Loading...
HomeMy WebLinkAbout0134 CAP'N LIJAH'S ROAD L -/3 of Town of Barnstable Regulatory Services 9MASS1�$ Richard V.Scali,Interim Director Building Division - - Tom Perry,CBO,Building Commissioner APR 12 zO1� 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us - TOWN OF BARNSTABLE Office: 508-862-4038 EXPRESS PERAUT APPLICATION - RESIDENTIAL NLY 08-790-6230 L Map/parcel Number 7 ,/ Not valid without Red X-Press Imprint �q - / `7 ,. Property=Address ell t J"Residential Value of Work$ / — Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address u zcrrn e t- ;f2 S f,-w I C - /3 4l C� n 'L. a�. S ✓;l I 62445 Contractor's Name au�S �SaN Telephone Number 10/-L2 Q&i11f Home Improvement Contractor License.#(if applicable)/73 Z 5' Email: Construction Supervisor's License#(if applicable) O Q-6-707 kworkmin's Compensation Insurance - Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# ,ql 3 16 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken 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 windows 9 of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor.plans marked with red S and inspections required. Separate Electrical&Fire Permits required. ;R'here required: Issuance of this permit does•not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requir d. SIGNATURE: ` Q:IWPFILES\FORMS\building permit fommlEXPRESS.doc Revised 061313 Aehewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Suzanne Fitzgerald Legal Name:Southern New England Windows,LLC 134 Capn Lijahs Rd RI#36079, MA#173245,CT#0634555, Lead Firm #1237 Centerville,MA 02632 WINDOW RE IACEMENT 26 Albion Rd I Lincoln,RI 02865 H:(508)771-1263 Phone:866-563-2235 1 Fax:401-633-6602 1 sales@renewalsne.com C:(774)487-8872 Buyer(s)Name: Suzanne Fitzgerald Contract Date: 03/28/17 Buyer(s)Street Address: 134 Capn Liyahs Rd, Centerville, MA 02632 Primary Telephone Number: (508)771-1263 Secondary Telephone Number: (774)487-8872 Primary Email: sfitzy113@yahoo.com Secondary Email: 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 and 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 to by the parties and incorporated herein by 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: $10,395 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: $5,198 Balance Due: $5,197 Estimated Start: Estimated Completion: Amount Financed: $10,395 8- 10 weeks 8- 10 weeks Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date 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: 1/2 dep & 1/2 bal paid by Greensky.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 03/31/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renew A dersen of T Southern New England Buyer(s)- � & Signature of Sales Person Signature Signature Eric Tavares Suzanne Fitzgerald Print Name of Sales Person Print Name Print Name t - UPDATED: 03/28/17 Page 2 / 11 1 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-095707 Construction Supervisor BRIAN D DENNISON 7 LAMBS POND CIRCLE, . ,. CHARLTON MA 01507 Expiration: Commissioner 09/08/2018 -.;� ;: n�le `�ar�t•�a�a�zccfec�t�� a���ci��crc%Jew. a Office of Consumer Affairs d Business Regulation s. 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Y Reglstm0on: IM245 Type: Supplement Card —' - Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS.-LL::; BRIAN DENNISON = 26 ALBION RD = _ LINCOLN,RI 02865 - Update Address and return card.Marl:reason for change. scA, Q m;alarn ❑Address Renewal J Employment Lost Card ",` ..: of Cov6amerAtfairs&Breiue$Rr;mt+naa Registration valid for individual use only before the - MOexpiration date.Nfound return to: ��067EIMPROVEMENTCONTRACTOR _ cG!; Office of Consumer Affairs and Business Regulation Registration y73pg5: Type: 10 Ant Plam-Suite 5170 `-"" Expira to ;"gA1.9YZ018.: Supplement Card Baston.IDEA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDER60N BRIAN DENNISON - 26 ALBION RD L INCOLN,RI 02865 lSihdersecre - Not valid without signature t W , - t The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dig AVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TBE PERNIlTTING AUTHORITY. Applicant Information Q Please Print LeFdblY Name (Business/Organization/Individual): So,,�(,ten �� &14 1l,n j V.)to J Dt1./ Address: o2ro1biv►� . City/State/Zip: Lail /l . Phone#: (40) Z 2 9 - 9 S DO Are you an employer?Check the appropriate box: Type of project(required): 1-cif am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling arry capacity.[No workers'comp.insurance required.] 3.[J I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. El Demolition 10[i 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 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a genera contractor and hirede sub-contractors listed on the attached sheet ❑ general d I h thb t 13_[:]Roofrepairs i These sub-contractors have employees and have workers'comp.insurance i 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c 14. Other W•✓�d 0 152,§1(4),and we have no employees.[No workers'comp.insurance required_] ►'t? 7114 ce-•t 4—• f S *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 thepolicy andjob site information. , Insurance Company Name: Wes tie rr1 Ins• Co Policy#or Self-ins_Lic.#: W G A �J Expiration Date: Job Site Address: 1311 (a 02 h n City/State/Zip: ���.f�v� �2 * •� 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 certify under thep andpenalties ofperjury that the information provided above is true and correct Signature: Date: Phone#• (L4 0 1 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,5.Plumbing Inspector 6.Other Contact Person: Phone#: SOUTNEW-01 UOLLINGER DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 5/2912016 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, ECTEND 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 ADDITIONALINSURED,he policy(iss)must be endorsed. If SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require an endorsement A statement on this cerFificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CoBiz Insurance,Inc.-CO PHOI FAX 821 17th St (AIC,No Ext.(303)988,0"6 A► No.(303)988-0804 Denver,CO 80202 �,CoSizinsuran!ce@!:obizinsurance.com INSURER( AFFORDINGCOVERAGE NAIC0 INSURER A:Continental Westem Insurance Company 110804 INSURED INSURER B Southern New England Windows LLC INSURER C i DIWA Renewal by Andersen 1 26 Albion Road INSURER D• ' 1 Lincoln,RI 02865 INSURERE: INSURER:F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED'BY,PAID CLAIMS. rL-M I TYPE OF INSURANGE I p yyyD POLICY NUMBER I POLJCY EFF P !I OMIuOCM 1 Llmrrs II X COMMERCIAL GENERAL LIABILITY t ;EACH OCCURRENCE g 1,000,000 J CLAIMS-MADE n OCCUR ICPA3936080 j 07101/2016 1 07101/2D17 I PREMISES lE.aaxumscel is I OO,fl00 ' 10 006 !MED EXP(Any one➢arson) i s , ;PERSONAL&ADVINJURY 1 S 1,000,000 f GEN•L AGGREGATE LIMrr APPLIES PIER: i i !GENERAL AGGREGATE IS 2,000,000 i i POLICY 1 J� I I LOC n I I PRODUCTS—COMPIOPAGG I S 2,000,000 OTHER 1! IEMPLOYEEBENEF] 2,000,000 I AUTOMDBILE LIABILITY COMBINED SINGLE UMQT I S 1,OOfl,flDO 1 ca aooderdl A n? �.ANY AUTO ! CPA3136080 0710112016�071OV20171 BODILYINJURY(Perp=ewn)_, s. E I ALL OWNED -SCHEDULED B I ' - - ' I ODILY INJURY(Per j S AUTOS AUTOS NON-0 F-D i tlent TY M DAAGE is HIRED AUTOS j AUTOS I I(Per 2txi � i S NUMBRELLA LIABiOCCUR J i EACH OCCURRENCE IsAEXCESS UAB CLAIMS�MADEI 1 ICPA3136080 0710112016 07101120171AGGREGATE ;s 1 DID I X I RETENTION s 0, 1 i [Aggregate I S 5;000,000 1 WORKERS COMPENSATION STATUTE 1 EERY I AND EMPLOYERS'LIABILITY YIN I I A ANY PROPRIETORIPARTNERIEXECUTIVE ❑� *CA3136081 071011201610710112017 c L EACH AcaDENr I s I,OOQ000 OFFICERIMEMELER EXCLUDED? N 1 A! � (Mendetmy In NH) I j I E.L.DISEASE-EA EMPLOYcq S 1,000,000 11 yas,desrnbe underE.L.DISEASE-POLICY LIMfr I S 1,000,000 DESCRIPTION OF OPERATIONS below 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VENiCLES(ACORD 101,Addflia al Renarlm Schedule,may be attached H mom space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL EO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN M -ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR®REPRESENTATIVE -- ©1988-2014 ACORD CORPORATION. All ngras reserved- ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable -Permit# L7-_IL � Regulatory Services F^�6montlrsfron:issued e • IIAENSTABLE, Richard V.Scali,Interim Director Building Division pR 12 2017 Tom Perry,CBO,Building Commissioner g 200 Main Street,Hyannis,MA 02601 TOWN N 0� BAM IMS!l ABLE www.town-bamstable.ma.us Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 08-790-6230 Not Valid without Red X-Press Impri►rt Map/parcel Number Property Address 1'`'10�70 �'+t o y �� 6A lid;<l� Residential Value of Work S�3, do�/� — Minimum fee of S35.00 for work under 56000.00 Owner's Name&Address �„e J�(;g S;,i(�o��d,�►-� A/0 ro.-1 C& Or BR C'i1 fP�/ ✓;G ,e /t D Z Contractor's Name IAA) tlws' /SDN Telephone Number YD/-L2S Home Improvement Contractor License##(if applicable) /7'3 S Email: Construction Supervisor's License##(if applicable) B QS'7Q7 - kworkmin's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name i[}L . Workman's Comp.Policy# 1/)CA V3/-3&6 R 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) ❑ side Replacement Windows/doors/sliders.U Value (D m( aximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Vl'here required: Issuance of this permit does.not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ""'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requir d. SIGNATURE: QAWPFILESTORMSIbuilding permit formslEXPRESS.doe Revised 061313 Reenewal Agreement Document and Payment Terms . � by denser dba:Renewal B Andersen of Southern New England y g Joe Higginbotham �;W, Legal Name:Southern New England Windows,LLC 11 Moromoy Cir %� RI#36079, MA#173245,CT#0634555, Lead Firm#1237 Centerville,MA 02632 wixoow 8E IACEMENT 26 Albion Rd I Lincoln,RI 02865 H:(508)771-0612 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Joe Higginbotham Contract Date: 03/30/17 Buyer(s)Street Address: 11 Mogomoy Cir, Centerville, MA 02632 Primary Telephone Number: (508)771-0612 Secondary Telephone Number: Primary Email: Secondary.Email: 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 and 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 to by the parties and incorporated herein by 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: $13,644 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: $5,000 Balance Due: $8,644 Estimated Start: Estimated Completion: Amount Financed: $$,644 8-10 weeks 8-10 week Method of Payment: Cash/Check We schedule installations based on the date of the signed contract and secondarily on Financing the date 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: Customer paid deposit by check, balance by GS. 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 04/03/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal B Andersen of Southern New England Buyer(s) ` Signature of Sales Person Signature Signature Victor Anger Joe Higginbotham Print Name of Sales Person Print Name Print Name UPDATED: 03/30/17 Page 2 / 10 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-095707 Construction Supervisor BRIAN D DENNISON 7 LAMBS POND CIRCLE CHARLTON MA 01507 Expiration: Commissioner 09/0812018 -'(7jjcicM6 S Office of Consumer Affairs 6nd Business Regulation L ' 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplemen!Card Eviration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS LL BRIAN DENNISON -' 26 ALBION RD LINCOLN,RI 02865 ---- . Update Address and return aud.Mark mason for change. ❑Address ❑Renewai J Employment C1 Lost Card SCA1 O 26:d-051' �Offia of ConsumerAlfairs&Business Regulation Registration valid for individual use only before the :. espiration date If found rehan to: kYOME IMPROVEMENT CONTRACTOR omCeorConsuinerAffairs and Basin Regulation ? ' ;Registration:1.732gs:, Type: lO Parl:t?lata-Sidle 5170 Explratico:;;;g/.191201t1.: ' SupplemM Card Boston.l4lA 02116 SOUTHERN NEW ENGi*C)WINDOWS U-C. RENEWAL BYANDEASON-;': BRIAN DENNISON .... 26 ALBIINN RD LINCOLN,RI 02865 �ypd Not valid without signature The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia NVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Q Please Print Lelnbly Name (Business/Organization/individual): Jp,Ag—cin hie-- �►�1C��Cin 1n)�rl� ��'J C; Address: c�& 7- &0v-1 � City/State/Zip: L:it i1 I Phone#: (401--------------- Are you an employer?Cbeck the appropriate bor. Type of project(required): 1-Cil am a employer with �:0 employees(full and/or part-time).; 7. ❑New construction 2.❑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.Q I an,a homeowner doing all work myself(No workers'comp.insurance required.)t 10❑Building addition 4.a1 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.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.0 I 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+ - 14.E3Other 4J 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. e 7 c aM t S 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-contactors 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 /le�'l'fG1 Wes to�� 1n 5 Co — Policy#or Self-ins.Lie.#: 1A1 C- A 313 bD e1 Expiration Date: Job Site Address: /�v 0� City/State/Zip: fed✓�ire- ' Attach a copy of the workers' compens lion policy declaration page(showing the policy number and expiry on 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 certify under the p and penalties of perjury that the information provided above is true and correct SiQrtature: � Date: Phone#: 04 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): I 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SOUTNEW-09 CZOWNGER tMMmDmnn') CERTIFICATE OF LIABILITY INSURANCE FoA-rE 6lMMIDW e 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, MCMND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT cohtfnum A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT: If the certificate holder is an ADDITIONALINSURED,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(6). PRODUCER CONTACT NAME CoBiz Insurance,Inc.-CO PHONE FAX 988-0804 821 17th St AIc No E:t:(303)988.0446 a No.(303) Denver,CO 80202 � �:CoBizinsurance pobWnsurance.com INSURER( AFFORDING COVERAGE I NA1C# INSURER A:Continental WesWm Insurance Company 110304 INSURED INSURER B j Southem New England Windows LLC INSURER c- DIBIA Renewal by Andersen 26 Albion Road INSURERD. I Lincoln,RI 02865 INSURERE: ; INSURERF° COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED-ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY.THE POLICIES DESCRIBED HEREIN is SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. IL1R I 77 TYPE OF INSURANCE !13 WVD POLICY NUMBER I POLICY EFF I P Mj LIMITS A I X COMMERCIALGENERALLIABILITY i i 1 OOO 000 EACH OCCURRENCE :5 , , i ; J rE CLAIMS-MADE n OCCUR ICPA3136080 j 0710112016 10710912017:POSES Ms ) i 5 100,000. MED EXP(Any Ono)>elsun) 15 10,00 I , ;PERSONAL&ADVINJURY 15 1,000,000 2,000,000 GEN'L AGGREGATE uw APPLIES PER I GENERAL AGGREGATE i S 2,D00,000 j POLICY`j JEC= I I LOC i I i PRODUCTS-COMPIOP AGG i S ' (EMPLOYEE BENEFI Z,000 U00 {AUTOMOBILE LIABILnY { i ; !COMBINED SINGLE 11MiT 15 1,000,000 ea scadmM A X! �.ANY AUTO i 'CPA3136080 07/01/2016 D710V2017{BODILY INJURY(PerpVsvn) {5. I ALL OWNED SCHEDULED { - -- - BODILY INJURY(Per accident) 5 t AUTOSAUTOS ='NON-0 ED I ; I s PROP TY DAMAGE :5 HIRED AUTOS AUTOS I i ; !(Per=ktent 5 j i i •" 1�UMBRELLA LIAB i,x I OCCUR I ! I I i EACH OCCURRENCE 15 5,000,OD0 A EXCESS LIAB �CW MS-MADE( ICPA3136080 0710112016 1:07/01/2017'AGGRECA;E I s 1 Si000,000 I DID I A I RETENTIONS Ole j 4 ' ggregate I s IWOWIERSCOMPENSATION j I { I I STATUTE +ERA I AND EMPLOYERS'LIABILITY YIN 1; 000 000 A ANY PROPR1EtOR/PARTNERIEXECUTIVE �l *CA3136061 :07/01/2016 10710112017 c L EACHAcoDEW 15 , OFPICt37lM6JIBt72 EXCLUDt9? i N I A 1, '000 000 (Mandatory In NH) I EL DISEASE-EA EMPLOY 5 If gas,dWbe under j j j I EL DISEASE-POLICY LIMIT I S 1,000,000 DESCRIPTION OF OPERATIONS below I ' I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Addidonal Remarks Schedule,may be attached R more space Is req%dred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE Wr H THE POLICY PROVISIONS- AUTHORIZED SPRESENTATIVE "-- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i OFIKE rqy, Town of Barjj f 4,bje *Permit# "'I v S]'A$L E Expires 6 montlu front issue date BAMSTABLE, : Regulatory M ep 12• Fee v 2 PH Thomas F.Geiler,�Director 22 qjp i6gq. �0 Building Division Tom Perry, Building Comnif 200 Main Street, Hyannis,MA 0260 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY p Not Valid without Red X-Press Imprint Map/parcel Number 7 a V%A Property Address ,� 1� ) �1/l`� T e� tj Residential Value of Work © �Q Owner's Name&Address Contractor's Name Telephone Number ��S,3(�' T`{� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Ci ❑Workman's Compensation.Insurance Che one: ET I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 'Zyr\ Workman's Comp.Policy# N J Permit Request(check box) Re-roof(stripping old shingles) - X-PRESS PERMIT ❑Re-roof(not stripping. Going over . existing layers of roof) MAY 12 2003 ❑ Re-side TOWN OF BARNSTABLE ❑ Replacement Windows`. U-Value (maximum.44) 90ther(specify) \V\S ,i` Vttj &0 *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signatur r Q:Forms:expmtrg Revised121901 R °FTHEToh, Town of Barnstable Regulatory Services BARNS BLE, ` Thomas F.Geiler,Director 9 Mass. �* 1639M. cM;.,a`` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Si n This Section If Using A B 'lder I, V s Owner of the subject property hereby authorize f �. c1,X ` to act on my behalf, in all matters relativ to ork authorize by s buLing permit application for (address of lob) e igna of Owner ate i Print N Q:FORMS:O WNERPERMISSICN Assessor's map and lot 'number ............../.�.��.. / V. :f SEPTIC SYSTEM MUST BE,, INSTALLED IN COMPLIANCE Sewage �P,ermit number WITH ARTICLE 11 STATE AR SA(NII,TARY(CODETAND TOWN c %I Etl TOWN- OF Bwta „ i B9flB,9TADLE; i G, 9 'EE6,3 t 'U [1 ~' INSPECTOR a �p i639:. 9� t �, �' • 9 , ram• ., �`r - APPLICATION 'PERMIT`_TO .......�C�?1�� ...`...................:........ ..................................................................; TYPE OF CONSTRUCTION .........`... .!.'�' :......... 1 ?.�................................................ t ........ ....... 40 �1`:......19� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for'a�� permit according to the following information: Locations ...'� ................0.... / ° ................... ................................... Proposed Use ........ ....... , ..................... Zoning District ../.............................................................:.......Fire District ..........1.... .tF'i� � ......................... �Eyl� .tJ •�i -:no t t� Name of Owner en,,:......... ..........................Address ........................ ............ ............................... Name of Builder ..��`��................................................Address ................. ............... .. .... .....................4 Nameof Architect ,...:.')..I............................Address ..... ......... .................................................. Number of Rooms .....0 ........................................................Foundation ....... 5e9:zf'. ........ C?.:' .G:.:.... Exterior ...... .�..//Roofing ...... ,. C�1/ ' 1................... Floors .... �1i�!...................................................Interior ......... ............ .. //�'®� �E Heating �� ! �.................................Plumbing ......�� ,/, �e...... "-....�-�vC...................... pa Fireplace ......�,??*_17.............�✓� e�`� .........Approximate Cost .........�.,,�.,......................... .... Definitive Plan Approved by Planning Board ________________________________19--------. Area ....0,2... - : ...:............. Diagram of Lot and Building with Dimensions Fee :o vx. ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH / • � A 1 . I hereby agree to conform to all the Rules and Regulations of the Town of Barn regarding the above construction. .. ....... .. .... Name ..... ?Tellegen-Ferrone f. No I'8762 / Permit for ,:,,1 1 2 story, t , single family dwelling ... ry Location Centerville................. .° 4 Owner ..........Tellegen-Ferrone.......................................... yf Type of Construction frame - •F. ....... ..................................................................... Plot ....= ............... Lot ......:.. 26 ................ ram �. Permit Granted ..........06tober 26 f'j19 76 . //�. .off. . . 'Date of Inspection 1.�...�1.'... Date Completed .... .. . /.7��................19 s y PERMIT REFUSED ................................ .......................... k 19 '......................:..................................................i.. �• '� , N -.•........•..••.•................••..••...................................... ....................... ....................................... ....... ....................................................... ....................... Approved .................... 19 .......................................... ..... ,. Assessor's map and lot number .....................�u�..- .'j.. / ,�l` r G?— „2(� a .- C Sewage ;Permit number ...................... (............................. r TOWN OF BARNSTABLE ypf TM E T� �.• t c DARISTAILE, "6 ;e0� 4 BUILDING INSPECTOR A�O N a' i r Y APPLICATION FOR PERMIT TO ...... !..1 ...`............................................................................................... • c TYPE OF CONSTRUCTION ............. .............................................. ........................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: � 'Location apt Proposed Use ..���C��i. ��'...:............................... ................................ ZoningDistrict ....../.... �.^�...........................................................Fire District ............................................................................... Nameof Owner .:.................................................................:.Address .........................,........................................................... Name of Builder ................. .................................................Address .................. ........ ... ......... ........�� Name of Architect `�� �'"� ...........Address .... � . Number of Rooms Foundation ��.�" !':."' Exterior +� +' ���'r / ...Roofing ....................... Floors / .E ...............�% /-"�'. ................................................Interior ..........: ..............._....:..: fir..... ''vc............... Heating �. - z.�t" g �I� -� IJG ......... ................. :..............................................Plumbin y..................................................:.......... //S'r"'� /l7�s'.°'"r"'> .........Approximate Cost . y�a Fireplace ` PP ..............................................^............ ...................... Definitive Plan Approved by Planning Board _________________________! 19________. Area /#1 S/` .......F ............................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH h I hereby agree to conform to all the Rules and Regulations of the Town of Bar stable regarding the above construction. / /%ry .. e /� Name .... ......... ^=^lefe"-,errpue =-192~174 . � 18762 l 1/0 story ' No ........ .'=.. Permit for� .................................... ' a1aula familv'6walll ng --- ------------.. . Capt. Lliab Road Location-- -------------^-------'' � � Centerville � ----'----------~----------- ' 7ellegeo~Farrmna ' Owner ------________________ ' � � frame Type of Construction -------------- ............................................. . , Plot ........................... Lot ... Permit Granted ......O.c.t.gbe�'26.---..lp 76 ' Date of Inspection ------------lg � Dote Completed ------------.]A . . � ' � PERMIT REFUSED ----'''----------------. 19, � ----- � ........... --^'—' .--'---'''1------ ' . ` — � kmp � Approved 9 ' ^ � . -------------- � -«~* ----.~--- � � ^�� FT..i.. ' u��/ ' —.--------'�`_------~--.---- G , ct MorE. 95't wlaF Ar. 567&4C& L.I n18 "04-t— WtZRA l �\ O �14-4 tiT t �EST. 1 Ex r s' :� �.or- /S 06/ ' #V lZO�Miu. Y ft►.r d 75 � $ 60 -- 7,4 1 u/L.D//vG 5 ETOACkf .2Equ/ZE-^,IeA17:nY Zo . F'24/ 1 7- /0 ' 5/ G2oAOSED ' '" SE P T/C 5 y5 TAM CONS 7-/2 LAC T/ON SHA [.L_ CONF02M TO A-IA sS . Oe-5/GN FLOW 340 GAL OA Y ENV/QoNMG-NT,4L COD& T/rrl-L y AA�/O TO[.vIV OF SARA,- S7 454a L L-A C 4-/ 2 A TE -C Z M/A/ 1/AIC� .�y!5!!NC, A/E�1LT/l ���CJG.AT/ONS p' TOP OF' .o20�oSEv LEACAI .4.eEA 070 FO UNOAT/ON MAn/NOLE. �Co✓E,� -r T� 2V/O /S COVEs2 WI' Tf-//A/ /" OF Fff�//5/-/�D GSA DE TO ,a2E VEA/T o=1A.4 -S �/20M /A/F'fLT2AT/A/6 S TOA/E coV-4z 'QCAS " T I Box �I Z/"W/PC n to M/N/ �6^�,N y _3,.Mw�— 4, D/q. iGs+r 4 DIA w /O'LL- c A </ p/T�,c/ FLOW L/NE - Y4 rc. -�_ "/FOOT /O A4W �/, T , z. M/nr �LrcA/ P/T /000 _Y- MiN /4',.�A.0or ^Y- WAS//EO _ _ e /n/v�7- r�- SrO n/E GA 4-L O N! /,v v :r `�� .6 ' t� A P L L /IVVEeT CA AC/ TV SE,oT/G TA�/,e V. .41ZDUn/O J'WATG 0T t/T/G ) /NVE,2T o tea OF /NTo SANK G(Z'�In P/T' / /IVVEZ7 N� GAr28A6E G,e/NDE2 `� cl 20' M/A111L4 U 4 ✓ 6 x 2 S I TG /-L A N , SEPT/G T�fve ro as A M>N<MUM LOCAT/O/V _.C6/y7-Z7ZV/GLC M,4SS DF /o 'A:;ZOA'f ,':--oVAJZ) gr,*AY 4n/,t;� 12EFE2E/,,fCE L64C/,l /TS. 8E/NG LOT 26 .�9,5 a�Gw'q,/ _ZA/ 2:744N t30og 274�, �z%466 ,� SED7-1(= TA^/ALf 01/57- 2 45U77/ON BOX �S OUTLETS) AND LEACN/NG X>/T' .��� TO �3E OF QE/n/F0.2CED COnJG�2ETE CO/VG,2E TE ST,2E AI,577V 3000 �/ X _�Z `O �. STEEL ,. 20000 3N 4t�df /O LDAI D/IvG BY C. �. S/-/O.�T CPAiG /4 T-O,2y LANE ;tc RAYtiOND �� D'e/;VEWAY n/OT TO BE LOCATED r - - -- — _ O V ,2 5 Y5 5 - ZO DE.NN/S , NILI SS. �� ��� 3 E TE A--) ZJNL E 5 N DES/GA/ L OA a/A/G /5 USC.D. I- C E ;e T/F y Tf,/A'T 71-16 Ex f S T/,t/G IIRII:e Ir 714,F- r u/G.a/A/G SE7ZAC,e I-ee- - Qv/rZE1*-fE c,Ts o/= TiaE raivN o,c 814 i2 n/. 74.13 L_A. DA TE NE,4 L TIC-/ AGF v T LI 1/AL..