02672 TUL 508-77S-3174 FAX 508-M-5336 E-MAIL: N-A.A ENTOCA .ECOD.INET MA,It17V TRAYWICK MEMBER MIS 6WtwEti Tune 15, 2000 S. and G. MacDonald. 110 Dolphin Larne Hyannis, KA O260.1 Dear Mr. and Mrs . MacDonald: 1n ,accordlance with our agreement, this office and the owners of 110 Dolphin Lane, Vest Hyanrnisport, MA, will reclaim these premises on June 30, 2000 upon, your 'termination of occupancy. Very truly, � J Martin C. Traywick l 06I20I2000 09;31 5087715336 CPAIGiVILLE REALTY Co PAGE 01 Cl2AIGVILLE REALTY CO. 648 CRA1GVILLE BEACH]ROAD BOX 216 REALTORe,' WEST HYkNNZSPORT,MASS.02672 TEL: 508-775-33-74 FAX, 508-,771-5336 E-MAIL: KkRT)N0Q4PEC0D.NET MART N TRAI'WICK MEKBE;R MIS s June 20, 2000 TO: Gloria Urenas VIA: Telefacsimile FROM: Martin C. Traywrick Dear Ids Urenas: See attached notice to S. and J. MacDonald., residents of 110 Dolphin. Lane, West Hyannispart, MA. � Dent regards, Martin C. Traywick r i CF 1HE l The Town of Barnstable • snxxsena�, • 9�A i6 � Department of Health Safety and Environmental Services rF1 39. 6. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner June 7,2000 Stuart Glovinsky 124 Bellington Lane Creve Coeur,MO 63141 RE: 110 Dalphin Lane,Hyannis Dear Mr. Glovinsky: This letter is to confirm our visual inspection of your property on June 5,2000. You are hereby issued a Cease&Desist Order for the following reasons: 1. The property is located within the RC Residential Zoning District Section 4-1.4. 2. There should be no commercial vehicles related to Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity. 3. No person shall be employed who is not a permanent resident of the dwelling unit. You are hereby ordered to discontinue the use of the above referenced property as it is now being used and use it as a single-family home. You are to accomplish this and notify this office to arrange for an inspection of the premises within 14 day's receipt of this letter. You have the right to appeal this decision. If you so choose,we will be more than happy to help you. If we do not hear from you within 14 days,we will seek further action. Since ely, Gloria Urenas ZONING ENFORCEMENT OFFICER GU/sc q:z981019a 7 71 CF WE A The Town of Barnstable MAUM&• wuvsTnai.�. - ; �e� Department of Health Safety and Environmental Services � 639 ► Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner June 7,2000 Stuart Glovinsky 124 Bellington Lane Creve Coeur,MO 63141 RE: 110 Dalphin Lane,Hyannis Dear Mr.Glovinsky: This letter is to confirm our visual inspection of your property on June 5,2000. You are hereby issued a Cease&Desist Order for the following reasons: 1. The property is located within the RC Residential Zoning District Section 4-1.4. 2. There should be no commercial vehicles related to Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity. 3. No person shall be employed who is not a permanent resident of the dwelling unit. You are hereby ordered to discontinue the use of the above referenced property as it is now being used and use it as a single-family home. You are to accomplish this and notify this office to arrange for an inspection of the premises within 14 day's receipt of this letter. You have the right to appeal this decision. If you so choose,we will be more than happy to help you. If we do not hear from you within 14 days,we will seek further action. Sine ely, Gloria Urenas ZONING ENFORCEMENT OFFICER ' GU/sc a q:z981019a f Building Department Complaint/Inquiry Report - s Date: �'`� — Rec'd by: Assessor's No.: Complaint Name: Location - Address: �U Wp Originator Name:- Street: Village: State: Zip: Telephone:D/C Complaint Description: Inquirya Description: For O/Scc Use Only Inspector's Action/Comments Date: — — Oc) Inspector. a • v� 0, VL Follow-up 7 Action Additional Info.Attached Copy Distribution: White-Department File Yellow-Inspector Pink Inspector(Return to OITce.:lfanager) +------------------------------ BILL INQUIRY --------------------------------+ (Action: . . . Interest-Date Orig-Bill A-Appraisal J-Other-Names . . . I IDisplay Original Bill detail. I I I I Year ' Type Bill # Cust # Name Notes/Special Cond? N I 2000 RE-R 11107 96185 GLOVINSKY, STUART I I I Parcel ID Property Loc/Ref Parcel ID I 1268-034 110 DOLPHIN LANE 268034 I I I Int Date Billed Abt/Adj Pmts/Credits Interest . Unpaid bal I 11 12/18/99 743. 82 . 00 743. 82 . 00 . 00 i 12 05/02/00 743. 80 . 00 743. 80 . 00 . 00 I 13 I 14 I Fees: 00 00 00 . 00 . 00 I Totals : 1, 487 . 62 . 00 1, 487 . 62 . 00 . 00 I JAN 1 Owner: GLOVINSKY, STUART Discount . 00 1 Mail Addr/Tel 124 BELLINGTON LANE Due 06/05/00 . 00 I CREVE COEUR, MO 63141 Per Diem . 00 I I Int Paid 11 . 69 i I 2 0 6 I +------------------------------------ -----------------------------------------+ +------------------------------------------------------------------------------+ (Action: Exit I (Exit the RE Original Bill Screen. i (Year/Bill# [20001 [ 11107] Tax Year (s) [2000 ] Add' l Names? [N] I ( Parcel [268-034 ] Namel [GLOVINSKY, STUART ] I (Alt [ ] Name2 [GLOVINSKY, ELEANOR ] I ( Street [ 110] [ ] Unit [ ] I I [DOLPHIN LANE ] DBA[ ] Own [ ] I IJuris [400 ] Class [1010] Status [A] [JAN 1 Owner: GLOVINSKY, STUART ] I ISubdiv [3 ] Zone [ ] List [ ] Lender [ ] Acct [ ] Sery [ ] I 1 # Fam [ ] SIC [55BC] Exempt [N] Legal description I (Acres [ . 2301 SF [ 10019] [#LAND 1 21, 700 ] I IBk/Pg [3024/119 ] [ ] [#BLDG (S) -CARD-1 1 57, 000 ] I I Values Prev Year This Year Tax/Exem Rate Amount Totals I ( Land Val [ 27, 900] [ 27, 900] [HYTAX ] [ 3. 740] [ 328 . 75] Taxes i (Bldg Val [ 60, 000] [ 60, 000] [LANDBK] [ . 000] [ 33. 75] [ 1487 . 6211 IPers Val [ ] [ ] [TAX ] [ 12 . 800] [ 1125. 12] Exempt/Abated I I Gross [ 87, 900] [ 87, 900] [ ] [ ] [ ] [ . 00] 1 ( Spec Assmnt Bal [ . 00] [ ] [ ] [ ]Net Taxes I ( Curr Land Use [ IL ] [ ] [ ] [ ] [ 1487 . 62] 1 I Curr Val Exem[ ] [ ] [ ] [ ] [ ] I I Curr Taxable [ 87., 900] [ ] [ ] [ ] I I I +------------------=-----------------------------------------------------------+ Town of Barnstable Department of Health, Safety, and Environmental Services IAENSTABM 1659. A,O� Public Health Division P.O. Box 534 Hyannis MA 02601 Office: 508-8624644 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health December 10. 1999 Stuart & Eleanor Glovinsky 124 Bellington Lane Creve Coeur, MO 63141 NOTICE TWATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located 110 Dolphin Lane; Hya , was inspected on December 8, 1999 by Glen Harrington, 'eltlr�nspe�terr-€ he Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: 410.351: Fireplace flue was observed to be inoperable (stuck in open position). 410.351: Bathtub drain was observed leaking into basement. 410.351: Hot water heater was observed leaking onto basement floor. 410.452: Kitchen exterior stairs were observed to be broken. i 410.481: No posting of owners and property managers,name, address, and telephone number. 410.500: Bulkhead stairs were observed to be rotted and cracked. 410.500: Bulkhead doors were observed not to be watertight. 410.500: Bathroom and rear first floor bedroom floors were observed to be rotted due to water damage. 410.501: A storm window was observed to be broken adjacent to the kitchen egress. 410.504: The tub wall was observed to be loose (no seal along back rim of tub). glovinsky/wp/q/ls You are directed to correct the above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH omas A. McKean Director of Public Health cc: Jim Maguire Jcc: Building Dept. 4 w glovinsky/wp/q/ls 41 �TMt:ro The Town of Barnstable Department of Health, Safety and Environmental Services Building Division 10� 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration /5—J I� "P Date: v Name: to 0 ✓� w U.v L G 4 Ll G Phone !#: Address: o Do l k ', Village: L&VL t~S Type of Business: �" �� t Map/Lot: 2( 9 03 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,%ibration,smoke,dust or other particular matter,odors,electrical disturbance,heat, glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity, .uid one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have ad an e with Ae above s lions fo w home occupation I am registering. Applicant: Date: Homcoc.doc 1 y ' r PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 p/ DATE: 08/30/06 TIME: 12:28 ------------------TOTALS------------------ PERMIT $ PAID 32.80 AMT TENDERED: 32.80 AMT APPLIED: 32.80 CHANGE: .00 APPLICATION -NUMBER: 20062892- PAYMENT METH: CHECK PAYMENT REF: 14726 ' Town of Barnstable *Permit#t;?ll64 j>),?JQ Expires 6 months from issue date Regulatory Services Fee `3c,� .Is 0 X-PRESS PERMIT Thomas F.Geiler,Director AUG 3 0 2006 Building Division Tom Perry,CBO, Building Commissioner rJ TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint lap/parcel Number ®3 roperty Address D A t lJ ` ®o Residential Value of Work 496Minimum fee of$25.00 for work under$6000.00 )wner's Name&Address a%r_ O NO 0 3IV/ ;ontractor's Name 6M 2 @� � Telephone NumberTome Improvement Contractor License#(if applicable) p — - - 21rorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance/ assurance Company Name Norkman's Comp.Policy# �� 1 l �opy of Insurance Compliance Certificate must be on file. ?ermit Request(check box) G r &I/Re-roof(stripping,old shingles) All construction debris will be taken to '71 a I SpD Sj �.�'V t ct_ ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value 2 (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign PrgpKty Owner Letter of Permission, cOP f the Ho m rov ment ontractors License is required. SIGNATURE: QTorms:expmtrg Revise061306 E t ne t.ommunweatin of lnussuc nu�rcw - y Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 01111 www.mass.gov/dia �Y Workers' Compensation Insurance Affidavit., Builders/Contractors/Electricians/Pluinlbers Applicant Information Please Print Legibly Name (Busmess/ora nization/Individual): OoIuC Rose Address: City/State/Zip:_- "�� i - 3b 3�! Phone#: 9�o AZZ n employer? Check the-appropriate boa: Type of project(required): 1, a employer with�0 4. ❑ I am a general contractor and I employees (fU and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or paler- listed on the attached sheet $ 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. Demolition working for mein any capacity. workers' comp. insurance. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical r airs or additions required.] officers have exercised their eP 3.❑ I am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.[9 Hof repairs insurance required.] t employees. [No workers' r comp.insurance required.] 13• -tither I�u lx/r *Any applicant that checks box#1 must also iiIl 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 anew affidavit indicating such ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy inforrnation. I am an employer that is providing workers'compensation insurance� for my employees. Below is the policy and job site information. &L LP Co - • 'Y tJnsur•ance Company Name: W . ct-e S Policy#or Self-ins,Lie. #: b [ Expiration Date: 1 0, 4. Job Site Addiess: o ri LCity/State/Zip:_[�l tea`5 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 apposition of criminal penalties of a fine up to $1,500,.00 and/or one-year imprisonment, as weL as cnril penalties in the formm,of a STOP WORK ORDEp, and-a fine of up to.$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify er a pains and alti perjury that the information provided above is true and correct. Si ature: Date: 4?- Phone#: svgOfficial use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Boa-rd of Health 2.Building Department 3.City/Town Clerk e.Electrical Inspector 5.Piumbina laspest.OY 6. Other Contact Person: Phone r: f °FINE, Town of Barnstable Regulatory Services BARNSTABLE9MAM '$ Thomas F.Geiler,Director fo;pray` ` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, sLai4- V V .5 (C44 as Owner of the subject property hereby authorize t e-ru2 0� to act on my behalf, in all matters relative to work authorized by this building permit application for: Ito 20 /X) (Addrifs of Job) 6 ��� Signature of Owner Date Print Name Q TORM&O WNERPERMISSION 08/27/2006 07:19 5087476629 PAGE 05 HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: Branch Name: Aj Date: 6t5 THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services One Marlen Drive,Robbinsville,NJ 08691 Branch Number: 1, Job#: a -3 Toll Free(877)513 3768;Fax:(609)631-9099 r NJ Lie#L044842 Ref#9723181-0O3;Db Lie#199711231.0 F� ,Federal ID#75-2698460 Installation Address: 110 To R�tN�a6 City state Zip Purchaser e: Last 4 Di its of Drlvice,s Lk-rk&Ex .Mo/Vr: -VA"Phonr. ,Home Phone: - Home Address: 'L .._ �_ (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): Project Information: i/We/You("Purchaser"),the owners of the property located at the above installation address,offer to contract with Home Depot U.S.A.,inc,('•Ijgme Depot")to fumish,deliver and arrange for the installation of all materials as described on the attached Spec Shec incorporated herein by reference and made apart hereof, Home Depot reserves the right to cancel this contract if,upon re-Inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. . DEPOSIT PAYMENT OPTIONS Y/1- (Sublecl to fund verification and/or credit approval.) d7l K 1, Chcck,Cashiers Check or US Postal Service Money order CONTRACT AMOUNT $ i:irl � (Made payable to The Home Depot). v /`j*I.,F,SS DEPOSIT $ 2. Credit Card"and/or other payment options-Circle One Below Visa MadterCard Discover American Express ' BALANCE DUE The Home Depot Nome improvement Loan The Home Depot Credit(:ard ON COMPLETION $ xjQnO lJ New Account ❑F,xlsdag Account (HII.&HpCC ONLY) *Minimum 25%of Contract Amount due upon Available Credit:S 0 (HIL& DCC ONI. execution of this contract. ---- - - Name as it appears on card: Indicate Payment Method For *By my/our signature below We agree to Ilow Home Depot to BALANCE DUE ON COMPLETION: �.,Zh. en Sli and fo the deposit indicated. Sigttattfic ---- — Date HIL or HDCC Authorization Codes Deposit Final Pa meut # 0-2-C / # 0-L-e- �r7 Purchaser agrees that,immediately upon completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement: This agreement and its attachments, including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE.,TO PURCHASER 1 Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 2S%of the contract amount if the job is cancelled by Purchaser AFTER the third business day. BY MY/OUR SIGNATURE BELOW, I/WE AGRLE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WF AC'KNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CRkJAT HiSTORY AND ME AUT14ORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM.INAD ERT T OMISSIONS OR ERRORS. / Date: SUBMITTED BY: ACCEPTED BY: Date: - „ Date: —_....Horneuwnet NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THF;REVERSE SIDE AND ARE PART OF"PHIS CONTRACT 7-18-06 C-SC White-Branch File Yellow-Customer Pink-Sales Consultant MARSH 1 - �» ,. y zy �' ��' N Q NZ E CERTIFICATE NUMBER •. =r-iq-; .:s..».::r.,. ;.%d t ts,• ,,., ,��" s sLi r���i j �.'E�v. f!�i r ATL-000915907-11 � s a� _. PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE ATTN:BRENDA BOOKER (404)995-2594 POLICY,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE I MAYA MCCLURE(404)995-3206 OR AFFORDED BY THE POLICIES DESCRIBED HEREIN. j TA(vl!ROUSE(404)995-3430 FAX(404)760-5663 COMPANIES AFFORDING COVERAGE I 347n OIEDMONT ROAD, SUITE 1200 - - 1 A T LA.N1TA,GA 30305 I CC.Mp,-,,:Y 100492-!PUS ,-GVVA-03/C4 I A S T E:''_FAST I<:S:.;RANCE CC^-:`•IPAI�IY INSURED - c MF rn — 'C-- —,E rDAT-HOMES .'!ICES INC. i B ZL;P.' i.4Pv1EP.:'. iINSI;R:aiC' CON IF?iiY -- CSA THE HOME LIE=0'-AT-HONIE SERVICES,INC. U - { .,—ram DE POT JSA i.. ' I �GMPA?i' ' . 455 Pr =S FERRY ".D i`i':`! C NEV. INS Cl )= �;`i BUILDI dG C-8 - - - — ATLANTA,GA 30339 COMPANY D AMERICAN HOME ASSURANCE COMPANY CQVERAGfSficate srlpersedes and:r'.eplaces any gre ously,(ssued cer ifica a for tiefpolicypeno i noted below_ THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DOIYY) DATE(MMIDDIYY) A GENERAL LIABILITY IPR 3757 608-01 03/01/06 03/01/07 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY.ARE EXCESS' PRODUCTS-COMP/OP AGG $ 4,000,000 CLAIMS MADE a OCCUR 'OF SIR:$1,000,000 PER OCC ' PERSONAL&ADV INJURY $ 4,000,000 OWNER'S 8 CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire) $ 1,000,000 MED EXP(Any one person) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-03 AOS 03/01/06 03/01/07 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) X ELF-INSURED AUTO PROPERTY DAMAGE $ H-YSICAL DAMAGE GARAGE LIABILITY AUTO ONLY•EA ACCIDENT $ I ANY AUTO OTHER THAN AUTO ONLY EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ f UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ G WORKERS COMPENSATION AND 6610998(AZ,ID,MD,VA) 03/01/06 03/01/07 X Toav L M,rs ER 1481,110M `.�, EMPLOYERS'LIABILITY C 6610995(AOS) 03/01/06 03/01/07 EL EACH ACCIDENT $ 1,000,000 G THE PROPRIETOR/ X INCL 6611326(OR) 03/01/06 03/01/07 EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERS/EXECUTIVE NY,WI E OFFICERS ARE: EXCL 6610999( ) 03/01/06 03/01/07 EL DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER WORKERS E. COMPENSATION CONTINUED 6610997(FL) 03/01/06 03/01/07 D 16610996(CA) 03/01/06 03/01/07 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES!SPECIAL ITEMS CE;TfRICA3E HO DE * s } CA'AICE4LAT.tQN� _*� z `:` A 3 SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL ln DAYS WRITTEN NOTICE TO THE FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,RS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: Walter Gilstrapo. .. r�,iztnx- Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration 1,26893 One Ashburton Place Rm 1301 Ex}�Iratign' 8�/3/,"2008 k ar r,a Boston,Ma.02108 lement Card 4 YI?¢ yll?P THE Home Depot,At dome Servt.c C'VIICHAEL BEDARf� 3200 COBB GALLERiA AtIANTA, GA 30339 Administrator Not valid ithout signature locate Coact pnor to wmd toilet loaton may vary sh My heed on to location of plumbing and ot.framing below then center window base on toilet location .x General Notes: = 9fi o let�n bac �9h All wort shall be performed m accordance.,nth all aW,cable codes, ti show r e, a to oolr"ultons,ordinances and respomible trade pnctces.All constNGGon shall comply wrath Che Wood Prams Constucbon Manual a fn - I 10"' .All contractor and subcontractor shall be resporeible hr0 i weds for and adherence to thur respective cedes,regulations,ordmances "Ing c R and respon,,bhe trade practices.The contractor and subcontractor ri — shall notify the Arch,Wt m wnbng oath detaib of a,devatron which __ -— .. :. ........ ...... would affect the code complance or durability of the project.The =a - Contractor shall ovexe and be fully reeporeible for the adequacy of a c � all waterproofing,flashing,venblabon and code complonce. dou I b t ch extend«otng heatmg/cooling o ductwork to new Bathroom 3/4' 1 I'-0' — _ — _ _ — — — , _ _ — — _ ._ re t N o «'ling nd event to remain M roof shingled to match«'king 1�1 O continuo.,ice and water 5/8'cdx plywood dhc a /: - y 2,)0 rak this rt «ot 9n ker to remain I2 ggt t pa .; 2x8 x I G ce,1,rq joists I o.c. i F� �j In 7 y 16 fasces w N Zt r vet and I wfhl n f ulaton i,to b tact witPi ce I - �� y fy t'gyp O 4 sum boa ` ((� CO ker «do at Re de,ra all etuker n/c Im open ng,td arc to ne up wth ex sting Bat Noor etude r a �7 �I m Z ver fy alldmemo ��gh ra dunng constructor m New BathrOOt�i f - c� 1/2°cdx p �hZt/hin w 2x6 etude 6" I,I B qla s labor t i,R licerner at sulated walls and ceding - r _ 71 um board - 1 long steel strap tes I c.at each stud I Roof Framing Plan Second Floor Plan 5caie: 1/4"= 1'-0" Scale: 1/4"= 1'-0" r ' - xi,tin nd event • Ex15t1ng House —roof dmngled to match«.bng 12 con �-, ❑ '" O l I over tinuo.,irammce and water shield me rave 3 O I x l O rake(trammed to+/-8 3/49 and 1 3 rake ta O m V J I x6 faeca I - > 0 frieze board - - N I x4 window tnm W n,N I xG and I x5 corner board, c — 'L =a houeegwl'a 1.match e—firg O 1x3r,dl tam @ -z a £ off] O zm 3� ILLIJI 1_ 0 L t fQ Cr055 Section Rear Elevation Left Side Elevation 5cale: 1/4" = P-O" 5cale: 1/4"= 1'-0" Scale: I/4"= I'-O" U • N � 1. 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