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CrouLe - Town of Barnstable *Permit# s Building Department Services �rres 6 mo Veheom issue dale B"xsTAstK : Brian Florence,CBOMASS /J , ► � Building Commissioner 4 ✓ Ea ata� 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us . a Office: 508-862-4038 Tp sFP 0 8-790-6230 U EXPRESS PERMIT APPLICATION - RESIDE ONLY Y�3 Not Valid without Red X-Press Imprint "'4N Map/parcel Number 1�/ p Property Address_ /t/ �°I)U SF T ❑Residential Value of Work$ �3, 9®- Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Of 4 Contractor's Name m,n R►L M UL L j N Telephone Number '5'06'A1( JF$'7 / Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) QY 07 (o Jorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name U \� Workman's Comp.Policy# — H 9 '3 1 $ # T — 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Ej Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) [ e-side- tvkd }� Ceelgr .90r' W tii4e aeco'r— ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must"sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors.License&Construction Supervisors License is required. SIGNATURE: I Q MPFILESTORMSIbuilding permit formslEXPRESS.doc 08/16/17 t . ?'Ire Commorriveatth of-Vassadtrrseft . Deparbmetrt of ludusbialAccide_rrts Q}fce 00"esfigadons 600 Wasth'urgton Street Boston,VA 02111 wymumaxsgorldia ! Workers' Campensatian Insurance Affdavitt:Bu'ddeim/C+orntractursM6ctdcians/Plumbers A 13plicant Information Please Print bIy Adarew. `� c o N N E MA K � W A`/ ' CiWstatd w. I AWrrnr)y TA MA Oa b`73 Phone sego 5 Are you au employer?Check the appropriate box: ' Type of project(required)- 1.U" am a to 4. ❑I am a general contractor and I 6. New construction employees(fi employer With�arrdfor par�time�._* have hired the sub-contt actors ❑r]1 2. I am a sale proprietor arpartner- listed onihe attached sheet. I- El Remodeling drip and have no employees These.sub-contractors have g_,❑Demolition, w°Azing for me �'in, employees andhave svorlcers' � 9..❑Build addition [No worlems comp.i sur-a ce comp-msuraut $ 1 Electrical m required] 5. ❑ We are a corporation and its � additions 3.❑ I am a homeoihaer doing all wcnk officers have exEmised their 1L❑Plumbfngrepairs or additions. mpseM[No wacl='oamp- right of exemption per MGL 17❑Roof repairs i.,==e required—]3 c.152,§1(41 andwe have no employees.[NO workers' 13.❑other comp.insurance required_) 'Any WHcs=dacchedm1m s#1 um also fac=the secdoabeIowshavdn diekw=kme compeasativ, arkyiafnamaFi m I ffawwwnem who sulmgt ibis aftida[,F mffiratmg busy an=.doing a1F wak sod then hiie outside coatmctms—submit a new affidadtt indication saclL fCamzactpis that check this baK must attached sa additional siceet sbawing the name of the�sad state whether or nwf6nse eotifies have ev9e yees.Ifthesub-ccatadacsbaveemplayee;dL-yamstpmuidedieir warken'camp.policy mmdsez I acre an employer Meisprouidirg workers'compensation fnsrirance for wry'enWloyees.Below is the pa cy aced job site it forratrfforl. Itt mince Company flame: 7-U R 1 C K� Poficy-,a,-tx Self-irns.Iic-� i) ����3 1 $ 'g- 1 7 F-VRztioa Date: Job Site Address 14 G k a V SG L rJ eityistate zip: H YA N N eS AAA Attach 2 copy of the wark-m'cooupensationpoHcy declaration page(showing the policy number and erpiratiom date). Failure to secure,coverers&as required.under Section 25A of MGL c� 152-can lead to the imposition of cairesfini penalties of a ' fine up tD$1,SOa OD anifor cure-y{earimprisbntneuk 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,coivemp vacation. I d o Hereby cat hfj�r us der th ' s muf pen 's ofpet jury that the urfonna€mi pro li w aboi a fs bw and correct Sitmature: Date f Phone A �� 41 r5'9 / OoWal we only. Do not smite in this area,to be compWad by dfy or town ocfat City or Town-. Penniff icense#. Issning Authority(tarde one): 1.Board of Hwltfi 2.Biding Department 3.CWrowa Clerk 4.Fleetrical Inspector S.Phrteeabimg Inspector 6.Oth-er Contact Person: Phi#: Information and 111Structions Massachusefis Creb aal Laws chapter M reggaes all employers b provide wa�ras'compensation fur tlmeiF euzpIayees. Pmsirantto Ibis stye,an MPloyee is defined as."_.every Personm the service of another under any contract ofhire, express or implied,oral or wiftbu." An.Moyer is defined as"an individual,partnership,associafion,anporation or o-ther legal entity,ar any two or more of the foregoing engaged in a Joint=bzp6se,and inchrding the legal representatives of a deceased employer,or the receiver or tustee of an individual,partnership,association or other legal enfifL employing employees. However fhe owner of a dwelling horse having not more than dune aparhn=s and who resides therein,or the o=4mnt of the - dweTTino house of anoaLer who eunploys persons to do mace,ccusf ucl ion or repair work on such dwelling house or on the grounds or bolding app therefo shag not because of such employment be deemed to be an employer." MOO chapter 152,§25CC6)also sues that"every she or local licensing agency shall withhold fhe issuance or renewal of a fice=se or permit to operate a businms or to construct buuldmgs iu the commonwealth for any applicant-Who has not produced acceptable evidence of compruan.ce wim the hi -an=coverage required." Additionally,MGL chapter 152,§25C(7)staffs"Neitherfhe connnaawealth nor airy of idsPDHdcal subdivisions shall meter into any contract for the performance ofpmblic wo&ummtd acceptable evidence of compEgace with the iusaranm. reguirea eEts of this chapter have Been presenfr-d to the comfractiug arzfhoz tty." ' Applicants Please fa oiot the woIkess,compensation affidavit completely,by checking me boxes fliat apply to your situation and,if necessary,SPPly snb�nfractor(s)n2uje(s), (es)and phone nurmber(s)along with their certificates)of j i,-x m ce. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno employees other f m the members or pamtaexs,are not regimed to racy workers'compensatiaa iusm mce- If an LLC or LLP does have employees,a.policy is required. Be advised that this affidayitmaybe submifin�d to the Department of Industrial. Accidents for confamaiion of fimmmlce coverage- Also be sure to sign and date the affidavit. The affidavit should be mtraned to the city or town that the application for the permit or license is being requested,not the Department of Exhl.cfr;al A ocidents. Shouldyou have any questions regarilmg the law or ifyou are regoaed to obtam a workers' compensation policy,please call the Department at the number listed below. Self-mm�ed companies should ear their self-rosin =license number on the appropriate line. City or Town Officials F Please be sure that the affidavit is commpletn:andprioi>rd legibly. The Department has provided a space at the bottom of th affidavit for you to f1�I.l out in the event the Office of Investigations has to col"ct You regarding the applican t- e Please be sine to fill in the penmst/Iicease number which will be used as a reference number: In addition,an applicant that must submit multiple pennit/license applicafions is any given year,need only submit one affidavit indicating current policy infbru ation Cif necessazy)and under"Job Site Add errs"the applicant should write"all locations is ( Y ar town)."A copy of the.affidavit that has been officially stamped or marked by the city cr town may be provided to the applicant as proofthat a valid affidavit is on file for fubim-e'pemdr s-or licenses A new affidavit must be filled out each yew.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial veatIn 0 Cie. a dog license or permit to bum leaves e#c.)said person is NOT regoiredto complete this affidavit. The Of of Investigations would hia,to thank you is 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 CogzeajtbE of�vsetts ' Depadment 4f lii�Aacide nt% Office of Iil..Ve dtacm= T(,-L 4 617 7-4900 Cxt 406 or 1-.977-MA&SAFF Fax-0 617 ` 27 '749 Revised 4-24-07 . W gavldia. {{{{"` � '= Town':,of'Barnstable - y Building i)epartment Services KASIL - R�A : Brian.Florence,CBO63 - �``� Building Commissioner w 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us , Office: 508-862-4038 Fax: 508-790-6230 a Property Owner Must ; Complete and Sign This.Section , If Usin-x A Builder - e Owner of the subject property e hereby authorize to act on„imy behal ' in all matters relative to work authorised by this building permit application for: ' (Address of Job)'. **Pool fences and alarm .are the responsibility of the applicant Pools " are not to be filled or utilized before fence is installed and all finah inspections are performed and accepted. Signature of Owner Signatureof Applicant Print Name' Print Name Date Q:FORM&OWNWERMISSIONPOOLS s Rev:09/16t17 Town of Barnstable . Building Department Services Brian Florence,CBO ' Building Commissioner 200 Main Street; Hyannis,MA 02601 . MaL www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: c4hovm 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. DEF 14MON 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 Rote: 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certifieation for use in your community. Q.-\WPFUM\FORMS\building permit fornu\EXPRESS.doc 08/16/17 UL NS ITR.0 Ifs' 'f T1ds Con,strucHan Con,true ( "Contra;dl)Is made anden tared 1rnto,as of : m17 ate),by,and Ibe ra De brAh ola (Name,hereinaftercalledthe us m )and ! 'ark M_ MOM, DBA Win lig and aft, ilrn having,fts ,fit 7� orrrar ' ., ' : 'a'l i erafter called the Ton-tracton. 1pmpe,q,Locaflon, 14GmuseL,n. lHyannis, MA y + !Iru c-onsideratli of t mutual Pmm,is hereafter seq.faft- rd Inte,d1n, lol Ibe o urnd hereb , ' a parlies!herelo Agree as follow crea�� hllgalr ;. itrur !> ff uraplalet fl !1 !lCj�dr"t�ed!lr�n us and shall;p �d�;g(p- �j� accordance ryrvi i��e��necessary��9g���{��yt�{� ��g��y�r� �.��ii�dl�y�y�y��h ►����� �� �roject e ����diti�■ gl in a, _ 'waI - � 0k �0�_.1 y i II',IF�4ncorda11 c mAl i !W!Ite, ALl a pdiN,iC ble�N.'so dl a 16i17Pfs-'P' irQa /ces ,6�I.�s, re 90adon,a:and offers_ 10-esedlooft . Gonlraclor ah ll do,al11he work in accardance,wills,fie terms of this Convtra,ela as,descrIbed, Remve the vAlteceder� roll m Rhl,e fork of the house. I'i stali Ty r!8 Lome vwrap ov the(bare wAUs. Remove the;using,onbyowln,d silly and Mplace vhlh a composite MU nosEng. !Remove and 1,M placeerr a nt3 siOl with a composite w nd ow sill_ install ine ,grade I:i 'mar sh[n,glas lu + galvar s 'arM nADOWLfir sh r es: I s ll ,n raiding to u�igM,skis of t ddar rig the Rance dlarail lem b k ,owr ,a: d replace he r ftd IM,under,tfnne,rake board the fight side of the frorl ho ust ng Azek compositatft. MOM a new dbor surroundthosen by lbetustamr inthj a Hamy Catalog. InslaO newthuffers, Contract Sum_!Irn a isi liar of the pedrr�nar by-Con,traclar of TUALfts and,dbligallons, h ereu nderOu slt raer shell contra r the!sum of.*$%9 me SOisdu 1O ner Oa9 .e _ ,1 e 'sum,up s—*g e confrra work_ orrtractc's,R n~s�lgfl Co ntra r Is.am inde Pe nd!,eniconlrac-,to r,ifo r$U:Wot,,k.,Iobe performed hereunder..71m deWled manwer:ard meMad of dblrtg ift. WoOk.shall bunder the 11 Con,trra 111 a of the, r�lrar rur 'er li tract a_. The ontra -orr,shall sp rWse and din,wtft'1 irng fts best, skiff's, F j'a .!Conlrador shall 5 'J 61 iI 1 r ur�Ituatirng�, r raintairrdIng and.su i b gaUsalety precautions;in nnac.0 n�mfith'the` . rmft,�' an lots .The Ca n lac r shall seewe and ipa f orall pe aWls,and , t.e.im lamMal Via,Ilicanses,and inspecNownecess, x for the proper exam, Eon on,0 and licenses t prop -p nof rc ` h a a Custamr and slug be delivered to,the Cup upon request The Contractor Sh,all gIVe,aJI noftes and ccrripCy milhall.a pOca:bia des,Iowa or�dinan c , wiles, � ;ula`t bri and!and amr u 'Co Who* ICmconnecGon wiih,the pi n of`1he'WoMk and the Oonlracloft obl ali h,ereurnder. !I aura n cior ad o edge a�di a,�e �� � qua Liar or � II rdct be ub+l� at any Insurance in uiriilia+ oi irtii� a'a fir Iha'hr� l't of tltiorrCraC : Cam,tonlaeg'Imi.rmm ,.CwWaclor.shall at afl,limaa mai tlalrn.,and keerp fWI forceand aff at E a¢ +m ap a and a'II Insurance a ra a I- r> ert, a._ _ or desiraMe for the prolacliorn of'the�lri roaia of�i ntractor�_ Contractor ai0l farenlsh to Customr certificates of insurance for fc oa ng ty-pes,oi f In ran _ a., Commerdal General LIA ifty Insurance; Ib. rs' I'pensadon Insurance locover MI fiabally under ft, Wbr11 ' Compensation Lava: All v a-s associated vAththis pmject Idl beditposed of propedy. 1111 WITNESS WHEREOF, it,,he,pardewherelo have execute-di sCord mact, asofftd and'mar first abovewrftlen. CUSIGM, 8jr Cordmatar i or pan: D Y By, � irin : Deborah Sokol Mai 'MOM, Mu ll[n, Roafin,9&$1 - dihgg, M,e 7,Connemara Ifty, W. 'far o u I 'A, Address, 4 Growe Un. IHyamnIsp Ike ; Phone-num r: 8- 7458-5 Lic-ense,Ilan: CSL#IM78 HIMS7281 frail address: d ko' WmaKewn Email address,. unvuilUn if3'og rm ail-Corn! t a . v • Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,NIA 02116 t Not valid without signature . 1 • C-�/fae�anvrrco�ruuecz�t�o��ar.7oac%uiiJeG�b Office of Consumer..Affairs&Business Regulation HOME IMPRLVEMENT'CQNTRACTOR Re ist*i'.n �467`8 s Type Expiratiorf la[ t g,"� MULLIN ROOFING`AT7gS ; ;V MA RK'MULLIN 7 CONNEMARA WAY�,:�F✓" W.YARMOUTH,MA 02673" dersecretary Massachusetts Department of public Safety Board 'uilding Regulations and Standards CS, 04076 _C $trtR% Sup -tsor �tT 6, MARK'IVI MULLJN'- 7 CdNNEMARA WEST YARMOUTH MA 02 73 . h' r ��.�y�i• Expiration: Commisslor> or" 09/07/2017 J NOTICE OF ASSIGNMENT EMPLOYER: COMBO I.D. STATUS OF EMPLOYER MULLIN ROOFING AND SIDING INC 000422586 Corporation 7 CONNEMARA WAY WEST YARMOUTH, MA 02673 COVERAGE GROUP 0422607 Coverage under this assignment The Waiver of Our Right to applies to Massachusetts Recover from Others Endorsement operations only. For coverage is available on Pool policies. outside of Massachusetts, contact Contact your agent for details. the appropriate Pool or Plan for that state. r INSURANCE COMPANY: AGENT MARGARET J GRASSI INS AGENCY AMERICAN ZURICH INSURANCE COMPANY OR DEBRA MARTIN Jonathan Scharnberg PRODUCER: 1188 MAIN ST P 0 BOX 3556 W WAREHAM, MA 02576 ORLANDO, FL 32802-3556 (800) 453-9843 AGENCY FEIN: 461155686 CLASSIFICATION OF OPERATION CLASS ESTIMATED RATE ESTIMATED CODE TOTAL ANNUAL PREMIUM REMUNERATION CARPENTRY-DWELLINGS - THREE STORIES OR LESS 5651 $22,387 8.11 $1,816 ROOFING NOC & YARD EMP, DRIVERS 5545 $1,130 37.05 $419 CARPENTRY NOC 5403 $0 11.00 $0 CARPENTRY-DETACHED ONE OR TWO FAMILY DWELLINGS 5645 $0 8.11 $0 EMPLOYERS LIABILITY 100/100/500 9845 MOD FACTOR 9898 .89 $-246 STANDARD PREMIUM. $1,989 ALL RISK ADJUSTMENT PROGRAM 0277 1.00 EXPENSE CONSTANT 0900 $338 TERRORISM CHARGE 9740 $7 , TOTAL POLICY MINIMUM PREMIUM $500 TOTAL ESTIMATED PREMIUM $2,334 DIA ASSESS. 5.6% $111 ---------- TOTAL EST. PREMIUM PLUS ASSESSMENT $2,445 INSTALLMENT BASIS: .Annual DEPOSIT PREMIUM: $2,445 THIS IS NOT A BILL COMMENTS Coverage effective 12:01 AM on 02/25/17. Subject to 11/18 Anniversary Rate Date. Add endorsement WC 00 03 08 to this policy. An approved Form 153 - Affidavit of Exemption for Certain Corporate Officers or Directors - was submitted with this application. DATE OF NOTICE: 02/28/17 PREPARED BY: Joanne Shea The Workers'Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street- Boston, MA 02110 (617)439-9030 • FAX(617)439-6055 -www.wcribma.org ; y NOTICE OF ASSIGNMENT EXT 530 * * VOLUNTARY DIRECT ASSIGNMENT LETTERID: 4765075 The Workers'Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street• Boston, MA 02110 (617)439-9030 - FAX(617)439-6055 •www.wcribma.org f I C�;D 5 G y - ' - Town of Barnstable Permit# Expires 6 months from issue date Regulatory Services - Fee �3 • RARNSTABLM Mass. Richard V.Scali,Director 1639. p1� Building Division X .PE5� Tom Perry,CBO,Building Commissioner lim '200 Main Street,Hyannis,MA 02601 J�L ,2 www.town.bamstable.ma.us . 2015 Office: 508-862-4038 TOWNWWAO--6230ABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ON Not Valid without Red X-Press Imprint Map/parcel Number 3 L CT- 1r;k, Property Address / j 6 R 0 U-5 E L A2 1-1 Y/f W LS ❑Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address DE&K A .rl S'Q/<Q Contractor's Name P-K Al UL L J Telephone Number_ r`0 d?�I 5'9 Home Improvement Contractor License#(if applicable) Email: _. /77 U eL/tU K®o F/JUC40 4 Construction Supervisor's License#(if applicable) © �w ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 7 1` 1 C Workman's Comp.Policy#_ L z ui� ® / 1- �p— it y Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Ueke-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.' Separate Electrical&Fire Permits required. *Where required:•Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ' ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. _ SIGNATURE: 1;;�e Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 ,``�o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM5/1/)15 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: Margaret J Grassi Ins Agency PHONE 508 295-2007 FnX Ne; (508) 291-1707 1188 Main Street E-MAIL ADDRESS: debm' ins@comcast.net West Wareham, MA 02576 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Atlantic Casualty Insurance Co INSURED INSURERB:Zurich Insurance Mark M Mullin INSURERC: 7 Connemara Way INSURER D West Yarmouth, MA 02673 INSURERE; INSURER F: COVERAGES CERTIFICATE N UMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M/DD/YYYY MMIDD/YYYY LIMITS A GENERALLIABILITY L117002080 2/26/15 2/26/16 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGETORENTED $ 100,000 CLAIMS-MADE F_IOCCUR ME EXP(Any one parson) $ 5 0 00 . PERSONAL&ADVINJURY $ 11000,000 GENERAL AGGREGATE $ 2,000.000 GEN'LAGGREGATELIMIT APPLES PER PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PRO LOCI $ AUTOMOBILE LIABIUTY COMB(Ea aBINEEDtSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS eraccident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 6ZZUB-2E59306-8-14 11/18/14 11/18/15 WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACODENT $ ZOO 000 OFFICE RIMEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EAEMPLOYEE $ 100,000 If yyes,describe under DESCRIPTIONOFOPERATIONSbelow _ E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACach ACORD 101,Additlonal Renrks Schedule,If more space Is required) 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 REPRESENTATIVE Debra Martin C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: MULLINROOFING@GMAIL.COM Massachusetts -Department of,Public Safety .r Board of Building Regulations and.Standards Construction Sppgrvisor License.CSsiQ41176 ":rrti L MARK M MULLIri -- ' 7 CONMNIARAOVA . u. s • West Yarmouth 1VIA OZ Expiration Commissioner 09/07/2015 e use group which guildmgs of any 991m3)of unrestricted- n 35,000 cubic feet( . contain less than enclosed space. r s a current edition of the Massachusetts possess {or revocation of this'license Failure to p Code is cause State Building WW.Mass.Gov/DPS = information visit: W For DPs Licensing — �epom��2arccuecr-lG�i a�C%�`ua�ac�cc�eG�t Office of.Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR � before the expiration date. If found return to: " 5egistr6tion 167281 Type: Office of Consumer Affairsarid Business Regulation 0 x0irati4n 8f3Q%2016 DBA 10 Park Plaza-Suite 5170 ylr _ Boston,MA 02116 MULLIN ROOFING ANI�SfDIM1IG MARK MULLIN. 7 CONNEMARA WAY + 1 W..YARMOUTH,MAU2673 "' Undersecretary Not valid without signature t MULLIN ROOFING & SIDING INC. CONSTRUCTION .CONTRACT This Construction Contract (the "Contract") is made and entered into as of 6- -15 (Date), by and between Deborah Sokolow (Name, hereinafter called the "Customer") and Mark M. Mullin, DBA Mullin Roofing and Siding, Inc. having its principal office at 7 Connemara Way, W. Yarmouth MA 02673 (hereafter called the "Contractor"). Property Location: 14 Grouse In. Hyannis, MA In consideration of the mutual,promises hereafter set forth and intending to be bound hereby, the parties hereto agree as follows: Contractor's Obligations. Contractor shall complete the following Project herein described in and shall provide supervision necessary to commence and finish-the Project expeditiously, in a_ workmanlike manner, in accordance.with the "all applicable codes, laws ordinances, rules, regulations and orders. Description of "Work". Contractor shall do all the work in accordance with the terms of this Contract,,as described: Remove existing roofing shingles from-the roof while protecting the home and landscape. Nail down any loose roof decking to ensure a solid roof deck. Install ice and water shield on all eaves, walls that intersect the roof,, and around pipes that penetrate the,roof. Install Diamond deck roofing underlayment by Certainteed over the remaining roof deck area: Install new white eight inch non vented drip edges on the eave edge. Install Swift start starter shingles over the eave and rake edges. Install new Landmark`Pro. roofing shingles. color Driftwood, to factory specifications by factory certified installers employed by, and directly supervised by myself. Install new ridge vent,over.the ridges. Install Shadow ridge ridge caps by Certainteed on all ridges to complete the roof. Remove and replace the white cedar shingles from the walls that intersect the roof Remove and replace the siding on the sunroom that•needs to be replaced. After completion of the roof I will register your roof with Certainteed for the four star Sure start warranty. 1. Contractor will furnish consumer copies of current insurance certificates for himself and any subcontractors. r 2. Contractor,will replace the rotted-siding on part of the wall facing'sun room. _,)d ,� ,L' `�C 4 w%r/l ir; -// L��c c F :.f')U case',;, r5-i3.15 .e- /1 >` 3. Contractor will provide in the contract the name and'address-of company honoring �D warranty and length of warranty. " C` 4. The final payment will be made upon proof that any subcontractors and suppliers have been paid in full. a' The Contractor shall supervise and direct the Work, using its best skills. Job Safety.Contractor shall be responsible for initiating; maintaining and supervising all safety precautions in connection with the Work. PermitsCEees and Notices. The Contractor shall secure and pay for all permits and governmental fees, licenses and inspections necessary for the proper execution and completion of the Work. Such permits and licenses shall be the property of the Customer and shall be delivered to the Customer upon request. The Contractor shall give all notices and comply with all applicable codes, laws, ordinances,,rules, regulations and orders,of any public authority in connection with the performance of-the Work and the Contractor's obligations hereunder. Insurance. Contractor acknowledges and agrees that Customer or.Owner shall not be obligated to carry any insurance in connection with the Work for the benefit of the Contractor. Contractor's Insurance. Contractor shall at all times maintain and keep in full force and effect, at its expense, any and all insurance coverage which is prudent, necessary or desirable for the protection of the interests of Contractor. Contractor shall furnish to Customer certificates of insurance for the following types of insurance. a. Commercial Genera l'Liability Insurance; b. Workers' Compensation Insurance to cover full liability under the Workers' Compensation Laws. All waste associated with this project will-be removed from the property and disposed of properly. IN WITNESS WHEREOF, the'parties hereto have executed this Contract as of the day and year first above written. Email address:dhsokolow@hotmail.com Contractor Company Customer r BY Print: Deborah Soko1ow Mark Mullin, Mullin. Roofing & Siding, Inc. 7 Connemara Way,.W. Yarmouth MA- Address: 14 Grouse In. Hyannis 02673 508 221.8591 Date: 6V315 Date: 6-5-15 Phone number: 508-827-4585 he Comrfronwealth of-Massachusetts Department of Industrial Accidents - - Off ire of Lmwi igatioru t 600 Washington Street y BoStM, 02111 wisni:massmgovIdiri Workers' Campensation Insurance Affidavit.Bu illdersiContractarslEIecfricians/P lumbers Al PEcant Infar matian Please Print Le��Iy Name V L� l - ^ Address: " C 6 VN E/h A-P.cQ lv/} City/St-atr_(Zip.. YK 0v 1 Nt bv1 phone 4j,': �� �'a t J7 g / Are you an employer?Check the appropriate box: Type of project(required): ` 4. am a general conacor an I.L.�t am a employer u�itb. ❑ I trt d I 6- ❑New constucfiion employees(fan ancVorpart--time)-* have hired the sub-contracton 2.❑ I am a sole propnetar or . rtner- listed ou the attached sheet: `l. ❑Remodeling These sub-contractors have ship and have no employees. -� $_ ❑Demolition wod:in for me in anycapacity-g employees and have wo&ers' 9. ❑Building addition [No t4-orkem,comp.insurance comp-rnsuraIIii—# required-] 5. ❑ We area corporation and its 10_❑Electrical repairs or additions 3.❑ F am,a homeowner doing aU work officers have exercised their 11-❑Plumbingrepairs or additions myself[No workers'comp- right of exemption per MGL 12.❑Roof repairs im-n=e required_]1 C.152x §1(4h and we have no employees-[No wor-as' 13.0 Other comp_insurance required_] •Any WKcaufdalcbe&sbox9l— also M out:the section below showingt eirwozkeecompensationpolieyinformation. #Homeoarnes who submit this diidatgt induatmg they ate doing all wo$and.then]tire autsi&contractors mast submit a new affidavit indicating suds �C:ontractors that check this boar must attached as additional sheet showing the name of the sub-cis and state whether or not those entities have employees.Ifthesub-contractors have employees,they m istprovide their workers'comp.polity number. lam au eitiplop�rrr fltcrt is pro�zding rvorkers'coiriperrsatioti irrsrirauce,�or a�ry�¢nrploy�eex Below is the policy rued job rite inforaralion. ,a' Insurance Company Name: V t Policy A,*'cr Self-ins.Lic_ ( ,2_2 L)a a C;)1 0 9,1 " e - / I F—kpiration Date., Job Site Address: ( G. (/ J"L),V 1 VA_AJ A.))� _City/State Zip: Attach a copy of the workers°compensationp.olicy 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$1,50a_00 and tar one-year imprisonment,as welt as civil penalties.in the form of a STOP WORK ORDER and a f to of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to.the Office of Investigations.of the DIA for insurance coverage verification x I d o Hereby cMi&under the pains acid peiiaWes ofperjary thatthe urf araxafionpm i&d abm e is tutus acid correct Sir�uafizre: `/� /yi/?GAL/� Date: -7 I j Phone ir O �--' ► 9 OfjaciaL use only. Do not write in this area,to be completed by city or torn official City or Town: PerinitUcense if Issuing Authority(drde one): 1.Board of Health 2.Building Department 3.CitylTown G1erk d.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions r _ lyMassaclrasefts Gdneaal Laws chaptar 152 reqaires all employers to provide war$ers'compensation for their employees, pursuarit-to this stag,an.eaplvyee is deed as."_.every person in the service of another under any contract of hire, express or implied,oral or written" An eaplaye'is defined as'an mdmdual,partnership,association,corporation or other legal ea t ty,or any two or more of the foregoing engaged m a Joint=tgni8e,and mchu:Eng the legal representatives of a deceased employer,or the receiver or trustee of an individual,parineis-hip,association or other legal entity,employing employees. However the owner of a dwelling house having not mom than three apartments and:who resides these or the occupant of the - dwelling house of another who employs pemons to do mairitmar ce,construction or repair work on such dwelling house or on.the grounds or budding appi rtenarst thereto shall not because of such employment be deemed to be an employer" MGL chapter 152,§25C(6)also staff:s that"every state or local licensing agency shall withhold ffie 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 compliancewith'the insurance.covexmgerequired_" Additionally,MGL chapter 152, §25C(7)sfatts"Neither the commonwealth nor any of ifs political subdivisions shall enter mto any contract for.the performance ofpublie work until acceptable evidence of compliance with the illS= 1 m re pErements of this cbaptex have Been presented ti)the contracting aniho " A-Pplicants Please fill oil the workers'compensation affidavit completely,by checking�e boxes that apply to your situation and,if necessary,supply sub--contactor(s)name(s), address(es)and phonenumber(s)along with their certificates)of incr„-ance. Limited Liability Companies(LLC)or Limited Liability-Partnerships(LLP)withno employees other than the members or partners,are not regtmed to carry workers' compensation insurance. If an LLC or LLP does have empIoyees,a policy is required. Be.advised that this aftdayit maybe submitted to the Department of Industrial Accidents for confirmation of inSnI' ce coverage. Also be sure to sign and date-the affidavit. The affidavit should be retuned to the city or town that the application for the permit or license is being requested,not:the Department of LoAnstrial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below self-insured companies should enter their self-incrrance license number on the appropr7atr,line. City or Town Oft-ieials t _ Pleas(--be sure that the affidavit is complete and prided.legibly. The Department has provided a space at the bottom of tale 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 peri�oit/license number which will be used as a reference number. In addition,as applicant that must submit multiple peffiitUcense applications in airy given year,need only submit one affidavit indicating current p olicy inf6=ation Cif necessary)and under"Job site Address"the applicant should write"all locations is (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 oa 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 Yee dog license or permit to bum leaves etc.)said person is NOT regained to complete this affidavit The Of of Investigations would like to thank you is advance for yom:cooperation and should you have any.questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. Y Department of 1a(imtdal Armen a' duce ofbvegfigatio= �Q4shingtan Sit Bastou MAG2111 Tel.4 617 727-49W cxt 4-06 or I-9 USAF - Fax#617-727 7M , Reviseti 4-24-07 E Town of Barnstable VE ReguYatory Services , _ Thomas F.Geiler,Director w. .. ' MASS Building Division , � . b Tom PerrY,BuildingCommissioner g ; 200 Main Street, Hyannis,MA 02,601. www-town.barnstable.ma.usLa !_ Office: 508-862-4038 F 508-7V 6296; l . PERNIIT# FEE: $ SHED REGISTRATION . 200 square feet or less fro 1 1s Location of shed(address) Village Property owner's name Telephone number .Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:304:30 PLEASE NOTE: IF YOU ARE WITBIN THE JURISDICTION.OF ANY OYTHE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. I : THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:05201 j Map Page 1 of 1 ti Town of Barnstable Geographic Information System New Search I Home I Help Parcel Viewer Custom Map Abutters Map Size ® Zoom Out In 0 ® "r"R KY Ra � q §-1PG Map: 268 Parcel: 263 Full . Property 2e8252 ... 2ee2e1 Location: 14 GROUSE LANE Info Owner: SOKOLOW,DEBORAH H 03; Location Information Map&Parcel 268263 Location 14 GROUSE LANE 768281 Vie Acreage 0.28 acres ur' Current Owner Mailing Address SOKOLOW,DEBORAH H 14 GROUSE LANE ti 2Ba28 HYANNIS,MA 02601 -1 Appraised Value(FY 2013) Extra Features $17,300 Out Buildings $2,300 k Land $103,100 Buildings $72,700 Total Appraised $195,400 '� Assessed Value(FY 2013) & gg Extra Features $17,300 2V a5 30 Fe Out Buildings $2,300 2psjp4 Land $103,100 — Buildings $72,7004 Total Assessed $195,400 Set Scale 1"= 30 I Aerial Photos MAP DISCLAIMER ((,� Copyright 2005-2010 Town of Bamstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA V1.2.4743[Production] http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=268263 4/9/2013 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION /;aMap VG Parcel Application # ' c (2 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis V Project Street Address 14 CTIQ1XA6C. (AIL, Village 4 M 0 07601 Owner �� � � Address /'-t' Telephone -0 9207 Permit Request d o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District fi Flood Plain Groundwater Overlay Project Valuation 0 " D0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ 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: ❑ Gas ❑ Oil ❑ Electric ❑ Other 2 Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/foal stove: `�Yew❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new s' e_ rm In Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: t 4 eI Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ CM Commercial ❑Yes ❑ No If yes, site plan review# Current Use --:Proposed Use- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) T Name Telephone Number 1-726� Address 2Z 1 License #qwmfA T g( 6 Home Improvement Contractor# 16/ 77 jA r "l n V //0/u/4 Worker's Compensation # � l S ALL CONSTRUCTION DEBRIS RESULTING FROM T IS PROJECT WILL BE TAKEN TO SIGNATURE DATE, FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED f MAP/PARCEL NO. 4 ADDRESS VILLAGE OWNER DATE OF INSPECTION: i FOUNDATION FRAME INSULATION 3 t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of*Industrial Accidents UV (Office ojrInvestigations 600 Washington Street Boston, AfA 02111 www.wass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El Please Print Legibly Apiplicant Information 6c Name(Business/Organization/individual): Address: (�� ��j� _ —_4— �r p City/State/Zip: Phone #: Are you an employer?Check the a propriate box:` Type of project(required): IXI am a employer with 4. �� 1 am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 7 ❑Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet.I ship and have no employees - These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. F] Building addition [No workers' comp. insurance 5• I� We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their ri �ht of exemption per MGL 11.❑ Plumbing repairs or additions 3.❑ I am a homeowner doing all work €� p p myself.[No workers comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees.anc[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. f 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: — — Policy#or Self-ins.Lic.#: dCIJ ' _— Expiration Date: C Job Site Address: I'T j.N'�D C __ City/State/Zip: YJ ®�• 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?.5A of NiGL 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$250. day against the violator. Be.advised that a copy of this statement maybe forwarded to the Office of Investigatio t e DIA for insurance coverage verification. I do here c ify der the pains and penalties of petyury that the information provided above is true and correct. Si nature: ___ Date: Phone# lhlb Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other _— Contact Person: Phone#: ,l t 11:►:ti•:►chua•tt�- Depar111uni Of Public safct} { Board Of Builditr.- Rc+,,ulati► is and standard, Ni Construction Supervisor Liceltsc Lv i!*e: CS BQ16 NIALL J 11OP'KINS B0X 231 " SCE YARMOUiTH,NIA 02W Expiratiolr: 4I22U73 �- {11 UIRi iS±iiV1irT Fr?: 14504 ti QtTiee�toun►er,1'fa rs Bc°g' l„rs' °e`�`i, Lie Cnse or regrsEration valid for indiv►du1.use o, k�Vge-91sttation: , HE IMPROVEMENT CONTRACTOR before the exP►ration date. If found returrr.t4 OM 161173 EX lratlon: Type' Office of consumerAtfairsandi34sinessj 1/20l2012 P Private Corporalioii 10 Park Plaza-Suite 5.190 �gttldon, Nti4C�WOPK►NS BUIGQERS INC... Basiott; i;l 0 ;6.' NIALL HOPKINS 21 G FRUEAN AVE:: SOUTH YARMOUTR MA-6064 UndersccreGlq _.. tot val t1P1tF►out s►gnature 3 F I } i ` 7 L i CERTIFICATE OF LIABILITY INSURANCE °"'� '� "' 09/09/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ios)must be endorsed- If SUBROGATION IS WANED,subject to the temrs and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certfficaW holder in lieu of such endorsement(s). PRODUCER CONTACT Mark Sylvia Insurance Agency NA F 771 Main Street ONE c :508 428-W0 a No 508 20-9227 LD,mss.'mark marks Iviainsurance.com OSterwlte,MA 02655 INSURER(S)AFFORDINGCovERAGE NAIC$ INSURED INSURER A:Farm Family Casualty Insurance Niail Hopkins Builders,Inc- INSURER B 118 Lakefield Road INSURER C: PO Box 231 INSURER D: South Yarmouth,MA 02664 INSURER E 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 REDUCED BY PAID CLAIMS- SWU LTTRR TYPE OF INSURANCE POLICY NUMBER MM nF IJCYEFF M EXP LIMITS A GENERALuAmUTr 20011-6275 10/30/2010 10/30/2011 EACH OCCURRENCE g 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TORENTED PREMISES Eaaoaarence $ 100,000 gA1MSMADE ❑X OCCUR MED EXP Airy one person S 5,000 PPERSONAL&ADV INJURY $ 1,000,000 GF-NERALAGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPUESPEP, PRODUCTS-COMPIOPAGG S 1,000.000 X POLICY JECOT- LOC S A AUTOMOBILE uaenJTY 2001 C53575A 6/25/2011 W512012 COMB SINGLE UMR erdl $ ANY AUTO BODILY KJuRY(P 3r person) S 1,000,000 AtLOWNED SCHDULED AUTOS AUTOS BODILY OIURY iuct) $ 1,000,00 AU 0 HREDAUTOS AUTOS ROPERTv1 $ 1,000,000 S UMBRELLA LtAe OCCUR EACH OCCURRENCE S LEXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS g A wORKERS cOMPENSATION 2001 VV6459 9/8/2011 9/8/2012 veC STATll X oTH AND EMPLOYERS'UALROM Y I N RY ER ANY PROPRIETORIPARTHERAD(ECUTIVE EL EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? ® MIA pawwawy in NH) EL DISEASE-EA EMPLOYEE S 500,000 If DESg2 yyes descniP110NTxN unOF OderPERATIONS blow EL DISEASE-POLICY LIMITS 500,000 DESCRtPTMN OF OPERATIONS I LOCATIONS I VEMCLES(AURch ACORD 101.Addfflomd Remarks SchWu4,U more space is regmWM . Carpentry,Electrical I- CERTIFICATE HOLDER CANCELLATION a v SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 1146 Rte 28 ACCORDANCE WITH THE POLICY PROVISIONS. SouthYarmouth.MA 02664 AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201OMS) The ACORD name and logo are registered marks of ACORD OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at ff / Y (Property Address) (Property Address) hereby authorize ► C?\ , (Subcontractor) C an authorized subcontractor for RISE Engineering, to act on m ' ehalf to obtain a building permit and to perform work on my propertyY D , r w,rjv .ilk•• r Owner's Signature ILI y� . Date APB 1 Q 2012 i , r 2 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application �l a 160 c Health.Division Date Issued ( 7i� Conservation Division '` Application Fee 1L_ Planning Dept. Per`.mit Fee o Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address SE- Village Owner "D '3 lit 5�3K Address Telephone 5 mil.)9 t-i�1.i (bs�s�:i �:�. M.(_ C S' Permit Request 't'� �. Vi Ar7Tj (�iy�' ail �YJ 1✓1 (!`j��� E—� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater.Overlay Project Valuation �; Const'ruc'tion Type d Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full M Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2- 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: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes eNo Fireplaces: Existing l New Existing wood/coal stove: ❑Yes ®'No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # _ Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # =; Current Use Proposed Use i.. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ' Name Telephone Number � `f Address `t a,S l�/6%r�(S �� License # 6_8 A- QJ 2— Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO . SIGNATURE DATE Z �� FOR OFFICIAL USE ONLY APPLICATION# -DATE ISSUED. .L_wMAP/PARCEL NO. 4. r E' ADDRESS VILLAGE f OWNER ;s DATE OF INSPECTION: --FOUNDATION' FRAME — INSULATION :• FIREPLACE t ELECTRICAL: ROUGH FINAL Y PLUMBING: ROUGH FINAL GAS: .e,ti ROUGH :a ,•,<'-. -. FINAL FINAL BUILDING` '(S ,c,DATE CLOSED OUT J, ASSOCIATION PLAN NO. r ' N' The Commonwealth of Massachusetts ' Deparanenf of Indusbid Accidena Office oflmestigations 600 Washington Street Boston MA 02.1.1.1 wwW mass gov/dia Workers' Compensation hunrance Affidavit: guilders/Contractors/FIectricians/PlBmbers Applicant Information ' Please Print Le I Name (Business/ imvhdm " 6i:✓ Orgamzah . dual) � r . � Address: I"� A-SH K►6v a. L City/State/Zip: 76.wNta ' I,YW. 02G k Phone#: ' Z --6-`iC Are you an employer?Check the.appropriate box; 1.ElI am a employer with 4.,❑ I an a general contractor and I Type of project(required): . 'Pployees(full and/or part-time).* have hired the sub-contractors 6• ❑Newt consbvction 2, r I am a sole proprietor or.parfner- 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' [No workers'comp.insurance comp,insurance,$ 9• ❑Building addition required.] 5. ❑:We,are a corporation and its I0.[]Electrical repairs'or additions '3.[] I am a homeowner doing all work officers have exercised their I1. Phmmbin `❑ g repairs or additions myself [No workers' comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12❑Roof repairs employees. [No workers' 13.❑ Other comp.insurance required.] Any applicant that checks box 91 must also�fm out the suction below showing their workers'compensation policy information,- t Homeowners who submit this affidavit indicating they are doing all work and them hire outside contractors must submit a new affidavit indicating such. tContracb=that check this box must a-ched an additional sheet showing the name of the sub-wnkactats and state employees If the nab-conhactnrs have employees they must provide their workers'c Policy whether or not those entities.have comp.p cy number, ' lam an employer that isproviding workers'compensadon insurance for my employees Below is the po&cy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.# , Expiation Date: Job Site Address: City/State/Zip: . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date): Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ` fine up to$1,500.00 and/or one-year imprisommeut, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 day against the violator. Be advised that a copy of this.statement may be forwarded to the Office of Investigations e DIA.for insurance coverage verification 7116 ereby under thepains and enalties op fPv7w'that the infonnadon provided above is true and correct ore: / "6�jrL J"2 Date: Phone#: Official use only. Do not write in this"'area to be completed by cit},or Town official . City or Town: Perm tUcense# Issuing Authori circle one t3' I.Board of Health 2.Building Degartmenf 3. '/Z`oWn Clerk 4.Electrical Inspector 5.Plnnnbiag Inspeettir 6._Other. Contact Person: Phone#: Nlassachusctts Dcpa"mcnt Of Public S ifct%; + BOxrd of Buil(Jin't' Rcg'ulations and Stan(Lu-ds Office of Cousumer Affairs&Bdsiness Regulation Constructiori Supervisor License HOME IMPROVEMENT CONTRACTOR, Registration: License: CS 68599 9 r1.25537 Type:.. Restricted to: 00 s Expiration 1/15/2014 Individual AN ONY SEAMU&QU'�fNN / ' ANTHONY S QUINN w 17ASHKINS DRf ANTHONY QUINN;,� a xk= I SOUTH DENNIS,-MA 02660• ' � I 17 ASHKINS DR �' � SOUTH DENNIS MA 02660, a f cam_ f Undersecretary �'�` Expiration: 4/6/2012 �r i ('ununissiiincr Tr#: 24309' n License or registration valid for individul use only,!',f before the.expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston;MA 116 Not valid without signature ANTHONY QUINN CONTRACTING OFFICE: (508) 398-2014 M091LE: ( 081 2a7-6997 , P.O.- BOX 796, SOU{TEg H DENNIS,Ift MA0Z660 .:>}�1�,� Vi,,.,fly.1�i 77t-1t�..J N Y CIC-))INN f�i C O ilt3I,F A C t I N C-i 0 January 27, 2012 Debbie Sokolov 14 Grouse Lane Hyannis, MA Estimate: Demolition— Remove bath tub,wall and remove the from walls and floor. Remove file backer from floor and walls. Remove shower unit,toilets'and two vanities: Remove closet from halh,uay and closet wall from bedroom. tabor and Dump Fee=$1,400' Framing: Build new wall along old bath tub and build new wall-to extend master bath: Build new wall for shower. Repair rotten floor in bathroom and install"new subfloor in bathroom as needed. Labor_$400 Materials $100 .Electrical: Install new lighting in bathroom and new extractor fans. Extractor fans to be vented to exterior. Install new GFI outlets. Labor and Materials=,$1,400, Plumbing: Install piping for two vanities and sinks, install two,pedestal sinks with drain-and faucet. Install new eater lines for two toilets and install two new toilets. Install water piping and drain for shower,then new mixing valve and trim kit for shower. Remove existing piping for bath tub and`cap lines. Install vinyl drain pan forshower. re Labor and Material 2,800' a. page 1 of 2 Licensed#068599 MA Registeation#125537 Fully ln.oUred i Sheetrock and plaster, install new sheetrock and plaster half way yp bathroom wai ve. Newly framed wails and'miscellaneous hatches as needed. All seams to.be taped and jointed, all screw holes ta-be filled.three coats:- Labor and Materials $1,400 Tiling: Supply and install%" Durock cement board to subfloor of both bathrooms. Durock to be cemented to.sub floor using flex bond thin set mortar. Supply and install iz" Durock cement board to walls of showier, all Durock seams to be taped and jointed: Install mortar mix base into vinyl shower pan. Install the (supplied by owner)to bathroom floors, shower walls and shower base: All tile to be grouted and sealed for.finish. Labor and Materials $4,500 Carpentry: bathrooms and master closet Install new baseboard in bathrooms and closet. Install new towel bars,toilet roll holders, etc. along with fiat mirrors. Re-install,existng door in piaster closet. Install wiring shelving(supplied by owner) in master closet. Labor and Materials=$1,350 Painting:two bathrooms and.one closet to be painted All new wood work to be sanded,filled,,caulked and primed as needed. All new sheetrock tad be primed. Ceilings to receive two coats of ceiling.paint: Y All walls to receive two coats of interior latex paint. All woodwork to receive two coats of interior semi-gloss: (All paint products to be Benjamin Moore; colors to be decided.) labor and Materials $2,1600 Additional work: 'riling- Faster bath Install % Durotk cement board on walls to.approx..40" high. Install the to walls to approx. 0",high.. Tide to be grouted and sealed for finish.:, page 2 of 3 License# 068599 MA Registration#125537 rullya'Insured �. a- t � �- Powder room: r install i4" Durock cement board to walls around toilet to approx.. 40" high. Install the to wails to approx. 40".high: Tile to be grouted and sealed for finish. (All the to be supplied by home owner) Labor and Materials =$1,500 Sheetrock and plaster.: I had only originally priced to remove sheetrock to approx. 4' high in the bathrooms. if you would like for me to completely remove sheetrock from'walls and ceilings in bathroom, it would be an additional$500. This estimate includes all applicable permits. All work'to be performed in a professional and timely manner. All construction waste.Will be removed by contractor. 'his estimate is.g€sod fear 30 days frorxo the above°date of January 27. 2012. Y ' Thank you, Anthony Quinn r t 2 24. -ZU 2 W 2I� `tom E'G ),r(". i, )?s Pt 6 T-r-va. i Ove(ne—S. OF �, / 20 ` L)PJ. + 3. ` , .1(rt �,� lt1 t i..i S ATa 6 t=4YZ-�7i't-"'d. C.�S,M(�w 6't iJv1 -,D page 3 of I _ Debbie Sokolow 14 Grouse Ln Hyannis Ma Existing Bathroom 12'-2" , Y-21/2" 7 6'41/4", 2'-101/4 1'-f0'x4=8' 1-101/2"x4'-8" - ° 0 co� 47sq`.f ' o . 00 cn x N) 2'-16'-8" I- Q 2-6"x6-8" (V i 1'6°` 3, 7„ 12'-2„ t i Debbie Sokolow 14 Grouse Ln Hyannis Ma 11'-10" 2roo" 5'-71/2" 3'-33/4" Proposed Ba 5!�fZ9hPLXS�9(O�► 1'-101/1"X4 8" �32 sq.ft.2,6" N !— F, 3'-0"�,�/ 8 4"X 8�O co sq.ft. ao CA 2•-8"x 6'-6" 2-6"x B'-8" , I 1'-7rr 6'-6n X-9n , i " u � ,1ti� -`•�"; ~� � � i4J � .�" � ✓�of '� Y J _ c.w } � E 1 o r �r .� r r%J dsT�i✓ / 'fax 3 r ✓r Of F� rr - - 'a r F ,_�/� ��3 / .11�if//��,r�/j/�jlr%// k a,,.«^ J ,. Aar .', ✓ ��. r�/r 'ri /"',~5 I%Hi'�1i'r 19��,>,����. ✓ ��K y s s�Ja �r f r� �✓a'SC'»dkri ram✓ S 3 '.33 >a Fa' G �% }�� � r s i i , r /�/// -.�/ / �" -. /( j:: � � �� .a✓ d � 1, �f y,r: d - '� lk- MW ME- mom - •'"*rr „tom _ - .�ce' - / $� One MOM W'ar�r ,_ a f 3 z Pon !�✓may/i/�% �,� � a' /� // 1 '� �� �`�5 � �� ����.` R$ �j 3 , 9 _ Wa Anit- 5{l F wor } t-` _ 'x'rool ' �rx�fls� r ,�,�.m WKS IN MEN= v, .� it Barnstable Assessing Search Results Page 1 of 2 Home: Departments:Assessors Division: Property Assessment Search Results New Search New Interactive Maps >> Owner: 2006 Assessed Values: HOPPE, PATRICIA J 14 GROUSE LANE Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $98,500 $98,500 . 268 /263/ Extra Features: $2,400 $2,400 Outbuildings: $0 $0 Mailing Address Land Value: $ 145,000 ,$1451000 HOPPE, PATRICIA J Totals $245,900 J 245,900 14 GROUSE LN ' HYANNIS, MA. 02601 2006 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $27.60 Fire District Rates Town Barnstable-Residential $1.90 $6.31 Barnstable-Commercial $2.51 Commei Hyannis FD Tax(Residential) $395.90 C.O.M.M. -All Classes ' $1.06 $6.54 Cotuit FD-All Classes $1.33 Persona Town Tax(Residential) $920 Hyannis-Residential $1.61 $6.49 Hyannis-Commercial $2.50 Other R, W Barnstable- Residential $1:60 Comm6r W Barnstable-Commercial $2.46 ,+ Total: $ 1,343.50 } t Construction Details Building Property Sketch Legend Building value $98,500 Interior Floors Carpet Style Ranch Interior Walls Drywall Model Residential Heat Fuel Oil Grade Average Minus Heat Type Hot Air Stories 1 Story AC Type None x Exterior Walls Wood Shingle Bedrooms 2 Bedrooms Roof Structure Gable/Hip Bathrooms 2 Full ' F http://www.town.bamstable.ma.us/assessing/assessO6/displayparcelO6map.asp?mapparbac... 1/26/2007 Barnstable Assessing Search Results Page 2 of 2 Roof Cover Asph/F GIs/Cmp living area 1176 Replacement Cost $123063 Year Built 1949 Depreciation 20 Total Rooms 6 Rooms Land 2 CODE 1010 Lot Size(Acres) 0.28 � S Appraised Value $ 145,000 Assessed Value $ 145,000 r View Interactive Maps > Sales History: s a: Owner: Sale Date Book/Page: Sale Price: HOPPE, PATRICIA J Aug 31 2001 12:OOAM 14193/064 $ 165,000 PUCHALSKI, ROBERT& PAQUIN, DAVID Jun 15 1983 12:OOAM 3758/258 $52,000 CHAFITZ, May 15 1980 12:OOAM $45,000 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value. FPL1 Fireplace 1 $2,400 $2,400 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area (Unfinished):. BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area UST Utility Area (Unfinished) (Finished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story (Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfinished) FHS Half Story (Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/assessing/assess06/displayparcelO6map.asp?mapparbac... 1/26/2007 Map Page 1 of 2 s. Town of Barnstable Geographic Information System New Search K Map Size � 3 wc�: Zoom Out In Parcel Viewer Custom MapIF Abutters - �I (Q1 JPG Map: 268 Parcel: 263 F F Location: 14 GROUSE LANE I 26.8253 � # 23 Owner: HOPPE, PATRICIA I 268261 # 22 — Location Information 3) 26824 Map &Parcel 268263 268252: "" #45 Location 14 GROUSE LANE #G` Acreage 0.28 acres -�P Current Owner .; Mailing Address HOPPE, PATRICIA J utr ` 14 GROUSE LN s 26 263 HYANNIS, MA 02601 268 62 # 1�4 #13IF = 268245, Appraised Value (FY 2006) Extra Features $2 400 Out Buildings $0 Land $145,000 °, Buildings $98,500 Total Appraised $245,900 268265." � Assessed Value FY 2006 .268264 # �` Extra Features $2,400 0 F f` 268091 Out Buildings $o #.54 Land $145,000 Buildings $98,500 Total Assessed $245,900 Set Scale 1" = 60 I Aerial Photos Copyright 2005 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v0.2,91 [Production] http://v ww.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=268263&mapparback=address 1/26/2007