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Home My WebLink About0005 HARBOR BLUFFS ROAD � � �� I Town of Barnstable Building Post This Card'So TF'at it'is::Visible From the Street Approved,P.lans Must be,Retamed on Job and this Card Must be Kept �� y r RtASS �b� g$' , Posted Until.Final Inspection Has Been Made ,„ . Where Ce t ficate,of Occupancy s Required,such Building shall Not`be Occupied until a"Final`Inspection has liee rmade Permit Permit No. B-20-2236 Applicant Name: Thomas Capizzi Approvals Date Issued: 08/17/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/17/2021 Foundation: Location: 5 HARBOR BLUFFS ROAD, HYANNIS Mao/Lot: 325-133 Zoning District: RB Sheathing: Owner on Record: DILORENZO, LEONARD&GARCEAU, Contractor Na a ,CAPIZZI HOME IMPROVEMENT Framing: 1 NC. Address: 5 HARBOR BLUFFS ROAD 2 _�Co.ntr_aetor License: 1007,40 HYANNIS, MA 02601 Chimney: . Description: REPLACE ENTRY DOOR INTO GARAGE WITH Ai7HERMATRU Est. Project Cost: $3,800.00 I � Insulation: FIBERCLASSIC HALF VIEW WITH GBG FC 65 SAME AS EXISTING IN Permit Fee: $35.00 SIZE. Fee Paid: $35.00 Final: Project Review Req: DOOR IS ENTRY FOR GARAGE ONLY. DOOR NOT BETWEEN Date; 8/17/2020 GARAGE AND DWELLING. Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by thi�permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. k Final Gas: All construction,alterations and changes of use of any building and structures shall bE in compliance with the local zoning by-laws anal codes. This permit shall be displayed in a location clearly visible from access street or road and shad II be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures by'the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: .. Rough: 1.Foundation or Footing " 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ij s ' '94t � I'ertnit � ^ �� aFVE> of Barnstable� ` &pires 6 mottllrs front issue date t f! ® tpry Services Fee anxrtsrnsra.KAM 3 n. 1, 1.6 9. mamma Richard V.Scali,Director APR 04 201 TOWN Division TOWN O� dMIMMAkpitilding Commissioner 200 Xlain Street.Hyannis,IVIA 02601 www_town.b amsta b i e:ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERIl�IIT A-PPLICATION - RESIDENTIAL, ONLY _ Not valid ivithout Red X Press fntpfint ibfap/parcel Number 7jZ`7 1 3 Property Address &417/►I [Residential Value of Work$� C/70 — Minimum fee of$35.00 for work under$6000.00 - L � Owner's Name&Address o/l 4/`, p b i t o(PR 7-0 4K 0 is� P -f 4Ab_&r 0_L(o01 Contractor's Name n�v,,J /3.i, .Telephone Number c{o f 2Z4-9& ^ d IIome Improvement Contractor License#(if applicable) 47 2 u 5- Email: Construction Supervisor's License#(if applicable) 7 O 7 12Norkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ �m the Homeowner L�rf have Worker's Compensation Insurance Insurance Company Name r-at►3 L]s _Ell SU f"E}� C�K i). Workman's Comp-Policy# W C A 3158 7 2—,9 2 c) 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 a Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) side Replacement Windows/doors/sliders.LLValue (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%vith other town department regulations,i.e.Historic.Conservation,etc_ ***Note: Property caner must sign Property Ommer Letter of Permission. - - - . - A copy the Home Improvement Contractors License'&Construction Supervisors License is require _ SIGNATURE: € C:\Users\Decollik\AppData\LocaNMicrosoftlWtindotvs\Temporary Internet Fites\Content.0utlook\2P10I DNIUMESS.doc Revised 040215 I Renewal Agreement Document and Payment Terms byAndehsen. dba:Renewal B Andersen of Southern New England Y B Leonard Dilorenzo ,�� Legal Name:Southern New England Windows,LLC 5 Harbor Bluff Rd �� RI #36079,MA#173245,CT#0634555, Lead Firm#1237 Hyannis,MA 02601 WINNOW RE tACEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)775-7123 Phone:866-563-2235 1 Fax:401-633-6602 1 sales@renewalsne:com C:(401)294-1004 Buyer(s)Name: Leonard Dilorenzo Contract Date: 03/20/18 Buyer(s)Street Address: 5 Harbor Bluff Rd, Hyannis, MA 02601 Primary Telephone Number: (508)775-7123 Secondary Telephone Number: (401)294-1004 Primary Email: amglad1@comeast.net Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents;and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $5,470 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $1,823 Balance Due: $3,647 Estimated Starr. Estimated Completion: Amount Financed: 7-9 weeks 7-9 weeks $0 Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for . delay. Notes: 1/3 deposit,1/3 at start,1/3 at completion Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank-You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 03/23/2018 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal n rse E Southern New England Buyer($) -e� � -J-)- Signature of Sales Person Signature Signature Paul Sandrey Leonard.Dilorenzo Print Name of Sales Person Print Name Print Name UPDATED: 03/20/18 Page 2 / 10 g, c Office of Consumer Affairs end Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS LL BRIAN DENNISON 26 ALBION RD LINCOLN, RI 02865 Update Address and return card.Mark reason for change. 1 Address Ej Renewal Q Employment (i Lost Card =;—Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the °~ HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: _.� Office of Consumer Affairs and Business Regulation Registration: .173245 Type: 10 Park Plaza-Suite 5170 Expiration: 9/19/2018 Supplement Card Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON ` BRIAN DENNISON ' 26 ALBION RD f l LINCOLN,RI 02865 Widersecre6ry Not valid without signature • Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-095707 Construction Supervisor BRIAN D DENNISON 7 LAMBS POND CIRCLES CHARLTON MA 01607 ny } Expiration: Commissioner 09/08/2018 r 12 The Commonwealth of Massachusetts ' Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 w� www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER UTTING AUTHORITY. Applicant Information Please Print Le 'bi Name (Business/Organization/Individual): e u3 Ut LQw, Address: ?& ALIS)OL) - City/State/Zip: Lf A1114P Phone#: �,f)[ _ 2 Are you an employer?Check the appropriate box: Type of project(required): L am aemployerwith ZO I'employees-(full and/orpart-time).* T.❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $• ❑Remodeling any capacity.[No workers'comp-insurance required.) 3. I am a homeowner doing all work myself 9. ❑Demolition ❑ g y [No workers'comp.insurance required.)t 4.❑ 10❑Building addition I am a homeowner and will be hiring contractors to conduct all work on my property. I will - ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions . proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof re airs These sub-contractors have employees and have workers'comp.insurance.t P 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14,.Other 152,§1(4),and we have no employees-[No workers'comp.insurance required.] rev ke—ie4 f/ 5 w *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. iContractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy 6djob site information. n_ Insurance Company Name inQ Policy#or Self-ins.Lic.#:_�(�C��a��7 Z, [ — Z.0 Expiration Date: �Ll Job Site Address: 5 44A.(-6 r 'Z I U City/State/Zip: MA ' Attach a copy of the workers'compensation policy declaration page(showing the policy num er and a piration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. t I do hereby certify under th ains andpenalties ofperjury that the information provided above is true and correct Si ature: tir, -5--ftleD2te: Phone#: CIO t- ZZ,e—i ec 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#: ' DATE(MMIDDIYYYY) AC"RL? CERTIFICATE OF LIABILITY INSURANCE 12/29/2017 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 CoBiz Insurance, Inc.-CO PHONE FAX 1401 Lawrence St., Ste. 1200 •303-988-0446 A/C No):303 988-0804 Denver CO 80202 ADDR1Ess: COMail@cobizinsLirance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC.dba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1252851166.. 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. INLICY EXP TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDIYYYY MM R /DDNYYY LIMITS A X COMMERCIAL GENERAL LUIBILITY CPA3158728 1/1/2018 1/1/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a OCCUR I DAMAGES(RENTED i PREMISES Ea occurrence $300,000 I MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000.000 POLICY❑JECTPRO ❑ LOC - PRODUCTS-COMP/OP AGG $2.000,000 X OTHER: I $ A AUTOMOBILE LIABILITY N CPA3158728 '{ 1/1/2018 1/1/2019 COMBINED SINGLE LIMIT $ Ea accident 1.000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS Ix AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR CPA3158728 - 1/1/2018 1/1/2019 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000.000 DED X I RETENTION$ 3' $ B WORKERS COMPENSATION WCA3158729-20 1/1/2018 1/1/2019 X PER OTH- AND.EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N I A E.L.EACH ACCIDENT $1.000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 79300733,10000 1 1/1/2018 1/1/2019 Each Occurrence $1,OD0,o00 Claims-Made Policy Aggregate $1,000,000 Retroactive Date 0 612 01201 3 Deductible $10,000 I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER I CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo Le registered marks of ACORD i s Cape Save I nc:. '- c 7-D Huntington Avenue ' South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 DATE Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permits = ' Dear Mr. Perry _ This affidavit is to certify that all work completed for 5 Harbor Bluffs Road (#201403240) has been inspected by a third party_Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, 1 William McCluskey i Nolsifila 1ZS 1W • u 4 s f .a Town of Barnstable Permit# Lfb Expires 6 months from issue date Regulatory Services Fee • s • ELARNUABM s MUM1659. Richard V.Scali,Interim Director Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number 3 z sue//3 3 Not valid without Red X-Press Imprint Property Address S' 11 4l?do d if/U`F AP LWII Afi f [Residential Value of Work$ /4/ 0 0 U Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address X ! o N,4,y p AI'4 Ot Aj-44 Contractor's Name d 0 A/ rf ✓ Kd li Telephone Number �rO,� YAP 9 J 11 (4�iZ21' tlpvt znrvoveJWAA1>F 2a4, s,0 dye 9jy Home Improvement Contractor License 0(if applicable) 1062 V1 Email: / f e Construction Supervisor's License#(if applicable) PERPHOor dw1 orkman's Compensation Insurance JU� Check one: 4 2014 ❑ 1 am a sole proprietor am the Homeowner El Worker's Compensation Insurance /TOWN OF BARNS ABLE Insurance Company Name 4 SJ o c i 4120 C 1 l4 t/,e4✓ S/1/l. Workman's Comp.Policy# Y V C G✓ G 1 0 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 Oxe-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Ctr?- Aj t C10O,q1?v ❑ Replacement Windows/door/sliders.U-Value (maximum.35)#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 SIGNATURE: T:\KEVIIV_D\Budding hangeslEXPRESS PERMIDEXPRESS.doc Revised 061313 Page 7 of 7 CAPIZZI HOME.IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACIIUSET"t S.:. :: LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT: : : OWN THE PROPERTY LOCATED AT MASSACHUSETTS . I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY:AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS�STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER ...,.. OWNER'S ADDRESS; p OWNER'S:TELEPHONE: LESSEE'S SIGNATURE:: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S_SIGNATURE: APPLICANT'S ADDRESS:: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428=9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE. ` { I CAPIHOM-01 APELL � a CERTIFICATE OF LIABILITY INSURANCE . °12127/2'013 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 WANED,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 ICAONNTF CT Ann Pell Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 We 134 Arc No Ext: I JAIC,NO).(877)816-2156 AIL South Dennis,MA 02660 E-"tADDRESS.apell@rogemgray.com INSURERS)AFFORDING COVERAGE NAIC 0 INSURER A:Main Street America Assurance Co. INSURED INSURER B:Associated Employers Insurance Co. Capiai Home Improvement,Inc. INSURER Capb7i Enterprises,Inc. 1645 Newtown Road INsuRER D Cotuit,MA 02636 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. IN SR R ADDLSUBR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MMMONYYYI MMMIDDPrIM LICY EXP UNITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY MPB1075H 61=013 6IN2014 DAMAGE TO RENTED PREMISES a occurrence $ 500,00 CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,0 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: - - PRODUCTS-COMPIOPAGG $ 2,000,00 POLICY X PRO JECT X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 500,00 Ea accident $ A ANY AUTO M1 M28044 6/8/2013 6/8/2014 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS-MADE CUS1076H 6IN2013 6/8/2014 AGGREGATE $ DED I X I RETENTION$ 10,000 - $ WORKERS COMPENSATION X I WC STATU- I OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETORIPARTNER/EXECUTIVE YIN N CC50050106472013A 12/25/2013 12/26/2014 E.L.EACH ACCIDENT $ 1,000,00 IM OFFICEREMBER EXCLUDED? M MIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601-0000 AUTHOR®✓}REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/06) The ACORD name and logo are registered marks of ACORD i , �:- in � � .h v TSTR R AU rim oxm t xII xcairas cea is waa kavW ' 3 + ` WAS i bo COP .� ray "Ink F s M s t' 7 AMA QM Nr v!Rio 07 i v "� �• � �`� a '� - Awl -4 MOW rAdyemy WIT t " MW 'In In _ z _ I CO)Wess Street,Sulfa IOQ Bostans 102-11-4-2017 xWwernass.gov/dia Workers' Compensation Lasurance A davAe Buiddexs/Coz��.c�o&ElectdcianslFlumbex APPReant bformation Please Priut Le bi, Naive(Business/Organization/IndMd-a Capizzi Nome Improvenlent Address:1645 Newiown.Road Cotuit, MA-02648 - Citylfate/Zip: Phone e#:508-428-0518 . Are you an employer?Check the appropriate box: _ Type*------------- ,Of (required): 1:®.I am a employex with 40+ 4..[� I am a general contractor and l' employees(full and/or part 4inae).* have hired the sub-contractors 6. ❑New consf ni-ction 2.❑ 1.am 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' - �o-wor ers co xnp�nsurance:... _ mice.•. — -required.] 5. n We area corporation and its 10.0 Electrical repairs or additions • 3: I am a homeowner doing all Work off have exercised heir, 11°. ri ]it •- . Q Plumbing repairs or additions myself. [No workers'comp: : right of.exemption per NIGL . . ❑Robfre airs. _ insurance requsrad.] c. 152; §1(4) and eve have no 12. :.D• ern to ees. P Y [No workers 13:[ th6r comp.insuxancerequired.] — A iy apr caatthat che`b1 box#1 must also fill out the sections below slioF�ing their workers'cgmperisation pot L y infozmation " T Homeowners who submit this affidavit indicating they are c9mg all work a.�"i then hire outside contractors must submit a u' affidavit indicatng such Contragtors that check this box must'attache an additiowl sheet show.ingfige name of the sub-contractors-and-gate whether or>iot those entities have employees. If the sub-contractors have employees,they must:provide then: workers'comp:policy number; X dA•an employer that isprovidbig workers'corvensation insurar�ee for my employees, Below the policy and job site �rj tiirtcctwrc. tusurance Company Name:Associated Employers Insurance Company. ,Poh- cy.#br•Self ins Lic #:WCC5010 5470.1:20T.1. .. D xpiration ate: 0 /iZ0/ Job Site Address: ,¢/�If 01: 4Pre ./pi' City/State/Zip. y/1 Nit//d itaclg a copy of flee workers' cagiipensation policy clecIaratioza page'(shoving the policy number and epiratioa date). Faxlure.to'secure coverage as required and' Section 25A of MGL C. 152 can:lead to the imposition of crinzirial penalties of a fuie tip to$1;500.00 and/or one-year imprisoniueiit,.as well as civil penalties in the,form,of a STOP WORK ORDER and a fine of tr '•to$250.00 a day a p y gaiust the violator. Be advised that a copy of this statement maybe forwarded to fhe Off ce o f havestigagons of the:DlA for insurance coverage verification. Z d®hereby certify under thepains andpenalaes ofperju . t the zrzfo rnationprovidedabove 1s true aril correct : .. _ Phone# 508-428-9518 fficral use:bnl}. Do.�not write in,this area, to lie completed by city op tolvn:officaal City.or Taivre: Permitucense# IS Authority(circle one): .: Board of Health ,Building])epartMeRt 3.City/Town Clerk 4.Electrical Iuspector 5.Plumbing Inspector -6 Otb ez- Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application(A 4 0 9 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 Raw- dl- 0/77 Y-S Village l (t el4 /S Owner �, �t� y�P�Z 0 Address 4 45 CL d(/ro _ Telephone li v 110917 Permit Request I r^ Se w CSC f� . d Ada c� C C_r 11wd S e o fair otZer crate sAnp Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation-01 ')0 0 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 o Basement Finished Area (sq.ft.) Basement Unfinished Area (sgfft) Number of Baths: Ful existing new Half: existing n'ey'vv _ 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 ❑ No Fireplaces: Existing 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name f 1 �� d P Vd1/�°-1+4C Telephone Number Address )TVl License # 0oG 1 `'L� `� �" y �� Home Improvement Contractor# V� i 3 Email Worker's Compensation #W h✓C 0 33 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 6W>W d SIGNATURE DATE /� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT AS:S,OCIATION PLAN NO. Building Permit Authorization I, Leonard:Di Lorenzo as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 5 Harbor Bluff Rd Hyannis, MA 02601 Signed Date } _ The Commonwealth of Massachusetts Department of Industrial`Accidents - Office of Investigations " 7 E r r 1 Congress Street,Suite 100 Boston,.MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electticiait /Plumbers. Applicant Information Please Print Legibly, Name (BusinessGUrganiiationl ndividual) Cape Save Inc. Address: M Huntington Ave City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-398-0398. Are you an employer?Check the appropriate box; Type.of project(required): 1.,F/ 1 am a employer with 4. [] 1 am a general contractor and I p 6, ,0-New construction employees(full andlor part-time): have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the-attached sheet. 7. []Remodeling ship and have no employees These sub-contractors have g. []Demolition Y workingfor me in an capacity. employees and have workers' y ' l? Y 9. [].Building addition [No workers comp.insurance comp.insurance t required.] 5. We are a corporation and its 10.0 Electrical repairs or.additions 3.0 1 am a.homeowner doing all work, officers have exercised their 11.0 Plumbing repairs:or additions myself. [No workers' comp: right of exemption.per MGL 12. - Roof repairs c. 152, §1(4),and we have no insurance required..]-' 13,0 Other Insulation • employees..[No workers' comp.insurance required.] 't\ny applicant that checks box #i must also fill out the section below sho«ing their workers'conipensa6onpohcy iiorniation. T Homeowners who suhniit this<affidavit indicating.they are doing all work and then hire outside wntractors.;must submit a new aFfidavifindicating such. 'Contractors that check this box must attached an:additional sheet shoring the name of the.sub-contmcteirs and state whiiher'oc not those ehfities havg. employees. If the.suh-contractors have;eihplovees,they must provide their workers'comp.policy number. 1 ant an employer that is providing workers'compensation insurance for no,employees. Below is the policyund joh.site information. Insurance.Company Name: Wesco Insurance Company Policy#or.Self-ins.Lic.#: WWC3085633 ._ Expiration Date: 04/09/201.5 Job Site.Address-- City/State/Zip: -I/ /l'1 (.�. o Attach a copy of the workers'compensation policy declaration page(showing the polity number and expiratiion date).; Failure to secure coverage as required tinder Section.25.A of MGL c. 15,2 can lead to the imposition of criminal penalties of a, fine up to 1,500.00 and/or one-year imprisonthent,as:well as civil penalties in the form of a STOP WORK ORDER and a.fine of up to:$250-00 a day against the violator. Be advised that a:copy of this statement may be forwarded to the;Office of Investigations of the DIA for insurance coverage verification. l do hereby certi under:the gins and enalties o er' +that the in ormat on provided above is tru and-correet. S i`anature: Date Phone#s Offrccul use only. Do not write in this area,to be co.tnpleted by city or town official. - City or Town:. - - Permit/License:# lssuing Authority(circle.one):: 1.Board of Health. 2 l3uildiug Department 3 Cty/Town Clerk. 4 Electricaldnspector 5.Plumbing.In spec tor " 6.Other Contaet Person: Phone#; CERTIFICATE OF LIABILITY INSURANCE °/14/roD'"Y""' 2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR.ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A.statement on this certificate does not confer rights to the certificate holder.In lieu of such endorsements. PROIwcErt: NAwiE: Colleen Crowley Risk Cpmp .Strategies Company Y PHONE Ext) (781)9H6-Aa00 FAC No:(781)963-4420 15 PaCella Park Drive AL Apogpss. Suite 240 INSURER(S)AFFORDING COVERAGE NAICi Randolph MA 0236$ P INsuRERA:Selective Ins... of America INSURED. INSURJERE-1-Safety Insurance..G an I y 33618_ Cape Saves Inc INSURER c:Wesco Insurance CompaII 7 D Huntington Ave INSURER-D JNSURERE: ::A South Yarmouth M 02664 INSURER0 COVERAGES CERTIFICATE N.UMBER:CL1441475243 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 AFFORDEDBY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CON DITIONS`OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. 1 TRR TYPE OF INSURANCE POLICY NUMBER .MMIDDDPOLICpmn Y EFF MMO11mC...EXP - LIMITS GENERAL LIASILtTY .. EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEG_ PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE EX OCCUR S1994480 `0/16/2013 0/16/2014 MED EXP(Any one person) $ _10,000 PERSONAL$ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENLAGGREGATELIMITAPPLIESPER' PRODUCTS-COMPIOPAGG '$. 21000,.000 POUCY X FRO X LOC $ AUTOMOBILE LIABILITY CO Es accident)I L LIMIT1 00aj OOO B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 6208200 1/6/2013 1/6/2014 AUTOS AUTOS. BODILYINJURY(Pecarcident) $ NON-OMED PROPERTY DA1vtAGE :$X HIREDAUTOS X AUTOS Peraoddent PAND,SMPLOYERS'LIABILITY UMBRELLA LIAR -E .._.. OCCUR. EACH OCCURRENCE $ 1,000,000 A ;EXCESSLIAB CLAIMS-MADE .. _ _ AGGREGATE $ 1,000,000 OW RETENTION . HI 19.94480 0/16/2gI3 0/16/2014 $ C_ RKERSCOMPENSATION- - - - fflcers. Included For VJCSTATU- OTH YINY L S R PROFRIETOR.PARTNEP�CUTiVE overage EL.EACH ACCIDENT $ 500 000 OFFICERIMEMBEREXCLUDED? a NIA (Mandatory In NH) 3085633 ./9/2019 1912015 E:LDISEASE-EAEMPLOYE $ 500,.000 Ifycs,describe undar GES RIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addltional.Remarks Schedule,if more space Is required) Issued as evidence of .insurance. . Issued as evidence of .insurance Thielsch Engineering, Inc:. is listed as additional insured as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION ms.ong@capeli,ghtcompact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE .EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light: Compact ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Margaret Song PO BOX 427/SCH AUTHORIZED REPRESENTATIVE 3195 Main Street Barnstable, M& OMO chael. Christian/CLC ACORD 25(2010/05) ®:1988-2010 ACORD CORPORATION. All rights reserved. INS025(261605).01 The ACORID name and logo are registered marks of ACORD .�----__ �.� f£�' �_ L S._ _� t'L^'��.__r.-• i.'�Lv. �'�' �! ..c.l�iLC_ L:_ _ v vGe. Once of Consumer Affairs and Business Regulation a- 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home improvement Contractor Registration Registration: 171380 T y pe: Corporation Expiration: 3114/20.16.. Try 243649 CAPE SAVE INC. WILLIAM McCLUSKEY ---- 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 - Update address and return card.Mark reason for change. sc V;,yri: _ address Renewal, I Employment ,- Lost _/rr. nJJiraUl.'PU•l.L ^'(�tr.ii!rr7i:r:G'/�.: . Office of Consumer Affairs Business lie-utation License.or registration valid for individul use only � i0tlfiE IMPf20VEiV1ENT COR'TRACTOR before the expiration_aate. If found return to: 'fiegistratson: 171380 Type: office of Consumer Affairs and Business Regulation .'Expiration: 3114/2016 Corporation IO.Parl:Plaza-Suite.5170 '= Boston,`.MI A 07-I16 CAPE SAVE INC. WILUAM MCCLUSKEY 7-DHUNTINGTONAVENUE, - � --.-'a--o-SOUTH H YARMOUTH,MA 02664 Undersecretary Not vali �thout sio-nature CSSL-142776 iu.. .. WILLUm d rVIC C'LUSKE 37 NAVSET ROAD West Yarmouth MA €22 .:; Jsw.^ jvjeJ, , 06/28/2015 L of rq� Town of Barnstable *Permit �`�� pExpires 6 months front issue r/a1r Regulatory Services FeeItAM �► Er ts. Thomas F.Geiler, Director i619. �0 f . ' $��'�yt. • _ Building Division . : s RESs Tom Perry,, CDO, Building Commissioner PERMIT 200 Main Street, Hyannis, MA'02601 www'town.bamstable,ma.us DEC - 7 2012 s . Office: 508-862-4038 i Fax: 508-790-6230 EXPRESS PERMIT APPLICATION — RESIDENTI a111D ' Not Valid►vldhojWRed X-Press Imprint BARMSTABLE Map/parcel Number c 3c:�S 33 Property.Address 25- 17�4e37e 114b,yl14 + A4 Residential Value of Work J 3 n Minimum fee of S35.00 for work under S6000.00 ,Owner's Name & Address L' d/,¢ ��Lei ,�2p` Sal M d Contractor's Narne Telephone Number L101- 6-7 1 qJ-T) Home Improvement Contractor License#(if applicable) 17'3 2 L/,.) a Construction Supervisor's License#(if applicable) 2 1 2 ❑Workman's Compensation Insurance r Check one: ' Ej I am a sole proprietor 1 am the Homeowner (t&.I have Worker's Compensation Insurance Insurance Company Name �, f . Workman's Comp.Policy# � � C 2 l lg �S` 3 � 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 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers ofroofl '' ❑ Re-side k ti #of doors ( Replacement Windows/doors/sliders, U-Value ( (maximum .35)#of windows aL *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e,Historic,Conservation,etc. ***Note: Property Owrier must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors Lic e& 'Construction Supervisors"License is re , SIGNATURE: ,° k 2AWPFILESVORMS\building permit forms\EXP cc i ' Zevised 072110, 42 Renewal - "^^r - • RI Reg#.12259;30839 �� ^� - CT HIC.0562725 byAndersen RENEWAL BY ANDERSE. NIA HI#119535 WINDOW REPLACEMENT an Ande Company 1137 Park East Drive•Woonsocket,RI 02895 ` read Hazard Control Firm 1 Phone 401.671.6401 a Fax 401.671.6262 License#LHCF-0059 Federal Tax ID#46-0566630 Southern New England Windows,LLC d/b/a ` Renewal by Andersen of Southern New England CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name - Date of Agreement �. Buyer(s)Street Address,City,State,and Zip Code - O E-Mail Address Home Telephone Number Work Telephone Number _ "o �F(7 Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal by Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this`Agreement"). 2 I'q �.�K•Irr/� Total Job Amoun�3 30 Estimated Starting te: Method of Payment ❑Check ❑Cash ❑Financed Deposit Received(33% Credit Cards are acce ted for de osit only- maximum I/3 of the Balance at job 33%� // J (Start of a07w P project cost. lease see Credit Card Payment Form.)By signing this Estimated Completion Dace: Agreement you acknowledge that the Balance at Start of Job and the Balance on Substantial yf / zq Balance on Substantial Completion of lob cannot be made'by credit Completion of Job(33%): 11 card and must be made by personal check bank check or cash. L, Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agreement.Buyer(s) acknowledges that Buyer(s) (1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only)Notice to Buyer:(1)Do not sign tbis'Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank:(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the frill unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess.goods purchased under this Agreement.(5)You may cancel this Agreement ' if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which ,regularmail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. Buyer(s)received the consumer education materials provided by the Rhode Island Contractors Registration Board. (Buyer's Initials) Renewal by Andersen of Southern ew,England;. Buyer(s By: 4 to ana i ature t - Signature Lem 'Lo Zo Print Name of Product Manage( Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. + - - - - -�- - - - - - - - - - �- - - - - -�- - - - - - - - - - -X- - - - - - - - `CATION NOTICE OF Date of.Transaction ' .You. may cancel I Date of Transaction ./ You may cancel this transaction,without Ay p nalty•or obligation,within this transaction,without any penalty or obligation,within three business days from the above date.If you cancel,any I three business days from the above date.If you cancel,any property traded in,any payments made by you under the I property traded in,any payments made by you under.the ' Contract or Sale,and any negotiable instrument executed I Contract or Sale,and any negotiable instrument executed by you will be returned within ten business days following I by,you will be returned within ten business days following receipt by the Seller of your cancellation notice,and any .I receipt by the Seller of your cancellation notice,and any security interest arising out of the transaction will be security interest arising out of the transaction will be canceled.If you cancel,you must make available to the Seller I canceled.if you cancel,you must make available to the Seller at your residence,in substantially as good condition as when .I at your residence,in substantially as good condition as when received,any goods delivered to you under this Contract or I received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the instructions of I Sale;or you may,if you wish,comply with the instructions`of the Seller regarding the return shipment of the goods at the i the Seller regarding the return shipment of the goods at the Seller's'ex'pertse and risk.If you do make-the goods available.X Seller's expense and risk.if you do make the goods available , to-the Seller andl.the Seller does,not.pick them up within. to the Seller and the Seller does not pick them up within twenty,days-ofAhe date of cancellation,.you:may,retain or I twenty days of the date of cancellation,you may retain or dispose,of;the.goods,without any further obligation.if you I dispose of the goods without`ariy further obligation.'If.you fail to make the goods available'to the,Seller,or if you agree I fail to make the goods available to the Seller,or if you agree to return the goods to the"Seller'and fail to do so,then I to return the'goods to the Seller and(fail to do so,then you remain liable for performance of:all:obligations under. you remain liable for performance of all obligations under the Contract.To cancel this transaction, mail or deliver I the Contract.To cancel this transaction, mail'or deliver a signed and dated copy of this cancellation notice or any I a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Renewal by I other written notice, or send a-telegram to Renewal by Andersen of Southern New England at 1 137 Park,East Dr.,`1 Andersen of Southern New England at 1 137 Park East Dr.,, Woons c tgt,R 02895,NOT LATERTHAN MIDNIGHT OF I Woons ket, 1 895,NOT LATERTHAN MIDNIGHT OF ha (Date) // (Date) I HERE Y C CELTHISTRANSACT16N. I I HER BY C NC ' THIS TRANSACTION. X Buyer's Signature Print Name -- Date. Buyer's Signature Print Name Date RbA Copy:White Buyer Copy:Yellow Buyer Copy:Pink s Renewal RENEWAL BY ANDER� J R'R g#'IC.0562839 �� Cf M 59/30839 byAndersen. '' MA Ht#t 19535 wixoow REPLACEMENT(..AM ,co „ 1137 Park East Drive*Woonsocket,RI 02895 Lead Haurd Control eirni . Phone 866.563.2235*Fax 401.671.6262 License#I11cr-0059 Federtl'fax IU#4G-OSGGG30 SPECIFICATION SHEET " Buyer(s)Name Date of Agreement LIC&WW" D; 10,6P.12-0 i6 1.2 The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR_ REMODELING AGREEMENT,of which this Specification Sheet is a part. WINDOW DETAILS 1. Contractor will Install a total of windows in Owner's home,using the following individual quantities: Double Hung(DB) Pg Equal sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash(2/3 top.1/3 bottom) Casement(CW) ❑ Hinge right❑ Hinge left(as viewed from exterior) Double Casement(CDW) Casement/Picture/Casement(CPW) ❑ 1:1:1 or ❑ 1:2:1 2 Lite Gliding Window(GW) ` Glider/Picture/Glider(GPW) ❑ 1:1:1 or ❑ 1:2:1 Awning Window(AW) Picture Window(PW) Bay or Bow Window Patio Doors(see separate Door Specification Sheet) Z. Yes ❑ No Qty of Windows to be Custom Fit Replacement: 3. ❑ Yes No Qty of Sills to be replaced by Contractor: r 4. ❑ Yes No Qty of Windows to be.New Construction Full frame(includes new interior&exterior casings): Exterior casings: ❑ Pine ❑ Maintenance-free material ❑ Factory applied 908 Fibrex brickmold � � �,I,,� 5. Glazing to be: ❑ HP Low-E-4 TM Other If other,please specify: t� (iaf (1A A. 6. Exterior color to be- White ❑ Sand ❑ Canvas ❑Terratone Exterior Only: ❑Cocoa Bean ❑Dark Bronze❑Forest Green 7. Interior color to be:X White ❑ Sand ❑ Canvas ❑Terratone ❑ Pine ❑ Maple ❑ Oak Note: Interior color can only be white,wood or same color as exterior. Wood interiors need to be finished by Owner. 8. Hardware:J<White ❑ Stone ❑ Canvas ❑ Brass Double Hung: „ 9. ❑ Yes'g No Install Lifts with Double Hung Windows 10. Screens: windows to have: ❑ Half or X Full screens Screens to be: ❑ Fiberglass ❑ Aluminum Truscene GRILLE DETAILS , 11.Windows have grilles: ❑ Yes No If yes:❑ Grille Between Glass(csG)❑ Removable Interior Wood aNTw)❑ Full Divided Light(FDL) Qty' Qty: Qty: Qty: Qty: Qty: Qty: OH DH DH DH CW/Picture Glitler CPW orG r. Draw grille patterns above *Use additional sheet if needed Owner approved(initials):( ) ADDITIONAL WORK DETAILS 121. ❑Yes Vo Contractor will remove metal frames of windows. Qty of Units: 13.XYes NO Contractor will install�LI�F'Vneew� paint-ready or stain-ready casings. Interior casing qty of openings: / Exterior casings qty of openings: X Pine❑Maintenance-free material 14.' Yes ❑No Contractor will install new paint-ready or stain-ready inside or outside stops qty of openings: _ Interior stops qty of openings: Exterior stops qty of openings:_ Pine❑Maintenance-free material 15. ❑Yes KNo Contractor will wrap exterior casings with aluminum coil stock of color. Note:Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing. 16. WYes ❑No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 17. RYes ❑No Clean up all job related debris including old windows will be removed.Vacuum nightly. 18. Yes ❑No A limited warranty shall be issued to Owner upon completion of the job and p yment in full. 19. %Yes ❑No Building Permit—Contractor will secure any and all necessary permits. T fee for the permit(s)is wet w included in the Contract Price 20.XYes ❑No All current promotions and discounts have been applied to the abov greement amount-any future discounts or sales are not applicable to this agreement. ' 21. Owner is aware that Contractor does not do any painting. ( )Owner Initials• 22. Owner is responsible for the removal and reinstallation of any existin m systems. Owner to call alarm co. 23. Owner is responsible for the removal and reinstallation of any window AC units. 24. Owner is responsible for the removal and reinstallation of window treatments&brackets 25. Additional job details:_Q/�._ !(L. / 26. J es ❑No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No final payment shall be demanded until the contract is completed to the satisfaction of all parties. It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM WINDOW' ~ AND DOOR REMODELING AGREEMENT,constitutes the entire understanding between the parties,and there are no verbal + understandings changing or modifying any of the terms.This Specification Sheet may not be changed or its terms modified . or varied in any way unless such changes are in writing and signed by both the Buyer(s) and Contractor.Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. _ Renewal by Andersen of uthw England Bu a s), r(s) a Buye - By;. e e c Si o r Manag ,i to, - Signature ' & ,9FL C �7 L . I L0 Print Name of Product Man er Print Name Print Name White Copy RBA fellow Copy Customer Renewal vAndersene 1*�xc b WINDOW REPLACEMENT am t .-Mpimy - �} t wood/Vinyl Composite IF n� . � Evat�sral F r,�sh�atcre - F{ting<tot�fif Dual Argon Low E Double Hung 100-00390547-005 ENERGY PERFORMANCE RATINGS A U-Factor(L1.S)/I-P Solar Heat Gain Coefficient 0 7 . 0 . 31 . 1 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance w 0qg. 53 _ Manufaeturerstlpulates that these ratings conform to applicable NFRC procedure,fur deleim nrng whole product performance,NFRC ratings ere determined fora fixed set of environmental conditions and a specific product size. ' - NFRC does not recommend any product and does not warrant the sultabillty of any product for any specific use. y Consult manufacturers literature for otherproduct performance lnformatlon. .3,, www-nfrc.org. �r w. �,SEq� This product meets cre t 1 i - - Seal's environmental .::, standards governing energy efficiency,heavy . � r _ •< O metals in the frame and ,4V sash materials,packa ' CEWO education mating,and erials. r duca DESIGN PRESSURE(PSGME _ 1 1 m av mr Ip - - '_ VrvnY.wr4.. H - LC5 t'. RbA DB Sloped Sill DH IN Testedto N.AFS-02or AAMA/WDMARJA 101/IS/A440-05. Maaufaeturerst ulstcamnfnm,nn.rrn the annhcable seaadards n .. Meets orexcaeds M.E.C.,C.E.C,61.E.C.C.Air lnfilltretlon requirements WDMA Hellmail,W,61—tion Program.. t 4y. t ; $g, t• f h A2, -. -. •5! .. < - 'fir: • » V •-r r .. 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 A licant Information Please Print Legibly Name (Business/organization/Individual): L►t! � '` Address: 3 / �Gxl"� 51L �-I V'� City/State/Zip: �-�� 52 ®alrq5Phone#: Are you an employer?Check the appropriate box: 1.(§ I am a employer with o2D 4. ® I am a general contractor and I T of project(required): employees(full and/or part-time).' have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling ship and have no employees These sub-contractors have 8. ❑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 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11. Plumbing myself ❑ g repairs or additions y [No workers'comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we havUo 12.❑Roof repairs 3a.❑ I am a homeowner acting as a employees. [No workers' 13.a Other Q4 Ie�Ce,rti, �' general contractor(refer to#4) comp.insurance requited.] w ; - •� d $ *Any applicant that checks box#1 must also fill out the section below showing their workers'compeno4oliry 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 airs 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.#Al q a [a 7 6 19 3 Sod 3 ?y �p�-on Date Job Site Address: S r bt) d tF� City/State/Zip: Q+� t 1✓�k Z(pt7 I y b Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 c under a pains and p aides of pe)Yury that the information provided above is true and correct 1lm Date: ec /, 'LOIZ Ph U yS`1) Offlcial use only. Do not write in this area, to be completed by city or town oJjiciaL CIty or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3 City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact pre'rson• Phone#: Client#:30124 SOUTNEW ' - .ACORD. CERTIFICATE OF LIABILITY INSURANCE" a - , DATE10/02/202/20n'rrY) 12 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(les)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 0* ACT Anita Little ' Willis of(Massachusetts,Inc. PHONE F ac No. c Ext:856 914.4600 AIc,No): 856-914-1881 100 Huntington Avenue F-MAIL ADDRESS: anita.liftie@willis.com r INSURER(S)AFFORDING COVERAGE NAIC 0 Boston,AAA 02116 _. INSURER A i Argonaut Insurance Co. 19801 INSURED INSURER B:Beacon Mutual Insurance Company 24017 Southern New England Windows LLC D/B/A Renewal by Andersen INSURER C: 1137 Park East Drive INSURER D Woonsocket,RI 02895 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 CONTRACTOR 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. LT RR TYPE OF INSURANCE ADOLSUBR POLICY EFF POLICY EXP IN SR WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS GENERAL LIABILITY pEAApCCMHHqOCCCCURRRENCE $ PREMIS COMMERCIAL GENERAL LIABILITY ES EaEoNccTuEr Dnce $ CLAIMS-MADE DOCCUR MED EXP(Any one person) $ PERSONAL 6 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROE T- J LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT t Ea accident ANY AUTO k " BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Pr. dent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LI1B CLAIMS-MADE - AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION AI�'92769$352394 8/21/2012 08/21/201 X WC srATu- OTH- AND EMPLOYERS'LIABILITY PIZ B OFFICEANY WMEMBER�EXCLUD D?ECUTIVE® N/A 68028(RI) E.L.EACH ACCIDENT $1 OOO OOO (Mandatory in NN) E.L.DISEASE-EA EMPLOYEE $1 000 000 It yes,describe under t DESCRIPTION OF OPERATIONS below 1.` = E.L.DISEASE-POLICY LIMIT $1,000,000 _ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,ili more space Is required) Named insured is a Renewal By Andersen Dealer CERTIFICATE HOLDER t CANCELLATION , 4 Southern NE-LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL, BE DELIVERED IN. 1137 Park East Drive ' ACCORDANCE WITH THE POLICY PROVISIONS. Woonsocket,RI 02895 '' •4 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) ' 1 of 1 The ACORD name and logo are registered marks of ACORD #S212686/M212684 AXL `M issachusetts- Department of Public tiafetc Board of Building; Re-ulations and Standards j Construction Supervisor License I ti 1 License: CS 42926 PAUL'H THIBEAULT. 26 ESTER ST r L' a N SMITHFIELD, RI 02896 �- ?r Expiration: 2/16/2013 Commimioner, Tr#: 9563 O fice o onsumer Affair and�BusinVssRe ul n , g 10�Park Plaza - Suite 5170 . ,Boston, Massachusetts 02116 V Home Improvement Contractor Registration Registration: 173245 y Type: Supplement Card Expiration: 9/19/2014 SOUTHERN NEW ENGLAND WINDOWS LL.. ' PAUL THIBEAULT n 1137 PARK EAST DRIVE ,r WOONSOCKET, RI 02895 - F Update Address and return card.Mark reason for change. -CA1 0 5OM-04/04-G101216 Address Renewal Employment Lost Card � . T/te �arvmonuieai o�./�aaaac�euvelta } Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation . Registration::':.173245 •Type: 10 Park Plaza-Suite 5170 Expiration; 9/19f2014 Supplement Card Boston,MA 02116 SOUTHERN NEW EaVG1.AND WINDOWS LLC. RENEWAL BY ANDERSON:. PAUL THIBEAULT 1137 PARK EAST`DR1VE, WOONSOCKET, RI 02895, Undersecretary Not valid without signature t. <. t r� Town of Barnstable *Permit# '26. . H � � � -- Expires 6 months fr9m issue dat Regulatory Services Fee i BAMSTABLE, 9 MASS. - qj 1639. �� Thomas F.Geiler,Director SS PERMIT Building Division MAR2.011 - Tom Perry,CBO, Building Commissioner # ., 200 Main Street,Hyannis,MA 02601 N OF BARNSTABLE www.town.barnstable.ma.us Office: 0 -862-4038 Fax 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 3,Z SJ/ / R Property Address 5 14.4 n 3 10 f'�f � U } 1� /-�i�'li l�7 t i J A .0 2 6©1 [Residential Value of Work d C)00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address v e LL Z.a j 1.1✓►ri �Ud* 1c;��1.. nlJ �-�+� -4L1+1i% A 4 d26,G/ Contractor's Name o ex_ 1n p�22t �✓ C.� i L21 ild eh-6 1/n 1� Q 2e/Z�= %s'/� �' /� Telephone Number Home Improvement Contractor License#(if applicable) 160 7116 I //I G Construction Supervisor's License#(if applicable). , `S g w ' 'Z.• •- &KV/orkman's Compensation Insurance Check one: ❑ I am a sole proprietor, ❑ I the Homeowner have Worker's Compensation•Insurance ." Insurance Company Name /�_C �4 jy i'i�-7�y k N C(J1,it- J C t�lx/p AV-v Workman's Comp.Policy# IV W C C 'i 5'� Y 3.2. Ll Copy of Insurance Compliance Certificate must accompany each permit. . Permit Request(check box) { [9/Re-roof(hurricane nailed)(stfYppmg oidThingles) All construction debris will betaken to uih;fieif Wj-l¢ S grlu u'ic/,,r� 1'Zt A ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑"Re-side #of door ,C33 s 4ro dod�,f Yee k�r. Replacement Windows%doors/sliders.'U-Value (maximum.35)#of windows 3 J/ y li yidT✓ �iXe'cQS 'Where required Issuance of this permit does not exempt compliance with other town department regulations,i:e;Historic,Conservation,etc:. b V. 6116) /U J' ***Note: Property Owner must sign.Property Owner Letter of Permission. A copy,of the Home Improvement Contractors.License&Construction Supervisors License is required.. " SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 The Commonwealth of Massachusetts . Department oflndustr^ialAccidents - Office of Investigations 600 Washington Street Boston,,ML 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applic. ant Information PIease Print Le gib Name(Business/Organization/Individual): . �{; ,ZZ i /`� mom° rjyi 1pr Address:J�p q V cc/71_�r J City/State/Zip: Q 7 V f 0 W 3 J Phone.#f: 5 S' Are you an employer? Check the appropriate box: Type of project(required):. I am a employer with 440 t 4. Ej I am a general contractor and I rt employees (full and/or pa -time).. have hired the sub-contractors 6•..[]New constriction 2.❑ I am a sole proprietor or partner- listed on the'attached sheet. 7. Remodeling ship and have no employees These sub-contractors have P $: Demolition • working,for me in any capacity, employees and have workers' [No workers' comp.insurance comp.insurance.$' 9. Building addition- required.] 5• ❑ We are a corporation and its' 10-F 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 I3 LYOther employees. [No workers' 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. 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. l am an employer that is providing wor-kers'.comp ensation insurance for my employees. Below is the policy and job site information. Insurance Company Name C, Q C .,SLr4/Y .�fwj - -— — Policy#or Self-ins.Li,.:- #: (,I�CC 113�2-7J F Expiration Date:_ '�' /z tl Job Site Address: 17 .14AV ill N 03/U/L j 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 ' flue 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 hivestigations of the DIA for insurance coverage verification Ido kereby c-er-t ccnder-th�-pains and-penalties of-per.ur- that-the-irzfar-mation-provider-above-is-txue-and-correct Signature: Dater 0313i/20®J Phone 2-6 Offccial use only.. Do not write in this area,to be completed by city or town offzciaL; - City or Town: Permit/License# Issuing Autlzority(circle one): I.Board of Health 2.Building Department 3r City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6..Other.. Contact Person: Phone#: Client#:47298 CAPIHOM ACORDTM CERTIFICATE .OF LIABILITY INSURANCE DATE(MM,°°'YYYY' 01/04/2011. 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(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 endor"sement(s). PRODUCER CONTACT AME CT Karen Walther Rogers&Gray Ins.-So. Dennis PHONE 508 398-7980 FAX 434 Route 134 MAID° EXt: vc,No ADDRESS: waltherka@rogersgray.com P.0.BOX 1601 PRODUCE - - CUSTOMER IDM - South Dennis, MA 02660-1601 - INSURER(S)AFFORDING COVERAGE NAIC# INSURED - - INSURERA:National Grange Insurance Co. _ - Capizzi Home Improvement,Inc: INSURER B:ACE Property&Casualty Ins.Co Capizzi Enterprises,Inc. " 1645 Newtown Road - . INSURER C: , Cotult,MA 02635 - INSURER D 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 P00CY.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 DDL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSR D. POLICY NUMBER MM/DD MM/DD LIMITS- - - A GENERAL LIABILITY MPB1075H 06/08/2010 06/08/2011 EACH OCCURRENCE $1,000,000. - X COMMERCIAL GENERAL LIABILITY - - DAMAGE TO RENTED PREMISES Ea occurrence $500,000. CLAIMS-MADE �OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY, $1,000,000 ^ GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC- $ A AUTOMOBILE LIABILITY' ' BPO10786 - 66/08/201 O 06/08/2011 COMBINED SINGLE LIMIT $ A ANY AUTO M1M28044 06/08/2010 06/08I2011 (Ea accident) 500,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS. - PROPERTY DAMAGE X HIRED AUTOS w (Per accident) $ X NON-OWNED AUTOS U1 $2501500,006 X1 Drive Other Car U2 $2501500,000 A UMBRELLA LIAB X OCCUR CUB1076H 06/08/201 O 0610 8/2 0 1 1 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE r AGGREGATE $5,000 OOO .DEDUCTIBLE - - $ - X RETENTION $ 10000 - $ .- B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X WC STATU OTH. AND EMPLOYERS'LIABILITY' Y/N - - - - ( - ANY PROPRIETOR/PARTNER/EXECUTIVE N/A - E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? - (MandatorylnNH) - E.L.DISEASE-EAEMPLOYEE $1,000,000 If yes,describe under - DESCRIPTION OF OPERATIONS below - - - E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD,101;Additional Remarks Schedule,if more space is required) - Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 r AUTHORIZED REPRESENTATIVE m 198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109). 1 of 1 The ACORD name and logo are.registered marks of ACORD #S61971/M61970 MEE Page 7 of 7 CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I,LEN DILORENZO,OWN THE PROPERTYLOCATED AT 5 HARBOR BLUFF LANE IN HYANNIS, MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: 5 HARBOR BLUFF AXE,HYANNi,MA 02601 OWNER'S TELEPHONE: 508-775-7123 LESSEE'S SIGNATURE: LESSEE'S ADDRESS: ` LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: t. . APPLICANT'S ADDRESS: 1645 Newtown Rd.,Cotuit,MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: r INSPECTION CHECKLIST [To be returned to main office with approved contract package.] Built In JOB NAME `� I nYw',)7 r'-) JOB# 3 s hl�f INSPECTION DATE PRODUCTION MANAGER �S ATTENDEES PROJECT MANAGER STORAGE/KEY(Circle one): Materials Storage: YES❑ NO❑ Location: Tool Storage: YES❑ NO❑ Location: Key: YES❑ NO❑ Location: DEBRIS DISPOSAL METHOD: Dumpster: YES❑ NO❑ Size: Dump Truck: YES❑ NO❑ Size of load: SM MED LG Project Mgr.to use shop dumpster: YES❑ NO❑ COMPLETE PROPOSAL READ? YES❑ NO❑ REASON (IF NO): PAYMENT SCHEDULE REVIEWED? YES❑ NO❑ REASON (IF NO): CONTACT PERSON FOR PAYMENTS NOTICE NEEDED FOR PAYMENTS? YES❑ NO❑ REMEASURED YES❑ NO❑ . INITIALS Ask: What are the most important things to the customer regarding this job to assure a raving fan? SPECIAL NEEDS: PROJECT SHEETS: SHEET DESCRIPTION DURATION NOTES NOTES: S_` Office of Consumer Affairs&Business Regulation License or registration valid for individul use only Q :_r HOME IMPROVEMENT CONTRACTOR before the expiration-date. If found return to: 01�. ; Registration .100740 Type:. Office of Consumer Affairs and Business Regulation fM =� n: 6/2372012 Private oration 10 Park PIaza-Suite 5170 / Ex P iratio i -_ = Corp Boston,MA 02116 OAPIZZI HOME IMRRO------ T ]NC. Thomas Capizzi,jr .- 1645 Newton Rd. gnu Cotuit, MA 02635 Undersecretary Not valid out signat re Massachusetts- Department of Public S2 eta Board of Buildin ; ROgulations and Standards Construction Supervisor License License: CS 57032 Restricted.to: 00 THOMAS.X.CAPIZZI.J.R , �^ 1645 NEWTOWN RD COTU IT, MA.02635 Expiration: 9/26/2011 Conunissioner' Tr#: 4113 PROJ'EC _ S NAME: ADDRESS: ��10 PERMIT# 2�< < l�OCD S PERMIT DATE: �l M/P LARGE ROLLE-D PLANS ARE IN: BOX ' GC Z . SLOT Data entered in, MAPS program On: 5 B Y: oFtt r ` ow-n of Ba `>a stable ' *Permit# Expires 6 months rom issue.date Regulatory Services Fee ' s ` v� fbs9. ,Thomas F. Geiler,..Director pT�oMPtt` -PRESS PERMIT' Building Division Tom Perry, CBO,_Building Commissioner MAR ' 2010 200 Main'Street, Hyannis, MA 02601 www.town.barnstable.ma.us �"OA O'F BARNSTA k, Off ice: 508-862AO3 8 Fax: 508-790-6230. EXPRESS PERMIT APPLICATION - RESIDENTYAL ONLY Not Valid without Red X-PressImprint. k1ap/parcel Number Property Address iiAL:7 ( {J , /!/✓'%� co residential Value of Worl. Minimum fee of$25.00 for work under$6000,00 !Owner's Name&Address L.e/J /1/ 0" -e' JZ 0 Contractor's Name , M A 2 / Telephone Tlumber 401'C 71" CV00 _ s I Ionic Improvement Contractor License#(if applicable) Construction Supervisor's License#(ifapplica,ble) 1� 06wor , kman's Compensation Insurance Check one: t ❑.1 a a sole proprietor . ❑ eV 1 m the Homeowner i i have Worker's Compertsation'Insurance' 4/1 Insurance Company Name �✓ (� �✓9/ (�t� Workman's Comp. Policy Copy of Insurance Compliance Certificate must be'on file. Permit Request(check box) ❑ Re-roof(stripping old,shingles) Ail construction debris wiII be taken to ❑ Re-roof(not stripping: Going over, existing layers.of roof) Replacement Windows/doors/sliders.U-Value 01'�5. (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservahon,`etcr ***Note: Property,.Owner must sign Property Owner Letter of Permission: A copy of the Hom6 Improvement Contractors:License is required, t t'WT I1 I:S\FORMS\buiIdink permitforns\EXPRESS'.doc` Revised 100608 The Commonwealth of Massachusetts ;De pa`rtment of Industrial Accidents t " Office of Investigations 600 Washington Street Y Boston,MA 02111, ^ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizaiion/Individual): Qo Q Address: )�? � y� Fig City/State/Zip: Phone#: 'Are an employer?Check the appropriate box: Type of project(required): - I. I am a employer with C)� 4. I am a general contractor and I' * have hired the sub-contractors 6. ❑Ne f construction mployees(full and/or part-time ).* - .. Y I _listed on the attached sheet. - .. .7. Remodeling _ 2.0 I am a sole proprietor or partner- e - ship and have no employees These sub contractors have g• ❑Demolition working for in any capacity.- employees and have workers', comp. insurance. 9. 0 Building addition [No workers'comp. insurance p , required.] 5. E We are a corporation and its I O. Electrical repairs or additions 3.❑ I am a homeowner doing all work• officers have exercised their 11.❑Plumbing repairs or additions myself o workers com' right of exemption per MGL Y p 12.0 Roof repairs insurance required.]t c.152, §1(4),and we have no " t _employees. [N .0o 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 doirig all work and then hire outside contractors must submit anew 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 any employees. Below is the policy and job site information. ' Insurance Company Name: e G(lAl ALA Policy#or Self-ins.Lic..#: ;1> Expiration Date- Job Site Address: AS. / � 0/' �(/ City/State/Zip.: J Attach a copy of the workers' compensation policy declaration page(showing the policy num 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$250,00 a day'against the violator. Be advised.that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: .i'T' -�—•�.�-- �- Date: Phone#: ` 2 7—C71 C Wl 0 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department,3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i is car -` 6f Co & sines"alatio T.fr d"ftm to: 40mF-fIViPRC MElTr aCgN'TRAC'TQR . Roard 4RG#ft9 p4gdwms wd slagar 03, s v Room,x`t , t t!' ti s "PT j 11 7Y# 285438 _ 7 Wn JAMES MOON iAlAif, k" VV@O ( 9CKEfi, Rv ;l Undersecretary ' " '• u, it�w:€ astt�- fl�S;tiit aafu63ti Re*kftdku RFWS, €►ip`4. tit Bull int!R ar.tl ll*wfuurt$-� Umnse sp. sold pad vir�Devi= 3 w ady ES MOOS AM PAINE ROAD CUMGMAXI Oi Rl M-4 ppic,�,k to Dnoft mri& SOW t From:Shaunna Robinson,Hunter Insurance At-Hunter Insurance,Inc. FwdD: To:Denise"Glade Date:9f13t09 09:45 AM Page:2 0 ACORN CERTIFICATE OF LIA13ILITY INSURANCE OP ID s DATE(MWDDiYYYY) MOONA-1 09/23/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON-THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P.O. Box 1 - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 Phone: 401-769=9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE NAIL4 INSURED MOOR Associates Inc. INSURER A: Rational grange Insurance co 14788 DBA Gutter Helmet DBA Renewal by Andersen of RI INSURER B: Beacon Mutual insurance.Co, DBA-Gutter He Roofing INSURER cc DBA Moon Works 1137 Park East Drive INSURERD: Woonsocket RI 02895 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. POLICY F_Xr1XA11UN - - LTR NSR- ' TYPE OF INSURANCE - POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $10 00 0 0 0 A X COMMERCIAL GENERAL LIABILITY MPS26619 09/16/09' 09/16/10 PREMIS'ESEe_o'=urence) $500000 t CLAIMS MADE a OCCUR MED EXP(Any one person) $10 0 0 0 PERSONAL&ADV INJURY $ 10 0 0 0 0 0 GENERAL AGGREGATE. $2000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $2 0 0 0 0 0 0 POLICY JPERCOT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 10 0 0 0 0 0 A X ANY AUTO B1S26619.. .: 09/16/69 09/16/10 (Ea accident) ALL OWNED AUTOS ) BODILY INJURY: $ SCI-rED XED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ . NON-OWNED ALTOS (Per accident) PROPERTY DAMAGE $ . (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1.000006 A X OCCUR CLAIMS MADE CUS26619 1 09/16/09 09/16/10 AGGREGATE $ DEDUCTIBLE $ X RETENTION $10 0 0 0 $ 5 WORKERS COMPENSATION AND X TORY LIMITS ER B ANY P.R ERS TORIPLA BIL TY 28586 10 `01 0 ANY PROPRIETORIPAR'MER/EXECUTIVE / / 9 10/01/10 E L EACH ACCIDENT $500000 OFFI CER(MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $5 0 0 0 0 0 ' If yes,describe under SPECIAL PROVISIONS below E.L_DISEASE-POLICY LIMIT $500 0 0 0 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 6 CERTIFICATE HOLDER CANCELLATION BUILDIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Building"Con t. Reg. -Board NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dept. of Administration One Capitol Hill IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Providence RI 02908 REPRESENTATIVES,. A�f�. D�ATIVEE , ACORD 25(2001/08) QACORD CORPORATION 1988. ar �is 3' 7 ti ro�GT� m " ' c pC 1 FloorPiae Z i``� //rp�I z$ n »,d o r c ID Number ° l V i g O,pys A 'c T;.. y- W va fl p7oyz kRl rom ItHe- Prod,ntsF ` Y i s ` •` FrMe y a g P f®ttoiyAppfled v <s Ondmould �ryry 1 YM4Y OMf IIY4Ks/B 0' �? Adual%Mdlhtndws 21 5= fit= AWeI fkigM U Indus C 101.�,�, e.' _ to the nearest ills' 00 f m v 'e n^K 3- 3 Sill Angle to f f I P filVRien � HUIQ•%a pWaR� 03. I '! r�pt7C ^ tD Sash Raft m�e 3 Color Exterior 9 � �• -F � wCs°.la+trir a x- n v ° GO Cj 00Sash Lifts or Pu ° (� '• � � � � �R � �•- Sash Locks Per SashSash Operation All two*4.6110"Oftiv �•a ZF 11 � a 'Ll M(cwl�OsU O O o Grille Profile 3 �..wa,/s k.enwm p I 1 1 I l B of Lites WAo U n m I I 1 d of Lites HIGH CV tt of urea Ode52 E a c. .31 MofLtaHiyA T�.r g w 4to < yz' ❑ LaJ ❑ °�' \ Estimated J Nfidffi N N� .N<• � w Sl+n r^ Est_ tird v w 'ft Y a A N o 'g xfor SpecWOr - 6*g� oFIKE Tp Town Of Barn' s 1 ab a Permit# Expires 6 monthsfrom issu-.dal Regulatory.Services.., Fee - BARNSTABLE, *+ RESS y M6 3S, �$ T� as F.Geiler,Director - �',rEo A U G 2 5 20 4 M 0,, Building Division TOWN OF BARNSTaifttry, CBO, Building Commissioner 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 Nlap/parcel Number Prq�erty Address esidential Value of Wort: � �� '��_ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 1V-t' ��Zo?rel1l7- Contractor's Name .1172rasy° Telephone Number 1'�� /—d� O 1 lipme.Improvement Contractor License#(if applicable} Construction Supervisor's License'# (if applicable) 119�� []Workman's Compensation Insurance Check one: I am a sole proprietor, ,.. ❑ I. the Homeowner, [ ave Worker's Compensation Insurance Insurance C;ompanyNarne. L {,C3'!/"�/ .� d✓ , Workman's Comp. Policy# 95li- J Copy of Insurance Cotapliance Certificate'must be on file. Permit Request(check box); »` r ❑ Re-roof(stripping old shingles) A 1 construction debris will be taken to ❑ Re-roof(not strapping:-Going.over existing layers of roof) -side Replacement indo' s/doors/sliders.U-Value ® S S (maximum .44) *Where required. lssuaiice'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 is.required. i i.'� PF1! 1 S\l(>RMS\building perniit forms\EXPRESS.doc 12evised 100.608. The Commonwealth of Massachusetts -� Department of Industrial Accidents -F Office of Investigations 600 Washington Street, Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizati Individual): A S 0C Address: �' LL n� 01 City/State/Zip: WON � J Phone#: /`C�� d Are an employer?Che the appropriate box: Type of project(required): 1. I am a employer with U 4. ❑ I am a general contractor and I employees(full,and/or part-time).* have hired the sub-contractors 6. ❑Ne onstructiop 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7: emodeling These sub-contractors have -ship and have no employees, ,` . 8. ❑Demolition ' working for me in any capacity. employees and have workers' 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 l 1.❑_Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑:Roof repairs insurance required.]t c. 152', §1(4),and we have no ` employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out,the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit Indicating such. 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 or my employees. Below is the policy and job site information. Insurance Company Name': Policy#or Self-ins.Lic. Expiration Date: •��/. Job Site Address: NA Rd City/State/Zip: /J/ d�l Attach a copy.of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP:WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of- Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains and penaldies ofperjury that the information provided above is true and correct. e. 9 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(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 e ryas r�vand.f � d 0 p `[ r3 �nsurner rs.& Basin Regutati�n bdom t.he a !r date=Urand rdm, tm MdME iMPROVEMENT_CONTRACTf}R Board otBaUft AVuhums wd Swdgtz s - . One Asbburton Pine eRm.qjgj 1,19535 - Bost o.021 ,' tpir tint � fii 2 11 �Tr# :285438 i1 OON ASSOC JAMES ON ' C C Y Ere WOONSOCKET, Rr, ; � < �� .� Undersecretary ResWd tm PFLicense- CS SL M44 WS »'Wj-bt sould pod on De-vites mi .Down JMES MOON 43 PAINt4�tt 4Wf tote CUMSERANID.RI Taft . . f °raw-Won of Ws, Items cart From vmwh,.,4 RQUASOA mufft knum-noo Mnk or l r'ma.mm ftdo, Tw,Der-loo.clodeDAYS INJOWPM4 CERTIFICATE. F LIAB U_. INSURANCE �� :t � _ __... '�'�}#�g�� ttw^( ��pf�yl��ry�✓�`fi�N.��s�$3 T`; fit`� ��`}�3��}sM�kpw�:�E"3��`I �'u�Yk 's� w �k��xar+ 'F ��s+♦ 8:&��i�dba 4 �trB T.� �� f ha �� Y+1a L a8kd i'K 3- M fiver 'Ral : P.01 uox :1 Vsw A . z TW, ' . 1�. � y+ "12W Yas RS 4*'S.i�r`rre *rT'.� a ....__.. ...... ..Xn.+�.�.... t ` ..�<��pa. ........... 1 +�•� 1�c y�.. ''emy.K'sE��>�F.Q'n�d��.i6sY.['StL�Y ''�PL T59iY Y.si' iY�� i'V3r3��'"L.i�ssW i"ie"6�3'�d.� .SPR ._ L`�.�Ytn3'� _ • AW $EBCJ?.!e$".:�'tT'r,'�_zriT.T=4 On WOMM4F FtW eMA•wa M=VJM=C=MAY eg e7aMM OR PY§" 'fJS�s°`+s. s.ty,t p��, �' �# 1 �> "a1a3 �sra� °} ' kktX9hilTdA' FfJCB ..:'. IS600000 eorMALAMM.4AM 42,000000 ^=d> lvs:slitMOO=-fit s $ 001 PUMAMMM BODILY IM� SCMMSDAMS mm XMccLe 0 CLAw MAW 0913_61091 AWZ-MAM tc _ A URM,Mouty 500000 #Wd'. 0 DAW WMnM9 Dept. oil -Wraini-s do I6 £xza T`3i 1 an3iTt'?m'as")urpomTwami mLIn Am=D one c.Wplt*3, Hill RX 02908 � � . OACORD OFORR logo 508 746 4056 P..01 . Floor Plan C �s a � n��. Ib Number ? o l H#�9 p I " �WOR! PoduaStyle 9 s Kn2 .ra.b..M.�.a mom &M ,3 g »R ` Frame Tyr s 9 �• (1 °� dlF—(F) BI'�� i � g� FactoryAppliedBridcmoulda. ActualWdth In Inches to the nearest 1116"I 8 Actual weightInInches ro� I roaMa6�• tl& Mth¢nearesttll6 � a SiH Angle Uia 9, - rt %�e3"_ iiIII n a, p"aaiAA rr) Sash Ratio owvw�nn.7w7s:u N �s �» rr. El CowlorExterior i s 3 M Color Interior g,� " wx sr CVrri .. ft U��—'q, C7 R f3 yy & ' Glazing CI st'wirms A N. ' ;5r rt "tl Eif n Sash llks or Pulls I i - ' Sash Locks pet Sash e I wa.cx;AAesP�rri+aa A.� y.� j - Sash Oapefation , c Hardware Qpflon swv,ntmewna4aew", IWACaI°• I ne @Jor Aumns'N O �,E I�n ' NAScreent�pe �+ QCl y, s«nvexrre°w°nrroM 11 WSR yo Grille Pattern CS nrorA-.u:.rcw Caon/afr° In (OaN a a p Grille Type n � •�. .� .eBG IaIW wFDL y 1J yI y ^ O 'A �. Grille Profile f secme,.red.amn.m ., � S11S3 ! 4 of tites Wide C7 d w S11S3 .. g.. ifof Liter HIGH o S2 a t1 of Was Mde Stsw of Lites High 3 � ° Estimated 00 ©d n �:•' _ 'O. V.W.. N Wldtti Estimated Zo Height G ? o F N it Casing Method ") p •m..rr 0,1 a W 6 � _ g for SpedafOrder, oFZHE r Town of Barnstable *perm►t# 900�el&jl �P� ti0 Expires 6 mmttl from issite date Regulatory Services Fee , BARNWA`�LE, 9 MA9S. i639. Thomas F. Geiler, Director ATfDMAtA " u BuildingDivision tiA 4f�Q Tom Perry,CBO, Building Commissioner �i/{� �� •' � 200 Main Street, Hyannis, MA 02601 �� www.town.barnstable.ma.us Office: 508-862 403 �, Fax: 508-790-6230 EXPI,8S N PERMIT APPLICATION - RESIDENTIAL ONLY Vol Valid without Red'X-Press Imprint Map/parcel Numbe3aal- Property Address �gZm(L 1�1, t �N r Vl�l Residential Value of Work > Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address Contractor's Name Telephone Numbe�%'� I lame Improvement Contractor License#(if applicable) Construction Supervisor's License# (if applicable) ��U lKWorkman's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ 1 am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 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 be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value (maximum,.44) e' *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. z py of th Hom Improvement Contractors License is required. SIGNATURE: r_ ITII.I.S\I HMS\building permit forms\EXPRESS.doc Revised 100608 Page 7 of 7 L CAPIZZI HOME IMPROVEMENT INC. �a SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, iw ,�i l p y-e ,c� cz-o OWN THE PROPERTY LOCATED AT S � ``►�l�}� fl�l l/ IN �yG C4 , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACC NCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: 7 OWNER'S ADDRESS: Sa'``Q OWNER'S TELEPHONE: 7�S 7 3 LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: / Ail APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: A CORDTM _... ...�. . CERTIFICATE OF LIABILITY INSURANCE °ATE(MM,D°,YrYY; PRODUCER 12(30/08. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers 8r Gray Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER:THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. O, Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis,MA 02660-1601 INSURED INSURERS AFFORDING COVERAGE NAIC# Capizzi Home Improvement, Inc. INSURER A: NGM Insurance Company Capizzi Enterprises,Inc. INSURER American Home Assurance 1645 Newtown Road ' INSURER C: Cotuit, MA 02635 - INSURER D: _ - ' 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, s LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION - DATE MM/Do DATE MM/DD LIMITS A GENERAL LIABILITY MPB1075H 06/08/08 06/08/09 EACH OCCURRENCE X COMMERCIAL GENERAL LIABIUTY $1'000 000 DAMAGE TO RENTED Pa EMI n $50 000 CLAIMS MADE �OCCUR ` - MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: - POLICY jE a LOC PRODUCTS-COMP/OP AGG $2 000 000 A AUTOMOBILE LIABILITY M1 M28044 .: 06108/08 06/08/09 ANY AUTO - - COMBINED SINGLE LIMIT (Ea accident) $500,000 ALL OWNED AUTOS ., i. '- BODILY INJURY.. 'X SCHEDULED AUTOS (Per person) X HIREDAUTOS "X. NON-OWNED AUTOS - - o .BODILY INJURY - �' .(Per accident).. - - X Drive Other Car PROPERTY DAMAGE $ (Per accident) .GARAGE LIABILITY .. AUTO ONLY-EA ACCIDENT' $ ANY AUTO � .. - _ . _ . OTHER THAN - EA ACC $ - AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY CUB1076H ¢ 06�08�08 06/08/09 EACH OCCURRENCE $5 000 000 X OCCUR CLAIMS MADE - ?. AGGREGATE $5 000 000` $ DEDUCTIBLE _ - - ." - _. _ X RETENTION $10000 $ WORKERS COMPENSATION AND WC6957000 .:r 12�25�08 12�25�09 X WC STATU- - .`:OTH- $ EMPLOYERS'LIABILITY - T R IMIT R ANY PROPRIETOR/PARTNER/EXECUTIVE g E.L.EACH ACCIDENT $$00,000 OFFICER/MEMBER EXCLUDED? If yes,describe under. E.L.DISEASE-EA EMPLOYEE $500,000 SPECIAL PROVISIONS below 1 E.L.DISEASE-POLICY LIMIT $500,000 " OTHER ". _. _- .. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry ; CERTIFICATE HOLDER , CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION, DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN - 2OO Main StreEt. y. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL' Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR` _ REPRESENTATIVES. - - AUTHORIZED REPRESENTATIVE ACORD 25(2001%08)1: of 2 #S40650/M40647 KW © ACORD CORPORATION 1988 t . D ��ie TOarrvrruiruuea`l!i o�,/vGaaacac/uleetta 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 Registri_tj,QO,, 100740 One Ashburton Place Rm 1301 pin.ili[i�=@ 23/2010 �t�; i Boston,Ma.O 108 . plement Card rMFra CAPIZZI HOMEt�M tARY GUSTAFS~� . 1645 Newton Rd. Cotuit,MA 02635 Administrator �04,ri- B(mrd . itho,t nature ,�: 'rI E•..se}iti.;i.3tti- t)i��iiaf'tarts:�rat i3fi fs.ut}ic �afct� -- - ___ . of Builtliia„ Rc"i+l.ittt'sl. ttttl Sr.1tni3:1i'il.s Construction Supervisor License p i icense: CS 74640 .. Restricted to: op e GARY GUSTAFSCN ; 8 SHORT WAY ` SANDWICH, NIA 02563 - i 11129/2010 . ' ,.. 7755 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street_ ' Boston, MA 02111 UV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): G�_Z2�, 1Z4. Address: ,f City/State/ZipQff\dq�Q M (Q? S Phone#: Are you an employer?Check the appropriate box: Type of project(required): I am a employer with N — 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. # 7emodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. .insurance- 5. ❑,We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I LE] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13.❑ Other *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 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: -D I)�,i a�it �A3A 2� kLl i km Policy#or Self-ins.Lic. #:� cM�� d Expiration Date: Job Site Address: City/State/Zip. 1 0, Attach a copy of the workers' compensation'policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year.imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der the p ns d penalties of 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(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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts. Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-'727-7749 www.mass.gov/dia J TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION.., w„ 35 : 1 Map Parcel 'Application # Health Division :� � -Date Issued �,d� Conservation Division :Application Fee U Planning Dept. Permit Fe e. : Date Definitive:Plan Approved by Planning Board ' Historic OKH _ Preservation/Hyannis Project Street Address /&_Z 60 g! Village 02 Owner �, A)UM PAUI�Address 7 Leg LAP 121 Telephone 5 09- r7 79—S 757 Permit Request VG V �� Dvg, /Iv NZcr" Square feet: 1 st floor: existing proposed '2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 000 "Construction Type�&NOvg�j9IJ Lot Size �� Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure _ (0 Historic House: ❑Yes R"'?No On Old King's Highway: ❑Yes o Basement Type: ❑ Full Crawl Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft� C., Number of Baths: Full: existing new Half: existing Number of Bedrooms: existing new es "� N Total Room Count (not including baths): existing new Firs 6 ,� t Floor R`'L CounT —ram-- .;, Heat Type and Fuel: CYGas ❑ Oil ❑ Electric ❑ Other Central Air: XYes ❑ No Fireplaces: Existing New Existing wood oal ste e: C Yes ❑ No rn rr, Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ `xisting ❑ 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �1 - Ala � " c� Telephone Number �/�VO 'P/?7 �i1 ,�J� Address / / � � �`� License # 1� 1� I/VIw Home Improvement Contractor# J Worker's Compensation # %0C...U1'"`808 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Y v &AIP SIGNATUR DATE LPG tO FOR OFFICIAL USE ONLY Y APPLICATION# .. i DATE ISSUED a ." MAP/PARCEL NO. ADDRESS VILLAGE ' � OWNER r - �. DATE OF INSPECTION: + .? FOUNDATION 4, ` FRAME INSULATION ; FIREPLACE ELECTRICAL: ROUGH �- FINAL 7 PLUMBING: ROUGH -` FINAL GAS: ROUGH - FINAL = FINAL BUILDING I - DATE CLOSED OUT ASSOCIATION PLAN NO. t. The Commonwealth of Massachusetts Department.of Industrial Accidents Off ce.of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant:Information Please Print Legibly Name (Business/Organization/Individual): 06 filoo Address: _- City/-State/Zip: ,A "1 "A hone #: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with c 4. ❑ I am a general contractor and I :'` employees(full and/or part-time).* have hired the sub-contractors: 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9. Buildin addition [No workers'comp.insurance comp.insurance. ❑' g 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-- comp.insurance required.] *Any applicant that checks boz#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; lContractors that check tliisboz 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. ys g Insurance Company Name: Ae, � ! ' Policy#or Self-ins.Lic. Expiration Date: 0 �f Job Site Address:J City/State/Zip: &,rwy%.;15 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.a, or.ohe-year imprisonment,as well as civil penalties in the form of a'STOP WORK ORDER and a fine of up to$250.00 a day'against the violator. Be advised that a copy of this statement maybe`forwarded to the Office of Investigations of the DLA'for insurance coverage verification. I do hereby a un r e pains and penalties of perjury that the information provided(aboveeis true and correet. Signatur :Date: Ph o e#: ' S S Official use only. Do not write in this area,to be completed by city or town offeiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: JAN-26-2009 11 : 12 PM LEWIS AND WELDON 15087785111 P. 02 May 16 2898 10'12.'01 18664Z46567 -> The Hartford Fax Paps @B3 ACM. CERTIFICATE-OF LIABILITY INSURANCE Bp I�urx R076 05-16-2008 PAYCREX AGENCY INC THIS CERTIFI ATE Is ISyUED qqS A(BATTER OF INFORMATION HIS AND C8NFEA6 NO RIGHTS UPON THE CERTIFICATE 1210705 P, O - F; O _ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1 30® PARMINGTnN AVE A TER THE COVERAGE AP ORD dY THE POLICIES 9F�ow IN TO. C 06_032 INSURERS AFFORDING COVERAGE i Avo•Aso — -- -- II LIncAA>xwin City Fire Ina Co j LEWIS & WELDON CUSTOM CABINETR Y LLC I WAD c. -" 1111 AIRPORT RD. rNI§ MA 0 UAR ate_ COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATFD.NOTWITHBT'ANOING I MAY P RTAI�MMME INSURANCE AFFORDED ORDED BY THE DIT ION OF ANY CONTRACT 0190IBED HEREIN S$UBJECT TO ALL THE T/RM9.EXCLUSIONS AND Cl7NDITIONS OF SUCH Pl1LIClEB,AUGRECATC LIMITS Rm0wN MAY HAVE RFFN MCdUCED BY PAID CLAIMN. /Swum pr Aa/n�lYlLocy N/AWM!1AAm►r N o MSReIA1,D!N•R� EACH OB INCA • ABIUT� - CIAIMO MADE OCCUR ME ADe A a Ira) a ' MLD P'M on• ••R a PC RiO AL ADV I JURY a D' • OENl AOOAfDAT!uM•T APPL Eg PO11 AL AGORA AT[ PO I V~' LOC PRODUCT®•COMP/OP AGO e 411rOmmu LIASK ffr i ANY AMro COMOP1:D SINGLE L'MIT' e liw aaametrt) ALL OWNED AUTOA 11CHEDULF.0 Aurco $DOILY INJURY e • IAar p.raon) HIRED AUTOS j QOOILV INJURY RDN•OWNED AuryY (Pr 400109161 a PROPiRTV DAMAGE e " IPa walaeeel 9UlAOPeIAMjl1'r ---- ANY AUTO LIA AC I Otir • �I - OrnC1THAN fb AEC a I AUTO ON AGO • ,�A"Paw LA•1N/rr . EACH Occ iNCE • OCCUR L� MIMRMADr ADORfOArI L D¢DucT;o�, • MET' TION e WORXNIECOAUONEAriONAI� WC ETATU. QTN. • A a o �AEnlrY I 76 Z X NP1808 �95/10/Da 05/10/09 E,L,eACHAccIDwr 6100,000 I .t L.L.OIRIAll•[AEMPLOVEi 1 01C0 Q00 4"m _.rsf,,, f„01 EAPE FOUCY LIMIT • QQ OOO rA7AM:W.WOM7A7NM00an�n!v�rlwatLBt�IDLGONaW14AWA,ar-w;w Camrnu[t,AtRPON/AOAW — -- Thoae usual to the Insured's operations . CERTIFICATE HOLDER��4oananw- urt►pleTps i CANCELLATION SHOULD ANY qF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE AQUINO INSURER WILL ENDEAVOR TO MAIL Town of Sandwich Building Doyt. 30 DAYS WNITTEN NOTICE 110 UAYS FOR NON.PAYMPNT)TO THE CERTIFICATE Z#tti1 I LTOQ!] HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO 16 Jan Sebastian Dr.. OBLIGATION OR LIABILITY OF ANY KIND UPON TNI INSURER.ITS ACINTE OR 9culdwich, MA 02563 111RIP111111111111INTATIV18._ A P0O ~ANA!/H1rarWF ACORD 26•6 m.9 �-' �ACORD CORPORATION 1906 Board of Building Regulations and Standard, License or registration valid for individnt use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 1.54680 Board of Building Regulations and Standards Expiration: 3l281,2009 Trff 254733 One Ashbortoil Piacc Rm 1301 Type: Private Corporation Boston,Ma.02108 ;. r LEWIS 8 VVELDON CUSTOM 6INETRY,LLC. CLARENCE HART { i 111 AIRPORT RD4 ' " • HYANNIS; MA 02601 s A...... 1 Administrator Not valid without signature g tute Board of Building Regina ions and Standards F One Ashburton Place - Room 1301. Boston. Massachusetts 021.08 Home Improvement.Contractor Registration ., Reqistration: 154680 Type: Pivate Corporation s- Expiration: 3/28/2009 Tr# 254733 LEWIS &.WELDON CUSTOM CABINETRY, .......... ..._.. CLARENCE HART �. 111 AIRPORT RD HYANNIS, MA 02601 __.. _ _. Update Addr-ess and return card. !Mark reason forchange. cA Cssown-os;os-r�csnsa i Address Renewal I ] Lost Card d �i r-. CD n. LO CO ti co 0 IO pRoerd of Building Regubtion..And Standards Q Construction Supervisor License w Licen'se: CS,•970e4 3 8irtfidF .e.:,.7116M964 6120:0 Tr# g 7QQ CHUCK HART JR tst 11 PERCIdP.LCR:4t'.� VJEST NARNSTkBLE. Commissioner cli CD CD CV CD C1J I Z — n ; - _ y LEWIs &WELDON Ct1mm $uILDERS DESIGN + BUILD PROPOSAL Lewis and Weldon Custom Cabinetry, LLC December 12, 2008 , DiLorenzo Residence 5 Harbor Bluff Road Hyannis, Massachusetts 02601 Lewis and Weldon Custom,Cabinetry, LLC 111 Airport Rd ' Hyannis, Massachusetts 02601 508-7785757—508-778-5111. g . PROPOSAL December 12, 2008 Between the Owner: Mr&Mrs DiLorenzo 5 Harbor Bluff Road Hyannis, Massachusetts 02601 Contact Primary Telephone And the Contractor: Lewis and Weldon Custom Cabinetry, LLC 111 Airport Rd Hyannis, Massachusetts 02601 608-778-5757 For the Project: DiLorenzo Residence 5 Harbor Bluff Road Hyannis, Massachusetts 02601 SCOPE OF WORK: Seal to limit dust penetration to all areas not to be worked in Dinning Room: • Patch&prepare opening for paint or wallpaper choice TBD- no allowance • Prep and paint trim on patched wall and ceiling one coat primer two coats finish Rear Hall/Bath • Replace door to garage with 30 minute rated fired code steel door • Remove floor and prep for tile • Remove toilet CUQV (�C • Repair door trim to match existing • Paint walls trim ceiling and new door one coat primer two coats finish • Install tile floor-Allowance for the Kitchen Area • Remove existing kitchen countertops • Remove existing cabinetry • Remove existing floor and install cement based subfloor • Plumbing for typical removal and new installation of new fixtures • Electrical as per kitchen plan • Build&prepare wall for new windows&door. Install full header if needed. • Trim new windows and door to match existing • Sheetrock and finish new wall • Eight 5" recessed lights in ceiling • Remove existing thermostat for ceiling radiant heat • Patch in or replace ceiling to match existing • Remove breakfast area fan and replace with lighting fixture supplied by owner • Dimmers on all new lighting • Phone connection to be relocated cable outlet not included - • All areas of kitchen to be prepped primed &painted. Walls, ceiling, and trim one coat primer two coats finish • Tile backsplash area—Allowance for file / Ado Sun Room • Same as common wall above ` °'`�" All debris removed Light cleaning of 1st floor of home upon completion of project Cabinets, hardware, sink, faucet, and appliances on another Agreement General layout and dimensions are not to change. Detailed dimensions are subject to change. Please note that file being a manufactured product will have variations in color and could include such characteristics as veins, stripes, small divots, and other inclusions. In addition, note that the tumbled file products, because of the tumbling,will have significant variation in color. This agreement is based upon:the listed tile choices and quantities, any changes may result in an adjustment to the total project cost. TOTAL BASE PRICE: $36,714.29 BASE PRICE INCLUDES: Scope of Work All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the proposal.All agreements are contingent upon strikes, accidents or delays beyond our control.Client to carry fire, home owner liability and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. By State Law,the homeowner shall have a three day right of cancellation. Upon such cancellation, if applicable,there could be an additional design and project coordination fee based on time invested(not to exceed 10%of total agreement),deducted from Deposit Lewis&Weldon LLC,as the homeowner's agent will obtain any and all necessary construction-related permits. Per MGL 142a, any owner's who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. "The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contra4 the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In MGL c 142A. Any inquiries relating to unresolved project concerns should be directed to; Registration Division, Program Coordinator,One Ashburton Place Room 1301,Boston,Ma 02108. Tel:(617)727-3200 ext.25239 L is&Weldon epresentahve Mr 6i rs DiEbrenz 5 Harbor Bluff R Hyannis, Mas husetts 02601 NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. Upon acceptance of this agreement, please initial payment schedule and sign agreement above your name. Keep one copy for your records and forward the other, along with your deposit check to Lewis& Weldon at 111 Airport Road, Hyannis,MA 02601. Please note that because of potential cost adjustments,this proposal is only valid for 60 days. Le 8 Weldo epr+esentatnre "rMsDiLore 6 Harbor Bluff. d Hyannis, Massachusetts 02601 PROJECT ALLOWANCES THIS AGREEMENT, Made as of November 26, 2008, Between the Contractor: Lewis and Weldon Custom Cabinetry, LLC 111 Airport Rd Hyannis, Massachusetts 02601 508-778-5757 And the Owner: Mr&Mrs DiLorenzo. 5 Harbor Bluff Road Hyannis, Massachusetts 02601 Contact Primary Telephone. ALLOWANCES INCLUDED: Windows Windows $2,200.00 Doors Doors $1,905.00 hardware $185.00 Tile Materials Mudroom Tile $180.00 Kitchen Tile $206.00 r ,. ap saw, " ffl. dr� i3.. d xa it`�..r O :t' x '� ,$r • PAYMENT SCHEDULE THis AGREEMENT, Made as of November 28, 2008, Between the Owner: Mr&Mrs 1311-orenzo 5 Harbor Bluff Road Hyannis, Massachusetts 02601 Contact Primary Telephone And the Contractor: Lewin and Weldon Custom Cabinetry, LLC 111 Airport Rd Hyannis, Massachusetts 02601 508 778-5767 For the Project: DiLorenzo Residence 5 Harbor Bluff Road Hyannis, Massachusetts 02601 $17,883.13 Construction Deposit a $ 7,153.25 Windows and Doors ready for delivery $ 7,153.26 Ready for Cabinetry install 3,576.0 Construction work complete $36,766.26 Total Construction 4 Lewis and Weldon Custom Kitchens 111 Airport Road Leonard DiLorenzo &Annmarie Garceau � 5 Harbor Bluff Hyarll=�s, MA 02601 � Hyannis, MA 02601 Telephone 508-778-5757 508-775-7123 home Fax 508-778-5111 01=26-091 401-440-4089 cell #11 19 — Ki chen Not To Scale ` - # �s ry I. 185 7/8 #6 #13 ' 701/2 36 18 30 15 24 ... 47 5/8 12 12 12 12 3 1/4 - 28 24 24 24 181/2 33 39 39 13 1/ #1353/1 #12 1013/8 57/870 24 _ 1 . p 36 #8 3,16 3/8 #7 I #5 24 . 111/2 487/8 - '24 #9 131/ 2 ... .781/8 25 3/4 27 24 33 2�26 3/8 2 36 - 228, - _ 237 5/8 #14 60 #4 167 5/8 S 93 5/ 1 115 314 #3 137 Lewis and Weldon Custom Kitchens Leonard DiLorenzo &Annmarie Garceau 111 Airport Road 5 Harbor Bluff -Hyannis, MA 02601 - Hyannis, MA 02601 Telephone 508-778-5757 508-775-7123 home Fax 508-778-5111 01-26-091 401-440-4089 cell #it 19 — (JltChen Not To scale .. I #1 - 185 7/8 _ 1 i2-16-1 /2 30 I 30 #6 -#13 r - E 70 1/2 25 _- 30 25 24 47 5/8 1 12 36-1 /?1/4 13 1/4 13 1/4 13 1/4 _ - 28 - 28 24 1�- 27 - 25 - 13 3 3 13 1/4I - - 13 1/4- # 1013/8 702 �� O CI) 2 16I1/2 - 2 I 13 1/4 68 7 3/8 21 �\ 27 Q 1 24 29112 29 1/2 2191/2 SO 12 2 �1 2 -. 18 1 2 - 18 18 16 118 25 '21 12 / 18 8 I _ 1 /2-21 33 1-1./2 i/ #5 16 3. 27 24 - 48 7/8 12 /2 921/8 O #9 32 781/8 33 - I33 13 1/2 2 24 #2 24 237 5/8 16 24 26 3/8' 24 �� 7 3/4 12 3/4:4 4 #4 167 164 3/ i i 3 48 18 1 110 21 /. 30 33 14 18 19 3 4 18 19 3/4 1s 1 2 -- 10 2 b 1410 #3 137 Lewis and Weldon Custom Kitchens Leonard DiLorenzo &Annmarie Garceau 111 Airport Road 5 Harbor Bluff 'Hyannts, MA 02601 Hyannis, MA 02601 Telephone 508-778-5757 508-775-7123 home Fax 508-778-5111 01-26-091 401-440-4089 cell Kitchen - Wall 2 Not To scale «3i -3i . -95/8'--' 24-- 36 13 1/4 i 30 1/2 32 32 60 ._ ..t 30 3D 28 1/2 86 72 14 5 32 34 1/2 - ' 181/4 - 90 1/2 11/4 \ 24 5 116 0 0 0 24 O �. 34 1/2 29 i 34 1/2 \\ j \ 23 3/1 j 14 1/2 4 S 4 4 j 39 36 24 3. 237 5/8 39 5/8 Lewis and Weldon Custom Kitchens _Leonard DiLorenzo &Annmarie Garceau 111 Airport Road 5 Harbor Bluff Hyarmis, MA 02601 Hyannis, MA 02601 Telephone 508-778-5757 Hyannis, MA home Fax 508-778-5111 01-26-09" 401-440-4089 cell Kitchen - Wall2' Not To scale 51/4 � 51/8 «-103/8-+ 24 16 1/2--+ 13 1/4 — 38 i i i i! 30 1/2 90 �� /,• 32 32 :7142 1/2 30 1 2 t 86 \ 38 L14 / 2 is 18 1/4\ � 90 1/2 D f 1I4 \ O 0 5116 05 16 5 16 57 F,. i \ 34 1/2 29 0 7 3/4 4 3 12 8 8 23 3/16 ` 23 3/1 9/ i 9 1/2 1 1114 19 275(16 17 301/2 6 4 15 281/2 f 36 21 —181/2 32 24—73/43/4 3/4 30 21/2 15/8 5 1/8 237 5/8 a • HEADER er w.»•ne„e•., 1 3/4"x 7 1/4" 1.9E MicrollamV L.VL TJ-OeorTO O0 Berle]Nymoor:70D4103027 ueer:l 2&120ov022r2'AM THIS PRODUCT MEET$ OR EXCEEDS THE SET DESIGN Pope, Cnphe Version:030.14 CONTROLS FOR THE APPLICATION AND LOADS LISTED Product Diagram to CtlncoptuaL AD Analysis Is for a Drop Beam M rnw, Tributary Load Width:6' Primary Load Group-Residential-Sleeping Areas(psf):30.0 Live at 100%duration,10,0 Dead Vertical Loads: Typo Class Llvo Dead Location Application Commant Uniform(plf) Floor(1,00) 120:0 120.0 0 To 7'8" Adde To CEILING JOISTS 10110 SUPPORTS: Input Bearing Vortical Reactions([be) Datall Other Width Length Lfve/OaodlUpllft/Tolal 1 Trimmers 1.50' 1,50" 1150/703 1 0/1853 L2 None 2 Trimmers 1.60e 1.50' 1150 1 703 1 0 1 1853 L2 None -See IL®ve*Specinar'alsuilder's Guile for delpll(a):L2 DESIcnI caNr,ol.s: �' Maximum Design Control Rosult Location Sheer(lbs) 1853 .1501 2411 Passed(62%) Rt,end Span 1 under Floor loading. Moment(Ft-Lbs) . 3662 3552 3557 Passed(100%) MID Span 1 under Floor loading Live Load Dell(in) 0.242 0.256 Passed(IJ380) MID Span 1 under Floor loading Total Load Dell(in) 0.390 0.303 Passed(L1238) MID Span 1 under Floor loading -Deflection Criteria:STANDARD(LL.U360,TUIJ240). -Bracing(Lu):All compression edges(top and bottom)must be braced of TV o/c unless detailed otherwise, Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIQNAL NOTES' -IMPORTANTI The analysis presented Is output from software developed bylLeve*. ILevelS warrants the sizing of its products by this software will be accomplished In accordance with ILevolit product design criteria and code accepted design values. The specific product application,Input design loads,and stated dimensions have boon provided by the software user. This output has not been reviewed by an(Level®Associate, .Not all products are readily avallable. Check with your supplier or ILevelS technical representative for product availability. -THIS ANALYSIS FOR ILevelS PRODUCTS ONLY( PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code IgC analyzing the ILevaI6 Distribution product listed above. PROJECT INP—ORMA119N., gEgSUOR INFO MATION: JASON COX Matthew Gustin 5 HARBOR BLUFF RD, Mid-Cape Home Centers HYANNIS,MA PO BOX 1418 466 ROUTE 134 SOUTH DENNIS,MA 02660 Phone:5083988071 X4987 Fox :5003004%1) mgust nCmidcape.nat Cevyrlvhr o 2007 W Mb Je, Federal Mny. MA - N1eroUxm,a le a revllterev Lredenvrk or llm 16. £�Z'd TTTS8LL80ST:o1 6SSt,86280S 3d1J30IW:w6jd 6T:60 6002-£0-83d HEADER .yrywnp.w" 1 3/4"x 7 1/4"1.9E Microllam®LVL TJ-0.m*d 20 saw Nunam 1004103821 uNr.1 WN0907r22 AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Pepe 2 t:fptne Verolpn:03014 CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Prdawry Load Group I 6.00"^ Max. Vertical Reaction Total (lba) 1953 1853 Max, Vo.rtieol Reaction Llva (11W ,1150 11.50 Required Soaring LOnoth .in 1150(W) 1.50(W) Max. Unbracod Longth (in) 42 Loading On all. 4pana, LDF = 0,90 , 1.0 Dead Shoat at Support (lh6) 510 -570 Max Shear at Support (lbo) 703 -703 Member Reaction (lbn) 703 703 Support Reaction (lba) - 703 703 - Moment (FC-Lba) - 134E - Loading on all apans, LDF = 1.00 1.0 Dead - 1.0 Floor Shear at Support (1b6) 1501. -1501 Max Shoat of Support (lbs) :1.853 -0.853 Mambar Reaction (lba) 1051 L853 Support Reaction (lba) 1853 1853 Moment (Ft-Lba) 3552 Livo Deflection (in) 0.242 Total Deflection 11n1 01390 E ' PRO ICT INFORMATION: OPERM INFORMATION: JASON COX Matthew GustIn 5 HARBOR BLUFF RD. MId-Cape Home Centers HYANNIS,MA" PO Box 1418 405 ROUTE 134 SOUTH DENNIS,MA 02880 r Phone:5083986071 X4987 Fax :5083984559 mgusthamidCepe,not Copyright O 2007 W i—14, redoral Way, WA xLOrgl 1en01.ir a-viet-od tred"W"k pf 11_10. £i£'d TIISWUBOST:01 6SSb86£80S 3dd30IW:woJ3 6T:60 6002-£0-833 ■ • HEADER nrw"r•.n..,n", 1 3/4"x 7 1/4" 1.9E Mlcroilaft&LVL TJ•rlealg0 8.00 aellol Numbor:7004100027 UeW:1 VS1209e 07221 AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Pnga I Onglneftelon:030.14 CONTROLS FOR THE APPLICATION AND LOADS LISTED Ell 2 Product Dloglrsm Is Conceptual. LOAD�� Analysis is for a Drop Beam Member, Tributary Load Width:8' Primary Load Group-Residential-Sleeping Areas(pef):30.0 Live at 100%duration,10,0 Dead Vertical Loads' Typo Class Live Dead Location Application Comment Uniform(plf) Fioor(1,00) 120,0 120.0 0 To T 8" Adds To' CEILING JOISTS,10110 SUPPORTS: Input Sowing Vortical Reactions([be) Detail Othor Width Length LlvelDaodlUpllWotel 1 Trimmers 1.50' 1,50" 1150170310 1 1863 L2 : None 2 Trimmers 1,50" 1.50" 115017031011853 L2 None -See[Levels Specinaesisutidees Guile for detail(s):L2 DESIGN CONT OLS: Maximum Design Control Result Location Shear(lbs) 1853 -1501 2411 Passed(02%) Rt,end$pan 1 under Floor loading Moment(Ft-Lbs) 3662 3552 3557 Passed(100%) MID Span 1 under Pioor loading Live Load Deft(in) 0.242 0 255 Passed(4/380) MID Span 1 under Floor loading Total Load Dell(In) 0,390 0.383 Passed(L1238) MID Span 1 under Floor loading -Defection Criteria:STANDARD(LL.LI380,TL:U240). ° •Bmdng(Lu):All compression edges(top and bottom)must be braced at 3'8"o/c unless detailed otherwise, Proper attachment and pasitloning of lateral bracing Is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT[ The analysis presented Is output from software developed by LLeve*, iLevel9 warrants the sizing of its products by this software will be accomplished In accordance with(Level®product design criteria and code accepted design values, The specific product application,Input design loads,and staled dimensions have been provided by the software user. This output has not been reviewed by an Ilevels Associate, .Not all products are readily available. Check with your supplier at iLavelS technical representative for product availability. -THIS ANALYSIS FOR ILavels PRODUCTS ONLYI PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology wee used for Building Code IBC ono"ng the ILeveI6 Distribution product Ilsted above. f 1 PBWCT INFORM611oN: OECSU98 INFo MR ATION: JASON COX Matthew Gustin 5 HARBOR BLUFF RD, Mid-Cape Home Centers HYANNIS,MA PO BOX 1418 485 ROUTE 134 SOUTH QSNNI$.MA 02860 Phone:5083986071 X4987 Fox '6083904650 .1 mguatlnomidcape.net copyright 6 2007 by MaYEA, Padgrol Wny. WA .uptoll.a1 1"a raglatarad trsdsmrk or It-10. , £�2'd LiiS8LL80ST cl 6SSb86£80S 3dUDGIW:Wojd 65:60 6002-£0-83AA HEADER v W.,.,..— 1 3I4"x 7 1/4"1.9E Microllam®LVL raB.ams 0 ae soda Ngaulx:10041g3w user,1 2M200V022-4AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Pa0132 MVIg.V.1lIan,03014 CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group Max. Vertical Reaction 'Total (lba) 1953 1853 Max, VarO.Cpl Reaction Liva (1bo) 1150 11.50 Required Soaring Length in 1.501w) 1.50(w) Max. Unbraced Length (in) 142 Loading on all opana, LDF.= 0.90 ,,1,0 D*bd Shoar at Support i1bo) 570 -570 Max Shear at Support (lbo) 703 -703 Member Reaction (lba) 703 703 Support Reaction (lbo) 703 703 Moment (FC-Coal 1.340 . Loadtng on all apans, LDF = 1.00 1.0 Dcad - 1.0 Floor Shear at Support (lba) 1501 -1501. Max Shoar at Support (lba) 1.853 -1.853 Mamber Reaction (lba) 1851 3.853 Support Reaction (lba) 1853 1853 Moment (Ft-Lba) 3552 ' Liva Deflection (in) 0.242 Total Deflection lin) 0.390 PROJECT INFORMATION: OP_EI4At0 INFORMATION: JASON COX Matthew Ouath 5 HARBOR BLUFF RD. Mid-Cape Home Canters HYANNIS,MA. PO BOX 1418 405 ROUTE 134 ` SOUTH DENNIS,MA 02880 r Phone:5083980071 X4987 Pax :5083084559 mgust1nQmldrAps,nat copyright 0 3007 by Lix-10, r.d.r6 1 Nay, Nn ' xlgrnttmq to.r.gl.[.[.d E[YdpN„k o! ft'—W £i£'d ITSS8LL80SS:ol 6SSbB6£80S 3db30IW:W0j3 6i:60 6002-£0-83A r " HEADER avw.v..nw,a., 1 3/4"x 7. 1/4" 1.912 MlcrollamV LVL - - TJ-OeomN 0.00 9erlol Number:7004100027 user:, 21Wr20ve02221AM THIS PRODUCT MEETS OR EXCEEDS THE SEA'DESIGN - Phga, On0lne Version:480.14 CONTROLS FOR.THE APPLICATION AND LOADS LISTED a y Product clo®rom is Conceptuei. LOADS!Analysis Is for a Drop Bearn Member. Tributary Load Width:8" Primary Load Group-Residential-Sleeping Areas(pef):30.0 Live a(100%duration,10,0 Deed Vertical Loads: Typo Class Live Dead Location Application Common! Uniform(plo Floor(1,00), 120,0 120.0- A To T 8" Adds To CEILING JOISTS 10/10 SUPPORTS: Input Soaring Vartical Reactions(Ibis) Dotal Other Width Length Live/Daed/Uplif total 1 Trimmers 1.50" 1,60" 1150/7031011853 L2 None 2 Trimmers 1,50" 1.50" `1150 1703 10118413 L2 None -See ILevelO 9peclfler's/Builder's Guile for delail(s).L2 DESIGN_CONr OLS: Maximum Daelgn Control Raeult Location Shear(Ibs) 1853 -1501 2411 Passed(69%) Rt,end'$pan 1 under Floor loading Moment(Ft-Lbs) 3662 3562 3557 Passed,(100%) MID Span 1 under Floor loading Live Load Dail(in) 0.242 0,256 Passed(Ll380) 'MID Span 1 under Floor loading Total Load Dell(In) 0.390 D.383 'Palmed(L1238) MID$pan 1 under Floor loading Deflection Criteria:STANDARD(LL11360,TL:L/240) Bracing(Lu):All compression edges(top and bottom)must be braced at 3'8"o/c unless detailed otherwise,,Proper attachment and positloning of lateral bracing)s required to aohleve member stobiilty. AD�,ApJAL NOTES: -IMPORTANTI The analysis presented Is output from 90ware developed by(Level®, il.avelSwarrants the sizing of its products by this software will be accomplished In accordance with ILovel*product design criteria and code accepted design values, The specific product application,Input design ' loads,and stated dimensions have been provided by the software user. This output has not been reviewed by an ILeveIG Associate, .Not all products are readily available. Check With your supplier at(LevelS technical representative for product availability. -THIS ANALYSIS FOR ILeve18 PRODUCTS ONLYI PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code 180 anolyAng the ILevelO Distribution product listed above. P-RGJECT INEORM61I9N: MATION: JASON COX Matthew GUslln 5 HARBOR BLUFF RD, Mld-Cope Home Centers HYANNIS,MA PO BOX 1418 466 ROUTE 134 SOUTH OeNNIS,MA 02660 Phone;5083986071 X4987 Fox :6003984568 mguagn(ohiidcape.net coeyrloht 0 2007 by ILAVoJal, radaral Way. N► - - Mfete3,ams in a raolotored trx,*ark of limvol0, ��Z'd TTTSeaeo.ST:cl 6SSb86£80S 3dH30IW:wcu_� 6T:60,6002-20-83J ' # f • ,, HEADER -. r y Wy.ng.w•, 1 3/4"x 7 1/4"1.9E Miceollam-0 LVL 1J-adnrr4D000$"Number:1co4i ur - . ueer,J =2000021,7lAM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN - - pepgs EnglgdVeeim:oaou CONTROLS FOR THE APPLICATION AND LOADS LISTED . Load Group: Primary Load Group T' 6.00" Max. vertical Reaction Total (lba),1053 1853 Mont, vOMI.c411 Reactior.-Live (lba) ..1150 11:50 - Required Bearing 1,009th in - 1.50_(W) 1.50(w! - - Max. Unbraced Length (in)y 42 Loading on all spans, LDF 0,90 1,0 Dead, Shoes at Support (lhs) 570 -570 Max Shear at Suppakt (lbo). 103 -703 Magiber Reaction-(lba) 703 703 Suppu.rt Reaction (1ba) «. 703 .703 i Moment (Fl.-Lba) - 1.346 - - Loadd,n9 on all spans, LDF = 1:00 ; 1.0°Dead + 1.0 Floor - Shear at support (lba) 150i. -1503. Max Shear at Support (lbs) 1.e53 -1.853 Member Reaction (lbs) 1e5; 1 3.853 Support Reaction (lbo) 185" -1853 - - Moment (Ft-Lbal '` 3552 - - Live Do F•Soct-ion (in) 0.242 - - - ) - " x• Total Deflection (Jon) PRO.JgCT WONATION: 9PERAToR-iNFORM 'PION: JASON COX Matthew Dustin 5 HARBOR BLUFF RD. Mid-Cape Home Centers' HYANNIS,MA, PO 0OX 1410 , 405 ROUTe 134 ` SOUTH DENNIS,MA 02580' Phone:5033960071 X4987 Fax :5083gB4559 _ Rlguatln�mldwPe,npt - Copyright O 7007 by Ll,—JO, r•d-61 WnY, WA KcrnJlms Jd o r gidtorOd tradw.'*of ILdvdla>. x - c £it'd TISS8LL80Sti:�l 6SSb86£80S 61:60 6002-£0-83d s . TOWN OF BARNSTABLE - � Permit No. _---�---- -----------�� I Building Inspector cash {$8 6 3.G 6} ©k OCCUPANCY PERMIT Bond � lid Issued to Irene Lowrance Addressx Lots 16 , 3 17, 6 Harbor Bluffs Road, eHyanxnis Wiring Inspector ' ,Inspection date Plumbing hispector/ y �' Inspection date Gras Inspector Inspection date X Engineering Department 'f"` y r , Inspection date! - ' jBoard_of_Health f � ��. J Inspection dateQg ly THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. I'�'0..... ......._.... 19.�--� I -./2F r_'-r..-z'-�.•z-_.r. - � .._... , ........................Building Inspector..._....................._._..,�._. �1 /,ass map and lot number ... ems....-- / tF=? Sewage Permit number .(X7�:..:�1.��s,..•...4,��.Qs.►r.{!b..-:...�1.� , . BAHHSTADLE" • House number ... .. :.. ........°5;..'...:. WITH TITLEaea 9 M " 'EN�e� Q6Vll61EIVTAL CODE A6� o�aY'a�e� l' TOWN OF iBARN 9TNTELfIONS a BUILDING " ll�ASPECtu' g17- ' APPLICATION FOR PERMIT TO ...:........... .......... .... ...:...... ................... ....................�67 .. ...................... TYPE OF CONSTRUCTION ..................................... ........................................................... .. ............... ... ................ n'< �_..... ...........19tJ TO THE INSPECTOR OF BUILDINGS: v The undersigned hereby applies for a permit according to the following information: Location .A.A- ...1. 4 Ci-117 ..... �. .. ..... .......i`?� / .,64u ....ie I�.a. .............................. Proposed Use .................../•r;!(f(�„�:........ GU��- ............................ ........ ................................................ Zoning District ...........:......�:�- �t��...........................................Fire District ................................... Name of Owner`} ?l? ,....... Q.( �..�' VI G ..........Address . .'U .. .a..�................................... �...... 4 / ,-Name of Builder' .A.4,Aiza.... �/?'1�.1��n�� ?Q ,�6x �� CsC+ �('`` ��...�� .. ........Address 1..........�...,........... ...... ..�.. ......L.�. Nameof Architect ........... -A........................................Address :............................................................................. Number of Rooms ............ ...............................................Foundation ..... �J......... .. ........d Exterior ....... ..f"�'.... ............. c ill......... ...................................Roofing .......... ... ...... [.C! a��........................................ Floors ......................................Interior .............w, .......... .... ............. ...:................................ l..... ... .. .. .. Heating .....(..�................. ....� .t-.....................:..Plumbing ............ � ... . .........31.................................. y Fire lace ............. .. 7 r p ..............................Approximate Cost ............ c:.l.!.° 1..:..`..................... ..... Definitive Plan Approved by Planning Board __________ ---_______ •.•.. . ....•. • -- 19 ----• Area L.. .. Diagram of Lot and Building with Dimensions Fee ........... /.. .. o............... SUBJECT TO APPROVAL OF BOARD OF HEALTH ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS t I hereby agree to conform to all the Rules and Regulations of the� ow of.Barnstable r ardi the above construction. Name .............. . ........... co � 0 � LOWRANCE, IRENE 24933 1z Story .............. Permit for • .................................... Single, Family Dwellijjq........... Location ...;Rt§... �....17...... ...Bluf f s"R.d. ........................................... Owner ......I"r L w:KAD.Qe .......e...n..e...... ........................ Type of rConstruction' XXialae........................... ................................................................................ Plot ............ .............. Lot ................................. Permit Grdnl,-ed ....Aril al................19 83 Date oiriiny)er-cfi,8n'..•,•... ................19 Date Completed.__...... .... ......... 75 e. re- a, f t 1;' A ,•yr Y. 'a' �p VrL 9Rr gg i n.'r fi 4a 4 E "rf,+r e ', 1�•� ` - , I ¥ �, �' r+ �"c9,y..��1�Ezt z ate, i' AM'�zi,��, r r r,'k.s�N - 'T� I d r r�'. �� A�w(�... •y,s x �� t<t. �zj tt l� }I # f*{ k��tsr 1a4 t + r �& q t 14 9�ts4 V _. • ay`i r:ii� �ft�r �� 'fir ,#, t"Tsi"r r � .• 6�j@ r��3' .�rFt�,i�*sa��.'j'�f�'�,,.-� z�g €�i�{} � 'tN )� r a:`y-eNr tip y qli i1°'c �� 1.1Y S� ��4Y.;� s `. - _ v ,"11 �l r7' •n.� r c N.eYtF ''t .v, }J9+ 2j� n fi„ �" i✓,✓a ?�y.J t i:4 �r oy,r'w� � ��`' r ram`"� 3 '$�A r• 'w• � � zy.r\ �/ � .. '�yh r, }`y'L4 �`iFSin } �. � d'fr b�4 Z 0,491 45 A��srrti �`�„,�'•, tl }} z+ f5n<r� Yu ix` r v �+ ep 17 y.SA ® - ... J�,�''•' :. Q . A ��; �k c a fi;�a � ass 1r? x 74/7T 6 A is ioz 45 el, 14 t M �,yH�,.�� ,•{ - .. ... -{�� fit; " C' N y Q a`!�.1 r, � IY 4 1v"�,'p�r r:' Y� Y. $ i r' pf S]Q6Ja �F► `je 1 x AT - 4/5/��a I�.� p� certjfy to v 4c/ELF A * Y - a rae_ u�.t of,-'a e� �! �, Fdr3'! +' u1 M• M :rrw�114 * + SdtC, I+ . ett IS�.''� " "�.a ca,GP�d 4X� the „9"`#r DI4• Q t A,11,!?� F'�+•L M1 GII�IT hl. Ml J DF �s�'�ttiF �•Get SA..I.e'' L.�..� 4!f�t+W�. �e�i.'�ii�:N A,;, , f, �'6s . '�7r` �'�,R'�a 1 t. Y ��'�j �'�iC-rR �FyY � �s.�� $ X�x,�y�'� yr�� deI�3:FtE3;° ��r004 lr©AI�S � ��s'i -. a ��O WIIU�►M, y fi. t �, �. �s � �P Pane WA��;Q '� �1' *} + ! 7 ,� R WIC I( a5 'x 5tt Y(•�$ as :.V js A 't°^• t ^t: i, r it No ��I p i r a _p F` °yi s} x.r t t _ `1 t,.$ :±n"ia+iy .T a�}C7`-.f } 7 1s' S,�R (H ''"� Q o t r, x t',ti E ,t e u ,1t YY C� �.^ • - 1t. t: r 1a P S ; )3 - l•Yh +Y C .}KJ., `i ^ ^ k� 1 .SM 'f(w i 9 i,t-. ,y. ski 1 .� bb "I �,>�. '•�.,, +i;', 6i ., .. t +tf s v a {:,:• a 1... - a 4 { TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ?23Application# �o 70 .2-960 Health Division �� Conservation Division ✓® Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ' b4ec r 6c Rzu LK Village /- y a I, v� f` S Owner I e ov)Q y-a !�i/&Y-.e o 2.c Address S_12�6 v-bcv- k3&. t Telephone :_G? v`—- 7 l .3 G2 L/G C/cz -/0 0 Permit Request 12 -e O L,C e ea :5'1-i 3 c/ X I f.7 c% L/ `164 3 Lf, Y �L/ � = IDeCIC fi..S�hC� Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 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 Central Air: ❑Yes ❑No Fireplaces: Existing 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-O-Appeal-#- ..- - - -T -= _ _—Recorded❑_ '-- - � co Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use co Zf BUILDER INFORMATIONrn Name L✓aa6(ar.� Lip C o Telephone Number `O�S' Address crS 4-,in 1'4V-e_ License# C79q I S c&,f1i VGrr,�� oc� �. IM: G'ICC a Home Improvement Contractor# i-17 6 0.3 Worker's Compensation# bW C.,S-y,j�. O 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATTUR /��' DATE c3- 7'07 FOR OFFICIAL USE ONLY � � t PERMIT NO. s DATE ISSUED MAP/PARCEL NO. ADDRESS, VILLAGE OWNER DATE OF INSPECTION: r p FOUNDATION �C r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH A y FINAL FINAL BUILDING -7 DATE CLOSED OUT ASSOCIATION PLAN NO. 1 ne t ommonweairn of lrluzzavnuacitai Department of Industrial Accidents Ogee of Investigations 600 Washington Street Boston,MA 02111 y www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluisibers Applicant Information Please Print Legibly Name (Business/Organization/Individual): J3.e 5 r /'i t V1 6&1r,) le ,I a&I—z .. Address: / b,ti.Y-iha &J4 &/�- ' City/State/Zip: G,rin6,ad, tnfl-- Oe�. *// Phone #: 5-O$- s!2 O Are you an employer? Check the-appropriate boa: Type of project(required): 1.P I am a to er with 4. ❑ I am a general contractor and I ❑ � Y �— 6. New construction employees (hall and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ ❑ 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 required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.® Other *Any applicant that checks box#1 must also fill out the section below showing their workers'eampensation policy information' t Homeowners who subnut 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: (r_U Gcn Gz T-In. S'eA r- C"o-',_ Policy#or Self-ins.Lie. #: 18.F (A/C_5- A I o Expiration Date: 1�,/O j Job Site Address:�S_ 614 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$1,50Q.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 and penalties of perjury that the information provided above is true and correct. Si afore: Date: ZL7 Phone#: Official use only. Do not write in this area, to be completed by city or town official. j City or Town: Permit/License# Issuing Authority (circle one): 1.Board of health 2.Building Department 3.Cityl-I own Clerk 4.Electrical Inspector S.I'lurnbii3a Inspector !I 6.Other Contact Person: Phone#: I o { zi) � 1-jl - 2 op IITF II } � IF . IIll i � rn TT III t---�-- _".-►'fit ir------- - f ` `�, zoo 00 1 , - �� m I o � ! 1 _ 1 Pi o GLf -- --- I i r i I ' G v 00 3p� w n � v � y � m � 3 q a -+- Q7 R o ti N 70 i E, • r t � I _.. ..................... i 6 1� If ii r , I� I� I ' I ` t V' p w aCb � N o N I4 � X � y Ll f k o 1 6 Vidal Metal Work 1 500 457 1648 P. 1. Zi J 1� �o i, ip I i I I f•f- O p i :V-c F � J i s t 'd 8b9? GSv ©OS T )I.Io0 IQ4aw Ta. S, Vidal, fetal Wank 1 500 457 ICU p. l .r • 12 50.00' C_ BENCH MARK 7 - CTR. � � `' OF C.BASIN EL. = 5.9 PAVED DRIVE / WATER METER PIT I B x OT AREA 4' I 10,400 SF f 0 n / (UPLAND z z j ., 0 4 If i ..4 o EXISTING DWELLING 4 " CONC. I 4PA'Tlp EXISTING DECK AND STEPS `I TO BE REMOVED AND .4 REPLACED WITH NATURAL WOOD ("IPE"). NINE 12" SONO TUBES TO BE POURED FOR STRUCTURAL SUPPORT. CONC. PATIO TO REMAIN. Ac EXIST. 4 PROP. DECK FOOTPRINT 12• �� DECK ; , EXPANSION, OVER EXISTING DOGWOOD _ _ _ CONC. PATIO (HATCHED J AREA) IRRIG. C ROL 1 .5% N IRRIG. NTROL 1 9 I 6 HOUS / COASTAL N_ 9 J 23.7% 3.35 37% 4 ' 3.45 AREA OF MITIGATION PLANTINGS EDGE OF BEACH PLUM AND PASTURE- DGE CREEK (MARS ROSE OR SIMILAR SPECIES H BAN APPROVED BY CONSERVATION COMMISSION f :ONC. CULVERT Sri o w Creek r tF t d SITE PLAN - N OF • , • . 5 HARBOR, BLUFFS RD. tH OF 4g8s9 H Yq NN ARNE ctic IS off. 508—J82-4541 0 H. �� PREPARED FOR lax 508—J62-9880 OJALA. N LEN hal No. 26348P DiL ORENZO �oFTME TO�ti Town of Barnstable yP °^ Regulatory Services Thomas F.Geiler,Director 1639. MA+�`m BuRding Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: 61� Estimated Cost c 3OAad Address of Work: S' IVL LUEE dzb 0 1°{5or9.t_"d --- Owner's Name: . Z67AZ 41,14 'MIel, 4v�6M-JZD Date of Application: I hereby certify that: Registration is not required for the following reason(s): QWork excluded by law ❑Job Under$1,000 OBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORD DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name QIorms1omeaffidav fie Lnaninaorcu�eal� a�✓ sac�ivae �-\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 127603 Expiration: 11/22/2008 Tr# 127491 Type: Private Corporation BEST FIT WINDOW&DOOR CO INC ALFRED BELANGER 8 HUNTINGTON AVE. C S.YARMOUTH, MA 02664 Administrator 1 .e BOARD OF BUILDING REGULATIONS icense: CONSTRUCTION SUPERVISOR , 4 � . l"W—libar: CS 067991 ,,xhdate: 12/30/1951 �rpires: 12/30/2007 Tr. no: 11220 - es4ticted: 00. T ALFRED M BELANGER.. 8 HUNTINGTON AVE. S YARMOUTH, MA 02664 Commissioner ,if F � s HUNAR N AVE. BEST FIT WINDOW & DOOR CO., INC. S.YMOUTHOUTH, 026 MA 02664 We Can Do It, You Shouldn't Have To Phone 508-398-9704 Fax.508-398-9744 Contract Name: Leonard & Anne Marie Dilorenzo Date: 4-06-2007 Address: 5 Harbor Bluff- Hyannis, MA 02601 Mailing Address: 42 Laurel Ridge Lane- North Kin stop, R102852-7123 Phone: 508-775-7123 E-Mall: Other: 401-294-1004 Size&Description Total 34' X 14' Deck-Using IPE Decking-To Include: • Demolition and Removal of the existing Deck • 12"Dia. X 48"deep concrete footings as needed to support structure ■ 2"X 10"Pressure Treated Framing to support structure ■ IPE Decking 5/4 X 6"Pre-grooved to accept hidden fasteners ■ Decking to be installed in a 3 sectional pattern as shown on drawings $27,135.00 (2 options for pattern-to be decided Prior to submitting Building applications) • 3-4 Stairs as needed to meet local building code height requirements (Constructed of Pressure Treated Stringers and IPE deck Treads) Squared Lattice To Shirt the deck,hiding any pressure treated lumber used for the frameiyork $1.500.00 ]PE's large Handrail-to finish the to►edge of the Cable Railing $765.00 Total $29,400.00 Non-Refundable Deposit Required (To file and attend necessary Conservation and Building department hearings to gain approval) $500.00 Deposit Required $14,450.00 Once Building Permit has been Approved) Additional Comments: Balance Due U I pon Completion $14,450.00 *This Contract does Not include the installation or cost of the railing around the deck or on the stairs. The railing is to be fabricated and installed by Vidal Metal Work per the request of the homeowner;and`is not included as part of this contract. **Best Fit Window&Door will file all necessary conservation and building permit application,and attend all necessary hearings. The homeowner will need a certified plot plan to present to the Conservation and Building Departments, it is our recommendation that the homeowner contact Down Cape Engineering at(508)362-4541 located in Yarmouth port, as we have work with them in the past and been very satisfied with their work. This is only a recommendation;you may use any engineering&surveying company you choose. , Rec'd Deposit 11/20/2006 Ck#749 $500.'00 05/03/2007 10:30 5038329555 NORTHEAST INS AGCV PAGE 01/01 A40ORD CERTIFICATE OF LIABILITY INSURANCE Op ID DATE(MMJ'DDMW) SEL�AA-2 05 03 07 PROWCER t' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Northeast Insurance Agy. , Xnc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 567 Southbridge St. ALTER THE COVERAGE AFFORDED BY THf:POLICIES BELOW, Auburn MA 01501 B 1M11i pk<O>�O:506^833-0404 rcax:506- 33-9565 INSURERS AFFORDING COVERAGE NAIC# 1NsI uRERA; Guard IsxsurE INSURED j_�..;.. ._..... nce 6rolip INSURER B: Beat Fit Window 4 Door CO Inc INSURZRC: _- 8 Huntlni 'ton AVC INSURER 0: .—.__...._ S Yaxmouth KA 02664 , COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE.INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITI•ISTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RFSPFCT'TO WHICH 74I8 GERTIPtATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED 9YT14E POLICIF^a DESCRIBED HEREIN 19 SUBJECT TO ALL THE TERMS.RXCLJSiONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFrCTIVE IN I LTR NOR TYPE OF INSURANCE POLICY NUMBER DATq MMJDDIYY pA?Pa MM WYY LIMITS GENERAL UA31UTY I EACH O.CURRENCE 3 _ COMMERCIAL GENERAL LIABILITY IVHCNIKU I PRE 15F (Eur -r- one Pe EXP(An CLAIMS MAD[ OCCUR MEC y rson) S E__..........:...::..,.,... PER50NAL d ADV INJURY 3 I GENERAL AGGREGATE B GF.N'I.AGGREGATE LIMIT APPLIES PER:I i PRODUCT$•COMPIOP AGO S POLICY }ER LOC AUTOMOBILE WABIIdTY C04981FJED SINGLE LIMIT ANY AUTO (Ea acGdenf} _ ALLOWNEDAUTOS F3ODILY INJURY S Y SCHEDULED AUTOS (Par porson) HIRFO AUTOG 9 DILY l lRY NON-OWNEDAJT03 tPeracodert)PF.OPERTY DAMAGE {P&: ttidCnt) i GARAGS LIAMUTY ALTO ONLY-GA ACCI06NT S ANY AUTD I OTHER THAN EA ACC S AUTO ONLY: AGG $ CX0l ?rUMDR8LI.A LIABILITY EACH OCCURRENOF, C OCCUR CLAIMS MADE i AGGREGATE 3 DEDUCTIBLE I S R6TFNTIOFs ;[; I �..:u,.......:....,..,..,..�....�..—«,.,.,S...w,.,,....,..,.,«....�.,,..«... WORKERS COMPENSATION AND _f TCRv uM(TS RMPLOYCRV LIABILITY _........... _... A BEWC542200 10/23/06 10/23/07 E.L EACH ACCIDENT $1000000 OFFICCRRIIMENB[R EXCLUDED?ECUTI\/E F„L,DICEASE-EA 9MPLOYFEj 6 1000000 U yyes,describe under — 9 E ALPROVISJONBbelow E.LDISEASE-POLICY LIMIT S3,000000 OTHOR DE RIPTION OF OPERATIONS I LOCATIONS F VEHICLE !EXCLU$I NS ADCED BY ENDORSEMENT I SPECIAL PROVIeIONS CERTIFICATE HOLDER CANCELLATION TOWNCIFE SHOULD ANY OF THE AEOV DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ' DATETHERLOP,THIS I9SU1 f91N9URBR WILL EN15F AVOR TO MAIL 10 aAY$WRItMi4 NOTICE TO THTG HOLDER NAMED TO TWA LEFT,SLIT FAILURE TO p0$0 SHALL Town of Barns table IMPOSE ND OE�, RV71'C RLJABIUTY OF ANY FOND UPON THE INSURER,ITS AGENTS OR 200 Main StreetBa:rnstabla MR 02601 REPRESPNTA AUTHORIZED RE AnvE Scott 1 ACORD 25(2001/08) ACORD CORPORATION 198$ j - c , Sewage Perm-It numbee9Z..Aftd,44A eln 1-e 1639. TOWN 'OF BARINSTABLE BUILDING INSPECTOR TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Exierior .........V.46V./......7".96 ...................................Roofing ......t4;�� A74................................................... Definitive Plan Approved by Planning Board --------------------------------19--------- Area .............�aj, Diagram of Lot and Building with Dimensions Fee .... SUBJECT TO APPROVAL OF BOARD OF HEALTH m --� —_ | � � | 7� \ | \ . OCCUPANCY FERMITS REQUIRED FOR NEW DWELLINGS I hereby agreE.U�-Zo�nform to all the Rules and Regulations of the Town of Barnstable regarding the above moma ......................... �� 6� ' Construction Supervisor's License =.�— ^I�Z��....... ` • Town of Barnstable *Permit# Expires 6 mon s from issue date ,o'f Regulatory Services Fee Tbomas F.Geller,Director l / Building ]Division Tom Perry,CBO, Building Commissioner 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 [ap/parcel Number 3;4 1 , roperty Address of r b 1 U F 4W110'A h l S ]Residential Value of Work�;6o a 3®,o c Minimum fee of$25.00 for work under$6000.00 iwner's Name&Address L e VNctr C)e— �G v-e n Z© 41)- LaUrP.j 14, K,riaAav�. :ontractor's Name Gt tr C ) ✓c 14.0 Telephone Nurhber �Q 7-///� tome Improvement Contractor License#(if applicable) 00S613 L-icerrse 0tff-zppiiealrle) ,&Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ' ❑ I aznthe Homeowner ®PS T I have Worker's Compensation Insurance asurance Company Name 1 . MAR 3 0 2007 - TOWN OF BARNSTABLE Vorkman's Comp.Policy#. 6n T :opy of Insurance Compliance Certificate must be on file. •ezmit 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 i (maximum.44) - 'Where required: issuance of this permit does not exempt compliance with other town department regulations,Le,Historic,Cgnservaiion,etc. ***Note: Property Owner must sign Property.Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. ;IGNATURE: j:For=:expmtrg xvise061306 .' I he t;ommonweatth of Massachusetts Department of Industrial Accidents W W Office oflnvestigations 600 Washington Street Boston,MA 02111 wwrv.massgovldia ' r Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEjbly Name (Business/Organization/Individual): . Care �- ie e_ � C�JYI•(� ��,G ,`�� I�►��+� Address: 3x�KHe"LJOY? ✓ City/State/Zip: 6 1 V-h Q ve n Phone:#t Y J—111J Are you an employer? Check the appropriate box: -Type of pioject(required) 1.❑ I am a employer with_ ? � 4. I am a general-contractor and I employees (full and/or part time). * have hired the sub-contractors b. ❑New construction . 2.0 I am a'sole proprietor or partner- listed on the.attached sheet. 7. ❑Remodeling - These sub-contractors have ship and have no employees 8, ❑Demolition working for me in any capacity. employees and have workers' S,..❑Building addition [No workers' comp.insurance Comp,insurance.$ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am ahomeowner doing all work 11.❑Plumbing repairs or additions ' myself. o workers' co right of exemption per MGL y � �• c - I2.7Roof repairs c. 152, 1(4), and we have no insurance required.]t § . 13:, Other- 'r employees. [No workers' 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 sbowing the name of the'sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provid'e their workers'comp.policynumber. 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#ar Self ins.Lic,#: � Z //9 Expiration Date; . lobSite � L6 City/State/Zip: 0( r)h 15 Attach a copy of the workers'.compensation policy declaration pac e(showing the policy number and expiration date). Failure.ta secure coverage as required under Section 25A of MGL a 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 ORD£R and a fine of up to$250.00 a day against the violator. Be advised that aDopy-of this statemetit may be forwarded to the Off,ce of Investigations of the DIA£or insurance coverage verification. I do hereby certjQ under the par .a d penalties of perjury that the information provided above is true and.correct, QSi afore: Q Date: Phone#: � Official use only.. Do not write in this area,-to be completed by city or town offrciaL } City or Town: Permit/License# - Iss-ing Authority(circle one) 1..Board of Health 2.Building Ilepartment 3. City/Towrr Clerk 4.Electrical Inspector 5.Plumbing Inspector I 6. Other ContactP.erson: Phone 9: Information and Instr°uctions 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 a`s�"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 mov er Qr trustee-of an individual,partnership, association or other legal entity, employing-employees. However the owner of a dwellfng•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." MOL 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 ins-=nce requirements of this chapter have been presented'to the contracting authority." ApP 'cants h • Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessa supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of r}', PP insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other.than the ' LP does have members or partners, are not required to c workers compensation insurance. If an LLC or L P q �3' mP 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 member 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"informatio, (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 fo any business or commercialventme (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 tc give us a call, The Department's address,telephone.and fax number; The,Com oawealth of Massaebusetts eparlmmt of li, tstdal.Accidents Office of In-vestigations 600'Washi�tgt Street Boston,MA 02111 Tel,#617-727-4.904 ext 406 ar 1-M MASSAFE Fax# 617-727-7749- 'Revised 11-22-06 www.mass.gov/dig MAR-30-2007 03 :44 PM P. 91 DATE.(MN OONYYY1 THIS CERTIFICATE IS ISSUED A8 A MATTER OF INFORMAVION PRODUCER ONLY AND CONFIRS NO RI0HT6 UPON THE CERTIFICATE Roglers&Gray Ine.Agency,Inc. HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Street ALTER THE COVERAGE AFFORDED IBY THE POLICIES BELOW. 3{41 Ctlurt Str P.O,Sox 3700 INSURERS AFFORDING COVERAGE NAIC 0 Plyrnouth;MA 02361.3700 INSURERA National Oran ®Mlutual Ina,CO. INeuReo --� Cara Free Hone:Inc INsuRERl3: Acadlle lnauranea �., 239 Huttleston Avenue INSLRER C: — Fairhaven,AAA 02719 IN&URERO: INSURER E: COVERAGES PSIR100 INDICATED, THE ANY QUING ES 00 INSURANCE CONDITION EL F ANY CUNTNlA^T pR OTHER C4 CUMEN WI�DH Ri SPECTOTRO WHICH THIS CER-RCATE MAY B 9 SUED OR DI MAY PEaTA1N,THE INSURANCE AFFORDED®Y 7Mi POLICIES 11ESCRIsFo HEREIN IS SUBJECT TO ALL THE TERMS,EXCLIiSIONS AND CONDITIONS OF SUCH POLICIES,A�3®RELATE LIMITS SHOWN HAVE SEEN RED'CEO BY PAID CLAIMS, OL LIMITS _ TYPi OF INSURAMIX POLICY NUM®ER EACH oCOURRENCE��$00 000 A aENERA6 LIABILITY M$077983 09/01/06 09t01/07 A TO ENT A 0 00 j( COMMERCIAL t3'aNERaI LIA61LiTY MLO L. t ► y nne Rotr)) 55 0 CLAIMS MADE aOCCUR PERSONALAADV;NJURY 81 000000 O&NERAL AGGREGATE Q 00 Q 0 PRODUCTS.COMPIDP AG(I s2000.000 GGN'L AGGREGATE LIMIT APPLIES PER; L POLICY FIR Lao AUTOMOB0 LIAetuTY COMBINd S:NGLE LIMIT S (Ea asWden enll ANY AUTO BODILY INJURY i! ALL O'NNED AUTOS IPer person) SCHEOULEOAUTOS BODILY INJt RY 4 HIRED AUTOS IPor eeeddentl �. NON•OWNF0 AUTOS (Per AAiAG ( e(Per eo E r — -- AUTO ONLY-BAACCIDENT b oARAOP.LIABILITY OTHER THIAN ACC 8 ANY AUTO AUTO ONLY: AGG 9 _, — - l,ACH OCCURRENCE $ EXCE$ilUM®RRLLA LIABILITY AGGREGATE $ _. OCCUR CLAIMS MA01 -� 6 $ { DEDUCTIRLE IIIRETENTIONC 8 U. QTN• 09141106 Og101107 wompte COMPEN"noN AND YYCA01951li41 Q E:L,EACH ACCIDENT $50Q OQO am tAYERB'LIABILITY ANY PROPRIETORIPARTNEWIXcCUTIVE E.L.D;8gA8E EA EMPLOYS 500�QO OFFICE"WISER EXCLUO'EC9 deeorl6e E.L.pISEA3E•POLI It UneerCY LIMIT Si5®Q Q� ROV N orHlR PROCRIPTiON OF OPRRATIONB I LOCikmc 40/72HICLES 1 EXCLUBION9 ADDED SY NNUORSELsGNT I aPt=DUL PROv19I0NS CE tCAT OLDERou A N I$w6uLq ANY OF TN_A90V!DSSCRIBBD POLICIBI®E GANClLLSa REPORe THE plpldiATiON Town of Barnstable Bullding DATE THERICIF,THE ISSUING easURB1 WILL ENDEAVOR TO MAIL 1l1_ GAYS WRITTEN Department NOTICE TO THE CERTIFICATE Hc1.DSR NAPIED TO THE LIFT,BIJT fAILIINE TO D®Sa SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER•ITS AOENTH OR 367 1fAlBln Street NT Hyannis,MA 02601 aEPRla ZED t, AUTNORIZEC RlpREtlNTATIV@ 12 DAC ® ACORD CORPORATION iBe ACORb 25(2001106)1 of 2 0824707IM24699 - i .i" � �lre -�am�noouueall�i o�✓�aaaaclauaeaa Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR a Registraf on 100503 F.xpirafion 6/1 q,/2008 , iYP Q $,upplement Card �(( 1 CARE FREE Hf3MS�pIC ROBERT PICKUP\ i iz, 239 Huttleston ave \� ' j Fairhavgn,MA 02719 (, Administrator OFFICE: (508) 997-1111 flWCARE ®® MA. BuilFAX: (508) 997-1297 der's Lfc. #021330 TOLL FREE: ) 997-1297 11 FREE Home Improvement WEBSITE: �S Inc. . Contractor's License www.carefreehomescompany.com 239 HUTTLESTON AVE. (RT 6)•FAIRHAVEN, MA 02719 #100503 MA. / #15179 R.I. NAME Le& b t LG2r n ADDRESS Z re- /ti1(,� e �YL lZlvz s Wt2 ZIP DATE z2- 6' CODE C3Z t'a l fs ADDRESS OF JOB `� TEL SQF '7,7S 171 Z3 JOB DESCRIPTION (�lU J y�lG se-c JO a. 6© a f 1a1s !I' ---------- re, palvi ar - f ,,� str;�rh �© a6G✓G a req Cray IGLG� /GiShin �Lcoo R ri� z t le. voulledL t` s 6o�c% lAce GUI GL r v� coo 1-C m y ll vt eTi y r 6061-COL0 r ��- n >� GL t n S a.l 5 f n c .tG tZl e z t �tn 1n -hc �s-t e-t�r �%ae 1'lv�y►� I�Svr'A�cC Cove r,�LjeaV1tS S� ec S I vtCI v ded 74 ar ae- 1 S J„JrtAA be tow Onq Scheduled Start e y LO ks Scheduled Completion (;11Ge A. Replacement of missing or rotted lumber is not included unless specified. B.All start&completion dates are approximate and could change due to weather conditions, C. Stripping of roof includes removal of up to two(2) layers of shingles, each additional layer to be charged @ ft'. D. Replacement of rotted roof boards/plywood to be charged @ ft'. E. Existing chimney(lashings will be reused; replacement, if necessary, is not included. F. Care Free Homes, Inc. is not responsible for mold/mildew conditions that are pre-existing or result from leaks not brought to the attention of C.F.H., Inc. promptly. The Company hereby proposes to furnish labor and material to complete the above work for the amount herein. Fulfillment of this order is contingent, however, upon the want of strikes, fires and any natural disasters, the ability to obtain materials, or any other conditions beyond the control of the Company. Cost of Project$ (aZ80 Q PAYMENT TERMS 011 M Date 2,21'a'� " - 1. You,the Owner,may cancel this transaction at anytime prior to midnight of the third business day after the date of this transaction. 2. You,the Owners,agree to pay any and all expenses incurred by Care Free Homes,Inc.in collecting money due under this contract and enforcing the terms of this contract, including but not limited to, reasonable attorney's fees, interest and court costs. DO O SIGN THIS CONTRACT 1F THERE ARE ANY BLANK SPACES CA R H S, INC. r A PIED: By: Buyer acknowledges Owne CARE FREE HOMES,INC. receipt of fully completed --- COPY of this Agreement Owner All contractors and subcontractors shall be registered by the director and any inquiries contractor or subcontractor relating about a to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Assessors map and lot number il �' Sewage Permit number fNn.. BARNSTABLE. i House number ..... !� NAG& ............................................. p 039. \0 f �Fp m a, -' TOWN OF. BARNSTABLE o A BUILDING INSPECTOR �. � � '� 1 ��. APPLICATION FOR PERMIT TO i TYPEOF CONSTRUCTION ................................... ? ......................................................; .............:........... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ALocation r ... � .... 777. ".......f7tA' �A'', �L ►! + �r.... .1 ................................... v Proposed Use., vGU ��G�1 ZoningDistrict ..................! :a! :..............................:.........Fire District ....................:`..........................................1............ Name of Owner�.11''f'Y�'!°:......... .........Address .. .—.......0 PS? Yc!.. �I.7,....... . Name of Builder Q (�`�f.:. ! 1,�1 ( 11j.!.........Address a/ I a f3 .... �./„ k «, /. ......................... Name of Architect ��, �.... .........................................Address ........................ Number of Rooms .............. :.........�.....................................Foundation ...../ ll/lP( ./�'1JW1 __. `...... ............................................. Exlerior ......_.....!...�....... ...................................Roofing .........;. ........................................ /A�, ' Floors A.....!. ,Qii............... ....................................Interior ........... /�IJ Heating Plumbing . ............... ....�.�....................... g_....... ......... ......... . ..................., .....,.. .......:. Fireplace ? '- .:..Approximate Cost:... �r. ,...,........ .......:......................................................... . Definitive Plan Approved by Planning Board ---------------_---------------19________: Area ........!..�?�.�...�........... &20 ,.S Diagram of Lot and Building with Dimensions Fee. ...............,..,..1.'.... ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I z/11W OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to,all the Rules and Regulations of the Town of Barnstable regarding the above construction. �� Name'......................... f ......................................... J LOWRANCE, IRENE A=325-133 325-140 Stor No 24933 1.... Permit for . ............................. Single Family Dwelling ............................................................................... Location „Lots 16 & 17 5 Harbor BluffsRd. ............................................. Hyannis ............................................................................... Owner .:.,.Irene Lowrance ..................................................... , Frame Type of Construction ..................................... s / ................................................................................ - Plot ............................ Lot ................................ � ,<1 Permit Granted Agri � 1 11 .......19 83 ........... ..... Date of Inspection ...................................1.19 Date Completed II � � j 7 f r 7 #- Assessor's map and lot number ...... ! ..r�..�. .��-3 THE t0� Sewage Permit numbeaea.. � '"+�'� .��1.��. /!. /a d�P� ♦� Z 33A"STABLE, i House number ........................................................................ r MABa f OD i639, ,offom ale TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........��/C/ ! tf3 ..... .Y/� �'Iica.... J`lJrf/ t'E ............................ TYPE OF CONSTRUCTION ........ /lIG!/ .....? i'Y7 .................. ..................................................:........... AV ......... ...........19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ��ffs7 , 1 d .........:.. .......P '�A� .I�.�f. /l/ Xl��.elcxl t.,�.............Location _...../..... ../........._./.... .`........... .......... ... ................................................................ e iV I�/d f c�' Cl P 1G ` $f ria 1`r2f z Proposed Use ..................................................................... ...........'....... .................................... ZoningDistrict .....................Fire District ................................................:................. ............................................................... J f Name of Owner f,''1v h, i�!12.!gM t':...................Address �i!3 rtr l v �C;...... � ff�v.+trts �.�. ............ ........ ....... Name of Builder �f � ... -......Address .................... �.>..�.C.�'`...�..�......l.`. :.... P!�'f!� `a Nameof Architect ...................................................:..............Address .................................................................................... Number of Rooms ..................................................................Foundation ......f. ........ 4. ,- ................. Exterior .........�//.!t!. � !......��,r, iw:..%...................................Roofing ......,............ .......................................................... Floors (n!A ....... .............Interior 1�.� ' IJG /ZFY ......................................:............................................. Heating ............ ./. '.�. r.�.�...........................................Plumbing ..........t...!!......... ....................................... ................... Fireplace iD........................................................Approximate Cost ........... �.��.... ...............................r. Definitive Plan Approved by Planning Board --------------------------------19•________. Area �C.. �..•t.: ..�.. .t.. 'r1� Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH a v OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree;to--conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ,: �, Name ,";�!`.r'............. -7 Construction Supervisor's License .. .j!... �ocloae Soo Deck No ..�83�B— Permit for -----------.c ...................... Location —.2..Haz]�uz'BIof f..�oad-----.. ' =yuuoie ' ---------^----------------'' Irene Lawrence -'''— ---------------------- Typo of Construction --��ume--------. ' ��. ' Plot ............................ Lot ................................ ' ~ ' ' Aouoot 15, 85 ' Permit G,onled ...................... .................lV ` Date of Inspection ------------lP Dote Completed ------�------]g ' ` � |� \ | ^�� ~ (~ ' . - . . ^ . . `. . ~^ ' | oF1RE Town of Barnstable *Permit# �, •yo Expires 6 months front issue date • 's snRrts Regulatory Services Fee n°U.� -rast.E. r� M^M $ Thomas F.Geiler,Director Building Division X-PRESS PERMIT Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 .)U I_ X 6 2004 Office: 508-862-4038 TOWN OF BARPVSTASLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Lnprint Map/parcel Number Property Address .�/�f��46Q , !`�'��/��f �1�6s�• ��d Residential � j OA"SValue of Work�� Owner's Name&Address 4fV b /f ff , — 71 3 ®t�' Contractor's Nam Telephone Number Ze �L Home Improvement Contractor License#(if applicable) I �� Construction Supervisor's License#(if applicable) � .o ❑Workmen's mpensation Insurance Che one: I am a sole proprietor am the Homeowner Whave Worker's Compensation Insurance Insurance Company Name// '�dt�• ��Ir�fil�.a.. Workmen'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 be taken to ❑Re-roof(not stripping. ,Going over existing layers of roof) Ea/Re-side, levq�(k ❑ Replacement Windows. U-Value (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 Property Owner Letter of Permission. Home ovem t Contractor cense is required. Sign re Q:Forms:expmtrg Reviseo53003 A f Town of Barnstable p41HE Tpk,H y o Regulatory Services 's Thomas F.Geller,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 W".tbwn:barnstable.ma,us Fax.- 508-790-6230. =: office: 508-862-4038 _ Tiqelprownermust Section _ �m lete-a�.d Si" �i;:This � .. _ If tJs lig_A-BWIder /[OR '-a:O ,as Owner of the subject property X Z� _ . to act on mybehalf, hereby authorize In aU matters relative to workauthorized.bythis building permit application for: (Address of Job) - Date Signature o' er Print Name Results Page 1 of 1 Home Improvement Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City, Name, or License number Select Search type: r AND �l OR Search Search Results Reg. No. Applicant Street City State ZipI Name I lExpirationi BW 288 ARROWHEAD WOODILL, 138860 CONSTRUCTION DR. HYANNIS MA 02601 BRIAN OWNER 5/21/2005 Total of 1 Records matched. 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