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0024 MYRTLE DRIVE
CX91-1 ,� . Z �- `3696) Town of Barnstable *Permit# off' Expires 6 months from issue date Regulatory Services Fee ,KAM s ustvsrna�,t, • , Thomas F.Geiler,Director -PRESS IT . Building'Division Tom Perry,CBO, Building Commissioner NOV — 8,2013 260 Main Street,Hyannis,MA 02601 ry ww.town.bamstable.ma.us. Office: 508-862-4038 TOWN OF B EO. EXPRESS PERMIT APPLICATION RESIDENTIAL ONL Y ,!G Not Valid without Red Y-Press Imprint T Map/parcel Number 7 06,3 Property Address YR714 Residential Value of Work$ /7,3' Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name 'K10or—° D`r1,:&:9_,0k S( / Telephone Number t01"1/'I--�0 3 � Home Improvement Contractor License#(if applicable) ' ?.6 Construction Supervisor's License#(if applicable) t9? 00-7 XWorkman's Compensation Insurance _ Check one: ❑ I am a sole proprietor ❑ I am the Homeowner r ' �I have Worker's"Compensation Insurance „ Insurance Company Name cfn Workinan'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-side01 F $kReplacement Windows/doors/sliders.U-Value • 3 (maximum.35)#of windows Z #of doors: „ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked'with red Sand inspectigns required. Separate Electrical&Fire Permits required 'Where required: Issuance of this permit does not exempt compliance xvith other town department regulations,i.e.Historic,Conservation,etc. **Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvem t tractors License&Construction Supervisors License is aired. SIGNATURE: ' C:\U"\decollW,44,pDaia\I.ocal\Mioroso ws\Tempora� ontentOutlook\SR76BDVA\EXPRESS.doe Revised 061313 r . The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 r, Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name usiness/Or ariization/Individual : rf,P e,7 Address: e 5 City/State/Zip: a4u 4a- aA- o-33 //Phone#: 774 ��� c f � -1 Are you an employer?Check the appropriate bpx: Type of project(required): L❑ I am a employer with 4. I am a general contractor.and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.El .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 workingfor me in an ca aci employees and have workers' Y P ty. $ 9. ❑ Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 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.] 4'Ce�ll - *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. /� � � G' I r Insurance Company Name: ►VUotP34i,`� Policy#or Self-wins.Lic.#: V (9 s 3 S 7 .� j 7 Expiration Date: 3 Job Site Address:-Z NZ. City/State/Zip: l9�Nj s t. 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$250.00 a day against the viol r. Be advised that a copy,of this statement may be forwarded to the Office of Investigations of the DIA for insuranopoverage verification. I do hereby cerlif Y under the p4s AWdpenal 'es o S u_ that the in ormadon provided above is true and correct Signature: _ __ .. Date Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Build:ng Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: O iceum �ai an s ne R.e d u � ss egu1 atian a 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Dome Improve#Ign :Contractor Registration ! s } Registration: 126893 a ? Type Supplement Carcl The Home: Depot At-Home Seivi�s ; ,,.:°,; :, JY Expiration, 8/3/2014 ANDREW SWEET - 2690 CUMBERLAND PARKWAY`SUI.TE_;. Q+ . -- ATLANTA, GA 30339 4, Update Address and return card.Mark reason for change. Address D Renewal [:] Employment Lost Card DPS-CA1 0 °AM-04/0"W216 Office oYC`g'nair' a r�useas egu at an License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to; Office of Consumer Affairs and Business:Regulation �Reglsll!'" on:,1?0693 Type: 10 Park Plaza-Suite 5170 Expirat�an;; /2 tq Supplement Carol Boston,MA 02116 Home Depolt-;rtaW9ietV�cs ANDREW SWEET 2690 CUMBERIAA P-MI ,-k A"Y$ � - --- ;, .. 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''��� 'r -ems �„" p' ',� . �; ,„ ;�,•,, , ,,,. u ., „ t, -: ;'n.. ,� xW . § ' Ya•.�, ^�� '"� `V�` 'RN�hx .;�� +YN ;�''Z� t1 <' v L .. - . a...x A �'`� •?2.-r r .,.,. ^fi �.+ ', ,''�,, rb �' � aga- � � ,�. r s' � ffi'Y -:n: :ties .� a'. ., x , :�'.',,* �'>✓i,.. %xa„ :.! �-, _ r .��,,:a; a lw .. - , r' , ✓- } _ '.�'A s. ",J. t . ,� _ ��. `dam � M ------------- , :r<a4 a ° ^�'' f k � � "8: ..,,e t. �� & 'AY• f " '�"'�' ��ie4" lei... ..� ". CF � xt -4 t F � , , r Y , e t� _ A + M , t ; r 4/1/2013 8:16:06 Atd PST (GMT-8) FROM: 10000 -TO 7 Page: 2 of 2 1 5 1508 302086 9 co CERTIFICATE OF LIABILITY INSURANCE DATEQ[MIODIYTYT9 - 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 AMEN, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN.THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement.on this cartilicate does not confer rights to the certificate holder in Iteu of such aridonemant e PRODUCER PAUL 8 SULLIVAN INS AGCY INC C014TACT N 1467 S MAIN ST Pm ON* FALL RIVER,MA 02724 E-MAILD 1I INSURERS AFFORDING COVERAGE NAIO wBURER �J&SEPH DUARTE&JOHN DALEY w R a: DBA J&J REMODELING INSURERC: 15 WILSON WAY INSURERD• MIDDLEBOROUGH MA 02346 TGURME: w URR COVERAGES CERTIFICATE NUMBER: 15914016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANOCONOIITONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCEDBY PAID CLAIMS. TYPE MR OF INSURANCE IN R POLICY NUMBER N SLIDFY JYY f GENERAL LIABILITY 1 EACH OCCURRENCE S CG P O oNrrm MMERCLALGENERAL(LABILITY s f MAMS•MADE�El'G=It 4fDEXP Myoni en) i. PERSONAL R ACV INJURY 11 GENERALAGGREQATE I GENL AGGREGATE-LIMITAFPLIESPER: PRODUCTS-CONPIOPAGG f POLICY M JFCT PRO. Lac - LIMIT t . AUTO►OBVIA UA91LITY _ - ■erildenl f - BODILY INJURY(Pei person) S ANY AUTO ALL OWNED 8~SCHEDUL SCHEDULED BODILY INJURY(Pei WAfto) AUTOS AUTOS A HI RED AUTOS AUTOS ere ey GE f i UMBRELLA I" .OCCUR _EACN OCCURRENCE. t ." "CESSLIAB CIAaIS�,AAOE AOOREQATE.77 f 060 RETENTION i 3 A WORKRASCGMPSWATION WC531S•3t34500-013 212/2013 2l2/2014 � ' -- AMD.dRPLOYERi'UAn4rTY YIN ANY PROPRIETORIPARTNERIEWCUTIVE eL EACHAOCIDENt f 100000 OFFICERMENBERE%CLwE07 tY NlA I/lendelOry 10 MR) EL DISEASE•EA EMPLOYE f ll 11yy0 descrbeunder OESCRiPTION iOPERATION bw E.LDISEASB•POUCYLIMIT S 500M 068CRPTICHOfOPEMTIONS/LOCATI Ne/VENICLea AlbshACORG10%Addalo Rem*sSchedult noreapsesU•rrgJrm) - Workers.dompensedon insurance coverage appges oriy to the workers compensation laws of the state of MA. NO PARTNERS ARE COVERED BY THE WORKERS'COMPENSATION POLICY. CERTIFICATE R CANCELLATION SHOULD ANY Of THE A9DVE DESCRIBED POLICIES BE CANCELLED BEFORE \ THD AT HOME SERVICES,INC.AND THE EXPIRAIM DATE THEREOF, NOTICE HALL BE DELIVERER IN THE HOME DEPOT ACCORDANcEwrri4 THE POLICY PROVISioN8. 26SO CUMBERLAND PARKWAY SUITE 300 ATLANTA GA 30339 AUTMMZW RErneaENTATTVE Jeff Eldrld e 0 1 NO-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05y' The ACORD name and logo are registered marks of ACORO �h�s �►ez>�Ly�ee ata cane . ,.. �...,, ,...,..,: ...,..., _ ,,.:4: � ,.. ,. ....:.. . .... .... ._..: ,... .. ,.. .,... .. ,..... ,_..,_..... . ... .. . R no s L s I ccienT efs`anedTL sup eYselQes �4 pzovourye�tsue&e ee°rt�ti.catsa.- I i HOME IMPROVEMENT CO\TRAcr Sold,Furnished and Installed by: PLEASE RE.<1ll'I'HIS CONTRACT THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 908 Boston Turnpike Unit I,Shrewsbury,MA 1545 Branch Name: Boston South Date:9/10/2013 Toll Free 8779033768;Fax 8009863610 ME Lic#C 02439 RI Cont.Lic#16427 Branch No: 31 CT Lic#H1C.0565522 MA Home Improvement Contractor Reg.# 126893 Federal ID# 75-2698460 Installation Address: 24 myrtle dr Hyannis MA 02601 City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: MIM'ames mcccarth 508)778-0642 Home Address: 24 myrtle dr Hyannis MA 02601 (If different from Installation Address) City State Zip E-mail Address (to receive project communications and Home Depot updates):dciudi naaol.com Marketing emails will not be sent from The Home Depot. Project Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy,and THD At-Home Set-vices,Ine.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installati on")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders (collectively,"Contract"): Job#:(Internal Referencef Products: Spec Sheet(s): Project Amount 7114168 Windows 7114168 $1,434.46 Minimum 25% Deposit of Contract Amount due upon execution of this contract Total Contract Amount $1,434.46 Customer agrees that,immediately upon comipletion of the work for each Product,Customer will execute a Completion Certificate(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder., Pavment Summary: The Payment Summary# 7114168 ,included as part of this Contract,sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). GENERAL TERMS AND CONDITIONS Responsibilities: The Home Depot:will provide the Products identified above,make arrangements to have the Authorized Service Provider perform the Installation services in a professional and workmanlike manner,and arrange proper insurances. Unless otherwise expressly provided for herein,Authorized Service Provider will obtain required permits and provide permit numbers. Customer:will identify any property lines,easements,covenants,underground or overhead utility lines,pre-existing physical or 11IMOM24A , Page 1 of 11 L Measure Tech Signature: 1 It the Contract was oreviousiv amended,use the amended Contract Amount(not the original Contract Amount). 2 If required by state or local regulations. Accepted by:jacampbell(Sep 10,2013,2:09 PM) M/M James mcccarthy(Sep 10,2013,2:08 PM) t I ry 11/30M•SA Pave 5 of 11- h May 11, 2013 Barnstable Building'Dept. . •The following is,a list of our approved°sub-contractors for The,Home. ° Depot: Ericsson Torres= CSSL # 100546 ' HIC # 163528 Michael Viola = CSSL#-099403, HIC # 140993 Vincent Smith CS # 106837=: HIC # 165927,; `. Timothy Thomas - CS # 51899 HIC # 152121 Ronaldo Solano -_CSSL# 101027' HIC# 152206 Joseph Duarte - CS #.70077. HIC #.132349 Douglas Szynal— CSSL# 103950 :HIC # 146142 T Brian Laroche = CSSL# 100478 ` HIC # 152612 Joseph McKeon CSSL#:98863 , HIC# 132614 If you have any questions please contact Mike Bedard our permit coordinator at 508-962-6942 or-myself.at 617-438,-9017. S' erel .. uss one - Bra Installation Manager THD At-Home Services,Inc: ° 908 Boston Turnpike- Unit 1•Shrewsbury,MA'01545 Phone:774-275-2139•Fax:508-845-6076 Toll Free:800-657-5182 Town of Barnstable *Permits Expires 6 months from issue date _ Regulatory Services Fee �T_j J Thomas F. Geiler, Director hLA T 4,Ar= 39 a,� �r Building Division ®"t/IVOP 8 Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 � www:town.barnstable.ma.us Office: 508-862-%f Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number, Property Address 1�l I' �' ) ', 1 tft/a yl YI t '] O Residential Value of Work I L 115—Y O F Minimum fee of$25.00 for work under $6000.00 Owner's Name&Address IJ M cCa r� Y 4 rI Gl!fit , Contractor's Name Cam,&i—C F a 6 s 6.0 y Telephone Number�,qE 77S 0/6 �otC,l r '� Home Improvement Contractor License# (if applicable) /��5e�.� grWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance ' Insurance Company Name Workman's Comp. Policy# WC 0 j 72 0 St) Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) . r� /Re-roof(stripping old shingles) All construction debris will betaken to'Ke- sE'e�.•rorA ❑ Re-roof(not stripping. Going over existing layers of roof) ZRe-side ❑ Replacement Windows/doors/sliders..U-Value (maximum..44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:\WPFILES\FOPMS\building permit forms\EXPRESS.doc The Comrttonwealth of Massachusetts Department of Ittdustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 wwwmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A Brant Information r I, Please Print Letribiy_ Name (Business/Organization/lndMauan: Ca (C Address: Ave, City/State/Zip: Ea or V CV1 o , 62 71 Phone,.#: 509 IM I I" Are yo an employer? Check the appropriate box: Type of project(required): 1. I am a employcr_with _L!S7 4. ❑ I am a general contractor and I * . have hired the sbb-contractors 6. ❑New construction employees (full and/or part-time). 7. REmodelin 2.❑ I am a sole proprietor or partner= ��on the attached sheet ❑ g - ship and have no employees These sorb-contractors have g, �]Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.•insurance comp.merrrance.$ 10. Electrical repairs or additions rtq��] 5. [] We arc a corporation and its ❑ p 3.❑ I am a homeownLr doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp_ right of exemption per MGL 12 [ f repairs insurance required.]t c. 152, §1(4), and we have no employees. [Na workers" 13.❑Otherid� comp.insurance required.] *Any applicant that checks box#I toast also fill out the section below showing their workers'conTm cation policy infounati=c t Homcnwocra who submit this affidavit indicating lbey are doing all work and then hirr outside contractors must cubtnit a new affidavit indicating such tcontracwrs that check this box nmist attached an additional shcct showing the name of the sub-contractors and stale wbdba or not thost cntifia have emplayas. If the sub-contmeirns have anploycrs,they must pravidt then' workrss'cornp.policy number. I am an employer that is providing workers'compensation insurance for my employees BeLow is the poLicy and job site information. l Insurancr.Company Name: �Ya r �� S v rc'M C e__ — Policy#or Self-ins.Lic_ '19 03 Expiration Date: D Q� fob Site Address: r' � d✓, Citylstatclzip:&Urbt,S4a/e,, 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 crimv.al penalties of a fine tip 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 statcmcrit may be forwarded to the Officc of Investigations of the WA for t'n�trramr,coyera)e yerifiCatiDM I do hereby certi under the pains- d pe alties of perjury that the information provided above is true and correct Si a: _ Date: — Phone# 56 9 257 Official use only. Do not writs in this area, tb be con ltted 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#: ACORD„ CERTIFICATE OF LIABILITY IN'SURA►NCE °A'E`W'�°""Y"Y' 09/18/2007 PRODUCER (508) 67!9 -6919 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Frank X. per jngll uranca Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR 1311 Bedford Street~ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 415E Fall River MA 02723-Od 02 INSURERS AFFORDING COVERAGE NAIC a>t INSURED INSURER A: National Grange Mutual CARE FREE HCHES _KC, INSURERB; Star Insurance 23 9 HUTTLE 5 TON AL'17E INSURER C INSURER D: FAIRHAVEN MA 02719- INSURERE: COVERAGES THE POLICIES OF INSURAWGE LINED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTVViTHSTANDING ANY REQUIREMENT,TERM OR CONDHTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED WTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOV&q MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPEOFINSURAN70E POUCYNUMBER DATE MM/DD DATE MW/DO/YY LIMITS A GENERAL LIABILITY, M9077983Q 09/01/2007 09/01/20013 EACH OCCURRENCE i s 1,000,000 X COMMERCIAL GENFRWiLIABILITY DAMAGE TO RENTED � PREMISES Ea occurrence $ $0,000 CLAIMS MADE lil OCCUR / / / / MED EXP(Any one arson s 5,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 .GE NTAGGRE"TELJMITpiP;PLIESPER: PRODUCTS-COMP/OP AGO s 2,000,000 X POLICY JEeT LOC AUTOMOBILELIABILI-TY / / / / COMBINED SINGLE LIMIT ANYAUTO (En ecddent) S ALL OVAIM AUTaOS / / / / BOOILY INJURY S SCHEDULE DIAUT-OS (Per person) HIRED AUTOS / BODILY INJURY NON-OVWEOAUYOS (Parecddarrt) $ PROPERTY DAMAGE (Paracddenl) $ GARAGE LJAE91.ITY AUTO ONLY-EA ACCIDENT S ANY AUTO / ' / / / OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUNBRELIALEABILIICYI / / I / EACH OCCURRENCE S OCCUR r CLAPTAS MADE AGGREGATE S 4 S DEDUCTIBLE RETENTION S S B WORKERS COMPENSATIONAaNO WC0378035 09/01/2007 09/01/2008 70RYLIMITS X OETRH EMPLOYERS'LlA81LN'Y ANY PROPRIETOR/PARTNEPJF—:rXECiTBVE E.L.EACH ACCIDENT s 1,000,000 OFFICERIMEMBER EXCLUDECa1 E L DISEASE-EA EMPLOYEES 1,000,000 If yea.desalbe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 OTHER I / DESCRIPTION OF 0PERA*NSfLOC.;AnOftVEHICLEWEXCLU8IONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Officers zaCLuded Ear Worbas Compensation CERTIFICATE HOLDER CANCELLATION ,( ( — SHOULD ANY OF THE'ABOVE DESCRIBED POLICIES.BE CANCELLED BEFORE THE - .5 OS EXPIRATION DATE THEREOF, THE ISSUING ,INSURER WILL ENDEAVOR TO MAIL t 10 , DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Town of Ba.rnaet&018 FAILURE TO 130 SO 84ALL IMPOSE NO 0911GATKIN OR LIABILITY OF ANY KIND UPON THE Building DEIPaxtmnent INSURER,tT3AGENTS ORREPRESENTATWES. 367,Main Stria9t - AUTHOWEDREPRE_SENTATIVE Barnstable MA 02601- (CORD 25(2001108) ©ACORD CORPORATION 1988 5n+INSO25(0108j,06 ELECTRONIC LASER FORMS,INC.•(000)327-0548 Page 1 012 ii CARE FREE owes ins. 239 Huttleston Avenue Fairhaven,Mass 02719 Telephone 508-997-1111 Fax 508-997-1297 Website: www.carefreehomescompany.com To the Town of. �l Job Address: City, State,Zip: L I, , owner of the home at the above tomer name 1 ation, authorize /areree Homes,Inc. as my agent to obtain all necessary permits and to perform all home improvements to my home as stated in the accompanying contract and application. 13 I'v 6C tomers name D e Board of Building Re�ons a�anacf Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only before the expiration date. If found return to: Registration 100503 Board of Building Regulations and Standards E xpirat ion i 3 010 One Ashburton Place Rm 1301 �, rType Supplement Card Boston Ma.02108 CARE FREE HOMES tNC F t ROBERT PICKUP 239 Huttleston ave Fairhaven,MA 02719 Administrator _ Not valid without sign ture , oFIK, Town of]Barnstable *Permit# _-�00 J,0 3Q4 S �' O Expires 6 months from 'ate Regulatory Services Fee BARNSrnst.E, : Thomas F.Geiler,Director y MAss $ �Arf 9 SS PERMIT. Building Division Tom erry,CBO, Building Commissioner J U N 17 2008 200 Main Street,Hyannis,MA 02601 . www.town.bamstable.ma.us Office: 508MMOF BARNSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint . Map/parcel Number Property Address Residential Value of Work ' `��� _ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ��✓�� S r 7"�1 Contractor's Name l "' JN,� �� �Y 7 P0M p l (izS Telephone Number b% ! L L r 7 Home Improvement Contractor License#(if applicable) 03 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [� I have Worker's Copm/pensa-t/ion 1�'�tI'nssurance f Insurance Company Name ✓V W l e S►7� �L `l n S C u" Workman's Comp. Policy# C7' �5 S Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side t/ IV Replacement Windows/doors/sliders. U-Value 7 (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: t (� Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �1 04/18/08PRODU ; arch ER 1-404-995-3000 Marsh THIS CERTIFICATE IS ISSUED AS A MA'1"ER.QF INFORMATION USA, Inc. ONLY AND CONFERS NO RIGHTS UP(N-4 T� CERTIFICATE HOLDER. THIS CERTIFICATE DOES . O'T Ah�END, EXTEND OR homedeiedmont Rd NE, Suuiteh 200 ALTER THE COVERAGE AFFORDED I Y THE P-LICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 _._T_ Atlanta, GA 30305 Fax (2.12) 948-0902 INSURERS AFFORDING COVERAGEINAIC#E INSURED INSURERA:Steadfast Ins CO — Home Depot U.S.A., Inc. 26387 d/b/a The Home Depot INSURERB:Illinois Natl Ins Cc 23817 2455 Paces Ferry Road INSURER C: ssur o American Home A C - --- I Building C-8 __ 19380 Atlanta, GA 30339 INSURER D:Now Hampshire Ins Co 23 2796 841 INSURER E:Illinois Union Ins Co 0 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NO(WITHSTANDING 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 CON[.-.TIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR DD' PO ICY EFFEDCTIVE POLICY EXPIRATION LIMITS LTR N POLICY NUMBER A GENERAL LIABILITY IPR 3757 668-02TEXCSS 3/01/08 03/01/09 EACH OCCURRENCE _ g4,000,000 ------- I X COMMERCIAL GENERAL LIABILITY LIMITS OF POLICY AR DAtnAUETOREN PREMISES LF.aoccurenceJ $1,000,000 CLAIMS MADE OCCUR "OF SIR: $1,000,000 MEDEXP(Anycnopsrson) ($EXCLUDED - [ PERSONAL&ADV NJURY 000,000 GENERALA_GGREGATE $•1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: I Ir PR7DUC'fS-CGMP/OPA3G I§^1,000,000 JECT Ex-1 I oOLICY PRO- LOC --- RALLOWNEDAUTOS AUTOMOBILELIABANY AUTOCOMOINEGSING!.ELIfvIIT(Ea acciden.) II SCHEDULED AUTOS 0ODIL Y INAK Y (Per person) HIRED AUTOS UODIL.YINJUR'%- -- -I_.- ------'. - _ NON-OWNEDAU10S I i(Peraccidenl) I$ - F PROPERIYOAMAC I I(Per accident) GARAGE LIABILITY — - -- -`---'-'"•'---'- -+ L,_UTO ONLY-EAACCIUENT 5 ANY AUTO - I OTHER THAN EXCESS/UMBRELLA LIABILITY AUTO ONLY: PGG I - -�'EXC - $ -'-'-- EACH OCCURRENCE OCCUR- CLAIMS MADE - AGGRF.GA'fF. !S -. DEDUCTIBLE -I RETENTION B WORKERSCOMPENSATIONAND 1928757 (FL) 03/01/08 03/O1/09 X WC:SI',\TU-r O'hl C EMPLOYERS'LIABILITY 1926756 (CA) 03/01/08 03/01/09 rn a ANY PROP(?IETOR/PARTNER/EXECUTIVE, E.L.EACH A('CR�,-,(; q r%00,900 + D OFFICERIMEMBEREXCLUDED? 1928755(AOS) 03/O1/OB 03 O1 09 T If yes,describe under / / h.L.DISEA� EA`A'PLOY"ts1,000,0Or SPECIAL PROVISIONS below E.L.C;SL:ASE-PC?LICYLIMII $1,000,00G � OTHER E TX Employer ExceBe TNS-C45197967 (TX) 03/01%08 .03/01/09 caurrence/SIR 25H/'1.M C Workers Compensation 19287.59 (QSI) 03/01/08 03/01/09 . D Workers Compensation 1928758 (KY, MO, ,NY, WI) 03/01/08 03/01/09 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS - - -' - I CERTIFICATE HOLDER CANCELLATION - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE-THE:2XFIRAT - TOWN OF CHATHAM - - DATE THEREOF,THE ISSUING INSURER-WILL ENDEAVOR TO MAIL U,'YS.WR' NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TC DO SO / 763. GEOROE RYDER ROAD IMPOSE NO OBLIGATION OR LIABILITY-OF ANY KIND UPON THE INSURER, TS Am REPRESENTATIVES. CHATHAM`6fA 02633 AUTHORIZED REPRESENTATIVE "- USA " ACORD 25(2001/08)datkinson 8556605 ©ACORD CORi10R/ S ��ie -�o��mon�uea/.t� a�� aaaclu�e� Board of Building Regulations and standards HOME IMPROVEMENT CONTRACTOR Registrc ion-,. 126893 i ! Expiration 8�/3/2008 I.I Type `Supplement Card + • THE Home Depot At Home Servic IMARK 3200 COBB GALLEPIA PKWY'#20 � � AtIANTA,GA 30339 Administrator r1 I } License or registration valid for individul use onl before the expiration y i date. If found return to: p Board of Building Regulations and Standards One Ashburton.Place Rm 1301 Boston;Ma.6108 i l 0,r�_ ,j Not valid with ut signature r a 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 1nPlease Print Legibly Name(Business/Orgmlizarion/In&vidud): �'I�- F C'p�T /'( � Andress: S 5 cz �e City/State/Zip: / �/C ,n ,I- 3 D 3 3 nn Phone.#: � 7 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-conhactors 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 a employees and have workers' working for me in any aP�3'• 9. ❑Building addition [NO workers' cOugiA, surance comp.insttrance.t 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 I LEI Plumbing repairs or additions myself[No workers' comp. right 6f exemption per MGL 12.❑Roof repairs t c. 152, §1(4),and we have no insurance required.] 13`� ther O A`2t0��`�k e'^ employees. [No workers' —T comp.insurance required.] 1 d caw S Any applicant that checks box#1 rmut also 5D out the section below showing their work='coxmsrtim policy inforrmtion. t Homcowoert who submit this affidavit indicating they m-c doing all work and then hint:outside contractors un st submit a new affidavit indicating such. %Cantactars that check this box nmst attached an additional sheet showing the name of the sub•contracl=and stun wbetha or not$rose entities have m>ploycm 1f the subtontraatars have employees,they must prcvidt their worla rs'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: �_w 4AA Y S ff f k t_ TKS C U.' Policy#or Self-ins.Lie.#: � R � � Expiration Date: n,, n / Job Site Address. ( Ale—le� 6,4` / I�� City/State/74: -111 j)r Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to si:cure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 WA for insurance coverage verification. Ido hereby certify under the pains•andpenalties ofperju y that the information provided above is true and correct Signature: G-'l lC ties J"\C Date: Z1, Uh Z or-) Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Tovirn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • F Information and Instructions s 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 representative's of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states'Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliznce with the insurance requirements of this chapter have been presented to the contacting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contactors)name(s),addresses)and phone number(s)_along with their certificate(s)of insurance_. Limited Liability Companies*(LLC)or Limited Liability Partnerships(LL.P)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 Bp 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 retuned 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. Sclf-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 ono affidavit indicating ctment policy information(if necessary)and under"Job Site Address"me applicant should write"all locations in (city or town)."A copy of the of davit 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,telcphone•and fax number. Tae Commonwealth of IMassachusetts Department of Industrial Accidents office of Investigation 600 Washingtan Steed Boston,MA 02111 Tei. #617-727-4900 ext 4.06 ar 1477-MASSAFE Fax#617-727-770 Revised 11-22-06 www.mass.gov/dia r °FmEr � Town of Barnstable f Regulatory Services 9:wxx "BI'E�` Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 tY Prop er Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize I A� M�/ y L: 'to act on my behalf, in all.matters relative to work authorized by this building permit application for: flb GAA1 ge , (Address of Job) Signature of Owner Date Print Name • • m License If Property Owner is applying for permit please complete the Ho eowners �cen Exemption Form on the reverse side. . t Town of Barnstable moor.the Tp�� Regulatory Services saxxsrwar a Thomas F.Geiler,Director MASS. Building Division PrED r`"A�a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 wvm.town.barnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 HON EOWNER LICENSE EXEMPTION Please Print DATE: 10B 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 performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption aie 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,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Superviso-. 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. MAY-29-2008 15:52 HOME DEPOT HYANNIS P.008 a]00E[1•Wa] HOIvtE ;I11�fPROVEMENT CONTRACT I iSold,Furnished and Installed by: Branch Name: c,� S Z�Oc$ TTW At-T•lome Services,Inc. r�Z Date: . — r s I d/b/a The 1-Iome Depot'At=Iior[tc Services :.. . . :' :..:. 345A Grecnwood Street,Worcester MA 01607 '5182- Ftk.508-756-2859 Brtlncb Piamber^.i M O 3 3ob:# .... '] Toll Free'(800):457. . Fcdcral•EDM 75-2698460 1 Lic fkCO2439 RI Cant Lic#16427 CT Lic*56552h; MA HOttw Iprpmvc3uertt Contractor Re8.012689.3 InstaAatiou'Addre&.,.. ' m�aG� City: ;:Srate.;; Zip.. UA 4 Digits of Driver's Purchaser(&):: :.,• ..;.,.., Uc.N&E - .Mo/yr:::.. Work Phone Home Phone.. bto?If (a-Cs3 ('� ) (5c53')�i0-fit 3• Home Address: ..State... ZiP. (I£'dirt'eent4iom..lnstallationAddress)• ,.'. City r•,, .•. .. :,� .• . . ., '- , Elrtiail ilddt ess(to'receive ypdaus'and�roinohons from The Home Proiect Information:- I/We/.tion("Purchascr I tale owners of the property,located at the above installation-address,offer to e Ser6ccs,.Inc:("Home Depot")to furnish,delivet'ana wirange for the installation of all materials contrnct'with THD At-Hom as desotibed,on�tlie':attached Spec Sheet,# incorporaud hercin'byrefercaceitnd made a part hereof Ilotoie>Dcpot reseryes:theYlght to.tancel-this=oontracG if;-tYpon':ro-inspeLtdon;: f the,job;,Home,Dcpot-detcrudnes that it cannot perform its obligations:llbe to-'a stntctil af-problem with"•the-home;p clug errorsor'betause work'regaired to eomplete;the_jobwus,not.ineladed in the Spee.Sheet or Contr.cK.:.•...:... ..'^`.: :.. .: ONS AXM ENT OPTI (Sub veritiadtt'aPproval.) ' DE�osrr, jectRo fund catinand/orcre CONTRA AMOUNT $ ' I: '.,Check',CashiernCbicicorUS.PostalServiceMoreyOrdor .. c able to The Home Depot)., .. • -.. (Mad'PflY tLESS DEPOSIT" $, 3(P�. .. 2: Cradii card•'and/or other payment opdoas-Cinla One Below ' ". .BAX,ANCE.ALJE Vixn MasterCtrd ptseover ' AmericanExpress ON C01 PLE i ON. $ �: 'Tho Home Depot klomcllmprovcmeai:Loan.. lulilomeDcpot Credit Card. ' j'Miwaitini'25o%ofContractAm'ormtdueupon 'fl'NewAcrnaat' Q•.EidstitiCAcconat '•(HA,•&t1DCCONC.1) ezecntiun of A this contract ONLY) Available Credit:S. :(BT4&,I DCC O � . Indicate Payment Method For AccdF; Bxp.Date:. SALANC>E'DUE ON COIV TUTION: . . Ntnte.as'it..appears on card: -:,:."_... : ..........:.: ::�..,,. ..-: ur'signshtiebelow,FWe:agme•td allo-ilome`Depot to tla r the ep indicated. C�neG� charge e.above referendxti credit card for d osit in .!Whcayou provide n,chedcaa.paYmatt',:yau;authorize us.either '. "? re , AatC . to.use'intono-.hoa&in your check rode a 61164imo electronic Cardholder's S' ta fund'.tramafer Bum yoar.account yr to process the'peymeu4 cheek traosaetion,•Wbm we:aae int'omution'&nm•your ch ck ro"• IlIL er UDCC•Authorizadon,Cadiz.. mako'sn clectronirtuvd trnnsfoG"Rinds:may.or w tbdrnwa from Deposit.' Final Pa ent your ae¢ount assoonas;the paymenti.rcceived,',andyou Wign9t rc—va}roar check back :' # Purcbaser:agtees'tltat imrnediately.upon completion of the work,Purchased will sxocuw a Completion Certificate and pay any balance due:Lnrcheser'also.agtees•to bej0iutby'and sevcraHy obligated andiiable hereunder: •.S.'.::%W":i!iel�Si:::Pr.'F`F.r•;:.?A'aur.V^:r.::r�::n'..7,..• _:+.�.,.:.:.:.a.W�'ei•:' ,yJ-;��cSl�:c ,:sri.t":n':.�.'::.�.�.: r,✓_....ar._....... ..Entire AQreement:,This agreement and.its attachments;melu .tn. sacra a eemcnt,:contatn t'he complete agreement between-the patties and call not be amended or mkidifred unless in writingAn a separate agreement signed botL.parties NONCE TO PURCHASER' '. Do:notsiyt►?tltls.coabactbcfore you read-,xt:You are.eatitled to a.sompletely filled-in copy:of-the,contractatthe time yom,.sip Keep it.to protect.your•rights-.no,not'Sign.aCompla"Co p etion C before this prd,:by'ts complete. Law . Prohibits home;repaircoutractors;from requesting'or accepting a Completion Certifcate signed.:by the owner prior to the actual iomplction of the Work to be performed.nmder'the contract.' You may cancel:this tran%action any time prior,to'midnight of the third business day after the date of-this contract. See Notice of Cancellation for.an explanation.of thls right.,There wffi be'a service charge equal to 10/o of the contract amount-if job isxaucelled''by Purchaser AFTER the third business:day,but.BEFORE materials'are.ordered.There will be,a'service charge equal to ZS%of tbe'.contract amount if job is cancelled by Purchaser'AFPER.materials are ordered. UNDERSTAND THAT TIC AGREEMENT MAY BE SUBJECT TO REVIEW BY.MY/OLIA:SIGNA CURE BELOW,FWE OF MY/OUR CREDIT HISTORY AND FWE AUTFIORIZE HOME, DEPOT T.O.VERIFY AND'REVIEW MY/OUR CREDIT RECORD WTIT3 AN INDEPENDENT.CREDIT REPORT•ING'AGENCY AND.RELBASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT'OMISSIONS OR ERRORS. ' . BY'MY/OUR SIG1�lA1ORE BELOW,T/WE.AGREE TO BE BOUND.BY TFIE TERMS''OF TICS CONTRACT. FWE ACKNOWLEDGE'RECEIPT OF A:COPY OF:TI•ILS`CONTRACT'AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. Date: SUBMITTED BY: Sales u i Date: _ ACCEPTEDBY: Z$-05:& Date: Putt i N07lCE:.ADD1T10NAI TERMS.AND CONAIT'IONSARE•STA TE6ONTHEREVERSYSIDE AND ARE PART OF THIS.CONTRACT 9-21-07 rev4.2-07"''CSC. . "''White-•Branch'File'''Yell0w—CustOmOr 'Pink=Sales'ConsUltant — TOTAT. P.nnR Town of Barnstable Building Department ` Complaint/Inquiry Report Date: < Rec'd b : Assessor's No.: G 1 ....__!Complaint l Name: �/<'d 'DA P L Location Address: c f:5- M/P 771 - d Originator Name: I< Street: A l k Village: State: Zip:Q Vic, 0 Telephone:D/C Complaint a Description: / - Inquiry 0 Description: For Office Use Only Inspector's Action/Comments Date: /® Inspector. �— ZF Follow-up Action Additional Info.Attaclied Copy Disoibudon: White-Department Fie Yellow-Inspector Pink-Inspector(Return to Ofce:lfanager) r ; i� %RNS•TABLE, r MASSACHUSETTS ASSESSORS MAPS 30 � R f. 1� O tynr.Z 80 7a le° u 74-1 A6AC 9G A is ti 79 r4/y 60 a 0 1q) 4i urr.ca L71 )) no yCA pC I t)4c rayon .41 PIC $ 5 , WENT e,� V /s1 � J d3 ��o s,`w� O 10 .264c pep 80 *e ) .S5w 71 69 064C yt• ►c r 6 K 26 '� 'I O 434C \8b , IV0 =64NC .L7ay et + h 0 h J�.a N h � ,h ,,� •2g t �,o5414 �A 65 3 C y►L c 7► h l M sr 0�1VE ' . 16 6 0 23 101 1o10 \eq b02 2�°L �0o g8 .Z1 K' f ao 1 af• ).�6) 11 yb:w Z5� 4 102 5 {r0 N 89 Z e .+ 5t►�" I LS IA'PO 9 4 j64 .SAL .L1•C �® n `ZO O Zigat 4� �0►0 at .�K'•' 0 A 1 v t �`obd, i•(5' 3_16) 11 f1 ® f•0 O ® vo ( la ® Z. 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