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0022 WASHINGTON AVE EXT.
a �Q:G�ti�C J ,�t. , --- -- - - / _ . _ - /��5" �r r-z���'s �.�•�� s?O D j ':3 I Town of Barnstable Bu ilding g IPost This Card So That rtpi5 Visible from the Strut-Approved Plaill ' ns Must be Retained on Job and this Card Musf IBAMSTARIA Kept )Posted Until Final;Inspection Has Been Made Permit suce Where a Certificate of Occupancy is Required,such Building shall Not be.Occupied until a Final Inspectign has been made. 1 e1 JlJll l r Permit No. B-20-1080 Applicant Name: Steve J Spengler Approvals Date Issued: 05/06/2020 Current Use: Structure Permit Type: Building-Solar Panel- Residential Expiration Date: 11/06/2020 Foundation: Location: 22 WASHINGTON AVE EXT.,HYANNIS Map/Lot: 327-033 Zoning District: RB Sheathing: Owner on Record: MORAN, BRIAN L& REIANE Contractor Namei',VIVINT SOLAR DEVELOPER LLC. Framing: 1 Address: 22 WASHINGTON AVE EXT Contractor.License: 170848 2 HYANNIS, MA 02601 - ' Est Project Cost: $3,801.00 Chimney: Description: Installation of roof mounted photovoltaic solar,systems 8.64kw 27 Permit Fee: $85.00 Panels Insulation: Fee Paid:`' $85.00 Project Review Req: .y' Date ,% 5/6/2020 Final: Plumbing/Gas i Rough Plumbing: Esu This permit shall be deemed abandoned and invalid unless the work authorized by this'permit is commenced within six months .after issuan ffIcIal Final Plumbing: All work authorized by this permit shall conform to the approved application`and the'`approved construction documents for which this permit has been granted. All construction,alterations`and changes of use of any building and structures shall,be in compliance with the local zoning by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire,Officials are-provided on this permit. Electrical Minimum of five Call Inspections Required for All Construction Work: 1.Foundation or Footing Service: 2.Sheathing Inspection r `Y 3.All Fireplaces must be inspected at the throat level before firest flue lining is installedn „A Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation Low Voltage Rough:. 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ? �7 ,ram 2c) I Parcel lJ Application # OD/ Health Division Date Issued*-! 3 Conservation Division Application Fee S Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address ���.�/r L,��9TB,� ,,�✓� �17 Village /V/V ,66ee _-5 Owner Address -.�--�,- Telephone��D ,. �GZ Permit Request ,� 61 c�l ,ram���� G`�`�y�D�� - y9./7_Z� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type / v �17e,4Al Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family A Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes /5LNo On Old King's Highway: ❑Yes ANo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing i neu46 � ^ma`s; Number of Bedrooms: existing _new z,,, Total Room Count (not including baths): existing new First Floor Room Count 'Q) Q , Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air. ❑Yes ❑ No Fireplaces: Existing New Existing wood al stoy ❑`1''' ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existingvE7 ne,\Y,- size— Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use -Proposed-Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name y;; ,) / -, ��/ Telephone NumberJ4�-- Address /E �� Lam' ��� License # D D ZEE r Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Al ��6�1DATED/f0 i FOR OFFICIAL USE ONLY APPLICATION# ` DATE ISSUED . F MAP/PARCEL NO. r r ,r ADDRESS VILLAGE p OWNER DATE OF INSPECTION: "`FO,NDATI,ON=4� i FRAME a!- r.-. ate• r'.� ..ar 1 -.INSULATION_. t FIREPLACE ELECTRICAL: ROUGH FINAL r; PLUMBING: ROUGH FINAL GAS: ROUGH FINAL F FINAL BUILDING`' ,7 r DATE CLOSED OUT ASSOCIATION PLAN NO. 1 Mrrssac'latrsctts - I)clutrUncl.tt of t'uhlic `:Ifct� 13oal-d of Re-ulario , and m.111( irds d constru-)ction Supervisor License a rill, l_Icen a.`-,CS� 100988 pi i -iiS n W ri p - HENRY CASSIDY 8 SHED ROW, • � , WESjF YcARMOUTH, MA 02673 Expiration;. 11/11/2013 Try' 7620 � C�/`�;. .0 ?C��yZ��'G'C�•1L-�l.�C'C?�1;�`l CZ'_J��l'� / ' 11 OfliCe of Consumer Affairs and Business Regulation r 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: '153567 Type: F P:rivate Corporation Expiration: 12/15/2t)14 Trill 233831 CAPE COD INSULATION, INC ....... _._ .. HENRY CASSIDY 18 REARDON CIRCLE - _.__.._....-. - S0. YARMOUTH, MA 02664 --.._-_.___..._..... Update Address and rettu'n cart.Mark reusou for chlulge. ] Address. (- Renewal _1 I?►nt.rloynlcul I bust Card 6 .,;,,.,,,n Ile,//cr+nmc'(r/C/" n`G l�:rJdrrrficr.Jr'CCJ unite of Consumer Affitir s& Business Regulatiou License or,registration valid for individul use only w110ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: , cyistration: 153567 Type: Office of Consumer Affairs and Business Regulation ;$Expiration: 12/15/2014 Private Corporation 10 Park Plaza-Suite 5170 Bostua,MA 02116 All WD WSULAtION,.'A61 . -ir.Nk)T t:ASSIOI, 18 kTAM)N CIR(lF. ; ) 1';1F:ftOUl 11. MA 02664 -- Undersecretary , Ot ViII wlthO f ' ira# 1'N The Commonwealth of Massachusetts - Department of Industrial Accidents ' Office of Investigations . 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ���pG� �� Address: / �`'9i City/State/Zip: yt D done Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ l am a sole proprietor or partner- listed on the attached sheet. T ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LE] 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 13.❑ Other /,4eY �f employees. [No workers' 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#:f�/�',. �� �`�g�/ Expiration Dater .d/I/o- Job Site Address: -2 ��j /y/j fa �7, i City/State/Zip: 1w4 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 certify. "der the pains and p rallies of perjury that the information provided above is true and correct. Signature: Date: Phone Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CAPECOD-27 MYOUNG E DAT (MMIODNYYY) �. CERTIFICATE OF LIABILITY INSURANCE 7r8l2013 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 JSSUING 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). PRODUCER License#PC-514062 CONTACT Margaret Young Rogers&Gray insurance Agency,Inc. PHONE FAX — 434 Rte 134 arc No Ext: South Dennis,MA 02660 AIL ADDRESS:myoung@rogersgray.com INSURER(S)AFFORDING COVERAGE —� NAIC B ------ -------- wsURERA:PEERLESS INSURANCE COMPANY _ INSURED INSURER B:COMMERCE INSURANCE COMPANY Cape Cod Insulation,Inc. INSURER C:Evanston Insurance Company_ _ _ _- 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,MA 02664 INSURERE: 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. NOTV41THSTANDING 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 _-T A'UD IJBR POLICY EFF POLICY EXP " _LTR TYPE OF INSURANCE INSR WVD1 POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY - EACH OCCURRENCE - — $� 1,000,000 �CfvfAGl`TOl2'EIVTED A X COMMERCl4L GENERAL LIABILITY CBP8263063 4/1/2013 4/1/2014 PREMISES Ea occurrence) $ 100,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 VENL AGGREGATE LIMIT APPLIES PER: r PRODUCTS-COMP/OPAGG $ 2,000,000 PRO- (��� — POLICY 1 JECT I I LOC $ AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT Ea acddent) $ 1,000,000 B ANYAUI'0 13MMBCKVMK 4/1/2013 4/1/2014 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS _ X HIRED AUTOS X NON-OWNED PPOP RT?_ AMAGE $ AUTOS PER ACCIDENT X UMBRELLA LIAR X OCCUR - EACH OCCURRENCE $ 1,000,000 C EXCESSLIAB CLAIMS-MADE XONJ453512 4/1/2013 4/1/2014 AGGREGATE $ 1,000,000 DELI I X I RETENTION$ 10,000 $ WORKERS COMPENSATION W'C STATU- OTFI- AND EMPLOYERS'LIABILITY l' L MI S - ` D ANY PROPRIETORIPARTNER/EXECUTIVE Y I N WCA00525904 6/30/2013 6/30/2014 E L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A - -- --- $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yas,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,090,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 1 Workers Compensation includes Officers or Proprietors. Addtional Insured status is provided under the General Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD s k Housing Assistance Corporation Cape Cod HOME OWNER W EATHERIZATION WORT( PERMIT & FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. +rt hereby consent to and agree that weatherization work may done by the Weatherization Program of Housing Assistance Corporation (herein after referred as "Agency") on t propertyjoca ed at: Lin -tom r-�1- v '(3 -- The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping &caulking of windows and doors, insulation of attics, sidewalls &, basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: ' i. I give permission to the "Agency" its agents and employees to travel onto or across said property with such,equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit'on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give my consent. Home Owner: (Signature) '71A — -- i — Date: _ rJL L3 Agent: (signature) Date; HAC approved Weatherization Company :.C. All Cape Energy.(Capeape Save Efficient Buildings,LLC Frontier Energy Solutions,. Loh:r &,.S.ons: . Resolution Energy of Town of Barnstable *Permit#/P/36 717 Expires 6 matths j;9m issue rste / Regulatory Services Fee f,7 BARNSTABLE, ; NAM Thomas F.Geiler,Director i639. CEO MA'I a Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 - www.town.barnstabl e.ma,us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �j l Not Valid without Red X--Press Imprint Map/parcel Number`gyp� 6 �_� Property Address S t11 �i'�N i' 1 �1 eery Gam' t s [VResidential Value of Work o 6V* Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name U90LO, ©T �d� �� - Telephone Number Home Improvement Contractor License#(if applicable) (.P ;F ? —3 Construction Supervisor's License#(if applicable) ® l b b �orkman's Compensation Insurance SS PERMIT Check one: ❑ I am a sole proprietor JUN 12 2013 ❑ Lam the Homeowner have Worker's Compensation Insurance Insurance Company Name &A) g� S N ee--) 3 TO& OF BARNSTABLE Workman's Comp.Policy# W L O 3 5 :5 3 I `7 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box). L [f 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 #of doors Replacement Windows/doors/sliders.U-Value 3© (maximum.35)#of windows t ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re, wired. 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Man A -N �1, lwf6 th W. -.I �T -8, 1 "If ARNIE, ,ug YN W.l� "ag R;S4 ME "Orl mpg Z Mp W, RM- .:.,......... ,�,c X"; 4— �'l c 'R 'T "IM A Y IRA 4i MIA-4�51 All 0. , 5�` ®Bice of consumer � ffa .rid]Business.Regulatioq. 1jl' 10 Park Plaza - Suite 5170 ,.;. ]Boston, l Massachusetts 02.116 4 Home lmprovert ent'Contkactor.Registration - Registration: 126893 Type: Supplement Card `i r - ` 3 i���"' Expiration: 8/3/2014 t to Home Depot `At-Home Services 4 '�, 1' MICHAEL BEDARD �'"�. t�: i,-• � ` } 21ei90 CUM BERLAND PARKWAY'SJITE`3OO ATI_.ANTA, GA 30339 r _ Update Address and return card.Mark reason for change. (� Address Renewal Employment Lost Card :fir .:crs •:, se;.,�..�<,;oi.Ctti��zie Sie "�oorunzootcuea�lli o�✓ ac6tt�4rQ`6 } i i-i-"c of Consumer Affairs&Business Regulation License or registration valid for individul use only i } 1 before the:expiration date. -If found return to: r i�l��p �iiVtP'2OVEMENT CONTRACTOR � [ office of Consumer Affairs and Business Regulation i Registration 126893 Type: 10 Park Plaza—Suite 5170 E;;piratson .81312014 Supptement Card Boston,MA 02116 The Home Depot At Home Services p 101CHAEL 3ED[�PD 2[i9U CUiVIBERLAND PARKWAYS Tr Not`va`d without signature I LAPJ`I J\ -GA 30339 Undersecretary A NFi ' The Commonwealth of Massachusetts Pn.nt Form - - Department of Industrial Accidents c Office of Investigations _ 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ap licant Information Please Print Legibly Name(Business/Organization/Individual): Address_g Le�F—, o City/State/Zip: 1 a?t•NGt. 3 n 3 Phone#: Are you an employer?Check the appropriat�e b;x: Type of project(required): I.ElL'�I am a employer with 4. l am a general contractor.and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached'sheet. 7. ❑Remodeling 2.❑ .I am a sole proprietor or partner- These sub-contractors have ship and have no employees 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition - o workers com comp.insurance? re ' p insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required-]- officers have exercised their 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 12.❑R of repairs myself.[No workers comp. c.152,§1(4),and we have no insurance required.]t UVOtOther �Llwea ' — employees.[No workers' comp.insurance required.] -j *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.' . t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for.my employees. Below is the policy and job site information. f hJ Insurance Company Name: 3 tP2� 5 - C - Policy#or Self-ins.Lic.#: W a 5�7 3 r Expiration Date: J Q `.-S Job Site Address: ti ` �`o� City/State/Zip: � Attach a copy of the workers'compensate n 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer0p and he ns and en h o e u that the in o=!It n provided above and correct Si ature: _ ... . � . ... ... ..... . . ..... .. . .......... . ... Date _�(� . / .. ...:....' Phone#: J " �o O fficialonly. Do not write in this area,to be completed by city or town official or Town: Permit/License# hority(circle one): Health 2.Build;ng Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: /1/2013 8:16:06 W4 PST (GMT-81 FROM: 100005-TO: 15087302086 Page: 2 of 2 co V CERTIFICATE OF LIABILITY INSURANCE DATE0%WVD"'Y" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER PAUL B SULLIVAN INS AGCY INC CONTACT 1467 S MAIN ST ' N FALL RIVER,MA 02724 PHONE -9611 PAW E-MAIL AQbj§S$, . :..,.. -..:., INSUR I S AFFORDING COVERAGE. .- :.. - .NAtC I IISU R �J SEPH DUARTE&JOHN DALEY DBA J&J REMODELING #LqtaERC: 15 WILSON WAY "SURERD MIDDLEBOROUGH MA 02346 "SURME: n u R COVERAGES CERTIFICATE NUMBER: 15914016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INDICATED. NOTWITHSTANDING;ANY REQUIREMENT,TERM OR CONORIoN 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. POLICY TYPe OF SURANCe I POLICY NUMBER N Y V �P I LIMITS . GENERAL LIAeiLITY EACH OCCURRENCE k P S E e o cwrenoe S COMMEiiCIAI GENERAI:iN6llnY CLAIMS-MADE'a•OCCUR MEO EV Anyc*% an 6, PERSONAL&ACVINJURY S GENEMAGOREGATE S OENL AGGREGATE LIMiTAPPLIESPER: PRODUCTS-COMP/OPAGO f POLICY F1 PRO• LOC S AUTOMOBILE LIAMAY ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS INJURY IRED AUTOH NON-OWNED 8 AUTOS ere eN O M $ UMBRULA U" - .OCCUR - _ EAM OCCURRENCE f EXCESSUA8 CLAM34MADE AGGREGATE S OED RETENTIONS f q wopluRs`C91wENSAT1oN WC5-315384800-013 2/2/2013 W4014 BAN AND.f3NW.0YERS'NABQITY YIN !� ANY PROPRIETOR+PARTNERrEXECUTIVE OINFlFnICdEebVryNE Ina BNE10R_xCLroEOT MIA aCACCIOENM $ 100000 F.L.DISEASE EA EMPLOYF4 S D if r deMoIb der DESal ION OFOPERATION bw ELDISEASB•POLICY LINT Is 500d00 06SCRIPTION Of OPIERAMNS/I.OGLTIONe/VEN1 AhobWORD 101,AOdRIo RmrAuSche"k1 =#*speeeb•Iequin� -Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA, NO PARTNERS ARE COVERED BY THE WORKERS'COMPENSATION POLICY. s CERTIFICATE N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THD AT HOME SERVICES,INC.AND, THE EXPIRATUM DATE THEREOF, NOTICE IMLL BE OELIWRW IN THE HOME DEPOT ACCORDANCE WITH THE POLICYPROVI!IONS. 2690 CUMBERLAND PARKWAY SUITE 300 ATLANTA GA.30339" AUr1OMM REPResENTATM Jeff Eldridge 91938-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201 t1/65)' The ACORD name and logo are registered marks of ACORO a1B o er`iiIl'ate ca`"ncel 3;AS is UpersielesrIL pioMv lour l 4lNup cerait iea tea. HOME IMPROVEMENT CONTRACT PLEASE PWAD THIS y p (,� Sold,Famished and Installed by: Branch Name: Boston Date: !v•1 �3 4 THD At-Horne Serviccs,Inc. d/b/a The Home Depot Al-lionre Services 908 Boston Turnpike,Unit 1,Shrewsbury,.MA..01549 Toll Frcc(800)657-5182;Fax(508)845-6017 Btaneh Number:31 Federal ID#'75-2698460;ME Lic#C 0243.0;R1 Cont.Lic#16421 Cr Lic#HICA565522;MA Honk Iuipmvemoint'Contraetoi Ilex.#12680.31 Installation address: a,'a- (IJe��JG►in 1�G Ate., le" City State Zip Purchaser(s): Work Phone: -Home Phone: Cell Phone: C ] [ ] [ l • Hume,Aadress: (Tf different.from Installation address) City State zip E-mail Address(to.receive project communications and Home Depot updates): ❑I DO NOT wisb to receive any marketing emails from The Home Depot Vect laforma ion:<Undersigned("Customer'),the win of the property located at the above installation address,'agrees to buy, THD At- one Services,Tnc.("The Home Depot-)agrees to furnish,deliver and arrange for the installation C Installation')of all materials described on the below and on the rcferencW Spec Shm-Ks),all cif which 4M.incorporated into'this Contract by this reference;along with any applicable Stale Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job*. pntc~ace mw) acts: S Sheet(s)#: Project Amount Roofing ❑Siding Windows Ll Insulation, $ ❑Gtrttm/covers OEnnyDeora ❑ +-i-D ❑Rnofing Siding Owindows Imlation QGuners/Covers ❑Entry Doors ❑ $ Roofing Siding windows ❑insulation $ ❑ eta Gua /Cowes QEnuy Doors Q []Roofing []Siding ❑IV, ndowstisulaGon'=== -- — $_._. QGuacts/Covers DEntry Doors ❑ Miirinwm 15%Deposit of Contras Anwout due upon eiecu*w o ftbb coa�rt Total Contract Amount. $ Melee Purch asers may rot deposit mare than on�vd of the ContractAmount Customer agrees that,immediately upon completion of the wont for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this ' Contract agrees to be jointly and severally obligated and liable hen:undtr.' The 146me Depot reserves the right to issue'a Change Order or terminate this Contract or any individual Prodtict(s)included herein,at 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,asb st6s or lead paint,other safety concerns,pricing errors or Because work required to complete the job was not incltided'in the Contract Pyment Summary: The Payment Summary,#_ included as part of this Contract, sets,forth the lytal 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 Contract at the time you.ergo. Do not sign a Completion Cerdfreatc(note: there is one Completion Certificate for each listed Product as defined by individual 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 Nome 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 OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOMR DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. A e tance turd Authgij&tioa: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with re �O to the Products and Installation st:McLs and supersedes all prior discussions and agreements,either oral or written,relating 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 agues that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement Accep by: Sub itted by: x � 'a�13 � ' ' 3 Cur me ature Date J Sales asultant's Signature ate Z )3 Telephone No. Custo er's Si attire Date Sales Consultant License No.. ,CANCELLATION: CUSTOMER MAY CANCEL THIS Wappikahto) AGREEMENT WITHOUT PENALTY OR OBLIGATION BV 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 SPECiF14CAlLY PRESCRIBED BY HAW IN CUSTOMER?$.STATE. NUT109 ',,ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE.REVERSE SIDE AND ARE PARTOF THIS CONTRACT 05-�0.72• White-Branch File Yellow-Customer Td Wd60:T 600E BT 'oaQ TLZEZ92BOS: 'ON Xtld pE'6LUFl: W021d t:. Y oFt r *Permit#Town of Barnstable n ? 7 ? 1SN Expires 6 months from' ue date btiS �O IVMOl lARNSTABI.E, Regulatory Services Fee 9 as�ss HE 6 T n ON Thomas F.Geller,Director Building Division Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red Z Press Imprint Map/parcel Number 7 o Property.Address �G�S�e Y� �� t� �A✓1 Il t S (� oacxj DKe'sidential Value of Workt'x Owner's Name 8c Address 0-0 c bona /j,a w z I A I' QLri Ave- -- &d-- - dvaf7174, Contractor's Name �.•n br c�y e a✓i�:i+ Telephone Number " 1 1=/ rr i a y> Home Improvement Contractor License#(if applicable) 10 3 7 5 7 a2d is Construction Supervisor's License#(if applicable) WNG43 CD Workman's Compensation Insurance �a Check one: ❑ I an a sole proprietor r. ❑ I am the Homeowner [have Worker's Compensation Insurance Insurance Company Name N'-T . 00* Workman's Comp.Policy# 1 QQ `j 9 y "3 0 1 , -W q Permit Request(check box) ❑'Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) e-side' Replacement Windows. U-Value 1c✓ (maximum•44) *where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature QTorms:expmtrg Revise053003 t CERTIFICATE OF INSURANCE ', PRODUCER '11 S CERTIFIC t D A R F 1NF0 T 0 ONLY AND CONMRS NO RIGHT$UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE .,Brydi:h&Sul Ivan Ins Agency DOES NOT AhSMI),MTE-ND Olt ALTER THE COVERAGE A101ORDED BY 7%M Inc POLICIES BELOW. 88 Falmouth]toad COMPANIES AFFORDING CO'VFAACE Hyannis,MA 02.601 uvsvltED Sprinkle 14orx a Improvement Inc COMPANY A.I.M, Mutual Insurance CO 199 BarnstableRoad LETTER A Hyannis, MA 02601 COVERAGES THIS IS TO C iRTIFYTRAT THE POLIQIE!OF IN$URANCB LISTED BELOW HAVE S13ENU$UBD TO THEINSURBD NA)VXD ABOVE FOR THE POLICY PBRIOD INDICATED. 'OTWITHSTANDING ANY REQIIIR2WNT,TERMOR CONDTTION OF ANY CONTRACTOR OTHER DOCUMENT WMIRESPECTTO WHICH THM CBRTIFICA MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORI]Fp By THB POLICIES DESCRIBED HEREIN 1$SUBJECT TO ALL THE TERMS, EXCLUSION!AND CONDITIONS OF SUCH POLICIES. LD41TS SIiOW"N MAY HAVE BEEN ItEDUCED BY PAID CLAIMS. Oa DasuRANCE POLICY Nt MSEa POUCV ERT.CTM POLICY aI�IItATIa LTA DATE(MM/DDAY) AATZ(MMI)D/YY) LIMITS GENERAL LLU InT ENBRALAGGREGATE S COMME CIAL GEt{6RAL LIAIIILJTY ODUCTS-COMP/OP AGG. S CIS MADE OCCURI B j OWNErJ' A cOKrAACTOR'S PRQT, R�NAL I ADV.INJURY OCCURRENCE S IRSDAMAGD(Anyomftre) S 1 D.EXPENSE(AAY en porsw) q AUT.. OUIZUS ILT(Y MDINIID SINGLY f ANY AU O LINIT ALL OW MD AUTOS I CIMO D BODILY INJURY D t.UTOS BO ILYPwj S }11RBD A S NONAW At1r04 ODILY%NJURY q (Par wddcw GARAGE LIABILITY PROPERTY DAMAGE q Li43 OACIIOCCURRENCE q R¢L FORM AOORSOATE f TNER'T UN UMBRELLA PORM WORICIIR'SCOM SATIONAND X WC TATUr C01. Jim AS L 11.rrYIMr A Ttlfl PROPHETr 7004943012034 011131HO4 05/13!2005 f , PARTNIIRSIB)CE IY£ x ��' DISDASF�➢ L r S S00000 OMCO&V ARE I OTtlEII SL DISEASB-BA F. Yf f S I(]0 000 DE60RtD?nON OP O 'IONS/LOCATION81YO LIM/2=- IAL iT xS CnawiCAT'E OLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Proof of jIIS ranee WIRATION D43 THEREOP, THE ISSUING COMPANY WILL ENDEAVOR T'0 MAR 10 DAY,9 WIUMN NOTIC$TO THH CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILUU TO MAIL SUCH NOTICE$HALL IIAZPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPON TIIE COMPANY, ITS AQ N 5 OR REPRESENTATIVE$. .....— _ AUTIi0RIZ8D R$PIZ]36ENTA :r _ The Commonwealth of Massachusetts - Department of Industrial Accidents office 011800121/fas 600 Washington Street . Boston,Mass. 02111 Workers'Compensation Insurance Affidavit name: location: c' phone I am a homeowner performing all work myself. Q I am a sole proprietor and have no one working in any capacity MI am an employer providing workers' compensation for my employees working on this job. cosn Ile- ad: t10YYlfy►�df YYI2 ►�1 drsss:::.,� l I �a ri'1�T'cL1�� t .. y city: ttJCtfn Vl I S t)oZ(001 phone No so'K 7 7 S ' CIE E insaranftV*=�• 700y 't '�t'�o 1 a cry I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who hu,: the following workers'compensation polities.:. coirioanr•trtamts- an gtldii ess�: .. .•....,.. . . phone. :.;}.;•':: ;...::;.'. . ice:•,+.':i.4 :.- .. :v:. , IntlftcaHtal�i•,. .- .•:. :: .}:•. ::.: ..;:.: "'.-' .. cotnoan�!stgm�• •• . . - city:>: phone N- Iiiauraeex�ao p�y#' SUNNI Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of s STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a COPY of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. do hereby c penalties of perjury that the Information provided above is true and correct ' ^G Signature Date Print name hone# U$ 7 Z5' 7check only do not write in this area to be completed by city or town official : permitAicense# nBuilding Department Licensing Board mmediate response is required C]Selectmen's Office pHealth Department on: phone N, nOther t (Maned J/95 P1A) Information and Instructions Massachusetts General Laws chapter.152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law an employee is defined as every person in the service of another under any contract of hire,express or implied,oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer;or the receiver or trustee of an individual , partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three.apartments and who resides therein,or the occupant of the dwelling house of another who employs persons:to do maintenance construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not.produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political`subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance.with the insurance requirements of this chapter have been presented to the contracting authority. Applicants { Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names,address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to.the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should--you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance-for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephcne and fax nurnl:r:r. _ .. .. ._... ... The & irass:.�lL:taS$:., Denartmenti of ndus�t-' a!A ta P.tu afflce of Inuesduadells 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 nhone #: (617) 727-4900 ext. 406. 409 nr 375 y Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR RegistrtQn; 103757 F.xptrat o¢� 't 12006 �^ype Piv2te Corporation SPRINKLE HOME,,IMPFOVEMENT, INC. Brad Sprinkle 199 Barnstable Rd. �.*T, Hyannis, MA'02601 Administrator ' BOARD OF BUILDING REGULATIONS j License: CONSTRUCTION SUPERVISOR j Number: -'S 006643 B i rtM:d ate: 10/08/1955 - Expires 1=0/08/2005 Tr. no: 5711 Restricted, 00. BRAD K SPRINKLE r/ 190 LOTHROPS LANE [ «� W BARNSTABLE, MA 02668 Administrator l0 -Z TOWN OF BARNSTABLE CAPE C D : INSULA11i t,�' 7tvr El N P-UA NB[R 05455 SP iT09V5P R' - B.TTB •�vmn S N �`Ol'I pT�t�05[ Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 _- - Date-.-- Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. /I Property Owner Property address ,(Village Insulation Installed: Fiberglass Ceilulosc R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ) ( ) ( ) ( ) Floors (�') ( ) (3c)) ( ) (X) Walls Sincerely He y E Ca sidy r, President Ca e Cod sulation, Inc. f = j �_�` •'i= 4•E S€ 7� -=E ,fEEC tl.,i(I€,. .�ii€ _�E 731 98 " Aiz s 'E Men at Work Landsca in y E �`Y22`A1et r WasYANNIS hin on Avenue Extention -�'? 6 Anonymous (Rob't Sylvia-771 8207 UNLISTEDI I I E� Washington Avenue Ext., Hy. neighbor 489-0256 •� i E t E€€EE ��'1i SEE 2 large trucks parked on property/workers' cars are parked there all day-crews are loud and angry �3 and causing a lot of noise. � art• ���+1 _.. .E tft rt i E i P1-LONE CALL': A.M. [PH R �U DATE TIME P.M. ZZ ZL �' phiONED RETURNED':: ONE Y{JURCALL AREA COD NU ER EXTENSION 'PLEASE ALL SSAGE WILL CALL ' AGA1N„ I S CAME T0: p...� ,SEE YDU ,L� WANTS TO ` N E D U I niv rsal 48003 --- NOTES �'` :::.::1256 >:.. . ::. ::::::. ::.::::::::::: ::::::::::.::::::.::.;:.;::«<::::.;;;;:.::>::>:««:::>::>::::>::»<:::<: '.......................................................... :` ` :.b.:�.:::.B ILD N ERVI E ::::>::»::>:::<:<:<:>::>:: :><:>:...». >::::>:::::>: >' c ::: Y>:::.:: X. > < . ..::• �� S G ON AVE EX``�, <:« ::>::r:::::::::::>: x.. ............................................... :;i:....:;i:iiS:::::::::::::::;::;:::;:::;.<:::;<::::::i:::::;::;:;:::::;:::::::::::i ' <"St HY NI ...... ........ X EX. rn I:a :::::>::>:::BOB SYLUTA ASHINGTON AVE:EXT ... ; :HOMEOWNER R RUNNING ABUSINE T F HI H C «' MP� ....E LOYEES NOISE, PARTIES. S BELIV ES »' <ITS OWNED BY M U RPHY. ::.>::>:.>::>:<: # C Ga .»>::