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0053 FERNBROOK LANE
a .� Q ;; ,�. , a _ .. . �_ ,: A .. ti .: �^ .. �I. . . .. �, ,. o — - �� ,. � . . -�. - � .. s :._ .. a �� ��W�����'� - .. _ _ ., _ .. _ ,, _ :. - - „ � n, _ ,. � � �.. ,. ., ._ . ., _ ,. p a .. Application number . 1...........................I.I.�...... i.e ate Issued....... ............a. . . .. ............................... BARN5TAB a. � p . 1►AM �16 9. `g APR Q Building Inspectors Initials.........(�g.................. ®V4'I!! �� �I��1u8TA,Bt p/Parcel........0Y.....�.�.5....C�LO TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: t 3 f e�� A,,a k � �Ceg /�. NUMBER STREET VILLAGE Owner's Name: L a✓r; /-]� n5 Kent Phone Number 7 7 S_ y Yq 2 Email Address:d h M e r,Q;l e cry.,c s- c 0,-, Cell Phone Number Project cost S /(o, p -- Check one Residential V/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Sep �-f(Q�� C'�r.-kG c-� Date: TYPE OF W®)I ❑ iding ❑ Windows (no header change)# ❑ Insulation/Weatherization_ u Doors (no header e char # 3 'g ) Commercial Doors require an inspector's review Roof(not applying more than I layer of shingles) Construction Debris will be going to W k sfe-1r?a a P..-/P,I - �i�, �-} �l 1 Z Z CONTRACTOR'S INFORMATION Contractor's name ; an -oAecn 4P,J �r� (eV4 rf'n Jow S Home Improvement Contractors Registration(if applicable)# 17.3 2-q_5 (attach copy) Construction Supervisor's License# 01 5`7 01 (attach copy) Email of Contractor Cr$Ljee+9 qs ; �• C M Phone number L101' z z R -9 goo ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tens Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department rapprovcal. *WOO➢ /COAL/PELLET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION �OMEO i Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMIS the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICAINT'S SIGNATURE • Date Signature All permit applications are subject to a building official's approval prior to issuance. i Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England David&Laurie MtCaskey Legal Name:Southern New England Windows,LLC 53 Fernbook Lane RI#36079,MA#173245,CT#0634555, Lead Firm #1237 Centerville,MA 02632 wixoow xE �acernExr 10 Reservoir Rd LSrriithfield,RI 02917 - - - H:(508)778-4492 . Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:(508)776-4659 Buyer(s)Name: David & Laurie MtCaskey .. Contract Date: 03/21/19 fie+ Buyer(s)Street Address: 53 Fernbook Lane; Centerville, MA 0.2632; ; Primary Telephone Number: (508)778-4492 Secondary Telephone Number:;(508)776-4659 Primary Email: dbmemaiMCOmeast.com Secondary Email: lauriemccaskey@ciDmeast.net . 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 b 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: $16,604 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: ;. $81302 - Balance Due: $8,302 Estimated Start: Amount Financed: $16;604 8-10 Weeks Method of Payment: Financing 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: All taxes including ; 100% financing; $8302.; $8302: 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 Buyers) 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 03/25/201.9 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 dliai Renew�ai)�q Andersen of Southern New England Buyers) fzy - '�.. Signature of Sales Person Signature Signature Paul McLean David MtCaskey Laurie MtCaskey Print Name of Sales Person Print Name Print Name UPDATED: 03/21/19 Page 2 / 12 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card 245 SOUTHERN NEW ENGLAND WINDOWS. LLC Registration:Expiration: 173 173 8/202U 10 RESERVOIR ROAD SMITHFIELD, RI 02917 Y Update Address and:Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suo0ement Card before the expiration date. If found return.to: Registration Expiration Office of Consumer Affairs and Business Reouiation 173245 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS.LLC Boston,MA 021181�` BRIAN DENNISON 10 RESERVOIR ROAD SMITHFIELD.RI 02917 Undersecretary 9wr, without signature sue? �.F v�-14 B t�.lS !W•.�6�"t is ems' �..Ja��..V ✓1 .iJ�'-...-.v oar � Eding Regu ations and Stanch;ds MAN D DEWSON CHARLTON -V 150�' Commissioner I i The Cotntt:otewealth of Massachusetts � Department ofIndustrial Accidents ~. P I Congress Street, Suite 100 a Boston,M4 02114-2017 ,•�' www mass goy/dia «-orhers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNIMLNG AUTHORITY. Applicant Information ' Please Print Legibly Name(Business/0rwiimtion/Individual): h �Q(� ���S;L? i�l n C �7L1-S Address: City/State/Zip:SM 1-f4 e1t4t R-- 1 OZg 17 Phone#: 410/-22�,g,- �y Arryan employer?Check the appropriate box: Type of project(required): aemployer with ?KtImp[oyees(full and/orpan-time).• 7. New construction 2.�1 am a sole proprietor or partnership and have no employees working for me in S: Remodeling any capacity.[No workers'comp.insurance required.] 3.[][am a homeowner doing all work myself.[No workers'comp.insurance required.)t 9. ❑Demolition 4.0I am a homeowner and will be hiring contractors to conduct all work on nY property. I will 10 Building addition . ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 5.71m[a a general contractor and I have hired the sub-contractors listed on the attached sheet 12.[]Plumb ing repairs or additions These sub-contractors have employees and have workers'comp.insurance.' 13.[] of repairs 6Q We are a corporation and its officers have exercised their right of exemption per MtGI.c. 14.[OtOther i Q Jo o-(- 1 d2,§1(4),and we have no employees.[No workers'comp.insurance required.] rep tel 'Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. J t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information Insurance Company Name: l'P el'15 n�(,W Q/t(,�°_ (.O . OF VIP t ) Policy#or Self-ins.Lic.#: �,�/C A .3 15 g 7 ZCI 2- c—{ Expiration Date: /" —2-0 L.O Job Site Address: E—P rn h ra oK L-aA e, City/State/Zip: ✓1 JIA 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 imprjsbnment,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 certi under the poi d penalties of perjury that the information provided above is true and correct Signature: Date: — Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.CityfTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i f�CVRO� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) �.� 12/28/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CoBiz Insurance, Inc.- CO NAME: 1401 Lawrence St., Ste. 1200 PHCONr o Exc: 303-988-0446 ac No:303-988-0804 Denver CO 80202 n DRESS: COMail@cobizinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B: FiremenS Insurance Company of WA,.D.C. 21784 Southern New England Windows, LLC. dba Renewal by Andersen of Southern New England INSURER C: Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:787175890 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR . POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER 1MMIDDfYYYYI (MMIDONYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 TO RENTE15-- CLAIMS-MADE I]OCCUR DAMAGE PREMISES Ea occurrence $300,000 MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,0W,000 X u JECT L_J LOC PRODUCTS-COMP/OP AGG $2,000,000 POLICY❑ PRO- OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/V2020 COMBINED SINGLE LIMIT $ Ea accident 1 000000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ $ A X UMBRELLA LIAR X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAB El CLAIMS-MADE AGGREGATE $15,000,000 DED I X I RETENTION$0 $ g WORKERS COMPENSATION YJCA315872924 1/1/2019 1/112020 X STATUTE ERH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N PA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 7930073340000 1/1/2019 1/1/2020 Each Occurrence $2,OOD,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 06/20/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD f Application number ....' ........ Fee ..................................... Building Inspectors Initials.............. ...................... sk y .°� DateIssued...................... ...... ...................... . ae -D► Map/Parcel ........ .................................................. TOWN OF BARNSTABLE 1 C90. 0 6 EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: _ C J U1 VU—. NUMBER i STREET VILLAGE Owner's Name:,1 2 -f cb T Phone Number '�`-?�( ,S 3 6 01 Email Address: Cell Phone Number Project cost$ JS , Check one Residential Commerciale OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK © Siding E Windows (no header change)# Q Insulation/Weatherization 0 ors(no header.change)# Commercial Doors require an inspector's review Roof(not applying more than 1-layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name t CAI \ Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN ' A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER....................................................... *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required. Natural Gas Yes No ,if yes,a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICANT'S SIGNATURE Signature ate loor All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts_ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ��w�. , Address: ILr� City/State/Zip: �S - Phone#: Are you an employer?Check the appropri to b Type of project(required): 1.El am a employer with 4. am a general contractor and I employees(full and/or.part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.: 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10:❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 1 oof 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#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those.entities have employees. If the sub-contractors have employees,they must provide their workers'comp:policy number. I am an employer that is providing workers'compensation insurance for my employees. -Below is the policy and job site 'information. Insurance Company Name: 9 Policy#or Self-ins.Lic.#: Expiration Date: ' Job Site Address: � (�.� �.. �' City/State/Zip: lk/,rj_� � 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 r insurance coverage verification I do hereby certify u t n e ofperj ry that the i o/9r tion provided above is true and correct: Si ature: te: I 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self:insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials i Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, ]ease do not hesitate to give us a call. 1 P The Department's address,telephone and fax number: - The Commonwealth of Massachusetts Department of Industrial Accidents " Office of Investigations 600 Washington,Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia I , A�gip0 DATE(MMtDD1YYYY) �1 ® CERTIFICATE OF LIABILITY INSURANCE w r 03/29/19 17I I RCEITTIFICATE IS'ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS :CERTIEICATEl)OES NOTAFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOYVTHIS.CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTArWE OR,PR_ODUCER,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 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 NAME: JIM HINDMAN Schlegel&Schlegel Ins Broker AICNNo Ell: 508-771-8381 FAX No): 508-771-0663 34 Main Street A.DDRe West Yarmouth,MA 02673 SS: schlegelinsurance@gmail.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: NGM INSURANCE COMPANY 14788 INSURED INSURER B: TRAVELERS HYTECH HOME SOLUTIONS LLC INSURER C: 44 COTTONWOOD LANE INSURER D: CENTERVILLE,MA 02632 INSURER E: INSURER F: • COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO 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. INSFt DDL SU5R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DO MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 10,000 A MPP5363F 01/24/19 01/24/20 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO- POLICY LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ , HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAR OCCUR ` F EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY Y/N STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBEREXCLUDED? NIA WC-1163792 01/30/19 01130/20 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 t I DESCRIPTION OF OPERATIONS t LOCAT IONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CORPORATE OFFICERS HAVE ELECTED TO BE COVERED UNDER THEIR WORKERS COMPENSATION POLICY 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 EPRESENTA E ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD i Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston,Massachusetts -02108 Home Improve r Registration - -Tc Reglstsaaom 184353 - CH ROO G SOLUTIONS LLC. M 12_BALDWIN:RD- Ex—iratiorr 01/04/2020 DENNIS,MA 02638 -. update Address and Return Card. SCA 1 0 2OM4)&17 �.....,._.__ ....... ......._..... ........... - �a�Posnvxona�rlflr,o�G�'rt'auac���aelfs ' Office of Consumer Affairs S Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE=_LLC- -before the-expiration date.-if found-refum-to: Registration:'a`.E)wiratlo Office of Consumer Affairs and-Business Regulation 01/04/2020- i0 Park Plana-Suite 5170 -: -HVTECH ROOFING.SowilQNS:=-L--C. Boston,MA 02118 PATRICK CLIFFORD 12-BALDWIN RD DENNIS.-MA 02MB - -Underseemt" or Not-valld-without-signature Commonwealth of Massachusetts Division of Professional Licensure Board of Buildinq Requlations and Standards Constructiont S11�4fvfsor Specialty GSSL-105951- Etpi-res:06/02/2020 PATRICK-CLIFFORD - , 12_BALDWIN_26 AD DENNIS MA 026 8 Commissioner CZ AWARAWWAWASE MEW smroerzea 12 Baldwin Rd. Dennis, MA 02638 OVERLAY ROOF INSTALLATION PROPOSAL (LABOR ONLY) Date: March 26, 2019 _. Customer: NAME: Bell Towernl.l*' TEL: 774y35.36_4.01 -John AT,TN.:.John Callahan STREET;r.,16,90 Falmouth R&=� r_�- � j� CITY.' J' Centerville; MA 02632 EMAIL callahanitc@mail:corn a` f t t- HyTechRoofing-Solufions-hereby-pr p Vises to pe�for�nt_he following services-in a neat and professional.manner and in accordance with the manufacturer's specifications and local building codes. This proposal is for an overlay roof, the entire new roof system will be installed over the existing roof shingles. Install CERTAINTEED LANDMARK LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION,CLASS A FIRE RATED,COPPER/ CERAMIC STONES for 10 YEARS PROTECTION AGAINST ALGAE CONTAMINENT,235 POUND, EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY, CATEGORY HI HURRICANE, STORM/HURICANE NAILED (6 NAILS PER SHINGLE using 1 '/4" roofing nails), MULTI-LAYERED, LAMINATED ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT HIN LES. COLORVJ2 i d 1 Install CERTAINTEED FILTER RIDGE (SHINGLE VENT II) ridge vent on the entire ridge area of the roof using the 3" hand nailing method, cutting in a 1" opening on both sides of the ridge. Install CERTAINTEED HIP AND RIDGE CAPS on the entire ridge/hip area of the roof using the 3" hand nailing method Install ALUMINUM& NEOPRENE SOIL PIPE FLASHINGS .install 12" lead flashing and GACO FLASH FOAM on the back side of all of the large HVAC units,counter-flashing them for extra protection. GACO FLASH FOAM will be applied heavily underneath and on top of the shingles in the areas where shingles are tied in with the HVAC units steel frame supports and all other non-removable protrusions. Clean and Remove Debris from the work area after the job is complete TOTNLANVESsTM4 NT: $29; .00 HyTech Roofing Solutionsi Takes-all�neclessary�precauti-&n i/nvoly{ed.witk""'-----7 ,� 17l ! ! / !,protecting:all persons�andproperty�from falling debris and �� blocking off parking areas. fir`- ,� HyTech Roofing Solutions —Has undergone OSHA certification, and abides by all regulations and guidelines. All persons are to be harnessed and tied off at all times when climbing up on the roof. HyTech Roofing Solutions- Will not interfere with the regular process of business for the businesses located inside of the building. HyTech Roofing Solutions- Is to had all materials delivered on side from the back side of the building and hoisted up using a boom truck. HyTech Roofing Solutions- Provides two complimentary roof inspections after the job is completed within the first three years. 4 2 r FLAT ROOF GACO COATING OPTION For the area specified near the leaking units, running 18 feet out from the wall of the building, covering a 1300 square foot area. WyTech Roofing Solutions is to Supply Coating Materials) Preparation: 1) Push aside all of the ballasted river stones and keep separated by a temporary barrier. 2) Blister Repair-Inspect for existing leaks and damaged insulation board or roof decking and replace as necessary. This will include the replacement of the insulation on any soft spots on the entire roof area. We will pull back the rubber membrane exposing the area in need of repair, and re-lay the rubber back down and patching in the seams with GACO 66s seam tape and SF2000 .Seam-Seal. 3) Clean and washAaway any a d alkdebrisfrom the entire roof area using GACO=WASHrand-a 33WOpsi pressure wash'er, �ccrubb ng down any areas of debris-in orde'rto p ep the roof for priming. Installation: f -- ry;�- �'i -��1�---•ororf-ar ea u,sing G�A,�t"rC O�='F i�Lt�EX`E532�0�Tp r�mr�le,r�aa rt a r�a_t e�oa f,.t3,'3 r- gallonsp e 100 squareifeet. ThiS,;Ts atwo,part epoxy.dhai locks into ithe roof,and,i np ove,s his poductilreae-an- sepaaleecadhes on f�or thesilicon_coatinT dn between the roof membrane anddthe silicone. 2. Apply GACO-FLEX SF2000 SEAM-SEAL This is a 100% silicone-based, elastomeric moisture curing waterproof sealant, to cover all roof details, curbs and transitions before the roof is coated. Also running 66S seam tape up and over all of the AC unit curbs. 3. GACO-FLEX S2000- Solvent Free 100% Silicone Coating (WHITE) on the entire roof area being coated creating a watertight seamless seal over then entire area. GACO- FLEX S2000 passes as a"Cool-Roof' system and achieves maximum UV resistance. Completion: 1. Inspect for proper thickness of S2000 coating to achieve a minimum thickness 22 dry mil's 2. Push back ballasted river stones spreading evenly across the roof area 3. Clean and remove any and all debris from the work area, leaving it as it were before we arrived. TOTAL ROOF COATING INVESTMENT: $6,500.00 3 POSSIBLE EXTRA CARPENTRY: Any rotted or otherwise deteriorated trim boards, plywood sheathing, missing metal flashing, side walling or any other carpentry needing replacement will be done and charged for as an Extra: materials plus labor at the rate of $ 60.00 per hour. PAYMENT SCHEDULE: A deposit of one half is due at the signing of this roof proposal and the final payment for the balance is due immediately upon completion. WORK SCHEDULE: All roof work is normally scheduled for completion within 30 days of acceptance and receipt of deposit providing the materials are available. Please Make Checks Payable to: HyTech Roofing Solutions HyTech Rooting Solutions Warranties all of the Labor for a full 20 Years. HyTech Roofing Solutions Has completed GACO westerns certification training and is currently certified toto offer arful]product warranty CERTAINTEED Warranties the shingles and laboyY00%` or the First 10 Years �- -N, and the Shin les,your LIFETIMEtif the shingles-bey cores defective. GACO WESTERN Warranties the silicon coating-from all manufacturing-defects for�a-fu1150 ; rje7i r1 'rs� �1f � jlt 9�1 �p ` ' !f•:U1 ,di } fit' ri �y r` HyTech Roofi-ng5-olut><.ons -Carries`�Workman's Compensation and Public Liabili Insurance on the above� ork 1 -Handles all permitting and-planning!involved with the above proposed work Is certified directly by Certainteed, and processes all warrantypaperwork involved TOTAL INVESTMENT: $35,525.00 (With All Selected Options) DATE OF ACCEPTANCE ? T Zdi ACCEPT Y: SUBMITTED BY: ;R:V.i Patrick Clifford —Alex Yaskavets � Authorized Signature (Business Owners)MA CSL license,105951 [[ MA HIC license 184383 4 r 4 Town of Barnstable 111I1 �` ,•� s. ,r.Y.n. ' x r -�, ¢ 'M. k . BAP.PW re Post This CardSo That,itEis Uis�ble From the Street Approved'PlansMust be•Retained on Job and,this Card Must be Kept MAS& Posted Untd.Iinal Inspection H16 as Beeri Made a erm• ° Where a Certificate of Occupancy is Required,such Build ng shall Not be Occupied un �l a Final InspeIr ctiow� , been made v o....�...,,...�:.wF..-,w .�..d..... Permit NO. B-17-3473 Applicant Name: Elwell Perry Approvals Date Issued: 10/18/2017 Current Use: Structure Permit Type`' Building-Insulation—Residential Expiration Date: 04/18/2018 Foundation: Location: 53 FERNBROOK LANE,CENTERVILLE Map/Lot: 208-085 020 Zoning District: RC-2 Sheathing: Owner on Record: MCCASKEY, DAVID B&LAUREN ConractoNanie =Elwell HPerry,Jr. Framing: 1 r Address: 53 FERNBROOK LN Contractor�icense, cS-104088 2 a: CENTERVILLJ=,MA 02632 EPtCost: $3,336.00 Chimey:, Description: 8 hrs Air Sealing. Weatherstrip 1 door: Install 12"OF r-2i& Permit Fee: $85.00 FIBERGLASS to 50'for damming. Install 9"Cellulose to.612'open Insulation: Fee Paid, $85.00 attic. Insulate.back of kneewall w/2" poly ins.board Install 2" poly ,r Final ins board to 80'kneewall.. Install a Thermadom,a Insta1112)8" roofer Date 10/18/2017 Al vents. install (2) exhaust hoses. Install 52 prop r vents Install (4) Y 4 x16 soffit vents. Install 2 poly ins board to 100 common wall , art Plumbing/Gas y Rough Plumbing:. Project Review Req: Building Official y �> Final Plumbing: : . Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within si�z.,months afterissuance. g All work authorized by this permit shall conform to the approved application a,nd the;approved construction documentsfor which this permit has-been granted. Final Gas: All construction,alterations and changes of use of any building and structures m shall be in compliance with the local zongby-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open fo6public inspection for the entire duration of the work until the completion of the same. s, Electrical a The Certificate of Occupancy will not be issued until all applicable signatures by the Budding and Fire Officals are provided own this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:'I Rough: 1.Foundation or Footing ' o. _ • �- 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection tow Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the inspector has approved the various stages of construction. Final` 'Persons contracting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A). Fire Department s� Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable iCEiPT ` ` 200 Main Street, Hyannis MA 02601 508-862-403'8 s Application for Building Permit's Application No: TB-17-3473 Date Recieved: 10/6/2017. 1 � � Job Location: 53 FERNBROOK LANE,CENTERVILLE N) #`s, Permit For: Building-Insulation-Residential Contractor's Name: Elwell H Perry,Jr. State Lic. No: CS-104088 Address: Acushnet, MA 02743 Applicant Phone: (508) 992-5770 (Home)Owner's Name: MCCASKEY,DAVID B&LAUREN Phone: (508).778-4492 (Home)Owner's Address: 53 FERNBROOK LN, CENTERVILLE,MA 02632 Work Description: 8 hrs Air Sealing. Weatherstrip 1.door.. Install 12"OF r-38 FIBERGLASS to 50' for damming. Install 9" Cellulose to 612' open attic. Insulate back of kneewall w/2" poly ins board. Install 2" poly ins board to 80' kneewall. Install a Thermadome. Install(2)8" roof vents. Install(2)exhaust hoses. Install 52.prop-r- vents. Install(4)4"xl6"soffit vents. Install 2"poly ins board to 100' common wall. Total Value Of Work To Be Performed: $3,336.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the.property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. - Signed: Elwell Perry 10/6/2017 (508)992-5770 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $3,336.001 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 10/6/2017, $35.00 XXXX-XXXX XXXX Credit Card E 4419 Total Permit Fee Paid: $85.00 ' 10/6/2017 $50.00 1 XXXX-XXXX-XXXX-1 Credit Card 4419 %. ems '•. ,.r, � � i Cv 1 ' Town Of Barnstable *fermi ( Regulatory Services F�6 hs e atvsrnet e iw AM Thomas F. Geiler,Director �fD MAr s . Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towmbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY t Valid without Red X-Press Imprint Map/parcel Number Property Address _53 rP.i1' L/(9��L residential Value of Work$ l Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 4- Q c�r-'l L�Q•S ". L� e .LQ Contractor's Name k /N4uj5Q y�l ,5cs0Ielephone Number �JO Home Improvement Contractor License# (if applicable)j r7 a S Email: Construction Supervisor's License# (if applicable) © � 70 M4rkman's Compensation Insurance 1Op+Check one: RESS PE "'IT ❑ I am a sole proprietor F S + Vm the Homeowner ave Worker's Compensation Insurance SEP`13 2013 Insurance Company Name �" m TOWW Workman's Comp.Policy# A, (Ci qg 7 g l oo 3 5-�L / cl L/ . OF BARNSTABL Copy of Insurance Compliance Certificate must accompany each permit. i 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) ❑ e-side WReplacement Windows/doors/sliders.U-Value ® o '3 0 (maximum.35)#of windows 1 #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 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 r require SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 : • _ �j} . �+��f�,/��� � e: ��ttta.Slv�rN _:. f.� 4 rFd,`f=nt'n��'.. �fi�'1�.4ili ri}i�]aSR��T6tJrl1'.�j ��-a.: //////////// 86ovW 4e=1,joi ruly•ram mver '1 v*Sccea ,�,el s 5e trar Pm&cqand/or srx dc��f e���;1Tch.ors lnad.Yindom,1L.0&bo"a mxual ,atir►k" dcy 6 a LhQ�!? w E[iO:J]'�t�QsE aWk i r y k= Fl+�+,n k,���'�F�.��:sr��.r�+asii,���a�d�.s�.�+�'���n 6lit tit�r,�l c}�e xt4twz r "Au [ RYuarlc. o eou ? 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NIOTI Dam of Tramsmcfinn O._ you''Ot d to -Qi;, U** of'tr Dian .Yb+il enay CAft- el chin crornsat:clo>rt� wlalmatt any. u !% t�"a wieha*A- �' this tran=CtloNr W?'r'thtavrt`a or�si9 r QUpdon„wAthNo thr"bueiness days:from tKo olba,ro �.Il`y�w.canc:el.ow - �� ���I ss * Eu�c►m 4h� c t�lr you�nc0'�anyproperty tradedin,any payrmrClYt9 loads you under tl~G II pperty ieled'frr. pa�►ratt nudeY und'rx the Contract or :SW40 -and oxacrttW ii Contm-ce or Sales and any aagW-Ale hwtrwymnt w4cuted You ts willba raltccmred 'wit iat #tiro larr,®aets dia]'s°6ollow�ti�j. li .>6u ituill be NBtIlM 1M9ehlrn t 'bu In fi -d' kle"ng. s ips ' tFoC.Srjkrr of yrtaur canctliathi4v 11e6 L,'.artd tiny a pCa':I C 4y the Shccf of leottr lQtneClla!>iort rtetet ,and any sec-urky+ In3em*t, arising +tart of Ow trwrnact t►,au vM It bre w0 writy intor=t ,mnsimQ routle o, the trap arcction will be tanedc&ffyou cancel Must rrwlce waltatb►I�to thct Semcr it cane e!!ed'Ifyoul c a.m.—L.y,�..00a rleust mailke avW13bla tb ciao Iler: atol�tb rlt .in,iFuunti�fly: ' tx1i61v+r�a w�rltet� I� at�rarr resGtla�aeo,�t�srrEw;tantialllr a.mad cotrdlxlani srs wirt�t r Yed,:sta �adt delhre d to yra'tn run&r thus Contractor 0 recelved�goods'deliveredi to-you trade flit Contract or 5 ,or your+ -ryr,ifdu wlalh,cAfinrlY fit: nslleeiollg of it S31e;or you:mar,.i61►ou wfst ,c®lnptjf with the nructltxns of they Seller r,+ogrdng:the mWin ai alipment of tfio zvvds at#the. die,Sol Far rngmnd146 d"retum uhipmcnt of the goo,ll's at the Seller%amp-eme and rUrL,14 you elo st+o wthe g�oo�ds: lalble Selicios.e%eq,so i:and rkk If y ou•do nnake tho,goods avat'labia too tie 5�1l1er ar l'tt''4!e $'eller,d ,awt p;slc *&rn* ,�t fr rretk,i,a `the � r ty 4 r sties 116t;ptek tires uls,witltfru twenty d of lite'dat e.'af"caneellationa you may detain or ii ew.. t d erf ehe' d'a+C;bf r tdl� 'bl�� 1►1b ' lbl or , . dispose of'the goods Wttho�a y fukl�r bPt�an.�f Yost' 1 dlspe�b� tfrb S6**'with4u%A fu�il�r li bra;l��vcn lad to makel the,;oods tvadlab'le to the SAW,or if jots .It fital lta anal Ewe l'a aw1a Ahle to tho.Seller,wr if yawl effeel to rc tho.. mdfa t® the s[lor sand foci s�,chen you o .'to,r*Wrrt the goods to the:Seiler and fail°to dwso;th, en a y a'u rain l al fe for parram—tanice of all olbllgtttlons under,,ft t nets Cairn liable for podwmance of all.►�b9�.p►ticim- v dale.thr: Cei itract_Ta canon ibis&ansaction,mail or deliver skined ContmCtAo�Cane@ thb transbction.nrtart o ff'deliver a slgnid and dated copy of tih'rs canceli'at'votn nods, or aay' other f and' 49jodi of thrs e2nta0aiden,'caul lee or any oilier Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts -Department of Public Safety Board of Building Regulations an Stan. 9 9 d Bards Construction Supervisor License: CS-095707 BRIAN D DENNISON 7 LAMBS POND CIRC+L ' Chariton MA 01507 1 ' I, `2,�.dcgc. " "' Expiration Commissioner 09/08/2014 . vie �pa�rfrirr �cu o � �audeli. Office of Consumer Affairs n Business egulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration . - Registration: 173245 . . Type: Supplement Card - SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9H9n014 DENNISON BRIAN 1137 PARK EAST DRIVE + WOONSOCKET,RI 02895 Update Address and return card Mark reason for change. sc.r ozawvn 0 Address E-j Renewal Employment Lost Card' ` rr mr<o(Coasomer Al6'vs&Basioeu Regnlaboa License or registration valid for lndividul use only*I CONTRACTOR before the expiration date.If found return to: - -- 1 Office fConsumer Affairs and Business Regulation Registration: 173245 Typo: - 10 Park Plan-Suite S170 Expiration:9119/2014 ;Supplement Uard Bosloa,MA 02116 - - SOUTHERN NEW ENGLAND WINDOWS LLC. - - - RENEWAL BY ANDERSON ' • .. DENNISON BRIAN ". 1137 PARK EAST DRIVE WOONSQCKET,RI 02895 Uodersesreury Not valid without signature - - r— The Commonwealth of Massachusetts Department oflndustrialAccidents Office oflnvestigations.,_ y 600 Washington Street Boston,MA 02111 ' r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibl Name (Business/Organization/Individual): ml�ue AZ LLB Address: of (a City/State/Zip: 1-/A/dj2& a ���r oLUS- Phone #: 4101 "2,;) 2" ?goo Are you an employer?Check the appropriate box: Type of project(required): 1.4 I am a employer with A O 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' insurance.t 9• ❑ comp. addition [No workers' comp. insurance p• required.] 5. ❑ We are a corporation and its 101-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 111]Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12:❑Ro f repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13. ther f QG?�r�n1� comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 5(>MIU (� . C A4L- Policy#or Self-ins.Lic.9:4, /Cz 9.Q 3 S02 J Expiration Date: Job Site Address: fT!b 1�v0.� LR�F. City/State/Zip: CeJU-FPS" 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 forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under he pains and penalties of perjury that the information provided above is true and correct � / 7 Signature: Date: 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-#: Client#:30124 •SOUTNEW ACORD-TM -CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 8/061206/201.3 THIS CERTIFICATE.IS.ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS=UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT.AFFIRMATIVELY OR NEGATIVELY AMEND;EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. • IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONT NAMEAC Anita Little Willis of.New Jersey,Inc. PHONE 856 914-4660 (A/C,,.): 856-914-1881 AIC No Ex! 1015 Briggs Road,PO Box 5005 E-MAILADDRESS: anita.liftle@willis.com , - PO BOX 5005 ? INSURER(S)AFFORDING COVERAGE NAIC q Mount Laurel,NJ 08054 wsuRER A Selective Insurance of the S 39926 INSURED INSURER B i Argonaut Insurance Co. 19861 Southern New England Windows LLC INSURER C 4 Beacon Mutual Ins.Co. . 24017 D/B/A Renewal by Andersen 26 Albion Road INSURER DI INSURERS Lincoln,RI 02865 : INSURER F E - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS WED 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 EFF POLICY EXP LIMITS - LTR INSR WVO POLICY NUMBER MM/DD MMIDD A GENERAL LIABILITY S202945900 8/10/2013 0811012014 EEACCHH OECCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES EaEurrence $1 OO OOO CLAIMS-MADE a OCCUR MED EXP(Any one person) $1 O 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 PECOT- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A S202945900 8/i10/2013 08/10/201 Ea accident $11,000,000 X ANY AUTO ' BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS I Per acc dent $ A X UMBRELLA LIAR occuR S202945900 8/..,10/2013 0811012014 EACH OCCURRENCE $5 OOO OOO EXCESS LIAR HCLAIMS-MADE i AGGREGATE s5,000,000 DED RETENTION$ I $ C WORKERS COMPENSATION 0000068028-RI 8/21/2013 08/21/201 X;WC STATu- OTH- AND.EMPLOYERS'LIABILITY ER B ANY PROPRIETOR/PARTNER/EXECUTIVEF AIC927818352394 8/21/2013 08/21/201 E.L EACH ACCIDENT $1 OOOOOO OFFICERIMEMBER EXCLUDED? N N/A I . (Mandatory in NH) E.L:DISEASE-EA EIf MPLOYEE $1,000 OOO DESCdescribe under RIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000 { DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) P r 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 . O'Nt� Aa� ©1988-2010 ACORD CORPORATION.All rights'reserved. t I s -A ACORD 25(2010/05)Y'+ - 1 of 11 .The ACORD name and logo are registered marks of ACORD #S215109/MV5088 : ' AXL t 4 ��'yo6trc bin TOWN OF BARNSTABLE Permit No. 25965 B Building Inspector Cash • - ----------- q r�06 • •. a � m . .. .. . r + » .a r s n. .. '�toraY► OCCUPANCY PERMIT Bond -----------------•-------- -- Issued to Bayside BuilCdinq .(Z . Address, , Lot 24, 53 Ferri7ir66le fame; Centerville t , Wiring Inspector �j w� b� Inspection date Plumbing Inspector C # �C.y...... Inspection date Gas Inspector CRL'Nn 'f" 'i, 7.IY.t�I� t Inspection date Ytl M X Engineering"Department `- y;�� � G' Inspection date Board of Health {�- Inspection date -02 � THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL. NOT BE ,OCCUPIED UNTIL. SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS.,AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ��- ..................... ls.. _ ........... ....... .. .................. Buildin�- Inspector (j _ _ y FROM - TOWN OF. BARN STABLE SUILDING DEPARTMENT Mr. Francis Lahteine ' �.- 4 , „. , , . . 1307;MAIM STREET HYAWS, MA 02M Town Clerk Phone: MY/w+.11.20 • ±l iF i� K!f Ik. 1Q aS'�!`4°ii N Yf;i4'M?Y - SUBJECT': ; FOLD HERE DATE i �..ye ti..y p MESSAGE ,_ -Work-'has been eonnpleted i4ndgr j, e : t .#ql�t 5�8, �s 24965; q (Bayside Suildipg Co- )*,*:* SIGNED DATE REPLY „ SIGNED 71 Ne7•RmI RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN.U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. o � �►►.1�G�- ,�F AM t LY ,•-. :3 B C O R o o M �' , ��� �-; t�- ►JO 'GARBAGE ;C7�NDEtZ. , ., ��• ? i;; pAI�.{ Ft.oW Ito X. 3 = 7,3oG.Rt? ! t r SEPT�G 'cA►�K - 33Ox150% A9%G.P. q 1000 i iD1'$POSAL' PIT vsic too0 GAt_. /�• P ,T r.vJALt., AV-SA. ' ~15A . ,$.F 'x.' �-•7r a �375 G.1'.•� � � � •;•`�, O�- t'i, t��"i # a`� - BOTTO/Irt, AREAr �0 S,F, � yB.� �► `k� � "'� I .. IGN *oT 5 v 2 .. -�-t�- fe jly . c>TA%- PA uY `'FLOw! =' 33o G.Po �( '��� �•z• �. -:r-r ; 1 aPEcZco�AT14N RATE.j 1''IN 2MIN .o�L�55 1�1 5�B•� k t' t F. z A' ;ca ; � • y � Z�' � � boy�t�4 f• l•iI OF LAN y9'7 I7 t ;i rwt t x i o 'WILLIAM G�• W. v . P .S'� r a ;.• C. N Y E N�Y 100 cpi JONES v,' /. J ► ', �. I f o:v t No .a � T. i•etr,� `s•.j �i 19334 4 ' yn F �v ;a Su 'TOP FWD Nog /g3f'a.s INS• 1 t� C, 7 f � oo INS• ` _ .t t t �- �2 D►5T. INS. "6. sV13.Siit/6,._ 1w X / s r.p T _. 7 ,. r C/PJ•3 ,TANK A1 = •4 j PIT INV. �j INV- u t - z'•I �O�,Et yt/I T u 7/• 9 T8. - 3 it +,I . Vp'14+4 Fr s CERTIFIED P�-�T PL:A►►J t ' L �.lo' SGAI.E �jGALE GE T - 4T Z =,►{i .RC-so1J GOMP�-YS Y+�ITN'THE SI�E•L1NE t z � 3. i A o SET 2�►GK R.6 R v tiZ>~M 6 N't,� V4 -TOWN Op ah9m. C C LOCATED tTHIN T FLovD Pl. IN :-; ` 1 DATE BAXTEQ.e C 5 u�Y E!(oe's T. Tu15 PLQN 115 No(' 4n5�-�' a' os-rEi�vII.LE 5. I 1�5-�•�MaNT SVeV Y 4-THE =FSE?5 Suoul,� NoT �F USEOTO �ETERI^IN� L.o'r t-IF4F-`5 APPLIGA►Jr ,Q,�/ /1��iQ(,,E� t r • clr OzAl . Asses,$or's map and lot number ✓..... ..... a 4 �`...... T �O%,THE T� Sewage Permit number ..................�°t!!�........... fl��.'�� � BA o� TIC SYSTE P /. Z USTULS, i MAS House number ...........................'...1.........................`..:..... A$.LEED IN CON, roo 039. WITH TVTLE 5 - A b,�;, �a YPY aye -4 r-y TMQ T O WN t OF DARR �.'S.1 XffL'E t' BUILDING INSPECTOR ............................... APPLICATION FOR PERMIT TO .....* .�n 1 ...... ... C�`�'�.. ..... TYPE OF. CONSTRUCTION: ...�DD. ..... 12!tir ems. ....................................................... ........ ..... } 7,, ............j..c. ...... . ..A9... TO -THE INSPECTOR OF BUILDINGS: The undersigned herrJJeby applies for a permit according to the following information: . Location ............�...l.........r:.�'.!`oto t.��.Z..- `! -:...... ...... .......................................................... ProposedUse ..... `�L`.DC .`........................................................................................................................................ . ..................................................Fire District ........... :....... .......................... Zoning District ..........L IL Ine ...............Address .......................... •L•.................................................. Name of Owner ............�. ............. � Nameof Builder ...................... ..........................................Address ..................... .............................................................. :.. a... ...1........ Dd.. .. ...............Address � .Name of Architect .......�. � � �` .............................. ............................................ Number of Rooms ........... ...... V... ..Foundation ......... ' 4fi r. .... 4 Exterior ........ ld¢p IVC .1n,4. 1. ......Ilv. .. ..............Roofing ............. . ..4!l.l�..\:....................................... Floors ........... ...'� .'f.....U.l` (..... ..............Inferior ............ .�!„�'�U.d' �.....� ..... ............... Heating -P H.. . a !s........ g P.U..c. 4�. ..... ................�.... Fireplace .............1c?.l lr.Gl/ti.... is ..�..`C? .lf. .....Approximate. Cost ........................................................ Definitive Plan Approved by Planning Board -----------_------_-------_---19________. Area " Aro Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ®� t_V 6, za ry N 3 , 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. Name ...... .. ... ........................ Construction Supervisor's License ..t . l�.. BAYSIDE BUILDING CO. No25965 ; Permit for Two S rV ............. . ................. .. .. ......... Single Family Dwelling.............. .............................................................. Location ..L.o.t...2.4............5.3.......F.er.....nbr........o...ok.......L4ne . Centerville........... ................... Owner ......Bayside Building.. ......... ........................................ , 'Type of Construction ...........Frame ............................... J ................................................................................ Plot ............................ Lot ................................ Permit .Granted ..JaMA4AZ- J.2............19 84 Y Date of Inspection ....................................19 Date Complete ................19f-