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HomeMy WebLinkAbout0052 CAPTAIN LUMBERT LANE T+„ _ N J v c $, r u n� It ,. t i '. .. 4•.. � .. - .f� .. ,." -. - i' a e!' .. s. r 0 a ^ !yp. x yy u f k. - a , { n II Town of Barnstable Buildin e : __ •. 9 Post ThisGard So That it�is Visible From the.Street A ravedPaans"Must be Retained on�Job and this Card Musi`betKe ;t9 n:<�111tN8'fAtil.E '.; 7 5': xz n'..: : °•` '? 1 ,', i• � R & ,,.: P �3.. Posted=.Until Final Ins ectio�nHasBeen:Made° z Permit �a> Where a Certificate of.Oceu anc as R'e'.uired�'sucha8uildm Yshall•Notbe Occu ied.untii•a�Fnal Inspection has been made�„ " Permit No. B-20-440 Applicant Name: BRIAN D DENNISON Approvals Date Issued: 02/14/2020 Current Use: Structure Permit Type: Building.-Siding/Windows/Roof/Doors Expiration Date: 08/14/2020 Foundation: Location: 52 CAPTAIN LUMBERT LANE,CENTERVILLE Map/Lot 147 011 010 Zoning District: RC Sheathing: Owner on Record: WARD,ALAN M&JEAN V p; Contractor Name"<.,BRIAN D DENNISON Framing: 1 A� � Address: 52 CAPTAIN LUMBERT LANE 5 Contractor<License- CS-095707 2 CENTERVILLE,MA 02632 Est Protect Cost: $7,965:00 Chimney : Description: Doors Per�mIt Fee: $40.62 Insulation: Project Review Req: Fee Pa* s $40.62 Date 2/14/2020 Final > Plumbing/Gas Rough Plumbing: } � Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorzed by this permit is commenced within siXinonths after issuance.. All work authorized by this permit shall conform to the approved application and�tthe,approved construction documents;for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and str ctures s all be in compliance with the local zoning blawsand.codes. This permit shall be displayed in location clearly visible from access street`or road and shall be maintained open for public inspection for the entire duration of the Final Gas: Nl work until the completion of the same. . '.,.aElectrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and'Fire Officials are provided on thispermit. Minimum of Five Call Inspections Required for All Construction Work: ., Service: 1.Foundation or Footing t Rough: 2.Sheathing Inspection ,,, 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Perso Saing With unregistered contractors do not have access to the guarantyfund" (as set forth in.MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: z qME r. R /� Application number +✓ ....-Zo.�... .................... 6 � MASS, a U p ING pEpT. Date Issued. .7 3 20 q Building Inspectors Initials...... FEB1 ................... o �I © � C� ARNSTABLE Map/Parcel......... ... .........��...............................TORN OF B ..... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION E:-- PROPERTY R'ORMATION Address of Project: r►b t- G,v erL te— NUMBER STREET VILLAGE Owner's Name: iF�4 Phone Numb Z ' 6 - SCANNED Email Address: Cell Phone Number 14 2020 Project cost S Check one Residential V1 Commercial OW 'ER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: S e INAl cha Date: TYPE OF WORK Siding Windows ( eader h ge)# ❑ Insulation/Weatherization Doors (no header chang ) #�_ Commercial Doors require an inspector's review J Roof(not applying more r of shingles) n Construction Debris will be going to Grl as4f--/y?AiJa J M,' i % , /Z r CONTRACTOR'S INFORMATION Contractor's name 6( Gn `74 n.�,'so r, - S„k�.e�n AfpaAl rf,'n chow S Home Improvement Contractors Registration(if applicable)# 17 3 2.q.5 (attach copy) Construction Supervisor's License# y9 E'70 (attach copy) Email of Contractor SL,)ef� ' . C bcn Phone number �(0/- 2 Z R -9,PDD ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR/F THE SUBJECT PROPERTY IS IN ,A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER ............................................................ *For Tents On1, 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 2 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.nerved at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pdra. Commercial events may require Fire Department approval XWG®D/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 CIVIL 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 PLICAN 9 S SIGNATURE RE Signature Date All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document and Payment Terms bJ'Afldeisen' dba:Renewal By Andersen of Southern New England Jean &Alan Ward Legal Name:Southern New England Windows,LLC 52 Captain Lumbert Ln. RI#36079,MA#173245,CT#0634555, Lead Firm#1237 : Centerville,MA 02632 WINDOW RE rACEMENT 10 Reservoir Rd I Smithfield,RI 02917 - - - H:,(845)505-8442. Phone:401-349-1384 1 Fax:401-633-6602 1 sales®renewalsnexorri C:(774)602-5091 Buyer(s)Name: Jean .&Alan Ward Contract Date: 01/14/20 Buyer(s)Street Address: 52 Captain Lumbert Ln.,�Centerville, MA;02632 Primary Telephone Number: (845)505-8442 Secondary Telephone Number: (774)602-5091 Primary Email: jeanbward@gmaii.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•. $7,965. 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: $2,654 Balance Due: $5,311 Estimated Start: Estimated Completion: Amount Financed: $0 6-8 weeks 6-8 weeks Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on Cash/Check 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: 2654.00 deposit-MC; 5311 balance due upon completion-CHECK 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 01/17/2020 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 By Andersen of Southern New England Buyer(a) \ Signature of Sales Person Signature Signature Chris Hutson Jean Ward Alan Ward Print Name of Sales Person Print Name Print Name UPDATED: 01/14/20 Page 2 / 13 /A 06 KIX221, 22 Office of Consumer,affairs and Business Regulation 1000 Washington Street- Suite 710 Boston', Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card i SOUTHERN NEW ENGLAND WINDOWS, LLC-- Registration: 173245 10 RESERVOIR ROAD Expiration:. 09/18/2020 ' SMITHFIELD, RI 02917 = sCA 1 a 20(vl psi» Update Address and Return Card. .-��/F. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only f TYPE:Supplement Card before the expiration date. If found return to: Reaistrafion Expiration Office of Consumer Affairs and Business Regulation t 173245= ,. _ 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLANb WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON t 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary r without signature Uommonwealth of Massachusetts Division of Professional Licensure Beard of Building Regulations and Standards 1,1onstrujc—tfor -`Supervisor CS-095707 _- -_ P-4 p i res: 09/08/2020 BRI D DENNISON �. y CHARLTON MA=0 1507 =' Commissioner i. The C'onlow swealdi"o Massachusetts 1r , Departimnt of Industrid Arcidents , I Congress Stree4 Suite 100 Boston,MA 021149617 www mass gov/din Werkere Compensation Insurance Affidavit:Builders/Contractors/ElectricianslPlumbers. TO BE FILED WITH THE PER-NUTTLYG AUTHORITY. . Applies Information Please Print Legibly Name(BusinesslOrsaniration/Individual): ena Ice ` do , S Address: U City/State/Zip:S t t-�j e-14,7?! OZQ /] Phone#: 4101—Z,Fr— Are You eu employer'Check the appropriate box: Type of project(required): 1 t a employer with employees(full and/or part time).° -7. ®New construction 2 am a sole proprietor or partnership and have no employees working for me in 8: ®Remodeling any capacity.[No workers'comp.insurance required]. 3. I am."homeowner doing all work m sei£ 9. ®Demolition ® ink y [No workers'comp.insurance required.]t 4.®I am a homeowner and will be hiring contractors to conduct all work on my property. I wilt 10®Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.®Electrical repairs or additions proprietors with no employees. 12.n Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.= 13.[]Roof re pa' - 6. We are a co ration and its officers have exercised their ri 14. e[ � - ®152,§t(4),and we have no employees. o workers'c of exemption per MCL c.. IN oatp.insurance required.] 'see IO 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. Vontracmrs that check this box must attached an additional sheet showing the name of the sub.conuactors and state whether or not Ihoso etuities have employees. Ifthe sub-contactors have employees,they must provide their workers'comp.policy number. P man employer that 1s providing workers'compensation insurance for my employees. Below is the poUcy and fob site informatien. ,Ira Lisurance Company Name: `f't reAeI1.5 ti LP,�'@/t�.t° OF Wfi-. L). Policy#or Self-ins.Lic.#: C Ooe% Expiration Date: Job Site Address: M Tir City/State2ip: PA'11 l Attach a copy of the workers'c mpensadon 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 penaltids in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator'.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifibadon. I do hereby ce under the p penatda of perjury that the information provided aba te is a and correcrt i ture: t Date: z- Phone Official use only. Do not write in dds area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ' 6.Other - Contact Person Phone#- 5 • AC Ro® CERTIFICATE OF LIABILITY DATE(AdAA1DD"YM BILITY INSURANCE F12/3012019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS,UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 CONTACT BOKF Insurance CO Risk Management NAME` 1600 Broadway, 9th Floor r AIC,N o :303-988-0446 A No):303-98"804 Denver CO 80202 ADD 1 : insureiRbokf.com y .. INSURE AFFORDING COVERAGE NAIC# INSURED INSURER A;Acadia Insurance Coma 31325 ESLERCO-01 INsuRER B:Firemen's Insurance Com an of WA,D.C. 21784 Southern New England Windows, LLC dba Renewal by Andersen of Southern New,England INSURERC:Homeland Insurance Com an of New York 34452 10 ReSerVlor Rd INSURER Smithfield RI 02917 fNsuitERE: INSURER F COVERAGES CERTIFICATE NUMBER:1098683046 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2020 1/12021 EACH OCCURRENCE $1,000,000 ' CLAIMS MADE OCCUR "' Y # MAE TO RENTED -PREMISES Me occurrence $300,000 MED EXP(Any one person) $10.000 ' i - - PERSONAL&ADV INJURY $1,000,000 ' GEN'L AGGREGATE LIMIT APPLIES PER: ° GENERAL AGGREGATE $2 00D,000, X PRO- POLICY 1-1 JECT LOC ` .PRODUCTS-COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY CPA3158728 1/12020 1/1/2021 COMBINED eDtSINGLEIJMIT $10 •, 000 a X ANY AUTO BODILY INJURY(Per person)' $ ALL O SCHEDULED AUTOSS AUTOS } BODILY INJURY(Per accident) $ o- r �_ X HIRED AUTOS X NON-OWNED P PROPERTY DAMAGE AUTOS 4 Per accident $ $ A X UMBRELLA LL1B X OCCUR CPA3156728 : ,..' 1/12020 1/12021 EACH OCCURRENCE $15 000,000 EXCESS LIAB CLAIMSaAAADE ' ` AGGREGATE $15,000,000. DED I X I RETENTION$n $ B PER OTHI- A DRK COMPENSATION EMPLO ERS LIABILITY Y!N i, WCA315872922 1/12020 1/12021 X STATUTE i ER + ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? N N/A , (Mandatory In NH) E.L.DISEASE-FA EMPLOYE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below '* EL.DISEASE-POLICY LIMIT $1,000 000 C Pollution Liability 79300?3340002 1/12020 1I1/2021 Each Occurrence S2,000,000 Claims-Made Policy x r A ate Retroactive Date OMM013 - s edT $25,00 000 , De00cUble $25,000' DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES ACORD 101,Additional Remarks Schedule,may be attac hed shed if more space is required).' Subject to all policy terms and conditions. :• ,`3•_ CERTIFICATE HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN - ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE •.t 01988-2014 ACORD CORPORATION. All rights reserved." ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Fr 1 KE q y Application number................................................ 6 ' l o �9 a Date Issued..... ........ .................. pq aaMNsTasi.E. � .... ;.. MUM K1 � F1639.��,®® JUN Building Inspectors Initials... . .. . . .................... 7 291 // e/o Map/Parcel......f y7....Q........................................ TOWN 1A8ARNS ABLE TOWN OF BARNSTABLE S) EXPEDITED PERMIT APPLICATION: ROOF/SIDING/'WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY RUOPMUTItON Address of Project: NUMBER STREET VILLAGE Owner's Name: -A//Q e,JQ rd Phone Number Email Address: ;�,,,5 d a s, :I.c o.r. Cell Phone Number 9-4 5 b S- a y y Z Project cost S 1 Z Z 1-1 Check one Residential Commercial O1YYlVJ1.r'R'SAUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR- Owner Signature: oa, ` ,4 Date: n(PE OF WORK Siding Windows (no header change)# Z ❑ Insulation/Weatherization El Doors (no header change)# - Commercial boors require an inspector's review J- Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION ®R1`Y1 A 7 IO Contractor's name c' a n 4/ � Fr" Id/ ' l-n Jow S Home Improvement Contractors Registration(if applicable)# 17 3 2-q.5 (attach copy) Construction Supervisor's License# 0J S 7 07 (attach copy) Email of Contractor QGLJee�9g5t � . C bcn Phone number YOL Z 2 R -�900 ALL PROPERTIES THAT KAVE ST RUCTURE5 VER TS YEARS OLD OR IF THE SUBJECT PROPERTY IS 11v A HISTORIC DISTRICT, YOU MUST OBTAIN H15TORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X 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;00arn-9e30 am or 3:30 pm-4.30pra Commercial events may require Fire Department approval. YWO®D/COAL/PIELLET STOVES x 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 CMIM and the Town of Barnstable. Signature Date FLICANT9 S SIGNATURE Date Signature All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal liy Andersen of Southern New England. Jean.Ward Legal Name:Southern New England Windows,LLC 52 Captain Lumbert:Ln. RI #36079, MA#173245,CT#0634555,Lead Firm#1237 Centerville,MA 02632 wiaoow ae iaeee�e.. 10 Reservoir Rd I Smithfield,RI 02917 H:(845)876-4248 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com' . C:(845)5b5-8442 Buyer(s) Name: Jean Ward - Contract Date:.06/13/19 52 Captain Lumbert Ln., Centerville; MA 02632 Buyer(s)Street Address: P ' Primary Telephone Number:.(845)876-4248. Secondary Telephone Number::(845)505-8442 eanbward@ mail.com Primary Email: 1 9 Secondary Email: Buyer(s):hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/6/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: $12,219 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: $6,109 Balance Due: _ $6,116 Estimated Start-. Estimated Completion: Amount Financed: $12,219 *.*9/3=9/6** **9/3-9/6** Method of Payment: Financing We schedule installations based on the date.of the signed•coritract.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.' ather are the most common causes for delay. Notes: 50%deposit-GREEN SKY,.50% balance due upon completion-GREEN SKY 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. Buyers)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 06/17/2019 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 By Andersen of Southern New.England Buyer(s) " Y Signature of Sales Person Signature ". '. Signature Chris Hutson Jean Ward ' .. Print Name of Sales Person. ' Print Name Print Name UPDATED: 06/13/19 ' Page'2 / 11 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement-Contractor Registration Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LLG - Registration: 173245 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD, RI 02917 - - - SCA t Ca 20M-05/17 Update Address and Return Card. � � ' e cvrvnoircc ea�li c ea; Office 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: Regisfiafion. Expiration Office of Consumer Affairs and Business Regulation 1:7524:5= .: 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC - Boston,MA 0211 BRIAN DENNISON !,Q 10 RESERVOIR ROAD u SMITHFIELD,.RI 02917 Undersecretary Without signature Y _ Commonwealth of Massachusetts t t Division of Professional Licensure Board of Building Regulations and Standards Constru.- l sn Supervisor , . CS-095707 _ pad;res: 09/08f2020 BRIAN D DENNISOIV e 8 BLACKWELL DRIVE CHARLTON MA -0 9507 , :4 r . IS..1 - ' Com, mssioner The Commonwealth ofhtlassaehusetts Department of Industrial Accidents I Congress Streets Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'ers'Compensation Insurance Affidavit*Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEItNII'ITLYG AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organiration/Individua():---_�Vtz h r►ti �O IA.} Address: j�se_r UDl r City/State/Zip:S M t-f�-&,Id t�- 1 OZQ l 7 Phone#: Are you an employer'Check the appropriate box: Type of project(repaired): �n 1. l am a employer with �'remployees(full and/or part-time).* 7. ❑New construction 2 am a solo proprietor or partnership and have no employees working far me in $; Remodeling any capacity[No workers'comp.inuuance requited] 3- I am a homeowner do' all work m t£ 9. ❑Demolition ❑ doing yse [No workers'comp.insurance required.]t 4.❑i am a homeowner and will be(tiring contractors to conduct all work on my pro". [will 10❑Wilding addition ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions Proprietors with no employees. ❑ 5.[31 am a general contractor and[have hired the sub-contractors listed on the attached sheet 12. Plumbing,repairs or additions ❑Roof repairs These sub-contractors have employees and have workers'comp.in 13.surance.t 6. We are a co ration and its officers have exercised their right14.[ the[ ❑1 A g 1(4),and we have no em to•ees urexemption per MGL c. P Y [NO workers'comp-insurance re4uire&] r'-p 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Hameowrters 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 dm ertities have employees. If the sub-coanctors have employees,they must provide their workers'ramp.policy number. I ant at engrloyer that is pro"ng workers'compensation insurance for my employees Below is the policy and fob site informoyon. /� Q Insurance Company.Name: r Q/W— (.O . O Policy#or Self-ins.Lic.#: UZA-,31,6' /02 YMy Expiration Date: L.O Job S ite Address: 5-2, e-* r ii L u fh!�.e-f u r►e 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 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 verifteation. I do hereby ce under the p ' penalties of pery'ury that the informaton provided above is true and correct i re: Date: 1 c} Phone#: Official use only: Do not write in this area,to be completed by city or town offcid City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Citylfown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#- ACOPR®W CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 16.� 1 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 CONTACT CoBiz Insurance, Inc.-CO NAME` 1401 Lawrence St., Ste. 1200 PHIl ONE 303-988-0446 aC No:303-988-0804 Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURERA:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURERB:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC.dba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 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 TYPE OF INSURANCE ADDL SU R . POLICY EFF CY EXP LTR POLICY NUMBER IMMIDQfYYYY1 (MMIMNYYYILIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/112019 1/1/2020 EACH OCCURRENCE $1,000,000 MA 0 CLAIMS-MADE a OCCUR DA PREMISES a occurrence $300.000 MED EXP(Any one person) $10,00o PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,0W,DDD X POLICY PRO- LOC PRODUCTS-COMP/OP AGG $2,OM.000 OTHER: $ A AUTOMOBIL.ELLABILITY CPA3156728 1/1/2019 1/1/2020 COMBINEDSINGLEUMIT a accident $1 0O0 0 0 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY r axidem AUTOS AUTOS ) $ NONLOWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident) $ $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$n $ B WORKERS COMPENSATION WCAM5872924 111/2019 1/1/2020 X ST TUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000.000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 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 A� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION I c3 0 I Map 1 `� Parcel I,I 010 Application # Health Division Date Issued CU Conservation Division Application Fee S Planning Dept. Permit Fee �Z�•-� Date Definitive Plan Approved by Planning Board Q�3hhl f� Historic - OKH _ Preservation/ Hyannis Project Street Address 1,UM I-J�l Village CgA4,ervr"lice. ` Owner LJcy- . Address_ Telephone Permit Request Fnn; y y' .secA vb,oP� 5_ -L ' TV Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total newt' Zoning District Flood Plain Groundwater Overlay tl Project Valuation &VD 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 Historic House: ❑Yes &o On Old King's Highway: ❑Yes Flo Basement Type: &<ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new 0 Number of Bedrooms: .3 existing ® new Total Room Count (not including baths): existing (0 new First Floor Room Count Heat Type and Fuel: ❑'Gas ❑ Oil ❑ Electric ❑ Other ' Central Air: ❑Yes ff No Fireplaces: Existing New 0 Existing wood/coal stove: 641ts ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ 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) Name Mark MacAl&_ �1 Telephone Number 6b9— -8-60 YG8 Address -P .Pi-' ,20 A,� License# c's 79�V OS7�Pr-e )14, f Home Improvement Contractor# / 3 71T Worker's Compensation # k S-® 8 7N 'JI-A-)79 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C�[1► � � SIGNATURE DATE / �� u ` 3 FOR OFFICIAL USE ONLY i> r .J APPLICATION# .5 4. DATE ISSUED ' ~MAP/PARCEL NO. ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION F FRAME INSULATION Y FIREPLACE ELECTRICAL: ROUGH FINAL ti w , { PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL'' FINAL BUILDING �c r DATE CLOSED OUT ASSOCIATION PLAN NO. } t -w 4�� The Commonwealth of Massachusetts ,r N; I Department of Industrial Accidents . Office of Investigations ;� 600 Washington Street ,� M 4 j Boston, MA 02111 r www.mass.gov/dia Workers'.Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ,3 J Name (Bus iness/0rganization/Individual): �{�- Gl �e/�js Address: ROCJ s o .9 S' Phone #: 6 Ci /State/Zi r, � S�c'T ��ty p: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with �' 4.'❑ I"I ain a general contractor and 6. ❑New onstruction employees (full and/or part-time).* have hired the sub-contractors 2. ❑ I•am a sole proprietor or partner- listed on the attached sheet, t emodeling ship and have no employees These.sub-contractors have S. .Demolition working for me in any capacity. workers' comp. insurance: 9. 0 Building add]tion [No workers' comp, insurance 5. ❑ ,We'are a corporation and its officers have exercised their 10.0Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL I I E Plumbing repairs.or additions myself. [No workers' comp. c. 152, §](4), and we have no 12.❑ Roof repairs insurance requiredJ t employees. [NO_workers' 1311.Other— comp. insurance required.] *Any 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. tContractors that check this box•must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurancefor my employees. Below is the policy andjob site . information. Insurance Company Name: Policy#or Self-ins. Lic. #: �(>�"m' �'��wYg—A-10 Expiration Date: Job Site.Address: 97;)-CA2T- � � �'� 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 a. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.06 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. 1 do hereby cert fy under e pains and pe alties o perjury that the information provided a ove is true:and correct. Signature: Date: 1 I Phone# !S__0. t y4k(a o 8 Fly. Do not write in this area, to be completed by city or town official . Permit/License# ity(circle one): alth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 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 not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority," Applicants Please fill out the workers' compensation affidavit completely;by checking the boxes that apply to your situation and, if necessary,supply sub-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 confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or ityou 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 (i.e. a dog license or permit to burn 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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-OS A Town of Barn-stable ` Regulatory Services uxxsrASLE, MIRg $ Thomas F. Geiler,Director ..wilding Division Tom Perry, Building Commissioner 200 Main Street,Hyanais, MA 02601 www.town.barnstable.ma.us Office; 508-862-4038 Fax` 508-790-6230 Property Owner Must Complete and Sign This Section If"Using A Builder /•• ll 1 as Owner of the subject.property b.ereby authorize /11'q2(� 1 I/4C./q-LL1 to act on my be,b-a f, M all matters relative to work authorized by this building permit application for. 1-14d)4- Addit s of Job) S6dture of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. t f�� own of Barnstable ray ` ' y� o Regulatory Services aAxxsntst e Thomas F. Geiler, Director MAIM 16 9. ,�� Building Division Prf° � Tom Perry, Building Comrrrissioner 200 Main'Street, Hyannis, MA_02601 vs Ww.town.barristable.ma.us Office: 508-862-4038 Fax: S08-790-6230 HO)I-EOFYNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village. "HOMEOWNER": name home phone#. work phone# CURRENT MAILING 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. DEFRTMON OF HOMEOWNER Persons)who owns a parcel of land on which be/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 constnlcts 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 100.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned "homeowner"certifies that,he/sbe understands the Town of Barnstable Building Department mum inspection procedures and requirements and that he/sbe will comply with said procedures and inim requirements. Signature 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. HOMXOWKERIS EXEMPTION .The Code states that: "Any homeowner performing work for which a building pm-rdt is required shall be exempt from the provisions of this sec6on.(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." lviany homeowners who use this rxcmption arc unaware that they arc assuring the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awarcncssoften 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 rrsponsibilitics 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/ccrtification for use in your community, im.ts..dchusctts Department of Public Satct� ' Board!of Building Re!-ulations and Standards £onstruction,Supervisor License License: CS 79358` MARK A MACALLISTER 64 EBENEZER RD ' OSTERVILL'E MA 02655 Expiration: 8/12/2012 ('unuuissiuncr Tr#: 907 ✓fie L�an�mzom�rie ✓vLavaac�ucJeb ; r f r License or registration:velid for indFv�dul use'only-, N Office oftiConsume�kAffairs&�usiness Regu ate before the expiration date. If found return to _ — HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Reguiatiep Registration\133744 AO Park Plaza-Suite 5170 Expiration-- 8/3/2011 Tr# 287245 Boston,MA 021,16 , Type RBA MACALLISTER BUILRING,F i MARK MACALLISTER " 64 EBENEZER ROAD. ---- OSTERVILLE,MA 02655:. Undersecretary. � Not valid without signature , AW TRAVELE RS J WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6KUB-0187N49*A-10) RENEWAL OF (6KUB-0187N49-A-09) INSURER: THE TRAVELERS. INDEMNITY COMPANY NCCI CO CODE: 11347 1. • INSURED: 1 PRODUCER: MACALLISTER BUILDING LLC FAIR INS AGCY 64 EBENEZER ROAD 619 MAIN STREET OSTERVILLE MA 02655 P 0 BOX 430 CENTERVILLE MA 02632 Insured is A LIMITED LIABILITY COMPANY Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 03-01 -10 tO 03-01 -11 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in "= item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit; o= Bodily Injury by Disease: $ 100000 Each Employee �= C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if.any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC .20 03 06A � - I D. This policy includes these endorsements and schedules. o= SEE LISTING OF ENDORSEMENTS EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating LL� Plans. All required information is subject-to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 03-1 1 -1 0 WC ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODl10ER: FAIR INS AGCY 2GJ8J s Towner Ba-rn o st abI e P� �t Expires 6 months from issue ate Regulatory Services Fee Thomas F.Geiler,Director Building.Division i 1 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA.02601 www.town.barwtable.rna.us Office: 508-862AO38 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION -- RkSIDENTL L ONLY Not Valid without Red X-Press Imprint Map/parcel Number. Property Address �`' .0 `� Li*zf'+ Ln Q(L k i I I dResidential Value of Work J �C DOMinimum fee of$25.00 for work under$6000.00 Owner's Name&Address J;(�Tyana Gunn cwr. Iuh r 1 oe-, Contractor's Name 1\J --,� 01UTL0 Telephone Number q Home Improvement Contractor License#(if applicable) 1 I Construction Supervisor's License#(if applicable)' • II ❑Workman's Compensation Insurance -PRESS PERMIT CheVIk one: ama sole proprietor l��v Z�Q El am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE � Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) R'**'Re-roof(stripping old shingles) All constriction debris will be taken to ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *%cre required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.I3i�cQn ,'Cq�servation,.ete.- ***Note: P perry Own r must si Property Owner Letter of Permission. copy f/ e H e ovement Contractors License is required. SIGNATURE I E=f ci r { 4 t3 J L Q:Forms:expmtrg1 Revise061306 - The Commonwealth of Massachusetts Department oflndustrialAecidents Office af-I"nvestigations 600'Washington Street Boston,MA 0211-1 www,rn ass•gov/dia Workers'Compensation Insurance_Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �- Address: City/State/Zip: (��� � 0al u O Phone.#: 190 4 u0 . Are you an employer. Check the appropriate box: . 4. I ELM a general [7E project(required):. 1.❑ I am a employer with ❑ g rat contractor and r �loyees (full and/or part-time ,* have hired the gab-contractorsew construction . 2.�as Ole proprietor or partner- listed on the attached sheet; 'Elmodeling ship and have no employees These sub-contractors have molition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp-insurance,$' ilding addition required.] 5. C7 We are a corporation and its ectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their mbing repairs or additionsamysel£ [No workers' comp. right of exemption per MGLinsurance required•]t c. 152, §1(4),and we have no of repairsemployees. [No workers' er comp,insurance required.] , "Any applicant that checks box#1 must also fill out the section below sbowing their workers'campcosation policy infarmation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContract=that check this box must attached on additionalshret sbowing the;name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors lave employees,they must pravidC their workem'comp.policy number. .Tam 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/StateMp: 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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of 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 WA for insurance coverage verification. I do hereb certify r t e p 'ns and penalties of perjury that the information provided a ove i true and correct Sienature: i (� •�� � • Date: 1 v Phone #: 1 FOther only. Da not write in this area,'to be completed by city or town aciaL n: Permit/License# hority(circle one): M Health 2.Building Department 3.City/Town Clerk 4;Electrical Inspector S.Plumbim,Inspector son: Phone#: • `-h�oOHE� y� : Town of Barnstable. . Regulatory Services YARNSTAELE, y MASS. Thomas F.Geller,Director sd � A,fD�u.�A1 Building Division Tom Perry,.Building Commissioner 200 Main Street, Hyannis,MA 02601 w-nvAo wn.b arhstabl e.ma.us Office: 508-862AO3 8 Fax: 508--790-6230 , Property Owner Must, Complete and Sign This Section Tf Using A Builder 7, k*qm Gu o un , as (?weer of the subject ro e P 1? nY herebyauthorize qtw�s to act on my behalf, in all matters relative to work authorized bythis building permit application for: (Address off ob) Signature of Owner Date Print Name QTORMS:OWNERPERMISS ION �'!e:-PomUnwmu�eall�x a�✓�aaaac/zecae%Za Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registmf q*n-:___1-24310 Board of Building Regulations and Standards Expirattori 6/`12009 Tr# 130873 One Ashburton Place Rm 1301 r Types individual Boston,Ma.02108 James Curley ='_ James Curley 287 Fuller Rd. Centerville,MA 02632 Administrator Not valid without re i �• Massachusetts.- Department of Public Safety � MM Board of Buildin Regulations and Standards Construction Supervisor Specialty License License: CS SL 99138 Restricted to:. RF VpS JAMES CURLEY 287 FULLER ROAD.. � CENTERVILLE, MA 02632 I i Expiration: 1/28/2012 Cunmissiuner Tr#: 99138 ti , t , r. TOWN OF.BARNSTABLE Permit No. __-___2-4417 Building Inspector Cash _----____-- OCCUPANCY ' 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 Bayside Building Cp.,# ZnC. Address lot #27 52. Captain lArlbert's Z-qne, Centerville J � Wiring Inspector ! .� Inspection date Plumbing 1nspecto1�/(2/-4,,.,�(4 Inspection date Gas Inspector ��n 1� f- +�R Inspection date b Nov 8-2— JV�ngineering Department �i/.EDIT0, 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_.....,... .......r. ................Building ..Inspector ...._�.......�.......__ Q el< ASseSSDP'S_map and lot number . .....,. ` '/..... Of THE TO Sewage Permit number" .'.s,?. - ...... ........... d� o� s • > BARNSTABLE i House-Number .................. ......... . �`�... ................. ..... s �� S:JBJECT `ro qP�'"I'iVr�l,. SEPTIC SYSTEM-M- }bar.a�e� �3LE � � �t COrPLiAART O W NOEoRA�;R N S TKUL91TLE � 5 ,* ENVIRONMENTAL CODE AND . BUILDING •I�NSPE�CTO s APPLICATION, FOR PERMIT TO j. ✓� :.` . . .t,)1.�`�G..4? ... ��`: .�y. � (.: ........... TYPE OF CONSTRUCTION .a..a. ....� �?'?.�.......................... . .. ......... .. ,.. .. ... ........ ...... :..f ... 19..�{...L�-- TO THE INSPECTOR OF BUILDINGS: 3 The undersigned,hereby applies for a perms according to the follow'ng info mation: Location .. r�....... . J � GL . . '�'!'.1.... Proposed Use .N... A/I< .. .; � .... .............. .... .................................... ................... . . . . .. . . . . . n Zoning District . ��......r.r 'ten, ..Fire District �. Name, Owner .. .: . .�... .�. :),;•. .....Address . .� �1/ LK. ... ............. .�. Name of Builder' ........ �.. . .................................Address ... ..1 r ...........................Name of Architect 121k... ...... � �� i.144.......Address ......: ............... ................. ............ Number of Rooms .:..... ......:...................:.....................Foundation .. ...................... - / ,may � Exterior C / -. 1.f` ' .SP....................:........................Roofing ............... .... ��j yt Floors .. .. / :4/. ...................Iriterior •:`Y•• .. X . .1���rj�5?� .. _ �/ Heating ll.�.. lV ............:...........................Plumbing ..........��.. �.....0 'ems f. Fireplace ......... ....�� ........ �I��.....................................................Approximate Cost ... ......./................... _ Definitive.Plan Approved by Planning Board -- -----------19--- Area Diagram of Lot and Building with Dimensions Fee .....�J�/,, . C/• SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS [.hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardi t above construction. j{G� Name ............... ...... .. . ... ....1��... .. . . ............. BAYSIDE BUILDING CO. INC. No 2447 Pqmit for One...Story .... .. .. ....... ... .... .... ...,FamilyD .l.li .g .n.. .....w..e.. .... .. ................ Location ,,,Lot #27, 52 Captain Lumb ert Lane............................................................. CCenterville........... ........................................................... Owner .....Bayside Building Co.. Inc. ................................................. .......... Type,41of Frame Construction ...... ............ ................................................................... Plot .......................... Lot ................................. October 6. 82 Permit Granted ........................................19 Date of Inspection ...........................19 ......................... 1,9 Date Completed .. .... Assessor's map and lot number 10.te ./-X. ...1f �•/� Bpi'THE T��♦ r P Sewage Permit number '. .. �. .c�.� d`� °,► r•e �� BAHd9TA8LE '-louse number 039 a �NORd�� TOWN OF BARNSTABLE BUILDING INSPECTOR era, APPLICATION FOR PERMIT TO ... 1 rT C ,."`.`.........5 . ... TYPE OF CONSTRUCTION ...: .......................................................... ............. A.. Z4 .rz TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following infoormation:. u. Location 1,i� .. ... ......... . ...:.......... ..................... ...! Z' .. :! " ..... ?�>>. Proposed Use /!. ,�. .. .< -- .......... ... Zoning District ..............r..:l .. ......Fire District ?t...........:.......................... ,.... ............� .......... ...... .. ...... Name of Owner ./,L -.��.'.. Address . . Name of Builder ..........r�..,4 �...... Address ... . k��� ........................:.......:.................. Name of Architect G.. .. L:�f "• it ........Address .......!. :r ........................................................... Number of Rooms .......... ..�....:......................................... Foundation .. L -z�'(—�Yl�f/1 D,Z:. 11 ..... I / .....:..:Roo fin G.. 0 J�?l-/.,,., Exterior �Q1�. .'.`.`���X..:�.�.................................. g ...:......:.:.......��:.... �. ..�.. ........... .......... r Floors . �.....r?` 4 ?.,1....<.-... (.:..f/.. ................:.Interior fiO` .sou %„L ?SZ .. Heating .....................................Plumbing ..•1✓Gf,,,� ...........':7 ":.?.. �.." !. { e.✓ Fireplace ... a!`5........� .. .........................................�!fJ ` Approximate Cost .���. I, ,. . ........... v Definitive Plan Approved by Planning Board '---r' ----------19--- Area . Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH � L . J I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable .regarding t a e above construction. Name Al BAYSIDE BUILDING' C� INC. A=147-11 0/0 24437' One Story No .......?r......... permit for .................................... ...Dwa1djxjg!!........... Location Xigt;...A.V. .....5.2....Q.4V..ta-ia..Lumber'L-- Ln. Centerville ............................................................................... B��yside Build.- Owner ..... ...........................199...QQ..... Type of Construction ..Fxame........................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .....,October.. ....6.z........19 82 ....... .... Date of Inspection ....................................19 Date Completed ......................................19 owltvc Xx } y,. p i , "' D � 'O I `• boo r���-=•" �; I ' y^ X/ �7 ' ' 'F 1 O i �V! r o _ �,E 5- 9oI Ab i ? , I Z 10' SIDE F- \� CERTI IED PLOT PLAN ! L D T 7 G�P l.L_u rl? �i. ,�.T !A A,'`. tA OF Al CE o IN SCA1.E DATE ►/01,11I 2 o sum DREDGE EN AYs�v�. I ;CE9tYIFY THAT TNEn'�'��b� CLIENT SHOWN ON THIS PLAN IS LOCAT.n EOISTERED REt31STER� . 8,/Z 23 ON THE GROUND AS INDICATED AN1,.. . CIVIL LAND d®� .,� ENGINEER SURVEYOR �.®Ya: CONFORMS TO THE .�OIdIWO LASS ,. C L®Y® vl.k'• . OF IDARNSTA ",ASS. T 1 2 M A I N STREET I ohrt !L j_.. - '_ ._,� :• __ N YA N R I S, MASS, �g�gE`�.,,�,pp� DATE � - ®: LAND 9URVEYM ..._.. . d ' } t # s i n"' � . 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