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0163 FIVE CORNERS ROAD
_. 9 ,, 1 �_ ad lS-ors S Town of Barnstab *Permit# Expires 6 months from issue date �T '^ Regulatory Services Fee �. S ! EAMsrABIA 4 MASS. 8' Richard V.Scali, Director , 163y. ♦� ArFO N1A'I A Building Division Jfe�� S P� Tom Perry,CBO,Building Commissioner RINT 200 Main Street,Hyannis,MA 02601 MAY 0 www.town.barnstable.ma.us 5 2015 Office: 508-862-4038 f TOWN OF BftOdA'� 6230 4EXPRESS PERMIT APPLICATION - RESIDENTIAL 0 �t Not Valid without Red X-Press Imprint Map/parcel Number 1(p O Property Address rn21.cas 1LA C%� 2LA C E -Residential Value of Work$ Minimum fee of 05.00 for work under$6000.00 Owner's Name&Address 22zfR= Nee- �L�s Contractor's Name O+-l't '} \� i Je�'+.tr..t. Telephone Number ��-�� (-J-(c�� Home Improvement Contractor License#(if applicable) tO l 1 L4q Email: yA a&Unr\ &Cuj Gyrn�r�cfi Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: E `Lam a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name r' Workman's Comp.Policy# v Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris willbe taken tom PVftr1C,U j l-+ ' ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (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 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 quired.— SIGNATURE: 1_ Q:\WPFILES\F RMS\b 'Iding permit forms\EXPRESS.doc Revised 06 313 ' e ot KAM ;,g Town of Barnstable Regulatory Services g rY Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 11 I oka-6 ,as Owner of the.subject.property hereby authorize h'4 to act on my behalf, in all matters relative to work authorized by this building permit application for: b3 vU Cep Y12�� �� Ce�r�ke�y►l�>✓ ` Y1 o : 0aC93c (Address of Job) Signature of Owner Date �j�a'��'iC2r 1'�o(1Lr�GIGI Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit formAsmokecarbondetectors.doc. Revised 050412 Massachusetts De pa,rrrncnr ,f ?a�i c S:lFe(y Board of Building Re9ulatiorls anci Standards ,A\ ()free of Consumer Affairs& Business ulation ( ii.i ru,ti, n tiul,.rX n.,r uME IMPROVEMENT CONTRACTOR _tense CS-014007 = ton. - i� R egistrat' 101149 Type. d expiration: 6/25/2016 Individual John P Dunn P.O BOX#924 I JOHN P. DUNN Marie Ann Terrace Centerville MA 02632 i John Dunn j l 80 MARIE ANN TERR. z3— ° 05/25/2016 j CENTERVILLE, MA 02632 Undersecretary i License or registration valid for individul use only Unrestricted -Buildings of any use group which r 'r. before the expiration date. ,1f found return to: contain less than 35,000 cubic feet(991 m)of Office of Consumer Affairs and Business Regulation t 10 Park Plaza-Suite 5170 enclosed space. , Boston,MA 02116 z Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Not valid without signature For WS Licensing information visit: www.Mass.Gov/DPS J iiset The Commonwealth of ipldentsts , Department of Industrtal Ai ci Office of Investigations 600 Washington Street lii Boston, NIA 02111 / ,vww.mass.gov/dia /Contractors/Electricians/Plumbers f Workers' Compensation Insurance Affidavit: Butl ers Please Print Legibly p licant Information i� y Name (Business'Organiza!ion/]ndiviaual); Address: & etc V. (+ram r(fa ( tea Phone ��r� `� City/State/Zip: (required): Are you an employer? Chet k the appropriate box: 'Type of project (req❑ New construction - I ❑ 1 am a general contractor and 1 6 j,❑ I am aemployer with have hired the sub-contractors - 7, ❑ Remodeling employees (full and/or part nme). listed on the attached sheet. t 8 ❑ Demolition 2.RL I am a sole proprietor or partner These sub-contractors have ship and have no employees workers' comp. insurance. I 9: ❑.Building addition working forme in any capacity.° ❑ eve are a corporation and its 10 ❑ Electrical repairs or additions [No workers' comp. insurance off officers have exercised their 11.0 plumbing repairs or additions required.] right of exemption per MGL 3 ❑ I am a homeowner doing all work c. 152, §1(4), and we have no 12.❑ Roof repairs myself. [No workers' comp. employees. [?Nio workers' !? . her t ) insurancerequiredJ comp insurance required. all work and then hire outside contractors must submit a new oam dpoltd cy indicating applicant that checks box..;I must also fill out the secn�on,reelow showing their workers'compensation policy infotTnanon. : Any pP t Homeowners who submii this affidavit indicating they are g Icontractors that check this box must attached an additional sheet showing the name or the r o em t loyee ors and t'n'Beloweir eis the policy and job site /am an employer that is providing workers'compensation insurance fo y P in/ormatton., _ insurance Company Fame: Expiration Date: Policy r or: Self-ins. Lic. 0: „5 �iV City?State/Zip: ! Job Site Address: 103 er and Attach a copy of the workers` compensation policy declaration page (shoFv I the policy numbofcrim naltpenalti date) of imprisonment, as well as civil penalties in the form of a STOP Oo the 0 ce of a fine Failure to secure coverage as required undSrr Section 25.A of MGL c. 152 can lead to the imposition Fine up to$1,500.00 and/or one-year Imp of this statement may be forwarded of up to$250.00 a day against the violator Be advised that a copy Investigations of the DIA for insurance coverage verification.:' provided above is true and correct l do her certify un er the pains and penalties of perjury+that the information pro ' . �� .Date: Signature �S Phone #: p tcial use only. Do not write in this area; to be completed by city or town official If Permit/License # ' City or Town: -. Issuing,Authority (circle one): ` Board of Health 1. Building Department 3. Cityi'hown Clerk 4. Electrical inspector S. Plumbing Inspector 1. 6. Other _ Phnne TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map FJ Parcel . © ,' Application # l Health'Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis v.. y , Project Street Address 162 z5z Co&k Ap Village Owner j B£4L�g� j9'1 ot-LT8J Address Telephone Y13 ° 39 - Permit Request . -A1 z 7f1 ft- Cra ` w Square feet: 1 st floor: existing proposed 2nd floor: existing - proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation .�d Va0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. d' Two Family ❑ Multi-Family(# units) Age of Existing Structure old Historic House: ❑Yes ©No On Old King's Highway: ❑Yes C<o Basement Type: Z 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: U/Gas ❑ Oil ❑ Electric ❑ Other , Central Air: ❑Yes III& Fireplaces: Existing / New Existing wood/coal stove ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑,existing .0 new size_ Attached garage: Rr'e'xisting ❑thew size _Shed: ❑ existing ❑ new size _ Other:'µ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ x Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use r APPLICANT INFORMATION �-- (BUILDER OR HOMEOWNER) Name l �,n :t&IG Telephone Number Jam+' ��� Address License # Home Improvement Contractor# Worker's Compensation # Zgq/ a433-4' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOi�,�� J SP rc SIGNATURE DATES 1 FOR OFFICIAL USE ONLY ., APPLICATION# x DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE: OWNER. DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL y FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. E M .� Dennis&Bea Moulton 163 Five Corners Road Barnstable MA 02632 Town of Barnstable Building Department Barnstable MA 02675 May 29, 2010 Dear Sir or Madam: This letter is to authorize John Clark of JS Clark Builders to apply for a building permit for work to be performed at 163 Five Corners Road, Barnstable. I am the owner of the property and have retained Mr. Clark's company to perform the aforementioned renovations. If further clarification of this matter is required,please do not hesitate to contact me at 413-387-7056 Yours Truly, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigadons 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/Organizationtlndividual): JCPkW CLA94 . �-5 -CL-WK- R.t•lcleri 3-JC. Address: -ZS f sr tA Al - City/State/Zip: fy 4S%,cc AA4 OZ 6,i 5 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ® I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 7. Remodeling 2.El am a sole proprietor or partner- listed on the attached sheet t g ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. H�G 9. ❑Building addition [No workers'coinp.insurance . S. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required] *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 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: FAtt Cls FA,�k C AALA4 Policy#or Self-ins.Lic.#: 200i �J6333- Expiration Date: Z 2 ' Job Site Address: f6 3 firji� 9��� o, ffaz,221M City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u r t pains and penalties of perjury that the information provided above is true and correct Signature: Dater Phone#• -Saf° Set • o Official use only. Do not write in this area,to be completed by city or town offtciai 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#• 06/02/2010 10:38 5084209227 MAIaC W SYLVIA PAGE 01 (,A-CQRa,w CERTIFICATE OF LIABILITY INSURANCE oflT12IMMJDDmYY) oI3J02/2010 PRODLK ET: (508WA-0440 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MarkSYhrialnsuranceAgency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 771 Main Street HOLDER. THIS CERTIFICATE; DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. Ostervllle MA 02895 INSURERS AFFORDING COVERAGE INSURED - NAIC* JS Clark Builders,Inc, INSURER A; Farm Family Casualty Insurance 25 East Way INSURER B: Mashpee,MA 02049 INSURER C; INSURER 0; INsuLfER E: • -COVE RAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUER TO THE INSURED NAMED ABOVE FOR THE POLICY pERlpp 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 ALI,THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ar I - POUCY NUMBER P Y EFFECTNE POLICY EXPIRATION "" LIMITS A GENERAL LIABILITY EACH OCCURRENCE 3 1,000,000 X COMMERCIAL GENERAL LIABILITY 2001XO243 4f29R010. 4/2MI 1 PDAMAGE TO . RENTED g - 50,000 CLAIMS MADE OCCUR ° )•^ _. MED EXP AD n) $ 51000 PERSONAL BAMINJURY 3 Included GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES Pea X PO Y PRO_ LOG; PRODUCTS-COwroP'ypG 2,000,000 AUTOMOBILE LIABIUTY ANYAUTO ICEOMB DES INGLE LIMrr 5 ALL OWNED AUTOS SCHEDULEDAUTOS BODILY 8 HIRED AUTOS NON-OWNED AUTOS BO ILLY INJURY(Pe s _ (PerPROPPERTYt GE 8 GARAGE LIABILITY AUM ONLY; ANYAUTO .EAACCIDENT $ OTNER THAN to ACC 5 AUTO ONLY: AUG S EXCESSIUMBRg1A UABILIIY EACH OCCUR____ i OCCUR IMS CLA MADE AGGREGATE B DEDUCTIBLE RETENTION i 9 WORKERS COMPENSATION AND $ A EMPLOVERS'uAB41rY 2001WB837 12l2/2g08 1211J2010 lTTVC�1,� X DTFI ANY PROPR16TORMARTNER&XECUTIVE E.l,EACH ACCIDENT 9 500,000 OFPICERMEMBER EXCLJ,OM — Syyaa�� E,L DISEASE•EA EMPLOY L 500,000 FECI O troMIS aglow Yes DTHER EL DISEASE-POLICY LIMIT $ 500,000 OESCRIPr10N OF OPERATIONS/LOCATIONS I VEHICLES'EXCLUMONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS Calp nby The workers W"ns2ft pDOCy does not provide coverage for John Claris, president CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE OEBCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Tom OF s Btreet ommnt 61E DATE THEREOF,THE ISSUING INSURER WIL!ENDEAVOR TO MAIL DAYS VMMMN 200 Main S Building be meM NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO BO SMALL Hyannis,NIA 02W1 IMPOSE NO OBLIGATION OR LJAIia.nY OF ANY KIND UPON THE INSURER,rr5 AGENTS OR REPRESENTATIVE$. AUTHORMD REPRESENTATIVE ACORD 25(2001M) a —` w ACORp CORPORATION 7I388 6, Wo VV .33dHStlIN` Jl`dM 1SV3 5Z' S;NHof:;; pp of"pahu;saa 6Z959 .$ :asua asua.3i aostnJ;3dns uG:t}�n�;suary �i).�r+pu�'�5 pmr� �u ►iar.in^' to �u`rhlinU ;1t►it rrog �t °;r. .3itynd.;c�.1001.1,rd.j =s�a,isnyira.r.t,at It ,,� Boar o ui rn a ula0 ons an �ars g g One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement,Contractor Registration Rt Registration: 145474 y ' Type: Private Corporation 4 Expiration: 2/1/2011 T►# 280672 JS CLARK BUILDERS, INC. ` '�➢e • JOHN CLARK { F 25 EAST WAY ".' _. . ... F MASHPEE, MA 02649a :Ft Update Address and return card.Mark reason for change. 51 Address ❑ Renewal ❑ Employment 0 Lost Card 0,4 J3A-7,110,01alc Jo 00, IS d � ff i t t j 1 � o 5 8 1 OFtHEr Town of Barn* stable *P rml P� ti Expires 6 monthsfrom issue.date Regulatory Services Feed ■ BARNSPABLE, y� MASS. Thomas F. Geiler,Director plFD Mpt a 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 Imprint Map/parcel Number-._ + � 6 b -) ZPro rty Address /'fie COJ'Al�I' " 1^ _ xfq� Residential Value of Wor►, 5 :700 1. Minimum fee of$25.00 for work under$6000.00 Ohvner's.Name&Address N/tl,j ! '/(0 'f//� r 1-1/v 6�1' e);� 1 �1-6'71-C 0 Contractor's Name- ���n7�S (��./� TelephoneNuinber Q � 1 lome Improvement Contractor License#(if applicable) Z ction Supervisor's License# (if applicable) 99 I/0:an's Compensation Insurance ®PRESS PERMIT Check one: V1, m a sole proprietor''' ,SEP ,-. 2 2000 m the Homeowner ave Worker's Compensation Insurance. TOWN OF BARNSTABLE Insurance Company Name Workman's'Comp. Policy# Gtl Copy of Insurance Compliance Certificate must be on file: Permit Request(check box) w ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ R . sid Wind e Replaceme o /doors/sliders.U-Value 01 .� (maximum .44) *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 is required, SIGNATURE: _ Q.`WTI-11_i:S\F0fZM,S\building permit forms\EXPRESS.doc kevised 100608 4_ The Commonwealth of Massachusetts - -Department of Industrial Accidents Office of Investigations " 600 Washington Street �r ti Boston,MA 02117 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly nNC Name (Business/Organization/Ind- 'dual): /V 0, Address: . IIS2 ERS City/S to/Zip: U)Odi v . 00 S Phone#: 41ol b /1— h qwo A;Are y an employer?Chec the appropriate box: `Type of projct e (required): 1. I am a employer withAd. 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. Vemodeling construction. 2.El am a sole proprietor or partner- listed on the attached sheet. 7. ship and have no employees These sub-contractors have g ❑Demolition working forme 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 officers have exercised their 3 I 1 l Plumbing r it r addirions amah m Pumb e a so❑ homeowner doing all work ❑ g p. myself. [No workers' comp. right of exemption per MGL 12.❑.Roof repairs 1 insurance re.quired.],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. 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 a information. Insurance Company Name: e6calv / Policy#or Self ins.Lic:#: Expiration Date: Job Site Address: ',i�/W�/? P/Vep,_� City/State/Zip:CeyA4k Attach a copy;of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the.imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator..Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. 57 Signature: s.:.. /` l /++� Date: Phone#: 7-10 Official use only. .Do'not w.rite:in this area,to be completed by city or town.official City or Town: Permit/License#; Issuing Authority(circle one) ' I.Board of Health 2.Building Department 3:City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A' kre Sa e s Sot duo if to-ad d , ROME'IMPROVEMENTCONTRAOTP# g� �� sons ' T&br v 01 Lion OWASSO C. if MOON 2� i =4 a WOONSO S1 t �s Uyadersteretaq .\ �,M1wuaemruaara.A`�` 'mnw .. • .. w - ` —___ - sinul 43- lam a i. REP..),W � is toy. PIE.ROAD Opt f-Dr mvm lion of WS Daum POW. v toles i . v. �:MIME &A M^m M,m A ter, 'm€,t StF1S�"i3 TIFICA E OF LIABJUTY INS URACEONLY AND WNP j NO RIM a UPON TRIP.Ca"M r K��er lusix , Inc, P ,`� t Sao Odd River Read, P.0, Box I A Pa�_`I K � �� 'Manville ax 02038-00� M, a 4 ISO- OO =401-769-9502 C VE ACT� td svl�" - r a �.0 a I r @ Wtctam* is park .. 00VI $ _.. AWMXV— to a"s'1: QCONX'3 N W.AARI sue'::£WOTI" tS.HITNYMgs"i= 'dWiC&& okyR' it-am OR 1�sp�pEYp£��"vgY`P��a«�.�s� ��"'•i2YiS �` 8�i�3? r �q, p £� ')�.�!� Jx:it.3 �:� �d•3£ d�`c ��u'd s�.3 i�b�-�f3+� �Y 'i'YY6n4�4i'��+raw'R-W- IIRL8'*x`�ai'4Mty MVAN MS I4V'.4.�3"em"L3�E RM-10ti! 7'e¢d' '4<`. FROX v':'�@<ulmm etx�20 ii33�fii Aw (1-1 Cccul € �} ;1000000 sums W.t`u"ry MOM"MUCE Vvem V . ,.� .. A T4fT � a a MW { ' " cr e7v,za� £JT3vs fi�•� ,rt3 ab''+da�' . . ., .:: ;': :':' s r i�a�''"�L.�i1' 6 �5�} X i - OBrt toDA Wilding Cvzt. � . 20=4 Dept, A Administration Wit . :........ .. �l. g y y�p�yr� Customer Name. J , � — Bfi i .---1 -- '==-- -- RenGw-rl by Andersen of Rbude fsiand& � � Sales.Agreement Address:# ^ TA.a Rd Cs.scome IDA': Ca-pe Cod �y �O� Cicy,Stace,Zip: __r ' (03a O.der Number: 1137 Park Ease:Drive ® b5'/�fildersen. Pnana lome: ��T S T— Woonsacker,923 02895 WINDOW REPLACEMENT an Andersen C.xnFw'Y D Phone-Work; S Page: of T Date: license fr RI-39839 RI- 12259 MA- Email: — 119535 CT-5627a5 UNITS Technical meavae GRILLES Dheensians e 0 70 9 �rt Aa ofi S n m =g � o E Roorn. Y r=3 �b v «a �' �'@s �3 'k �c a• c"° �'8' m�8 s6 �'g s, ��,'3 �o•F as a. 'L ffi ffi y^FRfCES Eg_ m s 3,� a•'�' E b`�° �5y 9D Ja ll �+c g Ru = E' u+ L ozQ Description a � xa H� cda g oC �� a7q < � cparg 88 „r ��` � ,rs as ri � ag t x3 -3 S cvc Owl GBtp -S �ow — D� `5 m Liri, SCO r m i . 0 !C 3 x r ki / .LL Ar Sa1 rgaF+heaDo«ewndawsandlcambe ro�dalfarrlewafenxAatsurdinhea e = PM vnenel7 M{seella eo sCtzditsorExpensts Su6Total&gpi) Payment;Method ... pooml x9g scmdn vaEil Far JD dabs acid is wbjert tv nrsepamee Try bod+CuetwunantlReneea]hY,lndecsrn M1fanagis as - {Slanting.v+r4P. t RG.pmr,PmrnoY{on,,;u.) _ - bdr�w - _ - SubTO't�l,aaaa.rarsl- 1! DesaiptioD!N4[p !��e((p /f 8 Pdce$ t7se4k sac Sub Total uuPawal R-1by Arid—Sala Rep--mdiisign—e kLZ= �+"�G r•�,t`Ml7l�+e:1 LJI„j!� credit c rd �s yd 8� Cuatomer A.ecep[alto=Yna wx I-Ire sudumind m rivrdsh sll artndmos and doors mquiaed m cwnpim 114. Mice.Credits:or E.xpense6 gnemmt Aw•u.•tia the urxt of VW agrees iq pay the nrnounr atsred in thia agraenent snd accn.E g ro dre w-i nmaar .. Q Financing f/i/'1 See Revel Side for Terms and Conditions of Sale.You,the buyer,may cancel y Total 0 this transaction at arty time grior to nudttight of the third busineas day after --- afraeaomnamy the date of this transaction. lease see attached notice of cancellation for an Sales Tax' explana on f this rtg;y(j� �/� u of Expenses AddhI-I Onlar Farms A%XW •}"P-d �, /y w�'�� X.,,-]•-� (eaary over :a m,se aedet f expenar mlumn as righti 1Afarlt rADlt Cost (Rlwso Fade aD fh¢t rvav�L 44SSLL9ErJI � M Do E ana Cumrartar Approwt rum T-. -Total Atftocmt afA9teetgont- 7 D uo Doer sa>Sm. _. Sped J Order Nai m LL Pe P r..- gfylgpav Mry.. sr. .. As<c roc Uaa - And-1.farue�er Sigrrature _ DepDsit Required l , •� 8g-%,.) •And J� .. SpaianYtKrldarY ' ''.i //rrra�psbt6.lg staid+p rr eerlewal bisrdmen Renmrdal and"rwinaton Plmaemke Sim ae am urahleoo 6fd on mpaolr,g .Iliilance Due on carppietlon twlpaeperagwhirhmay dms nmguarartae are .1dy tar•aa eang ate anyrreeend®,.aeaHaneaetil Dry unuen damage. .. betaeded is actidxM 5to,anginalwindow aotlythe responsipllgaE udifmwreE alrrirg Bsta�eien we wR¢rr>[ileb; _ s+his oweeaentudsss car�mgs al2rlxn unhs dle afaovrN UMra Atihie,9e tprtada repdrs upon your eeseavr!• - rem [Indd iiispr,trtatedale,im mPIPion, ped>iaalS'Amdahwe seysulle6 otherwise mud. At+heandofertiaballaombuc+fmldeMewiebe rerstoral,widdispnsalp(ptgdugsrepiseed. raaosetlaM rre willdeeaymlrnew windaA+s u+d WhiIB-Rernwwal by Anderson 1CtIIrAv•Insta1Pdtfan Pink,Hornaoomer - CuStortle Customer q..�� Cusiontet �,,d - thelnsWlatlen awn - trtittols: Mtaais /Tr yei ImiEalr Al f'�! - - 1 ft F.a.2W Ma.a.-.dO.n.rc+d•rybM.:.bpv,nJ.mu4NAd,m.C;penem G'l�ar,A.e.mn iu:,uA�un.W n�„Menro:l,n n.Wu MYo)A s PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 08/23/06 TIME: 12:26 ------------------TOTALS----------- PERMIT $ PAID 25.81 AMT TENDERED: 25.81 AMT APPLIED: 25.81 CHANGE: .00 APPLICATION NUMBER: 20062734 PAYMENT METH: CHECK PAYMENT REF: 5023 Town of Barnstable *Permit# � Expires 6 months from issue date Regulatory Services Fee _ Thomas F.Geiler,Director Building Division X-PRESS PERMIT eo-1, Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 AUG 2 3 2006 www.town.barnstable.ma.us Office: 508-862-4038 TOWMa085"N&TABL'E EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Zap/parcel Number 1b0q 67 roperty Address &`_ /`7 e 61,11ge residential Value of Work Minimum fee of$25.00 for work under$6000.00 )wner's Name&Address Den o t's [A 0 U.l h ontractor's Name n�dr�S_ � C Telephone Number ! .1R"/yXeop 6(T oZ d ome Improvement Contractor License#(if applicable) 7^7V onsuMuon sor's-incense-# -if bie)-A�!C Workman's Compensation Insurance , Check one: ❑ I am a sole proprietor ❑ Lam the Homeowner FffI have Worker's Compensation Insurance surance Company Name &(IeS.S J i orkman's Comp.Policy# opy of Insurance Compliance Certificate must be on file. ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-" Replacement Windows/doors/sliders. U-Value (maximum.44) *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 is required. 'SIGNATURE �:Forms:expmtrg tevise061306 ine Lommonweaim olmassachusetys r Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www-mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electlricians/Plura hers Applicant Information Please Print Le 'bl Name (Business/Organization/Individual): Q 0,7UUJ S ,�tjc_ Address: 3 5i City/State/Zip: E1,10C A Phone#: Ja r(o76 r.(a8 0 Arre,yo n employer? Check le ppropriate boa: Type of project(required):i.5:, am a employer with Je 4. ❑ I am a general contractor and I employees (fM and/or part-time).* have hired the sub-contractors b' New construction 2.❑ Ism a sole proprietor or partner- listed on the attached sheet t ❑ Remodeling ship and have no employees These sub-contractors have S: ❑ Demolition working for mein any capacity. workers' comp.insurance. . 9. ❑ Building addition (No workers' gmip.insurance• S. ❑ We are a corporation and its required,] officers have exercised their ME] Electrical repairs or additions 3.❑ I am a homeowner doing.all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself:[No workers' comp, C. 152, §1(4), and we have no 12.[3 Roof repairs insurance required.] t , employees. (No workers' comp. insirance required.] 13.0 Other sn*Any applicant that checks box#lust also fill out the section below sbowing their workers'campenntion policyinfonmatiow t Hmneownen who subarit this affidavit indicating they are doing all work eadthen hire outside contractors must submit a mew affidavit mdicatiag such; =contractors that check this box must attached an additional sheet showing the mane ofthe subcontractors and their workers'comp,policy information. tam an employer that is providing workers'compensation insurance for my employees. Below is the policy andj®b site information. Insurance Company Name: Policy#or Self-ms..Lic. #: SDI V 0 7;Z Expiration Date:5 / Job Site Address:.44? I! V e, �NPr City/State/Zip -'A Attach a copy of the workers' compensation p.eUcy 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$1,50000 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 c under the pains enalties of perjury that the information provided it ove is true and correct.. Si a Date: Phone#: �y0 " CO 70 r CP 0 — Official use only. Do not rYrite in this area,to be completed by city or town of 7ciax City or Town: Permit/License# Issuing Authority (circle one): 1.Bop-rd of Health 2. Building Department 3.City/.Towm Clerk e.Electrical Inspector 5.Plumbing Iusq�e a nor 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their emiployee*r Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,.offal or written." rp Y An employer is defined as•"an individual,partnership, association, c oration or other legal entity, or any two or more urF . of the foregoing engaged in a joint enterprise, andmchuding the legal representatives of a deceased employer, or the . receiver or trustee of an individual,partnership, association or other legal entity,rty, emptoy employingemployees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling hous°e of another who employs persons to do maintenance, construction or repair work on such dwelling house or on1be grounds or building appurtenant thereto shall'not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency'shalI 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 nbt.produced acceptable evidence.of com pliance 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 ofpublic work until acceptable evidence of coma liance with the insurance requirements of this chapter have been presented 0 the contracting authority." Applicants Please fill out the vmrkers' compensation affidavit completely,by ched6mg the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es) and phone mnuber(s) along with their certificate(s)of insurance. Limited Liability Companies.(LLQ or Limited Liability Partnerships(LLP)with no employees other than the members at 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 maybe submitted to the Department of Industrial Accidents far.confirmation of insurance coverage. Also be sure to sign atd 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 gourd der fheit self-insurance license number on-the appropriate line. CRT or Town Officials . Please be sure that the affidavit is complete and printed Iegably: The Department has provided=a space at the bottom. affidavit for you to fill out in the event the Office of lnvesti ations as to c tact you'regarding din the applicant of the a y g h on y gar g app ant Please be sire to fill in the perra t/license number which will be used as a reference number: In addition;an applicant Thai most submit multiple permit/lieens a 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 • fawn)"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 liome 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 of idavit The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a can 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 #11 617-727-4900 e;;t 406 or 1-877-MASSAFE. Fax t 617-727-7749 Revised 5-26-05 w-ww. mPSS.,Ov/dia I °FINE, Town of Barnstable Regulatory Services 9 BARNSTABMg Thomas F.Geiler,Director E16 9. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name Q:FORMS:O W NERPERM IS S ION ✓lie -omznxo ...." o��ac�ruoell Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: , Registra' ,49840--1 Board of Building Regulations and Standards 9tion One Ashburton Place Rm 1301 r _ ration o /2008 Boston,Ma.02108 type; Lid Liability Corporation at�E— ; It PELLA WINDOW, ul STEPHEN DICKIN � 1325 AIRPORT ROAb� X" �� ,� FALL RIVER,MA 02720 Administrator I Not valid without signature _ I fie 1°arnirrw�ruuea✓r o�,/�aoaac�iw.�seGYa -110 � A .r�� uiPF�/il �R 08164-3 B l49MD a' 1' � T�I1J'8 Tr, ix�: 47237 t { Sy 1 a i - C. mtr+�lo er �� d - Pella Windows & Doors 1325 AIRPORT ROAD FALL RIVER,MA 02720 TEL.508-676-6820 FAX 508-676-6823 June 19, 2006 To: Whom It May Concern RE: Contractor and HIC License I hereby give permission for Steve Correia to use my Contractor Supervisor's License #CS081843 and my HIC Registration#149840 to pull permits in the State of Massachusetts for all projects related to work performed for Pella Windows &Doors, Inc. Steve Dickinson Operations Manager Pella Windows &Doors, Inc Si Windows, Doors & Skylights I CERTIFICATE OF LIABILITY INSURANCE OPID 27 DATE(MMIDDNYYY) IcoRD PELLA-1 07/11/06 y 'PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Preston Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Greenwich RI 02818-0810 Phone:401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE NAIC# INSURED PFR Acuisition, LLC INSURER A: Peerless Insurance Company 24198 q dba: Pella Windows & Doors INSURER B: 1325 Airport Road Acquisition INSURERC:• LLC 1325 Airport Rd INSURER0: Fall River MA 02720 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATbNMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR !NSRE TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MM/DDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CBP8022572 05/O1/06 05/O1/07 PREMISES(Eaoccurence) $300,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 10,000 X EBL PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,0 0 0,0 OO POLICY JECT LOC Emp Ben. 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 A ANY AUTO BA8022972 05/01/06 05/01/07 (Eeaccident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ - EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $10,000,000 A X OCCUR ❑CLAIMSMADE CU8024072 05/01/06 05/01/07 AGGREGATE $ 10,000,000 $ DEDUCTIBLE $ X RETENTION $10,0 0 0 $ WCTWORKERS COMPENSATION AND X TORY LIMITS I ER A EMPLOYERS'LIABILITY WC8023972 05/01/06 05/01/07 E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under - SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ` DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town Of Ba, nstab'le NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Attn: Building Division IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 Main Street Hyannis.MA 02601 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) ACORD CORPORATION 1988 t� Contract Pella Windows& Doors Westerly RI, Centerville MA, Wakefield RI Seekonk MA, Dartmouth MA, Plymouth MA Serving Massachusetts & Rhode Island Phone: Fax: ram- r, � .., ._ .;�. .. • .w :.. Gz!:s..zr, t..>•-:,r7. .:x�,.�}. _. _ - .:.. „qx.:,n,.. �� ...Customer. .. .4� � ,. > : _ ��£ �, ,,y ro .ect./,Shi To. _, � _ 3 � .,. Order ,: -I . 0 ,..... � A..:. 4« s ....... a c.. ,..._ .... .. k ..,.. r ,��t tl a :emu_ ..,.�..-_.1PM"r �_:.. .,:, e. :,o...%X�«k�;,,�u_sn.>.o-.r+,.H -,,._.:Y ��i,pa..a�.�..:rvi.�.�'k�3+V+t-�W�k•!w .��.. Sr,,.'..�w �`ii.,.<,,..,.t+i. �:�,,..ra�..�''a'.yx,� �Ps.yr t,,, �!�:. � +¢{ ,�,�,.. `�atl. ,.,t4 tt+txl I_. �,,a R.�«,Ny�ls,<a'Y�nNu I;?�4.yX 0.•.I�{ if x�,134?if; D61010 ie1 Ce mou"IMR.&MRS.DENNIS MOULTON Date 6- orb 00/00/00 a O -D 0 1 L L o Al 163 WL : . No. Need Date 00/00/00 NO " A P-roN, MA olot.0 � � A Qo2 40 3 a Sales Rep.Name Prepared by Payment Terms Owner: Mr.&Mrs.DENNIS MOULTON Architect Bus.Phone: ( ) - Bus.Phone: A Dist.Order No. Bus.Fax:( ) - Home Phone: (508)428-8864 Cellular:( ) - Home Phone:( ) - N13) 3 Comments: One 3-wide Casement Composite,one Left Hinge Casement and 2 Double Hung Replacement windows prefinished interiors and installation provided by Pella. 11 Architect Series White Aluminum Clad Exterior and interior along with removable grills to be painted white by Pella. 100.00 off each installed window Promotion applied to each unit=$600.00 off total contract. COMMON ATTRIBUTES: Unless otherwise noted under"Description"all units contain the following attributes.Fixed units to not contain screens or hardware. Product Brand: 1C-- Prime Glass: � 71jud d Z7 Fins: aA)l r- Exterior Mat'l: 4, A4lNU M C44-b I DGP Color/Glass: I Muntin: Brickmould: Color: W/*1 7S I Shade: l Hardware: 01 h fit" ,n. ITn t,Price xten ed.... .��`'�'u� av �._K,rw '_ k � M .. ,. Item#IO Qty: 1 3-Wide Casement 3,003.87 3,003.87 Location: KITCHEN A:Left Hinge Casement,Frame:20-3/4 X 37: Architect Series,Clad,Model A s R,O: Y 3" X Y 1-3/4" 2,White, 5/8"InsulShld IG Glazing,White Screen,White Hardware,3/4" WallCond: 4-9/16" REM Traditional Grille(Grille Lites Wide=02,Grille Lites High=03 ),Fins (per design) B:Fixed Casement,Frame:20-3/4 X 37:Architect Series,Clad,Model 1 , White,5/8" InsulShld IG Glazing,3/4"REM Traditional Grille(Grille Lites Wide=02,Grille Lites High=03 ),Fins(per design) C: Right Hinge Casement,Frame:20-3/4 X 37: Architect Series,Clad, Model 2, White,5/8" InsulShld IG Glazing,White Screen,White Hardware, 3/4" REM Traditional Grille(Grille Lites Wide=02,Grille Lites High=03 ), Fins(per design) Value Added Items: Interior Prefmish Window(not I.L.T.)-Qty 3 Contract-Page 1 of 3 +Contract for Customer Project:MR.&MRS.DENNIS MOULTON Order No: - N ?n. . . r.... ,. xs .: �.. �^x• utsi view . Item. ,"Set � �, 9 ... ion ,. s Unt:,r �. c �.. 3 Price., ,•E ended fi t �� a .9.f �. .. r. .,.:.. � . ,I: ". a :�'. . k:...., is � ,.:�:�i ....... .. �. .,.I .: ,.....::. o,,..a..�,...�. x.,ar�'.aru,,.�`�9?+:s.^,1k,.7<w<�u.:fir:Prfo:�,a.:.�1,t:a.•e�V;��:r.,�,�.....:� � h4 a.,rer ren'.:�:�,„t-s�n+..z,+..c�:wa.r,A.k'1.k,�:�1..:7�''..wu�.�w..� �,� �t��:k��'.�:rv>,�.145,.....�„��+�r.L+ �:.m,:.c.�rw..: li'C»�o'�. ..w...«� �.�11.�:�zu..cSre,At�:.�'�-kwu�_..h�l.a�.7k��`,rk�mti:, Prefmish Window Access:Remov Grille 1 color-Qty 3 Install Full Tear Out 60"-72" -Qty 1 Disposal fee per wdo/door-Qty 3 Notes: Removable gills of 6 lites per casement to be painted white on both sides. Item#15 Qty: 1 Left Hinge Casement,Frame:21-1/4 X 30-1/4: Architect Series,Clad,Model 1,109.65 1,109.65 Location: BATHROOM 2,White,5/8"InsulShld IG Glazing,White Screen, White Hardware,Fins R.O: F 10" X 2'7" (single unit per design) WallCond: 4-9/16" Value Added Items: Interior Prefinish Window(not I.L.T.)-Qty 1 Install Full Tear Out 0"-36"-Qty 1 Disposal fee per wdo/door-Qty 1 Notes:No removable grills for single casement in bathroom. Item#20 Qty:2 Vent-DH Standard Jambliner Precision Fit Window,Make Size:30 X 46: 1,009.55 2,019.10 Location: BEDROOM Architect Series,Clad,Model 3,White,Half Vent/match Half Vent,5/8" R.O:2'6-1/2" X 3' 10-1/2" InsulShld IG Glazing,Full Screen, White Hardware,3/4"REM Traditional Grille(Grille Lites Wide=03,Grille Lites High Upper Sash=02,Grille Lites Ll High Lower Sash=02) .Value Added Items:Interior Prefmish Window(not I.L.T.)-Qty 1 Prefmish Window Access:Remov Grille 1 color-Qty 2 Install Precision-Fit(3 - 10 units)-Qty 1 Disposal fee per wdo/door-Qty 1 Notes: 6 over 6 lite pattern removable grills to be painted white on both sides. ..I., , ..... v. 1. j�.�.�'.�;��`a4�.,.'A�•k7�'.'au' .��'�a.,a»,.�.�.. u�i' �.,:,�,e�.mz�`.5 ., v. :�� � .. .� ...... aa.,,. t. ,...... ,. _ .::..�.�t...s.. ,..., �,, ,t, � ,i.,,I d,n IV .k .I.. '� Iv .,r N`',,. ACKNOWLEDGEMENT OF C.S.R. REVIEW WITH CUSTOMER(Customer initials): Terms and conditions: This order is made especially.for you, the customer. No cancellations are possible after 3 business days of the signing of this order. This agreement becomes a binding contract only upon review and acceptance by authorized Pella Windows and Doors corporate representative in Fall River, MA. All promises of shipment are estimates only, and our best efforts are used in every case to ship within the time promised, but there is no guarantee to do so. Seller shall not be liable for any direct, indirect or consequential damage caused by delay in shipment. For non-installed orders the customer represents that the window/door sizes and specifications shown on this order are correct and may not be changed or cancelled. The Scheduling Dept will call you with your delivery date. We provide tailgate delivery only , please arrange to have assistance on site at time of delivery. For Installed orders, 50% deposit required at time of order, and 50% upon completion. Contract-Page 2 of 3 Contract for Customer: Project:MR.&MRS. DENNIS MOULTON Order No: Taxable:Subtotal $3,276,14 CustomerSfgna a Pella Sales Representative Signature MA at 5.00% - 163.81 None at 0.00% 0.00 None at 0.00% 0.00 Non-taxable Subtotal 2,856.47 $ 1 JrJP(, Total $6,296.42 Date Date Deposit Received $0.00 WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale. All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details, taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wall system. Neither Pella Corporation nor branch will be bound by any other warranty unless specifically set out in this contract. However, Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening (egress) information does not take into consideration the addition of a Rolscreen [or any other accessory]to the product. You should consult your local building code to ensure your Pella products meet local egress requirements. Contract-Page 3 of 3 ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map -Parcel Permit# 1��f Health Division Date Issued 1411h/00 j Conservation Division Fee Tax Collector Treasurer_ Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village Owner dl?")'C,Q.q-_De'1 n,c Ma J&fiT Address iO! &&X /��'fc( j61AA4'/�t ' k Telephone y�Z?-ff T-6 Y13 -491 369V ' /Permit Request Iles j �Y / << T )C�i �� �(I Square feet: 1st floor: existing /So proposed 2nd floor:existing proposed Total new Estimated Project Cost �� Zoning District Flood Plain Groundwater Overlay 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 30 MS', Historic House: ❑Yes No On Old King's Highway: ❑Yes No Basement Type: Kull ❑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 -3 new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: A Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ANo Fireplaces: Existing �_ New Existing wood/coal stove: ❑Yes No Detached garage:❑existing Cl new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:Xexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes gNo If yes, site plan review# Current Use A,l�+ Proposed Use ClqjP BUILDER INFORMATION Name D 0) fl& Telephone Number j Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE , 1914AAAg DATE ZI J DU FOR OFFICIAL USE ONLY 4 PERMIT NO. t DATE ISSUED ~. MAP/PARCEL NO. ADDRESS VILLAGE '* OWNER*' DATE OF INSPECTION: , r FOUNDATION FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL - FINAL BUILDING ' ! - b DATECLOSED OUT ASSOCIATION PLAN NO. r °Ft ,ati Town of Barnstable Regulatory Services RMNsraBL& ' Thomas F.Geiler,Director Mass. �`�AtEo39.,A�`� Building Division Ralph Crossen,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 SHED REGISTRATION /--I rIle Location of shed(address) Village Dclylyl('S Property owner's name Telephone number Size of Shed Map/Pa el# - d , ignature Date Hyannis Main Street Waterfront Historic District? �o Old King's Highway Historic District Commission jurisdiction? U Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE CON3HSSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.,PLEASE SEE THE APPROPRIATE CONEMSSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg I N BA ASTABLE FEBRUARY 27, 1985 e SCALE : , 1 "= 40' { 1102 9�, rX 10 LOT, 13 16, 249±s , F , : LOT 14 N LOT 12 . `7'¢� /l 63. C� CN 1 STORY O Ln 0 100, 00 , i41 e commonweaun ` .> Department of Industrial Accidents - ^� --•--�: Office ofltn�esugatiaos 600 Washington Street ---- . Boston,Mass. 02111 Workers' Compensation Insurance Affidavit ti name: l 1 location �tF' `i r/e C(FPY i city ( �'�?"C�1✓1/�C� phone#6—V� I am a homeowner performing all work myself. I am a sole proprietor and have no one workingin anv apacity workers' ensanon for my employees,working on this job.: ::::::::::::.::::::::: m lover52 �mP : :.:.:::;.:::: :;;:;:.;:.::: lam an a P .................:..:::::.::::::::.:..:::.. :...:...:::.::::.::...::::::::::::.....::,:.::. .... .:.:::.:::::::::::.::.. :.:::.::::.::..:::.....:.::.:_::......:;::::::::::::::::::::::::.::: camp an v address-::: city... hone .. . . :: :•:<:;�;:»::>::::: :•>: insurance co. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contract°rs listed below who have the following wo ensation es: workers'. mp .. :.::....:::::P°Iic:.:;;.::;:;.::.::.:-::: .:;::, ::..... :::::::::...:.:::::..:.:.:- .......... . .............::..:....,:.... . ................................ ............ ::::.........::.::::..............:;;:;;:;:.:.�:.................::... hone ::... ...........:. .......... tv: ------------ ........:...: ::•.:. .. insurance ca //// camp .............. •:::.:::::.�;:.: :•:;:•.�::•::;:::::•::•:�:::::•...:: address- .............. <:#. OM e .... ......... ::::::::::::::::•:::•.:...:..... ..................................... .......,:.........,. ....... .............................................................:............................,:....:................ .......... insurance co a of crhniasi penalties of a tine up to s1,500.o0 and/or Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition p one yam,imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a Sae of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverge verift don. I do herehy c eTrfy under the pains and penalties of perjury that the information provided above is true and correed Date d SignatuAil re Prim name oftleial use only do not write is this area to be completed by city or town official nt ent city or town: permit/license# DBuildlngg Boa ❑Selecimetes Office ❑,check if immediate response is required ❑Health Department Other contact person: phone#: � (ltvuea 9195 PIA) r • ae�/ e • 1 • •11 :.• 1 ( N•/sill • it • • • • • 91 •11 •�// .P It • r �I of • • • • �;• •Z•111 1-T 1 J / / e=111 tN' 11 I - .tbi • prep dilw4sdb11 •:,1 .11 •1•I • I • • 1.11e �• • • • -/e • Iff / IF % • - • 1�• 1 I • • • •e I • •« 1 •II • •e .1■ •1 • • 11 wy: :111.1 • .II Is • Ir• • • - ••11 • aI • . • - • / • I w$l ' • .11 •ski • ow:oorA • •:.V� �• �•/I• • :) •r e1 • - • e 1 • u • •/:d 1 u •« .1• •11 • kii. =•un • • • -441IN • 1�1 •I • • I • •• 1 11 • 1 • u • 1 - / 1 - • •11�1111. ,/1 • 1 • w.V a w. 1/ �/ .1/1 •1 11 • 11• .111 • 11 • • 111 • 1• • I• • 1• :IIII• • •:• •It • • • 1/ 1/1 w• 1 •11 • / w• •11 •1 •- 1 'e11. •11 1 • • • I 11 • / • •1 •11 11 I ••/•• • • 1 • • • • MI 11 11�/ • Oki I 1 • ✓• • 1 • :•/Iu • It ..•1 • • �.+11 �. /• • .11 �•1111 • �/ 1 • �1 • •II • •'.1/� 11 .1 1 1 1 V 1 �71 t I 1 1 1 1 1 1 1 Y' 1 ' • 1 1 kj 11 1 1 YI 1 • I Y4\ 1111 1 J: 1 11 1 II 11 1 1 I do*($) 1 1 1 1 l / 1 • 1 1 1 1 1 1 1 1 1 11 1 1 1 11 1 1 1 Y" 1 • :.• 11 :./ / • 1• •11 I • 1 �1111:•/ /1 1/1 r1•11 • �% 1 I • .11 • Il • • 1• IM'. ••lipliY •11 1 C.614-16111 • .11 • Y•111■ 1• // •.1 •IIII .11 •I • 1 1.1 •-1•II. \•1 Is Y. • •�1• •) Y•11.1/ 1 ' II/ 11 11 11 1 V" �• 111 �••1 -••1I. • 111 MI • 1:/ 1 •�-•1 • :•/1 �• /• 11 Ir•111• •• 1 • • y1 i1 1 /1 ••• •. :/ •'•H 11•�1 `..tl •11 i1 • 1 w111n :.1(' 1 I .•11 11 • e1' 11 .1 .11 I U • Ii v111 _n •11 JI • • • II • •IIII•.11 IV.111 .� 1 • .11 • • 1 •11 IIII11 •�{ ell ' ' III •'� •II tr.1/' •I II /1 .t1 Y I •• • 11• II 1 • 1 aiikjeopki kill 1 - 1 /I Y CII 1 • 1 1 �1 1 1 iI 1 1 1 • 1 1 1 - :.•IIII i•a tob II «1 •V el vbis-j-,-j 1 a/ski 4 1/ .11 • /Ku •rr el 11 � 1.-.IIII •1 Irwl - II • �• �• 1 1 11 - 1 • .1 111 -•\1 �) 1 I11 •• « •-••1/, 11 • I 1 • • I 1 .n • • 1 .� • •�1 �.•r1 •In • 11 - 1 �• �• • • • Y. 11 '•11...• -MitI•71 17.1• •11 5@511 • 1 ✓- I 11 1 �••%• \11 �11 .1 /1 111111 1./ 1�• • • ' • 1 1 •• 1 • w•. 'I 1 11 ,1 Ie II / 1 b•Illu - I- .11 • • 111/�• ..•1 1 1 / :.• .1 •11 ='•1 1 •) • • �• 1 V .1 11 1 e 1 •IeIF 1 • ••• •y • • iil • 11 11 /1 �••1 /1 II m ski�. • •r.l• •II t 1• Y•111✓. M • • 1 ..•Y.t elill. 11 .11 1 1✓111 �'% ' I • ., 11 11 •tilllll w�'1 IIII\1 •..1 ' 1 1 I • �• ••11�. .•1 Y Illltl 1.� •1 II • 11. 11 - 1 •11.1�• II ', •. I11:lel e • // el 11 • 11�/ .1• .11 • �1.1 .+/1•. 1 • �-•1 11✓. t 1 ' / �• • 1 .� • •i:l• M • •orl 74- asokil 15L.,tell all 1 • .11 V •)4L#Loji sIT'ej 1 ti .1• •II .1Ili CA 1 • 1 its • 1 P1.1p1d, ,11 • 1 w • • • :N •• 1• 1�a 1 Y.1 � • •1 e✓ I jjjjjjj��/ jjj/�---- 1 ' - •, •rI:1.1 •e .•. 1 • 1 •11 .11 / Y•✓ 11 111 •�/ 1 1 oil 11 1 1 1 1 /,' ' 1 •11 1 1 1 1 • 1 1 I.' I I 1 1 1 1 1 1 1 1 1 I 1 . 1 I ► 1 1 ' II .� 11 I ' I true rq The Town of Barnstable ` � t of Health Safe and Environmental Services �' De �artmen ;,o �� P Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: PO ctpi n Estimated Cost Address of Work: Owner's Name: Dell d 6f -VL- ge4 Date of Application: / O G I hereby certify that: Registration is not required for the following reason(s): Work excluded by law riJob Under$1,000 ❑Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY.FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. * G OR 6 D to Owner's Name q:forms:Affidav Building Division jjAMSLABM ' - 367 Main Street,Hyannis MA 02601 sMess 1619• �ArFO MP't Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building CurrimnS_ HO'.NIEO%VNER LICENSE EXEMPTION Please Print DATE JOB LOCATION: 4 3 number street villagel`�y .HOMEOWNER": Ce P(d came home phone tt work phone# CURRENT MAILING ADDRESS:- A/Wa��!-� ��� city/town state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,grovided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner'certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said pr edures and requirements. Signature of Homeowneef Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION . The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors):provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q.Rules&Regulations for licensing Construction Supervisors.Section 2.15) This lack of awareness often results in serous problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities.many communities require.as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/cerciftcation for use in your community. Q:FORM S:EXEM PTN