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I 4M i.I N I I 11 � 1�,`, , �,,.���,.,,,,,,,���L�,���.'�.'�.'�.'�........i";,-, " ,2�' "I'll,� - i,P�,',,,�!-mi§-�iPqg", � , �� 41, - lo,,,�o-'�,�,�IL's,�i'st�����;�,,�� ii, " , , A 'if �,i� ;W �"�,i,if,g,� ,� ,k� ,.'� ,�.� 41.'ilifr,044`�`� s , �� , -- - I , L . � , , AR - - Application numb .... .....Z.............. .....l../..(.J Q� Fee ........�7�'.....�...� ...... .................. ' Building Inspectors Initials......... ..... .................... Date Issued............... .. :..1................................ 16 Map/Parcel.....: k..G. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: f ROOF/SIDING/WINDOWS/DOORS/TENTS%STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: NUMBER STREET VILLAGE ' Owner's Name: ��Yh /&104,,.4 r'gC Phone Number , 10 3 5,� 1 I Address: / ve f �°/-u/Cell Phone Number Email Addr . C 14 y Project cost'$ Check one Residential• Commercial. , a OWNER'S AUTHORIZATION ' As owner of the above property I hereby authorize to make application for building permit in accordance mith 780 CMR Owner Signature: Date: .TYPE OF WORK ❑ Siding (Windows-(no,header change)# 2 `Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review. ❑ Roof(not applying more than 1 layer of shingles) _ Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN 'I A;HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION.NUMBER.........................................f;........I........ 4 *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No es lease attach floor plan with exits marked �y P P ) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event 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 Fuel source being used LP tank 20 lbs. or>Yes No____, if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. , 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: i k"w7_4i y #-,,,ne 4 Telephone Number G3 l S6�� 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 APPLICANT'S SIGNATURE Signature--- Date All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 461 Please Print Legibly Name(Business/Organization/Individual): T-7, rtC ✓✓✓ �� _ Address: City/State/Zip: Cep fC�✓!I/c ;/!'�,� 0 _7Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance.: . e area corporation and its 10.❑Electrical repairs or additions required.]__ — 5 W ❑ � ti . 3:{�I am-a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify underthe pains and penalties ofperjury that the information provided above is true and correct~ Signature I Date: 4 ph on f#: ,Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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-contractor(s)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 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.permittlicense 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 Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia . Town of Barnstable a"'u. th'�`;�' Building 00, : ;.� - .[m, .:- ,,<;,L �..n: 'n ::✓�'S yS .:�:�.�+"5°.. �� � �x:>, � aq.-">ss i Post This Cartl So Thatrts Visible From" heffiStreetA ` roved"Plaris`IVlust be Retained onJob;and, is.Card.Mufit,be Ke t PP P � S Per p � - 1635►. � . @..x`� �' � �,�`;'�s,��<..:: .. ;;', S L �::.i � �?.:a.,..k+�` 5,,� a �°- .,eta y..�'3.. ,.a�," � >'`i �.,.::.;y � a u yam l l ,!,trod• Where a,Certificate of Occu anc; is Re wired,such Bulldm shall NotabexOccu ied "until a;Finalslns 'ection has been,made 1 ilj �:•:.F;.:e.k w�.:::� �. :;,... ,,��.r w. .,�.p,�_,�.,:y Y �,�q ..... >,.:. <:�s,�.-:::„�,g�>: ...,.,;. ,._..x. ::: .P . :z:,.,��,,, .�xa� .�,,. .. ..P�....,.�:_ .-.. .._.,.�.�u..�..,�.o,n � .{ Permit No. B-2016-0195 Applicant Name: E.F.WINSLOW Map/Lot: 168_008_008 Date Issued: 02/01/2016 Current Use: 1010 Zoning District: RC Permit Type: Addition/Alteration-Residential Expiration Date: 08/01/2016 Contractor Name: DAVID ANDERSON Location: 74 CARRIE LEE'S WAY,CENTERVILLE Est. Project Cost $ 10,000.00 Contractor License: 132379 Owner on Record: COTE,PALMA P&RICKER,ROBIN A TRS s Permit Fee $101.00 Address: 74 CARRIE LEE'S WAY „Fee Paid-, $ 101.00 CENTERVILLE , MA 02632 Date;;;2/1/2016 Description: EXPAND EXISTING LAUNDRY& MUDROOM INTO EXISTING'INTERIOR GARAGE SPACE(ATTACHED)ADD AWNING Iu Project Review Req g Building Official This permit shall be deemed abandoned and invalid unless the work authonzed by this permit;is comrrienced within six months after issuance. All work authorized by this permit shall conform to the approved applicationxand the°approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws a,nd codes. - This permit shall be displayed in a location clearly visible from access nd shall be maintained open for�pq_Jjp inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are providedron this permit. Minimum of Five Call Inspections Required for All Construction Work M• 1.Foundation or Footing 2.Sheathing Inspection - 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed w 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection„ 5.Prior to Covering Structural Members(Frame Inspection) 6.'Insulation d 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �044p V Map Parcel C�� N Application #� Ca Health Division Jq/{/j ©��� Date Issued 2,711, Conservation Division d T01VIVOF Application Fe` Planning Dept. egR�STgt4 Permit Fee �� D Date Definitive Plan Approved by Planning Board �E Historic - OKH _ Preservation/ Hyannis Project StreeAddress Village ^e'- .c. - . / �,I�.yiL/"�c Owner l�l c� a/ 1 Address p r ���/ & e Telephone e 0 �7 � Permit Request ,�}, t4vu T .Ga "Omlo a�IA 4;1,1 Square feet: 1 st floor: existing proposed 2nd floor: existing !�Proposed .------Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ® 4 Construction Type �� e Lot Size 06 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure A, Historic House: ❑Yes o On Old King's Highway: ❑Yes o Basement Type: ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) J9, Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new � Half: existing new Number of Bedrooms: xisting'��< Total Room Count (not including baths): existing �new First Floor Room Count Heat Type and Fuel<9P ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New V Existing wood/coal stove: ❑Ye No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garag �existing> new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals //Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes p16 If yes, site plan review# Current Use �[[ �; � Proposed Use APPLICANT INFORMATION (BUILDER.OR HOMEOWNER) Name %,A s> Telephone Number" Address License # Home Improvement Contractor# ��� Emailtc . rCiGd lL _: ie�s� ° orker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � SIGNATURE - TE Z 1401 s FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE f . OWNER I DATE OF INSPECTION: FOUNDATION FRAMEILG� INSULATION 0zja& r FIREPLACE ELECTRICAL: ROUGH FINAL F PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �. 1/4/2016 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 endorsements. PRODUCER CONTACT NAME: Rogers&Gray Ins.-Dennis Branch PHONE 508-398-7980 FAX 877-816-2156 434 Rte 134 E-MAIL South Dennis MA 02660 mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Hanover Insurance Com an INSURED EFWINSL-01 INSURERB:Allmerica Financial Benefit Insuran 41840 E F Winslow Plumbing&Heating, Inc. INSURER C:Arrow Mutual 8 Reardon Circle South Yarmouth MA 02664 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1857217023 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 R 0 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 ADDLSUBK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDVYYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY ZBNA787020 12/1/2015 12/1/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO RENT D CLAIMS-MADE X OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY 1 JE 0 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY AWNA787096 12/1/2015 12/1/2016 COMBINED SINGL IT $ Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED Per accident X HIRED AUTOS X AUTOS PROPERTY DA AGE AUTOS $ $ A X UMBRELLA LIAB X OCCUR UHNA787022 12/1/2015 12/1/2016 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED I X I RETENTION$10,000 $ C WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N 182�A 1/1/2016 1/1/2017 X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a N/A E.L.EACH ACCIDENT $500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Plumbing&Heating Contractor Central Vacuum is a division of E F Winslow Plumbing&Heating Inc. Certificate holder is an additional insured with respect to general liability when required in a written contract or agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF BARNSTABLE ACCORDANCE WITH THE POLICY PROVISIONS. 200 MAIN STREET HYANNIS MA 02601 au ED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i Pig!-t n of BanistAble ' 6Vli'}kYti`..SF���i J'Ftf.'1��-�iai7c�fay.ilSG'l���l ' . � ff�q-y'4.f�3�i��Yax3xs'Iy�1332:kuu'G.3'tG n il,� mr,Ztr, ,F� Fv„t, ;.�a .sr^_3Z}; ?c✓:C2 ]:-? � 31317 4*rr;iJ�:�zt?to 4':U:'t palmzydb d-js[7a ifl:agpcn pit: t i-- afox: t c >s trfgfs17� �r;�yli m be Slid orz� i���E,e�,���e��r�Ts iz�s��P;� a.s'� a�� M " uarIn f0 of C)-,-rrX sipmuta of.A.z�pimm (921e Way Mantvealflz n191fil-11aclasetGr ice of Consumer Affairs&Business Regulation License or registration valid for individul use only , ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: g Office of Consumer Affairs and Business Regulation =Registration: 132379 Type: 1.0 Park Plaza-Suite 5170 Expiration: 1/18/'2017 Supplement Curd Boston.,MA 02116 :,P r E.F.PLUMBING&HEATING CO.,INC DAVID ANDERSON 8 REARDON CIRCLE �:�err z;•r<= ,,'' _ � - SOUTH YARMOUTH, MA 02664 Undersecretary Not valid without signature Board of, Building Regulations aind Stand"a4rds Construction supe1-visor �. tii..i_.l..S. �•• 41, SO DENNIS MA.0266.01 s � Expiration Commissioner 09/10/2016 r i .�....r�t �' t T2 a �.�' 1 � �... ,{ /�.�t IR �� �`�• � �. e l'IF 1 .. tf1. n c 4 ., R LL Ilk Ir 13, � k� c.—t�—. ..•--t-off,����r.-: � ,�. - i` 7-1 Lk I t I. 1t ti� wrrYv � �' r®rrray..r..'xar� iT i tr'- 1: 1. 1 1° i It } 1 t ww: I LLJ View-With Dimensions PROP 3D �#��. Am 77 Al �� Wit' F�""' r..-..:. �- � •,. ,a�as,�w ��_^'" w�'""q n"" u-".. ,�..g.w+.u� ,...," `,.e< r. aew»..ri�° `..,1�#..._.t* $�»d'''+::.. ,�� � f r' }1 We. .3, ,4. i':�"''�R• R"f^:yea, we..q. +m�''-- ''+-e.ar�. ...:-_.� .ra+.�r- w: °�:. ^..�.SR^Ca s, .w.; �_�'4. n'��aa ryS "4x'"'C 'A�.:..k'., a•.�f�^^_. .,y+_�,��3.. 'r u "�N.x+�+a.P^.».. '�'^.�e.�,ti 44 2015-1.2-03-1.437 12/29/201.5 Page: 3 i 271e Com11101ritvealth of-Vassachusetts , Depa.ranewt o btdrrstrial Accideras l—cc of nt�estigaiions F 600 Washington Street r Boston,-41A 02111 tt im-n nass.govIdia Mrarkers' Coffipensatian Insurance Affidavit-Buildei-slContractorst'EIectricianslPlu nbers Applicant Information Please Print Legibly I'V acne3usQaetrganiz3tianlLn�rz*«1�,a�)= Address: ' Cityf tatel ig_ Phone� � Are a an employer?Cliec1�the appropriate box: Type of project(required): 1_ am a employer with, 4. 1 am a general contractor and I employees(full atldlor- have hired.the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7_ euaodeling ship and have no employees. 'These smb-contractors have g- �Demolition ' wodring for me in any capacity. employees and have workers [No workers'comp.insurance comp- nsurant?e_f ' 9.•❑Building additial - required_] 5- ❑ ;We.are a corporation and its 10- ectrical repairs or additions 3.❑ I am a h,omeoumer doing all work oft,have exercised their. 11. ` lumbingrepairs or additions myself[No workers'comp- right of exemption per MGL' 12'D Roof repairs insurance required..]` c.1,52,§l(4X andwe have no ' employees.[No Workers' Ili Other comp-insurance required_] *Any applicn tfiatchedcsboxiEltmustalsofilloutthesectionbelowshnWingtheirworker'compensationpolicyinformarian- Homeowners who submit tfiis affidavit indicating they am doing all want and then Ilse outside contractors amst submit a new affidavit indicating satin fCantractorsftt eheck ibis box must attached anadditional sheet shoaling the name of the sub-cwh clors and state whether or not those enridieshame employees.I€the sub-cont zctors have employees,they mnstpravride"their worken'comp.pelicy number. I am art eiitpZco,er tleat isproizdrrrg it�orke-rs'con-gwisaiiort irmirancefor Sriy enipLayees Below is tlto policy and job s&e information. Insurance Company Name.-AaAW2 ' Policy 4 or Self-ins..Lic_9: RkpirationDate: j y� Job Site Address: City/StatelZip:C r� ��•e"!'�� /NA Affach a copy of the workers'compensationpolicy declare n page(showing the policy number and respiration date), Failure to secure coverage as required under Section 25A of MGL c- 152 can lead to the imposition of rr. inal penalties of a fine up to$1,500 00 andfor one-year imprisonment,as well as chil 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verifcation I do kereb - t!�er the �zs aztdpezzab es ofpeduty tlrattlte infornzati nprmzd�dabbmv.� E azt correct Sitature: Date: ! 1 Zg�-a Phone i official use"Only. Do ztat asrke in this area,to be.cainpreted by city ortotrlr of j4ciaL'" City or Timm: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector '6.Other Contact Person: Phone 9: J . Information and Instruction Massachusetts General Laws chapter 152 requires all employers'to provide workers'compensation for their employees. pmmuantto this statute,an employee is defined as-"-.every person in the service of another under any contract of hire, express or iarplied,oral or written." An employer•is defined as"an individual,partaership,association,corporation or other Iegal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the Iegal representatives of a deceased employer,or the receiver or trustee of as mdividnA 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 bolding 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 arsarance,coverage required." Additionally,MGTL chapter 152, §25C(7)states"Neither the commonwealth nor auy of ifs-poIitical'subdivlsions shall enter into any contract for the perfomiaace ofpublic work until acceptable evidence;of compliance vt th the insurance.. c ter have been resented to the contracting authority-" R requirements of iisrs hap p - Appficamts � Please fill out the worker'compensation affidavit completely,by checking$e boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(en)and phone number(s) along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partaers,are not required to carry workers' compensation ins[Trance. If an LLC or LLP does have employees, a policy is r(-, i ed. B e advised that this affidayit maybe submitted to the Department of Industrial Accidents for conismaiion of i m ce coverage. Also be sure to sign and date the affidavit The affidavit should be ret=e;d.to the city or town that the application for the permit or license is being requested,not the Department of Induustrial Accidents. Should YOU have any questions regarding the law or ifyou are required to obtain a worker' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-ir,mance license number on the appropriate line. City or Town Officials f Please be sure that the affidavit is complete and printed legibly. Tie 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 pemrit(license number which will be used as a reference number. In addition, an applicant th7t must submit multiple permit/license applications in any given year,need only submit,one affidavit indicating current policy information Cif necessary)and under"Job Site.Address"the applicant sho77ld write"all locations in. ( 'br town)_"A copy of the-affidavit that has beta officially stamped or marked by the city or town maybe 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 vent Te (i.e. a dog license or permit to bum leaves etc.)said person is NOT mquded to complete this affidavit The Office of Investigations would at 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. Thu CGMMQaVjaan-of Massa chns-tM ' gegaztmtnt of Iliclustdal Accidents Gfuce of f mesdgatio�a CG4 wasbiyoou Stcret �a�Gns I�fA��111 - T(,-L 4 617 727-49QO i)t 4€6 or 1,3- MASSAFE Fay#617 727-7749 Revised 42407 v, ;tw.mass-govfdia i ' m in Hj�Ih 9rzd Areas:I10 iri h T-Yt ud Zarze Wood orrsirur�io as C de to k3�C Crur �A� Massachusefts Checklist for CoMpDance (7s0 CKR P1 Ch=k _ ComPBanco 1.1 SCOPE. Wind Speed{3 sec_ 10 mph Wind Exposure Category-_____�_____-__-__ --,_--------__B Wind Exposure Category.................Engineering Required For Entire Project.......................................0 12 APPLICABILITY -Number of Stories(a roof which exceeds B in 12 slope shah be considered a story) stories 5 2 sbries Roof Pilch :512-12 Mean Roof Height y (Fig2}_--------�_.__.:: Bulding Width,W__ - - ----- --_--(F9 3)--- -;_=-- =----_-----—ft c BO' Building Le�igth,L ,: .__--_------= ---(Fg 3) BO' Building Aspect Ratio(lNJ} .._._ _�_-_-- ----_-(Fig 4} __- _ <_3:1 _. - -- Nominal Height of Tallest Dpening2 '__'----•-_------ 1.3 FRAMING CONNECTIONS General compliance with framing connedDris__...------ - (Table 2)---------------------------.:__-_.__.___ 21 FOUNDATION ' Foundation Walls meeting requirements of 780 CMR 5404.1 Conte-•- -•- .......................... . ........................................................... -............. Concrete Masonry 22 ANCHORAGE TO FOUNDATIONt� µ 518`Anchor Bolts4mbedded or SIB'Proprietary Mechanical Anchors as an alternative in concrete only , Bolt Spacing-9eneral•-••---•----•-•--•••-•- ___--•(Tab{e4)._-___._---. in_ Bolt Spaciig from endTomt of plate (Fig Bolt Embedment- (Fig 5).___-- Bolt Embedment-masonry...... -__.__-__.--_(Fg 5)_.__:---=---_________________--- irL?15' -------(Fig 5) __.__—_ ?3`x 3`x Y.` 3.1 FLOORS - Floorframing member spans checlmd 7B0 CMR Chapter 55)_-_•-_------__.____N. , Maximum Floor D'pening Dimension-.--•-----------fig 6) ---=-- = -------•------•—ft:9 12' ' Full Height Wall Studs at Floor Openings less than T from Exterior Wall(Fig 6)--------------------.................... Maximum Floor Joist Setbacks Suppoiling Laadbearing Waifs or She'awaIlL k _____(1=ig 7)._.-_---_-•-- ---•----.-______—ft 5 d Maximum Cantilevered Floor Joists - i Supporfing Laadbearing Walls or Shearw'all__'. _.(Fig B) - -- ft`d -FloorBracing at Endwalls-....._. _... _._ __.__(Fig 9)___—_-•----_-_.. �__-- _--•- Floor Sheathing Type :_ __ - -. . - (per7BO CMR CFiapter 55) -= - Floor She�athlng Thicimess __ (per 730 GMR Chapter 55)_ _ .. in_ C`+ ,• Floor Sheathing Fastening 2)- d nails at . in edge/=in field , 4-1 WALLS ' Wall Height Loadbearing -(Fig In and Table 5) ft 510' Nott-Loadbearing Walls 10 and Table 5)_-__.__.:.--- _ ft5 ZD' Wall Stud Spacing ----_---- _.. _-(Fg 10 and Table 5)_-_�._._-.—ln__<24`o.c_ Wall Story Offsets ___._,__•---_-_.._-__�____ _.----_.__-__ ft d ' 4-2 EXZERI OR-WALLS' Wood Studs fc;adbearingNirafls____:---•-•--•_-• bl _ Non-Laadbear ing walls.__.__.-_____-•---:... _._.__:(Table Gable End Waal Braang — — Full Height Endwail Studs...-_.-._:_.__,_--•-___(Fig 10}_, ---:____.., _�__...------•----__;-. WSP Af1ic Floor Length ___._:--:----- Gypsum Calling Length(tf WSP not used)-__-------_--:(Fig 11)— -_.----_.._-_____ ft z 0.9W and 2 x4 Coniinvous Lateral Brace @ B ft:a.r;_(Fig li)....:................._..... - _-- ---_-_:- ' 'or 1 x 3 mTrng furring strips @ 1 T spacing-min.wl h 2 x 4 blocking @ 4 ft_spacing in end joist or truss bays Double Top Plat= = SpFjm Length --- -- _---•----------(H9 13and Table SpCrcR Connection(no,of 16d common naffs)_______(Cable 6)__---__.._-- -.___--.__:-_ — X FVC Guide fo f-Yood Cansfrzrrfion hz li igh Wlad Areas: II D fnph TYr_nd Zo1Le ' Massachusetts Checklist for COMPEaHCe(rso c�1Rs3ol.� Loadbearing Wail Connections - Lateral (no.of 16d common naffs)__--:----._.-_----_.- (Tables 7)__-_,---------•---_._-..------: Non-Loadbearing Wall Conner ions Lateral(no_of 16d common nails)__-_____.._-----(Table 8)-..... --______------_---_•------------ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans -• able 9 < Siff Plate Spans ----------- -----_-_(Table 9) Full Height Studs (no. of studs)------------______--------(Table 9)---------------------._..._. --- Non4.oad Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Headef Spans__-_----_----- (Table 9)___.____--_-_-_--_--.._ft. in__<12, Sill Plate Spans_._. (fable 9)-__--- -----.-..—ft_in _<12' Full Height Studs (no.of studs)-- ------_---_-(Table 9)--------____-------_________.__---_-__-- adarior Wall Sheathing to Resist Upldt and Sheaf Simulfaneousiy4 Minimum Building Dimension,W Nominal Height of Tallest Openingz -•-_-----•------_--- ...... 6`8' Sheathing - Edge Nail Spacing_�--------- (Table 10 or note 4 if in_ Feld Nail Sparing-_.-------_--------_--_--.._.(fable 10)-_---------------------_-.-. in. Shear Connection(no.of 16d common nails)(Table 1 _____---------------------------------__ Percent Full-Height Sheathing.____--__________(Table 10)___-._-____---_----------_-------------_% 5%Additional Sheathing for Wa11 with Opening>.6'8"(Design Concepts)--_____ Maximum Building Dimension,L _ Nominal Height of Tallest Dpening2___....___-................................................... _______<6'8 ` Sheathing TYPe---_-__--- --- - .(note 4) -- -------------------------- Edge Nail Sparing _ able 11 or note 4 if less Feld Nail Spacing-----__-_—__..__._ _._.__:_(l-able 11)________---,---------_---_---:------- in. Shear Connection(no. of 16d common nails)(Table 11)___.___ — Percent FulkHeight Sheathing—,___(fable 11)___.------_�_ 5%Additional Sheathing for Wall wrlh'Dpening>6'8'(Design Concepts)-,_-___ --- Wait Cladding Ratedfor Wind Speed?-----•---- __.-__-_.._.-._-..____. .__.__---•--_—-----------_-__ f-1 ROOFS Roof framing memberr spans checked?_________-•..(For Rafters use AWC Span Tool,see BBRS Website) Ro6f Overhang ------_------------------------------------------(Figure 19)____:,___-- ft s smaller of 2`or U3 Truss or Rafter Connections at L.oadbearing Walls Proprietary Connectors --•(Table 12) :------------------------ U= ptf Lateral- ----------------------------------gable 12)-------------- --- - __ L= plf 12)----------__ - ------S= P - Ridge Strap Connections,if collar ties not used per page 21.- (Table 13)__------�____._..____ .T= plf Gable Rake Outlooker-----------------w---_......_----_ -(1=figure 2D)..__.-•_-- ff<smanero_f2'or L12 Truss or Rafter Connections at Non-L oadbebAng Walls Proprietary Connectors Uplift___--:------_._......---.--.(Table14) U= lb. Lateral(no_of i6d common nails)__,(Table 14)_____________________________________L= . lb_ Roof sheathing Type_-___•------_---------_------(per 7B0 CMR Chapters 58 and 59)............. Roof Sheathing Thickness _in_?7/16`WSP Roof Sheathing Fastening-_..._.-_r:-_-_.-•_--__.(fable 2)__•-_---_--------_--•-- - ---•---___-- Notes: •1. This checklist shall be met in its entirety,excluding the specific exception noted in 2, to comply with the naquire.rnents of 780 CMR-5301.2.1.1 Item I. ff the checklist is met in its entirety then the following metal straps and hold downs am not required per the WFCM 110 mph Guide: a_ Steel Straps per Figure 5 b. 20 Gage Straps per Figure i 1 c_ Uprft Straps per Figure 14 d_ Alt Straps per Figure 17 e. Comer Stud Hold Downs per Figure laa and Figure 18b 2 'Exception:Opening heights of up to 8 ft shall be permitted when 5%is added to the percent full-height sheathing requirements shoe in Tables 10 and 11. 3_ The bottom sUf plate in extarior walls shall be a minimum 2 in_nominal Na kness pressure treated�2_grade. .r. AFVC Gi de to iYood Construction hi Ri,�h 11,72rzdAreas_ II0 mph f rrdZane Massachusetts Checklist for Compliance(790 CNIR 4. - a. From Tables 11)and 11 and location of wail sheathing and Bulling Aspect Rafior determine Percept Futl-Height Sheathing and Mal Spacing requirements b. Wood Stnuethral Panels shall be minimum thickness of 7116'and be installed as follows: L Panels shall be hstalled'Wb strength;M' parallel to studs. I All horbmnfal joints shall oc=over and be nailed to framing. uL On single stD y mnstruc iDn,panels shall be attached to bottom plates and top member of the double top pthtp—, iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel Upper attachment of lower panel shall be made to band joist and lower attachment made tD lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists,and girders shall-be a double row of Bd staggered at 3 inches on center per figures below-Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection:a),new house or horizontal addition—required if projed'is i mile or closerto shore(generally,south of Rte.28 or n_orfh of Rte.6) b)vertical addition—not requlred unless there is e„rtensive renm-ADn to the first ffoor c)replacementiVuidows—needs energy conservation compliance only(chap 93) S.Wood Frame Construction Manual(WFCM).for 110 MPH,Exposure B maybe obtained from the Americar►WDDd Council (AWC)website WrIENTHS FCE=DH 17,d.M CLS£Sd hlF.if_5 .. . ATS� • it li - - - .. ![ tl - • - [1 II I . tl tl t a t tt 11 K 1 t I rt R 1 tr t Ci t is t [t t1II 1 m rt. n to t r a L9cp r r !ct �t al ttxz i i _ d z t r II ffr - 0 FRAbWJG •'ll Iy W r-t U i t IDEiE� II zt • I17 ii t1 � t ,. 1 ! - I E ! 1 ' u tis l LE z sr �E It Il z Y - VLF✓Lv->=-+•�+` \ S AGGE ED •1 -. �rptr _ N s�kGitJ� 1 ; WAILPATn3Ur � pArlli RAW—MtZ oouat.Ei�JLaXcE sP,acM DEML ` See DeLdff fln Next Page Vertical and HDraDrrlal Mailing Detail - for Panel Attachment ; V=rii�af and HDriz�nthl Nailing for Panel Aflachmant A rotY Town of Barnstable *Permi U pExpires 6 mot i s m i e d e * Regulatory Services Fee_ 9 Mss. 1639• 0 Richard V.Scali,Interim Director � AjEp�.tA . Building Division ` Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: S08-790-6230 - =- EXPRESS PERMIT APPLICATION - RESIDENTULL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Propert]�Address e s WGt yPnfP�y( �e Ef Residential Value of Work S�pl /l8 Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address F11'2abe 46 5 14fi ae h tl/Uc k_ 74 6a,-I-;e L+ee't WAr �!A t-6-0'1(e rJ,4 a2-4 3 Z Contractor's Name pr/j&I.e Q;r�Vi,S ��;tl,g 11-6A i Snn Telephone NumberoC)17 Z Z 9-q 9 ZO Home Improvement Contractor License r(if applicable) - /7 37 q 5 Email: Construction Supervisor's License r(if applicable) _0�►.S 7 O EgWorkrnan's Compensation Insurance �MPRES PERMPT Check one: ❑ I am a sole proprietor❑ I am the Homeowner SEP 2 3 2015 fP I have Worker's Compensation Insurance TOWN OF BARNSTABLE . Insurance Company Name A!ewnCcut 3-nsucaY1ce_ raanv Workman's Comp.Policy 4 W C 017-8p 5$3,!�2.3 9 -1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris Will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side @'Replacement Windows/doors/sliders.U-Value • 3y (maximum_35)4 of windows 3 9 of doors: - ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *4trhere required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Note: Property Owner must sign Property Owner Letter of Permission. A copy o the Home Improvement Contractors License&Construction Supervisors License is required. v - SIGNATURE: QAWPFILESWORMSIbuilding permit formsEXPRESS.doc Revised 061313 • RENEWAL BY AND- EN atnt tri7321s byArlderseft. a �T etx�a0"4515 s_nuw anusreur .�,�. 26 Albion-Road !w Iancotn;RI02865; - wa r�nna�zsr Phone ft6GS63 2255 Rk 101.033§602 r<d«.i rmc:io a+c SoutLera New Wia avv%IIW d/b/mi Rea in�l by naae—— . Soi.tl4ern New t o&" `(P g 00 CUSTOM WVMOW AND DOOR REMODELiNGA(3REBMENT r vc 4l tlyer(ij.�hri �.�lC2` !1A�. - Ga:/ Dxeoiil2,een,a,a^ S Imo . y ` Buyer(a)hereby joindyand severally agrees to punhau the pialucta and%or services of Southern NewEn'IiM'Widows;MOM" d/b/a ReniQ by Andersen of Southern New.,F.ngland.(Contac►or"),in accordanoz with die terms end.:condiaons_deunbed:on the firer aad the rcverae;of, ilia and onA attacl[ea colt: this'A agreement. apeaftcaaon sheet(a)( _ecavrly, gieeirierrt"}:4 O!listoiic O;Condo MEW, TwojobAmounc.i'aL Cb tbttested Soretra 7 Meth6d.of Payment 0 Cheik O it i• ,I F—ced" Uip.k R«eir<e(33%k!9 � Credh C'ar ere, _ • aoceyted for depoak only=maximum 1/3 of the' f)a me a sort cf job(334.- Estlrtuna.tomp protect coat(Neale see Ciedc t ord Aoymenr Fam}Br i^8 : �;,� Agn emenr,you edarowledge that tht Bahno6 at Stan of job and die Baluice on Substuulal /�ii!/J�4T°+ B>fance on Subsmrnial Comptedan of job cannot be made dt by ere Completlon:of job(3I> cud and mm De made W penenal check tiaruc aheck or cash` Bsyer(s)agrees gad eadeeataads tLat thin Agreement conathtites ehe'`eatssr taadeartandhag betwcea the,partiey gad tfUt there are,no vI.,. mdeestaadiagia changing stay og;the terms of this Agreement.Btayer(a)atknowkdgeA iflat'BayerO; (1)has read true Agreement,mderstaads the terms oft this Agreement,and Las receiv ed a completed, igaed►and dated' copy of tbu iptorrned ofA greeent,iai ehtdiog the two attached Notices o4'CancellatIoa,oa thed ate:Srstwsittxaabma1 low- ANY BLA�2)Kw$aPsA CES ' (Rhode intend Sslsi 06ly)Nodoe to Idnyeei(1)Do got sign this Agreetneat if grey of�Me epaces intended foe the agreed terms: to�e eaxeat of then available iofosmatlea afar IeR bkuoh.(2)Yon ace etKided tos�opy of;this Ageemsntat the time yen i>"(S)Yon may at any time:pay offithe toll depaid b�ianee'due`aader thisAgeieinmt,and is so doing yoo racy be'esti , seoeive a partial rebate of the Smance gad iosoraace charger.(4)The:aeRer Isar no nght'to hmlatvfvliy eater yooe:premise% os'comnait any Meath of tiles peace to reposiass goodi Pm' aadee this Ageeeme .(5),Yua may eanoel dhis Astemeirit! it dt has not been slimed as the main office or a branch office of the seller,proidded you notify the seller at Lf s or;her malt o®ce or branch oboe shewa fin the Agreement by regtatesed o;ce:d8ed mail,which shailbe posted got 4tes thaamidoight of the thud cafradar day aiRer the diry oa hv>tieh t><e daYM tigus dhe Ag>semeat,'eicbldioB Sunday add amholiday`:oa which' regales mail deFiwenes are-got mule:See tbe.amampaaying notice o!eaaoeilation foavi'for aatespLnaeioa of bayee's rights:;, Buyer(>)reocived the'oonaumec educaaan maurrala prwraal by the Rhode Inland Coatractora Regwtraaon Hoard lBuye!':7s!h?trj Renewil bq New Englad Bnye(s) Biyer(s)` Signature `Print Nainc of Proaae=Managed t'nnt Nemc %_n f Name;; YOtJi THB�BUYER(B), MAY CANCBL THI$TRANSACTION AT ANY T1MB PRIOR:TO MiDNIGHT';OF TIi>r THIRD: HUSAVESB DAY AFTER T)�DAT>~OF'1'AIS TRANSACTION-SBE Tf1i8 ATTiiCHED NOTICE OF�CANCBLLATION FOBM$?, FOR AN E&LANATION OIRTHIS RIOHT NOTICE O NOTICE OF CANGFt.t,AT10N y Gate of Trivaacdon 4 You may cancel Date of Transaction You ntsr cancel thI­s transaction,without arty parhalty or obGgathon,within this transacdoii without arty penalty or:obligation,Widtln; dyer bustneu daj►s horn the above date N Yohr tnrhoel,any a three business; from die abort date„It you csncel,ariy ProN�traded In Ny ptijgnents made Taft jrau under the zl property traded. n,any paynh . made by you under dta Contract or Sala,and arty insfrumant exeeuttd I tvaet or sale.and any nagodable inat►vrihert!etaaeutad; by.you will bs returhhed wi n ten;busuhesti:dogs follohving I by you;v+rNl be e�etumed'within Een business days::Wllowin : eeoeiptby die Seller of your eaneellsxian iiodce,and arifa .� roeetpt�y the Seller of your cmicilladon nodce,.,ind any. security.intarwt arising out of tits traraactw will ba seeurk interest Arising out of the tramacdon wdl be eanceled.ltyou taricet,yo must mAlte available to theSeller nnc�eled.Uyou'cancel,you must snake available to the Seller st;your trosldathoe,in subst�ndally a food wldition a#:when, at your,resldence,in as corrdttoei as when wbamritla111!' good. , sroaived,any goodti dalhrored to you nrhdar this Conbsct or '1 rseeiwd,anfr goods delhiehvd to fiou under this Contractor., 5ile,or yeu nutf►,N you white,w w(dh the;Mabnrcdons of j SaN;o►`you matt N you wish.eomey with tha instrucdons of, the Seller.regardU, the return s irient of file goods at file diei Seller rogarding the roturn shipment of the goods at th6.., Sellers and r8k.K yo do snake d+s axai7able �I`Sailers nee and nsILlf u d'-make the g��dsaOpold: oa die and the Salkr does not phSc tTiam up whin : to tha Seer and im Sal!does.not pith then*up within; twenty of die:darn of cAnceilaton,you:may rotain ar i tweirty` of'the date of cantalfadon,)Pou mar stain os• �spose ohs goods without any furdhar obQgaaon.If you I d o die goods without any further:obligatorh.If you: tii(to matte dhe aootfs awihbls to the Sefler or if you agree j f mAioa the;goods aHailable fat the Seiler.or if lion agree bo rethsrtt the foods eo die.Seller aril fail bo;do sq tseah frou„I to trowrn the goods to die Seller:and fill'Eo do sq,;dhen you. temaln lintels for jirforrna s of aU oblEgat[ans under 6 j remain lwi dor parfontihanoe o!all obll�aooths.uaow.dN. COI p To cane.,twi tr'Ansacdo» inap.of delirer'a igned ' Con To cancel dJs liansacdon.iriail ar d�'iver a sib OW dated.Apr' 't tihtM.aaricelheion notice-or.any;other, ! and:-:dated„copjr. of Mills.:eAncallation notke or anfr other. iwritseih.ihotiae,orsend'a-eels too Rs,6W Ande►sen of 1 written nottoe;or send a talagram to RenewMi WAndersen of Soutfiem New at 2b Albion r 0286S; i Southern New_end at 26 glbion Road,Uncoln R102ge5,; ;Nt7!F LATER T idN MIDNIGHT OF j NdT LATER Tt�N MIO141 0t= (p (D ) i MERicBCELTHIS i HEREBY"CANCELTHISTRANSACTiON: Y CAN- TRANSACTION. {ur+ih "Now ap tu�ra st!>asw wYie Nair. trm' tllhll t'iigi'\Nhkts Btryer.Cgplr Teflow tltiyer Copr:'Ptnk. Southern: New, England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Departrneutt of Public Safety Board of Building Regulations and Standards s Construction Supen-isor ; License: C5-095707 BRIAN D DEMVISON UV 7 LAMBSPOND CIRs Chariton MA 01507 Expiration Commissioner 09/08/2016 Office of Consumer Affairsd Business Regulation 10 Park Plaza-Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 ' Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 911912016 ' DENNISON BRIAN :n 26 ALBION RD - LINCOLN,R102865 Update Address and return card.Mark reason for change. - su a zo>a-0s n EJ Address [:.,Renewal []Employment ❑Lost Card trice of Coosamer Affairs&Busines4Begulatioo License or registration valid for individul use only E IMPROVEMENT CONTRACTOR before the expiration date. irfound return to: 3Bitoffice of Consumer Affairs and Business Regulation istration: p32g5 TYPa 10 Park Plats-Suite 5170 Expiration: 9119/2016 Supplement-.;ard Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN _ 26 ALBION RD UNCOLN,RI 02865 Uoderucmi-y Not valid without signature ,., The Commonweal, of massacliusetts Department of IndustrialAccidents �1 !` Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114 2017 _ www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are you an employer? Check the appropriate box: O 1.0 IIatrt a employer with 20+ 4. ❑ I am a general contractor and I employees (full and/or part-time)�-*. have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or parter- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8_ [] Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.= 9. Building addition required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] c. 152> §I(-'.),and we have no 12.❑ Roof repairs Window Replacement employees. [\to workers- 11.1 Other p comp. insurance required.] *Any applicant that checks box 44 must also fill out the section below showing their n-orl:ers'compensation policy information_ 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 showima the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for►ny employees Below is file policy and job.site information. Insurance_Company Name:ARGONAUT INS. CO. Policy#or Self-ins.Lic.#:WC 928058352394 Expiration Date:8/21/2016 Job Site Address:'-, 74 (farrt e_ L e,e'r (;Jay City/State/Zip: ejei );lie, ✓"/A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date): Fai I ure to secure coverage as required under Section 25M1 GL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500-00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a-copy of this statement may be forwarded to the Office of Investigations of the DIA for\nsurance coverage verification. Ido Hereby certi ,under the ' s andpenalties ofperjurp that the information provided above is true and correct: Signature: 4Date: Phone 9: .4012289800 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1:Board of)health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SOUTNEW-01 PARKERNATHCO WO CERTIFICATE OF LIABILITY INSURANCE °ATIE 8113f2013120`"`"r' 15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES j BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, Ij IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)_ UYlltts of New Inc, CT Willis Ceftif#Cate Center clo 28 Century Blvd j a°c'areN mi:( � -7378 reox Sa (888)457-23T8 P.O.Box 305191 Nashville,TN 37230 i191 INSURERS AFFOR13MGCOVERAGE I NA1C;$ ! tresuRERA:Selective Insurance Company ofSOUNWast 39926 INSURED INSURER B:OneSeacon Insurance Company 21970 .Southern New England Windows LL C i I wsuRER c:Argonaut Insurance Company 19801 D/B/A Renewal by Andersen j 28 Albion Road INSURER D Lincoln,RI 02865 !INSURER E: !INSURER F: ! COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO VMICH 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 LTit POLICY EXP TYPE OF 1PISURANCE j - POLICY NUMBER POLICY EFF 1wDD ! uMrTs A X COMIAERCIAL GENERAL LIABILITY !EACH OCCURRENCE $ 1,OtI0,000 CLAIMS-MADE T,OCCUR ( X {S 2029469 09110/2016 08110/2018 i Pp y st et $ 100,w0 (MtED ExP{Arty ora pet�nj $ 10,01I0 { { :PERSONALS ADV IAMIZY !$ i rW, GEWL AGGREGATED¢APPLIES PER: i GENERAL AGGREGATE is 3,0O0,OFFN}j POLICY®JECT C LOC I E ! i PRODUCTS-COUPIOP AGO $ .3,000,000' OTHER: C !g AUTOMOBILE LIABILITY s �MBINED Stt/GLE LIMITEaaaident $ 1,000 A X ANYAUTO X S 202940 08/101ms 08110i2016 BODILY INJURY(Per person) s � ALL OWNED i SCHEDULED 1 . t AUTOS p AUTOS ! 1 I fiODiLY INJURY(Per accident) S I x HIRED AUTOS AUTOS�N-0YJtVED I I PROPERTY DAMAGE S r—� ; �Ieracf f f I 1 i g I UI R5Wft—LLALIAB OCCUR i EACH OCCURRENCE S EXCESSLIA9 CLAWSWDE i AGGREGATE I S RETENTIONS WORKERS COMPENSATION i AND E>VIPLOYStB'LIABILITY Y/N I X ATUTE [ER ANY PROPRIETCMPARTNER/EXECUT(YE ! 8028 !08121/2015!08121=18 EL EACH ACCIDENT S i DFFICERA&EMl3ER EXC LUDEW 116 i A€ "°M6ry In and i EL DISEASE-EA eAPLOYE S 1,000,00 'tfyyeess desrxd,e under ! ?OESCRiFTTONOFOPERAITONSbelow ! ! ELDIS]ASE-POLICY LINT S 1,000.00� C Workers Compensation WC9280=52394 08/21/2015;08/21/2016 See Attached DESCRIPTION OF OPERATIONS i LOCATIONS I VEE4MM(ACORD 101,Additional Remarks Schedule,may be attached 9 mom space Is required) THIS CERTIFICATE VOIDS AND REPLACES THE PREVIOUSLY ISSUED CERTIFICATE DATED:SMI12015 Aldo Policy includes additional insured when required by written contracUagreement as per policy form. HSS Holding Corporation,Inc.and anysubsidiaries are included as an Additional insured as respects to General Liability when required by written contractlagreement as per policy form. CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE E THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE W171 THE POLICY PROVISIONS. r I AUTHORIZED REPRESERTATTVE w I O 1988-2014 ACORD CORPORATION. AR rights reserved. ACORD 25(2014101) The ACORD name arW logo are registered marks of ACORD L 1�13�IH T U P ETROFBARNSTABLE CONSTRUCTION CO.LLc 546A Higgins Crowell Rd,WEST YARMOUTH.MA 02673,j a„ PHONE: 508-778-0111 FAX: 508-778-5010 '''' v 9: 59 V1 M.TUPPERCO.CoM -7VIS, Date: Town of Barnstable y Thomas. Perry CBO - 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work. completed for permit application # Issued on � ' has been inspected by a certified l � Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State-requirements.. Sincerely, Permit#: Address: Richard Tupper -7q Oarne License # CS-69058 CY, � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION lib• � � b Vic( Map C'( Parcel Applicatio1n Health Division Date Issued 17`I Conservation Division Application Fee Planning Dept. Permit Fee le 57 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address O—QYrIe, bees U)2A 1 Village Owner C 1 t?4yoe'�-h Hunt ou arx Address- d72 l 5 W*,V_1 lQ Telephoneao3 10 q(Dq I Permit Request M-ic., Lim Nwp Fx ytn r door (, )Ra4P" �'� onIry)l 121�r Je0.A(hQ dOOr f�We2Z; kff�C -C 10O►' CPW d0LA) C e_11'l,c 0e , C ox m rn rt0, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed 1`�-� Total 'ew qF Zoning District Flood Plain Groundwater Overlay ., r, c> Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) �� C' Age of Existing Structure Iq Historic House: ❑Yes ❑ No On Old King's Highway:``°]Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ 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 kteha A �t P - Telephone Number 00$ 117S O Address �q C.l __Pr License # W �a 05 (�QS UaLMDOJin ,mR ( oa&,?3 Home Improvement Contractor# Email l(1 , CDOO Worker's Compensation #Gc)l �Ol�SS9f' � ALL CONS�)' UCTIO DEBRIS R I SULTING FROM THIS PROJECT WILL BETAKEN TO�6 l GC r �,rrnOLh DA&73 SIGNATURE DATE / ' FOR OFFICIAL USE ONLY APPLICATION# €` DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME ,P INSULATION i FIREPLACE s ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 7fte' olr rotewealth v,�`'MassaarJttasetts' - Ike,�[v�pne�tl;Df...lsrrlaaslrial,,4�Di[lesats - � �l ce,of XnP., —1gtrfivns 1;Congress.Stpee4,Saife,100 �ostori,•,�A�D�1'I�2C1.�7 . WW .W ass gvv>ds+ Wtxrkers'Cpi nlaensatioai >E€asaarance A#fida�vit:Bra:li en's/Coa>to-OetorsJ Iecia-icia slPlttmTnea s: A pBca>nt.Laformaiioaa Please Prtint Le ib) alle(BusinessrOrgat,izationilndavidual): TU0p2r C3tistrt#Gloil Addmss:79b. Mid'tech I)r' Cityl%te/Zip:West Yarmouth,MA 02573 Ph4z1e; 508-778-0i l l Are you an employer?.'ChefP-the apt r4 �jtate bogy Type of'project.(aequrred) 1. I am a employer w�itla, `t. [] I am a general contractor and I employees-tfull and/or part-iune)'k have hired#tie sub co ib actors. 0 l iety construction .® I am a sole•propriet&or paisner listed on the�attacw:sheet:: . [�l2erriodelin ship and#lave xro employees I base sub-contractors have, g I3errtoltfon Workin for me in:an to . ci em la ees and have 4vorkers'g } pa ty.; P Y [No.x;porkers' comp.tn§ c-e comp.insumnce.1 9. ©_Building..addztion reyutred Wt.are a corporatton ti1d its; 10[�,E ectrical repairs Oradditions 3:: I am a 40meowner:doing all ?orJ office s have easrcks d their l [� Piumbuig.repatxa'.oradditioris, .IVself. [kilo workers' comp. rtgltt i exettiph©xi per.114GL 1 Rtxofrepair4 urance required.) } 75�.§I 0a_and.- Ave have no employees. o��cirkers' t3 other Weatherizat': on/ uompAosbrance required nsu 'a ion. "Any appli=tthat 6Ue box 97 mustalso fit out thi seci�onhE to t shgwm iheiruurkers'-com periuran paiicy�ntbtmakron t Homaowner��vho su mrr dus attI avit-Indira-ang-tt ey are do trgait��ark raid then hire ouU de contntcinrs mtut submit a new e,$itlaYit mtltcxLnrp such. Cuntracaors that ehecTcthrs bob mustatiacjred an alit rtttrnal sheet shun ing the na3}id of khe Sub contrF ctors And state whether ar nuttliuse entities have: employees: if the sulvlwntcactors have emgloyee th musf prm sae their t9ro�icers'comp.pbhay ngnibq i ain an emplayer that is prosYrlte ruvrkers'cottapensatrott tirsuraear a or.rsc e , l?Aforatreliizn., y nrplotrces :Bela3v is thepolio ran�job site insurance Company Narrie:APtC: Polit.3,#of Self-i s ic. W CS®05593012at37 :# }13t9 Expiratin Date... Tod Stte Address:, _ GitylState/Zap �itt`ach a copy o€!the worter5'competasahon polii y dectx oil pagiv(steow%ngthe poV nixiaer grill':cs ixati€t (s' l allure toclire.dive e as P n date.: rag t qu red under ecttoix'2.. t1t�iGL l52 can Iead'tg the iiripositiot trf t nminal gerralties ova:. ftr►e up to 7,51)O.flO and'o one yWIMprwnnxerit as WeH asct�Jil:pi naltitys to the:.form of.a.S;TL31?W(JRt ORDER and a fne. of up tb25U.00 a- aga`nsi the•nolatmr; Be advised that,a ca py oftl.is`Stat6trici 6-hay be.fo yarded to tho oilic4..c f Investigations o I)lA ar insarance Meta.0 .--f-10 ion. 7tereh ei~ti Zia pates artrl pi rrrtltaes a fperj ra thrtt dli�i�eformr tatr» rr�uided�rbave is trV& ` eDrre -Phone I: 809 1...... Gx earn rise only. Ao rxi t wiles 1-4 this area,to be.eQmp eteriby cite vr.toIvrx uj edttt. Cxts or:Town:_. L� PertinxQJLiceaise#. Yssuen Authorgl�g g>Ae ar. nent 3;titv/ ostiae CBerk 4, xectrical Inspector S.:p n t ing lus ector h _4lher - Coxttra¢tl'erson:: . C' 314t , CERTIFICATE CIF LIABILITY INSURANCE` DATE(@At410DtYYYY1 12/03/2@13 t THIS CERTIFICATEJS ISSUED AS A MATTER OF INFORPAATION,ONLY AND CONFERS NO RI6Ii SMUPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT:AF'FIRMATIVELY OR'NEGATIIlELY AMEND,k7ttND,6R ALTER THE GOVERAGEAFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE:;00ES-NOT CONSTITUTE A:CONTRACT BETWEEN THE ISSUING N§URER(S),AU.THORMEO REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poi)cy(Ies)rnust•be`ehdorsed: If:SUBROGATiON IS>WAIVED subject`to 3 the terms and conditions of the policy,cortain',pollctesrnap require an en dorsement A statement or this certificate doss noi:cdt ft t rights to the certificate holder 16 lieu of such endorsement(s). i. '.PRODUCER: ... -:.CONTACT` _. NAME- Lora Lowe Southeastern. Insurance Agency, Inc. �"°N„ : (508)9gt4l)l I FAx No (503)990-27.31. Arc 439 State Rd`- s E�MAIL: Box 79398 PR TOMER CUSTOMER ID#: .... .. :._ .:.. .. .. . N. Dartmouth, NA OZ747 INSURERS)ARORDINGCOVERAGE`.. NAtC . INSURED tNsuRERA: Arbi ljla;.Protection Insurance Tupper Consthiction Co LLC 1INSUREIRe AET . ?IrasuRERc: GNA.Surety 27 Roberta Drive: (INSURER Oc lest Yarmouth, 'MIA 02673: 3. INSURER`S: t ;INSUREWF; - COVERAGES CERTIFICATE NUMBER: 2013/14/1 REVISION NUMBER:`.• THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE ISSUED TO THE INSURED NAMED ABOVE-FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING'ANY REQUIREMENT,TERRA OR CONDITION OF ANY CONTRACT'QR OTHER':DOCUMENT WtTH.RESPECTTO WHICH.THIS CEEtTiF)CATE MAY BE ISSUED.OR MA7.PT B POLICIES T EDT TER@t1S; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE:BEEN REDUCED BY PAID CLAIMS. i SR ADDL B _. POLI Y- ._ .. _. TYPE OF,INSURANCE: f mrovr EXP - - - iTR .... . ...._. INSR.:WVD. . . POLJCY.NUMBER' .. Nl�q � L1MRS`. GENERAL:LIABILITY 850000874. 11101120111110112014.`EACt1 occiiRR ICE. _. s; . ..1T:DAMAGETO RENTED,. ,000;QO -60MMERCIAL GENERAL UA81UTY JJ PREMISE Ea ecn:rtence'. P 100 U4 CLAIMS-MADE TMEDEXPtMy,oneParson).. 5 5'gOU A'.: ,` 1_ PERSONAL 8 ADV INJURY t S. _ 1,000;00 GENERAL ACGk2EGATE: S 2,000.100t -: - GEN'L AGGREGATE:LIMITAP_PLtESPER`:. PROOIfGrS-COMPIOF'AGG �5 ....Z�QO(3,-R POWCY' ':-j0. LOC S AUTOMOBILE LIABILITY; - _.....,... - - _.. . .S6662400002 121011201:3. 121.0112018 COMBINED SINGLE U-IT (EiO apt) ANY AUTO - BODILY INJURY.IP srOeiU4. S ALI'OWNED Al1T05:; BODILY INJURY(P&acddent).S A X SCHEDULED AUTOS PROPERTY DAMAGE 8. X HREDAUTOS - (Peiiictideng_.. INC X NON:-O h1 ED All os $ ...._...:. UMBRELLA LIAB X -occuR� i. - 460005835. 1:1l01120.13 11/01J2014 IJiGHOCCURRENCE_ $ ,- i1,000-,00 EXCESS.LIAB CIAti�SMfOE AGGREGATE 3 1,00Q A. bEOUCTIBLE jj S IS I WORKERS COMPENSATION WCC500S593d1200 0/03/201310l03/2014 X oaruMs X DErRH l IANDEMPLOYERSLIABILITY Y1N ANY PROPRiETORMARTNER)EXECUnVE RICHAREI TUPPER I £ EL EACH ACCIDENT S 1,000' 0 B OFPCERIMEMBER EXCLUDED? N t A. jMandatMinNH) Lt)t9ED FQR.WC CO!lERA EL.CNSEASE-EAEFti�DYE s 1,U00;{) If ye�d PT O OF OPERATIONS E.L:DISEASE POLICY LIMIT S 1 000 00 ` 1 DES.,RiPTIDN OF OPERATIONS trebiv . ... ... . .. ......... OESCRIPTION:-OF OPERATIONS/LOCATIONS I VEiIICLE3'(Attach ACORD 101,Adddtonai Remarks Schedule,'('more space:(s requlrei!). - - CERTIFICATE HOLDER_ . CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLiCIE5 BE CANCELLED.BEFORE THE EXPIRATION DATE: THEREOF NOTICE WILL:BE DELhtERED IN, ACCORDANCE WITIi TH1=:POLICY PROVISIONS; "For Information Purposes 60k4 Tupper Construction C t AUTHORIZEDREPRESENTATIV£ Y7' Roberta Drive Ml:'Yarmouttt, MA.'Q2673_ 0;1988 2009.ACORD CORPORATION: All ri 'ttts Teserved ACORD.25;(2009109) therACORD name:and lago.;are registered marks o#ACORO IA kli.DiNts E' i ?L €f #;i !;Ply I I i i lr,QNf, 1tassaciic€sefts-t� par*rrFers�i r� i� a=eL t. 1�risrtrr&S Road,Stet t1.i?. �"oars#o#.,6u�;din�Rtgu,{`afjor�s aied Sta�dar�s a- trfm;NY 12020 C'x n.trt�c"rittn S>t iria,tr'1 ;87'r 1:2744274 #_icer;se: CS-069058 ..y + RICgg�� fHARD'S�TUPPER - n Y x,., ml _ WEST YARt�1€f3iF Ati.('i,:02 73 Ridbard,Tupper ..�', `iSE:RElE�i�51i1fFDR �#KTIOf�"$IITIDt�PI�`A5�(�313AiE$t; s ComFPf5aiE71tE': 124112014 ua ...... .. .- � .. ..- ... .,-...,.—. ._ ,tea. Ft9 - 5 A, ._7F,Cl1l7lN,(�lrtlG"lt��lt C) ICi,S.iIIC.JII!f'tlT:i; License ox reQistsa#ion gelid for insfivrdul"•use on►r .i_gtfine of Coasufncr Affairs 8 Business RegulaUos o a - O BE S6fdF'RQVENiIEMC:CONTRAC ft2�2 before toe eXpi date. :If found refurrs tot `Y Offte"off EIT-ss;aaad Buse{tess_laegu4aiscatir egistration: 978434 TYPO Expiration 41/1612016' tLC 14,Pa ;.aza-Su'a S3?4 _ Bo ,i�A 031 ',UPPER CONSTRUCTION CO"LLG fi - a , RICHARD TUPPER 1 ' B:h4tD-TECH',DI W.YARMOUTi:MA 026n t ndersecretarS iVo " vzth O.stgm qt e� 8END ERETi=REMa1fE: People tlalpEaPeapleutd a Safer War! °"_ _w------- �1EP�IhilL�tiAC �" ,c i�DFC8ll8ttC MEMBER- w Richard'Tf�pper Tupper C nttr.ut on ' BuiidiTigSafety Rrofessionat iviertber#•$ 58 1 g EXp 41301241" __ :.. j ,. emvysaej M� 5- o PA8TIC1PAM9 mass sauce PERMIT AUTHORIZATION FORM I Elizabeth Hanchuruck , owner of the property located at: (Owner's Name, printed) 74 Carrie Lees Way Centerville MA 02632 (Property Street Address) (City/Town) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weather Yproperty. 'zation work•on m •. � fir : Owners$igna re 9/8/14 Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Tupper Construction 9/8/14 Participating Contractor Date Rev. 12132011 1 . ` - ; 1= . �•'..y .,,:-::-,aw: ...:�j a•-..",v1a'?-z€'+wa;8; '^:.;y�t oT .�.^-f -. }'9+,n .a '":.. _ .-Y..: .. M ..1. `nz -.-�_e� = 3 Y • 't ° TO OF BARNSTABLE permit No. _- _ --295__---__ �� f � Inspector `. p 0 Y� MALCash $208.00_0 -- `OCCUPANCY ; PERMIT 'Bond Issued to Shipman -ConstrnctiOrl ;-Address' lot #19 74 Carrie'Le'e's Way, eenterville Wiring Inspector ��' s Inspection date `� ry ��•�-... Plumbing Inspectoe Inspection date _ _ ".Gas"Inspector. A 1q �,.; �. ,f' Inspection date k'/Engineering Department,` - �✓ ;�J.A!!> Inspection date Board of Healthy � � 7r ,,y _ spection date 212 -S 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. Building Inspector) ~ Assesses 1 p�pnd lot number ...l............. .. ...!<.._; ....... 7 Cam.+-- TFI E y Sewage `Permit number ..i. ..... ...... .....z(fu!Z.....:........:.. Z 339EHSTAXLE, i House number ................ .` ,t... :�...........................`.... 9� 039. F QED MAY a\ TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..G:G)nA4;71rucr . .........EnTi[i TYPE OF CONSTRUCTION .....�t1OC/ ... ...... !/ILYMk............................. .............................. !cr�fi6rY � ......19.�5 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: tt C Locationn ..............................TC<)2lzi F.s .............. .. ...... III ProposedUse ........ .L............f-Z/.7. a. ..... ............................................................................................ Zoning District . ...... .!.E�.�,?ia. �,g.,! Fire District ...�`�/ n^'i ...��.•.��t j.... S.� � �� �-� i ��lrry l�r, /-� =�? r `!........... Address -?:?��..�::> :�'F! ! J r Name of Owner .. LfoO��........... �... .................. ..... ... .. . Name of Builder v ' '�` 7...xZ? :?.........Address Name of Architect C'`te,C �RgrO^✓t4.�L!?E....... 4ddress .'aT'r`GTS fir CC`��t�....c t- Number of Rooms ................... .. ....... �,��.....�a 6JS...Foundation .pVf:.E ....... ............................... ,t Exterior .... !.A..�! Fiazn....... .............Roofing ....s1 !rl Z'!�......���L>t�: !.t ................................ Floors .................................................... Interior ....... .........:?L,�,F.% OCf...................................L ...E1 J a� .4'r.t t')j f ��'t•�.. $V y�5. �•{ »` 'Heating .........Plumbing ... 000� Fireplace .....n�,LF....p.....�.!11.!d.::.�s.....r2.-.r.�.d.r'.`:......................Approximate. Cost � / Definitive Plan Approved by Planning Board -------------------_-----------19________. Area. ...... ..!cT.•........ Diagram of Lot and Building with Dimensions Fee ............?j/... ............... SUBJECT TO APPROVAL OF BOARD OF HEALTH �(�'r 1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable 4 ayrdi g the above construction. Name ......... .� r�6-- t /. ........................... /1 ?Igr� w Construction Supervisor's License .:. ............ ....- SBIPMAN REALTY A=I68-008-008 ' ^f ^ ' {�m� ' _ ---.---_----. ... .'==...i+e-^"°m^+v.Dwelling...................... ' Lccbtion -I0-t..19,...74''Carrie'],ee''e'-Wxy ^ ...................__-~-~-~~^==-.----------.. ' Owner --. . -----............ . � Type of Construction ......E-KaW--------_ . ' --.-.--.--...-----....-------.-- . , ^ Plot Lot ................................ ------~--. ` Permit Granted -...Deyremnber..3�---]9 84 ' , . . . - Date of Inspection ....................................l9 , . ' ^ Date Completed ...................................... _ - ~~- - . . �_ �JL� /^ wu T ' ~- � ' . .� ' ` � ^^ � ._ _ ..., a •. ' Assessors map,and lot number ...r .................... "E To f / ERTIC SYSTE Rid d T R Sewag number .... ... ......��w�....... '... . :.. �3 y� .� !�J � i Sa C C3! r` AHBSTAD E House number 1 y IT TITLE 5 rhea C ............... ....`f....................... ........ y� qy syg #� �4 �+ B i63 L0� I C-NVI 14.11"tliS�',EN'TAI fi t' ,- { .. 9OO�fO MAV Or� TOWN OF B,ARNSTABLE } l ' BUILDING 11.SPECTOR APPLICATION FOR PERMIT TO ..C:CI!V4 t CT A„ „SC E,,,,,,,, i!?!i c cc�;v............„.. .. - TYPE OF CONSTRUCTION .....0 .. .�z X .°.4�JS:sz�cvm-m. ..��.t.:..Y...� ........................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... aT. .../�f...........GAt'-d�? ....:4- 1 .... `''�'!. C:!Jt.7,2!!oc:........... \y .• i •` ..............:................................... Proposed Use ........SfwG-.L.C........�F�/.7.L1.1.7....../.��5..??.��:�!.��:.................:......................... . Zoning District .. �. /,t ...........Fire District ... ... L jVA12,YM& / O'n .................. Name of Owner h �� � .Address Nameof Builder .....:...................... ...............................Address..................................... ..E................ C.9S�F c�,,,�e 'S�n9 �� ,ddress �f� �i'iaTa� l�✓°r C ., i�rcc Nameof Architect .........................'�................................. ................................. .......... ..f............................... 1 Number of Rooms ..................SAX....... ......&91,g5...Foundation RI.A!� ED......(9.!�1.fsAF?.F................_..:........... Exterior .....(-Af6C?A�...............SGll VC-c. .............Roofing ....A5eiwq-.r...... ............................... loors CiPETi. !6 ....................................;................Interior ........ .6 .......... ;f�UCC Gb�S�roc u�tz . eating o :/L.....A.0�........✓ .`(..- $ F �` JPlumbing 1 Fireplace Q/V Y ............. Approximate Cost 000 r ...................... .. A Definitive Plan Approved by Planning Board -----------____---------------19________ . Area ..... ...sSa.fir.;.•.,.„ Diagram of Lot and Building with Dimensions Fee SUBJECT TO' APPROVAL OF BOARD OF HEALTH r yG� f p S(P o 1 N OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of tb Town of Ba able a g the above construction. Name ......._......... ... ..........................................:��/�� Construction Supervisor's License ... S131�MA[J'r REALTY a U, Nc, 272,,, .,,. Permit for ....One Story............ •.v �.... $,.16 Family..Dwelling.......................Lot 19 74 Carrie Lee'Loc . .. ..........f............................................. Centerville -� ........................................................ .................. Owner ...Shipman RealtX. .......... _................. �. 1 z,, J = t . Type f: Construction .................... Plot/.e.� .....:.............. Lot ........... .......... Permit'Granted ....Decembp.... . ....19 84 Date oflInspectio ..... . .. . 19 ; 't•. Date Completed ti ...... ................... - 7 •^ ALTERED FLOOR 4Prc�pa dr�evertau!�jry:ardentrancea-.rea _�epap'&d 36"Into garag O. 62.a:. X• x: `x . ,x. x x x x x x x - x . 4 M��feet3at34 x j sr .` x .r rs FFLi i3�risag RotAlsl F=—�:. •� >�s't"". . t"PDom Rpm .. . �. " �� • c6s —tee- :; Tixmth. ttaticfitruds"Rdence z y ��Carrie Lis SAta��. ` P#tURO�E©�1 EREi3;`FEt9+D 'R[#1K C,4 E> f r 1!i r■ EXISTING FLOOR PLAN e2 - Entra - f a•° hen odry B $ y, _! Ck "noway edioam. r £ zrsoft"andREJ&Residence, 74 CaMe Lets Wad?mmm . „�c A:� C f View- With Dimensions LAUNDRY FRAME. , `J( rZC y 4„^ ,ate. r �. t".• ' c J9 + s ( ` z ` �k Till. i HAOCA -• \ :5 �' �a $ t " s � `•. ,Y ) ,� a'. 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