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Home My WebLink About0196 CAP'N CROSBY ROAD Cis b ~R��. e Y p a 9 p Town of Barnstable Pe Regulatory Services Fee. Evh=6s>� BAEMrAWA WAS& Richard V.Scab,Interim Director . Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis;MA 02601 wwwtown barnstable mkus Office: 508-862-4038 Fax:508 790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY NotValids MantRedX-PrwImpdnt Ma&parcel Number 19 3 'L I l Property Address "n er0 Sy (ekwl�e � ``� �� twoT P$(Residential Value of Work$_�,0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address a e- Ca M e ro YN Ca 12 ry fe ✓,lfe MA 6).6 3 Z. Contractor'sName —Telephone Number Home Improvement Contractor License#(if applicable) AR 6 9-/f Email: Construction Supervisor's License#(if applicable) 0 13 / l pocoa Workman's Compensation Insurance �r Check one: JUL 2 9 ❑ I am a sole proprietor TO i e If/V �o�� ❑ I am the Homeowner 'v O� p�� I have Worker's pAp11 Insurance ►l� TABLE Insurance CompanyName �l(J Worknran's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. r 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) lReplacement Re-side Windows/doors/sliders,Z-Value (maximum 35)#of windows #of doors: „❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections required. Separate Electrical&Fh7e Permits required. °Where required: Lssomcz of this pemiit does not exempt compliasscewith otla tows►&partnscnt regulations.i.e.Ec.Conservation,etc. Note Property er "gn Property Owner Letter of Permission. A copy of H Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: PAKEVIN D\Bmidistg Changes\EXP S RESS.dw Revised 061313 , HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Namet Boston North South Datel/p!t THI)At-Brume Services,Inc. d/b/a The Home Depot At-Home Services Branch Number.:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 .Toll Free 877-903-3768 Federal 1D#75.2(i9K4GU;M13 Lic#C 02439:.Ri Cont.Lic#16427 a Ci'Lic#Mc.0565522;MA lions Improvement Contractor Reg.#126893 Insttallation Address: l tI( `e 0 a/0 City State Zip Purdmer(s); Work Phone: Home Phone: ' Cell Phone: r r I tf�a Home Address: (.If different from installation Address) City State Zap N-mall Address(to receive project communications and Home Depot updates):... 0 I DO NOT wish to receive any marketing emails from The Horne Depot Proiect Information: Undersigned("Customer"),the owners of the proiperty located at the above installation address,agrcts to buy, and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation").of all materials described on the below and on the referenced Spa: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#: (inMraW wrcreecv) Products: Spec Sbmt(s)'#: Prqject Amount Rnnfing USiding F1 Windows ❑insuiation $ 7 10 i9cuttem I Covers ❑Entry Doors ❑ -La Q*,7 �yy Roofing iding windows lrtsulaticm �yy� $-sa 1 U-1 E]Gurtefs/CorvGrs ElFARy Doors ❑ ` ✓ r�+ ...L...._ Roofing Siding U PTmdows EJ Insulation $ ❑Gutters/Covers ❑Entry Door'❑ Roofing Siding Windows hisulaticm ❑Gutters/Coven ❑Entry Doors ❑ Ml�wotnoa2s%rirposltoruaturaaArnutnrtdtretrponeneammaetlt�oonnacL Total Contract Amount $ Maine Purchosers may not deposit moue than on-third of the Contract Ammmt �0 Custrmer agrees that, imrnodiateiy upon completion of the work for each product,Customer will execuEe a Completion Certificate, (one for each•Product as defined by an individual Spec Sheet)and pay any bitlanc a due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder_ The Home Depot reserves the right to issue a Changne Order or terminate this Contract or any individual Pro duct(s).included herein,.at. its discretion,if The Home lkpot or its authorized service provider.determines that it cannot perl'crm its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing crrcm or because ,. work required to complete the•job was not included in.the'ContraCt_ Payment Summary: The.Payment Summary# , 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). NOTICE,TO CUSTOMER Yoti.:tre,entitled to a completely filled in copy of the('Wdract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product Is complete. In the event of termination of this Contract,Customer agrees to pay The home Depot the costs of materials,labor,expenses and services provided by The Hume'Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE.HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS 1bIADX WITH0IIT LIMITING THE ROME DEPOT'S OTHER REMEDIES FOR MCOVERY OF SUCH AMOUNTS, Acceptance an 110110AX91ion: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the I toducts and Installation Services and supersedes all prior discussions and agreements,either or written,rnlatr to Products and Installation.Tlris Agreement canna he assigned or amended except by a writing signal by %ustomer and Th Home pot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the t of and has rec ived a co y of this Agreement, A p d by: (�irsturrtet' si art„e 7ed Date sultant' Signature Date x 'telephone No. �� ` ��1� � � �� Customer's Signature Date Sales Consultant License No. _ CANCELLATION: CUSTOMER MAY CANCEL THIS (as applicable) AGREEMENT WiT14OUT PENALTY OR OBLIGATION By DELIVERING WRITTEN NOTICE TO TAR HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A DORM TO USE TF ONE IS SPF,CIFICAi,LY PRESCRIBED BY LAW IN CUSTOMFR'S STA' E. N0111CF.:ADDITIONAL TiMMS AND CONDITIONS ARE STATED ON T KE REVERSE SMF,AND ARIA PART OF TBIS CONTRACT White-Branch File •Yellow-Customer Td Wd20:TT ETOE SE •ut'f TLEEE92BOS: 'ON XHJ Peswer: WOai O ' N O O J O ,� 'a»uno+wrea�0✓tZ'aaO u��' License or regi ation valid for individut use anly X Office of Consumer Affairs&B siaess Regelstion befort the ►ration date. if found return to: Dr Ct FiOQAE fMpROVEMENT CONTRALTO Oifice onsumer Affairs and Business Regulation 3 Registration: •150673 Ty 10 Plsca Suite 5170 Expiration: _.5/412014 DBA ston,MA 02116 N .:r (L Q!!E'S SIDING'CO. R PAi#AVjkW. WAIDEMA : �Cz:� 11 MAIN ST. `:1,'"<:,•a;�.-;' ;, ._--- __ � valid without signature d AUBURN,MA 01501 ";::. �:;,�'' , Undersecretary . fi 0 E - A N Massachusetts • Department of Public Safety Board of Building Regulations and Standards �. Cun-Iructiou Supervisor Specialty' t, O License:CSSL-101316 OD ►► �., i WALDEMAR PAOSM CZ'� O 246 MILLBURY S Ks,► r' CD Auburn MA OfiSOt, L ,_ tD ��'` ��•►`� Expiration to 10/2912016 The Comm xweakh of Massachusetts DeparbuW Of Illdizatrid Acckknrs. Office ofisivesd8ofiaw 6M Wasidagzon aS*v& Boston,ALL 021II ►n ww-==gov/dia Workers"Compensation bwwrance AWidavit: Sanders/Contractors/Mctrichms/Piamben . &cast hdarmaiion _.Please Print Leribly NXM(Busm�JzMionllzaiividwd): O C ` C'nY rs P�f-'t�r !"A Phone#: �1C"�, 4w Are You an emph3'te..Meek the appropriate bees: 4. l am a Type of projext(rt quiretd) I.❑ I am a e�opbycr with ❑ conmacaoa'and I _. Ioy�(full sadlor Pw-6m�* have bind tits b. ❑New commttdiaoa _ 2. a sok propeiew or partners Hsted on fix attached sheet. 7. ❑Remodeling Aip and have nD eisployces •Phew have L 0 Dernotitieen worldng far we in any capacity, czaphoYees.and have wow' 9. ❑BnOdutg addition [No wattcecs'con*.ms a �-insummce requirc&I S.0 We are a ceap om ion and its 10.0 Flearunl ugabs er w 3.❑ I am a hoemeowaa doing an work offers have emacised their I LEI Pl®bing repairs or a myselL[No vuodaces'camp. right of amempdon per MGL Mo Roof rigs insurance req&n ]t c.IS2,51(4), and we have no CMphoyies-[No wa t=, 13.[]Other cemop.-imstmenc e ] 'r�rEpp box uwsa�s am>isesuanh o t t mowsses wuo.aubuc dis oFri I ' ' tm>�aim. md�thry ass eloioE aU s�aek and then bee aotside amm�emtstmttt sabmaa neuraWavit =&L =C�uuarxosstbeadim&lksbmtmetaawcbndonaddidmdsbmt Amwint the ,oftmabcommon tad easevube6Mnrawthmentisicsbm ezPIoya L 9 the Ilm onpWACS,they snustpmvi t*w svmk= eamp,Portrq 6a, jimn arna employer that is pravMUag weerbua'cae4ept Lion iffAUr= a for AW saeptayM J3edow is the paliay aced job cite hes�aace Cow Name Policy#or Sew Lk-ft.- Date: Soh Pitt Addrew. _ _ Crty/3tstrJZip: Attach a copy of the worlcerc'cwnapeasatieen p eficy declaration page(shown g the policy number aad expiration delta. - Faihn a to accore covemp as requi ed m:der Section 25A of MGL c.M can lead to the imp�of ermine,peMaI&s of a fug up to S1,500.06 and/or one-year impriaomamut,as well as civil penalties in the form of a STOP WORK ORDER and a fmc of ap to=MA0 a day agoinet the viohator. Be advised that a copy of this oftmegttozy be fionvxdod tc the Office of IarorStintaz of the DLA for bmusiu a coverage vetii t eo hey cadft nxAmr and pmadfkz 3 e'hat the c pnnided above is true and e�t�rl s icicle am D#not wrote at their ar=4 to war tom apkid City or Town: Pam# Issuing Authority(curie sae): 2.Board of EUWth 2.Btdtdiag DgmrUwnt 3.City/Ttmrn Clerk 4.Mocuical Iaapeetw S.Plumbinr Inspect• b.other Contact Ptrsosr Phone tt: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street P Boston,NIA--02111 - www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LedbIY Name(Business/Organization/Individual): f 02 e & A17e er ic,e3 -Address: City/State/Zip: AA Phone#: 8, -5 6 Are you an employer?Check the ap o Ovate box: Type of project(required): I.�I am a employer with 20 'f . 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g• Demolition workingfor me in an capacity. employees and have workers' Y P tY• _ # 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its 10:❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roofrepairs insurance required.]t c. 152,§1(4),and we have no employees,[No workers' . 11 5 Other Re--S uCic_ comp.insurance required_] *Any applicant that chocks box#1 must also fill out the section below showing their workers'compensation policy infon6ation. 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-contmctois have employees,they must provide their workers'comp-policy number- I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance-Company Name: ' ,Z h&W f' r e Policy#or Self-ins.Lic. 77 5 1 y9.9 Expiration Date: 3��ZO h� Job Site Address:' tCrOsAy RJ City/State/Zip:5,1 k IQ Attach a copy of the workers'compensafion po•cy declaration page.(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil-penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the viola . Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DIA for• ce overage verification. I do hereby certify under the d en p1des 0fP erfury that the information provided above is true and correct.• Siena-ture: Date: 7- Z k —,20/S Phone Of,j cial use only. Do not write in this area,to he completed by city or town ofj daL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I T om fflCe Of r �U�PiGU.y Consumer Afairs and Business Regulation. 10 Park Plaza Suite 5I70 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 126893 Type: Supplement Card THD AT HOME SERVICES, INC. : Expiration: 8/312016 ANDREW SWEET 2690 CUMBERLAND PARKWAY SUITE - ATLANTA, GA 30339 Update Address and return card_I1Iark reason for chnn;e- sCAi _. 20>a-0sni J Address Renewal i_7 Employment [ I Lost Card C-�`��e�aarurczo�zcacalf�o/'C�%llicr;rccicc�cCt i Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: t Office of Consumer Affairs and Business Regulation Registration. Now-/Z" --=12689393Type:= =:_ 10 Park Plaza-Suite 5170 Expiration g/3/2016; Supplement Card pp Boston,MA 02116 THD AT HOME SERVICES THE HOME DEPOT AT_HOME SERVICES ANDREW SWEET 2690 CUMBERLAND PARKWAY S 4�� AN�`A,GA 30339 Undersecretary No41witut signature _ O Town of Barnstable *Permit# Regulatory Services >Vies 6 mant RARNWAMA ruse Richard V.Scab,Interim Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us , Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint. Map/parcel Number 3 a Property Address la ❑Residential Value of Work$� nimum fee of$35.00 for work under.$6000.00 Owner's Name&Address AA)ME7 ; /► A oa67 ZTContractor's Name n u f � Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) 070o 7 ,7 X-PRESS I I`ve dW IT [ Workman's Compensation Insurance AP 2 2014 Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ' I have Worker's Compensation Insurance TOWN OF BARNS ABLE Insurance Company Name bey Workman's Comp.Policy# 0 1?/ 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) - ❑ Re-side Replacement Windows/doors/sliders.U-Value . 30 (maximum.35)#of window #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor,plans marked with red S and inspections required. Separate Electrical&Fire Permits required, *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property er 'sign Property Owner Letter of Permission. A copy of H mprovement Contractors License&.Construction Supervisors License is required. SIGNATURE: TAKEVIN D\Buildina ChangesTM S RESS.doc Revised 061313 'xA • a cM onsumer an usless a ation 10 Park Plaza - Suite 5170 Boston, N*sachusetts 02116 14ome improveftntVvontractor Registration # Re0latretiow.. 126893 i •• ' { e: Type: Supplement Card I i„ Ex0ralion: 6I3/2014 The Hom® Depot At Home SeNi.,= s : :N � ' ' ►l ANDREW SWEEP' -- 2690 CUMBERLAND PARKWAY IT'a, r ---- . ATLANTA, GA 30339 `' 3` Update Addrear and retnrrt card.Mark reason for change. ` E) Address [:] Renewal Employnimit [] Lost Card oPe-CA1 4 IOWao M"11ol2re oMIN O&AM M"6a a l icerru or.regbilmdon valid for iadhddul use only ME IMPROVEMENT CONTRACTOR be%re the expiration date. if feved retare toe omce of Cousamer Awn and Bushman Repletion Rogleva" . 9 b89ii Ty": 10 Park Plan-unite 5170 Ew Supplement Card Boston,MA►02116 •1 ANDREW 26W CUMBERLAN�'I Y� ' MOM,M,+CAA 9038�v ,• ` Uaderdeeretary a Igaataro ^m yv 1 s �,,+,,. p :-�. .� �,:,° '�..-v `:r.:.. .''`"� ��#.;.c.r r✓' -.;yam„ ,� > �:,,.. 3 V s .. .,p�. ,a '��y• a. '�' €a� .. -. F ,� _ «, ';�w+. ,�..' i,-<'.'r� t'r •. "�,,'.,,p,��; r, a,",, '�^:rr 'yp�'�'- -•i�:y�. �;��` .x.�' s,E;� ��,•� '� '�• ..�f t ♦*47 )3' ! vim'. ,S� ✓3" �� -�', i r , '� r ,. , '�i ... 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C) Address: 'City/State/Zip: 303 3 phone#: �l d7; Are .� / f you an employer?Check the appropriate x: Type of project(required):. 1. I am a e 4. _atm a general contractor and I ❑ mpto yer-with 6. ®New construction employees(full and/or part time). have hired the sub-contractors 7. Remodelin -- listed on the attached sheet. ❑ $ 2.❑ I am a so pro-- or partner ship.and have no employees These sub-contractors have g, ❑DemoLtion. workingfor in an capacity. employees and have workers' y p ty. 9. ❑Building addition [No workers comp.insurance.$comp. insurance 10. Electrical repairs or additions required:]' S. [� We are a corporation and its, ❑ p 3.❑ I am a`homeowner doing all work officers have exercised their 11.❑Plumbing repairs or.additions myself.[No workers' comp. . right of exemption per MGL 12.D Roof repairs insurance required:] t c.,152,,§1(4),and me have no employees.(No workers' 13.f Other UtN comp.insurance required.] "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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.— , - I am an employer that is providing workers'compensIation in for my employees. Below is the policy and job site information. Insurance Company Name: 1%lew Policy#or Self:ins.Lic.#: (f- O.y ® I Expiration Date: ' Job Site Address: Q,ity/State/Zt : t)t Attach a copy of the workers' compensation policy declar:ttiot p(show! g the poliey number and exptragi®n 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 ene-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against th vi or: Be advised that a copy of this statement maybe forwarded to the Office of Investi ations of the DIA f6f ins c covers e verification. I do hereby certify under the p in tad p taltie ry that the information providedzabe is tr a and correct. Siature: Date: �. Phone# <V('.-71q ` (� Official use only. Do not write in this area,to be completed by city or town offaciaL City or Town. Permit/License# Issuing Authority t ri circle one): u h' ( 1.Board of health 2.Building(Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:--- Phone#: — ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations r" 1 Congress Street, Suite 100 l Boston MA 02114-2017 ..`, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letzibly Name (Business/Organization/Individual): Address:_ �U W City/State/Zip: k a d 7-39� Phone#: 7?J/- 7 S Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling X.ship and have no employees These sub-contractors have g; FJ Demolition working for me in any capacity, employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5: We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] `Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. xContractors 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 to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyAnder the pailis and penakies o er'u that the information provided above is true and correct Si ature: / Date. . Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. ther Contact Person: Phone#: T - J May 11, 2013 Barnstable Building Dept. The following is a list of our approved sub-contractors for The Home Depot: Ericsson Torres— CSSL # 100546 HIC # 163528 _ Michael Viola — CSSL#-099403 HIC # 140993 Vincent Smith - CS # 106837 HIC # 165927 Timothy Thomas — CS # 51899 HIC # 152121 Ronaldo Solano — CSSL # 101027 HIC # 152206 t Joseph Duarte - CS # 70077 HIC # 132349 Douglas Szynal — CSSL# 103950 HIC # 146142 Brian Laroche — CSSL# 100478 HIC # 152612 Joseph McKeon — CSSL# 98863 HIC # 132614 If you have any questions please contact Mike Bedard our permit n coordinator at 508-962-6942 or'myself at 617-438-9017. S' erel --- uss one r Bra Installation Manager THD At-Home Services, Inc. 908 Boston Turnpike- Unit 1 •Shrewsbury, MA 01545 Phone:774-275-2139•Fax:508-845-6076•Toll Free:800-657-5182 n G' HOME IMPROVEMENT CONTRACT 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 1,Shrewsbury,MA 1545 Branch Name: Boston South Date:4/13/2014 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: 196 capn Crosby Road Centerville Ma 02675 City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: Diane Cameron 774-271-2706 Home Address: (if different from Installation Address) City State Zip E-mail Address (to receive project communications and Home Depot updates): 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 Windows $2,109.38 Minimum 250A Deposit of Contract Amount due upon execution of this contract Total Contract Amount $2,109.38 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. Payment Summary: The Payment Summary# ,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 sand provide permit numbers. Customer:will identify any property lines,easements,covenants,underground or overhead utility lines,pre-existing physical or 0130.14 SFC Page 1 of 10 8. Room:Basement Notes: 1 Floor. Basement Pre-existing Conditions: ***Line Level Labor Codes Simonton 6500/6100E Basement Hopper Assessed Width=30 Assessed Height= 13 Basement Window/Door Wraps Wraps Color: white Misc Labor Hours=3.38 Misc Labor Notes=wrap bay in white Pricing Includes: Misc Labor SPECIAL CONSIDERATIONS: TOTAL CONTRACT AMOUNT: $2,109.38 Diane Cambron (Apr 13, 2014. 11 :15 0140-14 SFC Page 8 of 10 I, ° „E Town of Barnstable ermit# Regulatory Services ee F 6,nnna ron a BAMSTABIE ice.1639. Richard V.Scali,Interim Director II Building Division U • Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Addressox-s—lAw X Residential Value of Work$ Minimum fee of$35.00'for work under$6000.00 Owner's Name&Address IAIU t Altafi4L Jqy�Ekopj '- 4)Ci (fi M4 OLG 3Z Contractor's Nam I Uu If e- .Telephone Number 10/7-7/` -4 3 - > Home Improvement Contractor License#(if applicable) - 7 Email: .Construction Supervisor's License#(if applicable) 0 7 —/QQ 7 X®P RO-IT ' r dWorkman's Compensation Insurance: Check one: DEC 19 2013 ❑ I am a sole proprietor I-am the Homeowner- `L� 1 have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name ` A)s Workman's Comp.Policy# 14)6- 633.5'> 5::� Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) z - ❑ 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 + 3 C (maximum.35)#'of windo #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 permif does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note:,, Property Owner must sign Property Owner.Letter of Permission. 4; A copy of th H Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: T:IKEVIN_D\Building Changes\F.,XPRESS PE XPRESS.doc Revised 061313 t I HOME 1111I1Ik0V01ENT CON1'RACI' 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 I,Shrewsbury,MA 1545 Toll Free 8779033768;Fax 8009863610 Branch Name: Boston South Date:11/21/2013 ME Lie#C 02439 RI Cont.Lie# 16427 Branch No: 31 CT Lie#HIC.0565522 MA Home Improvement Contractor Reg.# 126893 Federal ID# 75-2698460 Installation Address: 196 Captain Crosby Rd. Centerville MA 02632 City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: Mrs.Diane Cameron (774)271-2706 774 271-2706 Mr.Michael Cameron 774 271-2706 Home Address: 196 Captain Crosby Rd. Centerville MA 02632 (If different from Installation Address) City State Zip E-mail Address (to receive project communications and Home Depot updates): 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 7160556 Windows 7160556 $6,033.71 Minimum 25% Deposit of Contract Amount due upon execution of this contract Total Contract Amount $6,033.71 Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. Pavment Summarv: The Payment Summary# 7160556 ,included as part of this Contract,sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). GENERAL TERMS AND CONDITIONS Responsibilities: The Home Depot: will provide the Products identified above,make arrangements to have the Authorized Service Provider perform the Installation services in a professional and workmanlike manner,and arrange proper insurances. Unless otherwise expressly provided for herein,Authorized Service Provider will obtain required permits and provide permit numbers. Customer:will identify any property lines,easements,covenants,underground or overhead utility lines,pre-existing physical or 11rJQn2SA Page 1 of 22 s a i Mrs.Diane Cameron Printed Name of Oamer-occupant Mrs. Diane Cameron(Nov 18, 2013, 6:09 PM) y. . r e r n. 11l$Q112-$A r Page,.22 of '22 - 1 The Commonwealth of Massachusetts Print Forrn Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legit Name(Bois:ncworgwnt,:cr4ndividual): Address: �-Y s5 Qw� pelf-�-� City/State/Zip: fafj GA. 4 - 11 1 Are you an employer?Check the appropriate lip li x: Type of.project(required): n •.,. 4. 1 V 1 am a general contractor.and I 6. (`'1 New construction1.0I am a employe coat. employees(full and/or part-time).* have hired the sub-contractors 2.[] I am a sole proprietor or partner- lusted on the the attached'sheet.- 7. ❑ - ship and have no employees Theme sub-contractors have 8. ❑Demolition working forme in any capacity. employees and have workers'comp. ❑Building addition o workers'con insurance Comp•insurance t _ [N p. 10.❑Electrical repairs or additions r�uireail 5: ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have Exercised their i 1.❑I iamb repairs or addit;oTe myself.[No workers right of exemption per MGL 12.❑Roof repairs - . comp. � c.152,§1(4),and we have no - insurance required.]t employees.(No workers' 13 Other /� C7 comp.insurance required.] $Any applicant that checks box dl mnst also fill out the section below showing their workers'compensation policy information' A Homeowners who submit this effidavit indicotiGg they ere doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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 fob are information. Insurance Company Name: 3 4 t t� ` •� j -� M1 Policy#or Self-ins.Lie.#: W � �� S 7 `J .3 �� Expiration Date: Job Site Address: l . SC3 City/State/Zip: Attach a copy of the workers'compensation policy declaratio page(showing the policy number and expiration date�' Failure to secure coverage as required under Section 25A of MOL c.152 can lead to the imposition of criminal penalties of a fine.up to$1gnn nn and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fire of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance co a verification. I do hereby cerli under the sins d allies o is that the in ormah'on provided above true rdcorred Si lure' 7LDate ..: . . .. .. ..�...J Phone#• ��`7�-7 v � �� Offuial use only. Do not write In this area,to be completed by city or town official, City or Town: PermitlLicense# Issuing Authority(circle one): ,,, _ A.x o,.+ i�al nP�t r S Plrsnthin Inspector 1.Board of Health 2.Building Department 3.%,fay,i Vrvu k 4 ..lectr_ I..sr__.o_ �° g P 6.Other Contact Person: Phone#- Alt co - � O m a mess Regulation Y b 10 Park Plaza - Suite 5170 Boston,Massachusl-tts 02116 Dome Improve,ri at.,Contractor Registration + r x Registration: 126893 Type. Supplement Card Expiration: 8/3/2014 The Homy: Depot At-Home Servid" Y ANDREW SWEET 2690 CUMBERLAND PARKWAY`5Uit . • — ----- - ___ ATLANTA, GA 30339 — -- -- -- -- -- 4. Update Address and return card.Mark reason for change. L� Address (] Renewal [] Employment Lost Card DPS-CA1 0 EOW04/04.4101216 Office o , wrote,ruseeSAlegn ati "'1`n� 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 Regsttration:-'g, 06g3 Type: 10 Park Plaza-Suite 5170 Expiration,_.'.. Supplement Card Boston,MA 02116 Home Depo�1_A144gMkAerltid ANDREW 2690 CUMBERLANi R';4'�Ofi`AY''S __ X95AM,GA 30339 '., Undersecretary 4ktEu signature^ Sj0v .x`'R a: 1J ..,fx.. >i, .:s f"+�'.. >. -„ :., ,, ..-...' � .,...,.. # .. ;.:,,sy; ,:.v�:.•.� e 3;-,,"''r<�z r .�„ - ::.:.. _ ."'': .R°'�:y�'S�xrr �a� rs�: - ,,3„� - T ,._, ".. •F.��.r:.F` :: ar. .,: ,::. �;, +A:•, + 4G.Nr, :..;;y.S.. xw t.m.s .,,�;�. l .,.sw„t r' :.,..._... < n:ro _.vu�,r,'€<'E"3�n>A '� ',- a: _v ,sC,"N, :4. ..:., Ms. n: ,. <u- .. �. �"�:,_..�.L� --d4w �w-?_ � .? i,�:, 3,•r.'.. 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The following is a list of our approved sub-contractors for The Home Depot: Ericsson Torres — CSSL # 100546 HIC # 163528 r Michael Viola — CSSL# 099403 HIC # 140993 Vincent Smith - CS # 106837 HIC # 165927 j Timothy Thomas — CS # 51899 HIC # 152121 Ronaldo Solano — CSSL # 101027 HIC # 152206 Joseph Duarte - CS # 70077 HIC # 132349 Douglas Szynal — CSSL# 103950, HIC # 146142 Brian Laroche —CSSL# 100478 HIC # 152612 Joseph McKeon — CSSL# 98863 HIC # 132614 If you have any questions please contact Mike Bedard our permit coordinator at 508-962-6942 or myself at 617-438-9017. S' erel uss one Bra Installation Manager THD At-Home Services, Inc. 908 Boston Turnpike• Unit 1 •Shrewsbury,MA 01545 Phone:774-275-2139•Fax:508-845-6076•Toll Free:800-657-5182 4/1/2013 8:16:06 Aid PST (Gl4T-8) FROM: 100005-TO: 15087302086 Page: 2 O • corzJv® CERTIFICATE OF LIABILITY INSURANCEF °A 411t2 °M11' 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 eert(ficate holder Is an ADDITIONAL INSURED,the pollcy(les)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 doe_s not confer rights to the certificate holder In Ileu of such snd0rsembnl a. PRODUCER PAUL B SULLIVAN INS AGCY INC QQN1W MAW, Ax 1467 S MAIN ST PHONE678--9611 FALL RIVER,MA 02724 E-WAIL ADDRSS, ' INSURER AFFORDING COVERAGE. NA'Ge INSURER INSURED - NSURERa: DBAJ&JDREMODELING DALEY 0"ERc: 15 WILSON WAY W URER0 MIDDLEBOROUGH MA 02346 INBURERE: COVERAGES CERTIFICATE NUMBER: 15914016 REVISION NUMBER: THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY pER1Q0 —woICATED.NOTWtTH5TAN01NG-ANY_REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH 71BS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED 13Y THE POLICIES OESCRIBED-HEREIN-IS-SUeJECT-TU-Alt.THE TERMS,— EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. VA F EX/ Mrs LTR Type OF NSURANCe IN R POLICY NUMBER N GENERALL41eRJTY I EACH OCCURRENCE f _ COMMERCVILOENERALLMILITY P 0 e Ntmtrenm f CIAIMS4MADE`a000UR MEOO:PAryons on) f. PERSONAL 6 ACV 1NAIRY S GENERALAGGRIMATE S GENL AGGREGATE LIMMAPPL.IES PER: PRODUCTS-CONPlDP AGO - POLICY PRO• LOC f AUTOMOBR.E LJAGAMY uxldent S .. BODILY INJURY(Per pman) S ANY AUTO ALL OWNED i�5CHEOULE0 BODILY IWURY(Pei WAftal ALT1(L�JJI GE HIRED AUTOS �� ere S UNDRE"LNB .OGCIIR EACH OCCURRENCE S . EXCL"LIAS ;CLAMS-MADE AGGREGATE S . s eta RETENTIONS. .. :•`*>-�.;'i..-. A•. NBATION WC531 S384800-013 2IM013 2124014VONRUArtY �N• - 0AM° YIN ELEACHACCIOENf S 10000 ANY PROPREITORVARTNEWEECUTIVE y -' OPFICERtrtEMaEN EXCLUDEDT�-_ _ tY MIA - "'`''' (NendamrylnNN) = FJ_DISEASE.EAMPLOW 11000 It yet,deaerbs under E.I.DISEASE-POLICY L"T S 500600 DESCRIPTION OFOPERATIONS talow o6eCRPT1.ONOFQF1RA-D ILOCA1113NS IVENIC AS[AlksbACORDwl,Additn d w nen R.milmiateeWo.b-i.4W�l .. - . Worktlrts compensation(nsurence coverage applies Only to the workers compensation laws of the state of MA. NO PARTNERS ARE COVERED BY THE WORKERS'COMPENSATION POLICY. CERTIFIEATF RoLSIRION SHOULD ANY OFTHEA13OVE DESCRIBED POLICIES BE CANCELLED BEFORE THD AT HOME SERVICES,INC:AND THS EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EPOLICYPROY1510Ne. THE HOME DEPOT ACCORDANCEWITHTH 2690 CUMBERLAND PARKWAY SUITE 300 ATLANTA GA-30339 AUTHOM ED REM2311WATWE Jeff Eldridge 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201 WOS) The ACORD name and logo are registered marks of ACORO "`h�stl0$crii �CIL Gtca°nce�s an arse s (. Prev 11/� v i ce'rtificataa. r Town of g_arnstable -�*P a f Expires 6 months fro issue date } Regulatory Services Fee i rim w RAMSTAB 16 9. � � Thomas F. Geiler,Director 2� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 . www.town.barnstable.ma.us Office: .508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number _ Property Address ' !1 � V'lC C" 0w l?_ ❑Residential Value of Work, ( Minimum fee of$35.00 for workunder$6000.00 Owner's Name&Address �1Qf�(�� 00,,,A !1 Contractor's Name. Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) " ❑Workman's Compensation Insurance 2�12 Check one: AEG 3 ❑ I am a sole proprietor I am the Homeowner BARN ❑ I have Worker's Compensation Insurance .`0NNN bF B Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit eq st(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 #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ 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. *** te: Property Own r mus ign PropertyOwner Letter of Permission. A copy of th Home I provement Contractors License&Construction Supervisors.Licensc is required. SIGNATURE: !�.Itiic Q:1WPF1LE51FORMS\buildingpe it forms\EXPRESS.doC - Rdvised 053012 u 1 Ix The C'ommonmeahh of Massat hfi serfs parftnent of ludusbial-4ceidena Offwe of Investigadons 600 Washington Sitmet Boston,MA 02111 Workers' Comp+ensafiionInsuranceAffidavit- BmltierslContractnrsl ctricians/Phunbers licant Information Please Print Legib 'N (D„So s , mtln v �idnal) 01J,^ n � , City/Sta C�� r 02 SzPhone 47 Are you an employer?Check the appropriate boz: T project 4- am a. contractor and I }`�of ect(required): p ] 1-El I am a employer with I❑ 6. ❑New canstructim employees(fu11 and/or part-time)-* have hired the sub-conhactors 2.❑ I am a:sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling ship and have no employees These:sob-contractors have S. ❑Demolition working for me:iri employees and have workers'any capacity. �.��j 9. ❑Building addition [No wrorlaers'.camp.insurance comp.;., recpjired 5. ❑ fle are a corporation trod its 1D.❑Electrical repairs or additions -]: ,3. Lama homeowner doing.all:wotic officers have e=cised their 11.Q Plumbing repairs or additions self[No'workers'ounp_ fight of emmption per MGL 12.❑Roof repairs- insurance required_]I c. 152,:§1(4) and we have no employees- o worlEers': 13.0 Other camp.insurance,required] t d ay applicant that checks troy#1 mnst also fill out the section below showing.the¢woikeie compensation policy infbnnation. 1-Aonoeown�ers wbo submit this affida tit indicating they are doing all work and then hire outside contractor nmst submit a new affida indicating such kontrictor that check this box Inust attached an additional sheet showing the na►ne of the smb-contractors and state whether or. those entities have employees.If the.sub-contractor lore employees,they must pmvide tb&workers'comp.ponc3r n miber. I am an employer that isproviatfng workerscompeas rtion,insurimce far my smrploJwes. Mom is the policy and job site information. on. Insurance Company Name: Policy#or self=ins.Lic.#i: Expiration Date: Job Site Address =. City/Stateizip: Attach.a copy of the workers'compensation policy declaration page(shotiving'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 $1;500.00 and/or one-year" as well as civil penalties in the form of.a STOP WORD ORDER and a fine of up to$ 0.00 a day against the vs tor. Be advised that a copy of this statement may be forwarded to the Office of Inirestiga. of tie DIP, for co ge verification, I do hereby c ?Under thapains: nd pena of pedkty that the information provided above is tare and correct Date: 1 d Z Phone f,►,, cial use only. to Do not write in this.area, be completed by city or town afficial City or Town: PermitiLiceuse Issuing Authority(circle.ene):; 1.Board of Health S.lading Department 3.Citf1£own Cleric 4,.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: } 6 r THE Town of Barnstable Regulatory Services BMWSrnsr.e, ' Thomas F.Geiler,Director 9� MAS S. ,0$ ''ri�n►ploy A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �12 Please Print DATE dOB LOCATION:"' n njimber street village "HOMEOWNER": , l NN name home phone# work phone# CURRENT rMAILING ADDRESS: city/town 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. DEFINITION 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. The undersi ed"hom owner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection , rocedures require_ ents and that he/she will comply with said procedures and requirements. Si ature of Homeowner - 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 performing 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 engages a person(s)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 Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person 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 responsibilities of a Supervisor. On.the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC wised 051811 • snxtvsrABIA • ' ,�� Town of Barnstable '0rfa rya+°' Regulatory Services Thomas F.Geiler,Director Building-Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.nia.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 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) Signature of Owner Date - Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. QAWPHLESTORMS\building permit formsTNPRESS.doc Revised Q51811 Assessor's map and lot number �� ..:.......:... -,.. ..«�� I / ��! �'l✓ THE t0 ` SEPTIC Sewage Permit number .............. .............................. TI. SEP C SYSTEM MUST TA IN COMPLIA r WITH ARTICLE 11 STATE , SAM LE, House number ......,.............. ..........:........................................ SANITARY CODE AND TO � 1639.0 ♦� ypY Ord REGULATIONS - TOWN OF .,B,A,RNSTABLIE r BUILDING -INSPECTOR APPLICATION FOR PERMIT TO ..,.Suffolk Realty,.Trust TYPE OF CONSTRUCTION .......s,ingle„family,, residential ......................................................................... t ......V5.QP&ejMW. .K... a...........19.2a. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �9P Location .......Lot,.#...2.o.:�in„Crosby..Road,,,,;C:enterv„ille.,:.. .. 0, 6 ,,,,,,,,,,,,,,,,,,,,,,,,,,, ..... .. .. Proposed Use ........single„farm..v...residentia.l...................................................................................... ......... Zoning District ......single family,,r,esidentialFire District ...Centerville-Osterville ............................................................ Name of Owner ...Suf,folk Realty, Trust Address ....P.r,0. .Boy 308„�, ,Centervi...................... ................ ......... ..... Name of Builder ..........Same...............................................Address .................Same...................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ................ ................................................Foundation ..............P.otlied...Q.QRQrQt.(;?........................ Exterior ..........cedar...shingles....................... ..Roofing ..........i�,S.Phsa.lt..Skli??Q .e ................................ car et over un Floors I?........................)..4�e��.�Y.McXlt..................Interior ....SkiICI-.Coat...plaS:kel�................................... Heating ..F.Oxced...hat...water...by....O11..................Plumbing ..........P.V.C................................................................ Fireplace .....br.ir-k-and...bl.o:ck.....................................Approximate Cost ......... 35,000.00........... `J Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ...................... .............. a v Diagram of Lot and Building with Dimensions Fee i SUBJECT TO APPROVAL OF BOARD OF HEALTH 97,20 t (' I hereby agree to conform to the Rules and Regulations of the Town of Bar stdble regarding the above construction. Name ....................... ..� �� '�.. ................ �8uffolk. Realty Trust A 1W 20581 one story No ................. Permit for .................................... single. family dwelling ............................................................................... Location 196 Cap'n Crosby Road ................................................................ Centerville ............................................................................... Owner .............Suffolk Realty Trust........... . ........ .. ...... . .... .. . ...... Type of Construction ..........................frame................ . ................................................................................ Plot ............................. Lot ................................ Permit Granted ........S.e tembpr..15......19 78 Date of Inspection ,Z; ....19 ..-Date -Completed i.,i 9 ..... . .. PERMIT REFUSED ............................................... ........;-,19 .......................C.,..... 04 ............................................................................ ......................................I............................................ ............................................................................. 'Approved .......*�....................................... 19 ............................................................................... ............... ........................................................... i Assessor's map and, lot number I.!!...1... ::.:..........................4.4 I ��/ , �TNE — - yoF ropy Sewage Permit number ......`-:. ................................ I EARNSTADLE. i e " House number r MABa • ........................................................................ TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR-PERMIT TO 5u`. n t eal ty Trust ........... .......o)_.......................................................................................................... TYPE OF CONSTRUCTION ....... .i nnl: ....:.a.m;i J;v..rPs i dent ia. ............................................................ ..... F?ni,ehF�r R ..........19..?:.�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......i..i:t...`. ...20 C:�.4#_ i C,rosbv....'ond......( .PntPry 1.1:�'.....?"la....:...02632............................ Proposed Use ........sin.gl.e...F im lv...r,esident a.1.................................................................................................. .. .. .... .. ... .. .. Zoning .District ......:iincrle -amily residential_Fire District ...CPnkPx'ZT�.1_l.e—(jStPl'Ville Name of Owner ....Sufolk realty 'T'rust" .. ...................................., „Address .... Nameof Builder ..........5am ................................................Address .................Same........................................................ Name of Architect ....Address Number of Rooms 7................................................Foundation nntarpd rnnc rPtP .................. .............................................................................. Exterior e1de'r shi.nat.es Roofing asnhal.t sbinal_ps ............................... .................................................................................... Floors ....5 ....� �t nvpr unrlerl_avmerni- Interior ckim—r-naf-, n1,aRt .......................................................... ..........::........................................................................ Heating :r.:...�.....r ..........fr'... her..^..... ...................Plumbing ..........RK................................................................... Fireplace ...... :!:... r.r:.....................................................Approximate Cost ..........�5 .:000.00................................ Definitive Plan Approved by Planning Board ________________________________19________. Area ....... �Ij6) :�.:%............ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH V a I t 4 I r 4 r. i t i r ` I hereby agree to conform to-all,the Rules and Regulations of the Town of Barnstable regarding the above construction. 6 1 Q r .c �fY Ck Name .................................................................................. Suffolk Redlty Trust A=193-211 ► ` a Na ::20581 Permit for one story,,,,,, ............ ..... single family dwelling. ........................................ ........ ...... Location ....196 Cap'n Crosby, Roa, Centerville ............................................................................... Owner .... Suffolk Realty..Trust................ Type of Construction . .....,frame Plot .......................... Not .........#20.................. I " Permit Granted .......3 to er•.•1.5••••••.19 78 Date of Inspection .................................19 Date Completed ... ..............................19 PERMITREFUSED ........................................ ... .................... 19 ............................. :!....11 ................................. ............... . ......... .......................................r ..............G`�' . .. ./.'..V...................... .....................................,......................................... Approved ............................................... 19 ............................................................................... ............................................................................... I _ � TOWN OF BARNSTABLE Permit No. { 1,ARI T L Building Inspector • Cash __________ 00 6)p. 00CUPANCY PERMIT Bond ------___---__—----__ "No building nor structure shall be erected, and no land, building or structure shall be used-for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Suffo1.4 Realty Trust Address FOX 100', Centerville Wiring Inspector / �/ %' Inspection date Plumbing Inspector Inspection date Gras Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. 19...... ...................... .......... ............................._......................_............._ Building Inspector A goAO R '0 7' Z.o-T 2s' l9 ��• �x�ST Z�/0In SAND. n 0 L D7" �P2oP/000� 2/A ��,� sio,✓ �000y.L,� I TEST HOLE RESULTS L©7-- 2�.. _ 7� : 27 PER, TO WN /2EC0�'DS zz I Go/ DATE : TO L\/N ti//9 TER !-S 1,::�) VA / L FI 8.L_ E %1/SP. M/.A-1 Il U./-I 8U/,D/R/G 6ET319C1<- /eEQU/ RE/"TENTS F/e OA./T 2O , s/DE DuelVE Y /`/o -r T•o Z3E . aaATED PeOPOSED 7Z) 200114S 3 0VEJ2 SE G,/EA-2 /,9C-3E SySTE/`'I UA/LESS DESIG -/ FLOW -330 G�L�D/9y H-20 ..DES / G/V L,OAD/NG /S USED . 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