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HomeMy WebLinkAbout0334 STRAIGHTWAY 33f S��r �HTw .�--z� Town of Barnstable *Permit# Expipa 6 months from issue date a� Regulatory Services TOf 1 Richard V.Scali,Director � NSrAB Building Division' 'Tom Perry,CBO,Building Commissioner , - _200 Main Street,Hyannis,MA 02601 — _www.to_wn.barnstable_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 g (D Property Address 3 3 S ❑Residential Value of Work$ r Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address P Ct-A Q yl Contractor's Name (� i(� Gc � r-`� "' ` c�.r- 4 Telephone Number S© R O O&5-1 Home Improvement Contractor License#(if applicable) Email: 60,11 C-"A G ,r d Q A D •r�'y Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance t Check one: - I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance r Insurance Company Name ��!h ��' �- "``3 V'CA,"`Ox Workman's Comp.Policy,# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All'construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) " ❑ Re-side , ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: moke/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 Owner must sign Property Owner Letter of Permission. . A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 ' The Commomvea h of-lased jusetfs = . Deprrhnerit.aflnihaftid Accidm& J E}fflCe GAMWS69,dims 600 Washi gtou Street Baston,.A"02111 ' wymmm govldia `-- — Warders' affipensan Iusi-ance rav n itdeislC� fraci�rslElecbr�ccans(Pliers - APPHcanf Infctrmai an - /!-- f—— - ---Please-F`rinf f -- = Name 4Pasinessta, ti.ladvic3nal Addr 2T C,(-V\� Sfi city/state c � Phone-g_- o .? �� 077113 Are you an employer?Check the appropriate bow Type of project(required)- I.❑ I am a employer uift 4 ❑I am a general contractor and I' 6. ❑New construction r1amI ees(full anwor parttime * #rave hiredthe sub-contractors .2. a sole prqpaietm orpaituer- d on the a4t shed sluff 7' ❑model ug ship and have no emmployees 3hese sub-coatracbzs have 8 ❑Demolition worlam g for me in any capacity: employees and have wodzers' 9_ El Building addi�og [NO Wodrars,comp.insurance- co=p_mertrantp$ - re ui�ed] 5. ❑ We are a corporafifla and its 10-❑Electrical repairs or adc5tions 3.❑ I am homeowner doing all wock officers have exercised their 1L❑Plumbingrepaim or add7tiems o v 06mrs' right of exemption per MGL- � �F- 17❑Roafregairs insurance required_]i c.I52,§1(4k and we hwe no employees-[No wodoers' W 13.❑tither . comp-insurance required.] 'stay,spplic 6=tchecksbosrl— elsoMoutthesectionbeIawshmdagdrk offseWcompensatiouporieyi�urmsaML IHameowaEm who submit d&a Edatdi;r•fr=r;•,g they are&ingalpwalautldm him onisidewatmcmrsamstsahmita new afndsritindicantsuch_ ICan=--to s that ehedt this box must attached an additiamsl sheet sboming the name of fe sob-ccatmtmes and stye whether or not those effiitk s ham emphryees.'If the mit-c=bactomhave Employee%dLeynaisr pro-vide Yhek wo&e&camp.palb7 number_ I ant an eznpinyer that is pmv dirW workers compensation inmiranae for azy empkyvesBelow is thepaucy and joh she infarmatiass . Insurance Company Name: Pfliicy�of�ro:s.Iic_�: F�pttntroszDate: • Job Site Address✓ CitylStawzl p: 4 Aftach a copy of the workers°comzpensationpolicy declaration page(showing the policy number and expiration date). Failam to secure coverage as requiredun ier Section 25A of MGL c�1572 can lead to the imposition of cri.n;nah penalties of a fine up to$1,50aOD andror one-year imprisonment,as well as civil penalties in the faun of a STOP WORM ORDERand a fine of up to$250-00 a clay against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations ofthie DIA for insurance coverage veEifsfian. Ida hereby csrrfify rssuler tha,si&zs and penalties o,fFet�zcry fJtatfJte irtformafimi prm &d abmv is hate mid correct Sit zattrre: Date- phone ik ?7 a 7 0jokial use only. Do star write in thb area,to be campletcad by city artomn oiciat City or'l'awn: P'ermdtlLicense# Issuing Aufhor€ty(cacIe one): 1.Board of Health 2.Building Department 3.CifyfF'own Qerk d Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person Phone#: aarm.atian and In.strucfion.s , Mass�setfs General Laws chaptm-152 regffnes all employes to provide wolkeas'compensation for their c:mpIoyees. ' Parmzz ntto this stern,an.MPIoyee is defined as-"-.curry Person in the service of an other uMder any contract'of hire, express or implied,oral or wr>ifnu." An eznproyer is defined as"air mdividnA parfnershi;p,associa i6n,corporation or other legal enihY,or any two or more of the foregoing engaged is a j oint use,and i achzding the Iegal Fepres �of a deceased employer,or the receiver or tustee of an individual,partnership,association or otherlegal entity,employing employees. However the owner of a dweIIi ag house having not more than tb=apartments and who resides theorem,or the occapant of the - dw ffing house of anoi`hec who employs persons to do mafitmaace,c mst uc ion or repair woik on such dwcEi ag house or on the grounds or btu'Idmg appmrnanttherefo shallnotbecause of such employment be decmedto be an employer." MGL chapter I52,§25C(6)also stains that aevmT state or local licensing agency Shan witShoId the issuance or renewal of a hceFuse or permit to operate a business or to con_stract bwIffiags in the commonwealth for any applicant who has not produced acceptable-evidence of edmp&anm with the ins once coverage required." Additionally,MCx-L chapter 152,§25C(7)states-Neither the cammaaweahhnor i'3y of its political snbd'idsions shall enter into any contzact for the perLv:once ofpublio woricuntil acceptable evidence of compliancewith the insuranc-6 requrLmmenfs of this chapter have been presented to the contracting anthodty_" - APpficants Please fib otrl the v,workers'compensation affidavit completely,by checl®g the boxes that apply to your situation and,if necessary,supply sob-contractar(s)rame(s), addres (es)and Phone number(s)alongw&their c rbficate(s) of insurance. Lfi itedLiabEityCompanies(LLC)orLimitcdLiabffity'Partaeabips(LLP)withno empIoyees otherthmthe members or partners,are not required to carry wo6cers' compensation msozmce. If an L LC or LLP does have employees, apolicy is rtquirecL De advised that this affida-Th may be submitted to the Dopa-imam of Indu-stiial Accidents for confm ation ofinsa ance coverage: Also Wmre to sign and datethe affidavit The affidavitshovld be retnmed to the city or town that the applicafion for the pemtit or license is being rvInested,not the Departmeat of hri-rtstrial Accidents. MLauldyou have any gnrs'tions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the nnmber Ii_sted below, Self-msin-ed comp=cs should='Lrx their self-iIIsorance license n:omber on the appropriate line_ City or Town Officials . Please be su' that the affidavit is complete and primed legibly. The Departoacnthas provided a space at the bottom of the affidavit for you tD fill out in the event the office of Inve st igati=has to contact you regarding the applicant Please be sine to fM in the pen;aiVlicease m abets which will be used as a refermce number. In addition,an applicant that must sobmit multiple permit Hcense applitstions m any given year,need only submit one affidavit indicating cun-ent policy inffbmation Cif necessary)and under` ob 5`ife Address"the applicant should write"all locations in (may or town)-"A copy of the-affidavit that has been officially sinmped or mailced 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 cifi=is obtaining a license or pezmif not related to any busfi=s or commercial veatr-ue (Le, a dog license or peunit to bum leaves etc.)said person is NOT reg�to complete this affidavit The Office of Invesiigadons would hie to thank you in.adymce for your cooperation and should you have any questions, please do not hesitate to give us a call- The Department's address,telephone and fax number 'I1e C-aattfiE taf us�#s DEegadma nt C&1nduStiat Aocidents f �e of J.VeStkat[o)V� Bwtau,MA 02111 Tf,-1.:'617' -4900=t 4-06 or 1477 MASSAFF Fax 9 617-727'749 Revised 4-24-07 1n .�Q��d� 9� ,�� ToWn of Barnstable QED MA'11. . Regulatory Services ` Richard V.Scali,Director ...... -- — --.�J Building Division --- _. Thomas.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 GJ1'4:Lr'4►+i G-a6:ea2 TiW c,'st J to act on my behalf in all matters relative to work authorized by this building permit application-for: 33 s, �-� (Address of Job Signature of er Date , WE��A]t2 V Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. f Q:\WPFMES\FORMS\building permit forms\EXPRESS.doc , Revised 040215 Town of Barnstable A Regulatory Services ;r �oFtHE r4 Richard V.Scali,Director Building Division * 31AJWSrr.4J3M ' Tom Perry,Building Commissioner MASS. 1659. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# . CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval ofBuilding 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 are unaware that they are assuming the responsibilities of a supervisor (she 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 Supervisor. On the last page of'this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFMES\FORMS\building permit forms\EXPRESS.doc Revised 040215 I OATH t3 f'3 p�`� m o o, WDIM t3 O , t3 Sim �7f3 SCCOND FLOM-4m So. FT. ®y 3 "• �3 3 3 l7 . • 07 CLOS Y ® eats-%oL ifs C24' CLOS aos y RIF d o gs tG �� W se m m CU DO m m '� m Oo T �• 31 m NOT TO SCALE _ FTQST FLppp. .. ' 816 S0. FT. 3 � n ma Z O TOTAL LIMNS AREA:IZM S0. FT. c nv, o iD 2 m m v ZL' 4-CF4 7-ek I:1) G5 17 �y7 11�i r-o t C5 0 0 /'� e.'' G3o {3•�p� Bari-., +tnooa.8i4.s4 FT. Pr t Town.of Barnstable *Permit# G� Expires 6 months from issue date j Regulatory Services Fee '- 4 sextvsTAst E rrnss.1639. Richard V.Scali,Director Building Division . IT Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 NOV 13 2014 www.town.bamstable.ma.us Office: 508-8624038 TOWN OFFRAo� ®E EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Addressn ' 62X. �f Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 /Owner's Name&Address All�/ Contractor's Name e G /,e Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's,License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ; ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to i ❑Re-roof{hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side D/ 3 [� Replacement.Windows/doors/sliders.U-Value maximum.35)#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: Properly Owner must si Property Owner Letter of Permission:' A copy of the Ho rov ent Contractors License&Construction Supervisors License is SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doe Revised 061313 To whom it may concern, All Trades-Douglas Cardinale is a sub contractor for Lowes of Brockton Ma. Please feel free to contact the store with any questions. Thank you, Install Sales 135 West Gate Drive, Brockton, MA 02301 Phone: 508-897-0067 Fax: 508-897-1720 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): LS Q/Of Address: lU®( Z_ IS City/State/Zip:. IV &e, hone#: e g`" 3 �D Are you an employer?Check the approprta-box: Type of project(required): 1. I am a employer with • ❑ I am a general contractor and I T?i * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition. working for me in any capacity. employees and have workers' [No workers'comp.insurance comp. insurance.+ 9. ❑Building addition required.] f. ❑ .We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am.a homeowner doing all work officers have exercised their 11:❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the seIction below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an addition1l sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they m�st provide their workers'comp.policy number. I am an employer that is providing workers'compensadon insurance for my employees. Below is thepolicy and job site information. _ f Insurance Company Name: �3 Gt'G>i Policy#or Self-ins.Lic.#: � io .6j �� '` �9 Expiration Dater Z/ 7� Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration p e"(showing the policy nu er 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 imprisonr�nent,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. Bel advised that a copy_of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verificati n. I do hereby certify u n ena th a information provided above ' true a d correct. Si ature: 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.Building Department 3.City/Town Clerk .4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:-- I Phone M i L.� f � ►t IT ME VEONT ' ton ! ' # Ott 13 1r Z 3 4 CA . n:• r a'p 4.' t LA D. 14A Niil _ T 2 � r; 4• L y. ,. _ _ �a3t. ..ce �-, , '" S . M ': I - . w. 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' a. k: ... , � -�%.� . . . . , .,.. r i I /�� v rirrnni�rnra�!/n C' r�.�nr�ntrM Mee of Consumer Affairs&Business Regulation,_ g License or registration valid for individul use only ME IMPROVEMENT CONTRA6TOR before the expiration date. If found return to: Registration: 148688 TYPE Office of Consumer Affairs and Business Regulation _ 10 Park Plaza-Suite 5170 Expiration: 10/18/2015 Supplement:;ard Boston,MA 02116 LOWE'S HOMES CENTERS INC _ ROBERT ABBOTT 136 TURNPIKE RD.SUITE 100 A7 SOUTHBOROUGH,MA 01772 i - Un'dersecretaq Not valid w" out signature j i • i i I I i i I ,I I j • i , i I i i i r i j I G a0 - NOTICE OF RIGHT TO CANCEL Your Right to Cancel You are entering into LOWE'S Installed Sales Contract!Number y�A) (the"Contract")that may result in a lien or security interest on your home in which property(the"Property")is to be installed pursuant to the Contract. You have a right to cancel the Contract,without cost,penalty or obligation,at any time prior to midnight of the third business day after the latest of(1)the date of the Contract;which is 1h) ­2 f�e (year),(ii)the date you received this Notice of Right to Cancel,and(iii)if you have paid or will be paying for the Contract by using your LOWE'S private label credit card,the date you received your Truth-In-Lending disclosures in connection with such credit card. Effects of Cancellation If you cancel the Contract,the lien or security interest on your home is also canceled. Within 20 calendar days(except in Connecticut where the period is 10 business days)of receiving your notice of cancellation,we must take any necessary steps to reflect the fact that the lien or security interest on your home has been canceled,and we must return to you any money or property you have given us or anyone else in connection with the Contract. You may keep any Property we have given you in connection with the Contract until we have done the things mentioned above,but you must then offer to return the Property. If it is impractical or unfair for you to return the Property,you must offer its reasonable monetary value..You may offer to return the Property at your home or at its location if different from your home. However,if you offer the reasonable value in lieu of the Property,the money must be returned to our business address shown below. If we do not take possession of the Property within 20 calendar days of your offer or accept the money within 20 calendar days of your returning it to our business address shown below,you may keep it without further obligation. How to Cancel If you decide to cancel the Contract,you may do so by notifying us in writing, by mail,telegram,or personal delivery, at: (Store No.and Street Address) (City) (State) (zip) You may use any written statement that is signed and dated by you and states your intention to cancel,or you may use this notice by dating and signing below. Keep one copy of this notice no matter how you notify us because it contains important information about your rights. To be effective,you must drop your cancellation notice in the mailbox,file it for telegraphic transmission,or deliver it to us by other means at the above address no later than midnight of (year) (or midnight of the third business day after the latest of the three events listed above). WISH TO CANCEL. (CustomePs/Resident Owner's Signature) (Date) ACKNOWLEDGMENT OF RECEIPT OF DISCLOSURES AND CERTIFICATION On this day of (year),each of you hereby acknowledges receipt of two (2)copies of the foregoing Notice of Right to Cancel;each of you who is a party to the Contract hereby acknowledges receipt of one(1)copy of the fully executed and dated Contract; if any of you has paid or will pay for the Contract by using your LOWE'S private label credit card,you hereby acknowledge having received the Truth-In-Lending disclosures in connection with such credit card;and you certify,represent and warrant to LOWE'S that you are all of the customers who signed the Contract and all of the persons who own and reside in the home in which the Property is to be installed pursuant to the Contract. ` (SEAL) (SEAL) (SE�# (SEAL) (Witness) THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A- /��C& DATA a,zi '-'� e�' " `�7'e d �'. . ' � x CONTRACT# 1 00G�� F ^.- ��� �"" ��` ' 'S' - a* � R `�. + .. 1,�,cif - �. ''> .� z'� 3• �r�"`r u MASSACI�U,sSET�I' LOWE'S AUTHORIZED RE RESENTATIVE NUMBER CUSTOMER t8 i T � STORE N0. STREET ADDRESS STREET ADDRESS ..w ,^,zr�ry�,,�-i t� y ' e � tx i•`'i W1 �� 1 �. '� � ° v '.i}(� -.> ri- r a } CITY STATE ZIP CITY STATE ZIP r : x 5 � � - Y•- , ( Yb_ J€£ Ell- Jr Ld 3 1C..3 ? f TELEPHONE TELEPHONE r j r z DATE LOWE'S HOME CENTERS,LLC S MA HIC NO.: 148688 � � CASH � n;BANK u a Lcc �` REG � ?OF ` FEIN 56-0748358 re CARD CHARGE �� r ;,i.w.; b '; ,r*. seas .,.'a+o- ..k... e t Tfiis 1s:only a ggote�for the merchandise and;services;pantedtttel his:be,wrne an;agree eat uponJpayment. Upon payme,� :e,-en6re,a reement i chxiir tfie-"s eaficall coin le[ed- es'of * �` a.INIP ,•. x� -rr . ",�. , docume 1``ffie Terms�a�d Conditions iFlcl�uled nth�fhis�doe�ume�nt and any otherxtldenc�a�and a a menfs hereto-shall be;refe ed to herein as this=MConhacf_' ,-�, °h' i �-y�r� �a•. .. t X�'s r��.-: r;-° PLEASE:READ`A1LT,ERMS,�`AND§CONDI710NS�ON fiHE F3EVESE SIDE OF<lHIStP,AGEA'ND"I OLLOWING AGES INSTALLATION STREET ADDRESS CITY STATE ZIP `` q.,.' - i'"°xw f>qi`-�•. I eel ,� ,f+..- '.' JJIt: Y l_. .,8,., i2r -:.0 t S�t�tia'tt b�.t,9 rS�k 1'4 nT •: A3 t •as,A—F "k•.,,s"'," F !#�., �=E�i,. 1... - ij''K -J. ° A I ,Yk'; !. s if JA #i3.d l 9 S •.t J f'.:r"^T AYE.', hsk f'. i d i.,.t .✓ .�j f ref`^ c.A,1. s f NOTICE TO CUSTOMER—PRICE CALCULATIONS: In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on.the measured square footage of the Project Area.As a result, the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. Contract Total Are permits required for this installation?: [/(Yes [ ] No *applicable tax included s,' ' E C ) 5 f' NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the,pamplet Renovate Right. By signing this Contract, Customer acknowledges having received a"copy of this pamphlet before work began informing Customer.of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. NOTE: If rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order must be completed and signed by the customer for any additional charges. Customer must initial. *Any work or material not specified is not included in this contract.Any changes or additions will be a1'an additional charge for the material and labor. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and' interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's-to copyright,use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,in�luding';but not limited to,marketing, advertising,publicity, illustration,training and Web content. By initialing here,Customer agrees to the foregoing,_,` % .---[Customer to initial to the left]. Work is to commence upon reasonable availability of Contractor and/or any special order orcustomer made Good(s)which is anticipated to be [fill in date].Estimated completion date is r,`:< [fill in date]. Said estimated substantial completion date is not of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable, insert-a statement of such contingencies). IF:THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. 1,COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [sr"Customer to Pc ay Full; OR [ ]Customer to use the following payment schedule: (1)Deposit to be paid upon signing contract. Deposit should be 1/3 the total contract price;and _:. (2)Payment of $ `s :r to be paid anytime-after this Contract is signed and'before commencement'of-installation;IfWe authorize Lowe's-' to do one.of the following(check.appropriate.box below). r�;. [ ]Charge my/our credit card for the amount of the payment indicated above anytime Ater the date this Contract is signed; or [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c 142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OONSUR AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PRC3 piffb-IN M.Gy By: _.%!,'��� .' Dater ,4 Lowe's Home_Center. LLC ,. By r Date: F.) ,(lwnar Crnriafirrc - _ PHOTO RELEASE:Customer.grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in i id to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowes-to copyright,use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful pu ose, n udittg, ut not limited to,marketing, advertising, publicity,illustration,training and Web content. By initialing here,Customer agrees to the foregoing, 1-) � ' '`[Customer to initial to the left). Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be s'r0 2 /`/ [fill in date].Estimated completion date is-Z .-.2/-/-/ [fill in date]. Said estimated substantial completion date is not of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable, insert a statement of such contingencies). :IF.THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [P1"E ustomer to�pyjjrt Full; OR [ ]Customer to use the following payment schedule: ..(:1)Deposit $ `if to be paid upon signing contract.Deposit should be 1/3 the total contract price;and (2)Payment of $ J � �— to be paid anytimera#fefthis-Gentraet•issigri rid hefgre eomrnensementvf irrstallafion;l7VVe authorize tbwe's to.do one,of-.the following{eheek,appropriate,box below}: Upcyl [ ]Charge my/our credit card for the amount of the payment indicated above anytime fter the date this Contract is signed; or [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUB>ff SU(,p DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE O rONSU AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT.TO SUCH ARBITRATION ASP DIN t M.G By: 1,. Data: 9 �' Love's H e Center LCC B L, i' as y. , -�: . Date:. f�? /Owner Signature THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY O'THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED , BY LOWE'S PURSUANT TO M.G.L.c.142A..THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.Y U ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUAND(SND SEAL(S)BELOW THIS DAY OF Lowy' Home C s, LLC Lbwe's Au t`i-o'nt 'zed Re re entatve OwneF�_V Co-owner or Witness Ctist mer acknowledges receipt of a true copy of this contract which was completely filled in prior`fo"Customer's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. FILE COPY ©2004 by.Lowe's.@ Lowe's and the gable design 55102 REV. 12/13 are registered trademarks of LF Corporation. SSZR135A LOWE'S HOME CENTERS, LLC BRM 1174 PAGE-•. 2 . DATE: 11/03/14 135 WEST GATE DRIVE BROCKTON MA URDERED FOR: PAUL HENRY PHONE: (508) 897-0067 ADDRESS: 334 STRAIUGHTWAY HYANNIS MA 02601 PHONE: (617) 605-9068 VENDOR NAME: UNITED WINDOW & DOOR MF CONTACT: ADDRESS: 24-36 FADEM ROAD PHONE: SPRINGFIELD NJ 07081 FAX: ( ) - PROJECT: 421451785 WHOLE HOUSE LOWES PO: 738966300 LOWES INVOICE: 78035 ASSOCIATE: CHARLES BUBELLO EST DELIVERY: 11/11/14 AR NUMBER: QTY ITEM ITEM DESCRIPTION BIN VEND PART# - COST EXT COST ------------------------------------------------------------------------------------ 4 266251 REPLACEMENT 4800 BASEMENT REPLACEMENT 88.43 353 .72 43 UI *** .15% OFF PURCHASE OF SPECIAL ORDER WINDOWS AND DOORS. OFFER VALID 10 /01/2014 THROUGH 10/21/20 14. *** 1 266251 REPLACEMENT 4800 SLIDING 7 REPLACEMENT 200.07 200.07 3 UI *** 15% OFF PURCHASE OF SPECIAL ORDER WINDOWS A ND DOORS. OFFER VALID 10/ 01/2014 THROUGH 10/21/201 4. *** 2 266251 REPLACEMENT 4800 SLIDING 5 REPLACEMENT 113 .02 226.04 0 UI *** 15% OFF PURCHASE OF SPECIAL ORDER WINDOWS A ND DOORS. OFFER VALID 10/ 01/2014 THROUGH 10/21/201 4. *** 2 266251 REPLACEMENT 4800 PICTURE 1 REPLACEMENT 250.62 501.24 01 UI *** 15% OFF PURCHASE OF SPECIAL ORDER WINDOWS AND DOORS. OFFER VALID 10 /01/2014 THROUGH 10/21/20 14. *** 2 379007 REPLACEMENT 4800 DOUBLE HU REPLACEMENT 130.80 261.60 NGS 80 'UI *** 15% OFF PURC HASE OF SPECIAL ORDER WIND OWS AND DOORS. OFFER VALID 10/01/2014 THROUGH 10/2 1/2014. *** 4 379007 REPLACEMENT 4800 DOUBLE HU REPLACEMENT 135.23 540.92 NGS 77 UI *** 15% OFF PURC HASE OF SPECIAL ORDER WIND OWS AND DOORS. OFFER VALID 10/01/2014 THROUGH 10/2 > 1/2014. *** 2 379007 REPLACEMENT 4800 DOUBLE HU REPLACEMENT 130.80 261.60 NGS 61 UI *** 15% OFF PURC HASE OF SPECIAL ORDER WIND OWS AND DOORS. OFFER VALID 10/01/2014 THROUGH 10/2 1/201.4. *** 3 379007 REPLACEMENT 4800 DOUBLE HU REPLACEMENT 130.80 392 .40 NGS 69 UI *** 15% OFF PURC HASE OF SPECIAL ORDER WIND OWS AND DOORS. OFFER VALID 10/01/2014 THROUGH 10/2 1/2014. *** SSZR135A LOWE'S HOME CENTERS, LLC BRM 1174 PAGE't 3 DATE: 11/03/14" 135 WEST GATE DRIVE BROCKTON MA 1 URDERED FOR: PAUL HENRY PHONE: (508) 897-0067 ADDRESS: 334 STRAIUGHTWAY HYANNIS MA 02601 PHONE: (617) 605-9068 VENDOR NAME: CONTACT: v ADDRESS: PHONE: ( ) - FAX: - PROJECT: 421451785 WHOLE .HOUSE LOWES P0: 0 LOWES INVOICE: ' 0 ASSOCIATE: CHARLES BUBELLO EST DELIVERY: 11/11/14 AR NUMBER: QTY ITEM ITEM DESCRIPTION BIN VEND_PART# COST EXT_COST ------------------------------------------------------------------------------------ FREIGHT $ 0.00 TOTAL $ 2737.59 aco CERTIFICATE OF LIABILITY INSURANCE °ATE` "" 03/26l20142014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies)may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 1 PRODUCER I CONTACT Marsh USA Inc. NAME: 100 North Tryon Street,Suite 3600 PAHiC o Ext: A/C No): Charlotte,NC 28202 ADDRESS: Attn:For questions contact:insurancerequest@lowes.com INSURERS AFFORDING COVERAGE NAIC It 47095-CASUA•ONLY-14-15 INSURER A: National Union Fire Ins Co Pittsburgh PA 19445 INSURED I INSURER B: New Hampshire Insurance Company, 23841 Lowe's Companies.Inc.and subsidiaries including Lowe's Home Centers,LLC INSURER C: Illinois National Insurance Company 23817 1000 Lowe's Blvd. Safe National Casual Co 15105 Mooresville.NC 28117 INSURER D: Safety Casualty Corp. INSURER E: Steadfast Insurance Company 26387 INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-002939185-26 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE ILISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT,WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE IN SR WVD I POLICY NUMBER MM/DDNYYY MM/DDNYYY LIMITS GENERAL LIABILITY 1 EACH OCCURRENCE $ Self Insured-See Below DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY � PREMISES Ea occurrence $ CLAIMS-MADE OCCUR' MED EXP(Any one person) $ _ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ A AUTOMOBILE LIABILITY CA2248403 AIDS 04/01/2014 04/01/2015 COMBINED SINGLE LIMIT 5,000,000 F Ea accident $ _ B ; X ANY AUTO CA2248404 MA 04/01/2014 04/01/2015 BODILY INJURY(Per person) $ A ALL_ AUTOS OWNED SCHEDULED CA2248$05 VA . 04/01/2014 04/01/2015 BODILY INJURY(Per accident) $ AUTOS F NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ I— $ E I X UMBRELLA LAB X OCCUR IPR3799301-01 04/01/2014 04/01/2017 5,000,000 EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE I AGGREGATE $ 5,000,000 DED RETENTION$ $ B I WORKERS COMPENSATION WC019901319 AOS,WC019901317 MN 04/01/2014 04/01/2015 X WC STATU• OTH- AND EMPLOYERS'LIABILITY I - T RY LIM T_$ _ R A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCO195O1320 AK,AZ 04/01/2014 ` 04/01/2015 2,000,000 B IOFFICER/MEMBER EXCLUDED? N N/A E.L.EACH ACCIDENT _ $ _ (Mandatory in NH) WC0199101321 NH,VT 04/01/2014 04/01/2015 E.L.DISEASE-EA EMPLOYEE $ 2,000,000 C IIf yes,describe under DESCRIPTION OF OPERATIONS below WC0199101318 NO,WA,WI,WY 04/01/2014 04/01/2015 E.L.DISEASE-POLICY LIMIT $ 2,000,000 A Excess WC XWC6636270 AIDS 04/01/2014 04/01/2015 WC:Stat/EL:$3mil;xs$2mil SIR A )Excess WC XWC6636271 FL 04/01/2014 04/01/2015 WC:Stat/EL:$3mil;xs$2mil SIR I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 1I 1,Additional Remarks Schedule,if more space is required) Insured is self insured for General Liability for the period of 4/01/2014 to 4/01/2015. . I I CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc. I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE and subsidiaries THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 1000 ACCORDANCE WITH THE POLICY PROVISIONS. Mooresville,NC 28115 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Paula Stapleton pp,�4 �JCR1�p>ta�er� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Town of Barnstable oFIME o Regulatory Servicgs1"r^ �� BAP4,S TABLE Thomas F.Geiler,Direc8�4 JU '4 • BARNSTABLE, 16 9 `�$ Building Division p� 2: S9 A�Fn►�►►'�° .Tom Perry,Building Commissioner 100 Main Street, Hyannis,`yM—XV2.2601—.. - _ www.town.barnstable.ma.us �$ION�`"� Office: 508-862-4038 F - -Fax: 508 790 6230 PERMIT# `7 °7 0 6 S— FEE: $ SHED REGISTRATION 120 square feet or less 4,Jill� S Location of shed(address) Village PA J L Property owner's name '. ` Telephone number Size of Shed Map/Parcel# "Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) !C� PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAYBE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN l Q-forms-shedreg REV:121901 340 m -P 2 9 � k 334 t+ . .......... ............... c:\conservation.dgn 6/4/2004 3:03:07 PM