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0124 LINDEN STREET
Application number.v ..........81.12 01� KO) - � Fee......................... ............. .................... JUN 10 2019 �, Building Inspectors Initials... . .. ........._ ..� Date Issued.:...�Q.. ........t%- �q .................... Map/Parcel.............:.......................'..................... TOWN OF BARNSTABLE - EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 1TUMBER STREET VILLAGE Owner's Name: (ter 7 � Phone Number I3 Email Address: Cell Phone Number Project cost$ ' Check one Residential_Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit inaccordance with 780 CMR )1j, Owner Signature: �� �` Date: S TYPE OF WORK 13 Siding 0 Windows ( change)header chan ) e # EInsulation/Weatherization 0 Doors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Mike McCarthy Construction PO Box 52 Home Improvement Contractors Registration(if applicable)Vest Dennis, MA 0 6tta0ch copy) on gad Cell g - Construction Supervisor's License# CSL-586(attach copy)69393 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............................................................ 1 � *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. Natural Gas Yes No ,if yes,a gas permit is required. If food 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-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: Telephone Number J 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 AP , I SIGNATURE � I�G11 Signature Date l All permit applications are subject to a building official's approval prior to issuance. INE o� Town of Barnstable -�2 BAR., LE , I Building Department Services *a MASS. 0�0 Brian Florence,CBO iA1 6. Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Mark Zabicki , as Owner of the subject property hereby authorize c��� C�-�fi. to act on my behalf, in all matters relative to work authorized by this building permit application for: 124 Linden Street Hyannis (Address of Job) Signature of Owner Signature of Applicant Nl Q( I C Z (A CIS. Print Name Print Name Date colk", allinxti;eff-i r Office of Consumer Affairs and Business Regulation 10 Park Flaza-Suite 5170 Boston.,,:' ` ` usetts 02116 Home Ii.prov. tractor.Registration TYR: . IrxSvicil "--" 1 MICHAEL MCCARTHY R istratiort: 1BCi ^'"'—" ,. � P.O.BOX 52 *; �`► Eiration: 06115MIg WEST DENNIS,MA 02670 t 41 .-. 3CA i 0 20M-05/11 Update Address and return card. Mark reason foroltange. n Arld is C!PAna"I rl mote ant Cj Les4 C ra C�/ee�arna�ao�:u�/c of°(3�aaoadcuaelle —. _.. Office of EgnsumerAffairs$Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:IndK4dual before the eViratlon date. If found return to: ;> Expiration Offlos of Consumer Affairs and Business Regulation ¢_ 13 06/1 b/2019 10 Park Plaza-Suite 5170 MICHAEL MCCA " 'y' J---: Boston,MA 11 MICHAEL F.MCC'.. 6 RANGLEY .; SOUTH DENNIS,MA 02t3so UndersecretaryNot valid without signature ;no Commonwealth of M.assachusetts Division of Professional Licensute M�CIfBeI MCC�ti y Board of Building Rec ulati0:s and$tariddrds: GonstrfyagD Mocar y COltst u"Oh p�rvisor CS-058-60 , Has steltyA tlf�e Nagtaltl Fiber tit trs Q4/t012020' Caifaiose TlaMing Coumo , 2.9"d day of August 2011 MICA.J fiACCkR PO BOX52 S WEST DENNISM�r �� NMATIQNAL F4BER AbltnlldYnAnreiMonad e A...c..,.,.....,. /► Cornmissicner OSHA 001.558712 - U.S.oePattment of Law , Oxupat 01381U"And Health Administration k. :_...... . ` Michael M � . cCarth Y hat:S"S1FiW.comPteted•2lWtoix0pF.upafwnal;Safetyand:Heallh r�udt�tGg %Safety Trairdng Course ft}. am a ffi 3z Aoyts o[ rfte Sat ::$Health:. . e Hou o 'ti�n �� _ U'NUieJon.Mnuiq.!„H (Date) .. The Commonwealth of Massachusetts Department of lndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia I-Vorlcers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE F LED WITH THE PERMTrMG AUTHORITY. Applicant Information Please PrintLegibly Name{Business/Organization/Individual): Mchael McCarM c,r��'r..�Tv�r. ►--�C. Address: Pa Box 52 City/State/Zip: Phone : Are you an employer?Check the appropriate box: Type of project(Yequired): 1.[E I am a employer with '�. employees(full and/or part-time).* 7. 0 New construction 2.❑I am a Sole proprietor of partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.]. 3.O I am a homeowner doing all work myself.(No workers'comp.insurance required.)t 9. El Demolition 10❑Building addition 4.❑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 I I. Electrical repairs or additions ❑ P 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 repairs These sub-contractors have employees and have workers'comp.insurance.! 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other �►'�>/��I+. 152,§1(4),and we have no 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 anew 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. Iam an employer that isprovidingworkers'compensation insurance for my employees. Below is thepolicy andjob site Information: Insurance Company Name: `N�' ,, �i r, ;I i 4-i k �i f'C 1 V ro c Policy#or Self-ins.Lie.#: I k/(.�N-4 S7`/ Expiration Date: 1'.1 ►f I�j 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 MGL c.152,§25A is a criminal violation punishabla 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. 17 I do hereby certify and t e Xlns gnaldes of Perjury that the information provided above is true and correct. Si ature: 4 Data: Phone#: Official use only. Do not write in this area,to he completed by city or town offfciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i = CcARTHY— TOWIN OF a � ,.° RUCTION C®. ; ��- U psi dal and Commercial Builderz , 3 EY RATION S PECIALIST , DI V 1�; i3 T March 15, 2014 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Street Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201201558;Status A; Parcel 310256 at 124 Linden Street, Hyannis, MA; Permit Type RADD and issued on 12:00:00 AM has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction 7, 3 Commonwealth of Massachusetts Sheet-Metal Permit Map 310 Parcel 01✓ . Date: Oq /06 hu 13 Permit 11R13d 3 Estimated Job Cost: $ , �QD ®® Permit Fee: $ `0':I0 6,3 Plans Submitted: YES NO Plans'Reviewed: YES NO Business License# - Applicant License# Business Information:R-J ( e n Property Owner/Job Locatio Information: Name: -.. Al( W t— Name: /V I�.c �1 C K I Street: I O(A rA A Street: City/Town:_.,n ief i.Ae__ VA City/Town: _ Telephone: : 7 q �0 ( ff� 'J I Telephone: _,3!3 59<1 Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial J-1/M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family V Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept. Approval Institutional— Other Square Footage: under 10,000 sq. ft.I over 10,000 sq. ft. Number of Stories: Sheet metal workL to be completed: New Work: 1� Renovatio- PERMIT HVAC Metal Watershed RoofingKitchen Exhaust System y SEP - 62013 Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: TOWN OF EAR1NSTAELE NSURANCE COVERAGE: gave a current i il' insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes No ❑ f you have'checked Yes. indicate he�tyrpe of coverage by checking the appropriate box below: a k liability insurance policy s" Other type of indemnity ❑ Bond ❑ D'VVNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Oassachusetts General Laws,and that my signature on this permit application waives this requirement j i Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 3y checking this box[], I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and iccurate to the best of my knowledge and that all sheet metal work and installations performed under the permit Issued for this application will be n compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: y ❑ Master Ile ❑ Master-Restricted iti/Town ❑Joumeyperson .. Signature of Licensee armit# ❑Joumeyperson-Restricted License Number. �� U se$ ❑ Check at www.mass.gov1di2 s:oector Signature of Permit Aoorovai The Commonwealth of Massachusetts 1 Department of-Indust ial Accidentr Office of Investigations uf '600 Washineon Street- _ Boston,M4 02111 www.mass gw/dia Workers' Compensation h:�Ance Affidavit; RaR ers/Contractors/Electriciaus/Pltlmbers Applicant Information Please Print Legiibb,, Name(BusinesslOrganizationllndividnai):. P 1 6 f A C_ Adiiress:_1171;Z_. F(1 LM(1�11� Rr4 CRY/Sta&zip: &V. i f f y At AA Phone.#; -q7 Y ' I ,9.3 1 " you an employer?Check the appropriate bow [2. . ] I am a employer with -4• [] I am a general contractor and I [7. of project(required) employees (full and/or part time).* have hired$ie sub=contrarfxs New conatr„rt;�,,, ❑ I am a'sole proprietor or partner- listed an the-affached sheet Remodeling ship and have no employees These sob-cordracbors have ]Demolition working for me�any capacity, employees.and have work$rs' [No workeisI camp.insurance comp.Insurance,$ 9, j]Building addition required.] 5. []'We area corporation and'its ME]Elrct ical repairs or additions 3.❑ I am a homeowner doing ifl-work officers have excised their 11.7 Phmb#g repairs or addifions myself [No workars' comb, rigid of exemption per MGL 12, insurance required.]t c.152, §1(4), and we,have no ❑Roof r epairs employees. [Na work' 1-3.[]Other ' .comp.>nsr¢ance required] - Any applicant fluat checks box#1 must also fah oat the section below showing fhc r wad=,compensation policy informati® t Hameownca who submit this xffuk it indicating trey are doing all work and thin hare outside contractors must submit a new atndavitindimting such. tCenttactms that check this box most attached as additional sheet showing the name of lhe sub-eontrachns and state whcfcr orn of faose eatities bane employees.ploy . If Eire sub-contm ers ctus bare employ ,they mnstprovide their workers'camp,policy Er. ; I am an employer that is providing workers cnmpensadun insurance for my employees Below is the parley and job site in,formation. Insurance Company Nave: Policy#or Self-ins.Lic.# ExpiratiouDafe: Job Site Address: _ Cdy�StatPlLip: Attach a copy of the workers' conopensafion policy declarafion page' (showing the policy number and eapirafion date). Fail=-to-secure coverage as regniredunder Sectinn25A ofMGL c. 152 canlea.d to the imposition of criminal penalfies of-a fin&tip to $1,500.00 and/or one-year m34m omnent,as wen as'civE penal ins in the f=of a STOP WORK ORDER and a fine th of up to$250.D0 a day againste violator. Be advised that a copy of this sbh merit may be forwarded to flee Office of havestigHtions of the DIA fark0mice coverage veafrcatiom I do hereby certify un d penalties of perjury aiat the infarmafion provided ab a is fro and correct �itmaftme: Data: Phone Official use only, Do not write in this area,tb be completed by city or.town offxiaL City or Town: PermitlLicense# 'Issuing A ±Taodty(circle one): .'1.Board of Health 2.Btuldiug Department 3.My/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. OthL Contact Person: Phone#: THE Town of Barnstable } Regulatory t a.arsr,,a�,E. • � ry Services z M 1�g Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barristable.ma.us Office: 50 8-8 62--403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A.Builder &G/� I , as Owner of the ro subject J P Pay hereby authorize to act on my beh4 in all matters relative to work authorized by this building permit ' �v7 / . /7" tfN'Al/S (Address of job) Pool fences and alarms are the ons res ibili f th responsibility o e applicant. Pools are not-to be flled.before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. ' I Signature of Owner Signature ofApplic t Print Name Print Name Date QF0xIvZ:0WNIWExMIssr0NP00 s .a Ck JHE Town of Barnstable Regulatory Services . STA81Z, Thomas F.Geiler,Director s nAsa 1639. Building Division R Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner perforrmng work for which a building permit is required shall be exempt from the provisions of this section(Section 109,1.1-Ucensing of construction Supervisors);provided that ifthe homeowner engages a person(s)for hire to do such work,'that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15).This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities mm,many counities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community, Q:forms:homeexempt SHEET METAL W : RS AS A JOURNEY RKE PERSON-UNRESTRICTED ISSUES THE ABOVE.LICENS2 ( IIyy� .. .. xJOAO M EHUMBIN:HO >:1815 FAL`MO'UTHRD RAPT.:. A5 CENTERVILLE ; MA 0.2 2 3167 . r. 52&3 OV28/14 I38494 s p rR �, 66557 gt 5w r 1815 FALMOUTH 'fir r m 'ss'aaH Y j �A�PT A5 rl ROAD e Client#:21832 2AIRR1 r ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 05/07/2013 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 Dowling 8r O'Neil PHONE 508 775-1620 F AIC No Ell: AIC,No: 5087781218 Insurance Agency EMAIL ADDRESS: 973 lyannough Rd., PO Box 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURER A':National Grange Mutual Insuranc INSURED INSURER B: ' Joao M.Chumbinho dba Air Rite 1815 Falmouth Road,Apt A5 INSURER C: Centerville,MA 02632 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 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. LTR TYPE OF INSURANCE IINDSRL SUBR y VD POLICY NUMBER MMMIDDDY EFF MM1OPOLIDY EXP LIMITS - A GENERAL LIABILITY MPT8454A 4/13/2013 04/13/2014 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DA AGE TO RENTED PR MISES Eaoccurtence $5OO OOO CLAIMS-MADE F x1 OCCUR MED EXP(Any one person) $1 O 000 PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 - POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident $ AUTOS AUTOS ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accldent $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AG EGATE - $ DED I I RETENTION$ III, $ A WORKERS COMPENSATION WCT8454A 13/2013 04/13/201 X STATU• OTH- AND EMPLOYERS'LIABILITY Y/N E.L. SEASE-POLICY LIMIT $500000 I ITS R ANY PROPRIETOR/PARTNERIEXECUTIVE E. OOO ACH ACCIDENT .$SOO OFFICERIMEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If DESCRIPTION OF OPERATIONS below yes,describe under - . . , D � DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable,Building SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S110912/M110911 L31 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - Parcel Map- '- Applica n'io nV Health-Division Date Issued Conservation Division_ Application Fee r Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board (� Historic - OKH _ Preservation / Hyannis I Project Streeti1 1,Address 13-1 Village Owner nJLI 1ae 4 Address Telephone f � �I 6;�4 Permit Request �� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed 3 TotaLnew* Zoning District Flood Plain Groundwater Overlay o ry rM Project Valuation Construction Type 4 Q Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting decun-Vtntation. Dwelling Type: Single Family Lr"' 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 ❑ Appeal # Recorded ❑ Commercial ❑ `d N Yes o If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ��I i 1l `C,,.a Telephone Number Address &, �Z _ License# �nh '� �l,/� (✓�-7, Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ;�. DATE Willy FOR OFFICIAL USE ONLY APPLICATION# rE DATE ISSUED f T _ _ MAP/PARCEL NO. s ADDRESS VILLAGE OWNER r Ik r DATE OF INSPECTION: FOUNDATION FRAME INSULATION' FIREPLACE p ,§ ELECTRICAL: ROUGH FINAL to- PLUMBING: ROUGH FINAL GAS: r., ROUGH FINAL ti.INAL BUILDING =f 4 DATE CLOSED OUT } ASSOCIATION PLAN NO. j. x The Commonwealth of Massachusetts .UTDepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov, is Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AvOcant Information Please Print Le bl Name(Business/organization/Individual):. b '_ Address: t�C: "L City/State/Zip: � � . nn.� /� oz.c1c- Phone.#: (SU) Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with •4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New constriction employees(full and/or part-time). . 2.["I am a'sole proprietor or partner- listed on the-attached sheets 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.Ms rance.$ 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 repairs or additions myself. o workers' . right of exemption per MGL � � c°�• 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.[�6ther comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'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 und�N4insnd nalties of perjury that the information provided above is true and correct. Signature: Date: 2rlJ i. Phone#: Official use only. Do not write in this area, to be completed by city or town offciaL 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#: usiness Regulation Office of Consumer Affairs and t 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration r Registration: 160393 s R - Type- Individual . - � = A Expiration: 6/16/2013 Tr# 213517 MICHAEL MCCARTHY 1 MICHAEL MCCARTHY P.O. BOX 52 '� 7 , WEST DENNIS, MA 02670 ( , � 'Update Address and return card.Mark reason for change. w.. <- Address Renewal Employment Lost Card DPS-CA1 is 50M-04/04-G101216 fie a� w�ursea�C� o�� aaac/Zu°eta License or registration valid for individul use only Office of Consumer Affairs&'Business Regulation g HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration :?169393 Type: Office of Consumer Affairs and Business Regulation Expiration 6/16F2013 Individual 10 Park Plaza-Suite 5170. - Boston,MA 02116 MI C AEL MCCARTHY- kF_ MICHAEL MCCARTHY u 6 RANGLEY LN SOUTH DENNIS,MA 02660 Undersecretary t valid without signature ' Massachusetts- Deportment of Public SafetN Board of Building Regulations and Standards ` Construction Supervisor License License: CS. 58633 Restricted to: 00 + MICHAEL J MCCARTHY PO BOX 52wd W DENNIS, MA 02670 Expiration:. 4/10/2012 OWNER AUTHORIZATION FORM (3 C (Owner's Name) owner of the property located at (Property Address) (Property Address) hereby authorize C ' C C (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Own is Signature '0 v t5 Date LLDEC 6 2011, 'k a2t �FIME Tay, 6 Town of Barnstable *Permit# ! IN170 Expires 6 neonths rom issue date �k Regulatory Services Fee `iu3seaaLE, 16 C MASS.. 9 mf' -�' Thomas F.Geiler,Director Building Division (2,, 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 Not Valid without Red X-Press Imprint Map/parcel Number V / /� �,✓a/rJ .Property Address 2 ,C.�I(1 �J I r-e,e_T [Residential Value of Work Ili, ;))/, 7 1 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address / , /a K zQ - L �A 4=,1"(1 j=c IQ S AU,arirl,S Contractor's Name a-e-1-e—s R b L G TT Telephone Number &/7— , Home Improvement Contractor License#(if applicable) -e 5 6//1 ��U-� �"� �¢ 1L /2 7 Construction Supervisor's License#(if applicable) d' 0/ AlWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [ ' I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# 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 of roof) ❑ Re-side #of doors [� Replacement Windows/doors/sliders.U-Value 0 (maximum.35)#of window--,-,-- * 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 Contractor License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 ' y ✓�Ze Toomam�uuea�.� o��Oac�u Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Type: klq,,,,w�Registration: 1,48688 Supplement Card Expiration:.--1{/18i2011 LOWE'S HOMES C5'NT-ERS INC MARIE SAINT-BRUN 136 TURNPIKE RD.SUITF 100 SOUTH BOROUGH,MA 0.1772 Undersecretary Y T I t Y zk "'n , yY 77 yv �a'1 5 s 1� 6: y� $ #N i , 7s fps „�. ;• i• Nla> a�ltutie#t+ Defiartment of Public > ,Satctn � Boat`cl of$uilcli. J�.Reirulations and S#an"dart94 Corastructi�in.5upervisor License License: Cs 80174 Restricted to:: 00 , CHARLES`P ABBOTT t 322 PLYMOOTH ST "` r HOLBROOK MA.02343 ' 5 - txpiration 12/25/2011 C umrt.riu�3cr Tr,:T0905,' R' The Corrnnoitiveaalth of Massachusetts Department of Indu striral Acriderm, Office of Investigations 600 Waashinggtorr Street Boston, AL4 0 111 Workers'leers' Compensation InsuiranceA#fidaxit: Buflders/ContractorsTlectiiciin.-./Plumbers Applicant Information /� I ,Please Print Legib v Name Business5,'Ot ag izationlnchvidual)_ L O w-t 's k1c)m ( I'S r I - Ct Thomas J3ttrgin Pae-L4-oaq Caty/ tare Zsp_ (iU`(lG �.21 c/ one, 01 : -7 - Q Are you an employer?Check tYte appropriate box:: Type of project(r equir�ed): 1.El am a employer with 4. [')(I arts.a general contractor and I employees(ful1 and/or part-time,)..* have hired the sub-contractors. 6- ❑New construction L.Eln— I am a sole proprietor or partn listed on the attached tweet. T ❑Remodeling ship and have no employees These scab-contractor;have. g- ❑Demolition working for me m any capacity- employees and have,workers' [No worker,:, comp-insurance cep-insrrrartce.. ❑Building addition required.] 5. ❑ We are a corporation and its MEI 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 12-0 Roof repairs insivance:required.]` c. 152, §1(4),and-we have no employees-[No workers" 131 Dthef 1 UI'4r(.L4LL(Q' (,oin&o comp- insurance:required.] relo tacem e rI4, *Ant apphr.=that checbs box-1 must also fill out:the section below showing their workers`compensation policy information Homeowners who submit this affidm-it indicating they are doing all wwts and then bin-outside lontractors must su'st=a new,af£idava indicating sudi- 4Cv-atractors that checis this box must attached sar addidozW sheet showing the name of xLe sub-contmctm and stale whether at.not those ewities have e€vloy ees. If the nib-cantracton ba.=e employees,they rrnist provide their workers'c€sntp.policy number., arra cart eprrpdtrt r tia€at is proxitfiarg at�ariC rs'ccrratlrertsaatiara irasarrraaac, ,ar�,rt, arapTarg^aes. Below is the policy Rant jab+:site inrforin adiaar. Insurance Compmy Fame: Policy#or Self-ins-L c. +: (,�j C '�f�y Q5 Expiration Date: Job Site Addre,,�,: !�_/ L'o Sf Citpstate/Zip. Attach a copy of the work-ers'compensation policy declaration page(showing the policy rnrm er and expiration date). Failure to secure coverage as required under Sermon 25A of MGL c. 15:2 can lead to the imposition of criminal penalties of a fire;tip to'S 1,500.00 and,'or one-year unprisotmrent,as well as civil penalties in the:form of a STOP 1XIORK ORDER.and a fine of up to$250-00 a day against the:violator. Be advised that a copy of this statement maybe fonvafded to the Office of Investigations of the DIA for insurance coverage verification. I do BaereiaJf c�ttifgnrander the pains and pe ra hies ofperjuty th a.t tine in fvraraaaran pro-idded abOve is tfaae and correct. ienature: ` ` Date: Phone 5-7 3 -20 9 Ca Official to se o3rt. Do not txrtg in this area,to be carrtpdete}d:bt'cey'or town ariaL Cif or Totart: PermitUcense A Issuing Authority(circle orre): 1.Board of Health 2.Building Department 3.City')'To,%m Clerk 4.Eleetrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: _-....._-. _-.,. �,.. ,- _ . 6 PAGE 2/003 Fax Server �~- OF LIABILITY CER-nFCA7TEICATE IS ISSUED AS A MATTER OF INFORMATION ONLY q INSURANCE °A'�` T ®FLOW, TM��E��AG �FIRMATryEtY OR NEGATOVELY AMEND, �PRESIENTA OF IN ND CONFERS NO RIGHTS UPON 1: PRESENTATIVE OR PRODUC PRANCE DES NOT CONSTITUTE OR ALTER T11E CERTIFICATE HOLD IMPORTANT: N the ANQ TMADDI�T7 �ATE I111TE A CONTRACT THE COVERAGE AFFORDED BY Sholder Is an HOLDER BETWEEN T61E ISSUING INSURER THE S �rtIHrRlte holdthe and er in lieu of such e�1cy,certain policies L IN8URED,the pollcy(les)mu, t8). AUTHORIZED P+tooucFR orsen�nlls) may require an endorae�t. q ba� ff SUB111t WN MARSH statement on this Ig WAIVEp,subject 100 N.TRyON STREET,SUITE 3201) isrtifi�dues n�confer rights to the to CHARLOTTE.NC 28202 NAITE FAX(7D4)374-M PHO►a 4709$ E IgA1L CASUA-0NLY-11.92 INSURED C ---L NO - UBRD OVER -------- LOM's Compenim Bic. --_ _---and Subaidlarles - - �_"�C -_ '----�-_INBU PO Box 1000 INSURER A:SBII Blsured RAO� NC 28115 !!+suRErt s.National Union ---- N . Foe Ins Co Pitfsbun�pA '_---- INSIIRERC;'NSU IIft _aER :: Netlonel Irts Co - _...-- COVERAGE$ INsuRHt�;IlfnoisUnion Insurance u -'--- 23817 THIS IS TO CERTIFY CERTIFICATE NUMBER: R t fiance Cary n96o INDICATEp. NO THAT THE POLICIES OF INS ATL-00219765610 CERTIFICATE WITHSTANDING ANY'REOUI U�NCE LISTED BELOW 28387 _ MAY BE ISSUEp ENT, TERM OR CONDITION oFBEEN ISSUED TO THE INSURED1�1�NUER: L�IXCLUSIONS AND CONDRION$OOFF SU�CF1 PERTAM, THE INSURANCE AFFORDED ANY CONT 711111111 POLICIES.LIMITS SHOWN ��BY THE POL�ICIESODESCR BED HR OTHER EREIN SBSUBJECT TOE TYM OF PRANCE - _MAY HAVE BEEN R �VfTH RESPECT TOIL PERIOD mewl UAa1Lr7rY EDUCED BY PAID CLAIMS, WHICH THIS A POLuw NusBae: POLICY EFF IC E�cP _ ALL THE TERMS, COMMERCIAL GENERAL LIABILITY CLAarS"MADE 8*411sured 04/012011 LpY1Ts -' - OCCUR EACH RR ENCE I04l01M12 �Auac€1Yi S A . - GEN L EGA-rE -- ME-pD FXp(_j paw)$--- LIMR APPLIES pepL PE - POLICY PRO, I AL a ADV--- B AUTO JURY 3 a LMBK rY LOC GENERAL AGGR r ----i- C X ANY AUTO ACTSCOMP/OP AG - G s-- B ALL owIED AU it CA43094M(AD$) —S SCHEDULED AUTOS CA4:I09410(Idq) 04/01/2017 Comm 04/01/2012 (Ea "ED SINGLE LIMIT CA4309411(Vq) 04A01/2011 ac`�r"1 I$ HIRED AUTOS 04/01/2012 BODILYINI� �'5 �- 5'ODD•00004/01211 04/01NON'OW I2012 BDDIv IuDAUros (Perms„ n i i- PROPERryDAMAGE .._..._-.�.-....-- F X UNI J.A LIAS X EXCEsg lrpB OCCUR - --- r--- g CLAI MgpE IPR3792901-00 -—.__---- DEDUCTIBLE S 041DI2011 RETENTION 04A012014 EACH OCCUSWILD RRENCE 13 5 AGGREGATE s--_- 5 ODD,ODO C I ANY PROPRIETORIPARTN "---- 3 - C OFFICER/MET�ER E 1Tr E Y/N Mandlin IN EXCI UDED2 � NIA �(ADS) X WC 3TATU I S ---__- D DEunderOFO wC061967335(MN 04�12011 0 oirX12 _..------- -.. B Exrass WC ERATtoI�s D" WC0819873U ) 041012011 04J012012 E1 EACH ACCIDENT s. 2,000,-000 El.DISEASE. - .._.__._.._. __..... B Exmm y� ) U/01/2011 O4/012012 EA EMPL _s 2 (AOS) E.L DISEASE-POLICY LIMIT I g -- 1 Evil ofOPFltAilpNS/LOCAiipgg/ LEg W-48178�) pM01n 11 04/01%2012 WC:$1gtlEl.>ly�14 kW SIR 2.00ll O�1rCraQC (AOfRh ACORD 101,AMtlonsl Rerlyrlq adwuk,8 mots spree Is rsrpl"2 MYC:SIa1/EL$3418;A6$2mq SIR :ERTIEll BOLDER CANCEL I gTION Lowa'e Compete,Inc. and subsifflejee SHOULD ANY OF THE ABOVE DESCRIIBED POLJCIE313E lP�O,,�B�o�x�1,000 THE EXPIRATION DATE THEREOF, NOTICE WILL "'00�WB,NC 28115 ACCORDANCE WITH THE CANCELLED BEFDrtE POLICY PROVIsil DELIVERED IN of 7Y �Rephie. EN7ATIVE Ins. DRD 25(2009/09) Diana Banffey The ACORD name and I090 are registered 1988-Y009 All CORpO marks of ACORD RATION• All rights reserved. e Remove this label after final Inspection;SAVE for future reference M Pella Corporation 20 Replacement NFRC Double Hung Annealed Thwiffamis One Wide National Fenestration SunDefense(TM)Low—E Rating Council Argon Gas Vin I Frame TO S E U—Factor Solar Heat Gain Coefficient 0.30 j 1 .70 0.21 bs.n_ mamas ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0.49 Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a foxed set of environmental condition and a specific product size.NFRC does not recommend any products and does not warrant he euhabliity of arty product for arty specific use.For more information,call(641)621—3114 or vied the Pella web she at www.11911111 afin or viol the NFRC web stoat www.ntm.arg Wind Load Design Pressure ENERGY I STAR (DP)(P�l +351-35 ' States Par ASTM E330 FM (Performance Grade35 Tested to ANSUAAMAINWDA 10111.8.2-07 11-1135 36eCe www.wdme.com Tested to ppMAIWDMAlCSA 10111.3.2/A440-06 WDMA License Nember:411—H-682 HR35 9140574 (N'x62") ment.h1m,stl Maim Conlorma,ce m Ua .—etmda WDMA Hallmark Certcation. Palls products labeled with the Window & Door enu ec urers Association A) Hallmark Certification are tested in accordance with applicable WOMA performance standards, Which requires products be tested for air infiltration, water infiltration, and structural performance. Peformance of Pella products will change over time depending upon the conditions of use. Far details on Hallmark Cerlllicalion, go to www.wdma.com. Complies with HUD 111(Ge"urg,PA) Meets or exceeds M.E.C.,C.E.C.,and I.E.C.C.Air infiltration Nequlremante Florida Product Approval System(FPAS)Number:FL11162 Glazing type and thlolmoss:Annealed,2.6MAlboth panes,designed per ASTM E1300 window or Door Actual Slze:30.376'wide by44.626"tail 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/Indiv'dual): C/ Address: 3ZZ a �� City/State/Zip: y3 Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑.I am a employer with 4. ❑ I am a general contractor and I e oyees (full and/or part-time).* have hired the sub-contractors .6. ❑New construction 2. am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity.. employees and have workers' [No workers' comp.insurance comp,insurance. 9• ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.[1 1 am a homeowner doingall 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#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'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 u er a pa' d enal ' s o u that the information provided ab ve is ue and correct Si afore: 9 PhonA91 (j Z 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#: ,--7777777777777777 d5 � 1 CONTRACT# 0001142 MASSACHUSETTS EXTERIOR SOLUTIONS INSTALLED SALES CONTRACT INSTALLED SALES SPECIALIST NUMBER CUSTOMER /S STORE NO. STREET ADD ESS STREET ADDRESS CITY STATE ZIP „ CITY STATE TELEPHONE03. TELEPHONE DATE LOWE'S HOME CENTERS,INC.'S MA HIC NO.: 148688 CASH xi CARD BANKL� CC FEIN:56-0748358 REc d J CHARGE - This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment. Upon pa ment,the entire a reeme Y agreement including the spegifically completed pages of this' document,the Terms and Contlitions included with this document and any other addenda and attachments hereto,shall be referred to herein as this Contract.";„ PLEASE READ ALL TERMSAND CONDITIONS ON THE REVERSE§)PE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREET ADDRESS CITY, STATE ZIP ', G/ Contract Total c re permits required for this installation?: [,�]Yes [ ] No *applicable tax included /4 7 OTICE TO CUSTOMER: Federal law requires Lowe's to provide you with,the pamplet Renovate Right.By signing this Contract,Customer cknowledges havidg received a copy of this pamphlet before work beganinf ming Customer of the potentidl risk of the lead hazard exposure,;, rom renovation activity to be performed in Customers dwellingunit. HOTO RELEASE:Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this ontract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity. ustomer-authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such hotographs for any lawful purpose, including,but not limited to,marketing, advertising, publicity, illustration, training and Web content. By initialing ere,Customer agrees to the foregoing. [Customer to initial to the left]. . ork is to commence up n reasonable.availability of Contractor and/or any special order or ZZIcustp►ner�de Good(s)which is anticipated to be [fille in date].Estimated completion date is 4®/2/,,910117 [fill in datej. aid estimated substantial completion date is not of the essence. A statement of-any contingencies that would materially change said estimated substantial ompletion date is as follows: (if applicable,inserter statment of such contingencies). THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. MPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: )Deposit $ to be paid upon siging contract.Deposit should be 1/3 the total contract price;and )Payment of$ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's do one of the following(check appropriate box below): ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. TICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142A WE'S AND OWNER HEREBY MUTUALLYAGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT WE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- OFFICE OF CONSUIME AFFAIRS AND BUISNESS REGULATIONS AND THE OWNER SHALL BE R QUIRED TO SUBMIT TO SUCH ARBITRATION PROVI E M.G.(L-G4. %> Date: L s e Cer�ers,Inc. % Date: . Owner Signature E SIGNATURES OF.THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED LOWE'S PURSUANT TO M.G.L.c.142A.THE OWNER MAYBE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN.WHERE THE CTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES. O NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND .ONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. IY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND.AGREE TO THE ERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT."YOU ARE ENTITLED TO A COPY OF THIS CONTR T AT TH TIME OF SIGNATURE: ITNESS OUR HAND(S)AND SEAL(S)BELOW THIS D F � • we's . ome s nc.. ecialist or Above Owner Co-owner or Witness tomer acknowledges recefpt of a true copy of this contract which was completely filled in prior to Customer's execution hereof.You,the buyer,may cel 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 m for an explanation of this right. 0981 (Rev. 12/10) FILE COPY ©2004 by Lowe's.®Lowe's and the gable design are registered trademarks of LF Corporation.