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HomeMy WebLinkAbout0102 MULBERRY STREET s r ' 0 ofVME t Tow. *Per f Barnstable m �� �o p Exp Re ire 6 monlGs ur issue dote . gulatory Services Fee RAMMN MAM 0.59. `0� A c(,� 1 Whard V.� 1 Division Scali,Director,1�..� ry� e�le,ry, %-M-9O " 1J 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 31 Q 352, Property Address 10 2 (Au I by rrY S t H Yarlrli s Vesidential 11 Value of Work$ 3,7 2 8 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address -& (-)e G ra C 10 e , S1 aoa; S M o o I Contractor's Name W DtJ UUOt1 JI fF t�F�f Telephone Number 78-/" of 3agIVN Horne Improvement Contractor License#(if applicable) J(o6 OZS'- Email: Construction Supervisor's License#(if applicable) 137 2 :7 7 2— ( vrkman's Compensation Insurance Check one: ❑ I.am a sole proprietor ❑ I am the Homeowner �j` I have Worker's Compensation Insurance Insurance Company Name jfA�XT X& `l f� W-Q ZA� Workman's Comp.Policy# Z-Z VJ F.C`—T Z6 &!�— 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) side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. **Note: Property Qwner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: C:\Users\Decol 1 ' ata\ cal\Iviicroso � .ndows\Temporary lntemet Files\Content.0utlook\2PIOl DHR\EXPRESS.doc Revised 040215 1 t A `Window World of Boston,LLC: "HICRegtatratlon *41 �Ces&Showrooms Number.ACummings Park 0 295OldOakStreet 166025>74 i Woburn MA,01801 Pembroko MA02359 Federal to:# -simply the Beat for Leas" (781)932.4805 (781)826-6261 27.14$1865. PY www.WindowWotldoi8oston,com Customer: .-cc, Install Address: F Phone(w).. City: State:MA Zi'`,'a E-rail F112 _.. ....... WINDOW WORLD GLASS OPTIONS: 1000 Series Single-hung All-Weld $189 77 SotarZone Elite aatryLZ 3 2000 Series DH Mech/Welded Sash St95 _Triple Glazed TG2" $1751 �4000 Series DH AH-Weld 5205-Im (•Senes 6000 0*) _6000 Series DH All-Welds 5240- . .. , - - 'WINDOW OPTIONS_ - - 2 Lite Slider 5334 .Glass Breakage Wananry: $15:IN WD 0 3 Uta Slider oa,a.tm:, of oiznq. S525' _1/2 Sueens S9INCLUOED; -Picture/Road Ute $334 _Fdam Insulation on Jambs arid.Head St'1�WCLDDED T:Awning g260. DoubleStrengthGlass $15INCLUDED: Casement S296 _Double Locks(>.26) S5 INCL.UDED: 2 Gin Casement S575. _Full Screens S22 _3 Ufa Casement an:,n:,n, nim , '5860 _Colonial Gdds(Conloured�Me S45 Prairie Grids $St _8eaementHopper $334 _Diamond Grids S69 _BayWlndovr-Wild Mount/INS Seat'S2666� _Simulated:Divided Lite, $182 _Bow Window-Sot(d Mount/INS SeatS2785 ;Tempered DH Sash(BSO)(TSO), S65 —Garden:Window S1880 _Obscure Glass(BSO)ITSO) SW _3petiaty.WindoW S ,Oriel Style(40160`or60/40) 330- - -_Beige l'Almond $40 Foam Enhanced Frame 535 ; !Wood Gra n IrNerior(Series 91100/SOM only)$100 P E 1978 BUILT HOMES(federal Lead,_Containment L V. {Light 0a1r1 Dark Oak!Cherry 1,Fax Wood Lead Sate Practices Required 425 /2) Rfcn Maple) MY HOME WAS BUILT IN:THEYEAW Initial. Broem Exteda(Arch.Bronze./Americm Tena)5100 _Designer Color Exterior $1,55 MISCELLANEOUS Cust6hry Extenar Aluminum Cladding D Textured'S75 3 Smooth G-8 $75 S Eva, Window Color ,j�l;(, Facing Color msAe oaGtida ?Meta window Removal S50 3 NON CUSTOM DOORS New Construction:VOO,Removal _Vinyl Rolling Patio Door 51t.or aft. S995 Specialty:Window Exterior Trim S. . . ,Y,mp Rolling Patio Door Wt $1095 /- MuR to Form MuIU Unit' S30au—- _Add to base p im tat Custan Rom Path Door11150 lnstali intetirn/Exterior Sops. SW21 10— _French Rag Sliding Pago Door Sk ar ft. 31295 Install:interior Casing Starts At 595 _French Rail Sliding Patio Door Sri $13sk Insulate weight Boxes t 20 _French Rall Siding Patio Door 9N.: S1495 _..-.-... . Root for 88yladw Windows. S5010 . . ,Custom Exterior Cladding StSo Existing New Comet.Ext.Retro Fit' s.I s _SolarZone,Elilo or ETC Glass. 5176` J Removal of Existing Bay/Bow S250 _GrI s Patio Door sizoRepair SiII,Jamb or replace sift nosing S50 -. _Woodgrain Interiors- SEes Fufi Su"in(Single)replacement 8150--:- . _EdedorDesignerColors $335 9 ) _IntertOrCasl Casing 2ia 3ie gt75. _MuSion Removal 330 ... Bay/Bow Conversion Ext.Retro Ft S3b0 _Handieset Options: 8 (New Siding"it Not match) Door Color / ._ ... .• R_OUND•UP Ins, WINDOW WORLD CARES ..,haide .. 8I;Jstb C'btdrtid'elTeanrcb Rosphl $ Customer declines salterlor.wrap and understands painting and/or repair may be required initial Customer declines grids on • . windows/doors Initial plaa$IME&Cusion e,is nuo asihle for the fo lovii g in Median%jh M tw to Pei q,Slat 4 Alm Systen6u N-amed Willing Petmd tees in wAss of 525.01i.Nomeaimcr and aCo do Association Allow al,ta5mik MiYd AM".Mal Boston p1d3p d,sldewA Pe M(tree h tcnneedm vein tiinaaadan. NO EXTRA WORK IF NOT IN WRITINot ustomer.agrees,to the terms of payment as.follows-. Eiden Labor ii Materials 5 SiteSetUp,Disposal&Delivery Fee S $195.00 Total Amount S--'* Ilk- ,.custom Order Deposit 50% S Ck#' Balance Paid to Installer upon Completion S Amount 7achg Window World of Boston aritkpates startingthis workon and bring suhsta iaey wiupeted InSe inity InterestYesAnY deposit acquired in advaaca a the sterna Ore wok ex 1/3%a the tows corrorni price ael co a anymaterial or eau poem a spedal aderor a1Nom made aature,rrhkh must Do a�redtn advance of tl}e Stan of the wort b aswre urot rite poled viR taaaM onscAedule:Ho oral payraei4 shag be domanded until the contract is competed to 0esatsfaegon of beat parties: All home improremem contractors and subcontractas shall be registered arid that ag Intaliee about a conna or subcontractor mating to a rtglatration:slraLd he:. directed to:Office of Cooaomer Arabs and BuAoafi RrtpdaUa4 Ten Park Plea,Solve 5170 Boston.MA 02110,Phones(617)923-8100 No wrti sh in*In prior to the algeklg at the contract and bmapdtW to the weer Of a copy a such caawct.Window Word of Restart wide;proAsic"of _ Boston Neat rat be deemed tesponshele for debr N ys In wakdesc�E (ral ndss agreemerd eau by ws Is required to Pley for aregutatotY,pemR 9RnSa0 a0acias at nd 6M all Cloolincb-14__tito atndMkklag. Notice:110u PURCHASER(S)obtain his once construction related pannah;law the work described anderthb screamed or deals with anrepistered convectors, the PURCHASERS)Is hereby advised that the 611041011 dispute,todcamea and morpsymod,the PURCIRASERIS)eel ont be erdhk0 to make a date or colleeflonhom the eunontyfand established bycbspter142A.MAL ' -you the er may dance t transe on at any me p o midnight o the r y after the a lots traraa6 ire. olive of cancellation moat be temftlno tied na later than tnld"id of the following third business day. IS A ORDER . KbAr Frarrcnlsa is trcmed sad tWtlova Wandaeoumr.uC. fkNr.M trait lYerMvrxMtd pre. ,mar.Do trot sign Mme.v zany eWrtk apaoee;: Date :Dona -Moro to any it"spacaw `Oars .... ...� t>.tw-sign if mere are-am Mani sescea. Dose , '�.. - `pwevasati;: - 'Whtra;rap/:�.D�a "Yeeow coPy:P� Flier oopy'.cUa r....tim,o.awiia 1 • f , � 4 %2552Cn USc,iS i•2N 2i"`n_n:ai Pu6ft S2i EI_: 3oz:c c;nuitdina Rear{-lions and S 2nda.ds _ic=_ase:CS-072772 JEFF C STEELE 24 SHERWOOD AVE r DANVERS MA 01923 o nissc"" 0 410 712 01 8 Office of Consumer Affairs&Business Regulation 'HOMEIMPROVEMENTCONTRACTOR Registration: 156025 Type: Expiration: 41122018 LLC WINDOW WORLD OF BOST ON,LLC, JEFF STEELE 24 CUMMINGS PARK SUITE 15-A WOBURN.MA 01801 Uoderseeretan j y . License or registration valid for individual use only before the expiration date.If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,INIA 02116 Not valid without signature i I f • The Commonwealth of Massachusetts n Department o.f'Industrial Accidents r Office"ice of'Investigations . I Congress Stree4 Suite 100 Boston, MA 02114-2017 www mass gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print Legibly Name (Business/Organization/Individual): WINDOW WORLD OF BOSTON LLC Address:24 CUMMINGS PARK SUITE 15-A City/State/Zip:WOBURN, MA 01801 Phone#.781-932-4805 . Are you an employer? Check the appropriate box: Type of project(refired): I.0 I ar"h .employer with 20+ 4. ❑ I am a general contractor and 1 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 ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.? required.] 5. ❑ We are a corporation and its 101-1 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.] f c. 152, §1(4),and we have no employees. [No workers' 13.a0ther 0 te%g o,-.� comp. insurance required.] re(9(a('e pn t n f 5 , -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 blame:HARTFORD FIRE INSURANCE COMPANY Policy#or Self-ins. Lic.#:22WECLJ2635 Expiration Date:0 1/27/2017 Job Site Address: 02 M V 1 be 1T H City/State/Zip:4YGlM i S K A 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 25ABfMGL 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$250.00 a day against a violator. Be advised that a copy of this'statement may be;forwarded to the Office of Investigations of the DIA for a cove erification. I do hereby certa;fy under t pa' and p a 'es of peril that the information provided above is true and correct Si tune: Date: Phone#: 781-9324' J9,(8'/ Offrcial use only. Do not write in this area,to be completed by city or town gfficiaL City or Town: Perffiit/L.icense# Issuing Authority(circle one): 1.hoard of Health 2.Buildiang bepartment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#. �18fit40®� OP 0.wn ��C���" DATe(�tealDDltrvvv) CERTIFOCA` E OF LPABQL6`Y HNSU 3ANCE OX2112016 .THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTTICAT1E HOLDER.THIS CERTIFICATE DOES NOT AFFIRiAMMY OR ME43ATWELY AMEND, EKTEND OR ALTER THE COVERAGE AFFORDO 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A COWIMCT BETWEEN 7NE ISSUNG INSURERft AUTHOREWD REPRESENTATIVE OR PRODUCER,MD THE CERTIFICATE HOLDER, INIPORTMT: If the certificate holder is an ADDITIONAL INSURED the pollcAles)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the polio►,COMM poflalSS MY require an endorsement A statement on this cerillicate dose not conbr ruts to the certificate holder In lieu of such endorseme s Penn Dunn-Gs0 CONTACTCER S Tilftga waQd,CFCU,c1c 3626 N.Elm St PHONE E, 7151 I 1397 Ge mshoro,NC 274 A D fldtutn.�t s C.Timothy Ward,CPCLI,CIC INSU S)AFFORDING COVERAGE NAIC U INSURER A:CP621 skis Co of Amefta 31 MURWWlndOwr World Of Easton,LLG INSURER B-Attmertca Plnandal Benent 118 Shaver Street Forth Wilkesboro,KC 2$sss INSURER C:HaMfd FbV b=ranwCo. IBM INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION TER: 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 CER T IF(CATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFOkDED 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. ILTR TYPEOFINSURANCE POLICYNUMBER P6UCYM POUCYE3fP LwM A K colsefoERcmL a9umL LIAR uw Cunt S4MDE ®occuR OI$6T9023Z76'I 0410912096 d�109/2®97 EACH acCURREn�ce s PREMISES Fa oa�merme S � Business Owners MED EXP(Any one Perm) S S,0 PERSONAL&ADV INJURY S 1,000,0(1 GEIWL AGGREGATE LIMIT APPLIES PER* GENERAL AGGREGATE 5 X0001 ElPRO OTHER:- AUTOMOBILE JECT LOC PRODUCTS-COMPIOPAGG S 2,000,00 OTHERAUTOMOBILE LIABILITY Coll LIMIT a ANYauTD AW68757615 . 0611612015 061161207B BODILY INJURY(Pupmon) s AUTOSrD AUTOS�D BODILY INJURY(ParaWdwd) 5 HIRED AUTOS NON-OVJNED PROPERTY DAMAGE AUTOS Paraacident S S' UMBRELLALIAB y OCCUR EACHOCCURRENCE S 1100,0 A EXCESSLIAB CLAIMS-MADE 089790262707 04/09/20116 W0912017 AGGREGATE S DED RETENTIONS S 1VORKERSCOMPEMMON AND EMPLOYEP,9 UABUM x STATUTE ER C ANY PROPRIETOR/PARTNEWF�(ECUTIYE Y I N 22WECL i2535 0112712016 01/2Y12097 EL EACH ACCIDENT S 900,000 OFFICER/MEMBEREXCLUDED7 NIA (Mandatory lnNH) EL DISEASE-EA EMPLOYEE 5 �0,000 If 99es,dasetiha under DESCRLPTIOtSOFOPERATIONSbelow ELOISFASE-POUCYUMIT S DESCR"DNOFOPERAIMNSiLOCATIONSIVEtitCLES(ACORD 404,Additional RemaftSdtedu%may 1.altaehedilmoras eeIsmqub� CERTIFICATE FOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EIPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROUISJORS. AUTHOR®REPRESENTATIVE ©1968-2014 ACORD CORPORATION. All rights resemed. ACORD 25(2014101) The ACORD name and logo aloe registered marlts of ACORD Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/25/ a f y Thomas Perry CBO Town of Barnstable Building Division ze', 200 Main St. Hyannis,MA 02601MIT RE: Insulation Permit 201507698 Dear Mr. Perry This affidavit is to certify that all work completed for 102 Mulberry St,Barnstable has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r - Map 31 Parcel 3 5 a Application # Q Q S 7 alr Health Division Date Issued 17 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ' Historic - OKH _ Preservation/ Hyannis Project Street Address 10 I -►o e/rm Village vbw ( S Owner Ro ey+ Address 50Lf'le Telephone Sod T T5 A 53 b Permit Request q( ems% 10.2 +0 the, a`EC- ee141Ose +v th e ov f 4A aAtc [ < hn , �►'► Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ :2.y ` Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ; Zoning Board of AppeaWNo thorization ❑ Appeal # Recorded ❑ - -�- Commercial ❑Yes If yes, site plan review # ' Current Use Proposed Use .E r APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name_ 11M o e C �.ve, c, Telephone Number Sot 3 9a o 3 9 _ Address _ RHO ���(�yPr License # 0 1 PoOKA, ma OWL[ Home Improvement Contractor# Email Worker's Compensation # &J W( ,313LAJH ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �0-rrn ov►j SIGNATURE DATE ( � S L FOR OFFICIAL USE ONLY APPLICATION# _. DATE ISSUED MAP/PARCELNO. a ADDRESS VILLAGE L OWNER i Y DATE OF INSPECTION: } f FOUNDATION Z FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. a`,5'�'"� - "�,. � . . '`. =rThe Comsnonwearltla of Massachusetts;:��*�.� ..-, wT�t�, ,. ,• T � . .} . Department.oflndushialAcedents,�° • - a. r. ::+ t'•>'"' .r .,f v t 1 Congress Street;Suite,1001+j�' '. r 4j"i Boston,MA 02114-201-T, -.. fuww massgova r ldi r, s;. , �... ,.r-C .-L •"F 'Workers'Compeasation Insurance Affidavit:BaderslConiracfo sLEleciricians/Plumbers. ,,TO BE FILED WITH THE PERMITTING AUTHORITY. „ . w Anolicant'Information " Please Print Legibly , i Name(Bus►.nessiorgatuzation/Individual):Cape Save Inc . Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 _. t Phone:#.508-398 0398 Are you an b pria k the employer?Check appropriate ox: i _ _ _ _ _ r T _t(regwred) �1 I am a employer Wrath 20 `� employees(full apWprpart-time) A _ #t 7 Q,New..construction� 2.a I am a sole pmpnetor or partneishtp and have no employees working.for me m r t 3 ,g D Remodelmig .7 h t � any capacity.�[No workers'comp.insurance required] r j �� t.c r. tF_ �� � '^ r a ' '-'•3�+ + , ] rx 'it l �..: ,�t., r,- t _ i,. - 9. 0 Demolition 3.�I am a homeowner doing all work myself,1No workers comp.,msurance'required:]t -.- ' a - 10'n Building addition —4.❑I am a homeowner and will be hir -' i. mg contractors to conduct all work on'my property..I will'"` ' - _„, _ . 5 , ensure that all contractors either_have workers'compensation:insuraneevr are sole I L[ Electrical repairs or additions proprietors with no employees. - >x , At. 12.E]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.t 14. Other Insulation 6.❑We area corporation-and its officers have exercised their right of exemption per MGL c f 152,§1(4),and we have no employees.[No workers'comp.insurance required:] t # *Any applicant that checks box#1 must also.flout 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 ' i `+Contractors that check this box must attached an additional sheet.showing the name of the sub contractots and state whether_ or not those entities.have ' E employees. If the sub-contractors, employees,they must provide their workers'comp.policy _ I am an employer tharis providing workers'compensation insurance for my employees. Below is the policy andjob.site ► ►, ';information.-- Insurance _. -._ .� i _ Wesco Insurance Company . • i :Com_ parry-Name:.- `- Polic #or Self-ms-Lie.#:WWC3136274`_ ` - . �{.�`� 6 f.. y . i = -Expiration Date..04/091201 r : ' Job Site Address: 102 Mulberry Street r: `City/State/Zip: Hyannis y Attach a copy of theworkers'compensation policy declaration page(showing the policy number and expiration date) q l Failure to secure coverage as required under MGL c. 152,§25A is a criminal Violation punishable by a fine up.to$1,500.00 and/or one=year imprisonment;as,well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250:00 a day against the violator:A copymof this statetnent;may,be forwarded to_the Office of Investigations of he DIA,for_insurance _... _ M coverage verification. I do hereby certify;underth patns.and:penaldes ofperjury:thatthe information provided above is true and-correct w Signature: Date: 11/10/15 i Phone#:508:-398 0308 -Official use.only.-Donot write in this area,to be completed by city or town:ofjRcaaL City or Town,: , Y=c . .r - , ,S.{.,., c•, �' PermitlLicense# t Issuing Authority(circle one).„ •, f•. ^` 1.Board of Health 2 Building Department_3.City/Town Clerk 4..Electrical Inspector S.Plumbing.Inspector:,,, 6.Other Contact Person: Phone#: ` A'ca CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) �.,../ 10/14/2015 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. I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGA71ON 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 Ileu of such endorsements. PRODUCER CONTACTColleen Crowley Risk Strategies Company PH0�E (781)986-4400 FAC No: (7e1)963-4420 15 Pacella Park Drive AD�ss,ccrowley@risk-strategies.com Suite 240 INSURER(S)AFFORDING COVERAGE NAIC i Randolph MA 02368 INSURERA:Selective Ins. of America INSURED INSURER Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc INSURER C:Wesco Insurance Company 7 D Huntington Ave INSURER D: - INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL15101402127 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 CONCITION 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD MMI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEU_ A CLAIMS-MADE XI OCCUR PREMISES Es occurrence $ 100,000 61994480 10/16/2015 10/16/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY�ACT- �LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED• X SCHEDULED AUTOS AUTOS AWNA46706600h 11/6/2015 11/6/2016 BODILY INJURY(Per accident) $ •. U PROPERTY HIREDAUTOS X AUTOS Pr et $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION Hil S1994480 10/16/2015 10/16/2016 $ WORKERS COMPENSATION Officers Included for X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER _ ANY PROPRIETORIPARTNER/EXECUTIVE Coverage E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? a NIA C (Mandatory In NH) WWC3136274 4/9/2015 4/9/2016 t E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remares Schedule,may be attached if more space is required) National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included as Additional Insureds with respects to the General Liability coverage of Named Insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 460 West Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Michael Christian/CLC O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) Town lof Barnstable ° Regulatory Services rsnrcvsrtisis Mebard V.,Semi,Director amass , s` Building Division Tom Perry,Buildidg Commissioneir 200 Maio Strut,Hyannis,MA 02601 nww.town harnstable_rria:as Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must ColxxpXet and Sign 'Inais Section. __.. If-ITsirl� .A.-Builder, ._ Y, •� 8.C hvnex the.subject.Proem -- —. - herebpauthori e in all taxers clativc-to work thoiize&this budding:permit application fon' Y ' . (Address af,job) "Pool fences and.alarms are the responsibityOf the applicant pouts are not to be filled or`ulilized before fence is installed.ah.d 0.final inspections arc performed and acreptaL /1 ' hnz of .;Ii; er Sig&tujrte of Ape cant rilxt i~Iam-, 1 1i1T !te Q:FORMS;Ott,\TERPF,:R2.A755lONP(X)1.S (Ih (Po),)Iv))z a11,(Vea.,-I�l- -c-, (��,,,z4t,,,I,;P .1 Office of Consumer Affairs.and Business Reg_ ulationn 10 Park Plaza - Suite 5170 y Boston; Massachusetts 02116 " Home Improvement Cdhtir actor Registration ` Registration: 171380 _ Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. �w z WILLIAM McCLUSKEY h - -- 7-D HUNTINGTON AVENUE• SOUTH YARMOUTH, MA 02664 --- _-- -- -- Update Address and return card.Mark reason for change. seal zone-osn "+ Address Renewal Employment 7 Lost Card �Ilr�rrie=riu+rncueca�a�>%l��it;n��cc��//�+ •} Office of Consumer Affairs&Business Regulation License or registration valid for individul use only iI QHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 171380 Type: Office of Consumer Affairs and Business Regulation 'Expiration 3L�-4Vf2U.16 Corporation : 10 Park Plaza-Suite 5170 == Boston,MA 02116 CAPE SAVE INC. ff ss, _ 4 < i WILLIAM McCLUSKEY Ej 7-D HUNTINGTON AVENUE' S C>a SOUTH YARMOUTH,MA 02664 Undersecretary Not vali rthout signature r r Massachusetts -Department of'Public Safe#y _ x Board of Building Regulations and Standards . a,�li�triiC`ufir��ui'iea:viiuT�uc.Cianv =a3e-sew, - . - - - 1 censer GSSL 102776 3 - WILL J MC U 37 NAUSET ROAD �' r West Yarmouth IWA Expiration Commissioner 06/28/2017 a Town of Barnstable *Pert R Expires 6 Inondls jro+n�ssur care C>0 • - ! Regulatory Services Fee t;AR*1STABr�!• b T- xAss ad Thomas F.Geder,DIrector il 9�\' s679• `0�� f0► Building Division �yi Peter F.DiiNSatteo, Building Couamissioner �i'�AC 367 Main Street, Hyannis,MA 02601 W S� Office: 508-862=038 NO V TO 2 2ppj Fax: :08- 90-6230 LY EMPRESS PERMIT APPLICATION - RESIDE Not Valid without Red X-Prat Imprint NS iAeC Man 1`UL. .Tarce:Number 3AD ® . /t'1915 Properny.-address Value of Work 3Go� Residential Owner's:Fame &.address p� CAP s�,P �l Telephone Number 7 7'.S Y� Contractor's;Fame Home Improvement Contractor License (if applicable) .Construction Supervisor's License-(if applicable) r 41 gworkman's compensation Insurance Check one: A. 2 I am a sole proprietor. I am the Homeonmer Fi I have Worker's Compensation Insurance Insurance Company Name COMP- Polio• woriu= s P . Permit Request(check box)` Re-roof(stripping old shingles) [1 Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windo%vs. U-Value (maximum,.44) Other(speci&) anee with ocher town department regulations.i.e.Historic.Conservation.= •Where required: issuance of this permit does not exempt comp'it Si�rtatur � Q:Forrru:esnmtrc:rt%•-070601 �� - r . �� _ �� , ,, �. ;: ,,{,. � � P d i j ' ) -"~' "^' Town of Barnstable Permit: 11j �L' Regulatory Services Date:S'' ,y l N - ---------Y)---- Thomas F.Geiler,Director Fee: . �oc� z � �, = -"--"-'"'" Building DivisionHAM -0- v� 1639• `e� Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: Phone: .�d j4Address. D Village:4��2� Map/Parcel: 510 L— Date: Stove A. New/Used B. Type: Radiant/Circulating C. Manufacturer: Lab. No. D. Model No.: Chimney A. New/Existing (If existing,please note date of last cleaning) B. Flue Size Wke 42 C. Are other appliances attached to Flue? D. Pre-fab Type and Manufacturer E. Masonry: Lined/Unlined Hearth A. Materials: -� B. Sub Floor Construction: Installer Name: Address: ,..� Phone: Location of Installation: C APPROVED BY: Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Stove.doc