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HomeMy WebLinkAbout0059 WALNUT STREET (HYANNIS) q-47 �pFIME tpy� Town of Barnstable *Permit& 7L 5 yam? p� Expires 6 months from issue date Regulatory Services Fee 9 MA6S. Thomas F. Geller,Director ArED MA't A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 - Fax: 508-790-6230 EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address u % W*6 N V,(S Residential Value of Work ` Owner's Name&Address Contractor's Name B i 1—RAy Grp Telephone Number 5 0 8.—4 2 2—9 6 9 3 Home Improvement Contractor License#(if applicable) 120456 t Construction Supervisor's License#(if applicable) CD _ - i ❑Workman's Compensation Insurance } ' Check one: 5 ❑ I am a sole proprietor '- ❑ I am the Homeowner i ® I have Worker's Compensation Insurance %`; Insurance Company Name American Workman's Comp.Policy# We 7 7 5 51 51 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) ❑ Other(specify). *Where'iequired:jssu ce of this peimit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg - Revised121901 t, r:y rra tF FJ40''� 7r Yr, .. }.. U7.id4t `T' I SEP-02-2005 FRI 09:46 AM SEARS/BIL-RAY FAX NO. 5083668640 P. 01 •► -�'���,_ SOLD, FURNISHED & INSTALLED BY Sales: 1-666-466-3853 Bil•Ray Aluminum Siding Corp. Service/Repairs: F,I f), No. of Queens, Inc. 1-888-245-'7294 J � 11-2320449 *190 Cedar Hill Road a Marlboro, MA 01752 JOB#_ !�5(14-7MAI NCW Y IJC CITY p01897 NFI L 10 NO-___� �AIASSACHUSETI'S LIC N0,17.0458�VERMONT LIC,NO.NCW YOnk CITY OCPARTtuICNf OF CnNsuI�IER AFfAIHS I IC No.0730665 NASSAU uc.NO 456-VERMO •SOFFu1 K LIC.NO 2t 18dlll �yoNKHODEERS I L N rUTLIC,NO PC9 4 WESTCIIEStFR WCo013—H9r • LONG BEACH GC2001 - NEW JERSEY LIC. NO. 9919269 • CONNCCFIGUT DIPARNENT OF CONSUMER AFFAIRS LIC, NO 00532174 SOLD L ADDRESS �&-r SIDING CON TRACT , I _ �/� J-�'`-� YL DATE— /7/ 01 17E10NE 110ME 6 q)� �F A�^_WORK D� �j b ) ._J_EMAIL— ,10d SITE ADDRESS (IF DIFFERENT APPLIED VINYL & ALUMINUM SIDING General Description of Work at Above Address: Type of House: Frame Q Masonry Approx Start Dato,,,_�.Lo_ A rox Con))lelion Dale Jd ,/ ~` tnralnREs - •�p 1 t - �Q k:L-�(w[ATIIEH 6 MATERIALS 110MITTING) rIRRIN51 I Approved Inalerlals will be furnished and Installed to these spoelflcotions. - PLEASE READ CAREFULLY:ONLY ITEMS CHECKED"YES"ARE INCLUDED IN YOUR ORDER. 1,(,� (D SOLIDVINYL SIDING-cover only Ilalwall areas designated for siding, 161IJ GLITTERS/L.EADERS•remove existin n4 replace with new custom except t ulse areas designated below• seamless gutters and leaders. White CJ Brown; / Size._... __ Color color 7 P turn Packago-&I+ 17 U C/�SFIU'1 I'FRS-provide&Install_ pairapproved�0,ystyrefle Custom Cnm0rpo51S color�.l e±ie y,�k r shutters. Color �,, _lA to O SLING will be applied to the fnilowelRniolit as unly: 1g MASers.MOUNTS- o • ' Cr1 Front Elevation car Elevation Q Othor pr vide&install for--,_exteriorbght rixUlres only. 9L oft Elevation Elevation D Othor 18A, Lights# 1081 Wai r/ Iect Otrclet� Cl Parllal Details: IBC.;DryerVent/�� Color- •1�"' ' ` U Entire Details: "` _ 1rJ,(;] (CC�GAOLE VENTS-provido and install vents, 2,Ll l INSULATK1.1-cover only(laTwall areas designaled(of siding with Color._ � No cireularortllan nts, ts, / �f`_�—_ inch Insuation. 20.P' U CLEAN UP-plopOrly atcomplotion of work. 3• h� [l tlsa n111�foved GALVANIZED STEEL STnf1tER STRIP where contractor 21• INSURANCE-A II workman's compensation and liability to b°maintained dinmsriecessaiy. (Not availablo with Nailita.) 22. WARRANTY-Mail tociislomeraflerconlpletion&hdt payment isreceived, 4. V1CJ Siding to be applied over existing Iotindation. 23, PAYMENTS•on NON-FINANCED orders installer is atithorized to collect 5. Use approved PCIIMATAB5 AND FINISH STRIP where Contractor deems 24 progressive payments. �f n�eessary in snn)e color as siding.(Not available with Nailite.) G nDDITIOA'L WORK-not specified abuve�A!'��P ! 6,M,C1 WINDOW OP(NINGS: ke.k '��' =_�_J-L'`a1�r- J U Cuslom virap with approved vinyl clad aIIJI 1tpum1��1 ►�--�l'� 4s. .'� Z� Color.(SyaGtl°l I, t �^�_�o��iT.'�, N V _ U Jur)ip over casings with siding and'J"channel 25.Q Work Not to Be Done i /E Color--.--,_.. -- Cl Channel existing window onlyu Andeisen type o - -• ° - ( 0• ryp r previously- . 011ier details— _ "" •---m -; 7.L&Ll CAULI(-,all sills with rubhorized color coordloated caulking. _ 2g,CI O ROpalr or'—'IowlnO Woods v►ne. �p— 8.U C.!I OORS f custom wrap with approved VINYL C.AD ALUMI Ufv}� � v� � T of Ito l's _, Color c� s,c,�L t"+ t 9 Q I" GARAGE DOOII FRAMES•custom Wulf,,Willi approved a V ALUMINUM Co VINYL CLAP) lOr,, Single U Duubte with Mu ,_ll G Doublo No Mull ]� 1(l.I( FASCIA•Ctlston►wrap with approved Total 'Sale Price $ [/ VINYL CUO ALUMINUM. Color_QLee,dQ,r .��- INDICATE rwim of rAYMLNf 11 L'I SOFFI f(eaves/ovclhangs)cover with approved SOLID VINYL SOFFIT,),; Deposit With Order T SYSTEM,Except aria anted bolow.1/3 Vented,Color f,n+s.>Y.LI,� 12•lG(/U ROl 1 EN WOOII-Will only he repaired of replacod where specified on $aymerlt ot1 lira Item#26 listed halow.Any additional areas ncodinq a repair Moasure or Start .. 3,T/. $ ill hO estimated upon(heir discovery and priced accordingly. - i )ocs noI inetuda wood studs,or oxtorior shoathing.) ©glance flue on 13 �J Remove rxistingg material extnnor of hot use. U OTher Substantial Completion $ . lUVinyl 1:1Aluminurn ,OWoodShinglO U Wood Siding If financed, balance payable In — monthly Installments al 14.0 h4 PORCII CC,IL.INGS•cover will i approved SOLID VINYL CEILING MAIERIAL approrlmately $ per mon01, payable by 'Owner" 16 contractor, i in the following areas"— ti but if financed by Owner then Owner will pay sald amount to the lending plus such _ i Interest and credit Aervice charge of said lending f motion payable dlroctly In the landing InslituUon loaning such n)onlos 15 - + �� • _ to "Owner" and wl l execute a Retail Installment ale iiot N�yo �l f�t1EAMS/COLUMNS-wiap with approved VINYL CLAD ALUMINUM. I R+�o (Nor•iiciiial on luundcolnrnns) Color,._,_ � obligation and any documents required by such L� Patolroe Paynlon4 lending Ins(ituuon in connection with said loan, arena(I Wdl Accroo. Notice. II financed, any holder of INS Consumer Credit Contract Is subject SALESMAN HAS No AUTHORITY TO CHANGE ANY ITEMS On MAKE ANY to all claims and dalcnses which the debtor could assert against the seller REPRESENTATIONS OTHER,THAN CONTAINED IN THIS AGREEMENT AND el goads or services ebshill,d , excanl hereto or with the proceeds horeol. "OWNER"REPRESENTS THAT NONE HAVE BEEN MADE TO OR RELIED UPON Recovu:ry by IN debtor shi111 not exceed amowlts paid by debtor herelmdec BY "OWNER".YOU ARE ENTITLED TO A COMPLETELY FILLED IN DUPLICATE "OWNER REPHESENI'S TO HAVE READ AND RECEIVED A DUPLICATE ORIGINAL OF THIS AGREEMENT.ORICIfIAL OF 1111S A(VIEEMENT AND TO (lE THE AUTtIORIZED AGENT OF ALL "OtVNERS" •OF Pills PRUPERIY UPON WHICH THE WORK OR 141E "YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR MATERIALS ARE CO 0E SUPPLIED, NOTICE TO THE HOME OWNER(S), TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS GUARANTOII(S), tESSEE(S), CO,SIGNER(S)," TRANSACTION. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN Conlraclor, at Thu elipense of owner, shall procure all permits required by law, EXPLANATION OF THIS RIGHT, ON ALL ORDERS CANCELED AFTER TIIE 1, DO not sign this agreement before you read i1 or if 11 contains any RECESSION PERIOD, CUSTOMERS WILL BE RESPONSIBLE FOR A 45% blink Spaces or 11 it does not contain everything agreed upon. ADMINISTRATIVE AND RESTOCKING TEE." t 2, Any person who shall have co-signed, 91eranleed or signed any ITIONS, BY to by app(rl by i or Hole relating to This agreement hereby accepts SEE SIGNATURE RERSE SIDE FOR BELOW, CUSTOM ADDITIONAL AG1REESL TERMS TO THE TERMS OUTLINED ON THE to br, bound by this agreement. i 3, Owner (s) represents that 1ho contents on the b'ICk of this agreement REVERSE OF THIS CONTRACT Is a true part hereol and has been road and accepted by Owner, 4. ALL'INSTALLATION LABOR GUARANTEED 1 (ONE) YEAR. MATE _, .•, I_1 o r�- -- ConlrRrtcr Accented l Print 0 y rsi„��"rot, - .-_•._ :;alo,Iri7n'sNamo\� Sionawre�.� r I (Cu4�umUr .r /I hlu�� 8,11eman's I Icense No, � Q,a.!_ ._. Signatur .rG.-• 1.. .-�,.— _. 0004 00NytdUp M%P(l0^1vao o,pi fcuvomor Sign flora) I / I I ,.. _ _ "► •. IS • r ' MAWALUM 4' Ila ��oftME rq,,� Town of Barnstable *Permit# 3I&q 60 y�P Expires 6 months from issue date ■ARNSfABLE, Regulatory Services Fee 9� Huss. 1639.. Thomas F.Geiler,Director �� ArFDN1P'`a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 - Fax: 508-790-6230 EXPRESS PERIVIIT APPLICATION - RESIDENTIAL ONLY rr�� (� Not Valid without Red X-Press Imprint Map/parcel Number `�/ O ��`1 Property Address residential Value of Work Owner's Name&Address Veti Aeeln,41t Contractor's Name B i t—R A V Grp Telephone Number 5 0 8—4 2 2—9 6 9 3 Home Improvement Contractor License#(if applicable) 120456 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 American Workman's Comp.Policy# We 7 7 5 51 51 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) [IRe-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issu ce of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revised121901 { HOME III. . .89.'MOB k . . . . .. .' lament John a-mol -NY 1100-3 ry f F4 SOLD, FURNISHED & INSTALLED BY Sales: 1-866-466-3853 Oil-Ray Aluminum Siding (Corp. Service/Repairs: ® of Queens, Inc. 1-888-245-7294 11-2320449 190 Cedar Hill Road • Marlboro. MA 01762 JOB# 1�5 59 `t 7 (00� MAINE LIC.N0.DD1893•NH LIC.NO. •MASSACHUSETTS LIC.NO.120456•VERMONT LIC.NO. •RHODE ISLAND LIC.NO.13707 NEW YORK CITY DEPARTMENT OF CONSUMER AFFAIRS LIC.NO.0730686• NASSAU LIC,NO.H2704150000 •SUFFOLK LIC.NO.21194HI •YONKERS 1397 •PUTNAM PC934 WESTCHESTER WC0613-H87 LONG BEACH GC2001 • NEW JERSEY LIC. NO. 9949269 • CONNECTICUT DEPARTMENT OF CONSUMER AFFAIRS LIC. NO. 00532774 SIDING CONTRACT TOLD DATE p� h )MIJI 17 05 q ADDRESS _ 59 � �U� � CITY �)�n�^ STATE ZIP 3 PHONE HOME Cog) :? S "_15 aT -WORK(Sot)'?-7 b EMAIL JOB SITE ADDRESS (IF DIFFERENT) APPLIED VINYL & ALUMINUM SIDING General Description of Work at Above Address: 1/ Type of House: Frame ❑Masonry Approx Start Date Zd Approx Completion Date 16 -7 Z L 21 -1•<5 (WEATHER&MATERIALS PERMITTING) (REQUIRESF RRI G) o I ' Approved materials will be furnished and installed to these:specifications. PLEASE READ CAREFULLY:ONLY ITEMS CHECKED"YES"ARE INCLUDED IN YOUR ORDER. Y NO YEJ NO 1. ❑SOLID VINYL SIDING-cover only flatwall areas designated for siding, 16. p GUTTERS/LEADERS-remove existin nd replace with new custom exceptt ose areas designated below. seamless gutters and leaders. White ❑ Brown Size Color 5 1 P tt rn�� Package grc A Z 17 � �)SHUTTERS-provide&install pair approvedpolystyrene Custom comer posts color f-/�,�p. ��i�f�r shutters. Color PP 1 A.M/Q SIfaING will be applied to the followinPRight as only: 18.�j Q MASTER MOUNTS-provide&install for exterior light fixtures only. G6 Front Elevation ear Elevation ❑ Other 18A. Lights#_� 18B.)Wat r/,lect Outlet#�_ 71-eft Elevation Elevation ❑ Other 18C.)Dryer Vent# I Color 00e.- ❑ Partial Details: ❑ Entire Details: 19.0 GABLE VENTS-provide and install vents. 2. ❑INSULATIOJV cover only flatwall areas designated for siding with Color No circular or triangle vents. 1 ";/`-I inch insulation. 20.PIL01 CLEAN UP-property at completion of work. 3. LYJ ❑ Use approved GALVANIZED STEEL STARTER STRIP where contractor INSURANCE-All workman's compensation and liability to be maintained deems necessary. (Not available l STEEL 22. WARRANTY-Mailto customer after completion&full payment is received. 23. PAYMENTS-on NON-FINANCED orders installer is authorized to collect 4. Siding to be applied over existing foundation. progressive payments.. 5. iLlj Use approved PERMA TABS AND FINISH STRIP where contractor deems 24.d❑ADDITIO AL WORK-not specified above ,IfL-t. 6. dnecessary in same color as siding.(Not available with Nailite.) wy�, ;,L Q,rvio f QWINDOW OPENINGS: y� �,,� Ly� � ❑ Custom wrap with approved vinyl clad alumi um 2 Vo w} # _-7- -Z.- Color � ,te WJOC, ❑ Jump over casings with siding and T channel 25.❑ 6d Work Not to Be Done # Color ❑ Channel existing window only(eg.Andersen,type or previously wrapped)# Color 1 Other details 7. U CAULK-all sills with rubberized color coordinated caulking. 26. ❑Repair or Repl ceJJ�following woods �W vv\ 8. dQ DORS-custom wrap with approved VINYL C AD ALUMI UNIT IG►Jn»� QA to- of F't (1 (vJ r A►�! .... Doors _ Color e, , 9. L) GARAGE DOOR FRAMES-custom wrap w' approved VINYL CLAD ALUMINUM. Color to..jySingle ❑ Double with Mull ❑ Double No Mull w r _ s = 5 u � HSCIA custom wrap with approved (/,� ./ /� 51�f± PrIC� NYL CLAD ALUMINUM. Color y&/er( •�'C- - f~INDICATE FORM OF PAYMENT - 11. OFFIT(eaves/overhangs)cover with approved SOLID VINYL SOFFIT Deposit With Order C.0 33% $ Q SYSTEM.Except area noted below.1/3 Vented.Color ) t�, 12.l�(3 ROTTEN WOOD Will only be repaired or replaced where specified on rayment on a �� line Item#26listed below.Any additional areas needing a repair Measure or Start e R 3No $ b will be estimated upon their discovery and priced accordingly. Balance Due On ❑ oes not include wood studs,or exterior sheathing.) Substantial Completion �- 34D/o $ 0 13. Remove existing material exterior of house. ❑Other J❑Vinyl ❑Aluminum OWoodShingle ❑Wood Siding If financed, balance payable in monthly installments of 14.❑ l� PORCH CEILINGS-cover with approved SOLID VINYL CEILING MATERIAL approximately $ ' per month, payable by "Owner" to contractor, In the following areas: but if financed by Owner then Owner will pay said amount to the lending plus such interest and credit service charge of said lending i itution payable directly to the lending institution loaning such monies nn olseoums Heve ' 15.❑ BEAMS/COLUM 2 NS wrap with approvedVINYLCLADALUMINUM. to "Owner" and will execute a Retail Installment eenAppnea. obligation and any documents required by such Deferred Bayment (No circular or round columns) Color lending institution in connection with said loan. 0!Interest will Accrue.' Notice: If financed, any holder of this Consumer Credit Contract is subject SALESMAN HAS NO AUTHORITY TO CHANGE ANY ITEMS OR MAKE ANY to all claims and defenses which the debtor could assert against the seller REPRESENTATIONS OTHER THAN CONTAINED IN THIS AGREEMENT AND of goods or services obtained pursuant hereto or with the proceeds hereof. "OWNER"REPRESENTS THAT NONE HAVE BEEN MADE TO OR RELIED UPON Recovery by the debtor shall not exceed amounts paid by debtor hereunder. BY"OWNER".YOU ARE ENTITLED TO A COMPLETELY FILLED IN DUPLICATE "OWNER REPRESENTS TO HAVE READ AND RECEIVED A DUPLICATE ORIGINAL OF THIS AGREEMENT. ORIGINAL OF THIS AGREEMENT AND TO BE THE AUTHORIZED AGENT OF ALL "OWNERS" OF THIS PROPERTY UPON WHICH THE WORK OR THE "YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR MATERIALS ARE TO BE SUPPLIED. NOTICE TO THE HOME OWNER(S), TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS GUARANTOR(S), LESSEE(S), CO-SIGNER(S)." TRANSACTION. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN Contractor, at the expense of owner, shall procure all permits required by law. EXPLANATION OF THIS RIGHT. ON ALL ORDERS CANCELED AFTER THE 1. Do not sign this agreement before you read it or if it contains any RECESSION PERIOD, CUSTOMERS WILL BE RESPONSIBLE FOR A 45% blank spaces or if It does not contain everything agreed upon. ADMINISTRATIVE AND RESTOCKING FEE." 2. Any person who shall have co-signed, guaranteed or signed any SEE REVERSE SIDE FOR ADDITIONAL TERMS AND CONDITIONS. BY to be bound by thisis agreement. credit application nose relating to this agreement hereby accepts SIGNATURE BELOW, CUSTOMER AGREES TO THE TERMS OUTLINED ON THE 3. Owner (s) represents that the contents on the back of this agreement REVERSE OF THIS CONTRACT. is a true part hereof and has been read and accepted by Owner. - 4. ALL INSTALLATION LABOR GUARANTEED 1 (ONE) YEAR. DATE 0 Contractor Accepted Print --- - (Signature) Salesman's Name Signature (Customer sign He e) Saleman's License No. Signatur -+%_ -- @2004 Bil Ray Group All Rights Reserved 0504 (Customer Sign Here) - T Zl COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY FaHury tlo p0$3•13z E current { OF ONE ASHBORTON PLACE tdasseoheszct�s itsto eu11dI"S t I E MASSACHUSETTS BOSTON,MA 02108 Code re causo t ur••rer°h+tJ°" s _ s . oFthJ IJcen � , , CAUTION' EXPIRATION r k DATE A C ;` j FOR PROTECTION AGAINST EFFECTIVE DATE LIC-NO. RESTRICTIONS THEFT, PUT RIGHT THUMB T o PRINT IN BOX ON LICENSE. TE °. BLAST114G OR RAT .RS .,{ I ::•:._, - m i(. ; I r m JMUST INCLUDE PHOTO. f - i! PHOTO(BLASTING OPR ONLY) FEE: •;.'•.'_'•. NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER ` „ DOB: - -- ri THIS DOCUMENT MUST BE « SIGN NAME IN FULL ABOVE SIGNATURE LINE I - CARRIED ON THE PERSON OF NATURE LIC SEE THE HOLDER WHEN EN f { OTHERS-RIGHT THUMB PRINT GAGEDIN THIS OCCUPATION. I TONER � HOME IMPROVEMENT CONTRACTORS REGISTRATION : Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 114156 Expiration 08/10/95 — - -- - - - ----- - I Type - D B A HOME IMPROVEMENT CONTRACTOR HOMESTEAD Registration 114156. ' CON ST SVC5 _o Type DBA. JOHN K . OROURKE Expiration 08/10/95 168 MAIN ST P O BOX 272 YARMOUTHPORT MA 02675 i HOMESTEAD CONST SVCS ! � . JOHN K. OROURKE; 68 MAIN ST P O BOX 272 ADMINISTRATOR YARMOUTHPORT MA 02675 " COMMONWEALTH OF MA►.$�ACHUS13 f TS DEFAI�'ME1�TT OF LNDUST'RIAIirACCIDENTS 600 WASHINGTON STREET ^ jarnes.: Ganooel: BOSTON, MASSACHUSETTS 02111 -or-:n.sstone-- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (licensee/permittee) with a principal play of business/ idence at: l6 9 /YI.kl l i. P r-,5 6 A-- Y* do yrl6lb2w— /9, A— 0 aL 675. (Gty/State/Zip) do hereby certify,under the pains and penalties of perjury,that: �1 am an employer providing the following workers' compensation coverage for my employees working on this job. Awflucmi POLICY 14960945, Gitw Aee;r, do # A951ae As oP-Yfr,' Insurance Company Policy Number (j I am a sole proprietor and have no one working for me. ( j I am a sole proprietor, general contractor or homeowner (circle one)and have hired the contractors listed below who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number 0 I am a homeowner performing all the work myself. NOTE.Please be aware tyat while homeowners wbo ernoloy persons to do maintenance,construction or repair work on a dwcliinz of not more tban t rcc units in which the homeowner aiso resides or on the Frouads appurtenant tbercto are not Fcncrally considered to be eraoloycrs unacr the Workers' Comflcnsation Act(Cl- C 152.sect 1(5)).applieatioa by a homeowoer for a license or permit may eyidcLlCe 6c Ict:21 tutus of an employer under the'Workers'Compensation Act. I u^ac^::nd t'^.:;:co-,v c:t:is s::u ncr.;will be forwarcca to &..c ✓ccz:-:C.t of Indus:-i:i Accidents' Of cc of lnsu=c.c for eoycraec `c' =::er. :ra :-- :o scr::rc cave.--rc as reeei:cc cnac Sccnon 'c�.'o:�;GL r c:c=r,ie:a to L11- imposition of erir:inal perauc ccnsis::};C of:firs of t:-- tc Si 500.00 an(c!or imprisonrn=.x of up to one ves-::ad c�u pcn:;ucs L'1 the form of a Stop'Work Order aaa a fine of S l 00.00 a.aav:€airs:me. Signcc this n2 3 day of 2& 19 X A 4 � a i ,FLU b � 169 .7 � Assessor's office(1st Floor): n Assessor's map and lot number c�j ( ' ( S'C� Prof YMe to`` Conservation(4th Floor): Board of Health(3rd floorj: - • Sewage Permit number • t Day AMLZ Engineering Department(3rd floor):` ''�1630'`��� House number Definitive Plan,Approved by Planning Board 19 t APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN � OF BARNSTABLE :BUILDING ' INSPECTOR APPLICATIONfOR PERMIT TO 1�'Q /NG �PZ PL ca4m G : Gt111yariw-, TYPE OF,CONSTRUCTION - . .y 2 � 19 l TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according )l to the following information: Location IA) 4 �� 1't�/ ct I,m I S Proposed Use /N6C Zoning District � Fire District YIyIU t`,� Name of Owner &A)6, 6 W ATtb Address _l"! WAbyar Name of Builder 14►1'I 957644> C'GN59-- Address_l�2 NA-/N s! Name of Architect Address Number of Rooms Foundation Exterior Roofing 7A7U'D�6L� 3� t/gsr�fL , ( -t Floors Interior Heating Plumbing 00 Fireplace Approximate Cost Area 6 AM Diagram of Lot and Building with Dimensions Fee Q OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. (fit Name Construction Si ipervisor's License /J� . DEYOUNG, EDWARD f V No Permit For REROOF & REPLACEMENT WINDOWS Location 59 Walnut St. , Hyannis F Owner Edward DeYounq Type of Construction Plot Lot Permit Granted May 23 i' 19 94 Date of Inspection: . Frame - 19 — Insulation - 19— Fireplace 19— Date Completed ,: 19 S 2- 3 - 9 KOO 2o « Gioc�3 f 'Town of Barnstable *Permzt r Expires 6 nw ha fram issri it b _ Regulatory Services lee v Thomas F.G+eiter,Director ' Building Division, VVV Tom Perry,C80, Building Commissioner .200 Main Strec4 Hyannis,MA.02601. "w.town.barnstable_nia us Office: 508-8624,038 Fax:508-740-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Allot Valid without tied Y Press fnwrhzt maplpaecei Number .310 Property Address esidentiat Value of Work %, GOI�� 0� Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address /rekin-e14 ano 7,5+7,./ 1Y,4t-l'e. ✓c'PY�tul� f 70-iNi4 J,. ,�yela;✓ 17-r4 Contractor's Name G <� 1i11-1-a-ve:, Telephone Number Home Improvement Contractor L,irense#(if applicable) /'0G 7y6 Construction Supervisor's.License#(ifapplicable(U r a „ ` � ` � t �r`�a ti ' Workman's Compensation Insurance , !l Check one: .! � C] I am sole proprietor t k< 'I 1 tW ; Ell I the Hozsi owner e 1 €�rltier+s Compensation Incur ce Insurance Company Name. Xrhl f y`li✓llce Workman�s Comp,Policy,# )0 Cc 4( Copy of insurance Compliance Certificate must accompany each permit Permit Request(checkbox) . 9/Re-roof(hurricane railed)(stripping old shingles) All construction debris v. I be taken to (.�'f�l�� ❑Tte zxnsf(hurricane naxiletl}(izot stripping. Going over existing layers of roof) t/!t yuWitf/�A1e Q Re-side #of doors 0 Replacement Wiado4ustdoors/slidem.'I�r-Value .(Miximum.35)#.ofwindows °tt,herc Mquitt4 Iss9rtnce vfthis PURIft does not eaeTpt compliance with others town depaitamf regulations,i.e.Historic,Conservabon,tic. ***Note: Pr�apertyrter must sign.Property Owner Letter of Permassirin. A`apy a E �me It�i€prove men contractors License cat CoQstruct t}n Supervisors L icons is quzr SIGNATUIM,i CAUsers lWAAppDataV-= ,.I ofhNviadol�stTe?n irary Internet file,-,IC ntrnt Outtook-1DDV87AAZWMitlSS.doc Revised 072110 The Commonwealth of Massachusetts . Department of Industrial Accidents 9-2 Office of Investigations ' d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applic. ant Information Please Print Le ibl Name(Business/Organization/Individual) C{d �Z-` / m'p— ,ter 0 ✓-'e M_e-n ' Address: I -e UJ 7 e cJr City/State/Zip: D- 7V i f AI A 19 4 3 5— Phone.#: 5D 69' �Z�' '9.-/J) Are you an employer? Check the appropriate box: Type of project(required):. I I am a employer with t 4. ❑ I am a general contractor and I employees(full and/or part-time). x have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 3. ❑Demolition working for me in any capacity, employees and have workers' comp. insurance.$ ' 9. ❑Building addition [No workers' comp.insurance P• 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 1 L❑Plumbing repairs or additions . myself. [No workers' comp. right of exemption per MGL 12.[�Roofrepairs "A$/1Odf insurance required.] t c. 152,§1(4),and we have no. employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such: tContractors 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. ' C'[�Insurance Company Name: Cj f �. (�7Ct f' !/A/4 7�j S. Policy#or Self-ins. Lic. #:�W eC-� 3�T� Expiration Date:.. Job Site Address: ss� `j/ City/State/Zip: /Y0,010 ✓ �� 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-here-bkc--er-tif--under-tlte-pains-and penalties-of perjury-that-the-infor-mation-provided above-is-tr-ue-and-Carr-ect. Si ature: Date: D 3 b I Ay0/l Phone#: L,5-V OF Ofj1cial use only. Do not write in this area,Yo be completed by city or town official City or Town: Permit/License# Issuing use (circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: . Client#:47298 CAPIHOM ACORDTM CERTIFICATE OF LIABILITY INSURANCE 7,TE, (MM/DDYYY) /Y04/2011 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 A the terms and conditions of the policy,certain policies may require an endorsement. statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT Karen Walther Rogers&Gray Ins.-So. Dennis NAME:PHONE 508 398-7980 FAX A/C No. o Ext: - A/C,No): 434 Route 134 E-MAIL waltherka com ADDRESS: ltherka@rogersgray.com ra g Y• P.O.BOX 1601 - - - - PRODUCER South Dennis, MA 02660-1601 CUSTOMER ID M INSURER(S)AFFORDING COVERAGE NAIC# INSURED" INSURER A:National Grange Insurance Co. Capizzi Home Improvement,Inc. INSURER B:ACE Property&Casualty Ins.Co Capizzi Enterprises,Inc. INSURER C: 1645 Newtown Road Cotult, MA 02635 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL UBR - POLICY EFF POLICY EXP LTR NSR D. POLICY NUMBER MM/DD MMIDD LIMITS A GENERAL LIABILITY MPB1075H 06/08/2010 06/08/2011 EACHOCCURRENCE $1,000,000. X COMMERCIAL GENERAL LIABILITY DAMAGE RENTED - PREMISESS(Ea occurrence) $500,000. CLAIMS-MADE FX1 OCCUR ME EXP(Any one person) $10,000 PERSONAL&ADV INJURY, $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $2,000,000 POLICY PRO- LOC $ JECTA AUTOMOBILE LIABILITY BPO10786 06/08I2010 06/08/2011 COMBINED SINGLE LIMIT $ : A ANY AUTO M1M28044 06/08/2010 06l08/2011 (Ea accident) 500000 BODILY INJURY(Per person) $ ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE" $ X HIRED AUTOS - (Per accident). X NON-6WNEDAUTOS U1 - - $250/500,000 X Drive Other Car U2 $250/500,000 A UMBRELLA LIAB IV I occuR CUB1076H 0 6/0 812 0 1 0.06/08/2011 EACH OCCURRENCE $5,000 000 EXCESS LIAB CLAIMS-MADE - AGGREGATE $5,000 000- DEDUCTIBLE - • $ X RETENTION $ 10000 - - $ B WORKERS COMPENSATION NWCC45843208 12/25/2010 12/25/2011 X ` C STArU- oTH- AND EMPLOYERS'LIABILITY _ ' ANY PROPRIETOR/PARTNER/EXECUTIVEY/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 . If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $1,000,000 - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD iiiii Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. .200 Main Street Hyannis,MA 02601 AUTHORIZED.REPRESENTATIVE 198114009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD #S61971/M61970 MEE ✓he 1oo7ronxo�u�a�Z oy✓UGcrea� . Office of Consumer Affairs&Business Regulation- -;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 Reg istration:>100'7_40 Type: 10 Park Plaza-Suite 5170 ExpiraCCDii-7232Ey:12_. Supplement Card Boston,MA 02116 CAPIZZI HOME'I:M2-R-0/EMEN i1NC. - A' GARY GUSTAFSJ 1645 Newton Rd. Cotuit,MA 02635 -. Undersecretary No id without signature N1 nsachusctts Drpartntcnt of Public Safct� 71 Bo.ti(1 of Buil(lin�, Rc'�ulatiun, .u1d St uulur(ts I Construction Supervisor License i is License: CS 74640 GARY GUSTAFSON , 8 SHORT WAY SANDWICH, MA 02563 1h Expiration: 11/29/2012 Tr-,: 7058 J Page 7 of 7 CAPIZZI HOME HAPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT OWN THE PROPERTY LOCATED AT IA-(A IN I ��ti ,MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. / SIGNATURE OF OWNER: OWNER'S ADDRESS: 144 OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit,MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: / G y r Rd (G RESPONSIBLE OFFICER TELEPHONE: f 0l yZvle-l�'/l—