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0009 KAY AVENUE
7' 1117-MR W I-V q- lit Iill e m 'Ise wy Town of Barnstabl �'q °FTME f°� e ® *Permit# E,rpires 6 months from issue date Regulatory Services Fie BARNSrABLE. 9�A MASS. Richard V.Scati,Director oY0`/ ro1639- TFD MA'S s Building Division Z®16 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 y Not Valid without Red X-Press Imprint Map/parcel Number Property Address q k1Y AVC ( en kl yl//e- 1Q Z6 Residential Value of Work$ p r1 7 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address y/11'e, G 3� �otr�•zSl.��'d�f/,�ir��rdv�� �1��-ZZG~2�3G �°7 Contractor's Name &odc l�14!10"O',F¢// Telephone Number 3�5F--1715-17 Home Improvement Contractor License#(if applicable) ��f1p Email: Construction Supervisor's License#(if applicable) CS Q 7575 3 DCrkman's Compensation Insurance Check one: ❑ I am a sole proprietor �❑-,�I.am the Homeowner L� t have Worker's Compensation Insurance Insurance Company Name NF-a0 /I9A i1r_ ,A-/V,; Q Workman's Comp.Policy# �� Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane.nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value o (maximum .32)#of windows rJ� #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *w'here required: Issuance of this pennit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: CAL)sers\Dccollik\AppData\Local\Mich soft\Windows\Temporary Internet Files\Content.Outlook\2PIO I DH R\EXPRESS.doc Revised 040215 r OF THE Tp� ti O•n Y % % BA STABLE, % - "9. Town of Barnstable CFO Mp'�A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize ktt es 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 If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\L,ocal\Microsoft\Windows\Temporary Intemet Pi1es\Content.0utlook\2PI0IDI-IR\EXPRESS.doc Revised 040215 Office of Consumer Affairs d Business egu�atioh 10 Park Plaza - Suite 5170 Boston, Mq�sachusetts 02116 Home Improve t,' ontractor Registration - Registration: 148688 Type: Supplement Card 7. Expiration: 10/18/2017 LOWE'S HOMES CENTERS LLC. "rL JAMES DONOVAN 136 TURNPIKE RD. SUITE 100 SOUTHBOROUGH, MA 01772 _„ E�.. 1 Update Address and return card.Mark reason for change. ` SCA 1 0 20M-05/11 "" Address E] Renewal 7 Employment r] Lost Card ,sue Vie rpamrntoxrue¢�i o�CivGaG6¢a�eu,"fel�t �\ ffice of Consumer Affairs&Business Regulation License or registration valid for individual use only s OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ro• Office of Consumer Affairs and Business Regulation Registraticztga Type: 10 Park Plaza-Suite 5170 Explo,#"�= f F'l 37 o7 Supplement.Card Boston,MA 02116 LOWE'S HOMES G; NIt3� .!✓.';', :z1s~ -- JAMES DONOVAN' 1000 LOWES BLVD MOORESVILLE,NC 28117 Undersecretary of valid without signature . The Commonwealth of Massachuseus Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers' C 3mpensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Info ation � Please Print Le 'bl Name(Business/Or anization/Individual): 10(ye A2- ze , �yr Address: o0 �} City/State/Zip: �i9� /� A11'j Phone#: 1,7q �6—zo 3( C �) Are you an employ r?Check the appropriate box: 1.�am a employ with 4. ❑ I am a general contractor and I Type of project(required): employees(ful 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 employees These sub-contractors have working form in any capacity. employees and have workers' 8' ❑Demolition [No workers' comp. insurance comp, insurance.: 9. ❑Building addition 3.❑ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions I am a homeow ier doing all work officers have exercised their myself 11.❑ Plumbing repairs or additions y [No wo kers' comp, right of exemption per MGL insurance required.)t c. 152, §1(4),and we have no 12 ❑ Roof repairs employees. [No workers' 13-0Other�Ta� comp. insurance required.] *Any applicant that checks I ox 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit 1 his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this ox must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-con tors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Nme:�� f ` t� t/'L' ._I11 no Policy#or Self ins.Li _#: 01.5 S T IN X V C 00 V11 Expiration Date: �— 1 � Z l � 7 Job Site Address: City/State/Zip:��� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration da e).r 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$I,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 c ti un r the ains and enalties o er'ury that the in orm Pation rovided above is true and correct. Si ature: _ Datex. Phone#: r! Z 3 FE6. Other only. D not write in this area,to be completed by city or town official n: Permit/License# hority Circle one): Health . Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector son• Phone#: i a CERTIFICATE "•��* AS A F LIABILITY INSURANCE �►TE DOES NOT °F Troar ONLY Aa® BELOW 7IlS CEIRTFICCIE OF r oR AMEND. OnIM�OR ALTTE n f+oLDER 718s ROMESISIIU►TIYE OR PRppAND ME $ HOLDER. A CONTRACT TM�MUNG �AupOUCWS k ■DOD ANT NFthe GAUM boiler is an ADpfilpliAl sabje�t�o the terms PORCr1�es)must ce _ have ADDA1 uD saOfthe mod hoidcr raw or atmh poRC9,cW ain paieies mad►reRmire an madomMENVOIL A� lot Risk servicessouth, Znc. tomths L Office • 1111 Metropolitan AvenM, Suite 400 we No cars) xa3-7122 Aror lotte NC 28204 u5A E, Ca00) 363-0105 0 (8)AfFDRoM OOVet"M _ Lare's Companies. Inc. secs its subsidiaries �'st insur 26387ance Company1000 Dare's Boulevard MOUR B: Matiornl Union Fire Ins Co of pi sville NC 28117 usA at9imIHBRC Herr Maapskire Zrrs Go ttsbtt—W S 384I `^��owCa mrmrmmse F: THIS IS TO C11ijitfFy THAT THE POLKAS OF 570flG15, q8 REVISION IN40MATED.ND7W9"STANDR4G ANYR- CERT IrATE MAY AND BE 6SUED OR MAY PEI� T T OONDITION OF ANY COH{RACT OR OTHER A80VE FOR TFIE POIJCY PERIOD TO WHICH THIS TYPE GNDffk)M OF SUCH POLICIES.LJAfIS Mp BE�DE REDUCED BY PIND CiAIi6H�IN SUBJECT�Tp ALL TERMS. NKCVjmwMEm taita shown are as req�rd tmmauty CwMSYUOE Y Y SeM yEued tours ©OOC{/t W/a/ZDt6 OVa'1/20t7 EACIHOOq VnEY �s�ae UNWAPPUBSPElt �AM ❑LOC GENEPALAG6AEGATE FROOUCIS-COMPMPAGC .o s AHralloetF t�maRar m r r AD >�12 ADS 04/O3/2 04/Ol/2037 c c x ANrAurO Y Y CA ISGU Cutat®$l�clElaer f5110001 000 a OWNS a aY AtJ ®® t+�► 04/ 04/03/20 aooerq,urrrcs.vd,,,,) p ONLY 6 NOU40WNf� Y Y CA 38622 eOOLYNJL1Ry(P r 2 ONLY AUTOS CWY VA O4/Ol/20 oa/Ol/Z037 YoAQAGE � • r4ir Woo e A urmatwuna x OatM r r ZFIt37923 EO x EMCESs ttme a_��� OYLOi 04 EACrr OCCURRENCE 530,000,ft G�e7 ApORSOME C f10'000,000 gtONA D LONNUTYy YN ADS ss Ol/20 04 0 2017EXMMoEW X pgtSiAT(r1E me Niw SIR appli per policy,te b condi 'am E.LEAMAOCIOW see 52,000, OFaPez►normr. E.L o �,v I2,000,000 9 Excess WC r )OrC6583043 04/03/20 04/03/20 E.LO�gE.pp�YLA" f2.000, AM EL Each Accident =AnSZR appl-I EL Disease - Policy3.000, per policy 8 condi Ions sease - Ea 13,000, EL Disease rcial Ger� Liability Sd ••reeat:s,ez,.��.oesr.y.w,B f3,000, I CER E HOLDER CANCELLXMM srHouLD AN► OF THE A90VE OEaCgOED WW LO•e's eeWPam;es, Int_ THEREOF."Ocoee ttal OHirM M Ao ELLED eE ttmr.E 1000iLLo eesaa'bbsssBo levaard A('r"01=D1 — Mooresville Nc 2SW-8S20 t6A e-�'o� ��lrilffC e.J ��elslet � ACORD 25 7tte CORD"M alld 1"0 are registered rrtarics�4"988-207 �RPORATION.AN righss+�0tved. I 8A n...e�lliF of Coos ser Affairs&Bmisaa ReSah6n License or registration valid for individul use a* . ME IMPROVEMENT CONTRACTOR before the expiration date. H fodnd return to: Win: 168027 • Tjlpe: Of ft of Consumer Affairs and Business Regniati n 3 :w' piration_ 12 7=16 : DBA 10 Park Plazi-So*5170 Boston,MA 02116 .%E`1;.[T=l KENDALL KEN :ETH KEND.ALL' FAIR-AV EN,MA02719 -� Uadaseathry •Not valid without signature _ Massachusetts-Department of Public Safety Board of 6::6E ing Reguia:iors and Sianca ds Cims.trucrion s-upei•i:,, License:CS-0751S3 Seaoet6 D Keada�` 5 Weeden plow Fairbwm MA GrM T Expiration Commissioner 01112M2017 The Co»trnonwea&h of Massachuse s Department Ojlndum WAcddents ' 1 Congress Street,Srate I00 Boston,MA 02114-20I7 Wukers' Com N'�'�'' °j'/dia peusation Lismanc a A,f W"It Barlders/Cont mcjors/E TO BE FUM WITH TBX p ING AUTHO /P.M nberL:. vlicatft inf�n Name� r on/Indridtial): ltCe/l/?C PleasePriut LN_`�� ., a t( MOA City/St IZiF: rl /hh OVL711 Phone#: .��f— 5� ' rl,�'y�'� __ ._--- F;Ar, ployer,Chu*the appivp>• te bola piayccSri& �ploye:s(fuIl atedlor prt-tie)_; T�oI Pmlet(re,Tu e P� arPWO=Ihip and haven 7 New cs �y °� lnrmein or•. caF�Y-(NO wcd=S'�-k5m ace i,gairect) 8_ ❑ Retaoc'' Q 3.0 I am a heaneowoe doit>g all wodc myself[No wod='camp- l t F. ❑Demolition 4.0 I am a hMW0w=and will k huM9 M&actmstDcondd all wodc on my FWaty. I win 10 C1 Btnldii3g atiditi_n "'dint all s�have workecs, ;�-or ate sole P mP®vnrs with no emplayem I LEI Electri-.--al repaits e:-azdi: 5-0 I am a geaesal wLhxtnr aid I have hired the sob.00�-�listed an the attacbed slims I2_ p ; lep3ii S c:: TLese °via have employ=aid have wa a s,caeip. t 13.[]�Rooffrepaus j 6.Q we aic a wrpoa ation and its offs=have cxatisedtheir tilt of exa zm pq MCZ c 152.§1(4)�and we have no employees.[No woda' *Any qqlica t that checia box:#1 mast aLso fill Ott the seetim Below showier thk warps'oampcm;ktica Poky i dcmil6on. Homeowm=-40 submit this affidavi2 they are doIDg all woait and tb=bite onhide tCauh-ach>ts tha d2e*this b.mmt attached aditoa l sheet must submit a new a davit iidra_ LC 1 payees If the sub-Comm the d'=of the WIW'7 M cius and staff whe�er or wt those emitim:, :•e �P�Y�s,fbey Est provide their wodoras'comp-pay ninnbct I um as employer'hat is pravidn';.. or workers'co»rperisab'on insurance f inlonna6on Y eFVI s Below it the no ' �•-• Iicy _t-"h sip: lnsttrance Compaaf Nance: Pofiry#or Self-ms_Lic_ _ F-V fi-4on Date: Job SiRe Addcess: /�- 9ve� �-�—�...._-�_ Attach a COPY of the workers'com �/s�P f-��� f e ��• pensation Policy dwkmtion Page(showing the Policy RMkr a.ad eagir•�, as.T_t Fmlre to secure ccvc age as retltured tinder MGL c. 152,§25A is a eammmal violation and/or one-year m�rsornne�as weR as civrl ptmishable by a'--me tr_�to S1,;:: :1 �Y against the violatsr.A des in the farm of a STOP WORK ORDER and a frie of up to T:�=copy of this stateffie�ut�y be the Office of Investigations of the DIA fru rstran � coverage vesfic ation- I do he; �urtder the p/airts and of perjury&at the information provided above is iru,mul co;--ec. SietratluE: -/N J Date. t 1 C 0 � ( c.� Plies 9 OOki&use oily- Do riot write in this area,to be conrleted by cio,or town ofj`idal _---"-- i C�i or Town-,r ISSII$g Amy(CtrC1C 6IIe� — — L Board of Health Z BIIrldfrza Department 3.City/Towu Clerk 4.Electzical &OtheF Inspector 5-Plumbing Itrs.t,�jor Contact Person: Phonet: 16 n IA 4 8610087104 RR Donnelley C2016.All rights reserved:=0667 CONTRACT# QQQ 4 . MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT LOW ES AUTHORIZED 1 REPRESENTATIVE 7' � R� l / OUP\ L J)lf�c}/lyz( STQRE NQ: STREtT AOQRESS STREET ADDRESS CITY r STATE r 21P CITY STAT .ZIP (21 jrre vl 1le TELEPHO TELEPHONE - DATE LOWE'S HOME CENTERS,LLC'S MA HIC NO.:148688 CASH ; BANK - LCC crwRce ., FEIN:S"748358 _ - o� � ..: CARS : � � This is only a quote for the-merchandise and services-pmrted below.This becomes an.agreement upon payment'Upon paymem;the entire agreement,hOuding the speaficalty completed pages of this.;. document,the Terms and Condition included withthis document and any.other addendaand"attachments hereto;shall be refeRed to herein as this PLEASE READ ALL TERMS AND CONDITIONS ON-THE REVERSE SIDEOF THIS PAGE,AND FOLLOWING PAGES BEFORE SIGNING. ° -` INSTALLATION STREET ADDRESS r CITJV� STATE ZIP Ly I �'�� .�Y � t r7Y�ti. id..l/"�.r4��„C� 1� �G �: _``_' ;f•�i£:�,'r'J.i� �-- r (� %CT `�:I/Y7 Ji��,`i;fi7.',a Eti/j"�e,�,tJ.;l L"vtt� �' +u � c'..�'>' D W t I , Of. �•( D VC NOTICE TO CUSTOMER-PRICE CALCULATIONS:In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As:a result,the parties agree that the lump sum Price Stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. Contract Total Are permits required for this installation?:[ ]Yes IkNo -applicable tax included NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right. By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure. from renovation activity to be performed in Customer's dwelling unit. NOTE: If rotted wood is discovered during installation additional charges.wili ap!0y.You will be given a quote and a change order must be completed and signed by the customer for any additional charges. CiZ— Customer must initial 'Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor.. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's to copyright,use and publish the photographs in print and/or electronically,and-agrees that Lowe's may use such photographs for any lawful purpose,ioc Dding,but not limited to,marketing,. " advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be. //—.�?�;,-./1, [fill in date].Estimated completion date is % _:/,o [fill in date]. Said estimated substantial Completion date is not of the esspce.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: _ (if applicable,insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: (1)Deposit $ to be paid upon signing contract:Deposit should be 1/3 the total contract price;and (2)Paymentof$ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): .k)�Charge'mylour credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c.142A.THE SIGNATURES OF THE PARTIES BELOW APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWES PURSUANT TO M.G.L.c 142A THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES.If customer has a complaint which cannot be resolved Informally,the home Improvement Contractor Law(M.G.L.c.142A)may provide Customer with the right to request arbitration through a private arbitration program approved by the Director of the Office of Consumer Affairs and Business Regulation,as an alternative to court action.The same right is not afforded to Lowe's unless this Notice is signed and dated by Lowe's and Cus t I claims by Customer or Lowe's concerning this Contract which cannot be resolved informally,and which are not covered by M.G.L.. c142A or subject t�a jurisdiction of small Ell ' court;sha_ll be resolved by binding arbitration as set forth in the Ge era/Terms and Conditions. By: . Date: /G7" 7 Lowe's Author'zed epresent five B"•'�' f,r✓�1,�,�. � s; /�� Custorri6r DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE. TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT HE HE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS DAY OF ��• tG Lowe'sAjde CentV,6LC 'r'R� vfr : Town of Barnstable *Permit6- Expirest�, 6 mont s rom issue date Regulatory Services Fee 9� MAC'i6gq• a Richard V.Scali,Director 10 p�fD MA'S 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 14 Not Valid without Red X-Press Imprint Map/parcel Number C�71 219v= / v Property Address ! `L� ` kV c4 e,n,kSYI Ile—_ / lie t�9 01A&3. Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 9 /Z-,4Y 4 V6 CC-1VtrV111e_ &41 01Re1;;1%Z Contractor's Name M Ad1—M A?Al ek Cl Telephone Number 5" 7-5 7 Home Improvement Contractor License#(if applicable) �1 0 Email: Construction Supervisor's License#(if applicable) `. 5 01,T15 ❑Workman's Compensation Insurance Check one: am a sole proprietor• ❑ I am the Homeowner ®� 0� ❑ I have Worker's Compensation Insurance , Insurance Company Name SEP 0+ 2016 Workmen's Comp.Policy# TOMMI OF RQRNSTABLE Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side n []Replacement Windows/doors/sliders.U-Value 1 ( (maximum.32)#of windows 5— #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 pennit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: L-1/GlJe C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet EilesWontent.0utlook\2PI01 DHR\EXPRESS.doc Revised 040215 of 114E rpm + BARNSTABLE, + Town of Barnstable s639.3q �0 ATFD MA'S� Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I ( . /la 6-#41f ,as Owner of the subject property hereby authorize 4u--,ef 11—"MM 1401C 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 If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2P101 DHR\EXPRESS.doc Revised 040215 ®triCe o fCons�� umer�.�fai�s d 0 park pjaz$+ suite uainease�u1a� Boat®n, ��sa uato �j'o i®n Home Improve chose 021 ment Coat'Qctor �6 CRY HOMES R@gjs�'a on 138 V Al ALLENDENTERS LLC. R�r tr•�n, 140008 SCUTN80R KE R�. SUITE Rio rr• oA BypAf•ment cp� �H' MA 01772� 10/18/z017 °°'''' t1 uoM.oav:� oot� pdoNAdd 4terAmjr#,4 sled9P Awna/,w �]Addrwa �a And nofurn M81MpROvRefits, 0 Ranawd D$pork rwooa fir ohanda ead uhaoa Ohj tiBOn: ,88e8 �NtRAC1�OR 'left e or,y 4t Ymene Q'Mt C "ll"O w1wee htlon; 10 /18/1017 tYP•� ®ro tho p fryMtA d►'•Ud Ibr rndividul Coniubor lrlbund un on(y C� ERB LLC, Supplement Carol 1 r•rk ply.Suits and 8u�roturn to: YS AL ALLB BosNn►IWA OZ116lts 81 ns"R18ulotlon 0101Nd88LVD NDta • of vIld�rthout+Ipn•tuh • r • 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office ofdnvesdgadons 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 1 Please Print Lezibly Name(Business/Organizationandividual): Address: � f 'ti i-t'J• [ -L/ City/State/Zip: �r% S�i'J`� / C .��ll/7 Phone# Are you an employer?Check the appropriat�e.bo • Type of project(required): 1.El am a employer with 4• l_1 '�a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I um a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling shipand have no employees These sub-contractors have S. ❑DemoIition working for me in any capacity. employees and have workers' [No workers'comp.instance can--insurance= 9. Q Building addition st required,] 5.❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.Q Plumbing repairs or additions myself[No workers'coup. right of exemption per MGL 12.Q Ro f repairs insurance required.)t c.152,§1(4),and we have no employees.[No workers' 13. i Cher _ L�ttzt l_ •tom 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 subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:_NAEL,L,' �I/ !/11.5 KCj Policy#or Self-ins.Lic..#: � °��.. Expiration Date: 2-0 t' Job Site Address:_ ` _._ t`- _ AV City/State/Zi{ Attach a copy of th. ,.orkers'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/orone-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pa ins and en 'es of perjury that the information provided above is true and correct Si lure: Date: Phone#: < �� 1 O ,L/7 — Octal use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#• �— CERTIFICATE of uaeIun IASU�A$ CE70, OMINWA � ��asAer 4aYerisa. E"°`°ez COWRACTWFWI TW aStan wo .wua�o�p Risk semoes Soft. Doc_ �f4e roi4reienafsuei �MWR�gsili1 A� , Mc®Fficti• � 'o Me Z x:$dies. Dlc_ Moms�a�etn *i--AR4oweW � !s aid eidia"es L a Kc 2I 1d �R Gtiaaal mien Pire DRs co�A OF FI �C Not re 71Ls c0 t �sQ T1Es�lpCBRIFYT1fQ7fE kffi� E � y yeti ,em,e�mr+s�� �s A°F usl�aa,o„r COIpIital OFAWr �►BE MS7�GIR yq��t 7H01 Qt ���3�ip 77E �5t10�1�7IE/i5{Oti��ARlxip�6V�OOfiRAC�pt QIi�COQ���F�t11E i'�QlR:YP� IVPEGF P'OL�surrssawNr,mfin„Eae� � ° E+e�ssueAWr TIDAM TMIEWM► POUCYNNEW aaotRa� X�amorR cwa - aar♦s aw/rI ICE ��vpss� reoeorp�� ®A= Lac PUMONAL&ADVO Wr v m�000� r G 7iE5270 c e X amvAUgp r r G �®SiClElaa �+ ® A MOMM AUMS 11I1 9 O{ °o.ow.� • r G sooar (sw�� >�271 wroasaior a Je�l� �►•u.e►q.�„+s _ room �. �0°a0� owtee r Y o s aaoa;y /01120I7 _ s•a40 oao tY�o.aOo. o c — Ae r se _ f3n,00p onwalwoffil r/ AOS d< WIN) M Ou Sut applies w Pbli X r vowarh i wadian ® m"®aoioarsaew q 5t 03 E! eruat� �•�• app liabv7itp is � �gerR� q+ilk iDMt5clha _ I~CF lie per Pa >;i. al dal Camillo" o Policy =i.000. �i��eDa:-sa�:.4 Sc1.09D� Houma SUMO ° UWL ME OB"°"pBi"'eM: — �II17,�p nsA Im Quip 1 68027- CMTRACM before�e f�ii fir d arc�! T7Pc �e6�laic. Tffia�a ®�•tCw� mamma.� KEWMW%lL _ - SOW 5170 MBNOETH ��s anal $ 16EpWALL Fes.a"CQ719 Not me Thee �VMMTM AVM� _ •" �AUTDOCt UNI OV .. 4- }-14F %��,n� ZLP—leas�hat ramie 4q3 ��wror �"�O` ' r7Pe.f v %mmilm s wod me ❑Ne�v cam •°� colWE3 9. casipee��araa�� �•'� v Bm7�°� n -�] at �jtbesat~ ��tie craamsm `� aa�n,e ��eet _ y �saad3"id'ons IN j.� ��lea�f9'satpa���mteeo�d�a ��mtaaea, �- � �ea � #� Aftach kxy �- Expfimfim� at ''III ci.2 MA is a cdmiw Acopy a Y be On opa stop Wpgg ORD a fme a p� o �0�'t to tL�0lfi�o� ��ofibe� up to$250-00a amagerAlleyal'rsari _ Al *°,7mi,be - �,�� 2- , 3- CONTRACT ft A" 099 3 B(AASSACHUSETTS,SERVICES $OLUTIONS INSTALLED SALES CONTRACT LOWES AUTHORIZED REPRESENTATIVE NUMBER CUSTOMER fr — STORE NO. STREET ADDRESS STREET ADDRESS CITY STATE ZIP CITY STATE ZIP TELEPHONE -- TELEPHONE L TE y ri DATE LOWE'S HOME CE NTERS,LLC'S MA HIC NO.:146688 CASH ti, caRo �� FEIN:SB-0748358 � 'CNARGE This Is only a quote for the merchandise and services.pdntetl below.This I;,"an agreement upon paymerrt.Upon payment the Ire agreement,indutlirg the spetlfiraly completed pages of pils documem,the Terms and Conditions indutled rdfh this document arM arty other adtlerMa and atlechments heretd,shaU.be fefefred to herem as this'ContricL PLEASE READ ALL TERMS AND CONDITIONS ON THE.REVERSE SIDE OF THIS PAGE ANDFOLLOWING--PAGES BEFORE SIGNING.;'.- INSTALLATION STREET ADDRESS CITY j STATE ZIP of NOTICE TO CUSTOMER-PRICE CALCULATIONS:In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. , Contract Total %?... [Are permits required for this installation?:[ Yes [ ]No *applicable tax included Y _,' NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit NOTE:If rotted wood is discovered during installation additional charges will apply.You will be given a quote and a change order must be completed and signed by the customer for any additional charges. - Customer must initial. 'Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's to copyright,use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,including,but not limited to,marketing, advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing. r [Customer to initial to the left]. Work ig to commence upon reasonable availability of Contractor and/or any special order or customer.made Good(s)which is anticipated to be fill in date].Estimated completion date is I I P % [fill in date]. Said estimated substantial completion date is not of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable,insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [-;J-Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: 6)Deposit $ to be paid upon signing contract.Deposit should be 1/3 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or ( ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c 142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.,S,.L,.G.ta2A...__. By; T -- Date: = Lowfome Centers,LLC BY; Date: Owner Signature THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED i BY LOWE'S PURSUANT TO M.G.L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEuGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS =' % DAY OF , Lowe s-'Home Cerrter N J �::%-.l j, Lowe's of ized-Representative Owner �/ Co-owner or Witness CurAorfWVacknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof.You,the buyer,ma cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. ® by 55102 REV. 12/13 �T_E�' " afire regi tered trademarks of of LF Co able design Addendum Contract No : tom/G 1� Date .� 1 % /-,/lr° ram; /: N r .jf/' h E 1 •� ( F' ? I / i d� =%x,! f .'7ir'f6v ' �i 6F-r--O —,4r' I P`'' n.y �., ..`.. ',•'j• 17 cr :'i I° { s 62; S. rt ii { ram- �✓L44Y PSE : ``� Customer: Stout Project Specialist-Exteriors. i 1 I CPO/ 40 �7 Town of Barnstable '*Permit# Regulatory Services Fee Itichard V.Scali,Interim Director pg% PERMIT BUflftg DiviSion . Tom Perry,CBO,Building Commissioner QC� 3 2015 200 Main Street,Hyannis,'MA 02601 wwwtownbaazstablimaus To�� �il OF BARNSTABLE y Office. 508-862-4038 U Far.508 790-6230 v EXPRESS PERMIT APPLICATION - RESIDENITAL ONLY Not VaW wahoutRedX-Presslmpdnt Ma`' /parcel N.ber g q jZ D q L C / Property Address A ✓e D'Resideuiial Valve of Work$ 7� L gel Almimum fee of$35.00 for work under$6000.00 Owner's Name&Address ► � 1 K e i� Ca17 Yj-A N A AGf r t S Ka Je. e P ,! e- MA O L L_ Contractor's Name A �_ Telephone Number Home Improvement Contractor License#(if applicable) AR 6 91.3 Emaii: Construction Supervisor's License#(if applicable) Worktnan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company-Name wfivo sm/pf ` Workman'sf Comp.Policy# W 1 7 7- Copy of Iasurance Compliance Certificate must accompany each permit. Permit Re (check box) Re-roof(hurricane nailed)(stripping old shingles) All conshvction debris will be taken to ❑Re-roof(hurricane naled)(not stripping. Going over existing layers of roof) ❑ Re-side _ ❑ Replacement Wmdows/doors/sfiilers,.0 Value (maximum 35)#of windows #of doors: Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections required. Separate Electrical&Fire Permits required. "Where required; Lmm=of ft pem&does not exempt compliaocewith othertovm&Tartmenttegulations,Le-H'istanc.Comm ahon,etc. Note Property er ign Property Owner Letter of PermWon. A copy of H Improvement Contractors Diem&COnstradion Supervisors License is required. _ SIGNATURE: ' T:ISEVIN D\Bufft ing ChangmMU S RESS•doc Revised 061313 , f HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: PLEASE READ THIS CONTRACT THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 908 Boston Turnpike Unit 1,Shrewsbury,MA 1545 Toll Free 8779033768;Fax 8009863610 Branch Name: Boston North Date:10/13/2015 ME Lie#C 02439 RI Cont.Lie#16427 Branch No: 33 CT Lie#HIC.0565522 MA Home Improvement Contractor Reg.#126893 Federal ID# 75-2698460 Installation Address: 9 Kay Ave,Centerville,MA 02632 CENTERVILLE MA 02632 City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: M/M Keith/Sandra Cha aris (508)862-0253 Home Address: 9 Kay Ave,Centerville,MA 02632 CENTERVILLE MA 02632 (If different from Installation Address) City State Zip E-mail Address (to receive project communications and Home Depot updates):kchag3b(d),comcast.net Marketing emails will not be sent from The Home Depot. ` Project Information: Undersigned("Customer"),the owners of the property,located at the above installation address,agrees to buy,and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installati on")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated-into this Contract by this reference,along with any applicable State Supplement and Payment Summary(where applicable)attached hereto_ and any Change Orders(collectively,"Contract"): Job#:(Internal Reference) Products: Spec Sheet(s): Project Amount F 8627147 Roofing 8627147 $7,289.00 Minimum 25% Deposit of Contract Amount Total Contract Amount $7,289.00 { due upon execution of this contract Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. Payment Summary • The Payment Summary# 8627147 included as part of this Contract,sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). 06117114-SA : Page 1 of 7 r r I HOME IMPROVEMENT CONTRACT PLEASE READ THIS CONTRACT NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time of sign.Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor, expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law.THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVER OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Contract is the entire agreement between Customer and The Home Depot with regard to the products and installation services and supersedes all prior discussions and agreements, either oral or written,relating to said products and installation.This Contract cannot be assigned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. You are entitled to a paper copy of this Agreement if you choose. If you consent to an emailed copy,your consent applies only to this Agreement.By contacting sales office(g77)9U3-376R ,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement at no charge. By signing below,you confirm the following: • You consent to receive only an emailed copy of this Agreement • You have access to a computer that can receive and open emails and PDF(Adobe Reader Version 10.1.4 or later)formatted documents. • Your email address is correctly listed on the Home Improvement Contract �A6 Submitted by: Accepted by: 1WM KehhtSandra Cha garis(Oct 13,2015,7:28 Sales Consultant Christopher G.Read Customer PM) License Name. Signature: 17(877)903-3768 Customer 7lls� Telephone No. Signature: Sales Consultant Accepted by:Christopher Read(0013,2016.7,28 License No. (as applicable) CANCELLATION:CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT.THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE 06117114-SA Page 7 of 7 r_ - ti. J Massachusetts ✓eparti-ne nt of Oi. burr safer, '--` soa:-d of Building Regulations acid Standards mistructlon surw:''t 3St:td' sp: ec-jalei �.Icense: CSSL-106026 JOHN CARTER �f 99 BRIGHAM STREE7t APT 2 Whitman MA 02182 Commissioner 01l087201.8' ._ I The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -�— Please Print Legibly Name (Business/Organization/Individual): off n CC(r►e r— Address: q t;j r 1 q6m St City/State/Zip: La�_tn0-r-, 023 r"— Phone M 78i-22;, b/Z 7 . . Are you an employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.❑ I a a employer with g 6. New construction employees (full and/or part-time). .,., have hired the sub-contractors 1 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. F1 Building addition_ [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LF]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.FI�Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13:❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the.section below showing their workers'compensation policy information. 1 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 isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date)'." Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a-copy of this statement may be forwarded to the'Office of Investigations of the DIA for insurance coverage verification. I do hereby Tejuder the pains and penahfes ofperjury that the information provided.above is true and correct. Signature. Date: ! / / Phone#: 71K1 Z7_3 &1 Z`l 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 on 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: The Commonwealth of Massachusefts nn Deparbuent of Industrial Accidents ?_ I. Office of Investigations I.Congress Stree4 Suite 100 Boston9 MA 02114-2017 ivww.mass.gov1d1a Workers'Compensation Insurance Afdavit: builders/ContractorslEleetricians/Pl>Qanbers Applicant Information Please Print Le2lhl� Name (Business/Organization/Individual): �drte- Address:Ci'08 City/State/Zip: h rew s(o u r .5 Phone#: S O8-�f� 7- io9 Z Are yqu an employer?Check the appropriate box: Type of project(required): 1.91' a employer with Z 0 t 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6_ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity_ employees and have workers' 9_ ❑Building addition [No workers' cornp.insurance comp.insurance? required-]' , 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[]PI bing repairs or additions myself. [No workers_comp_ right'f exempdon per MGL 12_ opf repairs insurance required.] I c. 15_, §l(-),and we have no employees. L-No n°orkers, 13.❑Other comp.insurance required.] Any applicant that checks box#1 most also fill out the section below showing their workers compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and:hen hire outside contractors must submit a new affidavit indicating such- tContractors that check this box must attached an additional sheet shoes-in_s the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractorshave employees,they must provide:heir comp.policy number. lain an employer that is providing workers'compensation insurance for my employees. Below is the policy acid job site information. Insurance..Company?`tame: P, p L,�44al',,p S�;/-e Policy#or Self-ins. Lic.#: (,,IC- _/7 7-3 1 q q 3 Expiration Date: 2 n Job Site Address.` A City/State/Zip: Cp, ,-err, IA 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 25�f 1GL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as a=ell as ci-val.penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day ag ' s violator. Be advised thai a-copy of this statement may be forwarded to the-Office of Investigations of the DIA o/inorance coverage verification. I do hereby certify uzd d gin" ar!d en dd juFy that the information provided above is true and correct r - Signature: Date: - Z a Phone#: - Ofcial use only. o not write in this area,to be completed by city or town qf,fzcial. City or Town: Permit/License# Issuing Authority(circle one): L Roard of Health 3.Building Department 3.City]Town Clerk 4.l;lectrieal$inspector sr_Plu mhing lfnspector 6.Other Contact Person: Phone#. I Z,1!_ , �.47 � 1 Office of r v o�,sue_ airs and Business Regulation ` _ 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - - _ - Registration- 126B93 _ - Type: Supplement Card THD AT HOME SERVICES, INC. : : --_ -. - Expiration: 8r312016 ANDREW SWEET 2690 CUMBERLAND PARKWAY SUITE=3:DQ . ATLANTA, GA 30339 Update Address and return card_Hark reason for chan.e Address _I Renewal Employment [ I Last Card ��e (conc��coytufealf�c%�'il�ttr:;or.�a�elf� Office of Consumer Affairs&Business Regulation 1License or registration valid for individul use only 3_ before the expiration OME IMPROVEMENT CONTRACTOR date. If found return to: --. - . - , Re istration Office of Consumer Affairs and Business Regulation 9 -26893 Type: 20 Park Plaza-.Suite 5170 -.-___ _.=__ Yp = Expirahoo _8/312M Supplement Card Boston,MA 02116 THD AT HOME SERVIGES,,W.0 THE HOME DEPOT A7 HOM_E_SERVICES ANDREW SWEET�<_ 2690 CUMBERLAND PARKWAY S � �— XWJAM,GA 30339 Undersecretary .No4iwit Wutspignature I DATE(N@9FD9M'YY) �® CERTIFICATE OF LIABILI`ff INSUNCE mn5rzots THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPOWTHE 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 WAWED,subject to the terms and conditions of the poNcy,certain policies may require an endorsement. A statement on this cerhTrlcate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA.INC. NAME I WO ALLIANCE CENTER > OHE 6d FAX No 3560 LENOX ROAD,SUITE 24M E-rdA1L ATUMI-A,GA 30326 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 100492 HomeD-GAW'-irst6 INSURER A•Skmffast Ittsurance Comigmamry 2MU INSURED LHUhAmelicanIm m mCo 16535 THD"'AT HOME SERVICES.INC. INSURER s DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hanpsiure Ins Co 23841 26..0;CUMBERLAND PARKWAY,SUITE 390 INSURER D'ffIms Naliolel inslaammoe Ca9my 7 ATLAVTA,GA 3M39 INSURER S, fNSURERF= tt COVERAGES CERTIFICATE NUMBER: ATL-=746646-13 REVISION NUMBER:8 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 WfIH 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- ILTRRI TYPE OF INSURANCE (ITJSD wv[)II POLICYNUMBER MDDTYY MM1DD YY LIMIT A t X COMMERCIAL GENERAL LIA MM ! 1 'C-L1D48877144B - 103A1If1015 D310112Di6 9.00D,OID EACH OCCURRENCE S CLAIMS-UTADE CCCUR DAMAG RENTED' 1 PREMISEStEao.) is 1.01A0M ( hUMITS OF POLICY Xs EXCLUDED_ l tdID EXP miry Rita person) S 1 I 'OF SIR SIM PER OCC i 9.10II.00D PERSO,YAL 8 ADV INJURY S Galt.AGGREGATE UMITAPPUES PER: i GENERAL AGGREGATE S 9.00Q000 POLICY jRa u LOC (� s I PRODUCTS-COMPIOPAGG S 9,OIX1000 ( OTHER_ I I II s B auTOMoa1tFUAa1LtTY t ;BAP29-nB63.12 103 112015 fOJ0i12016 (COMe� SINGLE LIMIT 5 LOW.= t i t x ANY AUTO ! (80DILYINJURYIPerpemon) Is ALL OWNED r I SCHEDULED iSELF INSURED AUTO PHY DKG "- SODILYIN.nt AUTOS AUTOS RY(Peraa3ceni) s H. i 1 ��NEO I I PROPERTY DAMAGE S HIREDAUTOS t I t I eratxide 11 . i ! (S UMBRELLA LIATi i ;OCCUR ( I EACH OCCURRENCE S f (EXCESS LIAR rl CLARASrtADE1 1 I AGGREC-ArE S OEO �RETENTIONS C woRKERs compmr.AnoN I IWCD17731493(AOS} I 03(0i/2015 Q3f0t12016- X PER oTrti I AND EMPLOYERS'LIABIUTY i STATUTE 8t C Y!H WC017731495(AK.KY.NH•NJ,VT) 0310112DIS 03/Ot2016 ANY PROPR(crOR/EXCL 1DED7 CUTIVE 1,00D,000 0 OFFICERlI;iQd6ERIXCLtJDED� �N!A E.LFACHACCiDB+IT 5 (Mandatory In NH) WC017731494(FL) i031012015 0MR016 EL DISEASE-EA EMPLO S 1•�•� If yes,describe under - E 1 DESCRIPTION OF OP.ERAJIONS below CanifiUed on Addtional Page i EL DISEASE-POLICY LnI1iT S 1•�r� DESCRIPTK)N OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101.Additional Remarks Scheddq may be attached n mote space Is rewked) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE OBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE VOLL BE 08.IVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30M - AUTHORS REPRESENTATIVE of Marsh USA Inc. i ManashiMukheijee �tflLvnjas� .9+� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE f BUILDING PERMIT ' PARCEL ID 248 042 GEOBASE ID 15403 ADDRESS 9 KAY AVENUE PHONE Centerville ZIP - LOT A&B BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 8776 DESCRIPTION SINGLE FAMILY DWELLING PERMIT TYPE BCOO TITLE CERTIFICATE OF 0 UPANCY Department of Health, Safety CONTRACTORS: and Environmental Services ARCHITECTS: TOTAL FEES: Im BOND $.00 CONSTRUCTION COSTS $.00 * BARNSTABL& MASS. OWNER ROTONDO, JOSEPH & ELEA 039. A�®� ADDRESS ROTONDO J C & CATALANO E EO M1� 43 COPPER LN CENTERVILLE MA BUIL I DATE ISSUED 07/12/1995 EXPIRATION DATE BY BA°RSTABLE; MASSACHUSET7�, i. 1 4:�P_E OMIT - :' x .A 2,40 Q�i� t '. - , `r ♦MATEY �l r 1_i 5 f`j 95 PERMIIF IY�O �T �r1�o APPLL4ANT QOtifZ�ciS �J !�Qyd ADCRESS 151;Great PinesDr.y'I�s�e� �09637 (NQ.) `(STREET) '= 3t 14 'kCONTR'S-LICE.A1 NUMBER OF PERMIT TO t ' F ZZ'111f 1_� I STORY S -Li�J.e 'falnily.,,r'eSiaenc,,� S~ rDWELLIN6 UNVTS„ 1 ...,z1�IP-R OYEMENFJ_t -___fPROPOSEO'�SSE -� AT (LOCATION) 9 Kay lyyeilue, Centerville.'. Lilt 412 T ZONING D-ISTR ICT- i (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT }. SUBDIVISION LOT BLOCK- SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Sewage i'r`95-449 AREA OR 1,640 $ 65 r QQU PERM rr 141.,34 VOLUME ' ESTIMATED COST yl FEE D (CUBIC/SQUARE FEET) _ i OWNER Prestige- Properties, Inc �- - Road., � zy T� BUILOIN � -. ADDRESS 1645 Faimouta Road, Suit. Z-1, Centerville BY -'TFrU k,--TTg-vim _ LICAN M THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE .INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR :ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. . 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. :� POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS �r Z Y 2 -c/-� ''e� 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 07 A5 2 9 57 BOARD LTH gs OTHER SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!L L BECOME"NULL AND VOID I F'CONSTRUCT ION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS.ApPROVED THEVARIODUS STAGES OF WORK IS NOT STARTED-WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. I i N N/F A.D. HINCKLEY 128.7 5' i W N LOTS A&B 17,591 SF 0.40 ACRES o N CONCRETE N C+ C FOUNDATION gB.Tt I to l 1 R=25.34 129 92' L=19.81'� LOT 9 COPPER LANE JOB # 95-026 CER TIFIED PL 0 T PLAN LOCATION KAY AVE. CENTERVILLE, MA SCALE 1" = 30' DATE 4-17-95 PREPARED FOR: REFERENCE LOT 42 PB 180 PC 155 F UNDINC SERVICES, INC. I I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. �H OF t �-98W ��� AR,NE down cape engineering, inc. p 3 LA i 0 CIVIL ENGINEERS � --- --•- ————— p — -----�---- — LAND SURVEYORS ,p p DATE SURVEYOR use main at. yarmouth, ma Nql i 1 a� wl k� Ely 6j' DA l `.vF !• PE , riry S 'l � '1, !? Y �J•� t ' Era a.t'Fya c t.•a °�Y fs.. *5�• `f+�x..r7`Y� rvr` ..,�� ' �� �.; w�N i e L'071 ` 17 t . So,45 a 1 ( p FO UN SEPTIC DE C41-CJ: DESIGN. FLOW: _ SEFT't TAA'X.• i fi USE A d wn `c'ap¢ Ong n9e.nng, z►�c S:DBS: --- ti �'IVIL ENGI'NEEf S TOTAL _ }VD -SURVEYORS IA USE:w° tt� fia, YARMOUTH, MA r�3'.i y .j, y —lc'SY/ `.h.af.• f� U.` Ir r - -- M y r y LLLN TZ Y IY tl4.� F a { erN. I z 1 i -- ��t} 1 , K� - .47 • � -' � ' 1� , •- 5�rub/�.,�tx. JI . w` .� ��t` �r fin/f'i`t# 1\ .�,- .. � .11•li 1` �:,—'----- �-_ 56 *Cox - - _ AI �� j 7�JI� � � f'(I i � '. � I :KII��I�ly•f ' .P r �`y . � (� 1+1TL. 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" � ��. -' � 1fr.r �.� f'fl7j`!t I.iF �� �t�t��" ;'• 6Y ii'A,,t".. - .'UX�ir s .+ s� yi�'X";(.. i' wt q, ! .,I;t � > �... .;.F„ w �tf�lr�ibih yttL 't ,Ir' }!`1' 1i {�r �.ry�. {s `''} °.�'. •t�4+�;r �,u F,>�yJ���w� ,�x y� r,�.t v+ tis r 1 i• .ti i �• ,. - �� !y ! t + - +ta,f u,�� i:, t `1 1`...: •p! •- � � h. t ial{ !F 1 ' { ti 1. •� 4 I.t` '�t ` ' seF q ♦� !i o;., yFK �}fi•� Ts' ! , ri tr�Y :„sib yy'};F, ,� - , i l tip(t4,t�t I '�� � �'�E 1i1 tLi{ �{�sft'! �!t �•��i�l ti� �% � ,df 'i f ,•' � �.I f 't 04/03/1995 13:57 5087713113 PRESTIGE PROPERTIES PAGE 02 JEFFERY JOHNSON ATTORNEY AT LAW y TWELVE CENTER pLACF 15M ROUTE 28 CENTERVILLE.MASSACHUSETr5026,12 tso8)79(l-s776 TILWHON (50)775-W29 FACSIMILE : March 30, 1995 11AI�lD DE�,YVBRED Ralph Crosser Building Commissioner Town of Barnstable 367 Main Street Hyannis, MA 02601 Re: Vacant Lot on Kay Avenue, Centerville, MA Assessors Map 248-parcel 42 Deer Mr. Crossen: Pursuant to your instructions for the issuances of a building permit, kindly accept this am my required opinion and representation letter for zoning purposes with regard to the above- captioned lot. l have personally reviewed the records at the Barnstable County Registry of Deeds. Assessors Parcel 42 abuts only Parcel@ 56 and 41 as shown on your assessors plan, a copy of which is enclosed for your convenience. Parcel 42 is in are RB zoning district, which according to your Planning Department, required 10,000 square feet of land area until the February 28, 1985 change to acre zoning. Parcel 41 has been in the Capra family since June 60 1963. 1 enclose copies of the deed into the Capras and their deeds back and forth into tzusts mince then. The Capras had no interest in Parcel 42 on February. of 1985 and have not acquired an interest mince then. Parcel 42 on your assessor* map - the locus has been shown as Lots A and B on Plan Book 180, Page 155 and has been in separate and distinct ownership since prior to the zoning change in 1985 as is evidenced by the enclosed deede, Since said change, the owners of Parcel 42 have not acquired any interest in either of the abutting Parcels 41 and/or 56. ti 04/03/1995 13:57 5087713113 PRESTIGE PROPERTIES PAGE 03, . ni n N� 7J i V•N,10 7G1 1i1:1L J - p Ralph Crossen Page. 2 Parcel 56 as Shown oh the assessors map has been owned by the Hinckl®y family since prior to the zoning change Arid wince February or 1985, they have not acquired any interest in Parcel 42 . Z have provided copies of these deeds as well. I trust that thi* is murf1cient Tor your deter-Minat.ion, and if r need to provide anything further, please` don't hesitate. to contact me, Sincerely' ,you JJ/nw JR a 10 ffio ?squire cc: Funding Services, Iaic; ' Aswssiir`s ffice 1st floor Ma ��' I�t a. G� Permit# 7 p v tonservation Office 4th floor 3 = S Date Issued S— Board of Health 3rd floor Engineering Dept. Ord floor) House# �} J °A � PlanningDept, 1st floor/School Admin."Bld . : ' � SEPTIC��$ Definitive Plan Approved by Planning BoardD- 30 19��e.�®T�►LLED iN C (Applications rocessed 8:30-9:30 a. & 1:00-2:00 .M. w a ' N®r WITH TITL ENVIRONMENTAL CODE AND MONS OWN OF BARNSTABLE Building-Permit Application Proiect Street Address / zd2'ZZ Village Ce vi-tr-rv' 14 Fire District C - 0 - M M ()%vncr pre-5k- c. Pror r(:;es, 4�c. Address 'L44s'-jalrwotifk-. Zd,� &- i Telephone -I-i t> 0 00 3 Permit Request: -Per r"-L t:o cc r.si r u c-ic V- w .1( Zoning District f" Flood Plain C Water Protection Lot Size �� Grandfathered Zoning Board of Appeals Authorization Recorded Current Use ►�a w la Proposed Use �'Tq a war t`1 I i rns Construction Type w ood },-2v?e Existing Information Dwelling Type<Single Family Two family Multi-family Age of structure '0v a'"' Basement tune l uc.<- Historic House Finished Old KinP s Hi h�wgy Unfinished x Number of Baths d, No.of Bedrooms Total Room Count(not including baths) S First Floor Heat Type and Fuel 6-fs Central Air NIA Fireplaces Garage: Detached Other Detached Structures: Pool r'/°' Attached Barn None Sheds "'IO Other Builder Information Name bo u l la o� Telephone number "1"1 1- 6003 Address Ij 1 Grew P��� �r. License# 60963y M a-s t.p,e, H A 0?-`'q 4 Home Improvement Contractor# Worker's Compensation # S 15 6 0 0 9'`1 3 rl 9 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RES TING FROM THIS PROJECT WILL BETAKEN TO R�iar'e3dhl La "l ' t� Proiect Cost Fee SIGNATURE DATE BUILDING PERMIT DENIE, FOR THE FOLLOWING REASON(S) ,2, BPERM T 96 FOR OFFICE USE ONLY ,�4/5/95 3449-3-- 248.042 >r� 9 Kay Avenue Centerville _ ADDRESS VILLAGE Prestige Properties, Inc., OWNER DATE OF INSPECTION: FOUNDATION FRAME J t ± - INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL 1 r • .PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING: -`f, �✓� E F i DATE CLOSED OUT: ASSOCIATE PLAN NO. t