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HomeMy WebLinkAbout0102 LINDEN STREET s4-,—71 r � Town of Barnstable Building z Post This Card SoThat it is Visible From^the Street-Approved Plans IVlust}be Retained on-Job and this Caid Must be Kept Posted Unt�l`Final Inspection Has�Been Made ,.n y . ` ,< Whe e a Certificateof Occu anc is Rewired„such Buldin rshall Not be Occupied until a Finallns ection hasbeen made Permit Permit No. B-20-140 Applicant Name: NOLIN, DONALD R&ALM M Approvals Date Issued: 01/15/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/15/2020 Foundation: Location: 102 LINDEN STREET, HYANNIS Map/Lot 310-258= Zoning District: RB Sheathing: Owner on Record: NOLIN, DONALD R&ALM M Contractor Name Framing: 1 .Contractor License Address: 767 INDEPENDENCE DR APT B307 2 HYANNIS, MA 02601 Est Project Cost: $2,000.00 Chimney: Description: windows-5 and 2 doors Permit'Fee: $35.00 is Fee Paid: $35.00 Insulation: Project Review Req: Date., 1/15/2020 Final: Y Plumbing/Gas i Roug h Plumbing: g g ; Building Official " ' = Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced with msix months afterlissuance. 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 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. 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: F Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund".(as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: E)� .�� ��' Application number.... /..C yU ................................. LDING.DEPT Q, Fee...................... ........... �- • JAN ` 1 5,2020 Building Inspectors Initials........ % .. .................... • �� TOW1V OF I3gRNSTABLE date Issued.:...... .�. ?� Map/Parcel.........�...`-. ..J�........... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION -Address of Project: NUMBER STREET VILLAGE Owner's Name: f�. Phone Number ' Email Address:0 '1 46_,�M_FQ;°;,6nZ_ ( � Cell Phone Number �%4 1 D d o ►� ��. Project cost.$ � C7 . . Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK 0 Siding ( Windows (no header change)# S Insulation/Weatherization Ea' Doors(no header change)# c3t Commercial Doors require an inspector's review ED Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) s' Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY,IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ j. *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. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide'a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or> Yes No ,if yes, a gas permit is required. k Natural Gas Yes No , if yes,a gas permit is required. If food is being served at your event please'obtain to Health Department`approval between the hours of 8:00am-9.30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's-Name: �n n&e., rasZD O/Y\ Telephone Numbers" 6 3 Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. 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 Applicant Information Please Print Legibly Name(Business/organization/Individual): Nnn(PL, mmr a Address: /log City/State/Zip: 0 2� 6 D 1 Phone#: qZv fo 3 Are you an employer?Check the appropriate bgx. '� Type of project(required): 1.ElI am a employer with 4. am agbneral contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). ,�, 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 m' any capacity. employees and have workers 9. ❑Building addition [No workers'comp.insurance comp. insurance.1 , ,iequired.] 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 box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year 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. nn Sim ature• '-1 M br--a4 C1/l`X Date: Phone# - -- .__ ---_ — Or' 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 J receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia ' p Application number..............c.p� ....... ... ........ Dfi" f sued..........L0.11.P.hi ................................ MARNSTABM Building Inspectors Initials.....e.V. ....................... arcel. .�l__O. S HA H 1� Ipi --... ............ ........................ TOWN OF BARNSTABLE I f5b � EYPEDITED PERWr APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY IWOR lVIA7 ION Address of Project: C.?- /_;g e/) 5f• H rt S NUMBER STREET VfLLAGE Owner's Name: -7c)6 n /l o I i Y1 Phone Number Email Address: 40,u tJfucs0 n ;`1 e vA o.co/n Cell Phone Number Project cost /. 9 S� — Check one Residential�_ Commercial OVV1VEWSAUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: See A4gjt,= C&67'ca—,f— Date: TYPE OF WORK ❑ Siding ❑ Windows (no header change)# "ulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review t❑ Roof(not applying more than I layer of shingles) Construction Debris will be going to W as4 e- th&^n Q Itz, G Jam,m o ,fi MA CONTRACTOR'S FORMATION Contractor's name_ Ai Lc.,,; Home Improvement Contractors Registration(if applicable)# 11 Z 7 8 S (attach copy) Construction Supervisor's License# J Off- ,S 3.5 (attach copy) Email of Contractor s,�eP-� M Phone number #o/-7/V- 6 3�9 ALL PROPERTIES THAT HAVE STRU Tt/RE OVER 75 EEA RS OLD OR IF THE SUBJECT PROPERTY 15 IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE eA PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ For Vents 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 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 I,�',yood is being served at your event please obtain a.health Department approval between the hours of 8 00am-9.30 am or 3.30 pm-4e30prm. Commercial events may require.Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand any responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date ­7 APPLgCAI 'S SIGNATURE Signature Date /� — All permit applicati are subject to a building o fiat's approval prior to issuance. Home Improvement Agreement: Page 1 Home Depot License Number(s): Visit www.homedepot.com/c/SV_HS_Contractor_License_Numbers for latest license info MA: 107774, 112785 Salesperson Name: Christopher Read Registration No. (if applicable): Home Depot U.S.A., Inc. ("Home Depot") or service provider named below ("Service Provider") will furnish, install or service the equipment listed below at the price, terms and conditions as outlined on this form. Nolin Don New England South 1-6LQ32RH Customer Last Name Customer First Name Store #/ Branch Name Lead/Customer Order# 102 Linden Street Hyannis MA j 102601 Customer Address City State Zip (520) 222-5433 1 1- donaidtucson239@yahoo.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 DELIVERING WRITTEN NOTICE TO HOME DEPOT AT HOME DEPOT USA INC., 2455 PACES FERRY ROAD, BLDG. B-3, ATLANTA, GEORGIA 30339 or EMAIL The Home Depot 1 @ customercancellationnortheast@homedepot.com 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 PAYMENTS 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 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 OEYDVR RIGHT T C NCI L. Acknowledged by: 09/19/2018 Customer's Signature Date 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: 11956.02 77]lncludes all applicable taxes. Excludes finance charges." Sales Tax: 10.00 (If applicable) *Maximum deposit ONLY applicable in MD, MA, ME(33%), NJ, Wl(99%) Dep. 125.0 Deposit Amount 1489.00 Remaining Contract Balance 11467.02 The Home Depot-2455 Paces Ferry Road, N.W. Bldg. B-3,Atlanta,Georgia 30339-Customer Care: 1-800-466-3337 Customer Agreement(C,E,I)(31 Jan.18) v 50.1.2 Massachusetts Department of Public Safety 1 Board of Building Regulations and Standards License: CSSL-102535 Construction Supervisor Specialty DONALD L BURNETT 31 MARION ROAD MARBLEHEAD MA 010, Expiration: Commissioher 12/06/2018 The Commonwealth of Massachusetts Department of IndustrialAccidents ` Office of Invesdgations d d I Congress Street, Suite 100 .Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Nnp[A RLtrRL°tt7 Address: 31 Ma6on R 4 City/State/Zip: lc; q Ol q (5'Phone#: / 7e- 7 �Ol2oZq Are you an employer? Check the appropriate box: I am a general contractor and I Type of project(required): 1.❑ 4.I am a employer with ❑ g 6. ❑New construction employees(full and/or part-time).*_ have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling hip and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.t 9. ❑Building addition required.] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I Ln 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. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContrractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year 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 hereft certify un the ' s and penalties of perjury that the information provided above is true and correct. Si afore: Date: Phone#: der 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#: The Commonwealth of±Massachusetts Department of Industrial Accidents ( ° Office of Investigations s I Congress Street,Suite 100 _ Boston,M4 02114-2017 www.mass.gov/dia Workers'Compensation Insurance kffidavit: Builders!Contractors/Electricians/Plumbers Applicant Information Please Print Le 'blv Name (Business/Grganization/Tndividual): D POP �/ D — Address: %B 1, S / MA1,,P & CITV'State/Zi : s� sd NA . 0/5 Y.- Phone#: 7 / LY 7 S Are you an employer?Check the i0propriate h x: Type of project(required): 4. I am a general contractor and I ]. �I am a employer with _� -- � 6. '1 New construction i,._='employees(full and/or part-time).* have hired the sub-contractors 1 ❑ 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 anv capacity. oioyees and have workers' 9 ❑Building addition ' o workers' coin insurance comp•ksurance.• i i p 5 'We are a corporation and its 1D.❑Electrical repairs or additions ! required] ❑ have exercised their j officers Plumbing repairs or additions 3.EtI am a homeowner doing all work 11.❑ myself. :iNo workers' comp. right of exemption per 1vSGL 1=.❑jLoof rep:3rs insurance required.] t c_152,§1(4),and we have no �( employee4. [No worke-rs' i 13.E Other�lS��t; o� comp. insurance required]•� I , WPe �2r%L of%ort •-ar.v apphc:ant La:checks box 01_must also 511 out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavii indica ingsacb. :contractors that check this box must attached an additional sheet showing the name of the sub-convectors and state whether or not those entities have --mpioyea. 1 the sub-contractors have emplovecs,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 sire infunnation_ Lnsi rmce Company Name: ( 1•JLr' `/y2 bitltf./ �N�onJ r'//'C� yit/S . C e. _ __ Policti#or Self-ins.Lic.#: J4 l o % Expiration Date: Job Site Address: !f� 2 Lt 11�Pn S City/Statelzip: n policy declaration page(showing the policy number and expiration date). Attach a copy of the workers' compensation p y P g � g Failure to secure coverage as required under Section 25A of VIGL c. 152 can lead to the inrposition of criminal penalties of a fine u:)to$1,500.00 and/or one-y imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day ag ' si 4elator. Be advised that a copy of this statement may be forwarded to the Office of Investig�ons of the DLk r' e coverage verification. I do hereby certify un a at the in provided above is true and correct Si ate: b Date: — Phone#: O — Official use ordy. Do not write in this area,to be completed by ci{y or town of ttdaL Cin'or Town: PermitUcense n Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector G.Other I Contact Person: Phone#: `C i' "2'1'f j -_ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home improvement Contractor Registration Type: Supplement Card HOME DEPOT USA INC registration: 112785 2455 PACES FERRY RD C-11 HSC Expiration: 04/22/2010- ATLAN TTA,GA 30339 Update Address and return card. Mark reason for change. ❑ Address ❑ Renevra! El Employment C Lost Card - Office of Consumer Affairs&Business Regulation —_=-- HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE SuDDlement Card before the expiration dale. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation — 12785 04122/2019 10 Park Plaza-Suite 5170 4OME DEPOT USA INC Boston,MA 02116 �r J ANDREW SWEET 2455 PACES FERRY RD C-11 HSC ATLANTA,GA 30339 Undersecretary d ithou signature DATE iMMMDD1YY y ACORO CERTIFICATE OF LIABILITY INSURANCE 02=', lk� 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 15 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)- CONTAC PRODUCER NAM MARSH USA,INC. PHONE FAX TWO ALLIANCE CENTER Arc No): 3560 LENOX ROAD,SURE 2400 E-MAIL ATLANTA.GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIL It CN101642069-HaneD-GAW-18-19 INSURER A:Old RepuNic Irsumnce Co 24147 INSURED THE HOME DEPOT,INC. INSURER B:New Hampshire Ins Co 23841 HOME DEPOT U.S.A.,INC. INSURER c:HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA.GA 30339 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353430-16 REVISION NUMBER: 3 THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT,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. 1NSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MMIDO EFf M�EXP LIMBS LTR A X coMM W m ERCLGENERALLJABiL MWZY312717 0310112018 10IM121" EACH OCCURRENCE S 9•�•Oa CLAIMS-MADE OCCUR PREMISES Ea 1.000,OOD LIMITS OF POLICY XS I MED EXP(Any one person) ;S EXCLUDED OF SIR:$1M PER OCC PERSONAL&ADV INJURY S 9.000.000 GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE S 900c X POLICY 0 PRJECTO LOC, PRODUCTS.COMPIOP AGG S 9,000.00c, OTHER: S A I AUTOMOBILE LIABILITY MWTB312718 03101R018 03101 019 COMBINED SINGLE LIMIT Ea acmderill i s 1.000.000 X ANY AUTO BODILY INJURY per person] S OWNED SCHEDULED I SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) S AUTOS ONLY AUTOS ) it HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY i Per aeudenf i S UMBRELLA LAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE OAGGREGATE !s DED RETENTIONS s g WORKERS COMPENSATION WC014122577(AK,NH,NJ,VT) 03101/2018 03101/2019 ATUTE ER AND EMPLOYERS'LABILITY YIN VNC 014122578 WI 0310112018 031D112019 5,000,COCANYPROPRIETORIPARTNERIEXECUr[VE ( ) H ACCIDENT SOFFICERIMEMBEREXCLUDED'I 7NIA ,nnn r.(Mandatory In NH) EASE-EA EMPLOYEE Sn yes,describe under Continued on Aftlional Page EASE-POLICY LIMIT S --------- DESCRIPTION OF OPERATIONS below C Excess Auto 297-t-1oD,1Oo2o,e 03101/2018 03101/2019 Urtut 4.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be anached 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. ManashiMukhegee I ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta A' r% ADDITIONAL REMARK S SCHEDULE AGENCY Page 2 of 3 MARSH USA.INC. NAMED INSURED THE HOME DEPOT,INC POLICY NUMBER HOME DEPOT U.S.A.,INC. 2455 PACES FERRY ROAD BUILDING G20 CARRIER ATLANTA.GA 30339 NAIC CODE ADDITIONAL REMARKS EeFEcnvE DATE= THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liabili Insurance Workers Compensation Continued Carrier:Indemnity Insurance Company of North America Pdicy Number WLn^C6478319i(AL,AR,FLJD,IA,KS.KY,LA,LiS.MO.NE.Nbi ND,OK.SC,SD,TN;WV;NY) Effective Date:031012018 Expiration Date:03101/2019 (EL)Limit:S 1,000,000 Carrier Nev.Hampshire Insurance Company Policy Number WC 014122576 (DC,DE.HI,IN,MD,MN,MT,NY,RI) Effective Date:0310112018 Expiration Date 03101/2019 {EL)lint:S1,000.oDa Carrier:ACE American Insurance Company Policy Number.WCU C64783221(OSI)(AZ.CA,IL,NC.OR,VA,WA) Effective Dale:03/01/2018 Expiration Date:03/01/2019 (EL)Limit:S1,000,000 SIR SuD0,000 SIR for the states of AZ.CA.,IL,NC,OR,VA,WA Carrier:National Union Fire Insurance Company Pdicy Number XWC 4595580(OSI)(CO,CT,GA.ME,MI,NV,OH,PA,UT) Effective Date 03/012018 Expiration.Date:031011201E (EL)UmiC S1,000,000 S1.000,000 SIR for the states of CO,ME,NV,141,OH,PA,UT S750,000 SIR for the stale cf GA S350,000 SIR for the state of CT Carrier:National Union Fire Insurance Company Pdicy Number.XWC 4595581(QSI)(MA) Effective Dale:033/01/2 1 q Expiration Date:031012019 (EL)Limit:S1,000,000 SIR:S500,000 TX Empolers XS Indemnity: Carrierlllinios Union Insurance Compam; Policy Number.TNS C4916693A ITX) Effective Date:03101r2018 Expiration Dale:03/012019 (EL)Linat:SIQ0D0:000 SIR.S1,000;CCr0 (CORD 101 (2008101) The ACORD name and logo are registered marks off A 008 CORD CORPORATION: All rights reserved. CORD Assessor's map and lot'riumber ` f THE T ie rCONNECT TO TO R T° ,~ . � ea �B9HH9TADLE, i House number ............ /.. ..Z.:... .......... ..............• r rnea p� �p 16 3 9. \00� TOWN. �OF BARNSTABLE BUILDING . INSPECTOR ,o�s-r� APPLICATION FOR PERMIT TO ..............................v...........cr....&...........A.A.A.......,............................................................... TYPE OF CONSTRUCTION ....:............../".Ot�f� I?,��1� ............................................................................. � !.L...zq ......19M. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following-information: Location ......J0Z:...�'::,. I^.-�. \ ........... ................... lf'!�. .,.. ..... ProposedUse .......5�ARAU.E.../1;�E_,SibElj.......................... . ....................................................................................... 1 ' ZoningDistrict ......i. .........................................................Fire District ............... .. .. � .., .................................... Name of Owner ....�1N1 .1....�-� ... A. Address l--.11�►�ECv ... t..I `.`%A( 3.!'�.!.. ....... ... ............4....... Name. of Builder ...N..I CHAEL, A T!4A HAIIU 3T lV�� ..................... ............. ..................Address ............... .................�... . ........ .................. Nameof Architect ..................................................................Address .............n.1..._...................................................................... Number of Rooms .........................................Foundation l; y� ..............................M otio GOOF .......... . ..................... I/ C.�� ....lAExterior ...................... ...... ..............Roofing ......... z b Floors �,cglvCT�E'7 E......................................................Interior ......... ........i,�iSuG ........................................ ................................ Heating ..................................................................................:Plumbing .................................................................................. Fireplace ............................Approximate. Cost .... 000 .. ........... Definitive Plan Approved by Planning Board ---------------_---------------19________. Area Diagram of Lot and Building with Dimensions Fee l of SUBJECT TO APPROVAL OF BOARD OF HEALTH t � r I '150 + r H©V.S 2.1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of theAToolf Barnstable regarding the above construction. Name ..... .... .... . .... ....................... Construction Supervisor's License ...�.�4� ............. FARNHAM, -HENRY C. No ...2.7B.N. Permit for ...Build...Garage y... ... .. .... .. .. g.............. Location ... Lillop.A et ...................... ............... .HiM a.. y. i.5............................................ < Owner Henry..C. .Farnham V, ................ .............................................. Frame Type of Constructi6n .......................................... tI ................................................. .......... Plot. ................... Lot ................................ .2 April 24 ,-.:� 85 ,Perm ......n19 branted ................................ Date"Sof Inspection ..................................�.19 Date, ofnpleted ....... .......... 19 r tij A < Assessor's map and lot number .... Q�°f TOIL y SewagePermit number ...................................................c�K r` d� T E o� 1i BAB39TABLE, i House number z— ............... ........ .. ..................................... yO MABa o� 00M0of,0m TOWN OF BARNSTABLE fF'l�ti BUILDING INSPECTOR APPLICATION FOR PERMIT TO ►J.,3TR u C.T' &A.A.A E f..'................................................6:........................................................... ... TYPE OF CONSTRUCTION rt?coo KRAM...................... ........... .............................................................................. ................ ......19. c TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �Z �.,.,I NbEj ST...........`�'_ 'T�T�4�:.� ..................... ,......I. . ........................................... ................................... �aAGE /AESIbE�j-T1/\L— ProposedUse ....... .... ....................................................................:.............................................................. Zoning District ...................Fire District ... ,. ..�., I '.�1 . Name of Owner A ...............Address �C)2 IN{{{DEN 37 % �YQNN ,5 Name of Builder ... ..1 C{-iAEL SI�IA�..................Address �`'iAIN JT � E�l)J`��� f. ... .................... .i. ................ Nameof Architect ................................................................. Address .................................................................................... AEU..Number of Rooms ..................................................................Foundation ...................................................... ...................... ✓. Exterior ..../2-... ........... .... fr..�.LE LE ........ /Z ���C. ................................... ................................................ Floors CRE7 E .Interior V P`}�I►...J N E� ...................................................................... ............................................ Heating_ .............................................:...................................Plumbing .................................................................................. Fireplace �.............................Approximate Cost .... 0d0 . ........... Definitive Plan Approved by Planning Board --------------------------------19--------. Area J4 X 2 Q M '�. .. Diagram of Lot and Building with Dimensions ' Fee '. ��0 ............................./.......... SUBJECT TO APPROVAL OF BOARD OF HEALTH'' 35'± YJSYIN6— fie+ ' {- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Tov)n of Barnstable regarding the above construction. Name .......................(J..................... I Construction Supervisor's License ...( Q'` .-- ..... ............... FARNHAM, HANRY C. A=310-258 ' 27b&2 Build Garage i No ................. Permit r .................................... single Family Dwelling ............................................................................... Location ....102 L.inden. ...Street. . .................. ....... ..... ....... .... .. Hyannis ............................................................................... Owner Henry....C.,...Farnham. . .................. ...... .. .. . ..... ....... ..... ' Type of Construction „Frame ............................................................................... Plot ............................ Lot ............................ Permit Granted April 24 , 8519 Date of Inspection ....................................19 Date Completed ......................................19 II 6 � 11