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0421 BUCKSKIN PATH
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BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: q2 l Jc I<s k; n n-f y; (le—, NUMBER STREET VILLAGE Owner's Name: A(allCi Oarpediy Phone Number 7 7W-L(7p -Z7L 5 Email Address: nan Ci' Cell Phone Number Project cost$ $.3 7 I Check one Residential V1 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: S e J-\a Od-4Q Date: TYPE OF WORK 0 Siding U Windows (no header change)#__ED Insulation/Weatherization 10"Doors (no header change)# I Commercial Doors require an inspector's review 01 Roof(not applying more than 1.layer of shingles) Construction Debris will be going to 2,Y160/r, /? L CONTRACTOR'S INFORMATION Contractor's name �r�un `7R�n�so� - �, ��n deg Lcr,s 1C.4 Jl.ndawS Home Improvement Contractors Registration(if applicable)# 17 3 2-Lt 5 (attach copy) Construction Supervisor's License# 09 S 7 0:7 (attach copy) Email of Contractor QGLie_e- q q�5(6 G�►')g, I. C 6M Phone number 110/— Z Z R -I goo ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *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 P 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-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side ROMEOwNEWS LICENSE EXENVTTION 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 procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICAINT'S SIGNATURE Date Signature AM permit applications are subject to a building official's approval prior to issuance. i {R'eAnn('ewal Agreement Document.and Payment Terms by Andersen. dba:Renewal ll Andersen of Southern New England 3 y g Nanci Carpenter Legal Name:Southern New England Windows,LLC. 421 Buckskin Path RI #36079, MA#173245,CT#0634555,Lead Firm#1237 Centerville,MA 02632 WINDOW RE LACENIENr .1.0 Reservoir Rd I Smithfield,.Rl 02917 : H:(774)470=2725 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:4075091446 Buyer(s) Name: Nanci Carpenter. Contract Dace: 11/01/18 Buyer(s)Street Address: 421 Buckskin Path, Centerville, MA 62632 Primary Telephone.Number: (774)470=2725: Secondary Telephone Number: 4075091446 Primary Email: . P g Secondary Email: V nancicar enter@ mail.eom Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a: Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document acid Payment.Terms,any,documents-listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed ro by the parties and incorporated herein b' reference(collectively, this"Agreement): Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total job Amount: $8r371 By signing this Agreement,you±acknowledge that the Balance Due,and the Amount Financed must be.made by personal check;bank check,credit card,or cash. Deposit Received: $4,186 Balance Due: $4,185 Estimated Start: . Estimated Completion: .8 to 10 weeks - 8 to 10 weeks Amount Financed: $8,371 Method of Payment: Financing -.We date�nlwhich w t ec b e complete the technical measurements on the date of the sigri�d contract The installation date that we:are providing at this time is only an estimate.We will communicate an official date and time at a later date..Rain and extreme weather are the most common causes for delay, Notes:. Taxes paid in Barnstable; Ma Buyet(s)agrees and understands that this Agreement.constitutes.the.entire understandings between the.parties and that there"are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor. Buyer(s)hereby acknowledges that Buyer(s) 1)has.read this Agreement, understands the terms of this Agreement;and has received a completed,'signed,and dated copy of this Agreentent,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this ' Agreement. NOTICE TO BUYER; Do not sign this contract if blank..You are.entitled to a copy of the contract at the time you sign: YOU,.THE BUYER,MAY CANCEL THIS TRANSACTION AT ANYTIME NOT LATER THAN MIDNIGHT OF 11/05/2018 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION; WHICHEVER DATE IS LATER.SEETHE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC. dbai Renew/f Ande�n/o/ESou�thern New England ' Buyer(sq) Signature of Sales Person Signature Signature Gino Montesi Nanci Carpenter Print Name of Sales Person Print Name Print Name UPDATED: 11/01/18 Page.2 / 11 Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home, Improvement-Contractor Registration Type: Supplement Card - Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS,LLG: Expiration: 09/18/2020 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Update Address and Return Card. SCA 1 Co 20M-05/1177 L Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 17.3245. ... 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON 10 RESERVOIR ROAD Ck" `� SMITHFIELD,RI 02917 Undersecretary t� �a� without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Censtru t-Pon� Supervisor CS-095707 _ = Exp i res : 09/08/2020 -� , BRIAN D DENNISON ` 8 BLACKWELL-DRIVE CHARLTON MA01507 Commissioner \ J The Commonwealth of Massachusetts Department of IndustrialAccidents, _ 1 Congress.Street,Suite 100 Boston,K4 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERNIITTLNG AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/individual): S�,�Gte�li ,f[� �i►s��f7cD L.1/.�d0►,/,s Address: /p &5erVn1_,- Rol , City/State/Zip: � -I�e �.Z z'2 17 Phone#: Are you an employer?Check the appropriate box: Type of project(required): l.�i am a employer with ai 0+'employees(full and/or part-time).* 7• New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.F�I am a homeowner doing all work myself.[No workers'comp.insurance required.] 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.Q Electrical repairs.or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.-' 1 �Roof repairs 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.. Other t^/ -C 152,§1(4),and we have no 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: 1--,re M eA 5 1(1 C�rt!/ — Policy#or Self-ins.Lio,/R: 6t/GA .3 5 s- 72-e3 Expiration Date: Job Site Address: `r' 2-� �c�C��S�i�1 �/ t�) City/State/Zip: 4A� V,We. l`'1✓-�- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration 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 statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under tl:e par and penalties of perjury that the information provided above is true a�correeo�clt Sienatur Date: Phone# L40 2-Z 8'`T IDO 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#: A®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMMD/YYYY) 12/29/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS 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 endorsement(s). PRODUCER CONTACT CoBiz Insurance, Inc.-CO NAME: 1401 Lawrence St, Ste. 1200 PHONE •303-988-0446 FAX No):303-988-0804 Denver CO 80202 E-MAILSS: COMaiI cobizinsurance.com INSU S AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Com an 31325 INSURED 65LERC0 01 INSURER B:Firemens Insurance Company of WA,D.C. 21784 db2Renewal by Andersen of Southern New England SouthernNew England Windows, iNsuRER c:Homeland Insurance Company of New York 34452 ba 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1252851165 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L S TYPE OF INSURANCE ADD L SUER ' POLICY EFF POLICY EXP POLICY NUMBER (MMIDDIYYYYI IMMIDDNYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1112018 1/1/2019 EACH OCCURRENCE $1,000,000 dWMS-MADE Fx I OCCUR PREM-t I Ea NItunrx $300,D00 MED EXP(Any one person) $10,D00 PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 X POLICY 7JET- F7 LOC _ PRODUCTS-COMP/OP AGG $2,000,000 OTHER $ A AUTOMOBILE LIABILITY N CPA3158728 1/12016 1/1/2019 COMBINED SINGLE LIMIT Ea accident $1,000,000 X ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per a 'dent $ A X UMBRELLA LIAB X OCCUR CPA315872B 1/1/2016 1/1/2019 EACH OCCURRENCE $10,000.000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10.ODO.00D DIED I X I RETENTION$,, $ B WORKERS COMPENSATION WCA3158729.20 1/1/2018 1/1/2019 AND EMPLOYERS'LIABILITY Y 1 N X STA UTE ER"- ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N 1 A EL EACH ACCIDENT $1,OOD,D00 (Mandatory in NH) If yes E.L.DISEASE-EA EMPLO $1,o00,000 ' DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 C Pollution Liabft 793007334D000 1112018 1/12019 Each Occurrence $1,000.000 Claims-Made Policy Retroactive Date 06202013 Aggregate $1,000.000 Deductible $10,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD WE Town of Barnstable *Permit# Expires 6 months front issue dare Regulatory Services Fee _ t sARNSTAaLt?. ' k Richard V.Scali,Director 113. p� POE BuRding DivistoIli '� a . Tom Perry,CBO,Building Commissior��® 200 Main Street,Hyannis,MA 02601 J rr 2017 www.town.bamstable. i �� 1J Office: 508-862-4038 O ARKS MOV08-790-6230 EXPRESS PERMIT APPLICATION - RESWENTIAL ONLY - Not Valid without Red X--Press Inrprzrrt Map/parcel Number �q2 '�Z Property Address 4"-), 0VCICSKi n Residential Value of Work''S.2A, 7 9 I Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address AfdldG+ C4C fi r yzl �iJc/CSC.-►, '��t-tG, Pi►��✓t l�e kfA 02_IO3 2. Contractor's Name E 'n,10,J 2?/1 / /1 rso/! Telephone Number 0 1 Home Improvement Contractor License#(if applicable)/ '3 2, Z Email: Construction Supervisor's License#(if applicable) 7 c7 (�Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ the Homeowner I have Worker's Compensation Insurance Insurance Company Name _ E; C a,� Workman's Comp.Policy# W C 8 5,9 7 2_9 2 0 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) [❑ side Replacement Windows/doors/sliders.U-Value 0 (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit.does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property caner must sign Property Owner Letter of Permission. A copy cKthe Home Improvement Contractors License&Construction Supervisors License is require - - t SIGNATURE: CK C:\Users\Decdllik\AppData\LocaNMicrosoft\Windows\Temporary Internet Files\Content.0utlook\21`10I DHR\EXPRESS.doc Revised 040215 r . 1" Renewal Agreement Document and Payment Terms g Y, byAndersen. dba Renewal By Andersen of Southern New England Nanci Carpenter Legal Name:Southern New England Windows,LLC . 421 Buckskin Path RI#36079, MA#173245,CT#0634555, Lead Firm#1237 Centerville,MA 02632 WINDOW RE LACEMENr. 10 Reservoir Rd I.Smithfield,.Rl 02917 - - H:(774)470-2725 - Phone:866-563-2235 1 Fax:401-633-6602 I(ales®renewalsne.com - C;467 509"1446 Buyer(s)Name: Nanci Carpenter.. " : Contract Date: 09/15/17 Buyer(s)Street Address: 421 Buckskin Path,Centerville, MA 02632 Primary Telephone Number: (774)470=2725 Secondary Telephone Number:.407 509 1446 Primary Email nancicarpenter@gmail.COm. Secondary Email" Buyers)hereby.jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern-New England("Contractor"),in accordance with the terms and conditions described in this Agreement ms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document and Payment Ter Document,the terms.of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement'). Buyers)hereby agrees to sign a completion certificate after Contractor has completed.A work under this Agreement. Total Job Amount:" $22,299. By signing this"Agreement;you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash Deposit Received: $0 Balance Due: $22,299" Estimated Start: Estimated Completion: 7 to 9 weeks 7 to 9 weeks Amount Financed:' $22,29.9 Method of Payment: Financing We schedule installations based on the'date of the signed contract and secondarily on the dace in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and,time at a later date.Rain and extreme weather are the most common causes for delay- Notes: Taxes paid in barnstable.. Buyer(s)agrees and understands that this Agreement.constitutes the entire understandings between the.parties and that there are no verbal . understandings changing or modifying any of the.terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written"consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s)1).has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices.of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE.TO BUYER Do.not sign this contract if blank.You are entitled to a copy of the contract at the time you sign YOU,.THE.BUYER,.MAY CANCEL THIS TRANSACTION AT ANY TIME NOT.LATER THAN MIDNIGHT OF 09/19/2017 OR THE THIRD BUSINESS.DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE"IS LATER:SEETHE ATTACHED NOTICE OF. CANCELLATION FORM FOR AM EXPLANATION OF THIS RIGHT..: Legal Name:Southern New England Windows,LLC. •' d6a:Renews y Aiide�rsje�n bi f' outhern New England Buyer(ss,)p4 ,. Signature of Sales Person' Signature Signature Gino.Montesi Nanci Carpenter Print Name of Sales Person ` Print Name Print Name UPDATED: 09/15/17. Page'.2-/ tt' , �riassachusetts. Department of Public Safi= � Board of Building Regulations and Standards 'License: CS-095707 BRIAN D DENNISON 7 LAMBS POND CIRCLE CHARLTON MA 01607 , Vo11mmissioner 09�08i2018 a '' _t� o_ _��csumeT._``a�sad4$usinz .�Qu`ai a _ J 10 Park Plaza- Suite ;i7t, - Boston, jiassacu ens 021 '- Limprove-tent o^tractor Registratior. _-_ Registradon: 173245 Type: Supplement Card - _ :piration: 90912018 SOUTHERN NEW ENGLAND WiNDbw LL BRIAiN DENNISON 25 AIION RE) ------- -- -- LINCOLN, RI 92835 --------------- �'UfIUle.?ddC'S5:lad ret�ID�tv.:Nar::za+uu'or•++:,o�c. —.Address _ 2ene:val'_Emplovjuent 'Lost C:rrd -litrce ni[:nnsamer.�Rai�•S 3esmcss Rc,^nlatinn"•r Acjsamriou-slid for individual ise only uetijre the , ex pit3tion date.df found return Eo: G NOME IMPROVEMENT CCNTRACTOR ORic of,:aosumer A:Tair.;lad 3usiness,3e�piatinu `Registratlan:R'3245 TYFe: !0 i ar!:?laze-SUitC SIM . EspiraUo..--gi.19/2073 Supplement Gard Boston.AN 92±16 SOUTHERN NE'N ENGLAND WINDOPIS REN&VAL BY.ANDERSON' - BRIAN DENNISON -- LI�COLN.RI 02865 '.ynders rcmrs - -Not ra amre e The Commonwealth 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 WITH THE PERNIITTING AUTHORITY. ApOicant Information Please Print Le 'bl Name (Business/Organization/Individual): e bt] .� OtdJs Address: ,2(o ,�(. aO �s City/State/Zip: LIJAJP Phone #: In - 2 Are you an employer?Check the appropriate box: Type of project(required): 1 xI am a employer with Zo femployees(full and/or part-time).* 7. New construction 2.71 am a sole proprietor or partnership and have no employees working forme in 8. ❑Remodeling any capacity.(No workers'comp.insurance required.] 9. El Demolition 3.F�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ]0 0 Building addition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.�Roof repairs These sub-contractors have employees and have workers'comp.insurance.: / 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. her W/n�ay�/ i 52,§1(4),and we have no employees.[No workers'comp.insurance required.] 11e(4le/�,e4 *Any applicant that checks box 91 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: lre me S oo — Policy#or Self-ins.Lic.#: (, 3IE 7 2- Z Expiration Date: h Job Site Address:. 4�1 zz n t tl f City/State/Zip: ( Prili /I 4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expirati n date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violafionpunishable 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 statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the ains andpenalties ofperjury that the information provided above is true and correct. Si ature: a Date: Phone#: !- 2-2.en 1 91e F Official use only. Do not write in this area,to be completed by city or town off ciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: f ESLERCO-01 SANDERSO ACORO" DATE(MM/DWYYYY) CERTIFICATE OF LIABILITY INSURANCE 06/07/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 CONTACT NAME: CoB1401 Insurance,Inc.-CO AICC,NN,Ext:(303)988-0446 ac,Nc:(303)988-0804 1401 Lawrence St,Ste.1200 Denver,CO 80202 E-N'ARESS: l�'L COMail@cobizinsurance.com ADD INSURERS AFFORDING COVERAGE NAIC# INSURERA:Acadia Insurance Company 31325 INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 Southern New England Windows,LLC.dba Renewal by INSURERC:Liberty Surplus Insurance 10725 Andersen of Southern New England 26 Albion Road,Suite 1 INSURER D: Lincoln,RI 02865 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR I SD WVD M DD MMIDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR CPA3158728 01/01/2017 01/01/2018 DAMAGE TO RENTED 300,000 PREMISE Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PEET E LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: EBL AGGREGATE $ 2,000,000 A AUTOMOBILE LIABILITY (CEO ..dED SINGLE LIMIT $ 1,000,000 X ANY AUTO CPA3158728 01/0112017 01/01/2018 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $• HIRED NON-OWNED PROPERTY AMAGE AUTOS ONLY AUTOS ONLY Per a.dent $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LJAB CLAIMS-MADE CPA3158728 01/01/2017 01/01/2018 AGGREGATE $ DED I X I RETENTION$ 0 JAggregate $ 1,000,000 B WORKERS COMPENSATIONOTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE El' CA3158729-20 01/01/2017 01/01/2018 1,000,000 ANY PROPRIETOR/PIEXECUTIVE E.L.EACH ACCIDENT - $ �FFICERlMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Worker's Compensatio WCA3158730-20 01/01/2017 01/01/2018 1,000,000 C Pollution Liability TIEDE664299117 01/01/2017 01/01/2018 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 17-18 Workers Compesnation Includes-All states except ND,OH,WA,WV,WY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE IFOR Informational Purposes ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �L J y l F I ��� ��. z�c�� i �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued `/ 3� -�7 Conservation Division Application Fee Planning Dept. Permit Fee - Date Definitive Plan Approved by Planning Board f � " Historic - OKH" _ Preservation/ Hyannis Project Street Address 4At Bocttsiuk)- PA-j?-( Village Cfi7tk.V0 L�l� Owner J1JAO C1 CAI'e_N�V Addressa/ G w Scc t fJ P 1 Telephone Permit Request Rr. 7V 0 VN-I-)OA) dE Ur f3o9 ill uc7 i& N0 511�0 Cr(,/�t-- Cl'1A C S7--A"A�dV P A)4�W WW!�NOW 6,usm= P�31 J//�A A� CL Square feet: 1 st floor: existing I&V proposed—Ah6 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuati n 3 oo Construction Type Lot.Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure r m Historic House: 0 Yes lNo On Old King's Highway: ❑Yes ❑ No Basement Type: ,Full ❑ Crawl : ❑Walkout ❑Other Basement Finished Area (sq.ft.) _ NOf�)E- Basement Unfinished Area (sq.ft) c�c'z Number of Baths: Full: existing_ new 3 Half: existing new Number of Bedrooms: existing 3 new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: X Gas ❑ Oil ❑ Electric ❑Other ' 6A5 Fi/Adg Central Air: ❑Yes No Fireplaces: Existing New Existing weed�eI�stove:*Yes Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ e Ming ❑ n.w s N_ Attached garage: existing ❑ new size _Shed existing ❑ new size _ Other: r� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# c, Current Use Proposed Use APPLICANT INFORMATION UILDER R HOMEOWNER) ^ T Name Z-O►rij 500 -AIA Telephone Number Address t� vLF Wic-c - License # 0 0 2-91.a =SANI>t l of k-A- oats_3 Home Improvement Contractor# Email '"SUoMA LA Q COM CA S i_ /J t-7" Worker's Compensation #WCC mo-,5"UOF926-,;k/6 A ALL CON TRUCTION DEBRIS RESULTI R M THIS PROJECT WILL BE TAKEN TO Ca x) 0jJ ; (e'A ►S ARSALI SIGNATURE DATE I/av,47 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ^• 1y' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. k The Ct7mme77I'T9ret fth l f MaYsa use JT a'parbment&f v&i4 Actidaz& - e a�'htw.�g' r�r�rtts• . � - 600 Wasbiugt I.-Sweet Basiton,MA O.U.1 . ff7FP14LTlTaSS�gflP/Fia - Wcwkm 3' CGmpeniafEIFII ce AffidaviL I3mIder-JCcif -AcftW&Me cfticLmsOumbers APPEcamt lufmmnfign Please Pr nt: .Name �� (�C�� �/OhC DL.V 7cxkS wc �f r haL�= I9IL� Cstgf��- E SAn1./�w� GJt Phflae� C,�2sS �3�f - r Are}rou an eu¢plager?.Cfrec]€the appr°priate b°s; _ 4 I am a TYPe°f prnat:et{reg�ed}_ I_� I a�a emplap�r�. O ❑ geuetal confrsctilr sail I 6. 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Sandwich,MA 02537n V TTi jsuomala@comcast.net 508-274-7553 To: Nanci Carpenter Job# 3534-1435a 421 Buckskin Path Date 12/15/2016 Centerville, MA 407-509-1446 Project Description: Bathroom renovation as described below r4Fon DESCRIPTION V n12,250_00 R BATHmer to tear-out toilet, sink, shower enclosure,wall tile,floor tile,tile subfloor, and all walls and ceiling(already in process) * Dismantle heat register cover for re-use upon completion * Reframe sink wall for new medicine cabinet to be selected by customer($250 allowance) * Remove existing shower wall framing and reframe to expand shower to 48" wide * Electrical wiring to include: * Purchase and installation of new Panasonic "Whisper-Jet" quiet fan($180 allowance). f- Fan to be vented thru roof * Installation of 2 new wall switches * Installation of I new GFCI outlet at sink ' * Installation of wall light box on wall above sink. Customer to provide wall light fixture * Installation of I recessed light above shower * Installation of 2 new arch-fault breakers as per code y * Plumbing to include: * Purchase and installation of 1 new high-boy toilet of choice($300 allow) * Purchase and installation of l new undermount sink($100 allow)"with lav faucet of ZL choice.($300 allow) * Purchase and installation of new shower valve, slide-bar,hand-held wand and hose and- fittings of choice($600 allow) * Reconfigure shower supplies and drain as needed for new shower enclosure * Purchase and installation of(1) Sterling 4-pc 3x4 fiberglass shower enclosure with door of choice($900 allow) "�#-1; _ - Quotation Total: NOTES Valid for 30 days 1) Contract does not include repairs due to unforseen poor Acceptance:(� Owner: q `� workmanship or decay,or permit fees t 2) Contract does not include painting,or filling of nail holes on Date: d ! interior trim upon completion Contractor: 3)`Debris container to remain on site throughout project 4)Project timeline: approx 3-4•weeks per bath Date: 5)Payment scheduje:. 1/3 at acceptance, 1/3rd after drywall, , balance upon completion page 1 3,, BID PROPOSAL Z • 01 4 Wolf Hill C.S.L.#082712 E.Sandwich,MA 02537 r 4 H.I.C.#160825 508-274-7553 w jsuomala@comcast.net To: Nanci Carpenter , 421 Buckskin Path Job# .3534-1435a Centerville, MA Date 12/15/2016 407-509.1446 Project Description: Bathroom renovation as described below ITEM DESCRIPTION TOTAL * Purchase and installation of one(1)Andersen Series 400 window cat#TW2432,white exterior,white prefinished interior, grills between the glass,full-screen. Interior of window to be trimmed with primed 2-1/2" Colonial casing,exterior to be trimmed using white Azec PVC materials,hidden fasteners. * Installation of new 1/2" moisture resistant drywall on all walls and ceilings,taped and- sanded smooth. Painting by others * Purchase and installation of 18" deep x 36" wide x 34-1/2"tall vanity with angle filler to wall and toe-kick. Customer to select color and style($450 allowance) * Fabricate and install custom granite countertop,color of choice($400 allowance) * Installation of 12" ceramic tile over entire floor,color of choice($160 material allowance) * Re-install existing heat register covers * Installation of new 2-1/2" Colonial casing on door and new 3-1/2" Colonial base trim to finish. 2 GUEST BATH 4 ` ° 11,900.00 * Mask hallway hardwood floor with floor protection for duration of project * Tear-out of toilet, sink,vanity,all wall tile/drywall to studs. Ceiling drywall to remain. * Dismantle heat register cover and discard * Break-up and remove cast iron tub,tile floor and underlayment. * Tear-out hallway closet door, save and re-use shelving. * Frame-in hallway closet door and reframe wall in bath to enable closet to be accessed from bathroom. NOTES Quotation Total: 1)Contract does not include repairs due to unforseen poor 'Acceptance: Valid for 30 days workmanship or decay, or permit fees Owner:%P, 2) Contract does not include painting,or filling of nail holes on Date: . t( ' 1117 interior trim upon completion 4 3)Debxis container to remain on-site throughout project contractor: 4)Project timeline: approx 3-4 weeks per bath Date: 5)Payment schedule: 1/3 at acceptance, 1/3rd after drywall, balance upon completion Page 2 BID PROPOSAL4 o � Q CI 4 Wolf Hill C.S.L.#082712 E. Sandwich,MA 02537 H.I.C.#160825 508-274-7553 jsuomala@comcast.net To: Nanci Carpenter 421 Buckskin Path Job# . 3534-1435a Centerville, MA Date' 12/15/2016 407-509-1446 Project Description: Bathroom renovation as described below ITEM DESCRIPTION TOTAL * Plumbing to include: * Purchase and installation of 1 new high-boy toilet of choice($300 allow) * Purchase and installation of 1 new undermount sink($100 allow)with lav faucet of - choice($300 allow) * Purchase and installation of new shower/tub valve($350 allow)and 4-pc 30" fiberglass tub unit($500 allow) * Reconfigure tub water supplies and drain as needed for new enclosure * Purchase and install new 36" baseboard heat register covers * Electrical wiring to include: * Purchase and installation of new Panasonic "Whisper-Jet"t quiet fan($180 allowance). Existing vent to be used * Installation of 2 new wall switches * Installation of 1 new.GFCI outlet at sink * Installation of wall light box on wall above sink. Customer to provide wall light fixture * Installation of 1 recessed light above tub * Installation of 2 new arch-fault breakers as per code * Installation of new 1/2" moisture resistant drywall on all walls,and closet walls,taped and sanded smooth. Painting by others * Purchase and installation of one(1)48"wide vanity, 21" deep, 34-1/2"high of choice($400 allowance) * Fabricate and install new granite countertop, color of choice($800 allow) - * Installation of 12" ceramic tile over entire floor and closet,color and style of choice($210 material allowance)- NOTES Quotation Total: 1)Contract does not include repairs due to unforseen poor Acceptance: Valid for 30 days workmanship or decay,or permit fees Owner: 2) Contract does not include painting,or filling of nail holes on to ' interior trim upon completion Date: l 3) Debris container to remain on-site throughout project Contractor: 4)Project timeline: approx 3-4 weeks per bath Date: 5)Payment schedule: 1/3 at acceptance, 1/3rd after drywall, balance upon completion Page 3 aF° BID PROPOSAL s' 4 Wolf Hill C.S.L.#082712 E. Sandwich,MA 02537 a + _ c H.I.C.#160825 508-274-7553 jsuomala@comcast.net To: Nanci Carpenter Job# 3534-1435a 421 Buckskin Path Centerville, MA Date 12/15/2016 407-509-1446 Project Description: Bathroom renovation as described below ITEM DESCRIPTION TOTAL * Purchase and install one (1) 3-panel smooth Masonite hollow-core linen closet door, 1'3x6'6, solid jam,brass hardware and knob. Re-installation of existing closet shelving * Installation of new 2-1/2"primed Colonial door casings,and 3-1/2" Colonial base trim to finish. Painting by others 3 NANCI'S BATHROOM 17,900.00 * Tear-out of sink, vanity,toilet,baseboard heat register covers,fiberglass shower enclosure and abutting wall, all tile and drywall on all walls down to framing, ceiling drywall to studs, and the flooring down to original subfloor below. * Partially remove original plywood subflooring to expose toilet and shower plumbing below. NOTE: Toilet and shower are not properly plumbed and vented, and will need to be totally replumbed to code. ' * Reconfigure/relocate toilet flange towards back wall to expand shower'. * Reconfigure/relocate shower supplies and drain to provide for 48" wide shower enclosure. * Reinstall original subflooring and construct new shower wall_between shower and toilet to ' provide for 48" wide shower enclosure. (/� Vv�c� H�.uT' .. ..3'I r�t� ��/� �- L.AV �Ar✓Gc'S'- (�5 v, .....-.,,� + lj '�f Q c SI t i C"�✓��o s v `. `dj t e. " �t/s`v�� o2.S�� ?v�RCr 14 NOTES Quotation Total: 1)Contract does not include repairs due to unforseen poor Accepts ce: Valid for 30 days ' workmanship or decay, or permit fees Owner: e ' 2) Contract does not include painting,or filling of nail holes on pate: l interior trim upon completion , 3)Debris container to remain on-site throughout project Contractor: 4)Project timeline: approx 3-4 weeks per bath Date: 5)Payment schedule: 1%3 at acceptance, 1/3rd after drywall, balance upon completion. Page 4 y BID PROPOSAL R. 4 Wolf Hill C.S.L.#082712 E. Sandwich,MA 02537 H.I.C.#160825 508-274-7553 -- jsuomala@comcast.net To. Nanci Carpenter 421 Buckskin Path _ Job# 3534-1435a Centerville, MA Date 12/15/2016 407-509-1446 - Project Description: Bathroom renovation as described below ITEM DESCRIPTION TOTAL * Electrical wiring to include: *Purchase and installation of Panasonic"Whisper-Quiet"ceiling fan * Installation of fan venting to exterior thru roof * Installation of customer supplied light over sink * (1)GFCI outlet,at sink * (1)arch-fault breaker as per code * (1)recessed light over shower ' * All lights and fan to be tied to existing single wall switch * Installation of new R-49 fiberglass batting insulation over entire ceiling of bath. Wall insulation to be left undisturbed. * Installation of new 1/2"moisture resistant drywall on all walls and ceiling, sanded smooth' and primed. 'Painting by others. ' * Purchase and install one (1)new 32" x 18" deep vanity of choice($400 allow) * Fabricate and install custom granite countertop, color of choice($600 allow) * Purchase and install one(1)solid core Masonite 6-panel door with lockset * Installation of new 12x 12 ceramic tile over entire floor surface,color and style of choice ($250 material allow) * Installation of new 2-1/2"primed Colonial door and window casings. * Installation of new 3-1/2'primed Colonial base trim to finish. Painting by others * Installation of customer supplied vanity knobs,and towel bar accessories upon completion 4 MUDROOM DOOR REPAIRS 180.00 NOTES Y Quotation Total: 1) Contract does not include repairs due to unforseen poor Acceptance: valid for 30 days workmanship or decay, or permit fees Owner:CA J�C/ 2) Contract does not include painting,or filling of nail holes on Date: 4 2 10 1 interior trim upon completion .3) Debris container to remain on-site throughout project Contractor: ` 4)Project timeline: approx 3-4 weeks per bath / Date: l!lt 7 5) Payment schedule:.1/3 at acceptance, 1/3rd after drywall, balance upon completion Page 5 k BID PROPOSAL � o � 4 Wolf Hill C.S.L.#082712 E.Sandwich,MA 02537 a 4 H.I.C.#160825 508-274-7553 - jsuomala@comcast.net To: , Nanci Carpenter 421 Buckskin Path Job# 3534-1435a Centerville, MA Date 12/15/2016 407-509-1446 Project Description: Bathroom renovation as described below ITEM DESCRIPTION TOTAL * Re-adjust door'am to enable door to closeproperly. Purchase and install one 1 new J J O , Schlage keyed lockset,keyed alike 5 GARAGE REAR DOOR LOCKSET 120.60 Remove existing lockset on rear garage door, and replace with one(1)neW Schlage keyed lockset, keyed alike with other doors on quotation 6 GREATROOM LOCKSET 180.00 * Replace existing lockset and deadbolt with new Schlage units,keyed alike and keyed with all doors above 7 FRONT DOOR 1,350.00 * Removal of existing Andersen storm door for re-use'upon completion * Tear-out of existing front door and all interior and exterior trim down to framing of structure , * Installation of new lead pan flashing at sill of door * Purchase and install one(1)new Therma-tru S-296 2-lite door assembly, 3'4x6'8 RHIS, double-bore, smooth fiberglass,adjustable aluminum sill, frame-saver jams, 2x4 walls,brass hinges * Purchase and install one (1) Schlage lockset with dead-bolt(brass) * NOTE: Quotation does not include alarm wiring if present * Installation of 3M flashing tape around exterior frame of door as well as expandable foam insulation around perimeter of door for optimal water and draft protection NOTES " . Quotation Total: 1) Contract does not include repairs due to unforseen poor . Acceptan Valid for 30 days workmanship or decay, or permit fees Owner: 2) Contract does not include painting, or filling of nail holes on Date: interior trim upon completion . 3)Debris container to remain on-site throughout project Contractor: " `4)Project timeline: approx 3-4 weeks per bath Date: 5)Payment schedule: 1/3,at acceptance, 1/3rd after drywall, balance unon,comnletion Page 6 BID PROPOSAL 4 Wolf Hill *� C.S.L.#082712 E. Sandwich,MA 02537 ._:� V _ ..3 H.I.C.#160825 508-274-7553 jsuomala@comcast.net To: Nanci Carpenter = 421 Buckskin Path Job# 3534-1435a Centerville, MA Date 12/15/2016 407-509-1446 Project Description:, Bathroom renovation as described below, ITEM DESCRIPTION TOTAL * Installation'of new rimed 2- "1/2 Colonial p casingon interior of door,painting b others �P g Y * Installation of new'1x5 Azec PVC trim on exterior of door, attached using Cortex hidden fasteners. * Re-installation of existing door-bell and street numbers * Re-installation of existing storm door upon completion 8 DEBRIS REMOVAL 500.00 9 Angies list labor discount: 650.00 i S NOTES Quotation Total: $43,730.00 1) Contract does not include repairs due to unforseen poor Acceptan Valid for 30 days workmanship or decay, . or permit fees �f Y P Owner: (W/`"-4i 2) Contract does not include painting, or filling of nail holes on Date: 1 interior trim upon completion 3)Debris container to remain on-site throughout project Contractor: i4 4) Project timeline: appro?k 3-4 weeks per bath Date: 5) Payment schedule: 1/3 at acceptance, 1/3rd after drywall, S j.) ,tq ' _ balance upon completion Pa g `. ( t1 U ����� � 05-Ob--'1b 1'L;4'1 •kI1U11-v, ti,wrin ins. 15.b, 306-10�1—(l1 t r-fps WWM i2! CERTIFICATE OF LIABILITY INSURANCE �05/06 016 l THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NOGATIVELY 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 REPRESENTATIVI)_OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the crrtfflcate holder is an ADDITIONAL INSURED,the policy(ie5)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 fights to the certificate holder in lieu of such endorsement(S). PRODUCER Toni E.Davies O.H.Dunn Insurance Agency,Inc. Poe F 84 Fairhaven Road . (506}322-3240 ,,(508);322�3241 PO Box 487 s_ toni@ghdunn.00rn Mattapolsett.MA02739 IN AF N4100 INSURERA: MAIN STAWRICAN ASSURANCE 29939 INSURED Englneefed Home Solutions Inc John SuDmala D 4 wolf Hill Rd MRFR5. ARBELIA INDEMNITY 10017 East Sandwich,MA 02637 INsuRERc; AIM ' U00000 ERD• S R INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 18 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 TIME POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID MIMS. TR TYPI=OF INSURANOB - PowoYNUMBER IMPSOMLIMIA, 1005YA LaRTB A COMMEwLALoeNERALWLeILnY MPT2927H OV26J2016 2/26/2017 EACH OCCURRENCE 13 1,000,000 11 CLAIMS44ADE ®OCCUR 500,000 NI£o tow cAn am S 10,000 PEPSONAL&ACV INJURY S - 1.000,000 f3EN'L AGOR£GAYE Lurr APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY ❑LAC P s-00IAPrDPAG6 2,000,000 OTHER: $ f� AUTWOMLEtIAMM 1,0200`1007 . 1010212015 10f0212018 $ -_. y eLqr t bd1LYINJURYW#rP w0--- 250,000 _ - BDDILY INJURY(Per ex�dmq $ 500,000 HIRSD AUTC& AUTOS x $ 260,000 UMOREI.LA 00 OCCUR OCCURRENCE i ExCESSLUI6 H CLAIMSAAAW AGGREAWYe D I I RETENTION$ S C WORKM OOM"IMTION WCC-500.5009028.2018A 04f28=10 04126/2017 AND EMPLOYERS'LIABILITY ANY PROPRIETCRMARTNERIEXECLnlVE ®a�A & E.L.EACH ACCIDENT s. 3U0,000 (Mandatory IEAN EXCIUOED? E.L.DISEASE•EAEMP E $ -- 50000 D Df OPOPERA-noNs baby E.L.DISEASE•POLICYLIMIT $ 500,000 DESCRIPTION OF OPERATIONSI LOCATIONS/VEHICLES(ACORb IOA,Adoftnai Remn*s$cW4ule6 maybe avacned If more apace Is required) r CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES SE CANCELLED BEFORE THE EXPIRATION BATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH TH6 POLICY PROVISIONS. AUTHORIZED REPRESENTA11116 IM 01088.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are m9istered mal'fle of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-082712 Construction Supervisor } y JOHN E SUOMALA 4 WOLF HILL uv EAST SANDWICH MAf402537 l� Expiration: Commissioner 09/21/2018 ' ��e�arrr.»aa�raerr�l�i o`'�ltr��ac�u'eCru� - r pffece of Consumer Affairs&Bus1ness Regulahop HOME.IMPROVEMENT CONTRACTOR _ Type �� Registration. 160825 Private Corporation ' Expiration "�/�6/2018 f INEERED HOMES II LU7FIONS INC. IN. JQHN.SUOMALA i 4 WOLF HILL r " E SANDWICH,MA 02537 Undersecretary a ; License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation. 10 Park=Plaza-Suite 5170 Boston,M 02116 _ i of valid Itho t signature • MA (No 5—)—k.Oc{u2AL- 6 VttS L JA L-L 7N \ Noy io SCALE NGi.JIc ct o. i W( N34t,J rn �1 :��� �.. • � -ram .��.� TEM R��2c� ,4 s _ ice 5-'34 bow rt. i . G 00 VA 000, 7Oickr ' - • i ��`�4 toss. Vc dl-Et TO Ex R= v X. au . . Nc'LI; y 13 x 6 6 ` OL Ct o 54E T Toi Ll _. kf ('�RAMc-per ®�►��j: - � - _ 2 Oo --- WA , - Y 9 Ntw v�izy - • 1 ' - R 15/ C�1 LO'C Ntw Vic ore-6 dcol x� h ADD A)t"; 3( x4o . 36' . 36 k 3� vo Town of Barnstable *Permit# r a Regulatory Services + BAMSfABIA ; MAM1.639. Richard V.Scali,Interim Director MIS Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRES PER IT APPLICATION' RESIDENTIAL ONLY q&j )ab� Not Valid without Red X-Press Imprint Map/parcel Number Property Address Ya l `�.t< �,���-T� �L1 u'1 XResidential _ Value of Work$171,_Q9- Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �— �a l X"K --) P97-f &4eryr� /�2 . 00263� Contractor's Name—611�-t7V/ e-. LeP1J7-/Fyl)OAC) &%L b Telephone Number QD1"7fy`63� Home Improvement Contractor License#(if applicable Asa W 6 Email: r Construction Supervisor's License#(if applicable) D �� Workman's Compensation Insurance Check one: ❑ I am a sole proprietoro *' ❑ I am the Homeowner �� t I have Worker's Compensation Insurance i - ; 2 ® 2 ' Insurance Company Name Nr� Nil�6 �/ 6 FEB 014 Workman's Comp.Policy# w(.-- 3� '�7 TOWN r)F7 Copy of Insurance Compliance Certificate must.accompany each permit. NSTASL' Permit Re uest(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits'required. •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ' ***Note: Property Owner in t ign roperty Owner Letter of Permission. A copy of the Ho e in rovement Contractors License&Construction-Supervisors License is required. SIGNATURE: T:IKEVIN MBuildingChanges\EXPRESS'PE T\EXP .doc , Revised 061313 Massachusetts • Department of Public Safety Board of guilding eS R uiations and Standards Ccin .tructiva Surer iwr Sped-Ay . license:ECSSi 101027 RONAL"5OIO ,,, .,� a 16 Mirth Stn*t01 Framiu&aai•MA—701 Expiration 12IM201S Commissioner i The Commonwealth of Mdssachusetts Print Four, 13epartment of Industrial Accidents Office•of Investigations { I>� 1,Congress Street,Suite 104 jr Boston,MA 02114-2017 � 1 www.rnass.gov/dia w Workers' Compensation Insurance Affidavit: Buildeirs/Contractots/Electricians/Plumbers Applicant Information Please Print Legibhr Name(Business/Organizationllndividual): 7— Address:, y city/State/Zip: acN�-Lt, vv� :�Phone#: Are you an employer?Check the appropriate box- Type of proiect(required): 4. I am a general contractor and I l.❑ :•Q New construction employees(full_and/or part-time).* have hired the sub-contractors listed on the attached•sheet. 7. ❑ 'modeling 2.El .I am a sole"proprietor or partner- Re ship and have no employees These sub-contractors have ' g: Demolition. *. employees and have workers' , _ working for mein any capacity f, 9. 0 Building addition . comp.insurance. [No workers comp.insu_ranee '10.�'Electrical repairs or`additions: required.] 5 ❑ We are a corporation'and its 3.El I am a homeowner donig all work officers have exercised their . , 11.❑Plumbing repairs or additions , myself.[No workers'comp. ' right of exemption per MGL¢ 12 4 Roof repairs _ 'insurance required.]t 'c,152,§1(4),and we have no 13.❑Other a 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. ` 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. 1 am an employer that is providing workers'compensation insurance for.my employees. Below is the policy and job site information. Insurance Company Name: .J Policy#or Self-ins.Ltc.#: IV C � ' Expira4ion Date: h Job Site Address: a Iut%�-S � /'�� `� City/State/Zip: V 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 S250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for in c c erage verification. I do hereby certl under the ai a en ies o er'u that the information provided above is true and correct Signature: Date• .Phone#: °t Tv///,.�"/. 6�3 pf Official use only.,Do not write in this are to be eompletedby city or town officiat s . City or Town. Permit/License# F Issuing Authority(circle one):: 1.Board of Ilealth'2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . ' Phone#• r Contact Person: I r F ice olCo sumer ai and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 I-fome Improvef ut'.Contractor Registration +, 3 Registration, 126893 Type., Supplement Card Expiration: 8/3/2014 The Home, Depot At-Home Servipis ANDREW SWEET I ,' 6 — -- 2690 CUMBERLAND PARKWAY` UI1"Fi ;Q�Q` : --------------- - -- ATLANTA, GA 30339 Update Address and return card.Mark reason for change. Address F] Renewal [] Employment Lost Card 0PS-CA1 0 °AM-04/04410121�(8,pn g p �y®�/ d6 Office 0&sur A a rlt 1 9 a nside-89 *U at a0in..a License or registration Valid for individul use Only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business:Regulation Registration:, #0693 Type: 10 Park Plaza-Suite 5170 Expira'tlgrl, .�f3� 1F Supplement Card Boston,MA 02116 Home Depot',l fi ipl 9.a� eMd 9 ANDREW SWEET..", 2690 CUMBERLANi ,P.'AiUV-41' — XM:5AtiVA,GA 30339 Undersecretary al t ou s)gnature� , THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�C(, I DATA AwO MIA Zoe CMA ,VAWM-PI T 03/08/2013 15.21 FAX G174886501 UNDERWRITING 11001/001 .r+cvac.�' � 3l812013 s� TFIiS t:ERT ICATt5 18 ISSUED AS A MATiER OG 0,00 MATION ONLY AND CONFERS NO RIGFRB UPON NE CLRTi RTMCATE DOES NOT AFMMATIVELY OR NEGATIVELY AME9D.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE ODES NOT CONSTITUTE A CONTRACT BETWEEN YW LBSUIP40 R&SUREA ,AUTHORMED REPR£SBNTATIM OR PRODUCED AND THE CERTIFICATE HOLDER. iMPt?RTANT: If the cortltteete hotde.I&an ADDITIONAL OWURED, p01kyy N) ust Oe andotselt_ H SUBROGATION IS tNAPM.V0101 t 10 00t01i1t9 and Co"dons ot[he Poncye certain Pam may roqullT an alttasamaM A atstameat on UI� flute dons not con(eT rights to iho eertltLeaq hotder M peu of sueh snooreeanotrtetab CONTACT PRODi1Gt�+ Thomas I.Woods Insurance Agency,Inc. (AMR:EaI (508)755-5944 �_, (508)791-9841 PO Box 2940 n OREBB Worcester,MA 01613 PRnrnx'Pa INSURERS AFFORDING COVERAGE aAtc t vI wsuRERA, Atlantic Charier Insunince Company VDAC :9211 H&R Roofing&Construction.inc. u,SURERe. INSURER C: 763 Waverly Street INSURER D: Framingham,MA 01702 ROMERE: wsuRER F: COVERAGES: CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIeS OF wLSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE MUREO NAM'D AROve FOR THE POLICY PERIOD INDICATED.NOTYV Y14STANWNO ANY REWARE MMI,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCVNENT WITH RESPECT TO VOWN THIS ' CERTIFICATE WAY HE ISSUED OR MAY PERTAIN,THE INSURANCE AFFOOZO BY THE POLICIES DESCRIBED HEAEIN IS SVWELT TO ALL THE TBRMB, EXCLUSIONS AND CONDITIONS OF SUCH POLIQFS.LnnTB SHOWN WIT HAVE BEEN REDUCED BY PAID CLAIAIB. to" TYPE OF INSURANtE Am aUaa POLICY NUMBER POLICY EFMt11VE POLICY EMRAT10N IAMiTS LTR USA wPo DATE IUBro fM DATEOMMOOM tIm r 4nd I GENERAL UABtUTY QCMXW W.E S CUUIrP4GALoelveelALtueam P ROPM LEO oamomlar I A MW W&%it o aAt AOGAW ATE I Gr"K A02REGATE VUrT APwes aEv _*0WP OP A00 I Pix4v D PROACT ❑LOC AUTOMOBILE LAAWL1TY **Axe LOUR I - ANY AUTO IEAA-- ALL C wgto Aum a B4OfLY iNNURY 91010eeaool ea: +A.E'oA.riOG El BODILY INAARY s Teo AC awes Aerloo PROPERTYOAMAGE s r:�3µQ'Ma7ED AVlOS (i[AAup,q, ntsleelew occvR WOUArY ❑ EACHC=URRENCE 8 - EXCM I" CkAL"QA" _ A03REtIaTEEl a oEDuctIBLE I s e�ElENT10N It NQPJQW ANy[w�a9T TM Alto U►LWtAVUAB3UY 3R wE WCV00990801 01-2512013 0225/2014 X TAWToaY YIN LUTSnR I�twR1xCLJDWT y f" ❑ Policy Co>:crago State:NIA EACH +T t 100,000 Muxwwv inn 1".cow"Leal#SPEMI.PROW39 $ama.. DISEASE•PQ=LIMIT a 500.000 DiWSE•EA m EtaPLQyEE t 100,000 OTHER OEbCRPnW OR oPfRAh6AW0.OeATIW aLAJ<a Uu�A AtaOlro tat A w,p1 atal4eke td»d'w'it mon aPW iv rigWladl - Attention:Please note that the insured has not elected coverage for themselves and there is no 1jayron covered on this policy. IN � .y - ..i�,. �, ?' r: sNOULD ANY THE A80VE DEtiCR10E0 PDUCJES BE CA1dL'!sI LE0 BEFORE THE THD At Horne Services,Inc.and The Home Depot EXPIRATION DATE r"rEOF,THE ISSUING ODMPANY yytU,ENDEAVOR TD MAIL 2690 Cumberland Pkwy,Suite 300 12 DAYS Vdtrne"NOTICE To THE CEI2TIFICRTE H�t3FR NAI�EO TO TH6 La IT. Atlanta,GA 30339 BUT FAILURE To 00 SO SWILL IM E NO OBLIGATION OR UABIU'iY OF ANY KIND UPON THE INSUREE YS AGENTS OR'.REpFMMENTATIVES. Almlonrr»R!_PAESt]ITAItVt? TtD 25 41MO) 1 An alQtua rwarralt. Page 1 of 1 CER't'iiF7CATE HOLDER COPY rt 1-1011E tAIPROVENIFNe C(jNTRAC'l" Sold,furnished and Installed by: PLEASE READ THIS CONTRACT THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 908 Boston Turnpike Unit l,Shrewsbury,MA 1545 Branch Name: Boston South Date:2/10l2014' Toll Free 8779033768;Fax 8009863610 ME Lic#C 02439 RI Cont.Lic# 16427 Branch No: 31 + CT Lic#HIC.0565522 MA Home Improvement Contractor Reg.# 126893 federal ID# 75-2698460 Installation Address: 421 Buckskin Path CENTERVILLE MA 02632 City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: Mr.Scott weichet 774 470-2725 321 947-0445 Ms.Nanci Carpenter 774 470-2725 Home Address: 421 Buckskin Path CENTERVILLE MA 02632 (if different from Installation Address) City State Zip E-mail Address (to receive project communications and Home Depot updates):ssweichel vgmail.com Marketing emails will not be sent from The Home Depot. Project Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy,and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installati on")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders ` (collectively,"Contract"): Job#:(Internal Reference) Products: Spec Sheet(s): Project Amount 7343924 Rooting 7343924 $17 s . ,597.70 � ` Minimum 25% Deposit;of Contract Amount due upon execution of this contract Total Contract Amount. $17,597.70 Customer agrees that,immediately upon completion of the work 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 hereunder. Pavment Summarv: The Payment Summary# 7343924 ,included as part of this Contract,sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). GENERAL TERMS AND CONDITIONS Responsibilities: The Home Depot:will provide the Products identified above,make arrangements to have the Authorized Service Provider perform the installation services in a professional and workmanlike manner,and arrange proper insurances. Unless otherwise expressly provided for herein,Authorized Service Provider will obtain required permits and provide permit numbers. CystomerF will ide tify any property lines,easements,covenants,underground or ove line ,pre-existing.physical or 01-30-14 s Page I of 7 Mr.Scott Weichel(Feb 10,2014,6:24 PM) Accepted by:crl0(Feb 10,2014,6:26 PM) environmental hazards,building code violations or other legal encumbrances that could affect the Installation services prior to the Installation.Customer shall keep posted permits on display at all times.Customer is responsible for any delays or interference caused to Installation by Customer or third party under Customer's direction or control. Start and Completion: Estimated Start Date: 4/7/2014 Estimated Completion Date: 5/5/2014 The work described in this Contract is estimated to begin on the Estimated Start Date and to be substantially completed by the Estimated Completion Date.Customer understands and agrees that such dates are only estimates and are subject to change, customer's obtaining credit approval in the case of financed ptirchases,and/or special order product production and delivery times that are beyond The Home Depot's control.The project coordinator will communicate with you front time to time to provide more detailed scheduling information and advise you with respect to project status and timing issues. Changes and Change Orders: Any changes to the work,including but not limited to changes necessitated by undisclosed, unidentified or unforeseen conditions on the site,are subject to a written Change Order("Change Order")signed by Customer and The Home Depot and any additional products or services included in such Change Order will be paid for in full before any such change is made. The Home Depot or its authorized service provider will not attempt to reniediate any such undisclosed,unidentified or unforeseen conditions and may immediately discontinue the Installation or ask for a Change Order. Neither The Home Depot nor its authorized service provider is responsible for delays caused by events beyond either's control.including but not limited to acts of nature,governmental actions,delivery delays or damages caused by third parties, labor strikes,Customer's credit or financing,or any incorrect information or non-compliance with this Agreement by Customer. Liens:Security Interests: As permitted by law,The Home Depot has the right to place security interests against Customer's property if Customer fails to snake required payments under this Agreement. If Customer makes the required payments,The Home Depot will not place,or permit its Authorized Service Provider to place,any security interests against Customer's property. After paying on any completed distinct phase of the work,Customer may request from the authorized service provider a signed lien release and waiver of any right to place any claim against Customer's property applicable to the work then completed. LIMITED WARRANTY: TO THE EXTENT PERMISSIBLE UNDER APPLICABLE LAW,THE HOME DEPOT WARRANTS THE WORKMANSHIP OF THE WORK FOR A MINIMUM ONE(1)YEAR FROM ITS COMPLETION DATE. PROVIDED CUSTOMER NOTIFIES THE HOME DEPOT DURING THE WARRANTY PERIOD,THE HOME DEPOT WILL ARRANGE FOR REPAIR AT NO CHARGE TO CUSTOMER FOR ANY DEFECTS DUE TO FAULTY WORKMANSHIP. EXTENDED WORKMANSHIP WARRANTIES MAY BE OFFERED ON SELECT PRODUCTS AND WILL BE PROVIDED AT THE TIME OF SALE. THE HOME DEPOT'S WARRANTY DOES NOT COVER DAMAGE CAUSED BY ACTS OF GOD, INSTALLATION OR REPAIRS MADE BY PERSONS OTHER THAN THE HOME DEPOT OR AUTHORIZED SERVICE PROVIDER,ABUSE,MISUSE,NEGLECT,OR NORMAL WEAR AND TEAR. MERCHANDISE AND MATERIALS ARE COVERED EXCLUSIVELY BY THE MANUFACTURER'S WARRANTY,IF ANY. THIS LIMITED WARRANTY GIVES CUSTOMER SPECIFIC LEGAL RIGHTS AND CUSTOMER MAY ALSO HAVE OTHER RIGHTS THAT MAY VARY FROM STATE TO STATE. WAIVER OF CERTAIN DAMAGES: EACH OF CUSTOMER AND THE HOME DEPOT HEREBY WAIVE ANY CLAIMS AGAINST THE OTHER FOR LOST USE,LOST PROFIT,LOST REVENUE,INDIRECT,INCIDENTAL OR CONSEQUENTIAL DAMAGES RELATING TO THE WORK,THE MATERIALS OR SERVICES OF THE HOME DEPOT OR OF ITS AUTHORIZED SERVICE PROVIDER OR THIS AGREEMENT,BUT EXCLUDING WAIVER OF CLAIMS FOR INJURY TO PERSONS. TO THE EXTENT CUSTOMER'S STATE DOES NOT ALLOW THE EXCLUSION OR LIMITATION OF INCIDENTAL OR CONSEQUENTIAL DAMAGES,THIS SECTION MAY NOT APPLY. Termination: If Customer breaches this Agreement or declines a reasonable Change Order request,The Home Depot may immediately terminate the Agreement without further obligation. If Customer terminates this Contract after the cancellation period but hg&M the materials"are ordered,Customer will pay a service charge equal to the greater of 10%of the Contract amount or the actual costs incurred to date. If any such termination by Customer occurs after the materials are ordered,Customer will pay a service charge equal to the greater of 25%of the Contract amount or the actual costs incurred to date. Ouestions or Concerns? If The Home Depot and its authorized service provider are unable to answer Customer's questions, Customer may contact The Home Depot at www.MyHomeDepolProiect.com. l kft-4z Mr.Scott Weichel(Feb 10,2014,6:24 PM) Accepted by:crl0(Feb 10,2014,6:26 PM) 01-30-14 SFC Pace 2 of 7 t 1 �oF1144E roy� Town of Barnstable Permit# 0 Expires 6 months from issue date n, Regulatory Services Fee * Y� * BARNSI'ABG Y SGgS. 10� r pp ���Ennnn 4 l�o)mas F.Geiler, Director Tf1 MA'SA I"EB 2 3 2009 Building Division .TOWN OF SARNSfq ry,CBO, Building Commissioner 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 Imprint Map/parcel Number 7 � Property Address — ---1� L� Gy;�,mlco— P.f�,1 A CeA kf U 1 �IU I krZLj,0, V tb v XResidential Value of'Work- 2t V O� Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address �A C'� �zc r��ti Cie r L. L���' Contractor's Name_ J p,eve . J ft Q Telephone Number I I LC 1 I lome Improvement Contractor License# (if applicable) Construction-Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor XI am the Homeowner a ❑ I have Worker's Compensation Insurance Insurance Company Name 1uA''� Workman's Comp. Policy #__ 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 �❑ Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders. U-Value (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 sigyProperty Owner Letter of Permission. A copy of the Rome Inyprovement Contractors License is required. SIGNATURE: i:`\�PHIAN'1:01WS\building permit forms\E PRESS.doc Revised 100608 1 1 4 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 Le 'bl Name(Business/Organizationtlndividual): MJ c Address:_ t ✓ L J/Ll v �✓.��'J J City/State/Zip: Il,;k,/'od i Phone.#: Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer to er with 4. ❑ I am a general contractor and I 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 g.•❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition comp. insurance t [No workers'-comp.insurance e aired 5. ' We are a corporation and its -10.❑Electrical repairs or additions . required.] officers have exercised their I L Plumbin repairs or additions 3. � am a homeowner doing all work ❑ g eP - � self o workers' co right of exemption per MGL y [N comp- 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. (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.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure io secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 rap 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 cem der the pains an penalties ofperjury that the information provided above is true and correct. Si tore: �J Date: Phone#• S Ol S LL Official use only. Do not write in this area,to be completed by city or town offWal, 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#: Information and Instructions � � Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,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 foregoingg-engag inmrprise�a ato -en n'm1u-dmgtlie leg represen atPe3Bf decxase empivyer;ar he-== - —.-' receiver or tiustee 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, §25C(6)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,MGL chapter 152,§25C(7)states"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 out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of fimuance. Limited Liability Companies"(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,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 Departrnent 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .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. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(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 officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (Le.a dog license or bum leaves to bu leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephone-and fax number: The eornmonwealth of MassachuseM Department of Industrial Accidents Offtce of Investigations 600 Washington Strut Boston,MA 02111 U. #617-727-4400 ext-406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 ' www.mass.gov/dia Town'of Barnstable Tt+ta Regulatory Services t Thomas t F.Geiler,Director r RLr�hi�`IRiF s f - " IN MAss . g Building Division PrED Tom Per ry,Building Commissioner 200 Main street;Hyannis,MA 026-01 f... _.._. _._....... www.town.barnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 r HOI%IEOWNER LICENSE EXEMPTION j1 Please Print DATE JOB LOCATION: t. J�/ CC r— number. street village / .HOMEOWNER" ,o 'Gf !j_'� 2.� S� IJ namehoYm phone# work phone# CURRENT MAILING ADDRESS: ' n _ l c l t h 1fj�I eityhown state zip code' The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. , DEFIIZTITON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit.to the Building Official on a form acceptable to the Building Official,that he/she shall be - responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. r The undersigned."homeownez"certifies that-he/she understands the Town of Barnstable,Building Department minimum inspection pro f ores and requirements and that he/she will comply with said procedures and . r ents. Srgnatil.of m Approval of Building Official „ Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with.the State Building'Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner polbr mig work for which a building permit is required shall be exempt from the provisions of this section(Section.109:1.1 'Licensing of construction Supervisors);provided that if the homeowner eagages a persons)for hire to do such . work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Liemuing Conshvetion Supervisors,Scction 2.15) 'Ibis lack of awarzricss often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlirense:d priori as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the rosponsibilitics of a Supervisor. On the last page of this issue is i form currently used by several towns. You may care t amend and adopt such a fomi/ceatificadon.for use in your community. Q:for ms:homccxcmpt 1 Ta�ti Town of Barnstable Regulatory Services 9s� $, Thomas F.Geiler,Director 1659-�'gEnru-°' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town_barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, < / v V , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: ) .(Address of Job) as 1'3l U l Signature o r Date --bp,\d YY-\V-4 1 Print Name If Pro a Owner is applying for ermit lease complete the � r r r Homeowners License Exemption Form on the reverse side. Q:FO RMS:O WNERPERMISSION 4l Assessor's map and lot number ........ ,. Sewage Permit number ..`........ ........:....................................... ,/ 1 THE ro�y TOWN OF BARNSTABLE Z BASHSTADLE, i F M6 9 BUILDING , INSPECTOR ° 0 MPY p APPLICATION FOR PERMIT TO .... �.... S'���F ; ........................................................... TYPE OF CONSTRUCTION ..........`�_s1cM'> . .................................... .............................. . y� .......19��. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r Location e�% � k id�1....... 'X 4� ................. ................................ .........�.... ProposedUse — �.. ...............................................................................................:......................... Zoning District /? � .................................................Fire District ..... .....:Q:'►�... I.U.f .............. ......................................... Name of Owner s (.`� ��� 1+�.�1 c`t> .<.. Address ��' .. �� .'...i°�-�'� Name of Builder . ' :? ! .`. .....ST.. i�2 �� ................Address � �+�c ..... C.��1 , C(.�J�F�I\l i LL Name of Architect ....... '.......... U......E .............................Address . Number of Rooms ................ ......................................Foundation ....��"-a �n�iG. /t—oCii�..........I ...... fie. Exlerior �* f'�?.Ate.....................................................Roofing ................ .................................................................................... Floors �ti1C2 "C� .........................Interior .........��(��J _ .................. ............................ Heating ►.�S C3 -........................................................Plumbing 1� ..................................................... .......... `. .............................................................. Ut 0.0 .................... ... Fireplace .........1.�C� IJ`t•...................................................Approximate Cost ................. .......................... .. Definitive Plan Approved by Planning Board --------------------------------19________. Area ...u .... .................. Diagram of Lot and Building with Dimensions Fee ..........!'r SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 T 'Ai 45 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name - `` ..:. %K .. `�'................. 7, -'6VILIAVIOUS , Ben A=19� No ...23053 Permit for .••ADDITION Garage to Single Family Dwelling ` ............................................................................... 421 Buckskin Path Location ................................................................ Centerville Ben Poviliavious Owner .................................................................. Frame Type of Construction .......................................... J ............. .............................................................. Plot ............................ Lot ................................ Permit Granted ..... ....3...0..i...........19 81 Date of Inspection ....................................19 Date Completed ..................... ................19 k PERMIT REFUSED ............... ......................... 19 ...................... ................................................. _ .....:.... .-. ..... '............................ Approved ................................................ 19 ....................................................................... ............................................................................. Assessor's ma'p and lot)number t Sewage Permit number g t.......................... SSP)' r ��� /C SYSTE T � s-r %THE �V�7/ T®W l� �F B AR N� �O E PLWVCE T ,UA9Ej�. 5 Z BlBH9TeDLE: i ®W)v REGV CODE 4�,® "b 9 BUILDING ` INSPECTOR L4T,oAii 't 0 YPy p'' i APPLICATION FOR PERMIT TO ..... 420 .....:. ...G.PAP`�� ................:.......................................... TYPEOF CONSTRUCTION .......... CKON................`..:........................................................................................ t ............................ :......197.�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......:.1..` ....... .VC .S 11 ....... -C 1............. ..................................................... ProposedUse ........:`CToot.� ..........N ................ ................................................................................................... \ Zoning District ......... ....................................................Fire District C(L.....CC:C;... ...... ..................................... Name of Owner ...............Address �tv,r S'C �-�e� 3�-0� c�SK��`?CA � Cew%eilC�� Name of Builder ... ................................................ Name of Architect �C� .....Address Number of Rooms O�� Foundation ...L��`J�. ..... .1o�1c-..../ Q3.�1ee�� ................................y. 1. ..... Exierior ..... ..�rC'r�P`Q-...............................:.....................Roofing .....:.'.! ��?1?t!Pa) ...........................................:....... Floors .Interior ��►j ..................................................................................... ...................... .......................................................... Heating Plumbing tJ� 9, .......... ..................................... . ....... ............................................................... ........... Fireplace ��' � �.. Approximate Cost 4 00 ............................................... ..... ............................................ Definitive Plan Approved by Planning Board ________________________________19__._____. Area � . ....v.. ............ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH —''wo U �Jx 45 y ------------------- I hereby agree to conform to all the Rules and Regulations of theTown of rnstable' rega_ e`above construction. Nam .. ... ................................... VILIAVIOUS, BEN ' No ................. Permit for,...AD.TUT.MW........... Garage 'to Single FamilY....'Ow lling rs Location 42g ................. Y Centerville .............................................. .... ................. a Ben Poviliavious _ Owner e . 4 Type of Construction ..E.ra,ma•.............. .. ............... ........................... ..............` Plot .... ................ .. Lot ................................ ti w 1 w Permit Granted ......AprU... .19 91 Date of Inspection .................................. 19 ' Date Completed .................. "'. ...19 �� �• � . /_:���%�� �; � � is • e t M , PERMIT REFUSED y ..........:.............................................. ..... 19, a,. `,. A Y ti '........ ......`.... . .. .................................. . ..................... ...... r ,4 ........... {.� y�..... ................. ... . .. ....... sus' }-, Approved �x ............................. 19 . ~•. .' ..V ` ...........0... �"�. ...............................X. n —M r s i 31 " Assessor's map and lot number ........ �o2............. . 4 g 1..� l L...........� .. S4Wa e'Permit number oFTHET, . TORN OF. BARNSTABLE B9BB9TOBLE,' 9� 1639. NAY a' D;U It D I NO I N_S P E C T 0 R , �D `,� q. {^ [• /7 APPLICATION FOR PERMIT TO .f31. �............ .................... ........................ TYPE OF CONSTRUCTION .............. ��.............. . ... .... .... .. .l!G......................................................................... J ... ... 1. .........t 9. .. TO THE INSPECTOR OF BUILDINGS: The undersigne``d��hereby applies for a permit according to the following informatk n: T� ........................ .... ... ................................:........................... Location .......... ............................... ...... ........`.. .................... ProposedUse ...... .......... .. ................................................................................................................ ZoningDistrict ................................................. .....................Fire District ............. �../............................................................ Nameof Owner ... ��jz .....� .:. .... .. . . ..............Address ..... ........................................................ Name of Builder ..� ... .....................................Address .... .............................. Nameof Architect ...................................................................Address .................................................................................... Numberof Rooms ...............(...................................................Foundation .............................................................................. Exterior .......................... ........................................................Roofing .... ...... Floors ...... ..............................................................Interior ....... .. ....................................................................... Heating ........................................................Plumbing ........................ ................ ........... Fireplace .......................1-12-l.6'7►•e .-.....................................Approximate Cost ..... ............................................. . ........... s. Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ......Vo.......................:........... 00 Diagram of Lot and Building with Dimensions Fee !_............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH P� r °° �' S I hereby agree to conform to all the Rules and Regulations of;theTown of Barnstable regard• the above construction. Name ............. .... .. ........................ Flynn, Tbxmoam F. 17269 build storage ' No ----,—..'Pern�� for --------_--.. ` . , shed ' -------..---------.—,,.-----. . ' . ' . . 421 Buckskin Path' fh Locozn ---------------------. = ' ` �..,__.__�eo�mrv�ll�_______`___ ' I�manmao F. Flynn Owner �—__.,—_----.-..��------__ frame Typoof. .......................................... - --------~.--._--------.�---' . ~' Lot '= ' ^ ' . ---------. ---. ------. ~ � I5 7� � ,Pe,m|t,G,onte6 ................����=----lg ' - . � Date of1nnpec pn '—,--119 ` Dote Con,pleie6 .wV^..w�. .. ......................lV � PERMIT REFUSED' —.�---'_—,'—.--._----�--.. lg ' ' ^ ` ...��.------..—~—`.--.—...---~.--. � ...................................................... , '^------`' -....---~—.--.—...--,---....—.—.—.—.. ^ ' ' ~ � ----.---.—.�--------..,.---~~.— - ~ - . - \ _------------.�—.� lQ � . . ` ' ' .....-------------.-----.—..—..— ` ~ ~ ` —`-----'---.--~---.--,...—.—,. '^ ' | |�~ I Assessor's map.. and lot number 1 qe__1 Szwage Permit number .... { ...........�I..'. .:..................... ICE_ V r °fT"ET°�� TOWN OF. BARNSTABLE BARNSTABLE. i M6 9 qp p Y BUILDING INSPECTOR O•EFY G • t APPLICATION FOR PERMIT TO .C .U�. . ... ............................................ TYPE OF CONSTRUCTION ...... ..t..,,, ................................................................ q..../. ....I T` ) TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:Location ......... ....... � .1...... ................................ ... ....... -k �` "I//`1�iC,' ................................................. ProposedUse ........:.....................`.,..................................................................................................................I......................... ZoningDistrict ................................................. ......................Fire District .............................................................................. SG�% Name of Owner ..0,�. .................. �.:../ 'a;?�'�- ..Address .................................................................................... it Name of Builder ..�.. ........................................:..Address ... a.�il!u . /! .................................. v Nameof Architect ....................................................................Address .................................................................................... .............. ..Number of Rooms .f .................................................Foundation .............................................................................. Exterior .......................... ...............................................Roofing ....(......,......................................................................... Floors .........................................................Interior Heating ......................... ..................................Plumbing ................................................................................ Fireplace ... - -......................................Approximate Cost ..... ........1 ..�..........................., ........... Definitive•Plan Approved by Planning Board ________________________________19________ . Area / �... ........ ..... .. .......... 0 0-'-• Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 17 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ✓ ........................... Flynn, Thomas F. No ...17269 Permit for storage ........................ ..............shed........................................................ Location 421 Buckskin Path ................................................................ Centerville ............................................................................... Owner Thomas F. Flynn .................................................................. Type of Construction frame .......................................... �I ................................................................................ Plot ......................... .. Lot ................................ Permit Granted .........August...15...........19 74 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... ............................................................................... Approved ................................................ 19 M ............................................................................... ° ............................................................................... t Assess(?r's map and lot number THE Sewage Permit nu . ........ ///,If 1r 71 mber ... ]BARISTAXLE, House number ......................................................................... MA8& 1639. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ .......i:.%........ ........................................................... TYPE OF CONSTRUCTION .....A)c--Q.S4............................................................................................. ....................... i........... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....... ....... . ... ... .. .... .... .... ........................ Proposed Use .... .................................................................................................................................. Zoning District ........................................................................Fire District .... ............ Name of Owner ...............................A .........Address ................................ I Name of Builder ..................s ..Address .....�;�.... ............. ......... Name of Architect ........... .................................Address ....................................... ............................................ C.k................ "o 0'r C- V T Number of Rooms ..................................................................Foundation ......................................... . Exlerior .............. ...............................................................Roofing ..... Vk ............................................................................... Floors ......................................................................................Interior .......&....................................................................... Heating ............ 0��e�� t-- ......................................................................Plumbing ................................................................................. C 1---, it— e"c�1-,> Fireplace .................I................................................................Approximate Cost .....................................6................. Definitive Plan Approved by Planning Board -------------------------------19--------- Area ......................................... Diagram of Lot and Building with Dimensions Fee .........:�I� ......................... SUBJECT TO APPROVAL OF BOARD OF HEA,L -1-13"791f- 001 I hereby agree to conform to' oil the Rules and Regulations of the Town/of Barnstable regarding the.&ve construction. 5X N&—n POVILIAVICIOUS, BEN A=192-122 24569 No .................. Permit for ...ADDITION ................................ Sing�,!:�J:ami�y...qW!�ft;Lj i Rg.............. ............... ........ Location ... A14j:�Kqxin...F�qltb................ Centerville ............................................................................... Ben Poviliavicious Owner. .................... ............................................. Frame Type of Construction ........................................... .............................. ................... .................. ........... Plot ............................ Lot ................................. t Permit Granted ...No.vember... .......19 82 .. .......... .... Date of Inspection ....................................1'9 Date Completed ......................................19 PERMIT REFUSED ....................... 19 ............................................................................... ................. ...... 1(........... ............................................................................... ............................................................................... Approved .... ........................................... 19 ............................................................................... ............................ ................................................... Assessor's map and lot number ......... ........... ............ ......... , �oF T e ro�� jSewage Permit number ... 6............ //..... ... ......4.. BAHBSTADLE, i House number ............ ........................................... DO Maea I O 1639. \00 0 MPY a' r TOWN OF BARN:STABLE BUILDING INSPECTOR APPLICATION FOR 'PERMIT TO ....... ...... ..... !`•'.... ........................................................... TYPEOF CONSTRUCTION ......Qm!°:............................................................................................................... ..........................:-:... ....:.........19�?�- "" TO*THE fNSPECTOR'OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 4./........l l - 1J ..` i� ........ ..... Y." )....... ProposedUse 4......:--r.................................................................................................................................... Zoning District ........................................................................Fire District .... e°^?.`1. 11 ►. t.l. y� L4 :f.... Name of Owner ®.D1.4r� J�G.IS`.�?`?.........Address ..� .......�Jis i....................�. �....... i... . �vq ? ..............Address Name of Builder ................. ....... ... 4.. ��.. Nameof Architect .............. .q ..... ...............................Address ............ ................................. ............................ Number of.Rooms ...................�.............................................Foundation ............................ df ............ Exterior ....... `���.i'".......................... ........................Roofing .....�S.. V .................... .......................... Floors �4 ......................................................Interior ... . .V........?.. ?............................................. Heating ............N.... ....-..................................................Plumbing ............ ....-'..... ... ........................... ....... Fireplace ............... .: -..............................................Approximate Cost ... Z�.............................. .. .. .. .. ... Definitive Plan Approved by Planning Board ________________________________19________. Area ....`......I....o©`S Diagram of Lot and Building with Dimensions f; �""-"' -�� Fee ......... �.Jr SUBJECT TO APPROVAL OF BOARD OF HEALTH3"'v7,z' . 2u—i 'i J r� I hereby agree to conform to all the Rules and Regulations of the Town if Bar nstabl' a reg ding the ove construction. Na ...... ;M..... !.................. 0 Sol POVILIAVICIOUS, BEN 24569 ADDITION No ................. Permit for .................................... Single ..........j...........I.F...a...m...i..l..y Dwelling Location 4.21 P 1 Buckskin ...................................ath....................... . Centerville . J,........... ...... ............. ......... .......... ..... ........ Owner.......Ben...P o.vi.l.i ay.i c.i.ou.s................. .. ..... .... A ....... .... .. .... .. T" of Construction ...... Y ............... ...........................I.,.......:......... Plot ... ......................... Lot ............. ............ November 1 - 82 Permit Granted ............................... -9 Date of Inspection ....................................19 Date Completed .:7......... .. 9--�n... r A A PERMIT REFUSED .................................. ....................... .... 19 • ..............................;................................................. ' ,S ` ' .' _ ; y it /L ............................................................................... . .................................................................................. . ............................................................................... Approved ................................................... 19 ................................................................................. .................................................................. ............. Assessor's map'-and lot number ....... . Ir dZPTIC Sewage Permit number ......................... . T �. 14LtZ.t SYSTEMAWST d �6 lT „ KJ / ` �VI� �� ,/ PL�I" N HA"STABLE, i a House number (� . � �y ® ® 0 a wV� 11 TIi-L i6 TOWN OF BARN A E" Fo BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...............l 6t-dL—..............�17,0/ �r .Q� ........ TYPE OF 'CONSTRUCTION ..............LV ......................................................................q� ........../....~.../.........................19 L TO THE INSPECTOR OF BUILDINGS: u The undersigned hereby applies for a permit according to the following information: Location ...Z7� �....V.ZED. , -1t......p.x&..................... ......... .... ........................................ ProposedUse .............al ll.....4.. .�............................... ................................................................................................. Zoning District /?C:.................................................Fire District Name of Owner � .�.�}.�Jr .�d./��1 AU.IC./.U.�.........Address .��...JQR..kl' .....19C1- ...yl�. r Name of BuilderG✓Y ......L� .........................Address ....��� . Nameof Architect ...................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ............:.......................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .... [ ...... Fireplace ..................................................................................Approximate. Cost .............CQ d.Q....................................... Definitive Plan Approved by Planning Board ________________________________19--------. Area Diagram of Lot and Building with Dimensions Fee f`l SUBJECT TO APPROVAL OF BOARD OF HEALTH ` aid ��►�.� '7 u' s/ ✓v f�'`�vn 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 ' ...... 7......................... Construction Supervisor's License Qz,. !'�.../.7............ ' BqUILAUKIUS, 8E0EDIBTS . - - ^~ 29299 Remodel /Add Bath No —'............. Permit for ..................................... , . ' _ Single Family Dwelling ----.--------~------------. . . Location42l Buckskin Path -------------------'-- ' ~ -- Centerville --------------------------. Owner . .......Deued— --�btu--�ouilau--- ki----- ua — — — — —' `/ Type o���on��ruc ion ...J�����--------_ -/ ` . —..------------------------' Plot Lot ---------. ----------.. Permit Granted �ay 6� 19 86 � � � ----' --------.- Dote of Inspection ....................................lg � - ' ' Date Completed .......................................l9���� � . ' .. ` . | '9 t �... 4i, r i ° • .�F..�T bhi,_ • °"t° °"�. tr3�iK.�V��..•t...R...., ..� .� ,.. .�. .. ,.L•_.. _ * � ..� .. � ,� I � Assessor's maVp. and lot number ....... .. - �pF TN E TO�� 4r O Sewage Permit number ......................... �.C. ....... ... d Z MARNSSeTADLL i Hai A j House number ........ ........................................................ 9 00 1639. a• 0 YPY TOWN 'OF BARNSTABLE BUILDING INSPECTOR 42 APPLICATION FOR PERMIT TO /M.,,��j ..............�9�.��� .1����.�'�.` �.. .......,..... ........ Otl : r TYPE OF CONSTRUCTION .............. ". ........................................ j .. ...1.....' ................19 TO THE INSPECTO OF BUILDINGS: x' The undersigned hereby applies for a permit according to the following information: Locationd,!;..... Z f�.....................�...°'H:`.�..!... ,c.................................................... ProposedUse ............. .....-�............................... .................................................................................................. Zoning District ................................../7 C. ..............................Fire District ............�... .......... ........ .................................. ..... g Name of Owner%_�J.;.P RTS....;60..1l..14.A.MIC.1.'V5.........Address .5. .....ORPI,'.....` .... r �!/.�..... Name of Builder / 1/ ......� .........................Address .... ���-1lt!^. ...........................1................ Name of Architect // ......................... . ....................................Address .................................................................................... Number of Rooms ..................................................................Foundation ................................. Exterior ..................................................................................`.`.Roofing .................................................................................... � r Floors ......................................Interior ..................................;................................................. Heating ".. : ......... ... ..... ........ :.......PlumE ing .-18f-- _ .. ....:... .... Fireplace ..................................................................................Approximate Cost �/-.qj1A.0........... Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL-'OF BOARD OF HEALTH., r i s f JaA& OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS i 1 hereby agree. to conform to all the Rules and Regulations of the Town of-Barnstable regarding the above construction. 4, Name . .. ...` .......�......................... Construction Supervisor's License a� Q..����............ ,,. � r BODILADKIDS, DENEDIBTS A~192-122 � �L 29299 Remodel Add Bath No'------ Permit for ------------ / Single Family Dwelling � ---------------.~---.------... 421 Buckskin Path Location ---------------------. � Centerville - --'r-----------'----------'- 8eoe6ibto BuuiIuukina Owner ---------.------------.. ^ Frame Type of Construction -------------- ' . ^ -------------------------- - ' Plot ............................ Lot ................................ ^ ' � ` Permit Granted .......May ...6...................... A 86 - Doha of Inspection ---------..^--lA Do�a Completed ------------.]9 ' ' ' ' ' \ ' . \ ` ` � ^ _ � ' ' - ~ ' ' . . .� ' ' . ` . ' ' \ ��� - ' ` | TOWN OF BARNSTABLE MARTSTAIM, M MAOL "L,639gar. BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... ......................................................................................... TYPEOF CONSTRUCTION ............n ............................................................................................... ....... ..........190 TO THE INSPECTOR OF BUILDINGS: The undersigned-hereby" applies for a permit according to the following information: er Location -foe .. ..................... ...... ........ q Proposed Use ...... ZoningDistrict .........................................................................Fire District ..........;...... .. .................... .................. 1010, Name of Owner ............................. ..............Address .... ........................ Nameof Builder ....................:...............................................Address .................................................................................... Nameof: Architect ..................................................................Address ....................................................... Number of Rooms ........&. ......................... . Foundation .......... ... .................... ................. .......................... ........................ Exterior .....................Roofing ..... ........................................... - . I - ....I................ ... Floors .......................................................................................Interior .......7;1- ...n Heating ..........067�.. .......................Plumbing ..... ........................... Fireplace ............. .............................Approximate Cost .....ev-.7,:-Ov...1.� �r-- .............................. Difinitive Plan Approved by Planning Board ----I-------------------------19--------- Diagram of Lot and Building with Dimens.on��i s 67 1 LJ CO (D 0 a. z E5 U) 0 U > L'�j - LL 0 < a.11 ru (V I-- 44- lAe -L- C Ll- LLJ 0 0 OV) < Z (n a. 0 ::D La Z) W, (a z (n = LU UJ LIJ Uj 0 CL� z z 0 z C) Q LIJ 37 LLJ < I-- C, U tr C1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................................. .............................. T- i mall, .Alan No ....�- 2.. Permit for .......one Story........ single family dwelling ......................................... ' Location yal. ....Buckskin Path = .. . .... ................................................ . Centerville ' ............................................................................... Owner Alan Small ....................................................... Type of Construction ................................................................................ Plot ........................ Lot ........... ................. 1 Permit Granted ....December.......................l3.............19 71 Date of Inspection ............. ......... ............19 Date Completed ..... .../... ...7an.......19 PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... Approved .................................................. 19 ............................................................................... t ...............................................................................