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HomeMy WebLinkAbout0001 PEACOCK DRIVE A Town of liar'astable mP IT *Permit# Regulatory Services lrs6 ronrissuednre e v Thomas F. Geiler, Director TOW TABLE �. Building.Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Off-ice: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESlbENTIAL ONLY �t Valid without Red X-Press Lnprinl Map/parcel Number ;C) Prop rty Address Residential Value of Work 51<7--minimum fee of$35.00 for work under$6000.00 Owner's Name & Address �` 1�((� e Contractor's NarneT,j��� Or T e hone Number t� P ra J Home Improvement Contractor License #(if applicable) - !Z n /3 'CAL/ �' Con °uction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑lam a sole proprietor 9I am the Homeowner 1 have Worker's Compensation Insurance Insurance Company Name l l/��if/ �S Workman's Comp, Policy'4 _ ® Copy of Insurance Cornpliance Cer ica e must accompany each permit. Permit Request (check box) ❑ Re-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to ZRep (hurricane nailed) (not stripping. Going over existing layers of roof) #ofdoors ment Windows/doors/sliders. U Value r rj S (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 Contractors License & Construction Supervisors License is re d, ".IGNATURE: f� \WPFILES\FORMS\buildingpermit fofms\EXPRESS.doc evised 072110 The Commonwealth of MassachuseUs J Department of Industrial Accidents Office o.,f Investigations la r t� 600 Washington Street,z r Boston,N14 QL 111 c: r s,'.. wwiv,maiss.go"'Idiat Workers' Compensation Insuranc e Affidavit: Build ers/Con#raetors/Electricians/Plumb. rS Applicant Information 'lease Print L:egibl� Name(Business/Organization/In'dividual)`. .✓""3' �- - p�- a Address: �`',� �' ' `/—tv City/State/Zip: 614411 L Phone#: J ��5 �IS Are you an employer?Check the a propriate box: Type of project(required): 4. am a general contractor and I New construction 1. I am a employer with �� have hired the sub-contractors 6 employees(full and/or part-time). Remodeling 2.❑ [am a sole proprietor or partner- listed on the attached sheet. 7. ❑ These sub-contractors have. g. Demolition ship and have no employees employees and have workers' comp. working for me in any capacity. insurance.= 9. ❑Building addition - [No workers'comp.insurance I O.D Electrical repairs or additions q required.] 5. Q We are a corporation and its ❑ I a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions 3. myself:homeowner comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13 ❑Other ' employees. [No workers' comp.insurance required.] 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *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. am an employer that is providing workers'compensation insurance for my employees. Below is tl:e policy and job site information. Insurance Company Name: '� Policy#or Self--ins.Lic.#: Q Expiration Date: . Job Site Address: City/State/Zip: �� number and expiration date). (showing the policy numb p declaration page policy declar ( g comp ensation o pg. Attach a copy of the workers p P Y Failure to secure coverage as requited under.Section 25A of MGL c. 152 can lead to the imposition of criminal penalties.of a nt,as well as civil penalties in the form ofa STOP WORK ORDER and a tine tine up to$1,500.00 andlor one-year imprisonme 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 certif nder t pains and penal/X perjury that the information provided ove is true and c et. Date: Si nature: Phone# G 1�' `e—�q e — Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# 1 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/TOwn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone Contact Person: #: 1 L The Commonwealth of Massachusetts Department of IndustrialAetidents Offtce of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aeplicaut Information Please Print Legibly Name (Business/Organization/individual): Address: (/�/',A0AI City/State/Zip: ," e Oro /� 0 2 Phone#: Are you a employer?Check the appropriate box: Type of project(required): 1.❑71ampla a employer with 4. ❑ I am a general contractor and I oyees(full and/or part-time).* have hired the sub-contractors 6. ❑Ne construction 2. sole proprietor or partner- listed on the attached sheet: 7. temodeling shipand have no employees These sub-contractors have 8. ❑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 1011 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t- c. 152, §i(4),and we have no. 13 Other employees.[No workers' comp.insurance required.] *Any applicant'thatchecks box#1 rnust 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'co ad nsurance for my employees. Below is the policy and job site information. Insurance Company Name:. ���v)� I -{-/1✓]. Policy#or Self ins.Lic. 0ao (9 Expiration Date: � 'Job Site Address: Lam/ &l/ Ub City/State/Zip: )/9/V* 0 , �rl 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 certi nder the pa ins annd�penalties of perjury that the information provided above is true and correct Signature. C� Date; Phone#: 6 Ob -'CA Official use only. Do not writ e in .fr this area to be Y completed by city or town o ciaL City or Town: PermitlLicense# 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#: \ office of Consumer Affairs&Business Regulation t 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 , Registration;:d'f26893 Type:.. 10 Park Plaza-Suite 5170 Expiration $%3/2012 Supplement Card Boston,MA 02116 i The HomeDepot'1 Home Serv166s DARREN 2690 CUMBERLAND,pARKNVAY S _ L GA 30339 :;.:.;---' Undersecretary Not valid without signature :l:t=h:tsi�:t>cit� - T:�dt:tr7tiia iii +it Public: `3ii::rt9 ni'$r:i!tlit2� �?c2eil:etinn. anti�i::nd:ert!> "- Construction supervisor License ocense: CS 70077 Re stricted to: 00 JOSEPH C DUARTE IS FALL ST WAREHAM. AAA 02571 , Expiration: 12W2010 t uwti�.i.a,t Tra: 7662 4:icrresas air rv�isl.• tt v>ilid Forindio'idul Uzi fe y d`ts®Js iSoan1 of HriWi®gft�KaAm>�oas sar!> i.c toov Ike ram dam if round r���aar ANIL 1 it1=NPROVEMEW CJ04MCT43" tw trd of gum in RqvIvtinns and standards Registration* 132349 tittr•:�thbwtnA.l'laicr 1-� EArwatbM1: 1!1 ij?I111 Ttf$ ??dill %ntu p,aka Q10b i�pe: Parin¢nhoQ ; _ i a J Reinode" a D j h Duatteow S 5 Fa!I S1 vato wisAwl fivabim Vrarsh®rn. ma 02$71 tdmini+ir:r.'a+ 5 FROM :jam9ad FAX NO. :5083622271 Apr. 6 2007 4:22AM P1 HOME R"ROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name Boston Date: T'HD At-Home Services,Inc: �J>�1-- d/bla The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Branch Number:31 Toll Free(800)657-5182; Fax(508)756-8823 Federal ID#75-2698460;ME Lie#C 02439;RT Cont.Lie#16427 CT l is 522:11AA Home Impruwaicut Contractor Reg.#126893 Installation Address: L APO Qa_�,,� �— City L © state Zip, Work Phone: Home Phone: _Cell Phone: Home Address: (If different from Installation Address) City State zip E-mail Address(to receive project communications and home Depot updates): Q I DO NOT wish to receive any marketing emails from The Home Depot Zoieet Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, d THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deUver and arrange for the installation("Installation")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(ccllecnva,' "Contract"): job#: dw— utt—) s. Pffliductb. Spec Sheets #: Pro'ect Amount ❑Ranting Siding _ Windows LJ Insulation ❑Gutters/Covers ❑Entry Doors ❑ ✓C`,(!j Roofing Siding M Windows Insulation $ ❑Gutiets/Covets f]Entry Doors f-I Roofing ❑ El Windows Insulation $ ❑Gutters/Covers ❑Entry Doors[If� ❑ Roofing FSiding Windows Insulation $ 1 []Gutters/Covers []Entry Doors ❑ Minimum 25%Deposit ofContradAmountdpe Upon emmilnoftbisoonttarL Total Contract Amount $ / Maine Putrhaserr may riot deposit more than one-dii d of the ComtradAmmat. Customer,agrees that,immediately upon completion 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.thi.s Contract agrees to be jointly and severally obligated and liable hereunder_ The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(-)included herein,it. its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural. problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety.concerus,pricing errors or because work required to complete the job was not included in the nt�ract. � Payment Summary. The Payment Summary# T- 3(Q Included as part of this Contract, seta forth the total Contract amount and payments required for the deposits.and final payments by Product(as applicable)_ NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Coniraet at the time you sign Do not sdgn a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by hidividwd Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other. amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS PAYMEN LIMITING THE HOME DF.POPT''S OTIMA REMEDi'ES FOR RECOOT FROM THE DEPOSIT VERY OF SUUCH OR E�AMOUNTS.� MADE, WITHOUT AccemWnce and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and installation services and supersedes all prior discussions and agreeutents,either oral or written,rrlating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot Customer acknowledges and agrees that Customer has read,understands,voluntarily-accepts the terms of and has received a copy of this Agreement. Accepted by: - Su itted by: X Zj Cos'"gym '.Signature Date Sales usultant�s]Sign C / Uat /riazv�hoS T�auMtt21 Telephone No. Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (as appliuiblr.) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE iS SPIECMCALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONiDMONS ARE STATED ON TM REVEIKE SIDF.AND ARE PART OF TMS CONTRACT I uq%iw_P a.vh9ni vanr-nmaernar ViWr-SaleSCansubant - J ° 3 3 r 3 1 3 � a 0 F•-1 m m Z r 3 m m IH O a f h Z 3 m � •--I a � Z 1 C/'� I-1 Z T —ti r o sa I - z cro -v mmo ma � 1 � acnva •� �- x •• 0 1--1 I o 00 .� v z m .• z •• o I � m a cn z - -r, tS 1 rn 3 pJ � m 1 o m r m crl x o r --i C] OS N N N 1 [D 0 0 0 O I y I I • I � I I I I y I Y I t r 'Town of Barnstable *Permit# eaRbo6 3 5 39 Expires 6 months from issue date Regulatory Services Fee �— g Y e � X"M Thomas F.Geiler,Director 1639. fa �p Building Division Tom Perry,CBO, Building Commissioner 0 f 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY X PRESS PERMIT Not Valid without Red X-Press Imprint O r r Q Vlap/parcel Number ay�,���SJ 1, v Zoos • ' ! TOWN OF BARNSTABLE Property Address t't ,21�bsidential Value of Work_ �� _ Minimum fee of$25.00 for work under$6000.00 Dwn-er's Name&Address 06 Contractor's Name_ "F--a Telephone Number Home Improvement Contractor License#(if applicable) 3 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ;T\1 have Worker's Compensation Insurance Insurance Company Name q 1' Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. i Permit Request(check box) . ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows. U-Value _(maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must si n Property Owner Letter of Permission. - H e ve e t tractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 _ .� ,m a�?.,.+.q '7 -N,>Y+n^ �� 3"'°Oart.,� :ymi `d•'e':1�y.s l j.,+s�._'drS� A.� arm-e - a9a:aa-7is .^S. 44 ;absf • 1 er?Cher kthaappropride boz: Type qf pro;�eet ire geed' : ,re yan an emp e�y 4. ❑I am,a gemxal cant 2dtr and I 5: []New ccnsamcdoa. [ I smt a cm0W7escwith_ Q2- a bWcbircd e�mY I(fox=warpart'11 MAV em tie attac�at s t 7• ®Remado ctor orpartaer. • �� Demolitian 13 am 8 sole props ne 'a ssnb-=tmcI0mI e ❑; . p U dbave ao eraphaYaea , workers'comp.$asaraaca. g, []13aft adc _. . vml*g �rsaem � S, ❑we are a corpas d a smdits •_ lon EwbicalxopaQs or amims ' jlc watbn arC=have caasa ed twir ° . rcquhvd•]., mkm j&ofet pctMGI. 11.[3Phaubimgnpa addit:�s I are also Moor .t aTi wor3c and TOIm no 12.[]Roofs epairs xaysel£(No w ' mp c.1311 11(4), epolioy,�msht . nyMWBut 1&0 bait1W �oaaa!eo ca out�e M Acams A�ffi UN"cow&==*.twsa�vAxrA I my ds&vkm�i�iC� �at�eowdax'����vit 3a�catbaf eb<y and e6ea wow .�ps,Yuj'i�as�oa� . Bmt tkim sad attack =tdt9 MIJ tw 9mvA ire�d*1 X644 ,. t rr jai is pra�Pdir:g workers,compensadon tt�.rt once fer•my ampkyf fs.•Jadow b tha oYigi ared,,�ab� s: arcs crc p oY . e&acd tamp myNanae: Ind . . CAP Jb SiteM&111' dectarattoa a shorrlag thepaticy number and expiration daft), ,troth a cop?ofthe workers coMpe nuanpAcy p� 'fie to slocar .wvmv u regaimdvx&gecdm,2SA gfMGL c.132esmila d to of STOP WOREOADI t.sad of M�Zaapmajtl;a a fine �otep to 31,i0 '90 m or ene ym iommot Im welt as o;y ofcalitaam a ' $teviolamr. Ba advtsad tbat a cagy of tma stat�emesntmaybe forwarded to Sse Office of , f np�o$ZO&I a day kgamst boas of�DdAfarIDsuor�atae s:ovea,Be vanaa. • r P p of psrf wy"the tnfdmdkn provided above-b Ime and correa do here by Ciro . D ef ; . no solot s ,fie it mowa�'eNtrove Chy ar Town: • permftlLicense# • I A {e:hcle 1.Board of$e&,,h 1.Building Depulmed I Cltyrown Clerk. 4.1<+lectricat inspertar $.Plumbing Inspsstoc 6.•Qdter Phone#s t o�t"E rqi, Town of Barnstable { snaxsraas,g, Regulatory Services Thomas F. Geiler,Director Building Division Tom Perry,CBO 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 ,.as Owner of the subject property hereby authorize 'V Fr" I to act on my behalf, in all matters relative to work authorized by this building permit application for: V- ✓11 (Address of Job) J G>25tG Signature of Owner D to C"b--1� 1�'1114 Print Name Q:Forms:expmtrg Revise071405 4 �6 3, Ii ask Li3 j _ ii tIh hri.d, 1-000-746-5E.E6 RES 97 ENERGY PERFORMANCE RATINGS U-Factor(U.SJi-P) Solar Neat Gain Coefficient 0 .35 0 . 26 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance • 0 . 43 o kbwbcuw ftulft to than nrlop oudatrn m ap kgId URIC p madws;ter demrmhN 0* p oW pulbrmena.NM radng+are damrmhed(nr a fled 3d of sndrommenhl mod kes and a epaglle product dn.Car 4 menuhct�e ara n fa alrter pradust pnrlbrrner><a Udbrmemai. www.nfton • r: EdEN1i11 SEAR uuit qualities for Lcar4T etar Rsgi.onrs): Nacthacs, Mocth I. •. Conical, Bouth Central, I.. • p southern I DP: +2 5/-2 5 pro: RB�.t°�-in. acdec-1s:Ia8511809AM.1 . _ :50375 HS ,sa ✓die TDo�rrvinarecue o��iv�aQdac�uae�`G � �\ Board of Building Regulations and Standards , HOME-IMPROVEMENT CONTRACTOR t.. Registration: 126893 Exprrat�on 8/3/2008 ,. Type Supplement Card I THE Home Depot,At Home Servic k MCHARD FALLONE 3200 COBB GALLERIA PMY-420 AtIANTA,GA 30339 Administrator EYICHAr<u rn6cv.� _ _ . . I - , q- 4,' p r x MARSw-I r r cERTI ILATE OI• IIV��RAI�IzLIE CERTIFICATE NUMBER � � �y �,�,. ..::�. ,��,, ....r A� _ �.:��n �'�; .� • .. `;_.,.>.: .. ���•,,r }��:;' ,�' ATL-000915907-11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE ATTN:BRENDA BOOKER (404)995-2594 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE MAYA MCCLURE(404)995-3206 OR AFFORDED BY THE POLICIES DESCRIBED HEREIN. TAM[ROUSE(404)995-3430 FAX(404)760-5663 COMPANIES AFFORDING COVERAGE 3475 PIEDMONT ROAD,SUITE 1200 ATLANTA,GA 30305 COMPANY 100492-IPUSA-GWA-03/04 A STEADFAST INSURANCE COMPANY INSURED COMPANY - THD AT-HOME SERVICES INC. B ZURICH AMERICAN'INSURANCE COMPANY' DBA THE HOME DEPOT AT-HOME SERVICES,INC. HOME DEPOT USA,INC. COMPANY 2455 PACES FERRY ROAD NW C NEW HAMPSHIRE INS COMPANY BUILDING C-8 ATLANTA,GA 30339 COMPANY D AMERICAN HOME ASSURANCE COMPANY COVERAGES Thls certlfcate supesedes and replaces any4prevlously,issued,certifcate for,ihepollcyEpenod'notetl•below, 3 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDDIYY) DATE(MMIDDIYY) A GENERAL LIABILITY IPR 3757 608-01 03/01/06 03/01/07 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' _ PRODUCTS-COMP/OP AGG $ 4,000,000 CLAIMS MADE Fx_]OCCUR 'OF SIR:$1,000,000 PER OCC PERSONAL&ADV INJURY $ 4,000,000 OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire) $ 1,000,000 MED EXP(Any one person) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-03 ADS 03/01/06 03/01/07 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $' SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) X ELF-INSURED AUTO PROPERTY DAMAGE $ PHYSICAL DAMAGE GARAGE,LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACHACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND 6610998 AZ ID MD VA we srATu- OTH G ( ) 03/01/06 03/01/07 X TOR ERi EMPLOYERS'LIABILITY. C 6610995(ADS) 03/01/06 03/01/07 EL EACH ACCIDENT $ 1,000,000 G THE PROPRIETOR/ X INCL 6611326(OR) 63/01/06 03/01/07 EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERS/EXECUTNE NY,WI E OFFICERS ARE: EXCL 6610999( ) 03/01/06 03/01/07 EL DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER WORKERS - E COMPENSATION CONTINUED 6610997(FL) 03/01/06 03/01/07 D 6610996(CA) 03/01/06 03/01/07 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS 'CERTIFfCATE HOLDER CANCELLATfO N � u3; SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL An DAYS WRITTEN NOTICE TO THE. FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: WalterGilstrap y < va t MM1(3102) a f x VALID AS OF 02/27/06 s s E ha r, cM'a., .x ,,,.,>..gy,t,,>",... ' 43�,•R' ..., a,r�r. ,<.. 3��. <��.,aa I .:... .n?),i ,A'r Danya Mahot 7743230034 p. 4 HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: Branch Name: .,•i i�'l�'t Date: !(. +'� �`� THD At-Home Services,Inc. —► '- d/b/a The Home Depot At-Home Services } r�.�, �) j'1,' 345A Greenwood Street,Worcester,MA 01607 Branch Number: ! . J J Job#: :" / 71, Toll Free(800)657-5182; Fax: 508-756-2859 Federal ID tt 75-269MO ME Lic'it C 02439 Rl Cont.Lic4 16427 CT Lic#565522; MA Home Improvement Contractor Reg.#126893 I Installation Address: M y State Zip Purchase s: Lost Digits or Driver's Lie 10&Ex .Mo/Yr: Work Phone: Home Phone: Home Address: N N - (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): N Project Information: I/We/You("Purchaser."),the owners of the property located at the above installation address,offer to contract with Home Depot U.S.A.,Inc.("kIQ )to furnish,deliver and arrange for the installation of all materials as NV described on the attached Spec Sheet ir: ll � incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS Q (Suhjcel.tofundverificationand,or credit approval.)I. Check,Cash iers Check orCS Postal ServiceMoney OrderCONTRACT AMOUNT $ � (Made payable to The home Depot). *LESS DEPOSIT $ 2. Credit Card'and/or other payment options-Circle One Below Visa MasterCard Discover American Express BALANCE DUE I'he home Impmvement.Loan. She home Depot Cn dit Card ON COMPLETION $ 310) 0 New Account I"�7161 ina Account (IIIL&HDCC ONLY) 'Minimum 25%of Contract Amount due upon execution Available CrtAlt:S (IIIL&IIDCC ONLY) f this contract. / Acctlt:W!J 13�rr): 0�!%Exp.Date: Indicate Payment Method For Name as it appears on card:_Ay ^1��V v"V lTI7 S BALANCE DUE ON COMPLETION: +13y ;oar signature xlow,I-VUe agree to allow•Home Depot to charge the above ref ended credit car ' r t c deposit indicated. i #h� bIA3 -/0 ee.Sgnature Date HIL or HDCC Authorization Codes ` Deposit Final Pa went # ) � # U Purchaser agrees that, immediately upon satisfactory completion of the work, Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement: This agreement and its attachments, including any financing agreement, contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled..to a completely filled-in copy of the contract at the time you sign. Keep it to'protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract" You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of , Cancellation for an explanation of this right. There will be a service charge;equal to 25% of the contract amount if the job Lc cancelled by Purchaser AFTER the third business day. BY MY.,OUR SIGNATURE-BELOW,UWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. YWE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT T1 - AGREEMENT IS SUBiECT, TO REVIEW OF MY/OUR CREDIT HISTORY AND 1/WE . THORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT AEPbRT94C/ AGENCY AND RELEASE THEM FROM AM, LIAMUTY INCURRED FROM Purchase s: Last 4 DI is of Driver's L.ic #&Exp.Mo/Yr: Work Phone: Home Phone: 4 n { N)A- { ) ( ) Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive updates and'promotions from The Home Depot): N Proiect Information: I/We/You("Purchaser"),the owners of the property located at the above installation address,offer to contract with Home Depot U.S.A.,Inc.(" )to furnish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet#; _>incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS ��ti��'� ( (Subject to fund verification and/or credit.approval.) Al 1. Check,.Cashiers Cltcck or US Postal Service Money Order td 1"� CONTRACT AMOUNT $ (Made payablC to The Home Depot). r2. Credit Card*ondior other payment options-Circle One Below *LESS DEPOSIT $ 1 Visa MasterCard Discover American Express BALANCE DUE The Home I mprovernent Loan fhe Home DC pot Creche Card ON COMPLETION $ ❑ New Accowrt I xisting Account (HII,&il11CC ONE?') *Minimum 25%of Contract Amount due upon execution Available Credit:S (r1I1,&11DCC ONLY) f this contract. Acct#:Ov7 •�Gl �!/"�[ G cp.Date:__ — ,`1A, t f Dame as it appears on card;___ Indicate Payment Method For BALANCE DUE ON COMPLETION: •By our signature below,11We agree to 4dlow]dome Depot to charge the above re r ecd credit car r t e deposit indicated. h l er's Signature Dale HIL or HDCC Authorization Codes Deposit Final Payment # 6 N Purchaser agrees that, immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to bej ointly and severally obligated and liable hereunder. Entire Agreement: This agreement and its attachments, including any financing agreement, contain the compete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely flled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion Certificate.before this project is complete. Law prohibits home repair, contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will-be a service charge equal-to 25% of the contract amount if the job is cancelled by Purchaser AFTER the third business day. BY MY!OUR SIGNATURE BELOW,I!WEAGREE TO BE BOUND BY'ruE,TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE RECEIPT OF A COPY OF TILIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE, BELOW, UWE UNDERSTAND TILVI' THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND 1/Wf WTHORIZE HOME DLPOT TO VERIFY ,,.ND REVIEW MYiOUR CREDIT RECORD WITH AN INDEPENDENT CREDIT ;1tEP R'T s AGL'NCY AND RELEASE. THErV1 FROM ALL LIABILITY INCUBI. E•D FROM INADVERTENT OMISSIONS ( or Xli t/q LS. DO NOT SIGN THIS CC'rf'TRACT IR THERE ARE ANY BL.4 tK SPACiiS. SUBMITTED BY: �' r ',r.Lr.:_' Date:J� I� i y.ales Coqp aat ACCEPTED B Daie: ,Homeowner ,�r/11oS' 17 /.0 Date:ll Homeowner NOTICE:ADDITIONAL.TERNIS,COYDITIONS AND WARRANTIES ARE s,rA,n o ON TILE REYI:ItSE SIDS';A11,1D:aRFd PART 01,1'1it S CON'rit\CT While:.nranchFilc Yellow-Customer Pink-,Salts Consultant 12-5-05 C-SC S •cl t,E00EZEbLL 4ot4eW eRueci SHED REGISTRATION location of shed(address) I ►J� i u uVl 1©71 S , l� LAM DTI 5 property owner's name xID size of shed -97 gnatu date Old King's Highway Historic District Commission jurisdiction? `}yU THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN shed - a ' �GOL Oof f.3 cErs��Kr -X�lorE; ^ssuMLp LaT �°Ic�T'EcTleR��+Ei2 Ajer=" � o 19 Sir 'r10 "{ V 19'� . t Of 9 s qo � L ^ . �y� R cl ' CERTIFIED U.::T PLAN I�OBERT zt ELDNC'D^,E �;,' f✓YA is .000,e IN SCALE G AgWIVE EN��� '�sv: �' [ CERTIFY THAT THZ FO��'DATio.v1 -� SHOWN ON THIS PLiLiN 18 LOC J[AT o ®1!lTERED rlRgSIBTgRD �p11 © � ON THE anouND AS 1 MCATIED Alm CIM LAND q� i �µENOINEE;'° Lsu;J4myolt ,: DT'... :. NFOIt�Oa TO ...E F:` NIiiA LA1�. :• u OF D�.OtN °r'AI! E M� 71 MAi N STR +0� N`'A N R I St M ilS S. SHEE`�A,�.OF..:.... 0 O►TE � REa. LA��0 sUItVEYOD } f 2✓ TOWN OF BARNSTABLE Permit No. 2$100. ---------------- ��� Building Inspector cash e o 8 ----------- OCCUPANCY PERMIT Bona Issued to Bayside Building Co. `Address a Lot 5A, 1 Peacoc Drive, �apsf- N,rgn"iQ-.nnrt- Wiring Inspector <�,,•�J II Inspection date Plumbing Inspector Inspection date Gas Inspector ow, Inspection date XEngineering Department � 9' i—', Inspection date - Board of Healtli. �- 1�a Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .......................................................z/ 19 .� � ---�— ......__ `............................Building ..Inspector......................_....._ o 1 ��'�°` �►ew TOWN OF BARNSTABLE BUILDING DEPARTMENT _ �aBaaT S TOWN OFFICE BUILDING rat HYANNIS, MASS. 02601 '�o rn�r►. MEMO TO: Town Clerk FROM: Building Department DATE: G` o7, An Occupancy Permit has been issued for the building authoriied by- BuildingPermit #.......... ........................................................................................................................ ...................................._. issued to S'f<t, '....r°� /f lJ i�,rr'..:e S ..... .��....'.....�� ���f.. ,. y� Please release the performance bond. THE MARNSTAM E. BUILDING INSPECTOR TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ' | Diagram nf Lot and Building with Dimensions Fee _______________ � 0J0B3 TO APPROVAL OF BOARD OF HEALTH � ' ' ` \ \ / ^ | . � OCCUPANCY PERMITS REQUIRED FOR NEWDVVE0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above Nome , --..�_, --__--____., »r �� x~�' �/{ -- Construction Supervisor's License —~.'.���.^.+--.. BAYSIDE BUILDING CO. A4 21-100- One Story No 7 Permit for SiAgle Family Dwelling ............................................................................... Location ..Lot 5A, 1 Peacock Drive ............................................................. West Hyannisport ............................................................................... Owner Bayside Building Co. ..............................:................................... Type of Construction .....game ................................. ............................................................................... Plot ............................ Lot ................................ Permit Granted ......June... 6i................19 85 Date of Inspection ....................................19 Date Completed ......................................19 CJ O �A , Assessor's map and lot number /``:(f�j,�...a�Z�<r�(....... arF`� THE t0 Sewa a Permit number Jgo ! �e INSTALLED IN COMP IAK a House number ...... . ........ ..................................................... WITH TITLE 6 L e�AGa is. 039. ENVIRONMENTAL C00C TOWN 'OF BARNSTABLE BUILDING ' INSPECTOR APPLICATION•FORS PERMIT TO ..: /z�/D .......15!GU .....� ?4.. ! . .................. TYPE OF CONSTRUCTION ......//`'. 4��Y...... .'! `' . ..................................................................................... �L l........ ..!C..............19 TO THE INSPECTOR OF BUILDINGS: _ The undersigned 'hereby applies for a permit according to the following information: Location .../9..T......6D�..... 1`7�.4�lJc., ....... /..vZ`................. .................................................... ProposedUse ..... /..4 .' .` ...................................................................................................................................... Zoning District ..........�..-. ................................................Fire District ...........V .�.5............ ............................... Nameof Owner ..... 41.je....t .....4r�..... ..Address ..........i� ........................................................... Name of Builder .........V.... .�".�!!L-Q....................................Address ............L. .........................................................:. Name of Architect .......S.�f�... .Ock ..6,>........................Address ...........ia.............................................................. Number of Rooms ......... Foundation .......... )P /..... !LL°. ......................... Exierior ..... ................................................Roofing ......... Floors l9'� U ��^' .........Interior ......... .......e . ., ..e :......... ........�-. ............... � . .. .,. ...0 .... ............................:... Heating ..... ....0 f..... ..... .. 5..............................Plumbing ....C.rt,J� /� .... ... �C ...... Fireplace ......ii�&(..C.�........�.......� .&....................Approximate Cost ........71�`..0..//.�......................................... t Definitive Plan Approved by Planning Board ________________________________19________. Area ....,1.1.. ...................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH V� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLI �S t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .vl'L�_.. .. ................................ Construction Supervisor's License ... yS.......... BAYSIDE BUILDING CO. t IT �8100 One S o No ....... ........... Permit for ..................................... !'Single Family Dwelling ............................................................................... Locat[6n ....Lo.t...5A.......I..P.e.aco.c.k Dr.i.v.e....... West Hyannisport ..................... Bayside Building 'Co. Owner .................................................................. Frame Type of Construction .......................................... . ............................................................................... Plot ............................ Lot ................................ Permit Granted .....j.kjAjp_Z�.q..................19 85 Date of Inspection ....................................19 Date Completed ..... ........................1,951-�--- G17 I5 r # NI K n k, e�dv�E,' ACS 0A4sp. Ga s CA x �. /emu� z .40,r�� 1 7 t \V! /g P�1131 9s V• V4 S Po i �.16zw 19 zv x a < ti�� ..ski .� •,q .. r CERTIFIED PLOT PLAN , :y.A aoET 'r firh cs 13. ti E L D H ED, GLi. v� , r rf a` s J `; Pdo 19367 Lc� f/Y/ �4./�t is oo e T ii 8CALE�'/ _ �/o DATE it r 2ys��E t CERTIFY THAT THE roalvo f g � I 0 SHOWN ON THIS PLAN 13 LOCATRO 0 RT�RE_ RE0ITERO 5.., a 1, ��aCIViL LL/INO k <`'; JO1, 00• �`°c. �.s. ON THE GROUND AS INDICATED <�( ' q-.2 ''i€NAINEER E ', eURVEYOR ��� � G� C41�ORMS TO THE ZONIap l.Ai�# � � r OF DARNSTAB E MA8 Stp Ja kt t i ,' k k� 5 �E , ;arnSr T12' MAIN STREf '�tlr ` RYA iVPliS, ''PASS. DATE RE®. LAND SURVEYOR