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M �1 Building Commissioner �ArFn ° 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number Not Valid without Red X-Press Imprint n Property Address �nd►5�j,n �SI�I(°. ro 2 632 ®Residential Value of Work$ 6 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 3 g v rrxs�n7t Contractor's Name nC- Telephone Number 94 4 314 3 Home Improvement Contractor icense#(if applicable)__ -4 3 9 Email: C\vUJlDvi6 LQ) ,cam li Construction Supervisor's License#(if applicable)�- -• (,� - WR [;Korkman's Compensation Insurance , Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [ have Worker's Compensation Insurance Insurance Company Name fiflA n{Y C C-Y A f f'e.( _ q iI14U nu&ge Cc Workman's Comp.Policy# W C V O l i i1 3 b U 'T Copy of Insurance Compliance Certificate must accompany each permit. Permit Req t(check box) nn II Bd Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �1S1 7I IDI O sj 16111 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) C-4-1y0 3 3$— 5 2 r- ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: ' QAWPHLESTORNIMXPRESS2017 ®� r • � � iis(3141,frRytt�b� '"� ®In51TECL,`If879nF5..�"tIAA.'1)Q6�� '`J - �t � wcimbrelo@gmail.com(Contractor):Z Step 1 D Step 2 Step'3 Step 4 Permit Information Contractor Engineer/Architect Setbacks M 5 Step 5 Step 6 . Step 7 Step 8 i Structure 6 Insurance Coverage Additional Information Documents&Regs Step 9 r Preview Ilk- Building Permit Application at 38 DUNASKIN ROAD,CENTERVILLE You must select a valid contractor license to continue.You can search licenses by typing the name, DBA/company,or license, number in the search box below. y Contractor Name or License(4 characters minimum) READY PROS,INC , ,,; Tip:Having a hard time locating your license?try searching by your license number(numbers only) , Available Licenses(Click assign to select a license) Type ,license No Expiration Date LicenseStatus ASSl9n Home Improvement Contractor 177039 - 10/2312017 Active - Prev Next \ a 04/2017 10:42 am From: 8555447767 To: Page: 1 IUassachusetts Department of Publia Safety Board of Building Regulations and Standards License: CS-083726 WILLIAM E CIMBRELO• <:• 17 SEA ROBIN ROAD ' OSTERVILLE MA 02656 Expiration: Commissioner 1012112018 ...... ..... ........ .. ... ... ... . ... ..... ...... ...... . ... ..... ...... ..... '''/,G,a �:ni;,+say;ra:n••/1/r/..•„��isat4ic;r%i� office of consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoc:eme3nt Card before the expiration date. It found return to: Reaistration Expiration Office of Consumer Affairs and Business Regulation 177039 10•r2212019 10 Park Plaza•Suite 5170 READY PROS,INC-! Boston,MA 02116 WILLIAM CIMBRELO .0 C&;1r�__._, C, 17 SEA ROBIN FID. C OSTERVILLE,MA 02M Undersecretary Not valid without signature i Office of Consumer Affairs & Business Regulation- Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) v = Consumer Affairs and Business Regulation x. Home Consumer Rights and Resources Home Improvement Contracting .Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. .. ........ ...... Search by Registration Number 1779 }Search 03 You must click the "Search Registrant" button to search by name or location. Search by Registrant Company name Search by Registrant Last name City/Town Search Registrant State Zip code .__..__.... Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Sunday, December 3, 2017. Search Results RESPONSIBLE REGISTRATION EXPIRATION RegistrantName STATUS INDIVIDUAL NUMBER ADDRESS DATE READY PROS, INC CIMBRELO, 177039 17 Sea Robin Rd. 10/22/2019 Current MYRIAM Osterville, MA 02655 ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. https:Hservices.oca.state.ma.us/hic/Iicenseelist.aspx 12/4/2017 DATE(MM/DDIYYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 07/10/2017 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 (none). Fisher Insurance Agency,Inc. PHONE AAXLALrI Noll: 1099 Pleasant Street,Suite 5 MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Worcester MA 01602-1248 INSURER A: Western World Insurance Group. INSURED INSURER B Western World Insurance Group Pocon&Sons Roofing Inc INSURER c: 55 Highland Street INSURERD: A.I.M Mutual Insurance Company INSURER E: Framingham MA 01702 INSURER COVERAGES CERTIFICATE NUMBER: P0001707101414551 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. ILTR TYPE OF INSURANCE BR POLICY NUMBER MMIDDY EFF MM/DDY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 A NPP8297277 06/20/2017 06/20/2018 PERSONAL&ADV INJURY $ 1,000,000 M'OTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000 000 POLICY ECT LOC 1,000,000 PRODUCTS-COMP/OP AGG $I $ AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT $ 300,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED X SCHEDULED NPP8297277 06/20/2017 06/20/2018 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ 5,000 AUTOS _ Per accident Deductibles $ 1,000 UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 D OFFICER/MEMBER EXCLUDED? ❑N NIA VWC-100-6021638-2016A 06/22/2017 06/22/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) CERTIFICATECANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Ready Pros,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 17 Sea Robin Road AUTHORIZED REPRESENTATIVE Osterville MA 02655 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 'A'`CPR b® CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 10/31/2017 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 NAME: Betsy Cuddy CUDDY INSURANCE AGENCY INC HONE Ell: (508)867-6850 FAX A/C No): ADDRESS: bcuddy@cuddyinsurance.com 220 N MAIN ST INSURERS AFFORDING COVERAGE NAIC# N.BROOKFIELD MA 01535' INSURER A: ATLANTIC CHARTER INS CO 44326 INSURED INSURER B READY PROS INC INSURERC: INSURER D 17 SEA ROBIN ROAD INSURER E: OSTERVILLE MA 02655 INSURER F: COVERAGES CERTIFICATE NUMBER: 207356 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F1 OCCUR DAMAGE TO RENTEDPREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ - GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $_ Ea accident ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $AUTOS AUTOS • HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER.. ' Y/N - ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? I N/A NIA NIA WCV01113004, 10/30/2017 10/30/2018 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is(equired) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). .The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GAF ACCORDANCE WITH THE POLICY PROVISIONS. 1 Campus Drive AUTHORIZED REPRESENTATIVE Parsippany NJ 07054 �` P Daniel M.Cro /ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 17- 31815 1 17 Sea Robin Rd., Osterville, MA 02655 Head.- Toll Free(855)544-7767 Mass.HIC# 177039 Inc. Fax.(781)656-0215 This is a roof ❑Order XEstimatel �jA4t ' Date: 11/15/2017 'Expires at 5:0013M on 12/29/2017 To: Robert Sherman E-mail: rsherman57 @aci .com 38 Dunaskin Rd Home Phone: 603 635-2758 Cell: 603 508-1714 city:Centerville StateMA Zip 02632 Project Location: SAME READY PROS,INC.AGREES TO FURNISH AND INSTALL THE FOLLOWING ROOFING SYSTEM FOR THE AMOUNT STIPULATED BELOW: SHINGLE TYPE: HD Timberline COLOR: Fox Hollow Grey ❑Keep existing gutters%No gutters []Add new ❑Remove only ❑Replace with: SHINGLE MANUFACTURED BY:GAF Color Size Gutter Guard St Ihlone &Down Spouts Your Ready Pros Roofing Project Includes the Following: , �, , a err ,,;;; ,�,;, eats rro+.aa,: wnj•c aNt at-j�verr ssrn�«. Q Complete roof tear-off and replacement.Up to 2 layers of asphalt shingles included2. Q Leak Barrier-creates a 100%watertight seal for your roof,protecting the most vulnerable areas of your roofing system,areas that if not protected,can end up causing damage to your home's interior that translates to costly repairs to insulation,sheetrock,paint and other a• M, interior items. ®Econo MGAF Weatherwatch ❑GAF Stormguard Q Roof Deck Protection-breathable underlayment to let water vapor escape from your attic to help guard your home against roof rot,mold,mildew and other types of damage from :h ` 0 moisture. ❑15#Felt MGAF Tiger Paw ❑GA.F Deck Armor Q Starter Strip-strips help to prevent shingles on the edge of your roof from blowing off or leaking when faced with the heavy rains and strong winds of a severe storm or hurricane. Ab.•dla9rem ty aM m•Y naU•P•wd Y_P.,U wf.wI d. Q Drip Edge-protects the otherwise exposed edges of your roof deck from the elements Structural Concerns: along rakes and eaves. ❑Vented drip edge along select eaves Scope of work shall not include detection,abatement,encapsulation or removal of asbestos or similar hazardous substances.Ready Pros has the right to discontinue Q Ridge Vent-allow excess hot and/or humid air to be vented from your attic.It has been work if and when hazardous materials are discovered and shall be entitled to carefully designed to let air out and not let rain or snow in. [:]Zinc strip along select ridges receive compensation for change in scope of work. Q Proper Ventilation—improves year-round energy efficiency,minimizes the likelihood of ice . Ready Pros is not responsible for structural soundness and shall have no liability dams in the winter and overheating in the summer. ®Patented AirVent intake vents whatsoever for the failure of the supporting structure to support men,materials, ® Chimney releading Qty: 1 ❑ Chimney cricket Qty: equipment,ice,snow and water whether it occurred before during or after the Q Permits required(fees extra)3 Q Step Flashing and new sealed pipe boots outlined work. • Ready Pros is not responsible for interior damage resulting from structural Q Job site cleanup&removal of visible deficiencies as outlined above. Q All warranty: GAF,Limited Lifetime 2We will provide written notice if any extra costs beyond this written estimate are required.Your verbal or written approval will allow us to proceed with extension to this contract.Some common modifications and their associated pricing are as follow: Roof deck or fascialrake repair or replacement will be charged at$ 2.50 per sq.ft.(in 32 sq.ft.increments)and$ 4.50 per lineal foot(10 ft.increments). If additional layers of roofing are uncovered, each additional layer will be charged at$0.35/s .ft./la er for asphalt shingles,$0.70/s .ftlla er if wood shakes,metal,gravel or slate. INmALS Includes up to 122 linear feet of patented EdgeVent intake vents along top of a select Were gutters or downspouts built prior to 19787 eaves and venting 2 bathroom vents to exterior via roof vents. ❑Yes❑No If yes,the undersigned agrees to the Terms: 1/3 with contract, balance upon completion. Ready Pros Lead Safe Work Practices Addendum. Labor Warranty(Years): A Protex-2 ❑Protex-5 0 Protex-10 Buyer's Signature BUYER'S RIGHTTO CANCEL1. Total price3 $ 14,650.00 BUYERMAYCAN( I.TIiISCONtRACTBYDEINERINGWRIIi�VNOTICETOTHESE1MATAN"MEPRIOR TOMIDNIGHFUFTHETiiIRDBUSINESSDAYAFTERTHEDATEUFTHISTRANSACTIUN BUYERMAYUSE. Down payment $ 0.00 i}IISCON CI 'STHE`NOTICEORANYOTAEkWRIT(ENiNOflCt,B�WRMNG"IFIEREBYCANCE, ATTHE-' Balance payable on BOTTOM AND ADDING BUYER'S NAME AND ADDRESS THE NOTICE MUST BE MAILED,EMAILED OR Installation/Delivery $ 14,650.00 IL,W DE TO HE SELL'ERATTHEADDRESSABOVE =1EMAIL'Jh6P►ns@neady-ptosCOm }' 3plus Permit Fees r .o ❑Bank Financing X Cash on Completion All material is guaranteed to be as specified.All work is to be completed in a workmanlike manner accordingto standard practices This contract invalid only with proper signatures.Ready Pros,Inc. shall not be held responsible for time and material delays,strikes,acts of God or any other matters beyond its control.Buyer and Owner agrees that the equity in this property is security for this contract Since this contract calls for made to order goods,it is not subject to cancellation except as stated above.Installation to start on or about 1-2 weeks from above date.Estimated date of substantial completion is All charges listed above.Ready Pros,Inc.to remove and haul away all job related debris.All sales and discounts allotted.All contractors and subcontractors must be registered bythe Board of Building Regulations and Standards and any inquiries relatingto registration should be directed to this agency.Ready Pros,Inc.shall obtain any and all necessary permits as the Owner's agent unless otherwise directed by Buyer.9 Buyer secures permits,he or she may be excluded from the guaranty fund provision of G.L.c.142A.If Ready Pros,Inc.must pursue Buyer for collection of amounts past due,Buyer will be liable for Ready Pros,Inc.'s reasonable fees and costs,including attorneys fees.A FINANCE CHARGE calculated at the rate of t.5%per month(78%ANNUAL PERCENTAGE RATE)will be added to delinquent accounts.All installation and completion dates are a pprodmateand subject to change without notice.Verbal promises can cause misunderstandings therefore this contract constitutes the entire understanding of the parties,and no other understanding collateral verbal or otherwise shall be bindin unless signed by both parties. Thank you for your order. Do not sign this contract if there are any blank spaces. --- « Buyer's Signature p Ready Pros Representative Bill Cimbrelo (781) 974-3173 X Buyer's Signature Ready Pros Authorized Officer Form RPI-ROOF-R12 l The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia NNrorkers'Compensation Insurance Affidavit:Builders/Contractors/Blectricians/plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AApplicantInformation �PleasePrint I,e bl £.. Name(Business/Organization/individual): • ' Address 'RqlBi►S D City/State/Zip: Wu Ile 4 tip. '0 2 6 55 Phone#: :rg� Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(toll and/or part-time).* e - " ,• 7, ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.) 9. [1 Demolition 3.❑lam a homeowner doing all work myself.(No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property.I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are solo pr prietors with no employees. 12.❑Plumbing repairs or additions. 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp,insurance.: 14.❑Other 6.❑We are a corporation and its officers have exercised their right of exemption perMC3L c. 152,§1(4),and we have no employees.[No workers'comp,insurance required.) *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit Indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. ; tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and Job site information. p �— Insurance Company Name: Pdaulc Policy#or Self-ins,Lie.#: WC Y 0 1 I 1 0 0 Expiration Date: City/State/Zip: al e,r=rrll 2 b F Job Site Address: 38 I lln nAi Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). , Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certt the sand ties =rJ ih he information provided above is true and correct. 1 r Si a e: _ ate: hone ��- 1 9q�- �►� � 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: - 4 Phone#•' '� • TOWN OF BARNSTABLE BUILDING.PERMIT APPLICATION - Map ZZSI Parcel ® —TApplication# l 0Z 3 Health Division Date Issued tee4� Conservation Division Application F Tax Collector 'Permit Fee Treasurer 00 /0/&Y/07 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village C.-E-.'I Owner -c IZT' r �tz4 M-c.,Z �r,,.ess ! L P �o fi N 03 0-1 1� Telephone G 3 _ (o'S 5 s 2"7 Permit Request M Co—v v rzc 'as , /of re--Z-I r _�, E.�•a ,y ;-� -2, 0;;;,rzC a -.—S ! tJ S r t- D_C�,2,z.5 S IN, h/ t a�. j J► #-I W A L.L. I &X Ofti����� �m � \ bwe",&A Square feet: 1st floor:existing--Lveu 5 rproposed, 2nd floor:existing_ proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation $ . Construction Type tiJperJ 'Fez Ar—Z Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. 1 f Dwelling Type: Single Family )L Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes 1A No On Old King's Highway: ❑Yes 4No Basement Type: $Full ❑Crawl. ❑.Walkout ❑Other Basement Finished Area(sq.ft.) 7 oe Basement Unfinished Area(sq.ft) `3 v Number of Baths: Full:existing 7- new 19 Half:existing new � Number of Bedrooms: existing 6 new Z Total Room Count(not including baths):existing ® new °''y First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes )d No Fireplaces: Existing I- New O_ Existing wood/coal stove: ❑Yes *No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑ex°sting C[new size Attached garage:*xisting ❑new size Shed:❑existing ❑new size Other: __Zoning.Board of Appeals Authorization_. ❑ Appeal_#_ Recorded 0 Commercial ❑Yes ❑No If yes, site plan review# n Current Use Proposed Use BUILDER INFORMATION — Name qTV,/,-C. J tom t4 iCr4 Y Telephone Number 50$ -7 -7. &2- Address_ 71 ,,7 0 0% q&V License# o 47 C. Q3 C& T—k- T— 0 ZG '3_S Home Improvement Contractor# I J a s3S Worker's Compensation# 016 b e—p d 05- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE t/y' DATE ' FOR OFFICIAL USE ONLY ! APPLICATION# j DATE ISSUED :I ƒ MAP/PARCELNO ~/ � y -ADDRESS ' VILLAGE OWNER . . k DATE OF INSPECTION: ' FOUNDATION fFRAME INSULATION t : ) FIREPLACE 9 \ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL \ GAS: ROUGH FINAL / FINAL BUILDING \ • ' ' ` . . DATE CLOSED OUT ASSOCIATION PLAN NO. w , / . Results Page 1 of 1 Licensed Contractor Look Up Select the search method: I License -, Maximum number of matches: 125 _� Enter Search terms separated by spaces. 147693 Select Search type: OF, AND C, OR Sear, h Search Results City/Town Name Lic. Lic. # Restriction Expiration Street State Zip Type MCELHENY, PO BOX COTUIT STEVEN P CS 47693 1 G 9/23/2009 460 MA 02635 Total of 1 Records F matched. Back to Home Page ` BBRS Privacy Statement i http://db.state.ma.us/bbrs/contract.pl 10/24/2007 THE -FOLLOWING IS/ARE. THE BEST IMAGES FROM -POOR, QUALITY ORIGINAL (S) I MF DATA —{ '� _ - ® "'IONALSHEETS IFNECESSARY. LICENSE TYPE. ISSUED BY LICENSE/REG.k -EXPIRATION DATE LICENSE HOLDER NAME L t 12. LIST ALL PARTNERS,TRUSTEES,OFFICERS,DIRECTORS,AND MAJOR OWNERS(10%OR GREATER OF OWNERSHIP)OF AN APPLICANT PARTNERSHIP OR CORPORATION,BELOW. USE ADDITIONAL PAPER IF NECESSARY AND INCLUDE NEEDED PAPERWORK(SEE INSTRUCTIONS). PLEASE INDICATE BY AWX'IN THE LAST COLUMN THOSE INDIVIDUALS WHO REQUIRE AN APPLICATION FOR ADDITIONAL REGISTRATION I.D.CARDS. USE.ADDITIONAL SHEETS IF NECESSARY.FULL NAME TITLE %OWNER ADDRESS - - -- ` S.it.:'�•( �C- HEi't oJµ���C IG.O O 9� 71 �QLIC•SC �-V �M1L' r. (Z CeTLar h� e ZG S S THE COMMONWEALTH OF MASSACHUSETTS Board of Building Regulations and Standards For DIPS Use.Only.. Home Improvement Contractor Registration Registration No: One Ashburton Place;Room 1301 r Boston,MA 02.108 Effective Date: Application for Registration as a Expiration Date: Home Improvement Contractor or Sub- Contractor Date Processed: MGL c. 142A; 780 CMR R6 1. �r I BUSINESS NAME: i tJ C rl F Y i��<<� D j•2 S r r If- APPLICANT PHONE#: SO`� y co`i - 1 -2-c 2. MAILING ADDRESS: 70 -tJ,X t�O CO ?` ZG•3,$r STREET CITY, STATE .ZIP 3. PERMANENT ADDRESS(IF DIFFERENT): 5 L O�J 17c►�1 RrD .v��S �I.��.� ��A Q �_L c{9 STREET CITY - - STATE ZIP - (PLEASE NOTE THAT A P.O.BOX IS NOT ACCEPTABLE FOR PERMANENT ADDRESS) - 4. APPLICANT TYPE(CHECK ONE): INDIVIDUAL DB/A PARTNERSHIP. TRUST /PRIVAiECORP. PUBLIC CORP. - L.L.P. L.L.C. - - (SEE INSTRUCTIONS REGARDING THE ENCLOSURE OF A CITY OR TOWN REGISTRATION CERTIFICATE IF D/B/A IS CHECKED.) - 5. FEDERAL TA.X I.D.NUMBER: Z I 1"l t7 1 s p 6.-NUMBER OF EMPLOYEES: 7. HAVE YOU REGISTERED PREVIOUSLY UNDER THIS LAW?_ YES NO , IF YES,PLEASE PROVIDE THE NAME AND REGISTRATION NUMBER IN WHICH YOU WERE PREVIOUSLY REGISTERED: NAME: C-'ity---0_t2 _r REGISTRATION NUMBER: I l 0 y g 5 8. A) ARE YOU CURRENTLY OR HAVE YOU EVER BEEN AN OFFICER,PARTNER,OR CO-VENTURER OF AN APPLICANT WHO PREVIOUSLY APPLIED FOR REGISTRATION UNDER THIS LAW(M.G.L.C.142A)? YES NO B) IF YES,PLEASE PROVIDE THE NAME OF THE APPLICANT AND NAME OF THE BUSINESS(IF DIFFERENT)AND REGISTRATION NUMBER: APPLICANT/BUSINESS NAME:(oY or c vet L (LS (•�+CO J;5z +' yy� "e4t-I r(`� �j REGISTRATION NUMBER: - - 9. A) ARE YOU CURRENTLY OR HAVE YOU PREVIOUSLY BEEN EMPLOYED BY A REGISTRANT OR APPLICANT FOR REGISTRATION AGAINST WHICH DISCIPLINARY ACTION WAS TAKEN BY THIS DEPARTMENT? YES - NO DO NOT KNOW - B) IF YES,PLEASE PROVIDE THE NAME OF THE INDIVIDUAL AND BUSINESS(IF DIFFERENT)AND REGISTRATION NUMBER: - - APPLICANT/BUSINESS NAME: - REGISTRATION NUMBER: - 10. PLEASE PROVIDE THE NAME,SOCIAL SECURITY NUMBER,AND TITLE OF THE INDIVIDUAL IN THE CURRENT BUSINESS THAT IS RESPONSIBLE FOR THE OVERSIGHT OF ' HOME IMPROVEMENT CONTRACTS: - - - _w-c vtE.J TITLE 11. DOES THE APPLICANT OR RESPONSIBLE INDIVIDUAL HOLD yANY OTHER CONSTRUCTION-RELATED STATE,CITY OR TOWN LICENSES OR REGISTRATIONS? YES NO IF YES,PLEASE FILL IN INFORMATION BELOW:ATTACH ADDITIONAL SHEETS IF NECESSARY. .. LICENSE TYPE 'ISSUED BY -LICENSE/REG.N EXPIRATION DATE LICENSE HOLDER NAME - Lt '4-1 1Z`2rt f-01tt_H—F.1 12. LIST ALL PARTNERS,TRUSTEES,OFFICERS,DIRECTORS,AND MAJOR OWNERS(10%OR GREATER OF OWNERSHIP)OF AN APPLICANT PARTNERSHIP OR- - CORPORATION,BELOW. USE ADDITIONAL PAPER.IF NECESSARY AND INCLUDE.NEEDED PAPERWORK(SEE INSTRUCTIONS). PLEASE INDICATE BY AN"X"IN THE LAST COLUMN THOSE INDIVIDUALS WHO REQUIRE AN APPLICATION FOR ADDITIONAL REGISTRATION I.D.CARDS.''USE ADDITIONAL SHEETS IF NECESSARY. - FULL NAME TITLE %OWNER ADDRESS - - c- �1 j71 f1�L L tc S i C•v C 2 C o T7 t wi D f ..-MING AN EXEMPTION'FROM THE REGISTRATION FEE AS A CSL HOLDER? V/YES NO __fION FEE ENCLOSED: S - GURANTY FUND FEE ENCLOSED: S f' O C. • V a _ INCLUDE TWO(2)SEPARATE CERTIFIED CHECKS OR MONEY ORDERS,ONE MARKED"REGISTRATION FEE"AND ONE MARKED"GUARANTY FUND." MAKE NECKS PAYABLE TO"COMMONWEALTH OF MASSACHUSETTS." PERSONAUBUSINESS CHECKS WILL BE PROCESSED BUT WILL TAKE AN ADDITIONAL TEN(10)DAYS. PURSUANT TO M.G.L.C.62C,§49A,I HEREBY CERTIFY UNDER THE PAINS AND PENALTIES OF PERJURY THAT 1,TO THE BEST OF MY KNOWLEDGE AND UNDERSTANDING HAVE FILED ALL STATE TAX RETURNS. 1 FURTHER CERTIFY THAT THE INFORMATION CONTAINED ON THIS APPLICATION IS A TRUE AND ACCURATE STATEMENT. - �L Signature of Applicant or Business Representative(if registering as business) Title Date ' I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Comp Affidavit: ensation Insurance Adavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):. S-TZNr�—1 vim.c ii�l."r_.A["1 gi S c.",4_ Address: PC- r5 C-,c 44 1�d• City/State/Zip: ©L63 5 Phone.#: 5a 4-7-7 --K 6 Z Are you an employer? Check the appropriate box: Type of project(required):. 1.EKI-am a employer with 3 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. El New construction . . employees(full and/or part-time). �I 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity.acitY• employees and have workers' #. 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions rnysel£ [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance aequired.]t c. 152, §1(4),and we have no employees. [No workers' A3.❑ Other comp.insurance required.] . *Any applicant that checks box#1 must also fi1 out the section below showing their workers'campensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below isthe policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#:_QE& 061 to f,•1`7 Expiration Date: 9 l o f5 Job Site Address: 5 7 1,/U (Z7 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 under the pains-and penalties of perjury that the information provided above is true and correct Sienature: �" Date: . Phone#: �✓0S- 4?-7 - tic) 6 y Official use only. Do not write in this area,tb 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#: Informnation 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 fm 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 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-inmranpe 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 bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number:. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washingtcai Street Boston,MA 02111 Tel. #617-727-4900 ext 4.06 or 1-877-MASSAFE Fax##617-727-7749 Revised 11-22-06 www.mass.gQ-v/dia ' ACORDM CERTIFICATE OF LIABILITY INSURANCE 9/4/200�) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McShea InsuYance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Osterville, Ma. 02655 508-420-9011 INSURERS AFFORDING COVERAGE NAIC# INSURED Steven P. McElheny Builders, Inc. INSURERA: The St. Paul. P.O. Box 460 INSURERB: The Hartford. P.O. BOX 460 INSURER C: C'otult, Ma .02635 INSURER D: 508-364-1926 FINSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY � PREMISES Ea occurence $ 50,000 CLAIMSMADE CI OCCUR MED EXP(Any one person) $ 5,000 A NPP916772 09/22/06 09/22/07 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYF_j PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS BODILYINJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILYINJURY $ NON-OWNED AUTOS (Peraccident) PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ (OCCUR CICLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND x ORYLAMITS OER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBER EXCLUDED? 0 816 C 17-7-0 5 0 9/0 8/0 7 0 9/0 8/0 8 E.L.DISEASE-EA EMPLOYEE $ 100,000. If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO Town of Barnstable DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL10 DAYS WRITTEN Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT,BUT FAILURE TO DO SO SHALL Barnstable, MA IMPOSE No OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED R PRESENTATIVE ACORD25(2001/08) ©ACORD CORPORATION 1988 i I °FTME,�y Town-of Barnstable yP Regulatory Services sax�sr� Thomas F.Geiler,Director 9 MASS. �p i6�g. aa� BuRdina Division lED Mpl b Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date • AFFIDAVIT HOME IMPROVEMENT CONTRACTORLAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, •improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost 0 0 a Address of Work: "5$ (?u�.!✓tS [C4 4 2D Owner's Name: ©f5 R T- 9 N to A 4 Date of Application: Q/b -1 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 FIBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES.OF PERJURY I hereby apply for a permit as the agent of the owner: Q I`�C o-� �•i 2 J��1 v►�cs�.�-b'J�.rl`' j�.�,L7`€�2S A 10 �Qom; Date Contractor e Registration No. OR Date Owner's Name Q:fml whomezffidav E Town of Barnstable t Regulatory Services 33 LE'$ Thomas F.Geiler,Director $ATffl 9- � Building Division Tom Berry, Building Commissioner s 200 Main Street, Hyannis,NIA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder I, I oR l S. �f} M y,� , as Owner of the subject property hereby authorize *;�-FWPI Me CL lf6-y 91AI AM to act on my behalf, in all matters relative to work authorized bythis building permit application for; . UN451�.w (Address of Job) G Signature of owner Date R06A �`, �-��,, ,✓ Print Name QyoFM.S:OWNER EP,'Y1ISSION - - Board of Building Regulations and Standards HOME IMPROVEMENT CONT License or registration'valid for individul us to' ' RACTOR before the expiration date. If found return t Registration <110485 Expiration Board of Building RegulAtions and Standarc 10/20/2008 One Ashburton Place Rm 1301 TY.Pe DBA Boston,Ma.02108 GROVER&MCELHENY BUILDERS STEVEN McELHENY rr,j 523 MAIN ST COTUIT, MA 02635 Deputy Adminish•ator ` '- --_ --- Not valid without Sig nat e a ✓fie � ��aaaacl__ --- BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR i Number CS O47693 :. Expires 09/23/2007 Tr.no: 6108.0 I i Restricted STEVEN P MC H q PO BOX 460 COTUIT, MA 02635 i Commissioner `l. SMOKE DETECTORS REVIEWED BL BUILDING DEPT. DATE FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING 1 :IMPORTANT - UPGRADE REQUIRED } _STATE B=ING CODE REQUIRES THE UPGRADING OF SMOKE DETECTORS FOR THE ENTIRE DVVELLING WHEN ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. NOTE. A SEPARATE PERMIT IS REQUIRED FOR THE INSTALLATION OF SMOKE DETECTORS-THE,ELECTRICAL i PERMIT OES: SATISFY THIS REQUIREMENT. i • f - . CARBON MONOXIDE ALARMS" Y _ MUST BE INSTALLED PER _• MASSACHUSETTS BUILDING CODE r t s q n e co _ , ` � � s H�;�,�q nl - �x�5T"�nI C� Co►.l 7 T1 a i.15 d aura: ,14•• .D. wvvRoveuar: bRAVM . - wTl: v A REV28M - • � 38 i7u•.i as�,..t Ra. • • - �RAJVci6lAlYBER ,s L N EvJ E6.ft'ESS wI►iTb EU .JDcZ-S7r--4TWZ6310 Nt,n! ir-,LGO Ex. c 4 HEY �j/tTF S N otc7lE.t N SO `t-o. Ex. Co•+�i+,anJ CO 'TUB-OGK WAt�I-- I,S k 1� z,«+ \4A�� .,✓� DF"yvIAu cua.E: _�.-0.. APPRDVEDeT: omvm w DATE: 1 �+ 3� p��►.i�sx,+-! , tom. - 3 'DMM/P70 NVYBER UX30 nonmo.o.+maonun,lmn.