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Home My WebLink About0397 ELLIOTT ROAD A PA4 Y,; I�,t �.Tl 11 1 Mpt NVINe,01,MY, vf,� g g,� .z"Vo i AN6§14 i kik "N' 6� I%WA p Ji el ,, I 41 Ftt�,V'R -Y Mim, g"F 7A Z .vl WIo; T 4 x "M 31 v PIFMIT.Ai Sg,' Mr 3-,wVtL"Y0 gg T"', �,U'flllt RVII A 4;lt 1,4 NP, jig" -1,;11M 11 lqk`,"`�'116121.-111-111�WAM.11111�,' q'i iti Y� p�)v 0 1 611 T*I Rlrfi ,,;�gp W W It , 1 11.1, 11.011", r. P 'X41 K,* �t! I, frlry� ".),fit, jf qp ��y I , 1, 1 ,'..).�N ,, 4 , , �Nlrl Aft ow mi m fn RIM M;I'M i,i :1, au M, I, M, A A" RV)M nAlr.Ml V I"'t U�,3 .1� �Nr Ig% i� A M A. i Kit I ITN' fl,'W ."j, 6 oi�, I Iv IFO� 11`11if,40� L 'IJ h"I z, if-4- T g 0ii9Gi_41'_Pt AY15 �v 2" -4A- mg� �u,L. 11 Town of Barnstable *Perm a s F-pires �lhs r r iss dnre Regulatory Services Fee ` s s MAM BARNSPABI.E. • t6 9.� Richard V.Scali,Director''OrEn,y,p�e d Building Division Tom Perry,CBO,Building Commissioner -200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY _ Not Valid without Red X-Press Impritrt Map/parcel Number ..Zc2L�—. 1 U 5 Property Address 30I (i o�T lR d� . �P r' Residential Value of Work$ 9 b Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �O be_i Si/1111✓n 011 S 3 17 S, ;o-f'� Ce,,4eryiIle Nf A oz 3 2- Contractor's Name E 'lldt7,,1 trr/, r /1 r:so/f Telephone Number(t{O►) 2 Home Improvement Contractor License#(if applicable) 1 7&2 57 Email- Construction Supervisor's License#(if applicable) 7 Q ® _ aKyorkman's Compensation Insurance , Check one: �^►'1.7 ❑ I am a sole proprietor SFp 21 ❑ m the Homeowner I have Worker's Compensation Insurance Insurance Company Name �p��C Workman's Comp.Policy# W 6 8 3 S S 8 7 2-9 2-a 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) R e-side Zeplacement Windows/doors/sliders.U-Value 30 (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit.does not exempt compliance«ith other town department regulations,i.e.Historic.Conservation,etc.` ***Note: _- ttPrmission.Propaycaner must sign Pro erh O� ner Leerofe - -- A copy cKthe Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\Decdilik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\21`10I DHR\EXPRESS.doc D� Revised 040215 I s' . r _ 1 (_f ✓'t�� j !I ! ! % �, ..lf J JJJ` Oj,L�ice of Consumer affairs grid Business Rec7ulati®n =_=_- ® Pare Plaza - Sete 5170 Boston, Massachusetts 02116 H'©tee 1rraFrovemq t Contractor Registration Registration: 173245 _ Type: Supplement Card �- Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDGINS:LL BRIAN DENNISON 2n ALBION RD LINCOLN, RI 02865 Update Address and return card.Mark reason for change. ; Address Renewal i. Etnployment Lost Card -_.---Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation `Registration:-173245. Type 10 Park Plaza•Suite 5370 Expiration:-911:962018 Supplement Card Boston,MA 02116 .t SOUTHERN NEW ENGLAND W-1.NDOWS LLC. RENEWAL BY ANDERSON BRIAN DENNISON 26 ALBION RD ��— t: LINCOLN, RI 02865 !—Undersecretary Not valid without signature Massachusetts Department of Public Safety .� Board of Building Regulations and Standards License: CS[�-095707 .6 5✓ BRIAN D DENNISON 7 LAMBS POND CIRCLES s . .CHARLTON MA 01 0 r Expiration: Commissioner 09/08/2018 ..�oner The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/din Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. � TO BE FILED R'ITH'THE PERNIITTING AUTHORITY." A licant Information Please Print Legibly TName- (Business/Organi=ion/Individual): e LQ Address: .2& ALtwip Cite/State/Zip: LtJAJP Phone#: 101 Are you an employer?Check the appropriate box: Type of project (required): l..X]am a employer with Zo femployees(full and/or part-time).' 7. New construction 2.Q 1 am a sole proprietor or partnership and have no employees working for me in S. Remodeling any capacity.[No workers comp.insurance required.] 0. ❑Demolition .�I am a homeowner doing all work myself. (No workers'comp.insurance required.]t • ]0 n Building addition 4.Fl 1 am a homeowner and wdi be hiring contractors to conduct all wort:on my property. I will enswre that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs Or additions 5.r7 1 am a genera contractor and]have hired the sub-contractors listed or the attached sheet 13-� ofThese sub-contractors have employees and hive workers'comp.insurance.- her C.._❑We are a corporation and it officers have exercised their right of exemption per MGL.c j 52 f-1(4),and we have ne employees. ("No workers'comp.insurance required.] lac eti Any applicant that checks box;`l 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 contractor=_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 emplover that is providing workers'compensation insurance for my employees. Below is the polici and job site information. Insurance Company Name' ire me s Policy 4 or Self-ins.Lic.3�: /Cf'I IE87 Z L — Z' Expiration Date: l O Job Site Address: �� 7 G�r t b ��` ' City/State/Zip: Attach a copy of the workers' compensation policy declaration page(sbowing the police number and e xpirsibon 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 IVORY ORDER and a fine of up to S250;00 a day against the violator.A copy of this statement may be forwarded to the Office.of Investigations of the DI_A for insurance coverage verification. I do hereby certify under th airs and penalties ofperjury that the information provided above is true and correct. Signature: Date: 'Ld �� Phone official use only. Do nor 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. Otber Contact Person: Phone#: ESLERCO-01 SANDERSO A�ORO" DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06/07/2017 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 have ADDITIONAL INSURED provisions or 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 endomement(s). PRODUCER CONTACT CoBiz Insurance,Inc.-CO PHONE FAX 1401 Lawrence St,Ste.1200 A/c,No,I;t:(303)988-0446 A/c,No):(303)988-0804 Denver,CO 80202 E-MAILESS:COMaii@cobizinsurance.com ADDR INSURERS AFFORDING COVERAGE NAIC N INSURERA:Acadia Insurance Company 31325 INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 Southern New England Windows,LLC.dba Renewal by INSURER c:Liberty Surplus Insurance 10725 Andersen of Southern New England 26 Albion Road,Suite 1 INSURER D: Lincoln,RI02865 INSURERE: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF.SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD M D - (MWDDrrrM A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR CPA3158728 0110112017. 01/01/2018 D"APREMIl E8 ea occuErrence $ 300,000 MED EXF(Any oneperson) S 5,000 PERSONAL&ADV INJURY $ 1,ODO,000 GEN'L AGGREGATE LIMIT APPLIES PER. - GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OPAGG '$ 2,000,000� OTHER: EBL AGGREGATE $ 2,000,000 A AUTOMOBILE LIABILITY EOM�BIINdEDSINGLELIMIT $ 1,000,000 X ANY AUTO CPA3158728 01/01/2017 01/01/2018 BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOOS BODILY INJURY Per accident $ AUTOS ONLY AUTOS ONEDY PR DAMAGE $ S A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000'OOO EXCESS LIAB CLAIMS-MADE CPA3158728 01/01/2017 01/01/2018 AGGREGATE S DED X I RETENTIONS 0 Aggregate $ 1,000,000 B WORKE AND EMPLOYERS'-LIABIILITY YIN X STATUTE EORH- ANY PROPRIETOR/PARTNER/EXECUTIVE WCA3158729-20 01/01/2017 01/01/2018 1,000,000 pFFICER/MEMBER EXCLUDED? N 1 A E.L.EACH ACCIDENT S (Mantlatory m NH) 1,000,000 E.L.DISEASE-EA EMPLOYEE S If yes,describe untler 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S B Worker's Compensatio WCA3158730-20 01/0112017 01/01/2018 1,000,000 C Pollution Liability TIEDE654299117 01/01/2017 01/01/2018 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached N more space is required) 17-18 Workers Compesnation Includes-All states except ND,OH,WA,WV,WY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE IF OR informationalPurposes ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Robert Simmons MR111.1M.N1 Legal Name:Southern New England Windows,LLC 397 Elliott Rd Rl#36079,MA#173245,CT#0634555, Lead Firm#1237 Centerville,MA 02632 26 Albion Rd I Lincoln,RI 02865 H:(508)771-1590 Phone:866-563-2235 1 Fax:401-633-6602 1 sales@renewalsne.com C:(617)699-7093 Buyer(s)Name: Robert Simmons Contract Date: 09/08/17 Buyer(s) Street Address: 397 Elliott Rd, Centerville , MA 02632 Primary Telephone Number: (508)771-1590 Secondary Telephone Number: (617)699-7093 Primary Email: simmons.agency@comcast.net Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $6,896 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $2,298 Balance Due: $4,598 Estimated Start: Estimated Completion: Amount Financed: $0 6-9 weeks 6-9 weeks Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that . we are providing at this time is only an estimate.We will communicate an official date and time at a later date.Rain and extreme weather are the most common causes for delay. Notes: Taxes in Barnstable Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 09/12/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal By Andersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature jim passanisi Robert Simmons Print Name of Sales Person Print Name Print Name UPDATED: 09/08/17 Page 2 / 10 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�C(, I DATA r Lessor's ffice(1st Floor): fsessor's map and lot num IorM c T onservatbn(4th Floor). SEPTjC SYSTEM o�e oard of?Health 3rd fioor� _ STALLED I Sewage Permit number . r 1 � 1�1PIT�TITLlo E 5 : s'ti"'`ntt Engineering Department(3rd floor): �� Ir1v1VIR®�IMENTAL Co `�� I House number ear � ! T®wN RECaIIL. TI® Definitive Plan Approved by Planning Board — 1g 1� APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2-00 P.M.only - TOWN OF BARNS ABLE 'BUILDING- INSPECTOR APPLICATION FOR PERMIT TO CT/2uc r �L's7.tJ• U9 � yil /cam D��C TYPE OF CONSTRUCTIONOj / 4 19-TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location :OT C ,C.L.C.1077—,� .. ��% ./yam Proposed Use vim/� rilti Zoning District District R Fire District O�Cv`38 Name of Owner AF,� ir / � �16ii✓✓� Address- Name of Builder �lc.�i /_�- `�;`V0,L)d- Addresss2-e�&/tff- ed `y_ H•0 GLG?O ( Name of Architect/t',LGli�,a.�L �J _S�v-raves Address S2-, Number of Rooms Foundation Exterior �L -� / e� c �"� Roofing '400 � Floors Interior � a-�-� Heating fr'f-/. Plumbing o0 Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee S-0 ��U o J zz 22 -Zy OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. n Nam �Gy Q /rtd.iLr Construction Supervisor's LicenseO�zZdS� s RICHARD F. 73L� No 3✓7`0'5"5 Permit For 2 STORY _ Sinale Family Dwelling Location 397 Elliott Road (Lot #3) , Centerville : . 4 Owner" Richard F. DeSimone , Type of Construction Frame ' Plot Lot' Permit Granted :Sept. 26 , 19 94 Date of Inspection: �1 Frame 19 Insulation 19 Fireplace I '3� ` ' 19 Date Completed - 19 0,3-� -- r 1 , ;; 4i ' _. -- ,. - _ ->. � tom_-�._ _-_..:._.��/= � �' .-. .-, .. �. �; t .., �. _ -- � I, 11 � ._._.--�.-.__ __ _._ _ _._--��----FF � �' � 1 .,a i . _. , _ _�. �--- - - - :. ;.. i r .. _.. .. . i --- :_- � ' i 'I 1 � � --- - . I _ LJ .- 1 W '\ 1 � � ---- -- - , , --- _ _ Y ._ - -----� - 17 iF-c r eEv�2aM _ � i FIE I� 11 �;i. • I I ' sue:.• '� ---- -��_... � lu lu( c r ' c IDfS-D 6/•X7 O• ./?F._f_J•G'�E.CC V%�9iG��:L<cs /e•.��. _ .2iC<.'T �i;7�_—' __ _ l s i s 6 t « - Or ll 12 i i J b •i. 5pp14 b w ,f fin, BA i a r � r tei fr 3 �; k 1 'a si 4 t � }t;R ';Le't�'S�-.y Ai 7�2 kph • z' rr kr � f�j� S r. � r EST"OF Mir INS �N�ATioN, AsNkST ILT' PLOT ILA i � Now o�� 4H . BAA$LB r F 5 { '3� A��D'J�O 5�O O' Y,.'_ S MASS �..� h a N H18 , LN: NAS`8EEN L ON ,:. T 3c�� N D 7 3 �pk �<aY� ROUND*A 101 ` F DATL S PT /s i99� scALE J0 GLI N7Jr h° Y `y, k, �:, �� i�c �, S'yi ' '?;5I IN } �.�RING 25 GREAT WESTERN ROAD P 0 OOX 7i� ' DATA' PROF S51 j SOUTH bENNIS, MASS: Jy URVYOR .: : o/ 02660 FA Xl 398- 063 r , s � s�c � of r��v " ��,,f,CCID. S J S �a•*�cs- Ga-��x� i;OSTON, ).-LA�SS/,Ci-3 US3-:- S 02111 "OR3{ERS'COMPENSATJON TNSURANCFAFaDAWT G;CCnse%scrmiaoc) with s prindj=1 plsocofbtrsinc&jaWcnct2C - do hcrcb ccrzi <CtcylSLacdZ;p) Y fj: trader the pins and parilcies ofperjuTY-d=a [] l -m an cmplo_vcr providing the follow;ngwork�•comper=zion covcr2gc formycmploy<.cs working on this Job- - 3nsumncc Company ` Policy Numbcr �) 3 am 2 solc propriczor2nd h.2vc nooncworlvng for rn, �) 12M 2 solc propricto cnc<l conu.- or homcowncr(ardc onc)=.nd h:vc h'rrcd the •coo hzve the following work'=-cnmpcnnnon i»ncc politics eontr�«ors Iistcd bclo., Conti«or `� `7s98.� Ias�:r-ncc Company a1icY 2�Iumbcr N-zmc afContrraor lrsu.-ncc Co.:�panylPolicy Nemnbcr �12- :122 Insursncc 'emp=ytlbl' NUmbcr D 12m 2 homco,�-r��rper:oz:ning:ll�cworkmyclL ROTE- w- l�lf:��of„ot ror<zt� i _ 1_, o<r:plcypccsccr to Lo r•i;uccxztr uertrvcs;oc etrc�sit�-c«oct=Li«mutt tt:4...0 L<b<cJ<o`•^'<f:J�o fcs�2cs of oc tSc�rcacjs t <enr:ter<rto (>eer_pIcy<rr`'e4v6<C7c�•<ri Cerr p�r+�tttt3etetozetDot�eoer_11j_ orpern;tr..:yc"�lccc< z=<3<tz�:�r.�c!�cr___-lovc ltcrC�2. ,<c]($)).xppi;=j-.ccby c2ct6cZ/ot :bcrxc•.acrfor� j:«as< pCCI]L.OL h<t fc^c<r:<:rcti_<cccjYci� ::c<r..cr.<.;�aic—rl<L.to6.< D<pzc-cncc�)r.Gcariclf<C�<nC'OT«cc�l:ac::n<tfor.cc�cr-<< �YrfiLtic:�-..�1 t};_t f_�Jcr<tc:«cr<cc•;a<;r rccc;r<�vr.Lcr Sccz;cr.?Sf,cf}/.G?] �<cr.:,:one c./� f�:cccfvr^tcSJSG G.CCU.1cr �crr pS c c sk�cc icr.- r...fct;t.cn Crg;n;n_3 pca-Juc: frc cfS700.00 ccfvptocr.<yc istScfc -�icfcStcpTJc&0pecrcn- e-y-�- �nc� this p�5 cTzyof 79 Liccn_cJPcrm.izzcc d/Z�d.S 1.iccnsor�Pcrrninor z. C(D2\/rMONWFA.L- OF K V TN 600 �amcs� Ga a�xri3OSTOiN, MA-S$ACi-?U$3-1 S 02111 -W()MC£RS'COMPJENSATJON INSURANCE AI:MDAVIT G;ccrucc/pCnn;exec) Stich s principal plsccofbusin=fresidcnaac - /qO7- do hcrcb ccrti <GggfSiacclZap) Y fj; under chc pins and peralt ofperjury; d=r: () I =man employer prodding chc followinsworkcss Job_ 'compensation covcnsc for mycmployca worl:in'g anrhi< 7nsumncc Company Policy Number �) l am a Solt prooricrorsnd h2vc nooncworking for rn, �) l am a sole propricto cna-�J conzrao or,homeowner(cirdc onc)and h:vc hired the eonuaa0a I '-ho hzvc the foIlowiagwork,= p� nsurincx po.ric�-cs.com don i utcd bclo". •- -- �d mil 1� 1"�—mc ofConuactor Insumncc Company bhcr N=bcr -N-zmc of Contraor lnsur--ncc CornpanylPolicy Number Izmc cfConcrccor • Insursncc CempanylPol' humbcr I am a homcoxncrperforraing�llthc-work mysclL COTE: PJ<: cbc:•;<L_t�?ilcf<c<o••r 1--c11:n�otr�ot ror<L�;:Lc«cGits iG�, t «moo crploy persccr to Lo rr2iGtccsacc,cctrtrtsct;cG or tcplir�-cost Oa n «r�c:2cr<r to ��L<bocxa•,ct slco t<s:�cs of oc t4<rtcacZ1=ppuaccxct t3ctcca sec ooc Lcc<t-_IJj• be<caploy<rr a_Icr ixC7e�<u�Cor�p<=$:tloc ACT<CL C 7$2,«c 1(5)),=pp1%c:t:oc by s bcrxo••a<t L fot a or�J<rfla r:y<h�<G« <3<rJ c: r.t cry<r.1o1 cr uc2<r TIC'Gorlt<r:'COCMP<c12t:oa/.ct <oF ci �ulcL to ti< TJ< --cnc c�Irtu:criJ/.<c�<nt'OTr«c!h:c:;ncc(or.cc�<r-�c �<afrctica=.rsl tl:a f:.ilcr<tc:«ca G:.;-• P--"�-- ic<cr,:i:ono of c 5 C--152 e:r jc:l to tic ir-..pccit;en cf�inin:l per.:l uc: f n<of vp cc SI Stt.AQ-.IJcc i--rtcrract c�vp co ors<yc s�c Y:l pc;:tries i-s ttsc fors c!:Sccp Zlcck Or�cr s�= 1 f,nccfS700.00: e,y=-g-:aaru Si�nc� this o`zs . c�zyof_ .A%' . 79 Liccn:cclPcrmitzcc �/� .�}_-d/Z�� ]��sorlPcrrnirtot HAYES & HAYES ATTORNEYS-AT-LAW, P.C. HYANNIS PROFESSIONAL CENTER 23 EAST MAIN STREET HYANNIS, MASSACHUSETTS 02601 HAROLD L. HAYES,JR. TELEPHONE(508)775-0080 OF COUNSEL TELEFAX(508)775-0693 MICHAELJ.HAYES JANE SMYTH SUTTON PAULINA M. REILLY August 10, 1994 Town of Barnstable Building Inspector Town Hall Hyannis, Massachusetts 02601 re : Application of Richard DeSimone, Lot 3 Plan Book 305/42. Riverview Landing, 1976 Plan for Hostetter, assessed to Paulina M. Johnston Map 227 Parce1 .105 Dear Sir: This is to confirm that this office has examined title to the above lot in order to determine at what point it ceased to be held in common ownership -.with .surrounding land., On March' 26, 1984 this lot was conveyed by Hostetter and Crowell (the developers) to Paulina M. Johnston . The deed was recorded in Book 4045 Page 273 . It has been held in separate ownership since that time . Please do not hesitate to contact this office if you need further information. Since el , Micha aye MJH/ I `—� COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY .' Fal/ar•toposst >rrrrent OF ONE ASHBORTON PLACE a. ��staaMs•traSlshSmHSis� IT MASSACHUSETTS 1 BOSTON,11A 02108 Cod•/scssss/orr•rogoon EXPIRATION DATE I C O ,I S T R.t S U P E R V I S O I oftAtslJas4s•.CAUTION I FOR PROTECTION AGAINST n 2/27/1 996 I EFFECTIVE DATE LIC-NO. I THEFT, PUT RIGHT THUMB RESTRICTIONS NONE 11 '/30/19`/3 01 2205 PRINT IN APPROPRIATE BOX ON LICENSE. , MICH.AEL A DESIMONE G 52 LOVE R D -�BL NG OPERATORS SS k 030-54-8611 W DENNIS IAA U2670 -�n�us l'PLU*PH T . PFlgTi_�,(A� 0.VG;OPR ONLY) 80. E ^ ' �0.00 NOT VALID UNTIL SIGNED BY LICENSE€AND OFFICIALLY J i.: 4 p 1993 STAMPED-OR-SIGNATURE OF THE COMMISSIONER I VVV 1 HEIGHT: l DOB: 02/27/1961 SIGN NAME IN FULL ABOVE SIGNATURE LINE. THIS DOCUMENT MUST EECAR -- \': . THE HOLDERED ON PERSON OF I _ THE HOLDER WHEN EN- I - COMMISSIONER OTHERS'=RiZ9 THUMB PRINT GAGED IN THIS OCCUPATION. - II Town ®f Barnstable *Permit 4/0 I t G__)__) v I ,4 0� Expires 6 months front issue daig,O t3' Regulatory Services Fee 1ARNSfABLE, • `®� Richard V.Scali,Interim Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,ILIA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PEST APPLICATION - RESIDEN'TUL ONLY Not Valid withow Red X--Press Imprint Map/parcel Number �_ Y Address Property P ®Residential Value of Work S l J` (00 b Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address o6erb SI rinrYlot 391 F-M oit flk Cente-YVi(l.e- , -�— Contractor's Name, n �� n Telephone Number }i -, ,� r J j t3t;�l�luC'll Home Improvement Contractor License#(if applicable) 1-7 399.5 Email: Construction Supervisor's License#(if applicable) Ci F-I ®Workman's Compensation Insurance KONE % PEIRMOT Check one: ❑ I am a sole proprietor NOV _6 2014 ❑ I am the Homeowner I have Worker's Compensation Insurance (, TOWN OF BARN STABLE Insurance Company Name t�LX1C�IJ �risl a n(f) CA . Worlanan's Comp.Policy# (L(_,12� 9 23 qG} 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 r w (maximum.35)#of windows _ #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with odier 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 requ' SIGNATURE: T:NKEVIPI_D\Building Change sTXPRESS PERMIT\EXPRESS.doc Revised 061313 i The Commonwealth of Massachusetts 5 Dep°�ent of fndustrialAccidents ,1 _ Office o•f Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers'Compensation .InsuranceAffidavit:Builders/Contract A licant Information orslEiectricinns/Plumbers (Business/O SOUTHERN NEW ENGLAND WINDOWS Print]Le 'bi r Name $anization/Inelividiral):. IVDOWS LLC Address: 26 ALB(ON ROAD - CitY/State/Zip: LINCOLN, RI 02865 Are you an employer?Check the a Phone . 401-228-9800 • 1.� I am a employer with 20 PPropriate bog. 4. ❑ I am a general contractor and IFproject(required): employees(full and/or p�� have hired tl�.e sub-contractors 6.2.❑ I am a sole proprietor or partner_ listed on the attached sheet ew construction ship and have no employees These sub-contractors havemodeling working for me in any capacity employees and have workers' molition [No workers'comp. insurance co $ required] �. �P-insurance. ilding addition '-❑ I am a homeowner doing all work ❑ offiece�rs�corporatzon and its ctrical repairs or additions myself P have exercised their mbirt re(No corkers com - ri t of exemption per MGLl; Pa or additionsinsurance requi�ed.l' c. 152, S1(4),and we have noofrepairs, employees. (No workers, er MNcowt�aLACEMENT comp.insurance required] *Any applicant that cheeky box tl must also fill out the section below shoRzn Homeowners who submitthis affidavit indicating are 1?their workers'compensation policy informaUion. eCon tractors that check this box must attached an adds o shy how and then hire outside contractors must sub employees. If tlrecub-contractors have employees,dz a the name of the sub-contractors and state aka near affidavit indicating such. they must Provide their workers' Nether or not those entities have I am an employer that is providing workers'com comp.policy number. infvnnation. Pensation insurance for my employees. Below is the policy alid job site Insurance Company Name_ ARGONAUT INSURANCE COMPANY Policy or Self-ins.Lic.#: WC927938352394 --- ExPiration Date: 08/21/2015 Job Site Address:—u-J-_ Attach a copy of the workers' compensation policy declaration Page City/State/Zip p- Failure to secure coverage as required under Section 25A of MGL c. 152 can lead t thepo Posi�bo f and t ll'ation date). fine up to$1,500-00 and/or one-year imprisonme as w ell as civil penalties in the form of a STOP of up to$250.00 a penalties a a da3 against the lriolator. Be advised that a co OP WORK ORDER and a fine Investigations of the DIA for insurance covera P3 of this statement may be forwarded to the ge verification Office of I do hereby ev fy under Me pains 43rd e i p nadties of'perjury thatthe ' arm orlon Sima provided above m true and correct. ture: ' `� ` h ne#: 401-228-9800 ` 0cial use only. Do not write in this area,to be completed by city or town o City or Town.. Issuing Authority(circle one): Permit/License# 1.Board of Health 2.Building Department 3.Cityrfown Clerk 4.EI 6.Other eeMeal Inspector S.Plumb•ing Inspector Contact Person: Phone#; 4A�� CERTIFICATE OF LIABILITY INSURANCE ; DATE(aWODJYYYII) 80/12/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFCA CERTIFICATE DOES NOT AFFIRMATIVELY OR N Tb HOLDER THIS EGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS-CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETYVEEN THE ISSUING INStJRER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT- If the cwWlm Ea holder an ADDITIONAL INSURED,the 11011cy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the tw.. and conditions of the policy,certain policies may require an endorsement. A statement on th certificate holder in B certificate dog not ootlfar rl8hts to the lieu of such endorsemangs). PRODUCER Willis of Bev J ersey, Lac. C/o 26 Century Blvd PNOME FAX P.O. Boa 305191 -877- 5- 37 -8 - 378 Nashville, 2N 372305191 v9A AVI)W certifieatesoriilis. - AFFORDetG COVERAGE NAtc• edSIfRERA�nlaetive laauraaca of BS 39926 OrSURED Sontheza Nev Ragland windows LLC 0VSlIRER B:Tha esaeon ahtnal lasureacs D/H/A 8eneral by Andersen 24027 26 Albion Road WSuRERc- Zasurance 19802 Lincoln, Rr 02865 pglp; DWRER E C aWURER F: OVERAGES CERTIFICATE NUMBER-402916o 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 DESCRIB® EIN IS SUBJECT TO ALL THE TERMS, HEli EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANKS. waft TYPE OF DWRANCE POLICY E" POUCY EXP PO ICY NUMB@t D 7C COAHI RCIALGEtE RAL LUOU Y Lam CLAlMSDE aO=R E $VS3,10D00, ,000 A tSES�Ea S ,000 ropWM �� one ,000 8 2029459 08/10/2014 08/20/2015PERSONALI IN000 CE:ML AGGREGATE UMR APPLIES PERPpUCYI JJEECTT LOCGENERALAGtiREGA ,000 PRODUCTS-COMPJ000 AUTOMOBILE UABUM X ANY AM uMR s 2,000,000 A a n� SCHEDULED 90WLv+AwRYtPe►Pe ) S AUTOS 8 2029459 08/30/2014 08/10/2015NONOAMM BDaLYWU (pereoddd) S X HIREDAUTOS X AUTOS PROPERTY S A X UMBRELLA UAB x OGCUR _ EXCESS LU18T- EACH OCCURRENCE S .5,000,000- CLAMMS�MADE 8 2029459 08/20/2014 08/10/20U AGGREGATE S 5,000,000 DED REfBMM ViOR!(ERS COMPENSATION S a NO EMOYW L"LITY' YIN X PERMYPR OTH� mVE OFRCEERIM��ER ACUMM? NIA 0000060028 08/22/2014 68/21/2015 EL EACH S 1,000,000 (UNHWWYMyyeas4,EasafDe EL.DISEASE-EA $ 1,000,000 DESCR►PT10N OF OPERATICidSS below C osk C-W/BL Cavgs F.L.DISEASE-POUCYUMT S . 1,000,000 NC927938352394 08/21/2024 09/21/2025 .L Rs. Acddmt - 01,000,000 tatutory Limits - WC L. Dlaaasa Policy Lmt - 02,000,000 -L Disease an. avloyae -.41,000,000 DESCRIPTION OF OPERATIONS/LOCATXSNS I VEHICLES(ACORD 101.AddmaW Rwnnb Sdwdul%my be s0admd If mma spare b CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCBES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED in ACCORDANCE WITH THE POLICY PROVISIONS. Southern NO LLC AUTHORIZEDREPRESENrATNE f4Albion Road n_,, /► cola, R2 02865-0000 ityytyt�J . 01988 2014 ACORD CORPORATION. All rights ressrved. ACORD 26(Z09�6/01) The ACORD name and logo are registered marks of ACORD SR M6629625 HATCHtlateh 0: 79627 .coat p�•I t RENE%vAL.sY ANDERSCN 26 Ar6im RAW..Umvin,RI o�l' Phone&I,.M,7.7tn Fax 401.683.E+60Z lwrirrr N�.�LnLr Mll.dow�ai�C lA/a It�MwaTb�Are.wdsentY�saNsMrL�6ad . CUSTOM WINDOW MID DOOR REMODEUNO AGRSZbMN ' ` t►�weatAevw.r■. ae.NL...wboaOpts-.,?�C.i.,1i0..ae 3:5 - 9 Lli/o7T A—D Z- w...».�S/l��e�S.9�nacYe Gcaxc�T�►��:. »N.,, .�-7.7� 15� M.,.*,a�„e,,�.�..:611-� . DrttKd bcf&y jcil*and tevtrapr aline,to petn twr dw pneduMpnd/ar.Mast.ref S�tuhrm New England Wan&-^.1=d/Wa Rnx wd ty Andrei.of Sawnhcm Nair -0-numve.in m a wd amr with the teems and cmiditiLsn dm-n%d cef do rnm aW do nary of this aRnarunt and on the attaafird tp,rifira$m dtretlol fndhrtirely�tM`.utRw.rnt7. O Rhode C Ceuda O II ul. TodNlAn,eee.ee/�j ��,� Ea.maefwatiore MaU+osd Ch dt UGsh inna0 EibM sc Sme d Joe Ax F-111,9&l0 o�os rVism cots^=ns Grdt Cadf*nw ddt Avmnm &w 7drt din Ibbnce K Start dlsb end tits tislaectan SwOsuntid 1v f� ldrur a►SubsvaiH Conpkebn d job arner 0.wOs blr gsAe CatreObsoeadjos MY . 1:/: tardssdsreataa>adsMor+«►yd+od6tatotd+td�.acsth . 8e7e48)erg"and tiad m.aets that We Agaemoat eoastitatee she ead a sodorstawdw botwws the thew am sae rerbd usdees rhea of the to a of thb . s . P �t..a ths) (1)has,seed chi. *�P gas f'*r Agetesest.suyer(s}seksswbdgeo tds sale(.} A�ewo%siadesstawia th.toots of this 0 a-, esy sad has sweei.ed s eoewtieMds signed,aid dosed. oopr of thbAgeeemest,bditdisg ehe two attaehsd Nodesa of Castxtladosy ew tht date Ant oestrus above Gael(2)wueeaD�" - isfoesodofBurr%eighteo=m ol0&Apwmeat.DOKWSIG =l$CONTRACTIFTHMAMMMBIAWSPAM (mode reund Salt OR&)Notion to Boyer:(1)De Get sip thIsApaewae If dap of sbe epee" ateaded for tw speed Mew. to the eatost of rhea awytTftbte bformsdos ass left btaalt:(Z}Yos an tackled to s eopyef"Aghrvement at the des d it.(3)Yoe war at aar dmo psy oQ the fall espaid bahmm dew wader this Atroewosq and b se delag Sea way be*add"too seotdve a partial rebate of the 6ssiaee Gad Issaraaee erharps:(4)The Geller has so riche to sHisrertattr caret oar psestbes. or soma Gap boseh of the poem to wepossrss goods pweehasod ssderthisAgreemeat.(3)You war oaueel"Agreemew ' U It has sat boss aigaW at the mass office or s bmaeh oWm of the sells;psovidel.roo no" the fa an st his ef br tads emm or brae&olBa shows Is the Ags eemeat by eogbtered oreeeoi la osa%which sbaD be posted smut"tbsn mldwight-.. of tha third"kadm d"after they day on wAieb do buyer sips dtAg eewesy e:ebrdiag Sunday sad Bey holiday es which . nge4s craft doliwrios are set wades See the seeswpssriag areiee of cammustles Forst for an serfs eadoa of heyeA tights. Suyerfr)serehed t1,e aoruumer educatiebt maseriab ptnaieW bii the Rha.kaland Contea�tans Relpanuioe Isued: (may l.�isyJ Aeseaval Andenm olSoutheerea Ne�+f nglaad` , .aoye�s} .. •Bnyp(o) . Bit Sipvteoe�t eduttltataaxrr. Sigtmtene SiDwture I'd Nardc c and -R.fajuwr P"Name Prim Name you.THE.BIJYFR(S}s MAY CIWCEt.THIS TRANSACTION AT ANY TIME PRIOR TO'AWMGlff OF THE THM BUSINESS DAY Arm TH13 DATE OF=n TRANSACTION.s=THEATTACHID NOTICE OF CANCEuAnoN FORMS FOR AN E U IANATION.OFTMB RICH L _- - NOTICE OF CANCELLATION — —— NCMCE OF CANCELLAMO �w Date ofTransscdon t d'�y 1 y.You snsr ews"I Data ofTraeaaedon You scut cancel this.transec"m wkhooA any Power e►obGga$ofy widiift_ . thb eraraacdo%without anal"tuft-or ebgta"%wkNn thret business day,front tM above dart.If ran cancel.am I theta bariftass dabs born 0o above date.N:r m wtafe any PwPKh►�.kk w Pgt�rett�ents made bl►tau atdsr H».1 prowrer tied �irr%*"wrenenes made M roc tutelar thi b r s d.ar�nsd�;=am,mnbnass days Poll hOr�ntu ud�w�h sa:a day. receipt.br do Seas►of-rota twectGatloe ttedosy and asp.,I riWpe by oho$0w of.roar eartctoadon,itotkt,mid any securiq htartst arising out.of &o lrane.cdon wiQ bt. 'seanitr httsr�.anus.= out of Ms:aansutkpi w0l bt eancetedaf yott cancel.rroans must mates artJlabis to eM suit. cancd.d.If yar came%yyoouu mutt maha aaitabtoto the S"6r ae your nsidertct,in./f�Mnuttiatly as good eo"t%n as worm. I .a*-- wsidsnm*in*ebseandefir es good co"dan as when seceiwd,ww goods deGwusd to you under dds Con"a a I �tceiwd,a"goods da1rtrertd t e you under-obis Contract er Saletoryouttunityatwaltre wkhtMinttrueoonsof`I Saitiorl►�+�Bl�!�,eanRtjlwithd�imovcooraot dtt Palle►regard dtt nttsttosl tteftt esf clot Sooda s<eitt. .do SNisr reg' dtt totes.stapment of rho goods ache: . seuw kl and►iA&if yar do wealrt tit goods ws*R to:� Sevw%��ps�ae and rill`Koren de mates do goods man" . a do o Setlo►and the Shceerdo"not pick dam up-wrkM - to tM SNM►and eM SNler dots not oily Mm up jef" twenty of-do date of canapadon.you map.mta%w. i twootty.da�rs of dw dot of canceftdoi%you may raahs or dispose of tM goods.wkhout cep Omdw►o ftailm N you. I dopost of the goods without arty AKdter ebGgadm N you ha a make dtt goods iraAabit to die SeGeyo►Nyou S.grst .I.fat?is n*W the goods*"PA%to tit Ssflsreor.If i agar .to taros.eM jatds to tM SeWr and tai!bs de aq ehon you."I to�do 9ood1,to tM SN1a and fate do sq thaw you toms.liable for"rh manto of all obligations order dw I ►arnsin 11able for Perfommm of all obgsadera under rho ConowtTo caned dtia wataaeti^mdfor deliver a slgmd Contrum10 caned dtis trartsacdon,mA 4w& wr a sipted. '. . and dated ooplr of ebb aeaGadoft.aodct or afry.outer.t'and load copy of this ancttladon notice or any oeMr. writtennetiaersenda topmwwdbyAndersanof l writesnodcrosmwa ,to RenowalbyAit%nmof Southeast Ntw at I Albion RI 02g6S,.t Southern Now tji at 1 Albion Road,Lincoln;Rl GUGS, ��NppOG,LATER THAN MIaN16HT O0' /�. . t NOT T AN MIaNIGHT OF I HEREBY CANCELTHISTRANSACT OK I I HEREBY CANCELTHISTRANSACTION. . . �,earNstya.eis. . .wt.rst�e o..e 'tw�rtisttatas• wwstw e►rs t' ItbACoPir"" ft+J's►CW-,(41ver by/W COW.ftett : Southern New England Windows d.b.a. Otassachusetts Department of Public Safety Board of E:vilcding Regulations and Standards i BRL4N D DENNISON 7 LAAM POND CIRC LIB Chariton MA 01507 , Coinmi:ssio e-r - 09l08/2016 == Office of Consumer Affairs and Business Regulation I. _ a ess R gu 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9/19/2016 SOUTHERN NEW ENGLAND WINDOWS LL DENNISON BRIAN 26 ALBION RD - LINCOLN, RI 02865 =_ Update Address and return,card.Mark reason for change. SCA 1 201145/11 i Address Renewal Employment Lost Card f��c�o»rrxoutrca�l�o��/l�U;rrr�a;r!!3 � . Rice of Consumer Affairs&Business Revulntioa License or registration valid for individul use only' - i �+—CtOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - t Registration: 173245 Type Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 . Expiration: 9/1912016 Supplement•:.ard Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD LINCOLN,RI 02865 Undersecretary Not va ithout signature k �1I1311N J Town of Barnstable *Permit# Expires 6 months front h=e date Regulatory Services Fee ages. Richard V.Scab,Interim Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Irnp Map/parcel Number 1 Property Address_ UI11 Per K oftX � Residential Value of Work$ p 5.CO Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Donal&Malt- 97 U Un l Road, eRXTte'y!I Lt hiq oa 3 7/ /3 9 Contractor's Name �vrc�C/I✓� Telephone Number Home Improvement Contractor License#(if applicable) /R 6 8'f3 Email: Construction Supervisor's License#(if applicable) 0 T V L 7— Workman's Compensation InsuranceCheck ��u as PE►�1 mo 11 ❑ I am a sole proprietor -NOVr, ❑ I am the Homeowner N s 2 01't I have Worker's Compensation Insurance lgWN RARNSTABLE Insurance Company Name Sf�-/Rc ° Workman's Comp.Policy# 0 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 'l 3 Replacement Windows/doors/sliders.U-Value • 3 0 (maximum.35)#of windo #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Lssuance of this permit does not exempt compliance with other town department regulations,ix Historic,Conservation,etc. ***Note: Property er 'sign Property Owner Letter of Permission. A copy of Hmprovement Contractors License&Construction Supervisors License is required. SIGNATURE: T:\KEVlN_P\Bui1ding Changes\M 5 RESS.doc Revised 061313 ,per The Commonwealth of Massachusetts 01 Department of Industrial Accidents Office-of.Investigations 600 Washington Street Boston,MA 02111 �.. •.°y www.mass.gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �r j jyJ� D 1T 7' 2 V/ � Address: S 6a_3_ City/State/Zip: 44, /" 15i • 3033 Phone#: 7 / `" 1-975-- .�y 3 Are you an employer?Check the appropriate a: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El 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.t 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 I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 - oof iepairs insurance required.] t c. 152,§1(4),and.we have no employees.[No workers' • Other (.( �� comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their woikers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all,work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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.#: W C, 0 7 ® / g Expiration Date:_ 3. Job Site Address: L1Qni P1#_ City/State/Zip:�Q� 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 A ator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for' a e coverage verification. 1 do hereby certify under t ' s nd nenattles of perjury that the information provided abov is t ue and correct. Si nature: Date: Gl ` Phone#: 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#: 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 A Ucant Information Please Print Lezriibly Name(Business/organizatio n/Individual) / 44 r Address: City/State/Zi : &'eh Qrr\, M O�-- Oa s7/ phone#: Are you an employer?Check the appropriate boxy I.❑ I am a employer with 4• ❑ I am a general contractor and I Type of project(required): 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' [No workers' comp. insurance comp.insurance.: 9• ❑Building addition required:] 5. ❑ We are a corporation and its 1011 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their . 1 I,❑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 3a.❑ I am a homeowner acting as a employees.[No workers' I3.❑Other general contractor(refer to#4) comp,insurance required.]. *Any applicant that checks box#1 must also fill out the section below showing their workers'compensatio4olicy 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. tContntctors 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 co policy number comp.P cY I ant an employer that is providing workers'compensation insurance for my employees. information Below is the policy and job site Insurance Company Name: Cbryl M f, fi li n 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$1,560.00 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 certi under A pains and enaldes ofpedury that the information provided above is true and correct ry Si a Date: / Phone#: OfflCial 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.CitytTown Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1 ��e�p�r�wn�oa2cuecc��a�C%l/�tcaaacLccae�l3 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only before the expiration date. If found return to: ��OME IMPROVEMENT CONTRACTOR ,) Office of Consumer Affairs and Business Regulation 7 Registration_: 126893 Type: 10 Park Plaza-Suite 5170 __ Expirafion—g/3%2016:;;• Supplement Card Boston,MA 02116 THD AT HOME SERVICES 11NC THE HOME DEPOT AT HOMESERVICES ANDREW SWEET ; �~ 2690 CUMBERLAND PA6,VIVAY S - XY AM,GA 30339 Undersecretary Nov with ut signature Massachusetts -Department of Public Safety. Board of Building Regulations and Standards Construction Supen-isor Spechilty License: CSSU) M62 •,�* . ' TIMOTSY P HANrSCOM 4 CIRCLE DRIVE Wareham MA 0271 Expiration Commissioner z:` 06IW2015 r HOME 17tff8QVVIWr.CONTRACT PLEASE RBAD THIS "} l Sold,Furnished and Tnstallipd by-. Branch Num.Bta6mi.Noreh&Seuth i?Qt� �E /—T TPtC1 AL-1otnc,��vbpcs,lnc, . . dIWi The HoMe bepiX At-tioaic Services Branch Number:31 mW 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 : Toll Free 877-903-3768 Federat m#75-2698460;NM Uc 0 C 02439;RI Cant:t ic#,16 pp 'Crtrc rix_ots�5s522;liMra ticme L�ofuYemoat Cw ! tt293 - onAddreme t , ROCc� 'ity State Zip Ptimhaser(s)t. Work Phone- llinne Manes Cell Phone: Hume Address: (Tf diff'ermt.from htstallation Addhvris) City. State Zip Mar AddnbS(to tecedve project communications and Home Duput updates): 1 ton NOT wishto receive any marketingeaxaits from The Home-Depot E ioct Woirmatimt: undersigned(°G�tanw")-the owners of the property located at the above installation address,agrees to buy, iiiidT11D AI Roan Smyiocsa lac.("The Hume Degof)agrees to furnish,deliver and anange Fur the installation{"Installation")of all materials described on the below and an the referenced Span Sheet(s),all 6f which are.incarporat d into this Contract by this refeacam along with any applicable State Supplement and PaylWat Summary attached hereto and any Change OrdtTs(soilecbvely, "Contract"): Job tt.u�+waaew.�i- f l4eM� SpecSt4etts) Prv4wt Amount' Wtodom hmulati Q f111-1i Q y E3C9uisers F Covers[]finery Dotes 0— ��. �/�� a 0 $ Roolit LISiftlS Windows U litsulation �t&00/0-ki {futon/Cacws 013atty Don,0 7t«.,o+s -79d 3 ❑ ooriing ag 0 Warms M hisnlntiim , ❑(:litters!covets 1,7FJtary lhnora[3 ' U Rdxitiit rural g ows liranlatldn I ❑tabus J coven Matey own 0 Minim®is'&'nepodnorC�tr.atAmormtdocupon�dthlsd�tracL TOW Contract Amount $ MO*Pundraem may not depodt mine Umt oft-third offieCmiradAmouil G lY✓ Customer agree that immediately upon completion of the work for each Product,Customer will execute a C.umpicnon Certificate (me for each Product as dcfincd an individual S Sheet and an baUnce due. As applicable,each Customer under this by P� ) Pay Y PPl � Coni'rad agrees to be jointly and severally obligated and liable hereunder. The Hdune Depot reserves the right to issue a C hange Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized se-ice provider determittes that it cannot peftm its obligatiods due to a Sttuctuf;a problem with the home,environmental harards such as mold,asbestos or lead paint;other sattdy'concerns,pricing lamas or because work mquirid to enmpieto tho job was not included in the Contract Pavtnent summary: The Payment Summary# ?-0 Y�;L� included as part of this i`unfina A,sets furW the total cpfi of arributlt and payments required for the deposits and final payments by Product(as applicable). N6TIcE TO cusTO1V R You'are entitled to a completely Blued in copy of the Contract at the time Von sign. Do nut sign a Completion Certificate(mite_ there is one Completion Certificale for each listed Pradact as de8aed by ladtvQmd Spec Sheets)before work an that Product is complete. In the event of termination of thh9 Contract,Customw of tech to pay The Horrm Depot the tom of materials,labor,expen i and services provided by The Hem De or Authorized Service Provider the slate of termination, us an other amounts set forth in this Agreement or�under applicable law. THE HOME MAY WFTHHOLD AM91M OWED TO 'rklE HOME. DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITUOUT LEMTING THE HOME DEPOTS OTHER REMIMM FOR RECOVERY OF SI)CH AMOUNTS Cyr settee and®idarstands diet this Agreement is the cadre agreement between Cuska ncr and The Home epos vat>1 f ad to the Produce:and installation services and supersedes all prior d iscusmms and agro merits,either coal or written,relating to said Praduc'ts and installation.This Agrmnent eartndte be assigned or arnerded except by a wfldRs sighed by Oistomer and The home Depot.Customer acknowledges des and agrees that Customer has read,unders[ands,voluntarily accepts the tetras of an ived a copy t'i- A y: gab ted by: L- Lt ? t-1 C,=mier`Signature Sales tant's Signal= Date ayojAr R'a'Zf Telephone No.-f 0T 25l0 4 Lasstdmier'S Signature Date Sales Consultant license No. CANCELLATION: CIJSx' MEA MAY CANCEL THIS ts%ai?Ptieehta) AGREEMENT WITHOUT PENALTY OR OBLIGATION By DELdvmm wxrrm NOTicE To THE HOME DEPOT BY MIDNIGHT ON THE THM BUSINESS DAY Ar= SIGNING THIS AGREEWNT. THE STATC SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS S't' cmcALLY PFMCMED BY LAW IN C(TSTOMER'S STATE. NOTICE;ADDrTtONAL TEEM AND MMorrrOM An STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT I Td WtzT:L TT6Z 9 qad UZZZ9MOS: 'ON XtJd Pe6we[; WOE I Lg Town of Barnstable -Pavia 061WL � 1 Regulatory Services �` '�`� � Richard V.3cali,Interim Director IT Building Division kPRESS PERM Tom Perry,CBO,Building Commissioner 2WMain Stt�,Hyannis,MA 02601 JUL 10 2014 www.town.bamstable.m.us Office: 508-862-4W8 'BLE EXP„PERMTr APPLICATION RESIDE, U Z-50—MMM �.. Not i�alfd iadtkotat RedX,A�ese L Moparcel Number Prop"Address lie Residetrtial Vahw of work a��U0 Weimum fee of SHOO fetwork Tder S6000.00 Owae�r's Narise Address & c),�'m j ny �"i , /l�(d i1t�91A/4 e t� vtSo�✓ 1 contractor,SName P l)a)F s� A �e�ll llt/� Telephone Number --2 Home Improvement Contractor License#(if applicable) l 73�J Email: Construction Supervisor's License#(if applicable) 0!S/�-7 91Workmonn's Colnpensatian Insurance Check one: ❑ I am a sole proprietw I am the Homeowner I bave Worker's Compem don Insurance Insurance Company Name wo rkman•s Comp.Insurance Copy of surance Com Cerbfiatte met atxompany each perntit. Permit Request(dteck box) ❑ Rye-roof(harrlcane named)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane named)(not stripping. Going over existing layers of roof) � uRe-side Z Rnt Window. doors/sliders.U--Value � J (ma�amum.35)# rs: #of d d000rs: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections requized. Separate Electrical 6t Fire permits required. *MmreWnv& Imam of this pemut does not exempt c omplonw with odw town dq m rtmaA regubbms,Le.Hatodc,Camsetv�etn. ***Note: Property Owner must sign Property Owner Lettw of Permission. A of the Hare improvement Contmetors License&Censtracdw SupwWars Licaw is req SIGNATURE: ;L T.IMVE� Dui CWmgn M�UM Revised 061313 ,a f� Renewal - 'Renewal. RENEWAL BY ANDERSEN _� ark Lurk 417323$ 1 Cr U.—40634555 ' WINDOW as PL CANENT mAndesnCanpoT 26.•Ubion Road • Lincoln,RI 02865 _" ICA rum#12,17 Phone 866.363.2235•Fax 401.633.6602 / H k ft,al Tax 11)ra6-crm6630 Southern New England Windows,LLC d/b/a Renewal by Andersen of Southern New England - - - CUSTOM WINDOW AND DOOR REMODELING AGREEMENT C Buyer(s)Name: ._. 1-ilk.. 7 ��7o�T/ Data cfAgreemenc Buyer(s)Sw=Adaress,Ciq Sese.and Zip Code/P.O..Box /!( LZQ l / -sill�r r )Y �7-7)�iSpU C/7 6�-,oerasAdae,c. � CAHmDrc1ePhoneNumer wor�rdePhoe NDu«:Buyer(s)hereby jointly and severally agrees to purchase the ptnducts and/or services of Southern New England Windows,LLC d/b/a Renewal , by Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described on the front and the reverse of ihL%agreement and on the attached specification sheets)(collectively,dnis'Agreement"',. ❑Historic ❑ Condo ❑HOA7 Total job Amount Estimated Starting Date: Method of Payment: 9rCheck Li Cash ❑Rnanced Deposit Received(33%): 0 o � Credit Cards are accepted for deposit only-maximum 1/3 of the Balance at Sore of job(33%): 7o project cost.(Please see Credit Card Payment Form.)By signing tuts Estimated Completion Date Agreement.you acknowledge that the Balance at Sort of job and the Balance on Substantial Balance on Substantial Completion of job cannot he made by credit Completion of job(33%):a'7�C card and must be made by personal check,bank check,or ash. Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agreement.Buyer(s)acknowledges that Buyer(s) (1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only)Notice to Buyer.(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the full unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(S)You may cancel this Agreement if it has not been signed at the train office or a branch office of the seller,provided you notify the seller at his or her main . office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day afteir the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.Seethe accompanying notice of cancellation form for an explanation of buyer's rights. . Buyers)received die consumer education materiaLs provided by the Rhode Island Contractors Registration Board. (Buyer's htitiaLr) Renewal b•Andersen of Southern New England Buy-(s) Buryer(s) r By Signature of Product Manager Signature Signature Print Name of Product Manager Print Name �^ Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FORAN EXPLANATION OF THIS RIGHT. �— — — — — — — — — — — — — — —�-c — — — — — — — — — — — - 4C— — — — — — — — — — — — — — —� NOTICE OF CANCELLATION �k NOTICE OF CANCELLATION Date of Transaction 6-17-iv You may cancel Date of Transaction 4— - You may cancel this transaction,without arty penalty or obligation,within this transaction,without any pe alty or obligation,within three business days from the above date.If you cancel,any three business days from the above date.If you cancel,any property traded in,any payments made by you under the ) property traded in,any payments made by you under the Contract or Sale,and any negotiable instrument executed I Contract or Sale,and any negotiable instrument executed by you will be returned within ten business days following I by you will be returned within ten business days following receipt by the Seller of your cancellation notice,and any receipt by the Seller of your cancellation notice,and any security interest arising out of the transaction will be security interest arising out of the transaction will be canceled.lf you carscel,you must make available to the Seller canceled.If you cancel,you must make available to the Seller at your residence,in substantially as good condition as when at your residence,in substantially as good condition as when received,any goods delivered to you under this Contract or I received,any goods delivered to,you under this Contract or Sale-or you may,if you wish,comply with the instructions of I Srule;or you may,if you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the the Seller regarding the return shipment of the goods at the Seller's expense and risk.If you do make the goods available )C Seller's expense and risk.If you do make the goods available to the Seller and the Seller does not pick them up within I to the Seller and the Seller does not pick them up within twenty d�}�s of the date of cancellation,you may retain or I twenty days of the date of cancellation,you may retain or dispose of the goods without any further obligation.If you I dispose of the goods without any further obligation.If you fat to make the goods available to the Selle or if you agree I fail to make the goods available to the Seller,or if you agree to return the goods to the Seller and fail to do so,then you I to return the goods to the Seller and fail to do so,then you remain liable for performance of all obligations under the remain liable for performance of all obligations under the Contract.To cancel this transaction,rnail or deliver a signed I ContracLTo cancel this transaction,mail or deliver a signed ' and dated copy of this cancellation notice or any other I and dated copy of this cancellation notice or any other written notice,or send atelegram to Renewal byAndersen of I written notice,or send a telegram to Renewal byAndersen of Southern New England at 26 Albion Road,Lincoln,RI 02865, ) Southern New England at 26 Albion Road, ,incoln,RI 02865, NOT LATER THAN MIDNIGHT OF 76-P'/Lam. I NOT LATER THAN MIDNIGHT OF a Date I HEREBY CANCELTHISTRANSACTION. I I HE(Date) CANCELTHISTRANSACTION. Buywta slgnaure Mnit Harts Dan BYyoft Agnatum Print Name pate RbA Copy White Buyer Copy Yellow Buyer Copy:Pink. Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Super)isor License; CS-095707 _% I i. BRUN D DENNISON --- 7 LAMBS POND CIRC Charlton MA 01507 Expiration Commissioner 09108(2014 l.[G ; •:� Office of Consumer Aff rs Business Regur lat on 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expira0on. W1912014 DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET,RI D2895 -- —------- -.---- — Update Address and return card.Mark reason for change. su e o rvurvi Address 17 Renewal 1-,Employment Lost Card orComan er AIGus&Business Regulation License or registration valid for MdWldul Ise only ' MlE IMPROVEMENT CONTRACTOR Office off expiration lots.a found return to: t: Office of Consumer Alain and Bosietas Regulation •�av,_,e;q,;"ReOlstratbn: 173245 Type; 10 Park Plea-Solve 5170 ' Expiration: GVIW2014 Supplement Ikrd Burton,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN 1137 PARK EAST DRIVE ��•�-- — - - WOONSOCKET.R102895 U ndrrarrenry Not valid without signature -K _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeQibl Name(Business/Organization4ndividual): LLL Address: (o /oA/ I-0a City/State/Zip: t!A' CO/IV , ./�IT. =2b5 Phone#: yD/ ,?a - ?,goo Are you an employer?Check the appropriate box: Type of project(required): 1.1 I am a employer with A Q 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. 1. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. 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 myself. ' right of exemption per MGL Ys �o workers comp- 12_Q 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 Ml out the section below showing their workers'compensation policy inform 'on. 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 mp employees. Below is the policy and job site information. �Y Insurance Company Name: SUr vu Policy#or Self-ins.Lic.#:R'/� ga 75�f O E� Expiration Date: a� f Job SiteAddress:1 / l/�� City/State/Zip: f 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 certi under the pains and pendfies of perjury that the information provided above is true and correct 5io-nature: Date: . 'hone#: �D�' oZ I;t ;9 — 9270 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#: Client#:30124 SOUTNEW ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 8/06/2013 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(les)must be endorsed.If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Willis of New Jersey,Inc. NAME: Anita Little PONE 856 914.4660 A"H N Est): No): 856-9141881 1015 Briggs Road,PO Box 5005 E-MAIL PO Box 5005 ADDRESS: anita.little@willis.com INSURER )AFFORDING COVERAGE NAIC A Mount Laurel,NJ 08054 INSURER A:Selective Insurance Co of the S 39926 INSURED INSURER B:Argonaut Insurance Co. 19801 Southern New England Windows LLC DB/A Renewal by Andersen lesuRERc:Beacon Mutual Ins.Co, 24017 26 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 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. LTR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MIDD MIDD LIMBS A GENERAL LIABILITY S202945900 8/10/2013 08/10/201 pEAACCH�GOECTCURRENCE $1 OOO 000 X COMMERCIAL GENERAL LIABILITY PREMISEg R rtDence $100 000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1 000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY PEARO. LOC $ A AUTOMOBILE LIABILITY S202945900 8/10/2013 08/10/201 E.eB�INd SINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per.cadenl $ b A X UMBRELLA LIAB OCCUR S202945900 01811012013 0811012011 EACH OCCURRENCE $5 000 000 EXCESS LIAR CLAIMS-MADE AGGREGATE $5 000 000 DED I I RETENTION$ $ C WORKERS COMPENSATION 0000068028-RI 8/21/2013 08/21/201 X we STA;u OTH- AND EMPLOYERS'LIABILnY YIN B ANY PROPRIETORMARTNER/EXECUTIVE AIC927818352394 8/21/2013 08/21/201 E. EACH ACCIDENT $1 000 000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT 0,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. Lincoln,RI 02865 AUTHORIZED REPRESENTATIVE • • /y ©1988--2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S215109/M215088 AYI ok q14-7114 Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 4/11/04 Town of Barnstable w _ f Thomas Perry CBO €n x Building Commissioner 200 Main St. Hyannis,MA 02601 NO RE: Building Permits ,, , Dear Mr. Perry, This affidavit is to certify that all work completed for 397 Elliott Road has been inspected by a certified Building Performance Institute (BPI) Inspector. Ceiling: R-19 cellulose Walls: 1" (R-7)Thermax on knee walls and attic/house parting wall All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION MaP� 8 � Parcel °4' OF A � _TA B E Application #T� Health Division 17 Date Issued `/ Lot*. .: .. Conservation Division Application Fe $ Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village C en d Y' Owner 1 m"r%.5 Address S aGmp, Telephone Q �--�� q4_ Permit Request �d�—�, -3 6 C.e&1QZ �'iD fi�C of �. \ . -kc_, 'n +-o py m, :Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure 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 XNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name W�� iqNcl"6,iw _--Telephone Number 5709 398 b39 g 2 2 I Address T ' '�'`n T License # C LID k T-I b �vA% aim, e,+�, m�r o 6 6�( Home Improvement Contractor# 7' 13 n Email Worker's Compensation # t WC 3 35 3 9 6 g ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE 3 ` 8 b1 r ' FOR OFFICIAL USE ONLY APPLICATION# '• DATE ISSUED r MAP/PARCELNO. s' ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t FINAL BUILDING 1 s DATE CLOSED OUT ASSOCIATION PLAN NO. r r f v: 4 x Housing Assistance Corporation Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE , THE APPLICANT HOME OWNER. IZc' f1t�' hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation (herein after referred as"Agency") on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping &caulking of windows and doors, insulation of attics, sidewalls& basements, attic and other ventilation measures and possibly replacement of,badly deteriorated windows. In consideration of the weatherization work to be done at my home 1. agree to the following: 1. I give permission to the"Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property.- 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five(5)years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give my consent. Home Owner. (Signature) % ✓��'` Date: tut"- i CAI ` i Agent: (signature) .Date: HAC approved Weatherization Company: t All Cape Energy Cape Cod Insulatio Cape Save -r;Efficient Buildings,LLC 1 Frontie-r Energy.5olutions. Lohr-&`Sons Resolution Energy The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations i 1 Congress Street, Suite 100 . Boston,MA 02114-2017 r www._mass.gov/dia Workers' Compensation Insurance Affidavit-. Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/individual): Cape Save Inc. Address: 7D Huntington Ave City/State/Zip South Yarmouth, MA 02664 _ Phone#: 508-398-0.398. Are you an employer?Check the appropriate boxt Type of project(required): 1. ✓❑ I am a employer with�- 4: ❑ I am a general contractor and 1 G. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole.proprietor or partner- listed on the.attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have g Demolition working for me in any capacity. employees and have workers' comp.insurance.f 0. ❑ Building addition [No workers' comp.insurance its .10:❑ Electrical repairs or additions required.] 5. We are.a.corporation and officers have exercised their 11.. Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work ❑ g p myself. [No workers' comp:: right of exemption per MGL l2.❑ Roof repairs insurance required.]r c. 1:52, §1(4),and we have no employees. [No workers' 13,�.Other Insulation comp. insurance required.] *Any applicant that checks box#1 mustalso 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 affidav t 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. 1 am an employer that is providing workers'compensation insurance formy employees. Below.is the policy and job site information. Insurance Company Name: Technology Insurance Company Policy#or Seif:ins.Lic. #: TWC3353968 _ Expiration.Date: 04/09/2014_ 9 � '' "} /State/Zi Cell- ;fV I I� .Job Site Address: Cit.T � o - - y p� '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 penaltiesin the form of a STQP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement ntay be forwarded-to the:Office of Investigations of the DIA for insurance coverage,verifcation. l do hereb certi under the pains and'.enalties of pej that the information provided above is true and correct: Signature: Date 3 Phone#: 508-398-6398 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#t. E `A�® DATE IMMrooivwvl CERTIFICATE OF LIABILITY INSURANCE 10/22/2013 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(les)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: Colleen Crowley Risk Strategies Company fafg-NONE . (781)986-4400 WC No:(781).963-4420 15 Pacella Park Drive A Suite 240 INSURE 3 AFFORDING COVERAGE NAIC! Randolph M 02368 INSURER SelectiVe IUS. of America INSURED INSURERB:Safety Insurance Company 3618 Cape Save, Inc INSURCRC:T113Chn010gY. Insurance,Coupany 7 D Huntington Ave INSURERD INSURER E South Yarmouth lei 02664 IIeURERF; COVERAGES CERTIFICATE NUMBER:CL13102268490 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOVN 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 SUBJEGT'TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMrrS SHOWN'MAYHAVE BEEN REDUCED BY PAID°CLAIMS. WSIR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM! M! GENERAL LIABILITY EACH OCCURRENCE: $ 1,000,000 DAM—AGE TO RENTEff- X COMMERCIAL GENERAL LIABILITY PREM S Ea o rrence .. $_ 100,000 A CLAIMS-MADE EX OCCUR S104480 0/16/2013 0/16/2014 MED EXP(Any one person) $ 10,006 PERSONAL&ADV INJJRY $ 1,000,000 GENERAL AGGREGATE $. 2 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS:-.COMPLOP AGG $' 2.10001000 POLICY X PRO X LOC $ XCI AUTOMOBILE LIABILITY Ee Nent IN L LI . 1 :000 000 acc _ 8 ANY AUTO BODILY INJURY(Per person) $` AUTOSAIED X rl SCHEDULED 208200 116/2013 1/6/2014 BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE. $ X HIRED.AUTOS N AUTOS P cad nt X UMBRELLA LIAB X OCCUR EACH OGCURRENCE $ _ 1,000,000 A EXCESS LIAB CLAIMS4ADE AGGREGATE $ 1,DOD,000 DED RETENTION Nit S1994480 0/16/2013 0/16/2014 C WORKERS COMPENSATION officers Included for. X LIMITS 1. OTH AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN Coverage E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? N/A 3353968 /9/2613 /9/2014 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AttachACORD tOI,Additional Remarks Schedule,if more space Is required) Weatherization Specialists' GL: Blnkt AI, B1nkt PNC, Blnkt WOS,, Per 'Proj Agg,; Per Loc. Agg ( GL Exclusions: Snow 9 Ice Removal/OCIP/Wrap Ups CERTIFICATE,HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIEG:BE CANCELLED.BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE chael Christian/CLC - ACORD 25(2010I05) ®1888-2010 ACORD CORPORATION. All rights:reserved. INS025,(201005):01 The ACORD'nam,e and logo arelegistered marks of ACORD r Office of Cmawa Affairs and Bfuhm Regulation. 1O.Pwic Plaza- Suite 51 Bo Massw How 6" ©r R r Y Try, SIttS Yit ZOM CAPE SA �� WILLIAM MOCLUDWY � f 7-D MUNTINGT` E `4 R- StZU' I I YAK M '1,z. wpm'm SCA 1 S 2OM-MR 1 y✓r' `-' ❑ ❑ ] cad (9/4 (Q0911/btm/tpylllLO�C-3/N�QQdQQb6t6¢Qb of Csr Alters A 1 v �Tdit d . Type• C"Poradon - is -Sa&s 5110 bookw6MAL02116 CAPE SAVE INC. ➢YiLf.fl1M 7A HUPfftt�Tt>hl AVnlC1 � SOUTMi YNRMO1J'l'H,MA 028134 1 Massachusetts-Department of Public Saf0ty Board of Building Regulations and Standards Construction Supenisor Specialty Licenser C -102M ors IS yy y a 37 NAUWr ROAD# West Yowalk IRA Expiration Commissioner 061t5 i • i i i 4 1 \t TOWN OF BARNSTABLE w CERTIFICATE OF OCCUPANCY PARCEL ID 227 105 GEOBASE ID . 13811 ADDRESS 397 ELLIOTT RO D PHONE Craigville ZIP. - LOT 3 BLOCK LOT SIZE DBA - DE ;LOPMENT DISTRICT CO `�' - PERMIT 9869 DESCRIPTION SINGLE FAMILY PERMIT TYPE BC00 TITLE CERTIFICATE OF OcUdpi ffthent of Health, Safety � CONTRACTORS: and Environmental Services ARCHITECTS TOTAL FEES: �Im AID BO $.00 `7' Qi► CONSTRUCTION COSTS $.00 i • * HARN3PABLE, MASS. 059. A1� OWNER DESIMONE, RICHARD F , D ADDRESS P 0 BOX 760 DENNIS MA 'BUI DING DIVISIO DATE ISSUED 0 8/2 3/9 5 EXIT RAT,I ON DATE BY � • I DIVISION APPROVALS FOR ' CERTIFICATE OF'OCCUPANCY F TO BE SIGNED,BY EACH DIVISION HEAD UPON COMPLETION BUILDING:-- DATE: COMMENTS-.' +. y r- PLUMBING."++- !! DATE: r.' COMMENTS:' ELECTRICAL: DATE: COMMENTS: GAS: DATE: COMMENTS: CONSERVATION: DATE: COMMENTS: OKH: DATE: COMMENTS: r HISTORIC: DATE: COMMENTS: FIRE DEPT.: DATE: COMMENTS: OTHER: DATE: COMMENTS: TURN THIS IN TO THE BUILDING COMMISSIONER AFTER ALL SIGN-OFFS`ARE COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIME., TO c yY- iTIME DATE M OF iris { fNantsla see yaa W PHONE i�ta.l again k�aw MESSAGE Q G l PERATOR: K O� 23-024--400 SETS 23-027-200 SETS, r�� - 73 y �„�. �� kWN OF BAkNS l-ABLE, MASSACHUSE l'IS - Septeril air 26 94 � 3� v DATE 19 PERMIT NO. 55 APPLICANT 1':Zcll-ia Sl A. JCSimone ADDRESS Cove Rd• f (:vent Dennis, MA -- (NO.) - (STREET) '(CONTR'S LICENSE) PERMIT TO Lulld Dwellil1g ( l ) STORY Single family 1 well-i.ig NNUMBERDWELLIN OF G UNITS -� (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) - 397. Elliott Road (LOC #3) j Centerville ZONING _PC AT (LOCATION) DISTRICT (NO.) - (STREET) BETWEEN AND - (CROSS STREET) - (CROSS STREET) - LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION " TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: SeJwag!e #94-415 "- - - HOOD AREA OR VOLUME 154v square feet ESTIMATED COST $ j75,UUU.UU PERMIT $ 1 s3.50 (CUBIC/SQUARE FEET) OWNER B U I LDJ• ADDRESS THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK»OR. ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON (PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,-.MUST BE AP- pow PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. - -_ MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING 'AND 1. FOUNDATIONS OR FOOTINGS. MADE.. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL.INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL FINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE.3. FINAL INSPECTION BEFORE- - OCCUPANCY. - - - POST THIS LARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL;INSPECTION APPROVALS 2 2 /J� — / _ j 2 3 HEATING INSPECTION AP R ALS ENGINEERING DEPARTMENT A/9-3 J J fUA 2 RD OF HEALTH '✓ n. OTHER SITE PLA RE EW APPROVAL ? �, . , �,•� c peO^ani)rfsr`p ..Ne '^� - 1 =��'T 'N�� aECl::NE NULL AND /OII% ;F_ i� NSTRI_.�-rlr� . � ,.. r _ f -r I-�.-. ;dt.ICz:,FD ON 1NjS CARD..`N BE T;)R fl1 ,a'r'Ssf:`Jt:J ir,L 1 I +i,,v: 4 "..UF I ^'OF K IS NOT STARTED WITHIN SIX MONTHS OF DATE THE i ARRANGED FOR.BY TELEPHONE OR WRITTEN CONSTRUCTION M1 • 1 PERMIT IS ISSUED AS NOTED ABOVE. 1 NOTIFICATION. To r~�Oate Time 6 W ILE if U WERE ®U M of Phone Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message r Operator AMPAD 23-021-200 SETS �fJ EFFICIENCYe 23421-400SETS CARBO JLESS t' \ p To Date Time WHILE Y U WERE OU M of Phone Area Code Number Extension TELEPHONED LEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message _ i c �. Operator AMPAD 23-021-200 SETS EFFICIENCY® 23-421-400 SETS CARBONLESS II � : Thy s1,T�aRl�? +b��sn'�'�,�""••.'��'.�"�„'�8:"�` �' ,� _ ,I , 3; ��. ;�„+'r-ar�T WW OF BARNSTABLE, MASSA HtJSEfTS 4+ DATE September 26 19 94 PERMIT 0 7 '�,0 C� NO. • /' APPLICANT Michael A. DeSlmOne ADDRESS 52 Cove-. Rd. ,. West Dennis, MA (NO.) (STREET) (CONTR'S LICENSE) _ Build Dwelling 2 Single Family NUMBER OF PERMIT TO " (_) STORY - g y Dwelling DWELLING UNITS 1 (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) 397 Elliott Road Lot #3 , ZONING AT (LOCATION) ) Centerville (NO.) (STREET) DISTRICT— RC BETWEEN AND (CROSS STREET) (CROSS STREET) '.. LOT SUBPIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT, LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE'GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Sewage #94-415 BOND AREA OR 00 VOLUME 5 75,000• FEE $ 139.50 �4u GIylAT'P feet ESTIMATED COST (CUBIC/SQUARE FEET) _OWNER - Richard F. DeSimone 8 Inde en Dennis BUILD o ADDRESS P dence Way, BY j f� �1HE?, The Town of Barnstable O� BARNSTABLE. • Department of Health Safety and Environmental Services MASS 163q. �0 Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection Location Permit Number 3 Owner �. �,��t�(j1� Builder. , 7) E 'S 1 t-A O 1lG- �G One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: j1 h10 LAIR l_ J2��-c-1�.1 G -k t ze boa Tc7. 3. �A 01PF C-GNSEwN71 -k Q�S Le- FT S�Q N s( i t,�Suup,,7- C ITT 4`6 L "\A.ES: st'& . Please call: 508-790-6227 for reeinspection. Inspected by V . S-�-C\/l:t4 S Date 20 FT. MINIMUM SOIL TEST TOP OF FOUNDATION 10 FT. MINIMUM CLEAN SAND DATE OF SOIL TEST ELEV. = I WITNESSED BY CONCRETE PERCOLATION RATE --MIN./INCH. COVERS 4" SCHEDULE 40 PVC PIPE 2" LAYER OF OBSERVATION HOLE 1 OBSERVATION HOLE 2 MIN. PITCH 1/8" PER FT. 1; _1 1/8" TO 1/2" ELEV.= ELEV.=-' ------- CONCRETE WASHED STONE on [ Top 17E ELEV. COVERS 12" _ __ _MAX. TOP1 4" CAST IRON PIPE (OR EQUAL) MINIMUM PITCH 1/4" PER FT. FLOW LINE-- lom WAS HED E ELEV. 0 2�O"� 0 0 LEVEL 0 J 0 0 0 ELEV. 2'0" 0 ELEV. 0 ELEV. 0 0 0 WATER AT--- EL. WATER AT- .'.:L4' 0 0 0 L ELEV 0 ir TR I B U Tj --41' o 0 0 DIS ON F- ::: 3/4- TO 1 1 "2" 0 0 DESIGN CALCULATIONS / 0 o 0 0 BOX WASHED STONE 00 NUMBER OF BEDROOMS Li- - 0 1 1000 GALLON TO BE WATER TESTED 0 0 Ljj r� 0 0 ELEV. GARBAGE DISPOSAL UNIT IF MORE THAN ONE OUTLET ------ TOTAL ESTIMATED FLOW SEPTIC TANK _GA1..//BR./DAY X R.) GAL./DAY 'RECAST LEACHING t 6' DIA. REQUIRED SEPTIC TANK CAPACITY GAL. BASIN OR EQUIV. WELL z _f ACTUAL SIZE OF SEPTIC TANK GAL. ZONE INDEX--- LEACHING AREA REQUIREMENTS ADJUST SIDEWALL AREA GAL./S.F. SEWAGE DISPOSAL SYSTEM PRO� iILL_ BOTTOM AREA GAL./S.F. NOT TO SCALE LEACHING CAPACITY (BOTTOM + SIDEWALL) GAL./DAY BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV. = RESERVE LEACHING CAPACITY GAL./DAY OBSERVED WATER TABLE ELEV. = NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. LEGEND: TITLE 5 AND THE TOWN OF RULES AND EXISTING SPOT ELEVAT"ION 00,,o REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. EXISTING CONTOUR 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 12" OF FINISHED GRADE. FINAL SPOT ELEVATION 3 EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME. ,7:t.l A 1 ` * OF M,SAW'TARY S�'SF' SHALL BE CAPABLE OF SOIL TEST LOCATION WITHSTANDING H-10 LO'ADiNG UNLESS THEY ARE UNDER OR MITHIN UTILITY POLE a 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL. BE TOWN WATER --W USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. CATCH BASIN 5, ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. \jw 6. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH i \ �''" DEEDED OR ZONING REGULATIONS. OWNER /1 APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. T A N 0 P --I o-f L4t-dpj -,u/4 ,$)ko_ o. P�F A 110 L4-v o,,4 -re L ,- A L C 4 ooz�?-o f In L I�; Q9 n • `Y '"'�;1" � i APPROVED: BOARD OF HEALTH 1w DATE AGENT Y-4 4 t PROPOSED PLOT PLAN i FOR L f 7 PROJECT LOCATION "lkl- r------- S WEE TS,F R E GINEERING 235 GVAT S�SX W TYR1 3N ROAD 0. ot 398-3922 SOUTH DENNIS, MASS. 02660 l t Gm A-r SCALE L4 It [!!!ED REVISED NO.[�B N 0. OF LOCATION MAP SHEET [s: 01994 SWEETSER ENgNEERtNG