Loading...
HomeMy WebLinkAbout0170 HINCKLEY ROAD �-�� 14 k Ie. Rcl, f Application number.......1?l if(...7 eft . y C ' NG DEPT Date Issued.......tl❑:. .1, .. BARiVSTABLE. : MAM eV2 . a$39. 20 , t I Building inspectors Initials..... ... �............... f� BgRN$]' Map/Parcel........ .. .� STABLE . ............................ TOWN OF BARNSTABLE E)'EDITED PEIt v=APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVESN EAT.HERIZATION PROPERTY..INFORMATION Address of Project: o 4);n ekle N-Y NUMBER Ctiln�'S Owner's Name; STREET VILLAGE �J,� Phone Number .7 7 _ Email Address: -I-),,r64J^4 Wt2 ' Cell Phone Number Project cost$ 7 17--- �, Check one Residential ✓ Commercial VV1V.U'_rJLS9�AY.IJI�® AT��1`C As owner of the above property I hereby authorize to make application for a building pemait in accordance with 780 CMR ------------- Owner Signature: .__See Date: TYPE O]F.WORX 4 ❑ Siding ❑ Windows (no header change)# ❑ Insulation/VJea Doors (no header thane # 1. thenzatton ' g ) Commercial Doors require an inspector's review 17 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S W®gh.LalLA'fl IO Contractor's name Home Improvement Contractors Registration(if applicable)* //Z 7 S (attach copy) Construction Supervisor's License# r,. f ?q0?4/ (attach cop' Y) Email of Contractor ,R ' _Sae S ina U''n Phone number 4fo/- 7 9 9 ALL PROPERTIES THAT 0�.4 i/E STRUCTURE OVER75 YE4RS OLD OR IF THE SUBJECT PROPERTY IS[IV TRIC A HISTORIC®!ST, YOU MUST OBTAIN!HISTORIC APPROVAL BEFORE A PERMIT T CAN BE ISSUED. �. APPLICATION NUMBER........................................................... *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No ' (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a:for profit non profit event Check one: Food served Yes No ' Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between tine houps of 8e 00am-9:30 am or 3:30 pry-4:30pm. Commercial events may require Fare Department approval *WOOD/COAL/PELLET STOVES Y Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side H011EOWNER9S LICENSE EXEAff 10N Homeowner's Name: ' Telephone Number Cell or Work number I understand naiy responsibilities under the rules and regulations for Licensed Coiistruction Supervisor in accordance with 780 CMI$the Massachusetts State Building Code. I understand . the construction inspection procedures,specific inspections and documentation'required by 780 CMR and the Town of Barnstable. Signature Date z A��L�CAl�TT'S SIGNATURE Signature Date All permit applicadt o are subject to a building official's approval prior to issuance. SPECIAL SERVICES CUSTOMER INVOICE Page 1 of 5 NO. H2612-1,35709 - ---------------------------------------------- Store 2612 HYANNIS Phone:(508)778-8948 65 INDEPENDENCE DRIVE Salesperson:JXC4ZUH HYANNIS,MA 02601 Reviewer:DLC198 Name Phone 1 • WISEMEN BARBARA (774)368-0984 REPRINT Address 170 HINCKLEY RD Phone Company Name • city HYANNIS JobDesaiption NRTS-ext door :2019-10-07 12:38 State MA Zip 02601- co,n'y BARNSTABLEWe the r - INSTALLER DELIVERY#1 MERCHANDISE AND SERVICE SUMMARY oldrtoc stomes htto limit the quantitiesofinerchandise merchandise #102 STOCK MERCHANDISE TO BE DELIVERED: REF# SKU QTY UM DESCRIPTION PI TAX PR4C#EAW EXTENSION R03 0000 984-590 1.00 EA ALEX PLUS WHITE 10.1 OZ! A o $2.38 $2.38 R04 0000-254-294 2.00 EA 3/4"X5-1/2"X8'PVC TRIM/ $23.48 $46.96 R05 0000-254-466 1.00 EA 3/4"X7-1/4"X8'PVC BOARD/ Y $29.92 $29.92 R06 0000-211-276 20.00 LF 11/16 X2-1/2 PFJ WM35 a CASING/1 12'and 1 8' iece A Y $0.99 $19.80 R07 1002-961-477 1.001 EA 6"X50'WINDOW&DOOR SEALING TAPE/ A Y $17.97 $17.97 R08 0000-715-499 1.001 RL I MULTI-PURP 16"X48"ROLL INSUL 5.3SF/ A Y $5.48 $5.48 R10 0000-933-616 1.001 EA 32X80 LH PREM 9 LT FG IS BM/ IA I Y 1 $218.00 $218.00 151FIENEind $340.51 _ DELIVERY INFORMATION: DELIVERY DATE:INSTALLER WILL SCHEDU o INSTALLER WILL DELIVER MDSE TO: SITE OF INSTALLATION#102 F INSTALLATION. INSTALLATION#1 0 R 02 ATED INSTALL BEGIN DATE: 10/01/2019 ESTIMATED INSTALL END DATE: 10/31/2019 MERCHANDISE TO BE INSTA CONTINUED ON NEXT PAGE*'* Check your current order status online at www.homedepot.com/orderstatus Page 1 of 5 NO. H2612-135709 Customer Copy �" s k SPECIAL SERVICES CUSTOMER INVOICE-Continued Name:WISEMEN Page 5 of 5 NO. H2612-135709 INSTALLATION #3 (ConBnued) REF#112 6 JADMINISTRATIVE FEE/ 1.00 EAFNT $50.00 $50.00 7 PERMIT FEE/ 25.001 EAJ N 1 $1.00 $25.00 INSTALLATION SITE NAME: WISEMEN BARBARA INSTALL LABOR CHARGE: $75.00 ADDRESS: 170 HINCKLEY RD TRIP CHARGE: $0.00 CITY: HYANNIS STATE: MA ZIP: 02601 CREDIT FOR DEPOSITIMEASURE: $0.00 COUNTY: BARNSTABLE SALES TAX RATE: 6.250 TAX:Merchandise-Y LABOR-,N • • $0.00 PHONE: 774 3680984 ALTERNATE PHONE: 774 2680984 INSTALLER SPECIAL INSTRUCTIONS: to be added to po 12403360 END OF INSTALL#3 TOTAL CHARGES OF ALL MERCHANDISE& SERVICES Policy Id(Pq: •-• - • $777.52 A:90 DAYS DEFAULT POLICY; SALES TAX $21.28 TOTAL $798.80 BALANCE DUE $0.00 'The Home Depot reserves the right to limit/deny returns.Please see the return policy sign in stores for details.' END OF ORDER No.H2612-135709 Page 5 of 5 No. H2612-135709 Customer copy Home Improvement Agreement: Page 1 Home Depot License Number(s): Home Depot license numbers are listed on page 3, and at www.Homedepot.com/LicenseNumbers ANGELA CAMARA Salesperson Name Registration No. (if applicable) Home Depot U.S.A., Inc. ("Home Depot")or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Service Provider Contact Information TBD I TBD Authorized Representative Name Service Provider Company Name TBD TBD TBD Phone# Service Provider Email Address Service Provider License#(s) Customer Information WISEMEN BARBARA 1 2612 H2612-135709 I Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 170 HINCKLEY RD HYANNIS MA 02601 Customer Address City State Zip 7743680984 15085349074 15085349074 BARBARAW12AHOTMAIL.COM Home Phone# Work Phone# Cell Phone# Customer Email Address NOTICE OF RIGHT TO_CANCEL YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: Contact Store Directly OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 2455 PacesFerry Rd SE I GA 30339 Address City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD.THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE.YOUR PAYMENT(S)WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE.YOU MUST MAKE AVAILABLE FOR PICKUP , BY HOME DEPOT OR SERVICE PROVIDER,AT YOUR SERVICE ADDRESS,AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED,ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: � to/ov2o19 Customer's Signature Date Home Improvement Agreement: Page 2 Description of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work or Specification which is included in this Agreement. Anticipated Delivery Date / Installation Schedule Approximate`Start Date: TBD Approximate Finish Date: TBD All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. Electronic Records Authorization You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement. By contacting your Service Provider, you may update your email address, withdraw your consent, or obtain a paper copy of the Agreement or. related documents at no charge. By providing your consent and verifying your email address above,you confirm that you have access to a computer that can receive and open emails and PDF documents. It do[]do not Q consent to receive only electronic records related to this transaction Y Contract Price and Payment Schedule Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or' in a payment addendum: Contract Price: $ 717.51 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 121.28 (If applicable, total amount of taxes included in Contract Price) *Maximum deposit ONLY applicable in MD, MA, ME(33%), NJ, Wl(99%) Deposit% Deposit Amount $ Remaining Balance $ Finance Charges___. Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement,to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. Insurance proceeds will❑will not❑be used to pay some or all of the total amount of sale. Acceptance and Authorization _ By signing below, you authorize Home Depot to: (a)arrange for Service Provider to perform any Services or(b)order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.) By signing, you acknowledge that: (i)You have read, understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii)You are receiving a complete copy of this Agreement; (iii)all rights and interests under this Agreement are solely vested in the person listed as°Customer'above; and, (iv) Electronic signatures will be deemed originals for all purposes. j X 10/01/2019 Customer's Signature Date X /s/The Home Depot 10/01/2019 . The Home Depot Digital Signature Date Call The Home Depot at 1-800-466-3337 for help. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Reguiations and Standards Constrv�b&n is ti�rvisor CS-074247 , ires 04/0412021 -317 PAUL M DOWNING fj a 25 ALCOTT CIR TAUINTON MA 02780 riFwal. Commissioner V The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations == "`-' I Congress Street, Suite 100 Boston,MA 021I4-20I7 - " www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): L►t L0, Address:_] �rl — City/State/Zip: -fi — h Q 30;?�­ Phone#: �— Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I wn a employer with _ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. VM' 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' insurance. 9. ❑Building.addition comp. [No workers' comp. insurance P- 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 q ) 12.❑ Roof repairs insurance required.]f c. 152, §1(4 , and we have no employees. [No workers' 13_❑ Other comp. insurance required.] *Any applicant that checks box#1 must also till 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 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 the policy and job site information. _-- Insurance Company Name: Policy#or Self-ins.Lie.-#: Expiration Date: 3 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder 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 certt under the pains and penalties of erjury that the information provided above is true and correct Si ature: ` --- - - 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#• ' 17ie Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suitd 100 Boston,MA 02114-2017 www mass:gov/dia 111orkers,Compensation Insurance Affidavit:Builders/ContractorsMeChIC STh mberL TO BE FILED WITS THE P,r,.u>urrrl'm1O AUTHORM Applicant Information Please Print Legibly Name(3usiness/o[gani�atinn/Tnd Address: q�� -�-�n T,rn 62;K e City/State/Zip: i Lv/' M O►S4 S— Phone#: 7-7 L4 <,�—'7 5_ Z l Are yotr.an employer?Check the appropriate bona Type of project(required): LQ 1 am a employer with . employees(full and/or part-time). 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working.for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.®I am a homeowner doing all workmysel£[No wodMM t 9. ❑Demolition 'comp.insurance requiredl 4.oram a he 10 Building addition rnaowner and wn71 be hiring contractors to conduct all work on my property.I ariii ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.2I am a general contractor and I have hired the sub-conhaotors listed oa the attached sheet 13.❑Roof repairs These sub-conttactos have employees and have workers'comp.insurancet 6.❑We are a corporation and its officers have cxemiscd their ' of rarem L4.�Otller CIO�1C rrght goon perMGL o. 15Z§1(41 andwe have no employees.[Nov.,oA s'comp.insurance required.] r *Any applioantthat cheolm box must also fill out the section below showing their wodomi'compensation policy ir&m nix= U Honicowaers who submit this a$4dmft indicating they are doing of I work and then hire outside contractors must submit a new affidavit indicating such. tcontmotors that checkthis box must attached an additional sheet showing the name of the sub-contractors and state whether or not-those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees_ Bek nv is the policy and job site information Insurance Company Name /V�f el7ec� �niLYl rle �dr�/l( �,. /7_7 Policy#of Self-ins.Lic.# )(►,jj- :S &5 5 41 -7 - Expiration Date: - - t� lob Site Address: / 70 �;� 1l1ey City/StatelZip: 3 f-i,}v�ili1. Attach a copy of the workers'compensation'policy declaration page(showing the policy numberTand eapiratign date). Failure to secure coverage as required under MOL-b.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonm ar, elltem vil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. py, thisent may be-forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un an emit all o information protr3ded above is true and correct Sitmattrru'- ate: 0 Phone Official rise only. Do not write its this area,to be completed by city or tmm offleiat City or Town: Permitucense# Issaing 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#: Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvemeri Contractor Registration -- -_---_- Type: Supplement Card Registration: 112785 HOME DEPOT USA INC Expiration: 04/22/2021 P O BOX 105451 = ATTN: LICENSE MGMT TEAM = -- ATLANTA,GA 30348 - - - - -- - Update Address and Return Card. SCA 1 20M-0507 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE Stipolement Card before the expiration date. If found return to: ReaisttaEion Expiration Office of Consumer Affairs and Business Regulation 04/22/2021 1000 Washington Street -Su' 10 HOME DEPOT U— Boston,MA 02118 -; ANDREW SW EEt -- ' 2455 PACES FERR'k I&C-41 HSC ATLANTA,GA 30339 - Undersecretary No slid It Ut SI nature i +�r+® DATE IMM/DDIYYY'0 CERTIFICATE OF LIABILITY INSURANCE )21060619 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 have ADDITIONAL INSURED provisions or 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 uONTACT MARSH USA,INC. NAME: PNO.ALLIANCE CENTER PHCN n E . AIC No: 3560 L ENOX ROAD,SUITE 2400 E-MAIL ATLANTA.GA 30326 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC S CN101642069-HOmeO-GAW-19-20 INSURER A:Old Re ublic Insurance Co 24 i47 INSURED INSURER 3:New HamUshire ins Co `23841 x THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C:HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD INSURER 0: BUILDING C-20 AFLANTA.GA 30339INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: AFL-004353439-28 REVISION NUMBER: 21 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. INS R i iAODLjSUBR POLICY EFF POLICY EXP i LTR TYPE OF INSURANCEINSD WVO POLICY NUMBER MMIDDIYYYY ' MMIODIYYYY LIMITS A ' X °COMMERCIAL GENERAL LIABILITY MWZ(314574 03101019 03/01/2022 EACH OCCURRENCE S 1.000,000 CLAIMS-MADE ' �� 'OCCUR ;DAMAGE O RENTED ` i 1.300,000 PREMISES!Ea occurrence) %< 51,000.000 MED EXP(Any one person) 3 EXCLUDED PERSONAL 3.ADV INJURY S 1.000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERAL.AGGREGATE i 1,'300:1300 X POLICY JE� _OC PRODUCTS-COMP/OP AGG S 1,000,900 OTHER: •A .AUTOMOBILE LIABILITY MI/VT8314573 03/0112019 03101022 COMBINED SINGLE LIMIT S 1.300.000 _ Ea accident) X i ANY AUTO 30DILY INJURY(Per person) OWNED SCHEDULED SELF INSURED AUTO PHY OMG AUTOS ONLY iAUTOS 30DILY INJURY(Per accident). S HIRED NON-OWNED PROPERTY DAMAGE i AUTOS ONLY :.AUTOS ONLY Per accident [UMBRELLA LIAR OCCUR EACH OCCURRENCE - S EXCESS LIAB CLAIMS-MADE ;AGGREGATE S DED RETENTION S S B I WORKERS COMPENSATION WC 012717099(AK,NH.NJ,/T) 03/01019 i 03101i2020 X ;r.RTUTE I �RH ;AND EMPLOYERS'LIABILITY YIN ' WC O12717100i )WI 0310112019 `03/01/2020 'ANYPROPRIETOR/PARTNER/EXECUTIVE - ; E.L.EACH ACCIDENT S 5.000,000 'OFFICERIMEMBER EXCLUDED? N (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE' S 5.000,000 DESCRIPTION OF OPERATIONS below as.describe under 'Continued on Additional Page E.L.DISEASE-POLICY LIMIT S 5,000,000 C :Excess Auto 297110011002019 0310112019 03101/2020 Limit: 4,000.000 A Excess General Liability MWZX 314580 03101l2019 03/01/2022 Limit: 8,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addltlonal Remarks Schedule,may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE - of Marsh USA Inc. Manashi Nlukherjee _1�Cauao ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ' AGENCY CUSTOMER ID: ON hD 1542069 LOC#: .quanta ---- -- - - - — --- - A RL)P� ADDITIONAL REMARKS SCHEDULE Page ? of 3 AGENCY NAMED INSURED .MARSH USA.INC. ME HOME DEPOT.INC. HOME DEPOT'-I,S.A..INC. PouCY NUMBER 2455 PACES FERRY ROAD 31LILDING;-20 --- -- ----- AfLANTA.GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ZS FORM TITLE: Certificate of Liability Insurance Workers Campensalion Continued: Carrier:Indemnity insurance Company of:Vorth.America Policy Number:'NLR C65890549(AL.AR.FL,ID.IA.KS.K'/.LA,MS.AO.NE.VM.ND.OK,SC.30.TN,V1,,'NY) Effeclive Dale:0 310 1/20 1 9 Expiration Date:07101/2020 (ELI limit:55,000A00 Cartier:New Hampshee Insurance Company Policy Numbec'NC 012717098 (DC.DE.HI.IN.MD.MN..MT.NY,Rp Effective Date:03101/2019 Expiralion Dale:0310112020 (ELI limit:;5.000.700 Carnet ACE American Insurance Company Policy Number:'NCU C55890586(OSI) (AZ.CA.IL AC.OR.vA,'NA I Effective Date:93101 019 expiration Date:03101/2020 (ELI Limit:34.000,000 SIR:31.000.000 SIR for the;tales of AZ,CAAAC.ORNA.'NA Carrier:National Union Fire Insurance Company Policy,lumbec XWC i565596(OSI)(CO.CT,GA,ME,MI,NILOH,PA.UT) Effective Date:03101 019 Expiration Date:03/01/2020 (EL)limit:S4,000,000 31.000.000 SIR for the;fates of CO.ME,NV,MI.OH.P.A.UT $750.000 31R Ior the stale of GA 3350.000 SIR(or:he sale of CT _ I Carrier:National Union=ire Insurance Company Policy Number:XWC i565597(DSI)(MAI Effective Dale:03101/2019 Expiration Date:03/01/2020 (EL)Limit:14,500.000 SIR:3500,000 CC Employers XS Indemnity: Camieclllinios Union Insurance Company Policy Number.TNS C65221019 JX) Effective Date:0310112019 Expiration Date:03/01 020 (EL)limit:S10.000,000 .. SIR:S1A00,000 ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD pl _ Town of Barnstable Building BARNM_ Post This Card So That�t isvV�s�ble,From the Street Approved Rlans Must be Retained on Jobs and.this Card Must be Kept 1 KAM .� Posted UntU Final Inspection Has Been IVlade f- # Permit Where a Certificate of Occupancyis Requ�red,'such Building shall Not be Occupied until a F�nalxlnspectwnyhas been made Permit NO. B-19-3862 Applicant Name: ANDREW SWEET Approvals Date issued: 11/18/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 05/18/2020 Foundation: Location: 170 HINCKLEY ROAD, HYANNIS Map/Lot: 310-090 Zoning District: RB Sheathing: Owner on Record: WISEMAN,BARBARA Contractor Name:: ,HOME DEPOT USA INC Framing: 1 Address: 170 HINCKLEY RD Contractor License: 112785 2 HYANNIS, MA 02601 w Est. Project Cost: $777.00 Chimney: Description: INSTALL( 1 ) REPLACEMENT ENTRY DOOR 'NO STRUCTURAL Permit Fee: $35.00 Insulation: Project Review Req: i Fee Paid: $35.00 :Date ,.,. 11/18/2019 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized-by this permit is commenced within six months afterJssuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall` n be in compliance with the local zoing°by-laws and.codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the Final Gas: work until the completion of the same. R . . Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on thispermit. Minimum of Five Call Inspections Required for All Construction Work Service: 1.Foundation or Footing Rough:2.Sheathing Inspection f w� .. 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 Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do'not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: FMA � „ . Town of BarnstableBuilding Post This Card So That it is Visible From the Street.._,. eet-Approved!Plans Must be Retained on Job and this Card Must be Kept Posted Until Final Inspection Has Been Made.. : �� �� 16s4 , s°i Where a Certificate.of Occupancyis' Required;such Building shall'Not be Occupied until a Final Inspection has been made. Permit No. B-19-3112 Applicant Name: Ashley Walters Approvals Date Issued: 09/23/2019 Current Use: Structure Permit Type: Building-Siding/W 1.indows/Roof/Doors Expiration Date: 03/23/2020 Foundation: Location: 170 HINCKLEY ROAD, HYANNIS Map/Lot: 310-090 Zoning District: RB Sheathing: Owner on Record: WISEMAN, BARBARA Contractor Name:,` ,KENNETH KENDALL Framing: 1 Address: 170 HINCKLEYRD Contractor License: 168027 2 HYANNIS, MA 026015 - -' -Est., Project Cost: $2 756.00 Chimney: Description: remove and replace 1 triple-wide window unit. no structural change # Permit Fee: $35.00 t ) Insulation: Project Review Req: li Fee Paidl $35.00 1 - :Date: 9/23/2019 Final: C/ Plumbing/Gas ,G Rough.Plumbing Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authohzed'by this permit is commenced within six months after:issuance. All work authorizedby this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public'inspection for the entire duration of the Final Gas,: work until the completion of the same. r i Electrical 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: Service: 1.Foundation or Footing I Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund” (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: ONkxl^ 'l= S� Assesgor's a "and lot number G P y , ;.... i SEPTIC GYST A MOST BE - a INSTALLED IN �GOAMLIANNCE A ,TICiWE II STATE WITH�" Sewage 'Permit number .... .....10..i."4. ............................. _ �, �� 1-, } SAf�ITA,R.Y CDEDZ. AN-1 'OWN �., - REGULATONNS.., TOWN OF BARNSTABLE •� i BAHB,STOIILE;:'i y. L � i . BU11' DING '1 INSPECTOR : �� 9�0,0�i6.39• ��� ,, r . y w, AV a fL L G . APPLICATION"FOR c PERMIT TO .......... .......................... ........................ ............................................. .2 t, ' TYPE OF CONSTRUCTION ...................................... ... ......................................' o R, .19. TO-THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the oI1 wing information: / 1 - �.n. u . ......�T. . ...... .... Location ..... ................ � .. . ..:........................................................................ ProposedUse .... .0 -T,. a- ......... ..nl...... !...:. ..0�'L.............................................................................................. Zoning District ........................................................................Fire District ................ ............................. /(/, Nameof Owner V......... ................................................Address [............!!..C..........................y..................................... G Name of Builder .....:�-:4? i"!: `.....t�'—. ;..a�ti.........Address .... .......... Z. 17-.l`...... ..... ......... Nameof Architect .........:.......................................::...............Address .:.......:.......................................................................... Number of Rooms ..:......... .....................................:............Foundation Ud. C tl�� ...� ... C. Exterior .......... .........................:.....................................:....Roofing ...................r..:... ! ....... ��................. Floors v.��` ........j�•0!/r'� ...........Interior r ::.�d11 /'-' ................................. .............. ..................................... Heatin r"d/l�"e_ .....:....Plumbing .: . - .. ............................................. M . g ............ ............. ..................................... ..r ..................?.......... -U Fireplace .................�.��:`-.:........... ....Approximate Cost .......... ...�. v.l.............................. . ........ Definitive Plan Approved by Planning Board ________________________________19________. Area ....../.:D.. ....... Diagram of Lot and Building with Dimensions Fee . .� ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 5 v' 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r N"e .. ......`........ ..?K... `-Cf�- c�f................ � , . ' . . L | - � . Carlson, Irving K. 17994 add porch to - single family dwelling ad ^ '^e of Construction frame -------------- � -----.—..'.--.-----------.---.. � � Plot Lot ..--------. ---..------- - ' ' Octwbmr .16 ~ 75 � - ' Permit Granted -------------.lg | . . ' . ' Date of Inspection .....................................l9 � Date Cpmo���� .--. ' lq �� . . ---------.� t ' PERMIT lREFUSE�-' ' , . ............................................. —'' lA ...........................................^.---------~. �r ........................,._—.------.—,.�--_--- � ^',''--'—'''------'--------'---~— , . ----.—.—,----.--....—....�.-----' �� ~ Approved .---------------.. 19 . ' . ^ ..------------------------.— . T. ---------------------^^ ^^^^— - ' ^ ^ ^ | � Assessor's reap and lot number ............,............................. / t Sewage Permit number ` THE TOWN TOWN OF BARN.STABLE Z EARHSTADLE;AGIL i » M6 9 o w B'UILDIHG INSPECTOR. ar a' Aa9 7� AIJ C4/- Z 1,4J G! APPLICATION FOR'PERMIT TO ....................................................................................... ............. . . ..... .. TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .............:.............!.....r...... ................................. �.s,a ..... .......................................................................... Proposed Use ........ ' ZoningDistrict ....�.......�.........................................................Fire District ............................................................................. X1 C -) � /' K: Name of Owner�.......................................... Address Name of Builder A.!11 .......Address .....t L..........�.t:.............: ......?....t�./VPI/1 ............ Nameof Architect -".........................................'..^:...:.."'............Address ,......�.-.•.......................................................l.................. Number of Rooms ............. ..................................................Foundation �l,S( /� CPiL? ...........I............ r .l........... ...................................... P�� <,A1- q L1" `",411 J)''-lExterior ...... ........ .......Roofng ...........................................................: l' ..................... ........... Floors r- /.-'�1 <a C /4- /`��Uv :-' Interior 1 Jr1 rin..................................................................... ....................... ......... r � �J • Heating . ....Plumbing �fJ ................................�............................................ u................................... I Fireplace /r�l '1! c Approximate Cost ............... ............................................ ............ f '....'� .............................. .. s Definitive Plan Approved by Planning Board ________________________________19________. Area ......,.................................... Diagram of Lot and Building with Dimensions Fee ........`..'?.... .�., SUBJECT TO APPROVAL OF BOARD OF HEALTH "l C l I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ;1 Name-•:................... `4 ......`....................................................... � ` � Carlson, Irving K. A=3lO~9� - . 17994 add porch to ' .—.--- Parnnhfor -----------'^ ' ~ . . m1nolm family dwdlino ----.----------~---.--....---- ' �� . - 1.70 Hinckley Road Location ........... .................................................... . . ' Bymxmmis ' . . Irving K.Owner �������' frame ' Type of Construction . . ` ^ . � Plot. . (October 16 75 . ` rerv/v G,pnn,o > ' ' ' Dote of Inspection ..................... ..............19 ' . . Date � Completed PERMIT R /FUSED . . � . . ` l9 . . . . . , -----. ' . . . � ................................... ............................................ . . ` . .......................................... ' ................... --- ---.- . ' / . ` Approved ............................ — lq ' . ^ ----------------------^'—~'—' ----------------------.---.' . ' ' ' U U �� � , yo%THETo�sTOWN OF BARNSTABLE t '33AIMSTABLE, 039. 0 BUILDING INSPECTOR ,4�� APPLICATION FOR PERMIT TO .............W AA... ...................................................................... TYPE OF CONSTRUCTION ....... ........... .........OA-f......................................................... .....Alv.e?....... .............19...4�0 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........... ....... .............................................................................................................. ProposedUse ............... ...................................................................................................................................... ZoningDistrict .........................................................................Fire District .............................................................................. Name of Owner ...Address ................... Name of Builder ................;W ZI.............Address Nameof Architect ..................................................................Address ...................................................................................... Numberof Rooms ..................................................................Foundation .........!:�e ....................................................... Exterior .................. (:!5 Roofing ....It !1.................................I........................... Floors W4.1 A ........................... ........................Interi or ............g5,6 e.,�.4pfr-x.................................... ..................... Heating ..................................................................................Plumbing ........................... Fireplace ..................................................................................Approximat(- Cost .........1;21 ............................................ Difinitive Plan Approved by Planning Board --------------------------------19--------- �'�G/ /� Gi% Diagram of Lot and Building with Dimensions 0 )L-- 14 /7 I kr I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... ..... ... ................... ............................... .. ............ Johnson, Yvonne No .122 Permit for ........add to single ................. .............. ................................ Location .......179..Ainckle3r Road J { .......................HISanni s......................................... Owner .......... vonne Johnson ................................... Type of Construction game,,,,,,,,,,,,,, q i ................................................................................ Plot ............................ Lot ................................ =s Permit Granted ......... ....19 69 Date of Inspection ...................... ..19 r?, Date .d ...Com lete �.1." ...p . 19 / ,v PERMIT REFUSED ................. ........................................... 19 r , .................................................................... ....... ............................................................................... ............................................................................... Approved ................................................ 19 r . -i ............................................................................... ...............................................................................