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HomeMy WebLinkAbout0278 CAP'N LIJAH'S ROAD 0�178 C?- prr. k. 0-4'r-Re e o TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division �_ Date Issued �Z Z Conservation Division Application Fee 100 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board f� Historic - OKH _ Preservation / Hyannis op«� Project Street Address Village G 11T 0/A ,Itn / l Owner Address Telephone Permit Request120W . zrm 0 K n ,�t l Get ► `"CA P" Square feet: 1 st floor: existing proposed _W2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation -Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. �. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure gO Historic House: ❑Yes dNo On Old King's Highway: ❑Yes '�lo Basement Type: dFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) rn9 Basement Unfinished Area ( ) q Number of Baths: Full: existing new 0 Half: existing new Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor Room Count, Heat Type and Fuel: S/Gas ❑ Oil O'Electric ❑ Other Central Air: ❑Yes tl(No Fireplaces: Existing New 0 Existing woodfcoal stove: ❑Rs ❑ No Detached garage: ❑/existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: 2 existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use �___ - - - = • -- Proposed Use- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) a � Name -GU� ,� ( Telephone Number AddresQ,f ? �✓ f2 License #—c I Q 16" Home Improvement Contractor# 2,0 , -7 0 6 62,6 - Worker's Compensation # ALL CONSTRUCTION DEBRISgESULTING FROM THIS PROJECT WILL BE TAKEN TO IL �► �, - SIGNATURE D $ 31 1 Z i FOR OFFICIAL USE ONLY Y APPLICATION# ,r ! DATE ISSUED MAP/PARCEL NO. ' ADDRESS i VILLAGE OWNER' 4 y DATE OF INSPECTION: FOUNDATION r , r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL ;k ' GAS: ROUGH FINAL- FINAL BUILDING 10L3 DATE CLOSED OUT aids. Lt: 1 .. ils fuF T 4 ASSOCIATION PLAN NO. s I ` The Commonwealth of Massachusetts { Department of Industrial Accidents Office of Investigations t1. `lf 600 Washington Street 1 1 l h ! v iii .1 Boston,MA 02111 F www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C*fi 7,t 6 � Address: 2-g;6 City/State/Zip: aA4. L,6 Phone#: Are you an employer?Check the appropriate b x: Type of project(required): . I El am a employer with 4. VII am a general contractor and I 6 04 mployees(full and/or part-time).* have hired the sub-contractors ❑New construction 2.0 am a sole proprietor or partner- listed on the attached sheet t ?• RfRzmodeling ship and have no employees . '` These subcontractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] Iofficers have exercised then I0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l-El Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required] t. employees. [No workers' comp.insurance required.]. 13.❑ Other *Arty applicant that checks box#I 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 their workers'comp.policy information. 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 theform of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date Phone#: Official use only. Do not write in this area,to be completed by city or town offeciaL, City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who.employs persons,to do maintenance,construction or repair work on such dwelling house. or on the grounds or building appurtenant thereto shall no`Fbecause of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings,in"the commonwealth for any applicant who has not prod`aced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C()states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confumation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured-companies should enter their self-insurance license number on the appropriate Line. City or Town Officials Please be sure that-the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: - The Commonwealth of Massachusetts y L Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4940 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mas&.gov/dia 07/25/2011 MON 11: 24 FAX 15087901677 FAIR INS 2001/001 A D® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 5/2/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the.policy(tes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CT Jackie Stewart NAMThe Fair Insurance Agency Inc. PH°NNo • (508)775-3131 IA. tsos)?eo-167? e 619 Main Street ADDREss;fairinsjs@capecod.net ER P.O. Box 430 =rRIDXDO003186 Centerville MA 02632, INSURERS AFFORDING COVERAGE NAJCn INSURE) INSURERA:Travelers Prop. & Cas. Ins Co 36161 INSURER B: Marciano Construction INSURERC; _ 40 Aurora Lane INSURER INSURER E. " S Yarmouth MA. 02664 INSURER F: COVERAGES CERTIFICATE NUMBER:11-12 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. NOT(ITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tNSR TYPE OF INSURANCE R - POLICY EFF POLICY EXP- LIMITS LTR INSR VAM POLICY NUMBER MM1DD GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMA ETU TE PREMISES Ea occurrenceZ_ $ . CLARAS-MADE FI OCCUR MED EXP(Any one person) S-- PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ LAGGREGATE LIMIT APPLIES PER I PRODUCTS-COMP/OP AGGOLICY PO LOC ' $ AUTOMOBILE LIABILITY COMBINED SINGLE LVAIT $ (Ea accident) ANY AUTO I BODILY INJURY(Per person) I$ ALL OWNED AUTOS - BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $, ]TIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAQrta-MADE AGGREGATE I$ DEDUCTIBLE jJ3 $ RETENTION $ 1 $ A VYORl�R3 COMPENSATION Y WC STATU- OTH-I JOEY LIMITS ER . AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNERIEXECUTIVE EL EACH ACCIDENT $ 100,000 OFFICERIMWBER EXCLUDED? NIA /220123/2012 (Mandatory In NH) I 3/ 1 / EL DISEASE-EA EMPLOYEE_$ 100,00 lI yes,descnbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Rernaft Schedule,If more Wee is required) `Ias4 M ' a CERTIFICATE HOLDER CANCELLATION belportbuilding@live.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE !RATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Belport Building & Remodeling LLC ACCORD#NCE WITH THE POLICY PROVISIONS. PO Box 2881 Hyannis, MA 02 601 AUTHORIZED REPRESENTATIVE, Kathy Silvia/FAIJS2 �✓/Q�— ACORD 25(2009l09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 poogw) The ACORD name and.logo are registered marks of ACORD The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 The Commonwealth of Massachusetts T. William Francis Galvin m Secretary of the Commonwealth;Corporations Division . *:. One Ashburton Place, l 7th floor Boston,MA 02108-1512 !r yla��` Tr Telephone: (617)727-9640 MACKENZIE BETTY ASSOCIATES, INC. Summary Screen Help with this form LZ_Request^a,Certificate I The exact name of the Domestic Profit Corporation: MACKENZIE BETTY ASSOCIATES,INC. Entity Type: Domestic Profit Corporation Identification Number: 000943022 Date of Organization in.Massachusetts: 01/26/2007 Date of Involuntary Dissolution by Court Order or by the SOC: 06/18/2012 Current Fiscal Month/Day: 01 /31 The location of its principal office: ' No. and Street: 45 WREN LANE City or Town: MARSTONS MILLS State`. MA Zip: 02648 Country:USA . If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No.and Street: City or Town: State: ` Zip: Country: Name and address of the Registered Agent: Name: KEITH MACKENZIE-BETTY No.and Street: 45 WREN LANE City or Town: MARSTONS MILLS State: MA Zip:.02648 Country: USA The officers and all of the directors of the corporation: Title Individual.Name Address(no PO Box) Expiration First,Middle,Last,Suffix Address,City or Town,State,Zip code of Term PRESIDENT KEITH MACKENZIE-BETTY 45 WREN LANE MARSTONS MILLS,MA 02648 USA TREASURER MARGARET M.MACKENZIE- 45 WREN LANE BETTY MARSTONS MILLS,MA 02648 USA SECRETARY KEITH MACKENZIE-BETTY 45 WREN LANE MARSTONS MILLS,MA 02648 USA VICE PRESIDENT MARGARET M.MACKENZIE- 45 WREN LANE BETTY MARSTONS MILLS,MA 02648 USA DIRECTOR MARGARET M.MACKENZIE- BETTY 45 WREN LANE http://corp.sec.state.ma.us/corp/corpsearch/CorpS earchSummary.asp?ReadFromDB=True... 8/31/2012 The Commonwealth of Massachusetts William Francis Galvin-Public Browse and Search Page 2 of 2 MARSTONS MILLS,MA 02648 USA DIRECTOR KEITH MACKENZIE-BETTY 45 WREN LANE MARSTONS MILLS,MA 02648 USA business entity stock is publicly traded: _ The total number of shares and par value,if any,of each class of stock which the business entity is authorized to issue: Par Value Per Share Total Authorized by Articles Total Issued' Class of Stock Enter 0 if no Par of Organization or Amendments and Outstanding Num of Shares Total Par Value Num of Shares CNP $0.00000 200,000 $0.00 100 Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership X Resident Agent X For Profit _ Merger Allowed Select a type of filing from below to view this business entity filings: Administrative Dissolution { Annual Report t Application For Revival Articles of Amendment Articles of Charter SurNender r zr I Viev!Fihngsl!I � New Search ' +i. Comments ©2001-2012 Commonwealth of Massachusetts I All Rights Reserved Help i http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFron DB=True... 8/31/2012 al s 1 s�✓1'''Y ry -'f a'{' f '�>rek r fir. A' .. 4 - � P Department of • Safety .1 Massachusetts B oard-of Building Regulations and Standards Ij i EEITHmAcEAzrEi i 9.- i BARNSTABk 912, 't SExpiration 06/1912013 1• t�!_1 Commissioner - i � x Y}"'Sx '; �'ir x.' x .gam��; T r •� ,... _ 'G yi F 3 tt Y 4' g r y ♦ 1�,'; IF ! F - t k3F� ,�,Y.�' e X 11 � .' 'a.}t ,y!a �`r �'• �"z' $I ` �. & t - j. 14 y.gx.J � 7; J'4 e�'�dl:y i,r{3r�.^,:� f , '• n # v _ T's�Y� C7 4y� 4"w „t Ny' �5 .,•a r�yrT d90 ti #.a� ,y�,r, Jar •t� sc} ",f +r, .�Ayl ! Hf (( -�� �, ,. { '. ey=a n'r^r*{.�y c A a�M '�,e j ✓M�- i' k +2 s.- 3 try T`•`�,,,.ft�,,;.. T 5 Z...:t 2t .a?,� �� .Y fa L -�f d�. f -r i 7. 14 ti v t j -�f�I� If�; r Y .M :j' � j�}it >; •a .§. - 4 S � t j� •''fptr `'�;Y � J ,�, .k6a�#'� �t a P r }•i�"� �"r 'e t i / V` , a a 4 t. v •� i 3yt 6�4g� y yl} fist',,} )� :'� F jl � '1 itl 4t ya},. f fr r��h'b� � a I � I T ��.9 T )5.l'�•� �# ,4 x� { - J "h' S S.,-, '>Y �+ z f is ,,x T x f y a �,1 •* 4 $ it q Y r � � "y F• i + aat y - �, �, $ g+ e k 0 z Y L - bS r 5 f IS 3 - r s+ t f s t1x n fg 2 K�• aan,!.,.Ft'4A$ m ta.CYk r}RS S S�n�T ✓ .r g + k s�5 ,,�_ xg.` �, .^ ,.}4 i s d x, ( I r 4 F::7 u'"t, 1.,.n • a< Z $ i asr 91te _62 Office of Consumer Affairs and Ifusiness Regulation J O Park Plaza - Suite 5170 wM Boston, Massachusetts 02116 Home Improvement Contractor Registration ---- Registration: 161464 k Type: Individual Cyr; �-.._ �l� :�• Expiration: 9/23/2012 Tr# 203706 KEITH MACKENZIE - BETTY KEITH MACKENZIE BETTY - 3286 MAIN ST � n BARNSTABLE, MA 02630 . P date Address.and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CA1 0 5OM-04/04-G101216 Office�iorls6f � ;� � License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: , a Registration: 167464 Type: Office of Consumer Affairs and Business Regulation. V)MACKENZ, Expiration: ,`W23/2012 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 IEMETrtY ii f1 4 KEITH MACKEN 0- 3286 MAIN ST BARNSTABLE, MA 012 fi ro: Undersecretary iNot valid without sig ture Jufi. I. Lit I i v;im Towu Of Barnstable' I `a Regulatory Services LI.RN6TA�LE. NAM Thomas F.Ceiler,Director , qb;Fp. Torn Perry,Building Commissioner 2�0 Main Sfi=e HPnais,MA 02601 *".town.barnstable.mams Office: 508-8624038 Fax, 508-790-6230 Property Grier must Complete and Sign. This Section, f—Using A B ilder Ij. $ U/�.k/`�r , as 0%wr of the st�bjeet psnpesty 0 hereby autbo �( � ��af �i tm act on ny,behalf, in alt matters relive to work wtho ized.by this budding permit application for z79 _ (��' ► [ Ll �5 (Add SS of ) S o r Date Punt Name .If-Propea Owner is applying for permit.please complete the Homeowners License Eire Lion Forte on' the revenc side. q:�dlwrs;vwrrErr��trss�ox 'THE r, Application numberg..'. �� O Date Issued.... BAIMST, LZ 4 63 SEP 112919 Building InspectorsInitials........ .............. F TOWN 01,- bARIMSIMLEMap/Parcel.............. . .......................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDWG/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: -?-7 NUMBER STREET VILLAGE Owner's Name: Jjd:2 t AJQ1 Phone Number Email Address: ,;1/ Cell Phone Number �1 Project cost Check one Residential V/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: le A-Az c-� OT-4c"* � Date: TYPE OF WORK Siding Windows (no header change)# 17 Insulation/Weatherization LYS Doors (no header change)# I Commercial Doors require an inspector-s review E] Roof(not applying more than I layer of shingles) nn Construction Debris will be going to Gfj a s4e--Irana I 6om-11 CONTRACTOR'S INFORMATION Contractor's name -SoAerr\ We-j &, Iev4 Home Improvement Contractors Registration(if applicable)# 17-3 2-q,5_(attach copy) Construction Supervisor's License# bq S-7 0: (attach copy) Email of Contractor q5<6 6nq; C 6(n Phone number L101- -,, 2- 9 -I TOO ALL PROPERTIES THAT HAVE STRUCTURE5,6VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY is/IV A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERmir CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents nts Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X , X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures; specific inspections and documentation required by 780 CMR and the'Town of Barnstable. Signature Date PLICAIT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. r Renewal Agreement Document and Payment Terms Andersen. dba:Renewal B Andersen of Southern New England Y $ Judy&William Shumway Legal Name:Southern New England Windows,LLC 278 Capn'Lights Road RI #36079, MA#173245,CT#063.4555,Lead Firm#1237 ''° Centerville,MA 02632 w,euow NE LACEMENT 10 Reservoir Rd l Smithfield,RI 02917 H:(508)681-0434 Phone:401-349-13841 Fax:4017633-6662 1 sales@ren"ewalsne.com C:8023790440 Buyer(s)Name: Judy'&William Shumway Contract Da"te: 08/23/19_ . Buyer(s)Street Address: 278 Capn: Lights Road, Centeryille,:MA 02632 Primary Telephone Number: (508)681-0434. Secondary Telephone Number: 8023790440. Primary Email: billshumway155@gmall.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: $4,239 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: $1,412 Balance Due: $2,827 v Estimated.Start: Estimated Completion: Amount Financed: 8-10 weeks 8-10 weeks $0 r Method of Payment: Cash/Check 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: 1/3 DEP 1/3 ON START 1/3'ON COMP 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 coniract 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 08/27/2019 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 ArWersen of Southern New England Buyers) Signature of Sales Person Signature Signature ` Eric Woods Judy Shumway William Shumway Print Name of Sales Person Print Name Print Name UPDATED: 08/23/19 Page 2 / 9 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS LLC 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD, RI 02917 - scA > zo-ro7i•os/n Update Address and Return Card. :I/ Gv�7/72/iI.CL'P_2G1�, i/-GC CIG' Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Recistiatibn. Expiration Office of Consumer Affairs and Business Regulation 1M45_=::_ 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON !,Q C'f 10 RESERVOIR ROAD U SMITHFIELD,RI 02917 Undersecretary vv Without signature Commonv�ealt of Massachusetts Division of Professional Licensure Beard of Building Regulations and Standards Constru_0—t-f6 -`5u ervisor CS-r095707 = i res: 09/0 /202® :y BRI AY\AA�� ® ®E NN's ON 8 BLACKWVELL DRIVE CHARLTON MA -011507 =� a Commissioner The Conwtonwealtft of Massachusetts Department of Industrial Accidents 1 Congress Stree4 Suite 100 Boston,MA 03114--2017 www mass gov/dia A'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electriciaus/Plumbem TO BE FILED WITH THE PEMMLYG AUTHORUY. Anolicant Information 1 lieu.) Please Print Legibly Name(Business/Ocganization/Individual):Y�(,G►`I he f rub Neu.) t I t 1,01 f) r3 1 Address: City/State/Zip:S ef�A eQ J'! 0 ? l 7 Phone#: 40/—ZZ r— Are you an employer'Check the appropriate box: L Type of project(required): 1. 1 am a employer with ;Z0 'employees(full and/or part-time).* 7. ®New construction 2 am a sole proprietor or partnership and have no employees working for me in any capacity.(No workers'comp.insurance required.] 8: Remodeling 3.01 am a homeowner doing all work myself.(No workers'comp.insurance requited.)* 9. ❑Demolition CC]1 am a homeowner and will be hiring contractors to conduct all work on.my property. I will 10❑Building additioa ensure that all contractors either have workers compensation insurance or are sole 1 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am ageneral contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurartce.t 13.0 f repairs 6.❑We are a corporation and its officers have axemised their right of exemption per MGL c. 14- Other *Z) 152,91(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. tContractors t(mt shack dds box must attached an addiaomel sheet showing the name of the sub-contractors and slate whether or not those entities have employees. If the sub-contractors have employees,d1eY must provide their workers'comp.policy number. I ant an employer that rs proWding workers'compensation insurance for my entp/oyeec Below is thepoUcy andjob site information. InsuranCe Company Name: r Q AV— 0p . a W . (� Policy#or Self-ins.Lic.#: WM,313, 812 Lp?y Expiration Date: LO Job Site Address: City/Stawzip: ,✓�n/;l�e ri 4Attach a copy of the workers'compensation policy declaration page(showing the policy number and expire '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 ce under the p ' penalties 4 of perjury that the infarniadion provided above is due and correct AIt Date: y—/ Phone#: 4 1 7 Z 9 JM Official use only. Do not write in dds 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.Cityltown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/28/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONT NAME: CoBiz Insurance, Inc.-CO 1401 Lawrence St., Ste. 1200 IAIC.PHON o t• 303-988-0446 IC No:303-988-0804 Denver CO 80202 A RESs: COMaiI cobizinsurance.cam INSURE S AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Com an 31325 INSURED ESLERCO 01 INSURER B:FiremenS Insurance Com an of WA,D.C. 21784 dbaSou Renewal New England Windows, LLCkern INSURERC:Homeland Insurance Com an of New York 34452 dba Renewal by Andersen of Southern New England 10 Reservior Rd INSURERD: Smithfield RI 02917 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:787175890 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR INSURANCE ADDL S R . POLICY EF POLICY EXP LTR POLICY NUMBER lMM1OOIYYYYI (MMID0NYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1I112019 1/112020 EACH OCCURRENCE $1,000.000 CLAIMS-MADE a OCCUR DAMAGE TO REN PREMISES Ea occurrence $300.000 MED EXP(Any one person) $10,000 PERSONAL rl<ADV INJURY $1,000,00D GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY❑JECT LOC PRODUCTS-COMPlOP AGG $2,000,000 OTHER: Is A AUTOMOBILE LIABILITY CPA315B728 1/1/2019 1/1/2020 COMBINED SINGLE OMIT Me accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED i AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON OWNED PROPERTY DAMAGE AUTOS Per accident $ $ A X UMBRELLA LIAB X OCCUR CPA3158728 1l1/2019 1/1l2020 EACH OCCURRENCE $15,oao,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,OOD,000 DED I X I RETENTION$ $ g WORKERS COMPENSATION WCA315872924 1I112019 111/2020 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? N/A Mandatory in if describe under a E.L.DISEASE-EA EMPLOYE $1,000.000 es, under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,00o C Pollution Liability 7930073340000 1!1/2019 1/1/2020 Each Occurrence $2.000,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 06/20/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE Na� , ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1 TOWN OF BARNSTABLE Permit No. l .,un.n. Building Inspector ...� Cash ---------------------- OCCUPANCY PERMIT Bond ----___------_-- ICI "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor ',first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ...................................................... 19....._ _ .................................................................._.............................._....._._._ Building Inspector "V " r_ r At op IV /S'+-+li,� `+- O l p' � 34 J N q V Q r*26 N U - /7 2 z6 sq.rrr. r,ow►s LcT y/3 .3o} 'ow M5,,97 zxoM?+ a xEiwt$T cx+ SNGINEERB--SU1tVLYQft$.` 3. pvgG RnND DRIVB ; LoT Z7� . - � 80UTEi YA1tMOVI't�•��r' CERTIFIED .. PLOT PLAN' -SCALE /'. 30.`. . . . DATE . •'�" PLAN REFERENCE Hov�On/ .o.n/ .4 P49 t l F f �NR2t:ES. :F. 674N�Y ZA I CERTIFY THAT THExl ? !d U!1lDRAf't� SHOWN ON THIS PLAN IS LOCAiTEQ ON..THE GROUND AS SHOWN HEREON AND THATAT•C"FORMS*THE CNAt S F;' STANLam/. ...� SETBACK RNUIREIKNITS OF THE: TOWN OF CEN l TEfZk C � ir•.. PETITIONER:: ISTERED Assessor's map and lot number ,/ %'' ' J27) t z y SIC SYSTEM 1 Co MUST.BE MPdIAWdF Sewage Permit number ...... ................................................... �j �j R /� R N T WITH TITLE 5 yo*TFiEro�� �.® 11 f Y L't1"1� 1 \ 1 �AI'm "MENTAL CL3DF, ;�- , Y BAWSTULE, ��d M 9• o6�pYa BUILDING . , INSPECTOR . APPLICATION FOR PERMIT TO ... ..��'....1..�.V. ' '............................................................ TYPE OF CONSTRUCTION ! !i^.R!................................................................. + 1 ........f..............19fp®. 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordin to the following information: a Location ............ ....... . ................. .... �............ Proposed Use .......�Y OY`- ................................................................... ........... .................................................................. . Zoning District ........................................Fire District Name of Owner ................`........... `.�.. ......................Address ............. ................... ..-W � ....... a A4 y vi ;. Name of Builder ....................................................................Address ..................................................................................... Nameof Architect ........../V®.M.........................................Address ..........................................,......................................... :} '.............................................. Foundation ......... ..............�iv��i... .�..�:..................... Number of Rooms ................. .-doMRoofing ...........!..:.:S i ..:........................................... Exterior ...........•.W....�.....v............. . � Floors ...... . ........ ........ .........................................................Interior .............�............. ............................... . ............. Heating T C ........ . Plumbing .......... .. ��y([ ��!! Fireplace ....... .......... ..N..�©...... `....°... .. ° . Approximate Cost ..........Vp 4®� `r Definitive Plan Approved by Planning Board --------------------------------19--------. Area ........ >3 ........1.5 Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTHd�j40 S t k l � 171 a , I �8 G6A ' poi'• , y� i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... .L . ....................... STANLEY, C. F. No 2.4.q 8..... Permit_fa- ...One...Stor.fir.......... 3 Single...F4jlj1Y...D-we.J 1ing............... ' Location ....LQ.t,..A26...27.8...Capt......L j•ah' s Rd ................ .............................. Owner,.,•.X......F.....S.tan2:ey.. .......................... Type-of Construction . Tr:axne.......................... i` Plot ............................ Lot ................................ Permit Granted August_.•5..........19 80, Date of Inspection ./...........�...................19 . Date Completed Q PERMIT REFUSED .................................... 19 ............................................................................... ...... ........ ............ 1 .. ....�.q�. ................................................. r 1 A rn .................................. 19 ' pP ' ts t .. ...8. . ................................................... r� ' Assessor's mop and )cn number ......................_',//—'---- Sewage Permit number ............................................ ... ......... ' ������7. ��^�� �� � �� �J�� �0� � �� �� �� TOWN ��'� ������|� �� � �������� - NAM BUILDING N ���m���������� �� 1639. ��NN � 0-N� N ���� INSPECTOR ������0m 0 00 �� �� �� ����� � �� �� � �� ��� ���� � �� �� ~ �� . /APPLICATION ��� PERMIT TO —�.�.--—��.............. ...—.!—....—��----------------------- � \ ' ��P2 �P ����������� ..........................................' '� ` ' ---------------------'' ' —'' ' ----- _ ........ ......................................�� - ' ''. ' � TO THE |NSPE[TOR Of 8U|LD|NGS T6e undersigned hane6v applies for o permit according to the following information: � , ~ '/ ^ . - / / . ^ ' � . Locohon ----------:----------'�------'^--'.�----�---�—'—^~~^----------��----' 'Proposed Use -----.---------------.--____________________,__,___'________. ' � ' Y, ~ Zoning District ----------...------------Rve DistriEt .................^....—..L—'.------.-----'—.. � / / ' ' ' /- , / / '' ^ Name of Owner —.��—./--.:-/.-----.f-------A66re� .--.� ^—.../.—'1.'L�'�---/~-----�—.-- ' | ' | Name of 8oi|6e, ----------------------'A66rex ---------------------------... Nome of Architect ............./��'�//..�-....................................Address -----------------.—.—.------_ Number of Rooms ----------------------Foon6otion ---'-------...�------....-------. Exle,io, ............... .................................—.............Roofing -------...--.' ------.----------.. . . ' Floors -----------------------_----.|�ericv ..............................................-----...—_-----. � Heating ---------------------------.Plum6ing ---------------------------. � Fireplace --------------------.---'..--ApproximooeCoo --^--- ................................... � Definitive Plan �v Planning Board �Q----. Area --.��'��\������—'��— � � � � � � �. Diagram of Lot and Building with Dimensions Fee ---` .���_\—.__....---' SUBJECT TO APPROVAL OF BOARD OF HEALTH /--,j - � ' ^ / | | ^ � | � - ) ' \ . . ~- �� - ` ' � . | her ebv agree to conform to all the Rules and Regulations of the Town of Barnstable ndi the above construction. Name � . �� � � � ��«l�3-Il3 STANLE![, C. F. ^ ^ � one Stor No ..22�O�.. . . °� SiAgle I7aozillr [welling ---------------------...��.--. � � - � Location .Lqt-��G_.378..�\�pt�_�iia�' a Rd~ | ' .................................. ~ ` ` Owner -{�-- | � , Type of Cons - � . ' . .-.---.. ` � ..... ............... ................................ > ' | ' � ! "="". \ � . . --- of '-,--� ol ....................................19 / . Date ^ / . ^ ^ \ . ^ . ~ PERMIT REF SED ' ................. 19 » --.. .l.. .�-L--.----. > � v* \ � \ . � , .......... ....... ............................................. , ' . . --.._..~------.-_---..~--.--., � ; . > '-----'-'''-`^~~~^^~^^^^'~^-'`^~^^^^^'- Approved ---------------- l9 ' . . . . --------~--.----....—..--..--.. . ` ` . -------'-------'------^^^'^^^^' ` GRANITE SILL 3 - 1021— / 1 // NEW BOX BAY s, " PROJECT I — 7 2 WITH 2# CN 1135 CASEME T — 7 WINDOWS, SHINGLE ROOF. — 101 // EXISTING OPENING in MAINTAINED W uW a W 21 Z w33338D 1 Az 1 23 W 1 833 AGW21 5 4 4WALL a j --�- -- — a d a"I�, — - - CABINET NEW BUILT IN SINK W ILS+1K DISH 2_IeTLL - - - STORAGE IN - - -- - - - - — — — — — — — — — — Z 2, ROLL OUTS F 00 WASHER OUTS 2 gI}CL O S "' GARAGE, STE a B36 BD 9 C] 81 8 B21 AMENDED i S'B 'O tv ITI'• .4gS j \ J J T I LT M&W DRAWER F/C 9 0.5 GAS . RELOCATED GARAGE " RANGE EXISTING 11 KITCHEN DOOR w W, ySB 30 3° TALL FILLER ts-- W AND SIDE PANEL ROLL OUTS J W B36 BD DB W CO KITCHEN �''h Z Z � t �--' Q TB Q O +?.... J � a. a u 36 FRIDGE w361 5-24E D )PIAINSCOTTING BACK PANEL TC C 2487 BD WITH 4 1 ROLL ! ! 1 S // NEW STONE OUTS xx 1 FLOOR XZ 71 1 DOC 3087CCO, FRIDGE j, \ /��\ OVEN 1 2° LOWER PANTRY J CABINET E—: 087 BD� 3067 BD� Z DEPTH) 1 2�� DEPTH)-- - -j L - - -- - J a 1 FILLER y EXISTING FIRST FLOOR PLAN Zn - 1 FT. PROPOSED FIRST FLOOR PLAN Zn - 1 T DINING ROOM DINING ROOM 27B, CAPTAIN LIJAH'S, CENTERVILLE, MA KITCHEN PROPOSALS, DWG.ND.278 20 1 2-1 A MACKENZIE BETTY ASSOCIATES, u SCALE = 1 FT. 1 :24) DATE 1 3TH JUL 201 2 - 'ARCHITECTURE AND CUSTOM BUILDING 3286 MAIN ST. BARN STAB LE. MAsenc NusETTe 0263❑ TEL. SOB 367 5900 i