Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0125 KNOTTY PINE LANE
/G��"J��� k n ,��'� r ._ 0 �, Town of Barnstable Building $0 7""..c s •,,.-° "'' � v. `.'�1 rr �y s axa ,sw. Y :. r• .+� .., x *;P: ;: m "rr c m.. , . I 'ostThis Card So That rt s Visible From he Street Approved Plans<Must be Retained on:Job and th�s,,Card Must fie Ke t 14A£a9. s '_.:. }k' ''� �'; �, ;,�a :' �.�• �^ � ram,: rn , tv a , P p 163Pos wted UntilFinal Inspection Has"Been Made � _• ,A ' ' fN ' , Where•.aGertificate�of Occupancy is R fired,such Bu ld rig shall Notes Occ�piedeunt l a F nal I pe�ction�has been made f Permit Permit No. B-18-1322 Applicant Name: MCAS LLC Approvals Date Issued: 04/30/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/30/2018 Foundation: Location: 125 KNOTTY PINE LANE,CENTERVILLE w Map/Lot 191-081 Zoning District: RC Sheathing: Owner on Record: GARDNER, BETHANY L Contractor Name:' MCAS LLC Framing: 1 Address: 125 KNOTTY PINE LANE y Contractor License�133851 2 CENTERVILLE, MA 02632 , Project Cost: $7,200.00 Chimney: Description: re-roof stripping old Kermit Fee: $36.72 Insulation: Project Review Req: ' Fee- aid $36.72 Date 4/30/2018 Final: Y k ' Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by�this permit is commenced within siz months afterissuance. Rough Gas: All work authorized by this permit shall conform to the approved application and,the.approved construction documents fo which this permit has been granted. All construction,alterations and changes of use of any building and structure shalWe in compliance with the local zoning by Ia v ancJ codes. Final Gas: This permit shall be displayed in a location clear) visible from access street o`r'r'.oaq�,nd shall be maintained open f 'y pe for A` ihsp cti 'n for the entire duration of the work until the completion of the same. % Electrical The Certificate of Occupancy will not be issued until all applicable signatures 6y the Burldmg andFire Officials are pro ued on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: a 1.Foundation or Footing :" ,;• Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT of Town of Barnstable *Permit# 13 ZZ Regulatory Services Fee 6montha from issue date BAMSTABLF. KASS. �0 Richard V.Scali,Director 2 Building Division NBCP 'ul Roma,Building.Commissioner d\I Main Street,Hyannis,MA 02601 \�i�``� www.town.barnstable.ma.us Ofce: 50;8��8'6 -40 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address ���CJ �� 1.��-C�r}' �,Qi] vib_) lytV3 esidential Value of Work$ �rf'JV, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address AgaA64tJO P-4 =- Contractor's Name �UC��-/ Telephone Numbero L/V • 30Q/ Home Improvement Contractor License#(if applicable) . / Email:/vl/�}'/ G� �� (ps 2> Q Vt1,A.0o Construction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ the Homeowner I have Worker's Compensation Insurance '4 Insurance Company Name u j_, nS1VW ?09 Workman's Comp.Policy# r'Q � � S Copy of Insurance Compliance Certificate must accompany each permit. Permit RegYst(check box) [I Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken top-mitLk R4 j` it ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) 6 / `S ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum,.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance 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: Q W0FILESTORMS\building permit forms\EXPRESS.doc 06/20/16 -- cornimonwea"of massac3uasetts Division of Professional Licensure Board of Building Regulations and Standards CSSL-104 4 85 Expires: 1f312612019 MARK 0 NICKERS,q PO BOX 2476 - ORLEANS MA 02663 , Commissioner _ Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration TYPe: LLC Registration: 133851 MCAS LLC Wation: 08/16/2019 D/B/ANICKERSON HOME IMPROVEMENT PO BOX 2476 OIRLEANS,MA 02653 . i. Update Address and return card. Mark reason for change. ri Los*Care '�1/C cS f:iillrifii7[[!f+/{[[f1 Gf / ?1i![C![[f-.iP _ _ `Q Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LC before the expiration date. if found return to: Raalstration Ecnirati n Office of Consumer Affairs and Business Regulation 133851 08/16/2019 10 Park Plaza-Suite 5170 MCAS LLC Boston,MA 02116 0/B/A NICKERSON HOME.iMPROVEMENT . hil C'J fir CL SO �• - 12 COMMERCE DRIVE _ Not valid without signature ORLEANS,MA 026S3 Llndersecretar} CERTIFICATE OF LIABILITY INSURANCE °ATE`MM'°°"""' 03/01/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers and Gray Processing ROGERS & GRAY INSURANCE AGENCY INC PHONE (508)398-7980 FAX AC No): EMAIL r ADDRESS: mail @ Ogersgray.com 434 ROUTE 134 INSURER(S)AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: MCAS LLC INSURER C: NICKERSON HOME IMPROVEMENT INSURERD: P 0 BOX 2476 INSURER E ORLEANS MA 02653 INSURERF: i COVERAGES CERTIFICATE NUMBER: 243979 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR( TYPE OF INSURANCE ADDL1SU R POLICY EFF POLICY EXP +� LTR I I POLICY NUMBER MMIDDIYYYY MMIDDIYYYY - - LIMITS COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE S I CLAIMS-MADE OCCUR OAPAAGE TO RENTED PREMISES Ea occurrence) S MED EXP(Any one person) I S N/A i I PERSONAL R ADV INJURY S GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE Is F-1 PRO- POLICY ECT LOC , PRODUCTS-COA4P/OP AGG S OTHER: I is AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT I S Ea accident 1 ANY AUTO f BODILY INJURY(Per person) S ALL OWNED I SCHEDULED f i AUTOS AUTOS N/A , I BODILY INJURY(Per accident) S NON-OWNED FPROPERTY DAMAGE I HIREDAUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR I ( I EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE N/A I AGGREGATE S I DED I I RETENTIONS I IS WORKERS COMPENSATION I X i STATUTE I ERH AND EMPLOYERS'LIABILITY YIN I ANYPROPRIETORIPARTNEWEXECUTIVE I E.L.EACH ACCIDENT S 100,000 A IOFFICERIMErABEREXCLLMED? NIA I NIA NIA l VWC10060211892018A 03/01/2018 03/01/2019 (Mandatory in NH) 1 E.L.DISEASE-EA EMPLOYEE$ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS b--Imv E.L.DISEASE-POLICY LIMIT I S 500,000 N/A I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only"Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at vww.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL 'BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis i MA 02601 Daniel CCr v y,CPCU,Vice President—Residual Market—WCRIBMA • ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01)' The ACORD name and logo are registered marks of ACORD r 37ke C©mrnomreaith of Mccssad-- && Dep"&ffent crf1udrrsfria1 Acciderds �► Office of WES61904orns_ 600 Washington Street Bostan,MA#211 kvrvt�mas�gvv�rfin . 'rttar1ers' CumpensatiGn Insurance Affidavit Builders/CantracbDrsJEIectricianstPlumbers A:Ppjkpp#TMfarmafran Please Pit Name � adi goal L 49/J�n 1�'� x �y1 , ci �l.e�.�►s Ike- z '3 _ , �o. W Are ya emploper?.Checkthe appropriate barn: Type of project(required): t. I am a employes with. 4 ❑I am a general contractor and I 6- ❑Inept constructicM employee3(full audfor pact time).* crave hired the sub-contractors fisted on the attached sheet: 'I. ❑Remodeling. �.❑ I am a sale prnpdetar of pmt3er- These sub-contractors have sup and have no employees 8. ❑Demolition wading far me in any capacst3`- employees and have wogs' 9..❑Buildup addition [moo ivorfaers'coaap comp_*„��,�I insurance 1 ecrcal �oas required-] 5. ❑ We are a cocparatifla and its ❑Eld repairs or 3.❑ I am a homeowster doing all WMt officers leave exercised their 1L❑�g repairs or additions. 15o f exemption per&GI myself o work='°° - . ,§1 dwehaveno i,�ncereauuedj L ofr 13.❑Other. employees-[NO tieorlce=s' coslp-insorname-regaited.) 'bayWitar dtatcbedsUos imastvisafiIIasztthesectioabelowshcrtifiagchairwolves'campensanaape&epinfo iom l amneowners Who subaft dais iadarst M,9 dWY amdaioz RU WOE.sad&-hive aatsi&CCUbXCftrS nmSt sdhmit anew afEdset mdiaQim S a L ICaatzactas ezt chw-1r s bmc nti=zMadud sir.additiffnal shed showing tine mmne<of the snd stale Whethet or not ftse enlitks hsee employees.Ifthesab_Mtzctashare empIcFfes,theym1srpm71de'tbAr=dam,cmzP.pGHq mxmber_ I arm ara errip r that is prauidfrrg waAers'caalpensadiml hLvarance for my encpfn,},ees $eToev it tJtR pmtij7 oral}ob s�e irzfarmaliarL InsuranceCompanyName: Policy 4,11 or Self-ins.Lic-I M V O iratioal3ate: _ Job Tice Addresr Cityfstafetz*p it7 Af#ach a copy of the wort-ere canzpensa onpolky declaration page(shoming the policy,number and,expiration date). Failure to secure coverage as required under Section 25A of INGL m 152 can lead to the imposition of criminal penalties of a fine up to$1, OUD andf'or o6i.:g srimpziismmenf,as well as civil penalties in the foam of a STOP WGIRS ORDER and a Rae of up to$254_00 a day against the violator. Be a&ised that a copy-of this statement maybe fxwuded to the Office of lavestsgati=of tie DIA for ins=mce coverage',7edGcation I do Iforeby caafi under'the pains and a.�perjury fhatthe in br mafimrpn*it da �a' true and correct fy Date: Phone A- J LID - '368-/' Of ciat axe anfy: Da curt awite in dds AM,to be camplited by clip artown qiftifil City or.oww Permtitffi;cense Issaing Authority(cane one): L Board of$eal& 2.Bw aTmg Deparhtneat 3•City1rown.Clerk 4.Electrical Inspector S.Plumbing Inspector 6.other Contact Person: Phone#: 6 �IME Town of Barnstable Regulatory Services BARNSTABLE n�►ss Richard V.Scali,Director i639 "1 Building Division FD MA`S Tom Perry,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, Bethany Gardner ,as Owner of the subject property hereby authorize Nickerson Home Improvement to act on my.behalf, in all matters relative to work authorized by this building permit application for: 125 Knotty Pine Road Centerville,MA 02632 (Address of Job). Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final ins ections are performed and accepted. Signature of*Own r Signature of Applicant Print Name Print Name - i n Iii?, Date ' 2 3 PROPOSAL MCAS, LLC NICKERSON HOME IMPR® NT •ROOFING •SCREEN PORCHES 508-240-3081 , P.O. BOX 2476 •SIDING •SECOND STORIES 508-255-5107 FAX ORL,EANS,MA 02653 •DECKS •RENOVATIONS •ADDITIONS •INTERIOR/EXTERIOR PAINTING www.nickersonhomsimprovement.com •SKYLIGHTS •1NINDOWS/DOORS E-Mail markl202653@y-ahoo.com •GARAGES y�� •KITCHEN &BATH REMODELING 12 Commerce Drive 7 -1 '� �� � PI?4 208 3905 oATE4/9/2018 To: 4�nt Lane Hyannis MA 02601 JOTAA Cnot'y ine Road Centerville, MA- JOB NUMBER JOB PHONE We hereby submit specifications and estimates for: - - 10 Insta ti e ad of li oleum "oor a 85 to a ove (Ma(erial all �ce at $3. . per sq•foot) ROOF - s Strip shingles off entire roof Nail all loose plywood roof sheathing where needed Install 8" heavy duty white aluminum drip edge on all lower edges and new flanges around vent pipes Install 33" StormShield Ice and Water protector on all lower edges, around.all-openings and.li^r all valleys Install Roofers' Select high performance black underlayment felt paper on remaining stripped areas Install roof shingles on stripped area as listed below- hurricane nailed (6 nails per shingle) Install ridge vent where existing Supply all labor, materials, debris removal and disposal fees GOOD =Landmark Lifetime architectural roof shingles - 235 lbs./sq., 10-year algae resistance and 110 / warranty estimated-at - _Y /BETTER = La dmark Lifetime Pro architectural roof shingles - 250 lbs./sq., maximum definition colors, 15- ralgae resistance and 110 MPH wind warranty estimated at B - andmar�Premium Lf a tme architectural roof shingle 3s 00 1 q., 15-year-a gae r ' tance and 110 MPH wind warranty estimated at ' OPTION - Install zinc strips at peak of roof at per lineal foot RI EASE INDICATE COLOR.nR CHOICE ON RETIcIRN€D-PROPOSAI We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Gnnt'd dollars($ ). Payment to be made as follows: $450 dollars,requested with signed proposal Progress payments on request AP. Aam All material is guaranteed to be as specified.All work to be completed In a professional manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders,and will become an extra Signature charge over and above the estimate.Ai agreements contingent upon strikes,accidents or delays beyond,our control.Owner to carry fire,tornado,and other necessary insurance.Our Note: s p posal maybe workers are fuliy covered by Worker's Compensation insurance. withdrawn by us tt ccepted within days. Acceptance of Proposal—The above prices,specifications and ��� 30 conditions are satisfactory and are hereby accepted.You are authorized to do the work Signature G as specified.Payment will be made as outlined above. Signature Date of Acceptance: 1 > Tom of Barnstable *Permit it Expires 6 mondisfrom issue date s a Regulatory Services Fee snttrtsrast.� = & p 63 Richard V.Scali,Interim Director A Building Division Tom Perry,CBO,Building Commissioner MAY 2 200 Main Street,Hyannis,MA 02601 6 2016 www.town.bamstable.ma.us TQ�IU U 1} q� Office: 508-862-4038 IU D R. ax EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number / f Q Property'Address 115 1(ily l•`T Y/l ri e //7. U° Residential Value of Work$07 3, /3 ' Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address Ljq/iy/ f-t p ��✓!�y (�"1r✓`�C r�{ L k.S;le tA)S K t s Kn 0-4 L✓t C4ile -Ville rq 0,2( Z -j rB&AAJ Contractor's Name t W5 /SO I✓ Telephone Number'1dl-27—r-fcft Home Improvement Contractor License#(if applicable)_7-32-il,,!� Email: Construction Supervisor's License#(if applicable) ?T7a 7 AWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name iUq 1 A)5 - 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 . i Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑-Re-side Q eplacement Windows/doors/sliders.U Value . 3 0 maximum.35 f w' Z ( ) o mdows / #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. �Wheie required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. '=Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILESTORMSIbuilding permit formslEXPRESS.doe q Revised 061313 l ` g ' - p eeFeAemtienr .n a R `._I r74�it§ +zl, rr CrIhmi� Lame.�lrn,p!�,�[ !ems atm�,gar R'cge"by A"ertem al( rmlJa atu lk? ,z Pm,sia ��L ,A _ , f§,apir�'ul 5-MAL rtk4c. ere? G6dr 17'.. 5�. - �J /�I 6dKiiJfuljfES� ] ! � �,"�'� BGC�altSisFV-frlger ".e:Tol"Pawwfwar6sw;,. r} t{s hceil,} �aiei7ly luiiJ �t*rd1}r aee rbwl iLTOdiBere Wysa�rit }.a% l�ts�'IP4' ra'Cd e9l ' J �r2t�l 1-1 ACr��°C69[xi Of Srru ieen NL-W 1�'tSOmnd{4 onftttL�i''�,ta ic,; xt—,'dmm vidl the t�r,m and�:�i cilia �[J ��ru������faaeiae.a�r��e �[T ad' ih grcea�»,c and�5u tJSc au rl� l spr,�i6 iu�tu sheep (06 -rcUrmug.ri geec �e . - To1311 Jot+l i.fj,Xm " e. id i:msne ige r,l'a_.�rr�� �Mgt �[A Eiermi �epaai ta@�et�ad1�j4'��— " Credit.Card§we m�r� erd{w Ida—, '—mbaftfrim 14 of'Che• fseim Ca ^e n Icy RS F ;€ k o� arTp $as s [ 61 =d d tr�;ilesat of JCbb 395 ' "e" {ob.caa be lim ie o e mde'bi Olwye.tM agrees and undersiapda that tker.Agmemeoz eoastictiles d4..c t ntice ont�.et i meln'srg t+reent the* � on vleAal underat�.ma;r g�tlaaa k"$my � ��� of tlnes�: mem cm, 1ga` IIS a pared and iZr 1 >ay aea tag ]I aC-kffq L Thal Bar hrremtat� oadersdacc r tirtra�.of e>:;gmena„ sled Copy of ahbt agreement;ice¢ diet a� r��ates�ei��sme�Laax ted� �,�mA dafinli On tho.�to w -*tten a _ d( s-oaselly co��eme p Cu. rigE(;trr eavel e6i9; rr� u 6t ]1�i1i'FSIGNT�I Q �4 *r FTF� :4 . Fil a�iS # E �Rkrrar�L�r�eurl a k 4]n1,�3r'Qaic�c oQ}3my (l);I cr t5 e€a�i3trJf aJr it a epaccslmttt�de ,far the:a a dl terms; to etc bat ma a then a�a t+�Eea Feria 9_$e�sa+e P Kilo Q lam endt�d to is copy c►f ih>a, a out�rU i a tab s aL Ytsu 6h y apt_ iu�r Eixeee�aaJt a£�tttr�liie➢l��a�d 1`s©lYanJ�p dvr oaelt 'Tit rKnEtt�, �!;J �a d'� ;r Y - u, ra ea is re�giitne a�a rebate+m the eaf ,tlinal,s� r�crl; ga�g�, JE� 1§eelle�l r�c�ragFii Uo uaJal'uDIL etr�yoi EsaGnises erat�9aaJ�eia.d taw: b. lhr1 tdr¢epos5 ss s.g rlrasedl®rYdea :.dlga+e ®yen. C5) era if'it s siQt b cae s3 etll at o Oflle:e mar o �*r- peg a�.�cnt b of 9i e e ai5 alrm �ler� rnwad' r m :e�l_lp at.1"or,Jur ea,ralea office aer l6ralach ofliittie 5 ttti:ThE't1 eeetutmi by t ster+ed ae"ad �v1�1ch.xh be PPsted ndat Wer �mm.rmnnlaeo,t: aC the th".CA_b dttr doy after,r e 44y tan w6ch the,.bey er se¢�a tfic Agreentemt;: lvdtieag d. y t uy:lao'Gsl4yy z ggglarva ade.•ii.v€ c� `ruotn,adc , 't"Tlile ardd _and m�ttcc + �!aue�o. :gam 1P --J� l �ai±ii6�U� slrgh et"a v`} S� 8 e hi.�5aLCii3 M-12m4a€ls Drmidtd by t�J � i��AOaTd 1ene� i.h ,�f' i�a1>ieCru:G'a'eira'13ogifmmefi ' ugtr� u� . By of llmduetAl.,ma Not xeene 1tOQJ, 71 •�hj9 i' G)�)L.T>iICS`:T '� f1tN �; iuL'Jl1E: WO It TI[3 IMMIOGEITF THE'7rliD BUSINESS Y A>l l'Flt I3�1L7?�QI�T JFIIS T'l4 j�I S� 1THE a�i?I',?tCK'D.;��I��Q;�F' t,�TC� `l[[X�i FCY7AY:��� FOR4N L!C TILON 017 THIS RIGHT'., _ — Gott o ,Trans �o E I n Yayi May €ancel ba,pa tl 1I° :tac�ra = ' 1 - P ,1f1)u r €s nsel'tlafs fr*amRactlbnf'wlitJhFoir an Onalry rw ablization, +,witih,ln I �iE trransacdon, wrkhout alny p oalcy or ,afblJ three'! b„ iness d fo,�a he aboves date.,ff a�nc�P�„a�n� tE� buii s t"firem NMI ab date.If ilea Property tided In,, pv�yrreer ma b Pw antler the 'I PraPart' wed in,.�' �� ou.,under the rz� a�.aslea Cis�s ct or Sale,an artlt negotl 6Je u 5frier ysnt exetlutied I Contra€t oe'' F arty nega€_able. insi of ent executed by you mill ba returnedwithin ten,Ihuilrwe� des "lowing i by 4 t�wfJI;lae returned w th n- tees bu iness f 11 rin re Vt by the Setiller� of your cancelladon u,mtic%, -and any ret:er t, securl intorest arlsIn C A, b1F Ike etlJetrt 4f l*our rawtellatir na#coe rdl eY g out +�i' flee t-rsi�sai�ie�ri �aeCl bey se�re� i.n�c�st �i'searg ..out �f t#ae tr�a:n�artia� �cL� ke,ratiseal'ed.II u r anc-eP,}rsta anust+rtake avmlabfe t*the"�ll'er '1 �n�s'Ced IFyt��a a rncefi�yrrtr+rlr�se a .av il'aLd�eo t eJiea at Your eP1€e,Ili:36bst taeii rail mod!a M4@it$on,as whenreceived `l �t ycrltirr r°�idere�ee an Simit�tral'I�.ay der/rtioelrrtion ais ie/dAetrl y goods:delivered to yqu under this Can tram agar!. IISaJ rr�¢�red, �Poads dellr d to jr4v e�erdet•�s�vtatrr�et an o-,trr you may ii<p u w,1.�.r.Prinply With the�fens&etf-o,�ns of � '�al�a��rocn eYra�n#'feu�i'IvNe�++sYp1'y� +#� �r��ts uQtfon3+�f tine selfor rreWcOn -tl,e eetearo sir pn, ore si#t9ee goads at;the tlse.; eiler regardlei o¢etivin z8ii errt erf �a�rds at the, I eII rYc 4 sires a.i i,sk.If p�iu diq malrr r ro good tcrsil o � ! elpWk eg rrse and i A,If yaaut do make the mod!a*a liMn r vwa<to he days f tiro d e e Se 10 and eFse to �u I!laiyo k tfr up SkJtfei rg I to t� SeI a an d the Soll�dot* but pick ttr up �iwltfitil .- y r 1ru_ :re�taln ur�' t entir davi af:thsh rfx*o, .r CaW% a..J �-- _ Southern New England Windows d.b.a Renewal by Andersen of S E ! Massachusetts-DegartTnent of Public Safety Board of Building Regulations and Standards aaastriledon supervisor !icense: CS-0937�I ERM D I® N - Chariton KA 81MR7 1 � ` z! a I Commissioner ®91D�2016 Office of Consumer Affairs find Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 17=45 Type: Supplerrmmtt Card Emiration: 9/1912016 SOUTHERN NEW ENGLAND WINDOWS LL DENNISON BRIAN 26 ALBION RD '- LINCOLN,RI 02865 update Adduce mmd n=m mtd Msrk Ftmu for dmgr- su:e mar os+� Ci Address i:Renewal i 1�po?'m� �Lou Card W.EWMM7 arconm AShin&Benin®REVIA600 License or registration valid for ind'roidni we only MPROVEMENT CONTRACTOR befaretbeelpiraC�dare.Iffaandrtamto: Office orcousumerAff1drs and Radom Regolativa 173M Type. 10PZA.plan-Suite5170 9ASM16 Supplemetdam Boslon,.MA07.116 SOUTHERN NEW ENGLAND W0tDOWS UC. RENEWAL BY ANDERSON -� DENNISON BRIAN 26 ALBION RD _ UNCOLN,RI 02M Uodenacretarr Not valid wehnar eignatare I I'll e Commo-n wealth of Alassach usetts / Department of IndustrialAccidents ;, . :.i; ( Office of Investigations I CoaxpressStreet, Suite 100 Vrl'im= Boston,M-4 021I4-20I7 www.m ass.aov1dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers ,AppReant Information Please Print Legibly Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/Slate/Zip:Lincoln, RI 02865 Phone#:401-228-9800 . Are you an employer? Check the appropriate bog: Type of project(required): 20+ 4. I am a general contractor and I i.FBI I am a employer with g 6. ❑New construction employees (full and/or part-time).` have hired the sub-contractoi;s 2.❑ I am a sole proprietor or partner- 7_ ❑ Remodeling listed on the attached sheet. ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers'{ 9 Q Building addition [No workers comp. ins urance comp.insurance - 10. Electrical repairs or additions required.] 5. We are a corporation and its q ]3. I am a homeowner doing all work officers have exercised their I I.Q Plumbing repairs or additions Q myself. [No workers' comp. right of exemption per MGL 12.Q Roof rennin insurance required.]t c. t 52, §t(4),and we have na ���d,G� employees. [No workers' 13.� Other comp. insurance required.] 14 cent en f *Any applicant that checks box 91 must also fill out the section below shoNving their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then}fire outside contractors must submit anew affidavit indicating such- 0 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. Iam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:ARGONAUT INS, CO. Policy olic #or Self-ins. Lie.#:WC 928058352394 Expiration Date:8/21/2016 Job Site Address- /1/76TT /9/Ile 1-4,17e- City/State/Zip: &�,Ivi l(2 Md1 a co of the workers' compensation policy declaration age(showing the policy number and expiration date).- Attach PY P P Y P Failure to secure coverage as required under Section 25Ar-efMGL 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA fbA insurance coverage verification. I do hereby certify under th a' s and penalties ofperjury that the information provided above is true and correct. r Date: =�S'—/ 6 Si afore. Phone#: 4012289800 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: SOUTNEW-01 SHETTYSHT DATE(MMIDDIYYYI) CERTIFICATE OF LIABILITYINSURANCE F8/19/2015 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the po()cy(ies)must be endorsed. if SUBROGATION 15 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT VVlliis Certificate Center Willis of New Jersey,inc. PHONPRODUCER E 877 945.737$ FAX No (888)467 2378 c/o 26 Century Sivd �c a� ( } P.O.Box 305191 ADDRESS:certficates Willis-com Nashville,TN 37230-5191 INSURERS AFFORDING COVERAGE NAIC I INSURER A:Selective insurance Company of Southeast 39926 INSURED tNsuRER a.OneBeacon Insurance Company 21970 Southern New England Windows LLC INSURER c:Argonaut Insurance Company 19801 DBIA Renewal by Andersen INSURER D: 26 Albion Road i Lincoln,Ri 02865 INSURER E • INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF.ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSUBJECTTO ALL THETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tL - Po CY EFF P UCY E7fP Umns SR TYPE OF INSURANCE INS WVD POLICY NUMBER MM I) 1,000200 A X COMMERCIAL GENERAL LIABILIlY EACH OCCURRENCE s ® S 2029459 08/1012015 08/1012016 PREMISES omrrm $ 100,000 CLaIMs MAOE OCCUR 10,000 MED EXP(Any one person) I S PERSONAL"i ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 3,000,flOfl GENT AGGREGATE LIMIT APPLIES PER: 3,000,000 PRODUCTS-COMPIOP AGG S POLICY® ECTT ®LOC S OTHER: con{etNEo sINGLE LIMIT s 1,000,00 (E2 acadectt AUTOMOBILE LIABILITY -- ANYAUTO S 2029459 Oat ()l2015 0811012016 BODiLYINJURY(Pvpem-) 'S ALL OWNED SCHEDULED BODILYIWURY(Peraccident)i s AUTOS AUTOS PROPERTY DAMAGE re NON-OWNED (Per acddentl HIRED AUTOS AUTOS i Is . --- N -)( UMBRELLA LIAB OCCUR i 5,000,00 EACH S A EXCESS LIAR CLAIMS-MADE S 2029459 08110/2015 08/10/2016 AGGREGATE J s 5,000,0fl0 lg DED I RETENTIONS ' WORKERS COMPENSATION STATUTE AND EMPLOYERS'LIABUZY 000006$O28 O$121/2015 08/21/2016 1,000,00 B ANY PROPRIE'rOR/PARTNERiEXECUnVE Y(pt j NIA F L EACH ACCIDENT 5 OFFICERIMB4BER EXCLUDED? L EL DISEASE-EA EMPLOYEE $ 1,(100,000 (Mandatory in NH) 1,000,00 It yes,deScillle under' EL DISEASE-POUCY ULUr s DESCRIPTION OF OPERATIONS below C Workers Compensation WC928058352394 08121/2015 08/2112016 See Attached DESCRIPTION OF OPERATIONS i LOCATIONS i VEHICLES(ACORD 101,Additional Remarks Schedule,nay be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL 1 BEFORE THE EXPIRATION DATE THEREOF, KpTICE WILL BE DELIVERED iN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance ©1988-2014 ACORD CORPORATION. Ali rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Y; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3` I Z Map Parcel 0 g Application #cX1026 .� Health Division Date Issued Conservation Division Application Fee Planning Dept. _ Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis _ Project Street Address 1 3. 5 K t%p I?',a e L ah e, Village ao+eer v- e Owner I�et1na n/ r (\er Address 5 a,Ml° Telephone �� — ©$ 3 .4 05 Permit Request Ar Sra l Q+t►c .9-��eoc .i i+1•, a�_ PdrA J? -Vt e c l l ja-s e +D in C;1&',n r, s . T,4 S+6 31 9- 11 go IO G c g,�4,55 1 ✓1 n 6 X 'S; C f'L-4S G t IL V r 'I'•► I Q�-i O m to 00 e t�� (`O G } 9_ D��i�'�/t✓1�'� Yl U Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation$3, b 0 0 —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 I ,� �'a' Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) _ Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: _ existing —new Total Room Count (not including baths): existing new First,Floor Room Count Heat Type and Fuel: , Gas ❑ Oil ❑ Electric ❑ Other_ Central Air: ❑Yes 04 No Fireplaces: Existing New _ Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ a; � Commercial ❑Yes J�No If yes, site plan review# = Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name W11,11ro Telephone Number 56 $ ' 30 - 03 0 Address (1 License #_ C J o "A Y a M o WTn, 111F7 6 a•6 6 Y Home Improvement Contractor# u 3 Worker's Compensation # �C-1� C 3 97 97- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 kPMp VA SIGNATURE DATE i K FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED -� - — .MAP/PARCEL NO. . ADDRESS . VILLAGE OWNER .w DATE OF INSPECTION: r` 3 FOUNDATION . FRAME y INSULATION.. FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS:-, ROUGH r a.* FINAL j ,? <<FJNAL-BUIL•.DING`f.' , t' r r_.DAT.E CLOSED OUT t ASSOCIATION PLAN NO. 4-6D West Ruin Stteet HOusi Assistance,,, .. *T �sas) Tr-1-5400 F�o$)ri5--7434) 3'I Y on aIl fines. poration HOME OWNER WEATHERIZATION WORK PERIL Fr&FUEL RELEASE; PLEASE Fn J.OUT AND SIC=N TMS XORM I YOU ARE THE APPLICANT HOINM OWN R- hereby consent to and agree that weatherization work may be done by the W theazation Program of Housing Assistance Corporation ( herein after referred as "Agency-) on We property located at The weatherization work done will be based on programmatic priorities and availability of f coding and it may include a.11 or some of the following measures-,,4 Weather-strXgp4&muMAg of windows and doors,insulation of attics;-sidewalls &basements,attic and other-ventilation measures and possibly replacement.of badly deteriorated windows.la consideration of the weatherization work to be done at my home I agree to the,following: 1_ I give permission to the ".Agency" its.agents.and employees to,travel onto or across said property with such equipment and materials as may be necessary to perform weathe -lion work on said property. ° 2_ The Horsing Assistance Corporation reserves the right to inspect-the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5),years after'the weathezizatioix work is completed I have read the provisions of this agreement as listed and freely give my consent- Home Owe: (Slgnatnre) �'s ,� `` �:-••� Date it X 4 S Agent (signature) Date HAC approved Weathcri ation Compauy Cah-ber'Building&Remodeling' Cape Cod Insulation " Cape Save• Creswell Construction Frontier Enezgy Soll OI}S Lohr&Sons: Peter Smith Resolution Enema_. Rock Solid Co=tn coon- A1] Cape Insulation , T The.:CoM monwealth of Massachusetts. Department of lndustrW Accidents Office of Investigations 600:Washington Street Boston, MA 02111 wwx.massgov/dia Workers' Compensation Insurance Affidavit:BuilderslContractors/Electricians/Plambers At►nlicant Information i Please Print Ledo-ly Name usiness/0 ' on/Individuai : JUG I C 4 t (B rgatvuzap ? .-_..-r, �..,�— .w i ��T�r- _ �-.-• -�. Address: [,iG-TD t S AyYz- City/State/Ztp: • YPti2Mour�- Are-you>an.employer?Check.the:appropriate box:. Tvpe of.protect:.(required): I. .I.am a employer.Willi-'. 40 I ant a_gcncral-contractor and,I . employees(full.and/or.part-timc). - have hired.ihrsub-contractors 6• Q New construction- 2.❑ I am a:solc proprietor or parhtcr- liaed.on-the attached sheet: 7. []:Remodeling ship and have.no employees These.sub-contractors:have g; Q Nniolition employees and have workers' Working,for me in any capacity. 0: 0 Building addition [No workers'comp.:insurance : comp.insurance.*: .required] 3: Q We area corporation and,:1%. 1;0.� Electrical. or additions 3.0 l am a.hor tcowner doing alC work officers:.have exercised their l l.Q Plumbing repairs or additions mysclf.tNoworkers'comp. right o.cxcm'ption per MGL 12.0 Roof repairs. -insurance required:)t c..152,}1(4),and we have no S cinpioyees. [No workers' 13t Me r_ 4�lM 'comp. insurance.required.), *Any applicant tbat checks box#1 must also 01 out the section below showing their workers'compensation;policy information t Homeowners wbo submit this affidavit indicating they are doing an work and thm hire outside contractors must submita.new affidavit indicating such hContractors that check this box must attached an Additional sbeet'showing the name of the sub..-contractors and state whether or not those entities have: employees. If-the sub-contractors.have employees,tl eymust provide their workers'comp.policy.number. I an an:et„ o that is mvidin workers'corer ensaaion_insurance or myemployees.. Below is the O cy and; b site Pj per p 8 P f : P: 1° informadox: Insurance Company Name: 1 Ins ra. Con, O Policy'#or Self tns:Lic:;#: T C. Expiration Date: l �•I a.0 Job Site.Address:: CtylState/Zip: Ceti Ccr . 1 0— .A 5 copy of the:workers'compensation policy declaration page(showing the policy number aud.exbiration:date�, Failure:to secure coverage as required under Section_25A of MGI,c. 151 can tend.to the imposition of criminal:penalties:of a 0—to$1,500.00 and/or one year impri t;a sonmens well.as civil penalties in.tbe form:of a STOP WORK ORDER and:a fine of up to S250.00 a day against the:violator. Be.advised that,a-copy Of this statement:maybe.forwarded:0 the Office of Investigations of the DIA for insurance:coverage verification. I do herebyter dfp yndet-the:pa'mlm.dpenai&Wyfgerinry that the Oforimlion provided above is true aitd correcL Signatum. Date. 3 . Phone# Of}rctal use only: Do not nrrite In tIris,urea,to be.,to by city.yr town official. City or.Town::.. < Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building.Department I.City[Town Clerk 4.-Electrical Inspector 5.Plumbing-Inspec"tor b.Othei Phone# GContact:Person: . _ ACC) CERTIFICATE OF LIABILITY INSURANCE 10/20/2011 THIS CE�tTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CT PRODUCER NA MP Shannon Sperrazza Risk Strategies Company PHONE (781)986^4400 FAX o.(781)963-4420 IAIC15 Pacella Park Drive EDMAILDRE ssP errazza@risk-strategies.com A Suite 240 ' INSURERS AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:SeleCtiVe Insurance INSURED INSURER B:Safety Insurance Company 33618 Michael McCluskey, DBA: Cape Save c INSURER C.Technology Insurance Company 7 C Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02644 ` INSURERF: " COVERAGES CERTIFICATE NUMBER CL11102041451 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MWDD/YYYY MM/DD/YYYY GENERAL LIABILITY `' EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 A CLAIMS MADE a OCCUR PPS1994480 0/16/2011 0/16/2012 MED EXP(Any one person) $ 10,000 + , PERSONAL&ADV INJURY $ 1,000,000 r -GENERAL AGGREGATE $ 2,000,000] GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 FXI POLICY PRO- LOC $ JECTA COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ 1,000,000 B ANY AUTO ' BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 6208200 1/6/2011 1/6/2012 BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED ' PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident X Undennsured motorist Ell s iit $100000 300000 X UMBRELLA LIAB X OCCUR CPP91994480 0/16/2011 0/16/2012 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ C WORKERS COMPENSATION Executive excluded , X WC STATU- O R AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N _ from coverage - E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? a N/A C397972. 0/21/2011 0/21/2012 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required Issued as evidence of insurance. National=Grid Corporate Services,LLC d b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc. , and Housing Assistance Corporation are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER - CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Housing Assistance Corp 484 Main Street i AUTHORIZED REPRESENTATIVE Hyannis, NA 02601-3698 � . Michael Christian/SMS ,ACORD 25(2010/05) . 01988-2010 ACORD CORPORATION. All rights reserved. INS025r�MnnA�M Thn AnnDn namn onrf Inns or*►ania*orad morire of arnian P - d O fice of?ownsucvme��rAfair and&Bu�smessegula�ion 101'ark Plaza- Suite 5170 Bos ton, Massachusetts assachusetts 0211.6 Home Improveitt Registration Registration: 164432 - Type: Supplement Card CAPE SAVE - Expiration: 10/6/2013 WILLIAM McCLUSKEY 8201 S. HOURD CT - CHAPEL HILL, NC 27516 Update Address and return card.Mark reason for change. )PS-CAt 0 50M-04/04G701216 Address � Renewal Employment rl Lost Card � , ✓iL2 V097Y/)ZO'12f!lCQL[dL O�✓�GlLQdO.CftGQ2�b .. .. .. � ._. ..... ...�._ .. _. -. _ -- ._._ _-. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR F before the expiration date. If found return toi Office of Consumer Affairs and Business Regulation 1; Registration 164432 Type: , 10 Park Plaza-Suite 5170 Expiration t016/20:13 Supplement Card Boston,MA 02116 CAPE SAVE WILLIAM McCLUSKEY - 7C HUNTING AVEr S.YARMOUTH,MA`6M664V Undersecretary Not valid without ' nature f l f '= N`lassuchusetts- Depariment of Public Safetl .Board of.Building Regulations and Standards Construction.Supervisor Specialty License License CS SL 102776 , Restricted.2o IC. �_. ;*° • WILLIAM 1 MC CLUSKY 37 NAUSET ROAD WEST YARMOUTH, MA 02673 Expiration: 6J28/2013 ('aomissi„ar`r Tr=: 102776 r ' Y l 38f 25:201 a 09:23 9193212955 PAGE 81 i 01 CAPEO ,,'SAW Weatherizattwon 508-39 -0398 August 22, 2010 To Whom It May Concern: William J. McCluskey is anemployee of Cape Save. He is authorized to negotiate contracts and building permits for our.company. Michael McCluskey Cape Save—Owner 929-593-5939 cell X Huntington-Avenue, South Yarmouth,MA 026" 3�2b�13 Cape Save Inc. iQ{F ,01 7-D Huntington Avenue ?/ South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 3/17/12 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St.Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 125 Knotty pine lane,Centerville has been inspected by a certified Building Performance Institute(BPI) Inspector. Ceiling: R-19 cellulose Box Sill: R-19 fiberglass All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey f� Engineering Dept.(A floor) Map 121 Parcel ' Permit# - House# /o?s Date Issued Board of Health.(3rd Toor)(8:15 --9:30/1:00-4:30) -`j rL 7 N Fee U. Conservation Office(4th floor)(8:30- 9:30/1:00=2:00) 9=/J` 7 �, '�41�•® ���� Planning Dept.(1st floor/School Admin.Bldg.) Definitive Plan Approved by Planning Board 19 - ��f0 MPS p`a� ®� �,ftr TOWN OF BARNSTABLE -� 4&0 Buildin Permit Application Project Street Address 12 ` ��© do e_ Village C +erJI t l Owner ..- ( / Cw► f° Address Telephone —]71—92 S/1 " Permit Request I7 Q fr,(\ 21C 4 First Floor square feet Second Floor square feet Construction Type � Estimated Project Cost $ 1 ' Zoning District Flood Plain Water Protection Lot Size F Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 7 :j-S_ Historic Hous ❑Yes 9/No On Old King's Highway ❑Yes Basement Type: ❑Full ❑Crawl ❑Walkout Other Basement Finished Area(sq.ft.) /✓d Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing L New Half: Existing New No.of Bedrooms: Existing New Total Room Count(noZas ding baths): Existing ��New First Floor Room Count Heat Type and Fuel: ❑Oil ❑Electric ❑Other r Central Air ❑Yes ;(No Fireplaces: Existing New Existing wood/coal stove Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) d❑ tached(size) ❑ am(size) None In Shed size C ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes U No If yes, site plan review# Current Use Proposed Use /' p Builder Information Name C��ehn (] C�u 9� J�_ Telephone Number -7 7/ — /63 S Address ,37 6A Sk e ,8d License# &I /R,1 a z 6 3 z- Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ✓ 9 BUILDING PERMIT DENIED FOR THE OLLOWING REASON(S) FOR OFFICIAL USE ONLY _ PERMIT NO. DATE ISSUED. T 4 MAP/PARCEL NO. ADDRESS VILLAGE t + OWNER DATE OF INSPECTION: , FOUNDATION FRAME INSULATION 1 FIREPLACE v ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL } GAS:' �r ROUGH FINALell FINAL BUILDING'` �.�_qY //,..w✓✓ - � , %I��s DATE CLOSED OUT ASSOCIATION PLAN NOS. i r r The Town of Barnstable .,� . Department of Health Safety;and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissione For office use only 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: dde--Li Est.Cost ?o 0_0 Address of Work: �L� f`�'o- A Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 n"ROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL G 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Z7 Date Contractor Name /s Registration No. _ OR The Contmonff'ealth of Massachusetts Department of Industrial Accidents .3 �. Olfice8//11Yes&9JAMS lir �= ,, 60011 hi'aA ton Street :': Bos ton, Mass. 02111 Workers' Compensation Insurance Affidavit �ip_Isant information: `— Please PRINT le�j (V"""'"• "�"- ""`-�'- ~M` - w - // a n cat; n tv I am a homeowner performing all work myself. � I am a sole proprietor and have no one working= in any capacity C3'rant an entpiover providing workers' compensation for my employees working on this job. enimmov name: address: • cih: phnne#• . iwmrnnce cn. flolim,# I am a sole ro rietor beneral contractor, or homeowner(circle are) and have hired the contractors listed below who hay e the ollowin� workers' compensation polices: comnnnv nnmc: �A J,(1 e address• On—: phone#• insurance rn. Holier# cmmnnnv nnmc: address- rite: -hone#• insurance co. Holier # Attach additional sheet if necessaty� :.< __"ram%' "�'�- '-" _.•i ..-Ji'•' yy..".:�. ..._-... .Y.rr:S....�« = «..•.� :cry.-lv: -.:::►..•:-.«yyit•�.ti�i!•.Mic'w�a6 Failure to secure coverage as required under Section 25A of R1GL 152 can lead to the imposition of criminal penalties 01'2 line up to S1.500.UU andior une rears' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. 1 understand that a COP) of this statement mai be funvarded to the Office of Investigations of the D1A for coverage verification. s'- 1 do herehr ccrrtJjr raid rc prtitts mtd penn/tics of perjure•that the information provided above is true and vrrec`r. Signature '7/f7/9'7 Dat Print name Phone!* official use unh• do not write in this area to be completed by city or town official L city or torn: permit/license# rIBuilding Department C3Uccnsing!Board [ 0 check if immediate response is required Selectmen's Office f 011ealth Department contact person: phone#: MOther s: information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for tttc: employees. As quoted from the "la%%`. an enipl(�ree is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An enzpinrcr is defined as an individual. partnership, association, corporation or other legal entity. or anv two or nor, the foregoing enuaged in a joint enterprise, and including the legal representatives of a deccasctl employer, or the ecceiver or trustee of an individual , partnership. association or other legal entity, employing; employees. However the owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the d\vellimg house of another who employs persons to do maintenance , construction or repair work on such dwelling Ito: or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an empioyer MGL chapter 152 section 25 also states that even- state or local licensing agency shall withhold the issuance or rencival of a license or permit to operate a business or to construct buildings in the commonwealth for an• applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ; been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and Supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Incustrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "iaw' or if you are require- to obtain a workers* compensation police, please call the Department at the number listed below. Co.- or ,rowns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom o: the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Plez be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any questior please do not hesitate to give us a call. Tile Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 ` Phone #: (617) 727-4900 ext. 406, 409 or 375 a ' ! 1 ! j i I _ I s ism h s5�C 1 y( t o t /�s k�o7ry lo h"L 1 � i / g i f i � I 1 � j /Apli/t tC/ J • ��, ..� yet•, ' � !'-, / / q i _o i AC✓n, 1y� CPNC n �e 7 Y I S w� i i f i i I 1 i Assessor's map and, lot-,number ....�..�.:l.P�.�:... Zrm'/it so j7 i �NSI�PSewage num er . ..•..:-......: (/ b `1 . 7NE� - TOWN- OF `BARNST fiLE Z MARNST"LE, • ! , -2639. RU-ILDI1G INSPECTOR APPLICATION FOR PERMIT TO ...................... .. .4�G�. .. ...1.��i................................ TYPE 00 CONSTRUCTION ... .......tc..4 !e i.................................. .................................................... c. ...... `..l....................19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: .? P. . ... ........CZ�.. . . ........:.......................... l C Location ..... ' ... ProposedUse .......•........� CC� .... .................................... . . ....... .......................—........... ............,......................... ZoningDistrict ..............R.:. ..........................................Fire District ...... >.t�t ......... .. ..................................... t Name of Owner 4sGG9 .........`�f .............Address ../.2 .�.... � �!``� .. ... . .... . .. . ....... 6x acl �� .............Address ........ �............2..........................T........... Name of Builder ..... ....... ..:................�. Nameof-Architect ..................................................................Address .................................................................................... Number of Rooms .................... .................... .......... ... ..................... .0 ..Roofing �. Exterior V . .......��Z:��....................................... g .......,.. . . ...:�`.......... ........ ........ .A.:�................ WFloors ......................Interior ............ Heating . ......... � ........................Plumbing .......... ........... Fireplace ...................................................................................Approximate Cost ............... �� ................................... .. .. Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area s• Diagram-of Lot and Building with Dimensions Fee g.............. ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. t, Name .................... Brook, Fredda , ` 9138 ad -to single - -� Na Permit for .... ................. ....... familq`_ dwelling .......................125 ....................125 Knotty..Pine Lane........... Location Centerville.....:. Fredda Brook Owner .................................................. ........ J n t frame Yj ' vr' Type of Construction .....................:.................... ..........................................................`................... j +i. , 4 t R ~ Plot ............... ..:......... Lot ................................ y a L/�f r-� t z. F �• April 22 77 Permit Granted .......19 Date of Inspection ........ {�19 ^. Dale C m let'd- PERMIT REFUSED '_ �. f ro':.................................... 19 ....................... : ' t / . .......................................................... .. ................................................. ........ . �� f ti ` ........................................................ ................ ............................................................ .......... Y Approved ..................................... ...... 19 ...�.....�� � �s ��,��.� •�Y .,`i-ram.� v � �Gr ..t:. .�rD'ai-/"�w_J.7',� zv`° J' �'"� 'y`'ti 'Y''�a a i Assessor's map and lot'-number 1. 1- 77 Sewage Permit number .......................................................... L ofTHETo TOWN OF BARNSTABLE Z BASBSTAIILE, i -. ,� 039. .e0� BUILDING INSPECTOR _, 'Fp V0 a l _3 APPLICATION FOR PERMIT TO ........................................ c /!r /a. c n :...... .. /........................ y VTYPE OF CONSTRUCTION l af`. : ........................................................................................... .`. ...... ...................19 7� TO THE INSPECTOR. OF BUILDINGS: The undersigned hereby applies for a-�permit according to the following information: Location ... .?..� !.�,�? r��/ , .. f t...{ia . ... L � ..........r. .. :...: ?�.r��. .......:........ t2(YC�%�i�t: �: vu......... ram... .. ...................................... Proposed Use ....................................... .............. ................ ..... ...... ............................. Zoning District '.............Fire District ...... .................................... Name of Owner .:.'./?.;tr fir!-f.� !/J�J !"!...............Address " .�. ......... a �Yq.. Name of Builder !.!. r:�.... `�.....:�✓O-1-4..............Address ........ ....�'�" ...........�..... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .................... ..................................Foundation ... .........:......................... ............. Exterior .(A.`......... d.,.A— .........................................Roofing ...........,�...?...................ti.:...........6.........................: - J Floors ............l..'.ifV ;..............................................................Interior ......... .....cr? ,....................................... f 1 J Heatin �. ...l�a Vera..•.....................Plumbing ----- Fireplace ..................................................................................Approximate Cost ................ ................................ ?.. Definitive Plan Approved by Planning Board -----------____---------------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee .............�:t ............... SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 \ E ,3U ; { 3 U l t F 1,64 ' 7� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 19-4, .................... Name ........................................ Brook, Fredda A=191-81 19138 add to single No .................. Permit for .................................... A familydwelling ............................................................................... Location ..........1.25 5..Kn.o.tty...Pine...Lane . . .. .... . ...... ........ ................... Centerville ....................C......................................................... Fredda Brook Owner .................................................................. frame Type of Construction ......................................... ............................................ .................................... Plot ......................... t ................................ Permit Granted ...ApT.i.1...22..................19 77 Date of Inspection ....................................19 Date Completed ......... .........................19 PERMIT REFUSED ................................. .. . ......................... 19 1. ,. -I..;............................ .......................... ..................................I............................................. ................................. .......................................... ......................................... ..................................... Approved .............................................. 19. ............................................................................... ............................................................................... �/- ETO�4 TOWN OF BARNSTABLE ii • i 89HHSTADLE. i - NAM BUILDING INSPECTOR ' f APPLICATION FOR PERMIT TO / O? .. ............................................................................. TYPEOF CONSTRUCTION ..................... ........................................................................:.................... ~ ..... .( . ...... /......... 19.7.� TO THE INSPECTOR OF BUILDINGS: The undersigned her by applies for a )permit according to the following information: Location .c ,-- .�2. .. J?. .. �L�,c,�t. .. t-ss...................... .. .. .................. wT ....... Proposed Use ........6-k'.e...... . ......... . .................................................................I............... "<...... Zoning District .........................../a....C.................................Fire District ............,. ............. ... . Name of Owner ,1.7. �.. ,1 .....Address zz. S.. r .4 t� 1 ... ............. r/ f .' - e r Nameof Builder ....................................................................Address .................................................................................... Nameof Architect .................. ...........................................Address ........................................................ ....................... ...............Foundation................ ....�d'' 1t�r C°.r ......... Number of Rooms �•� Exterior ...� .G .....d.........................':�!..O.:d.':. ...........Roofing ..........�s�%� ,��r ..................................... Floors .............. ...............................................Interior ........ . Heating .. . ��.....:.........................Plumbing 1... ........ ..........��.. . ....................... Fireplace ...................001-4 ...................................................Approximate Cost ............... .. ,c... ..U..................... , // 9C tV Definitive Plan Approved by Planning Board ---------------____________19 Diagram of Lot and Building with Dimensions ` LU SUBJECT TO APPROVAL OF BOARD OF HEALTH r LLJ (i O ^ m VVj Q Q Z CL �-- Q aR ww w o X < 0 m = f a_ LL_ .p z LL ttu 130 Z � r Jm 1Q w� _ 1cn = = Z - 1 0Q �Z� � z l a... ;9: Q u� d 0 Z v Ld cn Q I hereby agree to conform to all the Rules and Regulations of the'Town of Barnstable regarding the above construction. Name ..... ..... ... . .... .... ... � .... Cape -=y Realty Trust � I5I53 one story, No ................. Permit for .................................... ) single family dwelling `.-.---.-~~----,.-.--,.---.-..-,---. ` Knotty Pine Lane 'Location .--,...^.-..---....-..-.,---.- Centerville ^^'--^-''-~'-------'~^'--~-'-'-'~'-'- Cape Bay - | Owner ---.--..---.�-.---�.- ~.t .-_-.--... ' frame « ' Type mfConstruction .......................................... � � | ----``^'^-^----'-^---''-----~'-'—'' #1n ! ,"" "w ' ' ^ | *orm* 21 ?2 Permit_ Granted_ --yav/; ' Date Clzmoleia6 19 PERMIT REFUSED ' ----.-.--.--------.----.. 19 . ^� _.-_.---------..-.-.------_.--..-.. - ----'--'-''---------''--------'--'-'- --------'--------'---'---'-----''-'' '-_---.-------.--_---.-.'---.-.---.- ^^� ! _..---------..--.-- l� Approved � . .. -------------'--^^^~-^'^-'--^^'- r , -------------..~-.-.'.,...-.---... ( _ . � | ' | /