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0143 WHITEHALL WAY
fy3 C�ti��� h��l w • ��` - - - - - - - - � Ex�ar�afmnr�edete Town Of Barnstable Regulatory Services _ Fee Q y asap$� Richard K Scaff,Interim Director t? 'Rufldiug Division r Tom Perry,CBO,Building Commtssioner 200'Main Suet Hyannis,MA 02601 1�;vv to,,vn.bamstable.ma,us FEB 9 ZU16 Office 508-862-4038 r _ - ®WN OF Fax 508�90 6 30 EXPRESS PERMU A,FPLICATIONRESIDENITAX BLE o�7 ^�� Not Ytrlid lvf 1toutRedX-Press Imprint Map/parcel aP/Parcel Number Prop6ert Address , 3 V�ft/'�i� �i_ N "A�, Yesidendal Value'of Work l0��7i v Minimum fee of 35.0Q far�vork t�der 6009.00 Owner's Name&Address- A 1QVJ jk leoleA Contractor's Names( .£. � <;: p tin n i ele honeNumher[ 1�22g-c1 k(1,O Home Improvement Contractor License#'(if applicable)_ /7 ? T- Email: Construction Supervisor's Licenses(ifapplicable) OR 5 7 n? Workman2s Compensation insurance Check one ❑ I am a sole proprietor Cl I-am the Homeowner. I have Worker's Compensation Insurance Insurance.CompanyName "— Worlanan's Comp.Policy SitilC q 8n .;` :2 3 q.y Copy of Insurance Compliance CerttScate must accompany each permit Permit Request(check box) ❑ Re-roof(hurricane naffed)(stripping old shingles) All construction debris rill be taken to ❑Re-roof(hurricane naffed)(not stripping- Going over.- -• Wdstin layers Of roof) ❑ Re-side 5(Replacement Windoivs/doors/sliders.U Value 30 (iriautimt 3'F of windowQ r of doors: _ ❑ Smoke/Cubon Monoxide detectors 4 floor plans marked with red Sand-inspections required. Separate Eij&-ic al&Nre Permits required. 'TiAlhae required Issuance of this Ian fines nonexempt cotrroiiance with othrr'tmm department reautation%L&Histodr,Consmmfi n,etc. '*N- ote.- ProPert3'lp caner m&t sign Property Owner Letter of Permission. A copy t} the Home Improvement Contractors License&Constraction-&pervisors License is required. _ SIGNATQRIi: �Q:XWPFILES1F0RMSQd- p foj�ESSdoc Revised 061313 • i b�pW" - al s 1gc+rz RE, 4'�Z; w AMENS r traram. rrgus; cwiecrsr�r �coe..: . i6 AFS0 . •' Lin colri' � o2,(lfi ?emrt�3�zs� Phon-P S%L02235•Fax 401.£.4S SM ` •--=F vir So craavccaBaeglzed d721 o _ CUSTOM%M' -DG AM DOOR ►:EA11ODKILI!(iAGIt$E SENT �.. " (d. aairZxrZoeo'a14Lt3�c .'. 02- 601 ;_�' 77- E�'61J�9�s=s Hva.t♦4-y ... 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Renewal . s) /. >?'c+E/A�3�dxw:c�l�cv�.c%�f�.�es• � Posit tk lOf3,"TfiB BUYEF"). MA'cJLli Off-THM TR"5.6C 1N AT A Iib>�FWOR TO ItiSIltmtatLT 4iF Tnz YHD SDUKMIt-4YAFTFR.TMDffROfTMTR&NSAC,TIOK.$$E'T .A1W, MI)NOTICE o1E CANCKLUnON Fi3) MAN E30FIANA'ITIONOF'THfSfi G ee 040nCE OF CANg LEAT1€xN r - aaabe of Tits n , ;Ewa m9,,earaereJ Die,art Try " +f ,< 6 _trm,�.,�,cancel this tr&vw!do14 wEthoaz Pe Td e6rggabon,witiunx tine r- -- fign,withoet ta[tp Pewhy ar ny within. three busii7ess days ira[rtu> e a V4 i f YOU '� Il three bugAiw:dae)ry feo[rf�e above dates-ff you Gai[ea�acry gnop9cr£y'tyradrrd: -mis':by you eider t 'i rapt wed ir4 wry 1 trade W YOU'under the M ttr -_or Sale 3_nd arty'�W6Able t e�sec Aed tl ritract ar SAI*andi any ncmotatd'e I'nstlrument ewmd �JF 7 + will be returned r }thin tau lie day$folk-Ing :o by ran Win be nftft ed Wf €ern barai11e3a_Kys Ea21IW ng tme pt the Seller of your cancellation naitic%and any 11 receipt 4 die Seflar 1*4 ymw faflan na�dE'e.wtd_,arry setsarflr tit € `iig nrut_of tlta ta�nsastioo veil he sc[sariay ic. ss at sie�g out a# lee o[t willi be eaneeledltyoti cu or you nwit nu dw i iag'lwui the,Senor` 'A ���+ + if }ants out of ee as ltadte thr 5etgee flame tit a`atr$V�Ayr AtegArAt!Coadttion as vdlen 1 eC.y resi rr'in. bstaTrgally gpad!tmn yr n, treselred, jocNh de'G ed ft you,un dear this Vic#or :1_wed, �/gt d'cliirer�ed�a��tdiv ti.is Co,nbact'aa Sale} you if w3yhy ca 1i�eerth iltte its, oetioteh oft Sale;or your nth%°f�y*b'" "co v**dw irmb iiac ons of tslt cgu 'PAo , > 9�at a tf�e 5etly to rn stularrr�lkp# at tdta_ settsr3 fYon -+tie aerau to_ SeCer�s� e[�ei k.ILKu d'6 d -evarl w 6a i!u rh Seiler'does.not plait Gp vrrtliin-.' to tits Seller aed the_Seller d4£ii not pick witinin wft _ of tit e '�nttYAlatioc you r>rua�r:r ewn Ar °' 7�6f she date'of caac ftdoN yw [Main or p�$a of g further aW .if ybi[ 1 &spose a4 the,good'n widwout aV fistter amid If you faa to goods av actable.to the Seger or if you ag vc 1 M. on,tea the ga6ds avallabit to tthe'Sd erg or d you airee. e6 uFil tha to the"kw aruf farll to dtr se,ehen y6U 1 to return dw each t*dw Seiler and fail to do so,deer you "Whain ieaPe{, r performance of all ow,hpilons under the 1 rernaFry li pe_Kermanee-ad a ." render the, Gc aft To to rood this ttransa bon, or d' ' r a signedCnnbwLTb,camel Iles tnutmation6 rnWl or dela per a agreed and' and copy of da cwtallatiohi natic . or any odiei ' and' dated copy of this caneella6m notice ar any Wher writbm notice,or ww d atelewram tn,Rww_PAM'al by Andersen of wkeen not .or tend a hJegMjn to Ii " Ikd rye' souduerti Alea'ETii�di 2G Aib94utt . Ill 5r I-Soudker,,Nora England at 26 Aibion Roadl, 0 65e NOT F�lTB1 i9tCaN;ECHIT t3E , @ " LATER TY1�kN M',IDI4ft'sFl iyp (Date}} HIFttY CI9ANCELTHISTRANSA..CTK_d♦ t 11 HEREBY t ANCELTI-IiSTiiANSACT10K If +.copy MA .-M 3ww Copy:wow UTte t pr F9r* Southern New England Windows d.b.a Renewal by Andersen'. of SNP Massachusetts-Department of Public Safety Board of Building.Regt,ilat•Icns and Standards Construction Supemkor rns : CS4)95707 BRMAN D DBNHLSbN.:. 7 LANBS POND CIIt� t Chariton MA 01*7 4� n`L Commissioner 09/0812M UFF n��>GC? (��C.'fi7 f/tti%fZl.G'G�CL/ fI•to l' lllLC/l-£.GJ6'�-,�:1 iL Office of Consumer Affairs and Business Regulation 10 Park Plaza--Suite 5170 Boston,Massachusetts 02.116 Home Improvement Contractor Registration Roa1stra0on: 173246 TVpe: LLC Eiora6on: 9/1912018 TB 25*rJU SOUTHERN NEW ENGLAND WINDOWS LL MATTHEW ESLER 26 ALBION RD LINCOLN,R102865 Ululate Address and return card.Marls reason.fnrchsnge. Addrms n Renewal (]EmPiovment ❑Lost Card c�ife�w:smonra!Af ol'cs�ruouLsbd7 - .•. 4N (ice ofCoa==r Affaim&Designs Rtlalet[w License or registration valid for individal use only ME IMPROVEMENT CONTRACTOR bdere t5t ettpiration dsh.If found retorn to: 173246 Type: Office ofCoasomer:Athirs and BmMels.RequiRUon . ration: GiMOIS LLC 10ParkPlaar-SutteS170 . �'. Bottom KA D2116 S0117HERN NEW ENGLAND WINDOWS LLC. rt .RENEWAL BY ANCERSCN .. - MAT7HEW ESLER / 26 ALEION RD /+ a LINCOLN.RI 02865 — Uodedesremr7 _ Not TUid without sigeature The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations _ 1 Congress Street, Suite 100 Ic� Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Legibly Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are you�n employer? Check the appropriate box: Type of project(required): 1.0 I arr�a employer with 20+ 4. Q I am a general contractor and 1 6. ❑New construction employees (full and/or part-time).* - have hired the sub-contractors 2.❑ I am a sole proprietor'or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8; Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp.insurance.: required.] 5. E] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I Ln Plumbing repairs or additions myself. [No workers'.comp. right of exemption per MGL 12.❑ Roof repairs . t c. 152, §1(4),and we have no insurance required.] 13. Other Window Replacement 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 t1omeowners 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. Insurance Company Name:ARGONAUT INS. CO. Policy#or Self-ins.Lic.#:WC 928058352394 Expiration Date:8/21/2016 Job Site Address: 1 3 E� L City/State/Zip:t&41C, -4S Attach a copy of the workers'compensation policy deel4ration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A.off'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' surance coverage verification. I do hereby certi under the ' s and penalties of perjury that the information provided ab ve tsrue and correct Si ure: Date: Phone#: 4012289800 , 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#: I . SOUTNEW-01 SHETTYSHT - -- ------------—------.. -- .------------- -•----- ---- -- —_._-....__ CERTIFICATE OF LIABILITY INSURANCE„ 8f1912015 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: N 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 CNAOenT Willis Certificate Center Willis of New Jersey,Inc. PHONE (87l�945-7378 No,(888 467 2378 c/o 26 Century Blvd o P.O.Box 305191 ADDRESS:certlficates@w(lilS-C* Nashville,TN 37230.5191 INSURER(S)AFFORDING COVERAGE HAICO INSURER A:Selective Insurance Company of Southeast 39926 INSURED INSURER B:OneBeacon Insurance CompaMt 21970 Southern New England Windows LLC INsuaER c:Argonaut insurance Company 19801 DIB1A Renewal by Andersen t= 26 Albion Road INSURER D: Lincoln,RI 02865 INSURER E INSURER IF 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE EFF POLICY EXP LIMITS LTR D wVD POLICY NUMBER D MMDMYYY A X COMMERCIAL GENERAL UABRJTY EACH OCCURRENCE $ 1,000,00 WMMI:TO RENTED CLAIMS-MADE ❑X OCCUR S 2029459 08/10/2015 08/10/2016 PREMISES Ea xa„reace S 100,00 MED EXP(Any one pew) $ 10,000 PERSONAC&AOVINJURY S 1,000,00 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 3,000,00 POLICY a PRO- LOC PRODUCTS-COMP/OPAGG $ 3AOO,O 00 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT g 1,000,000 , A X ANY AUTO S 2029459 0811012015 08110/2016 BODILY IwURY(Perpreson) s ALL OWNED SCHEDULED BODILY INJURY(Per acci0iaQ S AUTOS AUTOS NON-OWNED PROPERTYOAMAGE $ X HIRED AUTOS X AUTOS Per accident S X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS L1AS CLAIMS MADE S 2029459 08/1012015 08/10/2016 AGGREGATE $ 5,000,00 DED I RETENTIONS- 5 WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY 11000,00 B ANY PROPRIETOR►PARTNERIEXECUTNE YIN N N►A 0000068028 08/2112015 08121/2016 EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1,000,00 If yes describe under' E 1 DISEASE-POLICY LIMIT S 1.000,00 DESCRIPTION OF OPERATIONS below C Workers Compensation r928058352394 0.812112015 08121/2016 See Attached --.. , DESCRIPTION OF OPERATIONS 1 LOCATIONS►VEHICLES(ACORD 101,AddMma1 Remarks Sehedrde,maybe attached ff more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 'THEREOF, NPCE WILL BE DELIVERED IN ACCORDANCEIMTH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE %idence of Insurencle '` 01988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD .. q /p� is Town of Barnstable Permit# ' Expires 6 m tH o �; ate ~°^ Regulatory Services. lee SARNSPABLg KAMM9� t 8' Richard V.Scali,Interim Director t�AA'l~ �� Building Division ` Tom Perry,CBO,Building Commissioner APR 14 2016 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: Tool±-�> 2� s BARNSTABLE Fix: 508-790-6230 - EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X--Press Imprint Map/parcel Number.07a Property Address /73 LtJ; *4" j Residential Value of W,o�rkt$ ./d, Z�3 Minimum fee of 535.00 for work under$6000.00 , Owner's Name&Address /V aw"6 461 low Contractor's Name t /soxj Telephone Number 401-ILr-fSW Home Improvement Contractor License#(if applicable) 1732YQr -Email: Construction Supervisor's License#(if applicable) 0 7S74 7 AWorktnan's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name L0NAt,q- Workman's Comp.Policy# W d--Qa ga3W"iS 07.3 9 7 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to i ❑Re-roof(hurricane nailed)(not stripping..Going over _ existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders,U Value •30 (maximum.35)#of window #of doors- ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Wheie required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must.sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. _ SIGNATURE: Q:IWPFILESTORMSIbuilding permit formslEXPRESS.doc Revised 061313 1 r 120 cr PJ.aM1 4330, a�risw nutaanrwe maarx g u,.. r62 I7�7L (� Figllld;�i$i;RICO _ r a?S-4[22? Ptwaec 3t �83.22']3 Fax 401.533 FSS➢2:. mcm:raw.m _(� SooWZn?49wEup)2;ttdMdlaws. UZ d1b/g 'Yl , R®aait hyAndme o $�a�Lasaklsw;�a isud �th�L D ?i�v •f'iCTmm y l�])O 4''AJND DOOR REMODRIANG AP_ttLMKNNT , •�r`C{4,'.h3f,C Ll6�6F�BG°1H1E - - _ ,� .. 2 y¢d I S�aac.As ts,GYSs a a=d,Zp C-6t I P..9 Bmc' Ft>srr� mt��lsc �6M+' 7 ':�a+ .PdipF0WK06bar u)rt attar jai a(g se ei lye Y Viers to p�uc6;aaP .t ptrt t lca siulr yr aervkcel o-f Sa utheret Ne\+;E aced'Y6ndvv-- LLC d/blaliedew-J, by ltiat srrt of"Srnxt rr: etY Fib Und,("Cdntrac .>'ry,in azcii •atcc with 4Fs bertue a13a.castd&xm d=ribcd an EhC�.Frvett zad etc re eras',sf finis• Pmrni a►tdcaYhe.eRth:il eci6ti�a�ign txe4tl a�ll�cheti tliv . . � �{ �, me' `+ C3 Hf9tasir G'Coasdo •�' �' �i Method ied efrh YiKieiie„U a;eedt} - - .Irsyaift't�GCt�S�td1� ._ - i ,C CLI ';t�I+9.8Ui+€(,CC •;r an 17 Ofi'+' -.- CsFj=r-7r9�.,.t1'6�14 p1�a1r1F'xlffl nr {�.9.` ' : . .. 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FOR _ �uoN al•Tr.Gr Y r,. -, Nt j E cal , , ?+6O7lCE OF ibAmclMlt - < .Ytiu €aortal Oatta ofTran"sashan I�ste ot7frrsalorr ntr&ji • �d 'r =�' � ,You may trance,` tltiii trat�aetra v ll0ut pt�, l'f�r ar etibli,Qatran,wrtlttn i tbag trarr�ae6ort.wttltou Penal or ub® t6as vsitirin•, tYi I,ialitess ►Narii fife all �Ie:If:) rvanogl,arry dlraq:baanasa 'a trss the,al)1dyre date'<Ifu cancel;"atrtar.- p �rt', traded ¢4r= ��rn�tde,6y yrou under ttbs ,t rnpe r�adetl!,.,pajrtvtenta'rnade by y_u=+urtder'thc d:untrset.or 5iala..$rtd r�sgodahl'e Ilntrument 6�aaCrrtadl"I tfi is 0r 9'ale,and;d»y rteg able inArwment meted bi Yori w.101i bei Tecirr ee t wWo n to swniss dwys cii'vtving li bY,7► 9B.4e r+rmurrtadl within ten busjpM.wry fo(da,rrl'ne ►\e,oecpt.bar:tlte:Sefiet of ymr canczllition:gaacey and l; r sicips!.•blr din Sallor,of Our caneeflat(ee natiEer and,ankr tY- Se,.artsug skit of tpl ,tray tan WvIn be,, sectcrity t Est W, qs o+it of the rre.>saset6or-will be to ec ed:ityou cancel, u ffiu I:nralm&mfls W'e to tha'$,ePjir C eaneakIL I sate ,yau.nWSt;Mafia Wtaf lily to die Sidki at yavr r esi'dWce,Ili"3t 4tly as,gaod eondG on$s when. at l' rt .m w stanefally"g M ,eondltioar as witnvn "d,24 00f:.ddlvered to ya-a under thk il,6 ct or .i; reCeaved,U Svud�s"""red to'ypa ut�tler"ContraC ci` S or you I" if yott i#A^i,aunplyl'V-M the ins�etabr�trf.t Sales or", am'" tf you wish,cornp�F with the instructions of tl C Selle!"rega dift ttie retsrrn slri llt bf<he otu 'as tht3 s'.,tf dbrg dre returri`BrOp'rilenf tIQ goo ..aktlu. $NIa ane4 artd t ilk it'y�tt do m�Irg ods irniable SeGtEds' nse and risk_If iris de mallm the japtfsaa�ailahle \ m ifr®S er.sad the-Seluer d'oea not I� m up within to the Sauer and the Seller does rnst pick them up witltirt'• tapir I�of the ds4e of Uncedlation,r*" msy retilm or �:. tweisty dayis of the dabs of earscml[atcckf%'you retalh,or ' d' aEthe g�oed�yylthouE suwl►.$ 2her trfrlJgatlOits if you 6 iipose of 4Fis goad9 witllotkt,Gtsy fUrt[.ec:pfal�gation IfiYOU . fill m e.tlae gaudS a.�ll ble'ty tlt Seller,or iRy�OU agree ;1; falf to ma[ae they goods available to the SeIIeIi•cr if ywagmc ta.ret.ii to rite 0ds to tfia Seller and tad,to do so,then you I, to return th,40r.ggoods to the Seller anal:fail.to dtp ui rn then reafn It'able r Pe prn"anc'e'of all after ao ai s under the '�; remn Naable for perf6r trance of all Ailptforrs under tl±a, CuntractTo cancel tws tear mt-m mall at deliver,a:sGgrbed C0116-1kA.To cancel thm 6insactk6n.awl:or de114 a Sllatied, ' aAd' d!aftd'copy elf ibis cmuAladwi.nodeo or arry other :l And d'atad.espy of:till's oittellacGon rtoE;ce or artir other" wrl4tenint�ee,csendsitel ram toRenetiratby. Andeasenof','I Writtannnci�,orsend,sl�leg►arrttoRenewtalbyAndertP.nat. Seutfivn'lde�a En��1laat sit 1 Albion Re I! r in, d296 .t p SoI[slieb rr PlEviv ERgla�tJ'at fib AI 'on.Road u olri 3; [NOt LATERTl I,KIDNtG31T OF II N(Yrr,LATER,1 N M10HIG ifi OR. ��, f Da HERIEBY CAWCELTHISTR ACTION. `' i' 4061&'Y CANCELTMISTUNSACTIoN. (tMx QPy,:W►ELL liuparCepp.,Yellow guYer�Wp-r.Pt It I Southern New England Windows d.b.a Renewal by Andersen of SNE r: I'• '� Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS4MWM —Y.TT' `LL BRIAN D DENNISON 7 LAMBS POND CM Chalrbon MA 01*7 r Expiration Convnissiorer Q9/08l2016 Office of Consumer Affairs Ind Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement.Contractor Registration Registration: 173245 Type: Supplement Card Expiration: SM92016 SOUTHERN NEW ENGLAND WINDOWS LL DENNISON BRIAN 26 ALBION RD LINCOLN,RI 02865 Update Address and return card.Marie reason for ehaogs Address C Renewal E)Employmew ❑Last Card su,a aruav+, ❑ lfia of Conserver Alfsin&Bosious Resalation Litanse or registration valid for individul use only E 1MPROVEMElIT CONTRACTOR beforetbe ezpiratien 1182L If fooad return to: Office orcoasamer:.Bairs and Bnsioes Regulation y, Istra6on: f73245 Typo 10 Park Pb>a-Suite 5170 Ettpiratlon: 4119l2016 ,Supplmnerd.-ard Boston.MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN , 26 ALB10N RD LINCOLN.RI 02MS Uaderacereun tiot valid without signature The Commonwealth of'Masssachusetts Department of Industrial Accidents Office o.f Investigations I Congress Street, Suite 100 h �` Boston, MA 02114-2017 lv/ www mass gov/dita Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers __RR icant Information Please Print I�eMMY Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are you en employer? Check the appropriate box: Type of project(required): 4.20+ am a genera contractor 1.0 I aryl a employer with. ❑ I l ttor and I 6. ❑New construction.. employees (full and/or part-time).* have hired the sub-contractors 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workin for me in an capacity. employees and have workers' Buildingaddition [No workers' comp. insurance _ comp.insurance. 1 ❑ 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ 3.❑ 1 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 13.0 Other Window Replacement employees. [No workers' comp. insurance required.] "Any applicant that checks box 41 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 anew affidavit indicating such tdontractors 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. lam an employer that is providing workers'compensation insurance for my employees Below is the policy acid job site information. Insurance Company Name:ARGONAUT INS. CO. _ Policy#or Self-ins.Lic.#:WC 928058352394 Expiration Date.8/21/2016 Job Site Address: /3 W t�r� vv City/State/Zip: /'"' 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 1VIGL 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' urance coverage verification. I do hereby certifu under the ' s and penalties of perjury that the information provided ab a is true and correct Signature Date: q Phone#: 4012289800 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 b.Other Contact Person: Phone#: 1 • SOUTNEW-01 SHETTYSHT DATE(MMIDDNYYY) A�® CERTIFICATE OF LIABILITY INSURANCE.. 8/19/2015 FORTHIS IS CERTIFICATE IS ISSUED AS A MATTER OF GAT NEILY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THETION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE �DPOLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NE BELOW. THtS 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 terns 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). CONTACT Wims Certificate Center PRODUCER NA E" (I;$8)467-2378 Willits of New Jersey,Inc. PHONE //g77``945-7378 FAX Not. y AIC No Ext:t / c/o 26 Century Blvd A pAss certificates@willis.com P 0.Box 305191 M Nashville,TN 37230-5191 INSURERS AFFORDING COVERAGE _- INSURER A:Selective Insurance Company of S70 INSURED INSURER B:OneEleacon insurance Company Southern New England Windows LLC INSURER C:Argonaut Insurance Company D/B/A Renewal by Andersen INSURER D: 26 Albion Road INSURER E t Lincoln,RI 02865 ' 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 PERTHIS IOD RESPECT TO CH CERTIFICATE MAY BE ANYSISSUED OR MAY PERTAIN, THE INSURANCE DOCUMENT ANY CONTRACT OR OTHER RANCE AF ORDEDB HE PO IL C ES DESCRIBEDHEREIN IS BJECTTO ALL THEITERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMBS POLI Y EFF POLICY EXP INSRR TYPE OF INSURANCE INS POLICY NUMBER MMIDD MMOD EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL UABIUTY 0811012015 OW1012016 $ 100,00 S 2029459 PREMISES Ea occurrence CLAIMS-MADE ®OCCUR 10,00 MED EXP(Any one person) $ PERSONAL'&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 3,000,000 POLICY®PRO- JECT ®LOC 5 OTHER COMBINED SINGLE LIMIT MS AUTOMOBILE LIABILITY (Ea accident)INJURY S 2029459 08/1012015 08/1012016 BODILY INJURY(Per person) I A X ANY AUTO BODILY INJURY(Per acddenqALL OWNED CU ULED PROPERTY DAMAGEAUTOS ON-0WNED - Per accidentHIRED AUTOS AUTOS EACH OCCURRENCE X UMBRELLA LIAB X OCCUR 5,000,00 S 2029459 08/1012015 08/10/2016 AGGREGATE $ A EXCESS LIAB CLAIMS-MADE - S DED RETENTION$ OTH- X STATITTE ER WORKERS COMPENSATION 1,000,00 AND EMPLOYERS'LIABILITY 0000060028 L0812112015 08/21/2016 E.L.EACH ACCIDENT $ANY PROPRIETORIPARTNERIEXECUrIVE Y� E.L.DISEASE-EA EMPLO $ 1,000,00 OFFICER/MEMBER EXCLUDED? N N f A (Mandatory In NH) 1,D00,00 "Yes describe under' EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below Q$/21120 55 08121/2016 See Attached ' C Workers Compensation C928058352394 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached ff more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, {=CE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A4 Evidence of Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable *Permit 2 Q FR: 6DO Expires 6 m6nths from issue date Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS.PERMIT APPLICATION—. ' RESIDENTIAL ONLY Not Valid without Red X-Press Imprittt . Map/parcel Number Property Address- x 4 f` a residential Value of Work Minimum fee of$25.00 for word under $6000.00 Owner's Name&Address t ,cQ Q ,. v �- v. )) `,�/. Contractor's Name ' e� C Telephone Number( G o&/ 3( Y— `S 6 Y 3 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 7 a d d ❑Workman's Compensation Insurance ® RESE PER p Check one: "E' _ IT ❑ I am a sole proprietor Q C T% ❑ I am the Homeowner �. Zo0$. [&I have Worker's Compensation Insurance n TOWN OF BARNSTABLE Insurance Company Name akA. , l lAeC4 Y J , --P Workman's Comp.Policy# [7a, `) -`b 4 � - Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) pn'"- � t VRe-roof(stripping old shingles) All construction debris will be taken to 6&a_4l�.�d. eeelv ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement.Windows. U-Value (rnaximum.44) ""'~-----_ 1u1 A. *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. 7S ' f _` ;7 4 f Home Improvement Contractors License is required. SIGNATITRF: ll��oT PQ�tI2 Q:Forms:expmtrg Revise071405 The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.masagov/dia• Workers' Compensation Insurance Affidavit; Builders/Contractors/Electridans/Plunabers Applicant Information Please Print Let_b] Name (Brosiness/Organization/lnd v.idu4: P l� Address: City/State/Z •/A Phone#; q Q$— , �f : 4 Are you an employer? Check the'appropriate bog: Type of project'(required): 1,( I am a employer with_ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-c artracto 7. ❑Remodeling 2.❑ I am a sale proprietor or partner- listed on the attached sheet ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp,insurance. 9. ❑ Building addition [No workers' Gornp.insurance S. ❑We are a corporation and its rfficers have exercised their 10.❑ Elechical repairs or additions equir&] o 3.❑ I am a honieawner doing all work right of exemption per MGL l l.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.XRoof repairs insurance required.] t . employees.[No workers' 13•❑ C►dler comp.insurance required.] *Any applicant that checks box#1 crust also fill out the section below showing the&workers'compensation policyinfounetion: ` t Homeowners who submit this affidavit indicating they are doing all work andihenhire outside contractors most submit anew affidavit indicating such ;Contractors that check this box must attached an additional aheat showing the name of The sub-contractors and their wo&ae comp.policy ixrformatlun. • I am an employer that Is providing workers'compensation Insuranceformy employees. Below Is thepo14 and job sits Information. Ins rance CompanyName: cm,,r -, LA Policy#or Bet".Lac.t*: c)a.f 3 3�t 1 clex) Job Site Address: 1 t/ City/5tate/Zip: �G Attach a copy of the workers' compensation p.ollcy declaratAn page(showing the policy num er and expiration date). Failure to secnrg coverage as required under Section 25A of MGL c. 152 tan lead to the imposition of criminal penalties of a fine up to$1,500,-,90 and/or one-year impris=em�as well as civilpenalties in the.form of a STOP WORK ORDER and a tine 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 tender the pains anddppenaldes of perjury that the information provided above is true and correct; Si tore: V Date: -2 ��j Phone#: O f5 3 YL y 0 L-ia ask off- Do M*€ 1� Ah area,to ve c• d b'cry of t4m efiRwid City or Town: YermttfLicense# Issuiq Authority(circle one); 11.Board of Health 3.Building Department 3.Cttyrl-owa Clerk 4.Electrical inspector S.Plumbing Inspector 6. Mer � I Cofftaet Person: Phone#: In forma' tion and Instructions Massachusetts General Laws chapter 152 requires all employers to provide wbAers' compensation forfhemr employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any on of hire, express or implied,.oial or written." An employer is defined as-"an individual,partnership,association,corporation dr 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 thri 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 tir repair work on such dwelling house or on the grounds Or building appurtenant thereto shall not because of such employment be deemed tobe an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate it business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states'Neither the cormnonweaM nor any of its political subdivisions shall enter into any contract for the perfom=ct ofpublic work until acceptable evidence of commliance with the insurance requirements of this chapter have been presented to the contracting anthority." Applicants Please fiII out the w.omicers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of nnsusaace. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or pmInem,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required: Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit. The•affidavit should be 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 listedbelow. Self-insured companies&oM-hater their self insurance license number on-the appropriate lime. -- x City or Town OfPiidah- . Please be sure that the affidavit is complete and printed legibly: The Department has provided a space id the bottom. 'ofthi afhdayat for you to fill outia the event the Office of Investigations has to contact you.mgarding.the applicant Please be sure to fill in the permit/license number which wM be used as a reference im�bei. In addition,an applicant that mot submit multiple permMicense applications in any given year,need only submit one affidavit indicating cmxent policy iaformation(if necessary)and under"Job.Site Address"the applicant should write"all locations in _(city or town)."A copy of the affidavit that has been o$icially stamped or marked by the city or town may be provided to the applicant as proof that•a valid a%davit is on file for future permits or licenses. Anew affidavit mustbe filled out each ' year.Where a�bme owner or citizen is obtaining a license or permit notrelated to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would Else to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a can The Department's address,telephone and fax camber: The Commonwealth of NWsachasetts Department of Industrial Accidmts effice ft 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 e-xt 406 or 1-877-NIA.SSAFE ' Fax#617-727-7749 Revised 5-26-05 vrww aaas5.gov/dia Town of Barnstable regulatory Services , �z MASS Thomas F.Geiler,Director �''°TFD►M�►1e ,� Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA b2601 Ww w.town.b arnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder I, P,l Ckoa42 c 1 U�c Wc'g Al Z!4 ,as.Owner of the subject property hereby authorize %RS R ra cl P c,J Jc--3 t;(1C to act on my behalf, in all matters relative to work authorized bythis building permit application for. J (Address of Job) Signature of Owner Date t� c ch p l2 1(nc�4 Print Name Q:FORMS:O WNERPERMISSION i� r 1 fie �o7rvrreareureaLC� o�,-/l2aaaac/zuaet7a" ;Board of Bwldmg;'Re'gulations and Standards 'Construction'$upervrso?rUcr ense" r _: License 'CS 48086- 1: Ex_ n._a t-i_o_n, Tr# 20064/28/2010 it F. ,I { r�Restrictron� 00 9 '.mot r } , € yr - BRADLEY PADDOCK-`h AR MSTON6cMlLL'S'''MA 02664 t • _ ,.. .. . .. ;_. - '.Commissioner ,- 15/ltc "l�L�77�720?2�uea`Cl o��i7iGdb��CitudeQ6 - _ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 121967, One Ashburton Place Rm 1301 Expl,ration 7/3/2010 Tr# 273518 Boston,Ma.02108 TYPeridividual BRADLEY A.PADDOCK r BRADLEY PADDOC4K f, 24 DEBBIES LANE .,` ° l �Q-a..` ✓ - .--- __ k "' Not valiut signature MARSTONS MILLS,_MA�02648 Administrator ' • ' � } e gA, 1 ISSUE DATE 0712212008. 1,winm PRODUCER THIS�CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION.ONLY AND Miller McCartin CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE dba Dowling&O'Neil Ins Agcy DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 Iyannough Road Hyannis,MA 02601 COMPANIES AFFORDING COVERAGE INSURED - Bradley A Paddock dba Paddock Home Improvement COMPANY A A.I.M.Mutual Insurance Co LETTER 24 Debbie's Lane Marstons Mills,MA 02648 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. CO TYPE OF INSURANCE - - POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MMIDD/Yl� GENERAL LIABILITY GENERAL AGGREGATE PRODUCTS-COMP/oP AGG. COMMERCIAL GENERAL LIABILITY. - PERSONAL&.ADV.'INJURY Q Q CLAIMS MADE=OCCUREACH OCCURRENCE - OWNER'S&CONTRACTOR'S PROT. FIRE DAMAGE(Anyone tire) - MED.EXPENSE(Anyone person). AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT ANY AUTO - - " BODILY INJURY ALL OWNED AUTOS _ (Per person) - - SCHEDULED AUTOS HIRED AUTOS - BODILY INJURY NON-OWNED AUTOS - (Per accident) HGARAGE LIABILITY � PROPERTYDAMAGE - EXCESS LIABILITY - EACH OCCURRENCE UMBRELLA FORM - AGGREGATE - OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND STATUTORY LIMITS OTHER EMPLOYERS LIABILITY X HE PROPRIETOR/ EL EACH ACCIDENT 100,000 A ARNERs\EXECUTIVE - _ - FFICIERS ARE: 7021339012008 06/06/2008 06/06/2009 EL DISEASE--POLICY LIMIT 500,000- INCL ®EXCL EL DISEASE--EACH 100,000 EMPLOYEE COMMENTS/DESCRIPTION OF OPERATIONS OR LOCATIONS: BRADLEY A PADDOCK IS NOT COVERED BY THE WORKERS'COMPENSATION POLICY. ERT ETC Axe Q DER r,zy E�:,f, i� �., :,£, EL�1 ¢ $ " , ... r �z s ., SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE HEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 WRITTEN NOTICE TO THE CERTIFICAT OLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION R LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. TOWN OF FALMOUTH 59 TOWN HALL SQ FALMOUTH,MA 02540 kUTHORIZED REPRESENTATIVE Assessor's offioe (1st floor): Assessor's map and lot number .......�.. ..�..':.. � ... poi THE To` Board of Health (3rd floor): �5 OR, (��• fO�Q `� D . S4�wage `Permit number ......................... 6-rep id ............................... t BAUSTADLE, S Engineering Department (3rd floor): ,! S. v ■AGa House number � 1�f3 F-) ,s�1639. ®� ................... ................. 'E0161 a. APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only TOWN OF B ARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... J TYPE OF CONSTRUCTION (,j d d Cn C i�'d'C�✓r! ... .......................................................................... ........................ �. ... 19...----- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: lC)-� - K)�`. "� C_.!C .�� �C�C/1 n I"S Location _........... ............�1�.��........n........................................... ProposedUse ......:�1...(.n..C•1..... t..... <.�...! .!................................................................................................................... II L/ "Zoning District :......I..............................................Fire District .....1"-1... .h..r1.! 1.!... . Name of Owner O_f e.n...bir. ........... .. .tAddress .................1......�� ............�� .VA.TK'G.fJL'./-P Nameof Builder ..... t. �J.......................................Address .................................................................................... Nameof Architect .........�........................................................Address ...........�...............................�........................1............... Number of Rooms ........ .....................................................Foundation .....I..4��c!�r.��d....CP<�l .A�..l-F'....... Exterior .. ........ .../.!l.Gl. ....... �.��&..,s.Roofing ....Avo..Ac-,...!. ..... .: .. ...................... Floors1. ..I... ... G ;!f�.e.. ....................Interior ......�) t" ..v f. .....r ��.C..�x Heating ...... ....Plumbing ... n......':..). .............................................. Fireplace ..................................................................................Approximate Cost 1....................................... .......... Definitive Plan Approved by Planning Board ----____ _�� Area T z Diagram of Lot and Building with Dimensions 7 7 X 26 Fee 7c.............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH Cc,�� 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. / Name ........ .........,.....,..�f��.�................� ........ U Construction Supervisor's License ..... GREENBRIER CORP. A=272-188 No ... Permit for ....One,,,StorY............ :Single..FamilY..Dwelling,,,,,,,,,,,,,,,,, Location .......Lot,.A13,,,...143„Ajt.P-haII...Way ...................!Y.annis................................. Owner .....Greenbrier Corp,, ....................... Type of Construction .FKAMP............................... Plot ............................ Lot ................................ Permit Granted October 28, 19 86 Date of Inspection ....................................19 Date Completed 19 a . ...................................... TOWN OF BAR NSTABL� r � E, MASSACHUSETTS .. A�Z7� l88 _*! D T19 �Qer_'. PERMIT ATE 6�ei°. 8 AFiP ICANT 'ADORES 1 OKI- •' •T IC'.. I -NSE) PERMIT TO Ili-let,nfOPI I'irhg (�_) .,STORY,` D ELl`RING UNITS rt..,i;?,k .+�,,',.. •(TY;PE,OF..IMPROVEMENT) _J. NO., ,. ZONING' AT.(LOCATION)' DIS„T„RICT RC'� 1 E 1 ar °BETWEEN=` AND ,(CROSS STREET) "i. (CR054,i ST REET)'.`' SUBDIVISION•' LOT BLOCK. 5 ZE BUILDING IS TO BE FT. WIDE BY ' "FT. LONG BY FT AN HEIGHT AND SHALL CDNFORM iN CQNSTRUCTION TO TYPE USE GROUP BASE MENT:WALLS>.OR{FOUNDATION ... .. .. - ..I TYPE) RE 4 RKS.. Bond AREA OR e P R r yOIUME< ESTIMATED COST yl 45�onn,Q E MIT E�FEET). Q FEE n g ' OWNERsc@@CiK#� 6e BUILDING OEPT ADDRESS :� gg -�r9•r.—T}---r—vEircBi � BY' � OFANY`A PP,L ICABLE SUBDIVISION RESTRICTIONS.. - - MINIMUM OFc'3•THREE CALL • APPROVED PLANS MUST BE RETAINED ON 1013,AND THIS WHERE APPLICABLE- SEPARATE INSPECTIONS.REQUIRED FOR-:" CARD KEPT.POSTED.UNTIL FINAL INSPECTION HAS'BEEN PERMITS . ARE REQUIRED FOR ,'4LL-C ONST RyU C_T ION WORN ELECTRICAL;'..PLUMBING. AND - 1. FOUNDATIONS'OR FOOTINGS. ' .MADE. WHERE ACERTIFICATE OF OCCUPA NGY' IS 'RE- MECHANICAL INSTALLATIONS. •2. PRIOR-.TO,COV.ERING STRUCTURAL QU.IRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL - MEMBERSIRE TI T BEFORE FINAL INSPECTION HAS BEEN MADE.3:-f INAL INSPECTION BEFORE •' - OCCUPANCY.,; POST IRIS CARD 50 IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPPgROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 G Ag HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT OTHER'- 2 D 4 n U$r' Z,�B BOARD OF HE WORK SHALL NOT PROCEED UNTIL`THE INSPEC PERMIT W!LL BECOME NULL AND VOID IF CONSTI LICTION INSPECTIONS INDICATED ON THIS CARD'CAN BE -TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN.SI.: MONTHS OF GATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCT ICW. ( PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. a —; oSINE>o� TOWN OF BARNSTABLE Permit NO. .30105 BUILDING DEPARTMENT { B°g;a TOWN OFFICE BUILDING Cash nr%v HYANNIS,MASS.02601 Bond ......... . CERTIFICATE OF USE AND OCCUPANCY Issued to Greenbrier Corp. Address Lot_ #13, 143 Whitehall Way Hyannis, Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. March 31, 19 8� ,��� /�" �-t-�'--G-- ..... ... . '�.................. Building Inspector �'fy��•'. TOWN OF BARNSTABLE _ BUILDING DEPARTMENT _ leai�r TOWN OFFICE BUILDING rua ♦g t639' �� HYANNIS, MASS. 02601 �o rnr►• MEMO TO: Town Clerk FROM: Building Department DATE: i An Occupancy Permit has been issued for the building authorized by BuildingPermit ............................................................................................................ :..._............................ . issued to i�ij n-eA,'..h...!!;4{-rer � ...� �...3...........r A`fI-33........AJX,-r-hHLL Please release the performance bond. i /a=43,9;4k:wo .5F A SSV►Ma Ldr". # Y yw � FK I. y nQ f r h . O v r< T Lo IV 709 /�.o - .w ,,. ' (,U . T iV /nV . I1I - - •,>*+tip L I a T f : r � I CERTIFY THAT THE •� 'cyi SHOWN ON THIS PLAN IS �o ic�i7 y1 LOCATED" ON THE GROUND �I�F^ �a \Y, ♦o .' -. h.. 1. AS INDICATED AND CONFORMS ��� sTF. TObTTH,E -rZ�OQN II NCG LAWS OF e C s eZ Z,7 Y f 4: LAND S RVR DATE' EG 15T E 0 E O LEVY 8t ELDREDGE ASSOCIATES,INC. ; C:ERT'I �ED PLOT PL �r CLIENT '- � ENGINEERS — LANDSCAPE ARCHITECTS JOB NO. 'r LA'f �3 T� lrL a� PLANNERS— LAND SURVEYORS DR, BY:, IN 4 889 WEST MAIN STREET CHKD.BY {Z�tS } CENTER�/ILLE, MA. 02632 SHEET..LOFJ— SCALE "-4(:�° ! DATE Al I s k MI. = (lst floor): r F �F TN EAssessor's-offioe • Assessor's map.and lot number ........... TO SEPTIC SYSTEM MUST Bb'ard:of Health .(3rd floor): 'J ek .,: INSTALLED IN COMPLI, t, b6-to- Id � �; . . Sewage Permit. number :..................� ............F JS....... f� WITH'TITLE 5 ! 8��& L Engineering Department (3rd floor): /(N ENVIRONMENTAL CODE "i63q' �0 Housenumber ...:............. .................. .., ....................... ,-,; yaY d TOWN. REGULATIONS ° APPLICATIONS PROCESSED _,8,30 ,9:30 A.M. and 1:00-2:00-P.M..onlyi TOWN OF :BARNSTABLE ' BUILDING ,' INSPECTOR ` APPLICATION FOR PERMIT TO CO.n. �. c� .l.L�.�I.. ............................ TYPE OF CONSTRUCTION ...4 -�..... ............................................................................... ......................... ' a TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for a per it according to the allowing information: - Location'-.1d .......... .. .....L.l��.! ..!..... -. C� .!..1...... .... .... ...(v^, .. .). ProposedUse .......S... . .... ...It..... ............................................................................:........r.............. ...1 ...................Fire District ..:.. 1... 4G ,V1Il.,.�Zoning District...... .. ............ .,....................:`:.., .... ..'l. ........................... Name of Owner ....� Jl. �.�. '.n... .( I..e: .. ...l JAddress U........ l.d.:... f. 1. eC Ut..I..C.. t ,Name of Builder :..„ /vl�..... ...................Address ....................................:.....:............ ....."......:.......... Name of Architect ........:....................................:....................Address .....................:..............:....... . ....Foundation .......U�� .� ....�.��.... *`Number of Rooms ....... ....................:.............. ......... . �... ......... 4 Exterior .. . .�-.. 1.Y1. [.eS....... ....�.l. S.Roofing ...: .. ......a.3.:5 Floors ...."�/..1 .... ..1..... ... / ..!..."....................Interior ...... .!.`. ..:..fl-Q. .9................................... ..;.'..............Plumbing ...c .:<J.��`. ... ............................................ .Fireplace ..............................:...................................................Approximate Cost .... a, C�...................... - ' c -7 7Z Definitive Plan Approved by Planning Board ___________ 6.1.9.a- .' Area '...:..... ..../...... .......... Diagram of Lot and Bui]din with Dimensions 5� g g• T �� Fee ................ ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH M 1 G)-(X l d ��e`z G)O, 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. Name ...... . . . ....... Construction. Supervisor's License .. �.. ...(... 1 •.... GREENBRER CORP. (` 301.05 One Storyr' .� No ........... Permit for ...... ............... ........... .... Single Family Dwelling Location ,•Lot #13, 143 Whitehall Way :- ,� , f ,•, �., '� cw 4 a -Hyannis :r .f\,j `\ t � � Greenbrier Cor. ..... � ..... ........... �, Owner ....................................P............................ d { �- Type of Construction .....Frame.....:.................... Plot .. ....:............. Lot .. . ..... .................. - `; - October 28 86 { Permit Granted ...19 x / a Date of•Inspection ..dl.. Zl..... .....19 t,J Date Complete ....�J .. .'j +'19-r7 . �} i 1`'f rf v .!: ,�� t.�� '�i''S�r � �„�-•- �� �� r Jar �« ���. -... .'^� •� r� ��'•� ` .. � � 'r f ,' � ,fir' '`-? F t • `ter,.