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Home My WebLink About0070 WOODBURY AVENUE m;3o �- � �s ., �O �� J � -- --- - - - ----- _______ - --- ----- --. �, ypF �qy, Application number .. l.`J ... q . o�. Date Issued......I..... ........... ................I............... YnRxsrrwste. . v MASS. Building Inspectors Initials......... ........... ... ........ 'DrFo MAC° Map/Parcel................ ......... ... .......... Qo6 � V� WN OF BARNSTABLE . 0N6T' EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY MORMATION Address of Project: 7o- o c( "'Ave , NUMBER REET VILLAGE Owner's Name: A I Luc i e Phone Number 7 7 _qq y- /7-7 1 Email Address: Cell Phone Number Project cost$ cl 7 2- S — Check one Residential V Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: See -F\4.cj�4 Date: TYPE OF WORD FD SidingU Windows no header change)# `-( Q Insulation/Weatherization ( g ) �— ❑ Doors (no header change)# Commercial Doors require an inspector's review ED Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CJW5�e CONTRACTOR'S INFORMATION Contractor's name le -tee le — G,lli40� I Jo r 0 12' 30 s�n Home Improvement Contractors Registration(if applicable)# Z �d22 S (attach copy) Construction Supervisor's License# O1 Z 7 7 2- (attach copy) Email of Contractor co/il Phone number 7 91 I — -5 7 ALL PROPERTIES THAT HAVE STRUCT S OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a:for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pnL Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEEO9'V'1®ERIS LICENSE EXB`ilYgJC YION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedure s,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date Lgtl..AN g 9 S SIGN TM Signature _ Date All perms a °ons are subject to a building official's approval prior to issuance l s W1{' dow. orld of Boston MA HIC Registration Offices & Showrooms Number: ® 15A Cummings Park 0 295 Old Oak Street 166025 Woburn, MA 01801 . Pembroke, MA 02359 Federal ID # (781) 932-4805 (781) 826-6281 82-4898432 www.WindowWorldofBoston.com Customer: „ � Phone (h) -]") 194 E V I'l ab,Z& Install Address: - � (.rr�g�, _M Phone (w) City:HE.W'..3, State: MA dip E-mail WINDOW WORLD GLASS OPTIONS 1000 Series Single-hung All-Weld $199 SolarZone Elite-Dual Pane $1.19 �, 2000 Series DH All-Weld $215 Triple Pane/Krypton $369 4000 Series DH All-Weld $240 (Series 6000 Only) 6000 Series DH All-Weld... $260 WINDOW OPTIONS 2 l ite Slider $374 3 Lite Slider (,is,1ra,1/3) (1I4,1/2,1/4) $575 Glass Breakage Warranty (4000/6000) $151NCLUDED Picture/Fixed Lite (0-83 UI) $365 1/2 Screens $91NCLUDED Picture/Fixed Lite (84-430 UI) $445 Foam Insulation on Jambs and Head $11 INCLUDED Awning $310 rouble Strength Glass (4000/6000) $15 INCLUDED Casement - Plus$49 (DH-Sash Rail)$330 Double Locks (> 26") $5 INCLUDED 2 Lite Casement $595 Full Screens $25 3 Lite Casement (11% /3,1/3) (1/4,1/2,1/4) $910 Colonial Grids (Contoured/Flat) $65 Basement Hopper $434 Prairie Grids $75 Bay Window-Soffit Mount/INS Seat $2660. Simulated Divided Lite $182 Bow Window-Soffit Mount/I N.S Seat$2785__ Tempered DH Sash(BSO) (TSO) $75 Garden Window $2040 _ Obscure Glass (BSO) (TSO) $75 Bay, Bow, Garden Oversize (+109 UI) $975 Beige/Almond $40 Oriel Style(40/60 or 60/40) $75 Wood Grain Interior(Series 4000/6000 only)$100 _ Foam Enhanced Frame $35 (Light Oak/Dark Oak/Cherry/ Fox Wood PRE 1978 BUILT HOMES (EPA LEAD SAFE RENOVATION) Rich Maple) _Lead Safe Practices Required $30.—i Brown Exterior(Arch.Bronze American Terra)$100 MY HOME WAS.Bl,)ILT IN THE YEAR i s1 I it all Designer Color Exterior $175 _ MISCELLANEOUS Window $ Custom Exterior Aluminum Cladding (Two-Bend) Window Color U Textured$90 ZI G-8 Smooth$90 $ inside. Outside Facing fiolor, NON.-CUSTOM DOQRS Metal Window Removal $75 Vinyl Rolling Patio Door 5ft.or Eft. $1095� New Construction Vinyl Removal $175 Vinyl Rolling Patio Door 8ft. $1195 Multi-Bend Cladding $20 Add to base price for Custom Rolling Patio Door $1250 —-- —Mull to Form Mufti!:Unit $30 French Rail Siiding:Patio`Door 51f.or 6ft. ' $1395 Install interior/Exterior Stops: $50 French_llaii Sliding Patio Door 8ft. $1495 Install Interior Casing Starts At $95 French Rail Sliding Patio Door 91t. $•1595 Insulate Weight Boxes $20 Custom Exterior Cladding $300 _ u�Roof for Bay/Bow Windows $500 SolarZone Elite or ETC Glass $305. Existing New Const. Ext. Retro Fit $150. Grids Patio Door $210 Remo val of Existing Bay/Bow $250 Woodgrain interiors $395 Repair Sill,Jamb or replace sill nosing .$75 Exterior Designer Colors �L $595 Full Sub-Sill (Single) replacement $175 Interior Casing 21J2 3142 $275 Handieset Options $ Mullion Removal $50 $ Bay/Bow Conversion Ext. Retro Fit $450 (New Siding Will Not Match) Door Color ® ROUND-Up FOR WINDOW�1i10 II.1D 9,�RES '. inside; Outside f vUQLVI I IVI ucL.w 1Va CALM i A VVI aN ai to ui iuv106at tua Patt ion U ctI iuwt t CNatt t i iay uC Gu 11r%aut ]I, - 3 Customer declines grids onj�A _windows/doors Initial DISCLAIMER:Customer is responsible for the following in connection with this contract:Painting,Staining,Alarm System disconnect/reconnect Building Permit fees in excess of$25.00,Homeowner and or Condo Association Approval,Historic District Approval.City of Boston parking&sidewalk Permit fees in connection with installation. NO EXTRA WORK IF NOT IN WRITING! Customer agrees to the terms of payment as follows: Extra Labor&Materials $ 9 "*� Site Set Up, Permit, Disposal&Delivery Fees$ $389.00 �:)'R .�` � �, ( Total Amount $ Custom Order Deposit 33% $ . CI<#S6 , 115 Project Start Payment 33% $, A F, s Balance Due Day of Installation S °....- 5S- Amount Financed $ ` Window World of Boston anticipates starting this work on( ,f=o,��L? and being substantially completed ink" days.Security Interest:Yes No Any deposit required in advance of the start of the work SHALL NOT exceed 331/3%of the total contract price or the actual cost of any material or equipment of a special order or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule.No final payment shall be demanded until the contract is completed to the satisfaction of both parties. All home improvement contractors and subcontractors shall be registered and that any inquires about a corrtract or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170 Boston,MA 02116.Phone:(617)973-8700 No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. Window World of Boston under provision of Chapter 142A of the general laws is required to apply for and obtain all construction-related permits.Window World.of Boston shall not be deemed responsible for delays in the work described in this agreement caused by regulatory,permit granting agencies,authorities or individuals. Notice:If the PURCHASER(S)obtains his own construction related permits for the work described under this agreement or deals with unregistered contractors, the PURCHASER(S)is hereby advised that in the event of a dispute,judgement and nonpayment,the PURCHASER(S)will not be entitled to make a claim or collection from the guaranty fund established by chapter 142A,M.G.L. You the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Notice of cancellation must be in writing postmarked no later than midnight of the following third business day. THIS IS A CAST® RDEI_ N® ®R RESALE! This Window World°Franchise is independently owned and a erated by L&P Boston 022rating, �Inc..under license from Window World,Inc. if I Owner:Do not sign if there are 0 blank spaces. Date Bs Salesman:Do not sign if there are any blank spaces. Date Owner:Do not sign If there are any blank spaces. Date Boston 0&18 White Copy-Original Yellow Cop y-File Pink Copy-Customer Hayes PrinSng 336.667-1716 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards _or:strvctior. Supervisor CS-072772 Expires: 04/07/2020 JEFF C STEELE - 24 SHERWOOD AVE - DANVERS MA 01929 Commissioner ^!Jr (!r:7::7i:1"YIU:i'r�i�/! rJ: 1�r7.iJrli//pJrr/ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Registration Expiration 166025 04/11/2020 WINDOW WORLD OFBOSTON,LLC. JEFF C.STEELE 15A CUMMINGS PARK WOBURN,MA 01801 Undersecretary The Co mmonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers* Compensation Insurance Affidavit:Builders,Contractors/Electricians/Plumbers. TO BE FILED NVITE THE PEPJgM NG AUTHORITY. Applicant Information Please Print Letribly Name (Business/Organization/Individual): (�i)o/a,J Address: 15'H Can,,,-►:r►�s �� IS City/State/Zip: n � o Phone : -7g 1 —9 S Z Q 5— Are you an employer?Check the appropriate box: Type of project(required): I.Yam a employer with 'L_employees(frill and/or part-time).; 7. New construction 2.�I a*m a sole proprietor w partnership and have no employees working for me in 8. Remodeling any mpacity.'rNo workers'comp.insurance required.1 I ❑Demolition m a a homeowner doing.all work myself.T o wo;ker comp.irserance reeuireG. 4.[]I am a homeowner and will be hiring contractors to conduct all work or,my property. I wily l0 [1 Building addition ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 72.F�Plumbing repairs or additions I am a enerai contractor and I have hired the sub-contractors listed on the attached sheet. 5.r7 O These sub-contractors have employees and have worker='comp.insurance.' 1-•DRaOf repairs j 'i4.QOther ❑We area corporation and its officers have exercised their right of exemption per MGL c. I.i j 1 d2_t i(4),and we have no employees. ?io workers'comp.incur U required.; l `Any applicant that checks box 0]must also fill out the section below showing their workers'compensation policy information. 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 emple gees. Below is the policy and job site information.Insurance Company Name: (-A al't--Ca-r1 1F l'P Tip S J RA f�C E CO - Policy# or Self-ins.Lic.#: 2 Z Wr_ C L_1 2�2,�5 Expiration Date: /- Z 7— / Job Site Address: 70 tJooA t City!State''Zip: / S Attach a copy of the workers' compensation policy beclaratioD page(showing the policy number and expi. ation date). Failure to secure coverage as required under MGL c. 152:§25A is a criminal violation punishable by 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.A copy of this s tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi Lion. I do hereby cer under a pai erjury that the information provided above is true and correct Signature: r Date: Phone#: -3 2-- 05_. a use only. Do not write in this area.to be completed by city or town official Cith or'Town: Perinit:rl.,icense 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#: A R CERTIFICATE OF LIABILITY rr 3=2018 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THI5 CEF2?IFICATE DOES NOT AFFIRMATIVELY Ott NEGATIV€LY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POL.lCIES BELOW. THIS CEIiTII=[CATE OF INSURANCE 00% NOT CONSTITU'1't;A CONTRACT BarMEN THE ISSUING INSURER(S),AUTHORIZED REPRMNTATIVE OR PRODUCER,AND THE CERTIFICATE ttOLEJER, IMPORTANT, If the certfRCate holder is an ADDTIMONAL INSUREI;3 the PO Cy(es)MIM have ADDITIONAL INSURED provisions or be ondorsed. If SUBROGATION 1S WANED,subject to the temps and twilltions•of•the policy,certain po0cies may require an endorsement A statement on this certificate does not confer rights to the oerttltcate holder in Ilea of such endommnert(s). PRODUCER Marcc sh&McLdnnan Agency LLC Cart V►BfcFter CIC,CISR CSIA MS N.Elm St. PH.— 336-644-68so Greensboro NC27465 A No:212-607-MI6 A Cam• mamlNnR✓ com AIrFO W14de COVERAt Nalc o INSURED INSURERA:Atlmerice Financial Benebf I 3g534 Iwo Window World of Bostolt,LLC a B.Hamrd Fire Ul umce ommmemlj968z 118 Shaver Sfreel INSORER c.MOSsachusefis Insurance Camppy i 22MB North Wflkesboro NC 28659 IlusuRERn, lldStI1RGR8: ' COVERAGES JMRF. CERTIFICATE Nu1tA13ER'l016D15Tf2 M NUMBM THIS is TO CrFTIFY THAT THE POLICIES OF 1NSURANCE-L19rED'BELOI'N HAVE BEEN I CERTIFICATE MAY BE ISSUED OR MAY Pt_RT SSUED To THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWYMSTANDING ANY P.EQUIRErgENT,TERM OR CONDITION OF ANY COAITRAC7 O1tOTHER.D000MENT MOTH RESPECT TO UtUilCH THIS QIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TE �p EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAWS RNS, LS TYPEt}PIMRANCE LS PDIiCYNU POL[CYS+F P 6XP ^, X .COr1AMERCIALGENERALLIABILRY I RltdrTS 8 4PEIZ�18 EACHCCCUZRENCE $10HI�D ICLAIM56180E a0.�`GG1R ' i ! PRE31fJ fl00 MED E;p(w 9�f0 r!<rNot1 55.000 t PERBONALfiADVHENRY $;004000 i aEDYLP.GORE0A7ELW)TP,P1`14E5 PER: POLICY JFER LOC GENERALAWREGATE` $2004000 ! OTKM i PRODUCTS-COMPIOPAGG 32.090.6W A {AUTiD=B.EuAH)LrrV , (�� i I AVbBeTS/6Ib I 6/'18i w eHelm s ED SINGLE Li I--l-l--fft ANY ALTO IOWNED t SCHEDULED I BODllYINJURY(PergaPe L._..�AUTOS ONLY NAUTOS OR-CRAWED i BODILY MURY Mar acd enq 8 AUTOS ONLY ! AUUTOS YONL ) RTY OdAGE --- -1 i i 111 ! s C i-iC UM9RELLAIIAB !X OCCUR OD5J902827 „EXGSES9LUi6 i t U112097 4Hr2Ch8 EACHOCCURRENCE CLAl1NS)MD£ ' i dOgaaD j AGGREGATE 32OOROW DEDONS g IWORIQ?rtSCONtPENSATION S ANDENiPLaYERB'L1AaA1TV YrN. j 22WQ9 I7895 ! 1/27i10r8 1l27=9 =S t 1 QT?i ANYPPOPRIETOMPARTNERIEXE�^.UTiUE oFFlCEFMIENffiFREXCLUDEpp ;Ala ': E.LEACHAOCIDENr V 5600.000 (Malwa"ry in NH) t>yya8,dessrihevl O I � E LDI3EASE-EA Eb1PL0'!E 55o40u0 �_. CESCRI ON OF ERA S4¢lav E.L DISEASE-POLICY LIMIT 580 Wo � t I i j t i I I I �scRaPsrovoFaPF.RATtaN9rtacAnaNsle (AcostD�ar,Aaestonalw�,a►lssscxew►��rceaaaw�aairmoR�e�rlsrequue�n - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE-DESCRIBED POLICIES BE CANCELLED BEFORE •r#E t:)f MIION DATE THEREOF, NOTICE WILL BE DELMMED IN ACCORDANCE WTH 7HE POLICY PROVISIONS. AIM0RIZWNEPM�MTA7PJE f 019804015ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD nine and logo are registered r mft of ACORD The Town of Barnstable 'A1f34, ' Inspection Department �0 hill 367 Main Street, Hyannis,MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner December 27, 1993 Northern Mortgage 128 Route 6A Sandwich, MA 02633 RE: A=307 205 70-72 Woodbury Avenue, Hyannis Gentlemen: Please be advised that the duplex dwelling located on the above referenced property, built as a duplex in 1969, is a legal non-conforming two family dwelling. Upon inspection of the basement on December 27th no apartment was in the basement. This is a duplex dwelling. Very truly yours, J eph D. ha uilding Commissioner JDD/gr Town of Barnstable *Permit X;,20a%1,3 g� Expires 6 m the from issue date °T Regulatory Services Fee anatvsraB�e. M"9. Thomas F.Geiler,Director Building Division 1 RESS tpE ry,CBO' Building Commissioner MAR 2009 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 5W V�, Fax:508-790-6230 a APPLICATION — RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 3 ®77 �d Property Address W - N 0012 OC&�R . E Residential Value of Work ��OQ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address A Lg r:iOrf L—L-k G 1 E� t S Co(o Pt4 t tit m r y 5 L_tA EAF.ni STABS-A A-AA......... Contractor's Name?ATzt 1C.- A'EPLrG ihA11.D%a Ps Telephone Number S� ' C�( S•�3q 1 Home Improvement Contractor License#(if applicable) ( 51 O l y Construction Supervisor's License#(if applicable) Cl(.Q 36H 51Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner W,have Worker's Compensation Insurance Insurance Company Name ¢A�C �L��j Workman's Comp.Policy# L4 k•Lk Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to N e-roof(not stripping.:Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.L-Valuue (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. copy of the a Improvement Contractors License is required. SIGNATURE: C:\Users\decollik\AppData\ ocal\.Microsoft\Windows\Temporary Intemet Files\Content.OutlookkMY7NB4IL\EXPRESS.doc Revised 100608 . snxtvsrae>.e, . , b MAM Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CB0 Building Commissioner ' 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 3 Property Owner Must Complete and Sign This Section , If Using A Builder I, A 'as Owner of the subject property' hereby authorize APTASTABUe to act on my behalf, in all matters relative to work authorized by this building permit application for: - (Address of Job) Signature of Owner Date I � Lct C(e.f- Print Name If Property Owner is applying for permit,please complete the Homeowners_License Exemption Form on the ' .reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\MY7NB4IL\EXPRESS.doc Revised 100608 .e -� ✓die �UanUrremuaeal�z o�✓�aac%uaeCta t` "t r* Board of Budrng-Regulations andStand'ard§ CoriStructton Supervisor Ltc¢nse` Lt�e7tse: CS 96399 Bitthdit �-J 0/29/1965 r. xprra t6F '•- !_9/2010 'Tr# 96399 _ tt PETER MUNRO <' p 97 HARBOR BLU r • HYANNIS' A 02601.9� Commrrs�ingr € ' ✓/ae i�arrunu»wle¢ i a�✓j/laaoac�uaetta' Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration,: 151016 Y /11/2010 Tr# 273249 r-Type-1 'BA BARNSTABLE BUj$ = 1 PETER MUNROF � � 97 HARBOR BLU HYANNIS,MA 02601 D� Administrator ..' TRAVELERS J t" ; WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY a s - TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY-NUMBER: (6KUB=0407M54-9-08) NEW-08: ; INSURER: THE TRAVELERS INDEMNITY,COMPANY 1 NCCI CO CODE: 11347 'INSURED: PRODUCER:. MUNRO, PETER F . DBA _ THOMAS E SEARS INC AGCY BARNSTABLE BUILDERS 34.00PE ST 97 HARBOR BLUFF RD..`, � HUDS:ON MA _01749 HYANNIS MA 02601 Insured is AN INDIVIDUAL _ Other work places and identification numbers.are s.hown.in the sched.ule.(s) attached. 2. The policy period is from 08-01 -08 to 08-oi.-o9 12:01 A.M. at.the Insured's malling address. 3. A. WORKERS COMPENSATION.,INSURANC.E: Part One of the policy applies to the Workers _ Compensation Law of the state(s) listed here: .� MA , B. EMPLOYERS LIABILITY INSURANCE:"Part Two of the policy applies to work in each state listed in. item 3.A. The limits of our liability under Part Two are: F Bodily Injury by Accident: $ ' 1 OOOOO'Each Accident t Bodily Injury by Disease: �; 500000'Policy Limit Bodily injury by Disease: -$ 100000 Each Employee, C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here.'` COVERAGE REPLACED BY ENDORSEMENT WC-20 03 06A D. This policy includes.these endorsements and schedules: SEE- LISTING OFr-ENDORSEMENTS EXTENSION, OF~'INFO PAGE 4.• The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating - �— ; ....Plans.-'All required information is subject to verification and change by audit tote made ANNUALLY.. DATE OF ISSUE: 08-19-08 KB ST^'ASSTGNr MA OFFICE: ORLANDO INDUS AFF 161 ` PRODUCER: THOMAS E. SEARS INC AGCY f 28YLi=' 000270 The Commonwealth of Massachusetts z ' 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): (�S /4 L&((.�� S ,`�(LI(�(r_6 Address: City/State/Zip: t-at,_t i ej Y v`X o z&o l Phone#: 13-& l AVI u an employer?Check the appropriate box: Type of project(required): 1. 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp. insurance.: 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 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the 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 thepolicy and job site information. Insurance Company Name: y F` �I�S • _ Policy#or Self-ins.Lic.#: (S! LJL5 "0�-61 M 74" --05 Expiration Date: Job Site Address:-1 0- Z Waowi P.-( F—t� . City/State/Zip:qY At-w 1S AMA 02&0j 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 n er a pai d pe i s of perjury that the information provided above is true and correct Signature: Date: Phone#: 5__ a 39 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#: [ ] [R307 205 . ] LOC] 0070 WOODBURY AVENUE CTY] 07 TDS] 400 KEY] 218954 ----MAILING ADDRESS------- PCA] 1041 PCS] 00 YR] 00 PARENT] 0 LUCIER, ALBERT P MAP] AREA] 61AC JV] 394898 MTG] 0000 31 PEARL STREET SP1] SP21 SP31 UT11 UT21 . 18 SQ FT] 2240 MILFORD MA 01757 AYB] 1969 EYB] 1975 OBS] CONST] 0000 LAND 20700 IMP 93900 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 114600 REA CLASSIFIED #LAND 1 20, 700 ASD LND 20700 ASD IMP 93900 ASD OTH #BLDG(S) -CARD-1 1 93 , 900 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 70 WOODBURY AVE HYANNIS TAX EXEMPT #RR 1869 0080 RESIDENT' L 114600 114600 114600 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE] 01/94 PRICE] 92000 ORB] 8994/135 AFD] I LAST ACTIVITY] 10/24/95 PCR] Y R307 205 . *P P R A I S A L D A T KEY 218954 LUCIER, ALBERT P LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RB 20, 700 93 , 900 1 A-COST 114, 600 B-MKT 104, 100 BY 00/ BY ML 7/88 C-INCOME PCA=1041 PCS=00 SIZE= 2240 JUST-VAL 114 , 600 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 61AC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 61AC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 207001 LAND-MEAN +0% 1146001 74880 IMPROVED-MEAN +250 250 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP]ADJS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [000] DATA-.[ ] XMT [?] llt� , . . R307 205 . Is P E R M I T [PMT] ACT*[R] CARD [000] KEY 218954 000000001 PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT f 5 1. 9 CM U) R Vy U tD O N f 9 I 1 RESIDENTIAL PROPERTY MAP NO. LOT NO. FIRE DISTRICT STREET Woodbury Ave. Hyannis SUMMARY "7 LAND H BLDGS. j c '20rj OWNER TOTAL RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: LAND BLDGS. ws Davi dq Gertrude M. 2/21/69 1428 796 B TOTAL .18 a LAND 01 BLDGS. ri - acts. TOTAL LAND BLDGS. TOTAL LAND BLDGS. TOTAL 1. LAND BLDGS. TOTAL LAND BLDGS. TOTAL LAND INTERIOR INSPECTED: O BLDGS. r TOTAL � DATE: /O "� /f j �/ / _.!f..,..�' .. v - LAND ACREAGE COMPUT IONS BLDGS. ND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOUSE // oc)'> a/ �n LAND CLEARED ONT BLDGS. ai REAR TOTAL WOODS&SPROUT FRONT LAND REAR BLDGS. WASTE FRONT TOTAL REAR LAND BLDGS. TOTAL LAND BLDGS. -. LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH% FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND 0 ROUGH TOWN WATER 0) BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND - SWAMPY NO RD. BLDGS. Conc. Blk.Walls Bsmt.Rec.Room St. Shower Bath Bsmt. PURCH. DATE . i:onc. Slab Bsmt.Garage St. Shower Ext. Walls PORCH .�P/RIC .trick Walls Attic FI.&Stairs Toilet Room Roof RENT ✓ ��v W�0 U T/L .lone Walls Fin.Attic Two Fixt. Bath Floors y ' .•iers INTERIOR FINISH Lavatory Extra �� FP •1 2 3 Sink .2 a>l usrnt. F �-.�.ti.Z� ! r/4 Plaster Water Clo. Extra Attie ; 1/2 ,t EEXTERIOR WALLS Knotty Pine Water Only Fi - Ca A/C f ;rouble Siding Plywood No Plumbing Bsmt. Fin. 3 j PL)NE L single Siding Plasterboard [Int.Fin. C- C r O O r r - Shingles TILING CE H I Blk. G F P Bath FI. Heat i;,re Brk.On Int.Layout Bath FI.&Wains. Auto Ht.Unit Veneer Int.Cond. Bath Fl. &Walls Fireplate .;nm. Brk.On HEATING Toilet Rm.FI. Plumbing ;olid Com.Brk. Hot Air N4/ q Toilet Rm. .&Wain! -- Tiling Steam Toilet Rm.FI.&Walls , Blanket i= Hot Water St. Shower hoof Ins. Air Cond. Tub Area Total , Floor Furn. '7 X/o ROOFING COMPUTATIONS 8ti✓' B I,,f' `—/ ' ' Asph. Shingle Pipeless Furn. / 0 p S. F. 33 4 a ; Wood Shingle No Heat 02 6 S.F. j Asbs. Shingle Oil Burner • a 0 S.F. j', f p 3 I / `gam: 3.r Slate Coal Stoker S.F. rile Gas S F OUTBUILDINGS ROOF TYPE Electric S.F. 1 2 3 4 5 6 7 8 9 10 1121314 516 71819110 MEASURED Cable Flat Hip Mansard FIREPLACES S.F. Pier Found. Floor iu 7l•,; Gambrel Fireplace Stack Wall Found. 0. H.Door LISTED s FLOORS Fireplace Sgle.Sdg. Roll Roofing Conc. LIGHTING Dble.Sdg. Shingle Roof Earth No Elect. DATE, _ Shingle WellsPlumbing Pine ' Hardwood y�/ ROOMS Cement Blk. Electric ` PRICED,¢ Asph.Tile Bsmt. 1st �. TOTAL 3 IV a 5-3 Brick Int.Finish Single 2nd t 3rd FACTOR rnf^ --- REPLACEMENT f S ^• Yra'�ri:a�:? OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. D. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. a., ..r;;d'++:Ki ' DWLG. 0 L rY S f 1 6 -51r, 6 3,;? d-d' 3 ;Z 90� 3 4 5 k 10 TOTAL }. A i y 90PERTV ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CLASS I PCS I NBHD KEY NO. 0070 WOODBURY :AVENUE 07 RB 400 07HY 07/09/95 1041 . D0 61AC R307 205. 218954 NAND/OTHERFEATURES DESCRIPTION ADJUSTMENT FACTORS TY UNIT ADJ'D.UNIT IUCI£RP ALBERT P - MAP- Lantl-By/Da,e Size Dimension LOC./Y R.SPEC.CLASS ADJ. COND. P PRICE - PRICE ACRES/UNITS VALUE Deschplion - CD. FFDe Ih/Acres #LAND 1. 20,700 CARDS IN ACCOUMT - 10 1BLDG.SIT. 1 x . .18 =10c 328 34999.9S 114799.9 .18 20700 48LDG(S)-CARD-1 1 93.900 01 OF 01 #PL 70 WOODBURY' AVE HYANNIS COST 114600 BATHS 2.2 U X C= 100 12000,01 12,100,0 1.00 12000 3 #RR 1869 0030 MARKET 1041CO FIREPLACE U- r X C= 100 3100.D ' 3100.00 2.00 6200 9 #UP FY96 INCOME USE A APPRAISED VALUE A 114.6CO J U PARCEL SUMMARY AND 20700 I`\ S LDGS 93900 T -IMPS M TOTAL 1146CO E N CNST N DEED REFERENC Tye DATE Recorol.e P R I O R YEAR VALUE T Book Page Incl. Mo. Y,.DI sale,Pr py A N D 2 0 7 C 0 S 8994113.5, 1;01/94 92000 BLDGS 93900 6077/328: I:12/87 165000 TOTAL 114600 1428/796: b0/00 BUILDING PERMIT Number Dare Type Nrounl J LAND LAND-ADJ INCOME SE SP-BEDS FEATURES 8LD-ADJS UNITS ti 20700 18200 Const. Tol al ear Built Norm. Obsv. Class - Unils Vnils Base Rale Atlj.Rate A Y I Age Depr. COntl. CND Loc %R G Repl Cosl New Ad, Repl Value+ S,� Heigh, -Rooms ir.Rms.B.1h. I F P-,.11 F. 02CT 000 100 100 63.60 63.60 69 75 19 80 90 70 134096 93900 1.8 8 4 2.2 12.0 p non Rate Square Feet Repl,Cost MKT.INDEX: 1-01) IMP.BY/DATE. ML 7/88 SCALE: 1/00.85 ELEMENTS CODE CONSTRUCTION DETAIL W"'<ri 100 63.6D 1400 69960 TWO FAMILY DWELLING CNST GP:00 FWD 85 8.50 80 680 *---10--* N STYLE 17DUPLEX 0.0 FWD 85 8.50 80 680 ! FWD ! ! FWD ! DESIGN .46JMT DD 0.0 B20 60 38.16 1100 41976 8 8 8 8 _XTER.WALLS 11 OOD SHINGLES 0.0 FFB 650 65.00 20 1300 ! ! ! ! EAT%AC TYPE- i1 AS-WARM AIR 0.0 FFB 650 65.00 20 1300 *---10--*---------44---------*---10--* _N TEE;I FINISH 02 b ANELING 0.0 � NTcR.LAYOUT 12 VER./NORMAL 0.0 ! ! INT-EA QUAL'TY U2 ANIE AS EXT-ER. 0.0 3 ------- -- -------------- -------- ! ! LOOR STRUCT 03. D JT/ST BEAM 0.0 W ! ! E LOOR CO%(if§_ U4 ARPET _ 0_.0 E To,.-Aleas JAua= 160 Baae_ 1100 ! ! OOF TYF E US AM---- -ASP- S 0.0 E --------------- -- ------------------- '.A T BUILDING DIMENSIONS 25 BASE 25 LECTRICAL 01 VERAGE 0.6 BAS W44 N25 FWD N08 E10 SOS W10 ! ! OUNDATI0�1 ill 0_UR_EDC_0_NC 9_9_._9_ A SAS E44 FWD N08 W10 S08 E10 ! ! L .. BAS S25 _. ; i NEIGHBORHOOD 61AC HYANNIS LAND TOTAL MARKET ! ! PARCEL 20700 114600 *-----------------44----------------X AREA 2848 VARIANCE +0 +3923 STANDARD 2.5 9� ON , . �r y a o-o a zz i rl } TOWN OF BASNSTAH REP SUPPLEMDNTABT/CONTI TIO�BEPOAT NAME (LAST, FIRST, MIDDLE) DIVISION /D1P! qMAJ)L NOTE DETAILS i OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL IS ETC- �a --zo -- oil i I I • i SUBMITTED BY PAGE t � � ................. .... . tvi 110 WE Kum m 30 205 x.... Bill :.BUILD....... ......:.. «< �•:•a.,lucier... OODBURY A E <.z;> ..:.:.:::::::::........... ANNIS :..................::.:::. > ... .. ' .:... .:::..:..::::::::::::: ..:......:.:..:.:.::.:>:::.::::.... :.:.: :.:........:.::::::::.:::.::::::.:::::::.:.: < « .................................... ....... .... 1 oil ON 10; AM . . ...... . . LEGAL ??????????? AL. . . . '. . . . . . on :> .:SEARCH ............ ................................................................. 'Y M A ENT Zip f l