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Home My WebLink About0041 LARCH LANE ... . .. . _ . _ . . � - u � i 6 .. (I J' u L - 5 v � Application numbe&a)-ka.................... BnawsrnaLs BUS Date Issued....., . ..... ..... v............ �p�NG 9 sMAM � DEp� - 39. �� Building Inspectors Initials....... FEB 2 6 2020 Map/Parcel..../91... fJ.G. .. o ................... TOWN Of BARNSTgSL E TOWN OF BA STABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION SCANNED PROPERTY INFORMATION FEB 2 8 2020 Address of Project: All ��ati /n 1�„1e�yi.l le— b _ NUMBER STREET VILLAGE Owner's Name: Phone Number Sblf- 7 7P -9.Z S� Email Address: ��,5 P '� ye a �,., Cell Phone Number 5o S_6 k�Ty f - Project cost$ 4 Z P Check one Residential V1 Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Sep �-{{a�� -�- Date: TYPE OF WORK 71 Siding UVndows (no header change)#_&_ Insulahon/'Weathenzatton 17 Doors (no header change)# Commercial Doors require an inspector's review J Roof(not applying more than 1 layer of shingles) / r Construction Debris will be going to t(j a s4e-/qana CONTRACTOR'S INFORMATION Contractor's name I;rtan `7Rnniso✓% SoA-errx Afe.&J (FrS(Cv,C� d0ty Home Improvement Contractors Registration(if applicable)# 17 3 L.y 5 (attach copy) Construction Supervisor's License# y9 S 7 07 (attach copy) Email of Contractor Ct$� lee- 9 q56 G ; . C 6M Phone number L10I- z Z R -I R ) ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. - I APPLICATIONNUMBER............................................................ *For 'Tents Only Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X I X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES x Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOMWER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICANT'S SIGNATURE Signature Date 2- '2—& 0 All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document and. Payment.Terms byAndersen. dba:Renewal B Andersen of Southern New England YEffie Pearson Legal Name:Southern New England Windows,LLC 41 Larch Lh RI #36079,MA#173245,CT#6634555, Lead Firm #1237 - Centerville,MA 02632 w��oow ME ....Enr 10 Reservoir Rd I Smithfield,RI 02917 H:(508)778-9251 Phone:401-349-1384 1 Fax:401-633-6602 1 sales®renewalsne.com C(508)681-9483 Buyer(s)Name: Effie Pearson Contract Date: 02/14/26 Buyer(s)Street Address: 411arch Ln, Centerville, MA 02632 Primary Telephone Number: (508)778-9251 ' Secondary Telephone Number:(508)681-9483 Primary Email: pearsoneffie@yahoo.com Secondary Email: . Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern'New England Windows LLC d/b g /a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other.document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $10,776 By signing this Agreement,you acknowledge that the Balance Due,and.the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $3,591 Balance Due: $7,185 Estimated Start: Estimated Completion:' Amount Financed: $0 8 to 10 weeks 8 to 10 weeks Method of Payment: Cash/Check We schedule installations based on the date of the signed contract and secondarily on . the date in which we complete the technical measurements.The installation date tha Pt we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: Taxes paid in.Barnstable, Ma.. Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and.Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,.including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not:sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 02/18/2020 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal By Andersen of Southern New England Buyer(s) l0krz., Signature of Sales Person Signature Signature „ Gino Montesi Effie Pearson Print Name of Sales Person Print Name Print Name 1 UPDATED: 02/14/20 Page 2 / 12 Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts. 02118 Home. Improvement<Contractor Registration Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS LLC 10 RESERVOIR ROAD Expiration: 09/18/2020 . SMITHFIELD,RI 02917 t _ iCA t 0 20M-05/rf-1c/7 Update Address and Return Card. �TP •GY)9/Ytp/dIOPO.GlJL C�l/mi-:�.colclG: - ' Office of Consumer Affairs&Business Regulation . HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Reaistiation. Expiration Office of Consumer Affairs and Business Regulation 1:Z8245- 09/18/2020 1000 Washington Street•Suite 710 SOUTHERN NEW'ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON 10 RESERVOIR ROAD ° . SMITHFIELD,RI 02917 Undersecretary �" without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations.,and Standards ons r t� n Su'per.v so CS-095707 _ i res: 09/0812020 BRIAN C DENNIS®N - 8 BLACKWELL,DRIVE , CHARLTON �/IA 01607 vy . � � ai. �•1� ` r•r 1^�J� Commissioner 6. rn. The C'ommlonwe di pfAIass a acl us etas , Department of Indusbid Ac dents 1 Congress Stree4 Suite 100 Boston,MA 01114-1017 www mass gov%die Workers'Compensation lnsurance Affidavit:Builders/Contractors'Electricians/numbers.TO BE FILED"WITH THE PERsUTrLYG AUTHORfry. Applicant lnforaeation Please Print Let±ib[v Name(Business/otnanizwion/lndividual): Address: City/State/Zip;S-Mrt4eldllR' ! OZ9 /7 Phonek '40/ Z2,Fr- ? e0y Are YOU au employer'Check the appropriate box:- Type of project(required): . i. l am a employer with � re toy ee (full and/or part-time). , 7. []New construction am a sole Pra rietar or 1mm csh an-d have no employees work ing, for me in 8: ®Remodeling any capacity.[No workers'comp.k u:nce required.] a 3.0 1 am a homeowner do' all work myself: 9• ❑Demolition _ � Y [Nee workers'comp.insurance required.]r • 4.❑I am a homeowner and will be 3 conttactets to conduct all warts on m L will 10 Building addition A my property. ensure that all contractors either have workers'compensatioa insurance or are sole 11.❑Eleck ical repairs or additions proprietors with no employees. 12.[]Plumbin;repairs or additions_ 5.13 lam a gancral contractor and!have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs ,These sub-contractors have employees and have workers'camp.u*15 nce.t * P A 6. We me a corporation and its oEfhcen have exercised their d �Othe[ A) G /.1 Gep � L.1 right of exemption per MGL c. 14. 152,§1(4),and we have no employees.[No workers'comp.irrsorattce required] eAny.applicant that checks box RI must also tiU out the section belowshowing their workers'compensation policy infar.,w, . t Homeowners who submit this affidavit indicating they are doing all work and then hire outside eanhwetors must submit anew affidavit indicating such. tConttactars that check this box must attached as additional sheet showing the name of the subcontractors and state whirler or not those entities have employees. If the Mkoal rectors have employees,they must provide their workers'comp policy number I am an employer that is previdln;,workers'compensation insuranceformJ'employees Below is the pogey andjob site informatloj% Insurance Company[Name: T'!I^ee In (.O Policy#or Self-ins.Lic.#: �t��i�f� 10—il Expiration Date: Job Site Address:_ /` kzo�c-A L/I 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 MGL c. 1i2,J25A is a criminal violation punishable by a fine up to S1,S00.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to MOM a day against the violator•'.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veri tfkation t do hereby ce wader the p ' penalaia of perjury that the infornwbion provided above as rue and correct i µ D Z-L _l v Phone 4: Official use only. Do not write in dais area;to be cormp&ded by city or towel offuial City or Town: Permit(License# ' tssulne Authority(circle one): 1.Roardof Health 2.Building Department J.City/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i _.Lim'®® CERTIFICATE OF LIABILITY INSURANCE FDAT /30/2D/YYYY) 12/30/2019 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 IS SUING INSURERSO 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 ;ARE CT BOKF Insurance CO Risk Management p A 1600 Broadway, 9th Floor � •303-988-04�i6 .3 Denver A/C No. 03-988-0804 er CO 80202 ADORES insure bokfcom INSURERS)AFFORDING COVERAGE NAIC It INSURER A:Acadia Insurance Company '31325 INSURED EsLeReFiremen's Insurance Coma of WA,D.C. 2Southern New England Windows, LLCdba Renewal by Andersen of Southern New England C:Homeland Insurance Com an of New York 34452 10 Reservior RdR o:Smithfield RI 02917 E• INSURER F COVERAGES CERTIFICATE NUMBER:1098683046 REVISION NUMBER:.. THIS-IS TO CERTIFY THA T THE POLICIES F 0 INSU RANGE 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 NTH;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, r EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL SUER LTR TYPE OF INSURANCE POLICY EFF POLICY EXP POLICY NUMBER MMID MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/12020` 11=021 EACH OCCURRENCE 51,000,000 CLAIMS-MADE OCCUR e', PAN I S a occurrencel ENTF� $ ` k MED EXP(Airy one person) $10,wo PERSONAL&ADV'INJURY 81,000,0D0 GEN'L.AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE S 2 000,0 X POLICY PRO- j ± JECT I_1 LOC PRODUCTS-COMP/OP AGG $2,000,000 - OTHER: $ A AUTOMO&LE LIABILITY CPA3158728 + 1112020 1112021 EeM13INED SINGLE LIMIT $ aW�n Se X ANY AUTO BODILY INJURY jeer person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident $. ` AUTOS AUTOS .„ ) ' x HIRED Al1TOS Ix NON-OWNED PROPERTY DAMAGE AUTOS- Per accident $ A X UMBRELLA LIAR X OCCUR CPA3158728 1112020 1112021 EACH OCCURRENCE $15 000.000 EXCESS 4JAB CLAIMS-MADE AGGREGATE $15,000,wo DED I X RETENTION S_p Is WO - RICERS YEW LIABILITY COMPENSATION B ON , WCA315872922 1/12020 1/12Q21 x PER_ AND EMPLOYERS'WLBIUTY Y/N -k STATl1TE" ANY PROPRIETORIPARTNER/EXECUTIVE E L EACH ACCIDENT $1,000,000 OFFICERNEMBER EXCLUDED? ❑N N I A (Mandatory In NH) EL DISEASE=EA EMPLOYE S 1,000,ODO It yyes,describe under DESCRIPTION OF OPERATIONS below ., EL DISEASE-POLICY LIMIT 31,000,000 C Pollullon Liability 7930073340002 Clalms-Made Policy 1/12020 1N2 ceun 021 EadlOence- ffi3OOD,000 Retroactive Data o82t12013 - Oe9du�W-8 $2:aw0= DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addmono Remaft Schedwe,maybe attached if more space is required). _ . a Subject to all policy terms and conditions. Y=` ' CERTIFICATE HOLDER' -CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN- ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 15(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable �� -a o=3 Eq,;res ammdLs fiomfsme date 4 4 Regulatory Services opq`- Feet fQ anarisTaar.� � — arass �, 4*4 if) Y�� Richard V.,Scali,Interim Director Division JAN 0 Nil- %fiding PER Tom Perry,CSO,Building Commissionrr� 6 200'Iain Street Hyannis,MA 02601 �°" OF MI'mtown.barnstable.ma.us ARIV44 Office: 508-862-4038 Fax 508g4k 6230 EXPRESS LERMT APPLICATION - RESIDIENTL41 ONLY Nat VaUd whhour Red X-Press Imorint Map/parcel-Number,j 9 �L 00A `Le— (Residential Value of Work-S Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address rS o►1 Contractor's Name 57cH' W^al.�. �},•r�z•, S / f iG t�or1 n i Telephone Numberffin l)2 g-G k ZO Home Improvement Contractor License_(if applicable) 7 32 LL Email: Construction Supervisor's License j(if applicable)_p ci�:Zj)? 19Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I-am the Homeowner I have Worker's Compensation Insurance Insurance Company Name_ A rAn,l G%it %r o to Y1 Ce_ Workmen's Comp.Policy I;tlC 19 L8n - 3��2 3 C1't 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 t! ❑Re-roof(hurricane naled)(not stripping_ Going over.,-.existing layers of roof) ❑ Re-side M Replacement Windows/doorsliders-U-Value y sl • 3 O (maximum 3':a of windo-ws 7 . : I of doors: - ❑ Smoke/Carbdn Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&-*ire Permits required. *Where required: issvamce of this permit does not exempt compliance with other Unva department regulations,i.e.Historic;Conservation,etc. " Mote. Propertypner nuit sign Property Owner Letter of Permission. A copy it the Home Improvement Contractors License&Construction Upervisors License is regtured. - - SIGNATURE• QATPFILESIFORMS1Wdd'mg permit foranOUIRBS.doc _ Revised 06131-7 'I°J`.Y�t`l C 173702i18Reneral byA, nM6t64 RENEWAL BY ANDERSEN g� ad- CT I.aXn1E NOW{SSS wnsor MEW_Qt r.t-u no ac; 26 Albion Ro "'L�ncobi;.123 02ii65 lied tam aizzT: Aj G Phone 866.56E 2235•Fax-401,633 66ff 1 �WCW Tax m a46-bscssso ��4 � Southem New England Widows;I.LC d/bra . of.Soathern New England w . Renewaf by Anderne» �t C SfOM.WiNDOWANDDOORREMODELIIVGAGREEMBIVT m 9F17T, D 56w,(,)saw"A!&csc(g3aa°uidZiyCode 11 :sox `�•I`•. ^.-_,..._x x.. ._. 6600 t6M•il .... _MaeaTekokoaeMrmber• ��WoeTlRlealOonerermbe;- -- =Buytr(sj liaebyjmrity and segcrally -es topurcf ass thepn, ucts aod/oraertnc of Southern NcevEnglan I:Windowe,LLC d%bYa Renewal; `by Ai,&n n of Southern New-Frig' d oContracto d ihe:reverse o Ibis ageeemint and'on the.atra b Historlc [I Condo. Ci HOA2: Toia1 aban«i15t 'L Y Y Eigmttco-starttrecuc. Method of P�mait ,o check t�cash ftgance0 _ __ _. � _ __ T C C�}s�rear<cept>fd for�dgpsuit atdX mttdtrttxn 1!3 of d►as ... . -- Beiruice tt SnrE of Job(3376) Fsumue0 Camptetton l3xc prgect cost(Pkese see Cridit Card Hrytlleet form)By signing this a tterrt you atJmowtedge tfitt the Baltltce at Snrt of Job andthe= Battnce on SL+t+� 1 / �2 W k^ on SubscantlaF Completwn of job annot be made by credit, 'Comptedon of Job(337 Qr G _card and must ba snide by personal check ink cheeic`or Hill' Bdyer( )s dad nnderetaa that thts enL conatriotes tke',entrre uadtrstaa' agrees m long between the parties,,and that there 4i:- o verbal onderstan gs ehan�n$anyof the terms of.this Agreement Btryer(s)aclmowtedgta that`Bnyer(s) (1)bas deed this Agreeiaiiiti a stande the tertne of tbts Agree 0ps and hob received a cotsfpleted,atgned,dad dated, copy of'tlils Agreeiment,in'cht t1e two attiched IVooloes ofiCanoelladon,oadre datcfurst written above,aad(2)was oraity informed of Bnydr s right to c "t6ssAg ePa erit:=DO NOT$IGN TEi1$GO1yT1tACT IF;TSERS AR$AI11y BLAIVB SPACES.; (R/►ode Island Salsa Only)Nott 46 ers(1)bo notsiga eh is°Agreement if.asiy;of the spa«s intended faz We agreed terms; to tlee esctlnt of tTeii available on ale leR blank](2)Yon are eadtled to s►copy of thiaAgreement sit the t>rnc you sign fit.(3)Yon-may at:any time'paq . 'ifie foII Hope,d 6alaace dne-ender t)is Agreement,aiid is eo doing you may be entitled io: receive a=ptisdal rebate of she u and ieaaraactcharges:{9)The seller has tto right to ndttwtully enter yot pretnisea° ros commit nay breach of the to repossess goods pnsohased ender this Agreement•(Sj You nay teasel this meat if rt has qot beeast$ned at;the oi$ce or a breach ogee of the seller,provided pon''notffy the seller as bra orr main' :o&e or branch office shown m eAgreement by registered o certified mail,vvbsch atiall be posted not Inter rhea midai t' "of the third calendar day alter day oa which the bayer st$ns the Agreement,exctudtng gnnday and nay holiday oawh>ch? eegatas_inail'detirri}ee aredot , ,_"rSee the;aceonRpaayuttgnottce of cancellation Corm for an vcplaaatioa:of bnyer'e n�tp.; 13u�er(s)secetvedil c co>a�tsrtier edu a:matcctals provided by the ItFiode Island Contraetoislteglstratlgn Board ($uyei's Irrta4L _ __ --- ;Renewal by Andes of 3 rretrFmgliud ;Signature°_, dud-Alwia TrI tgna ure Signature' . f✓� ;.print...'attte of Product-Man Print Narnc> t'rint.Vame•. YOII, TIC BUYSit(S),MAY dwTHIS iWMACTION,�AT ANY TIME?PRI6A4w h6WiGHT OP TIfIi THIRD )3USM _g DAY AFTER Tt DA OE THIS,TRAPISACTION SEE THH ATTACIiBD t!tOT[CE OF`CAIYCBT.LATIONFORMF f FOR AN;EXPLANATION OF S 1tIGHT O NOfICE OF CANCE t AMfi aru Date of Transactson f You malt cancel I *Date of Transaction You may cancel .this transaeeton,widwut ally orro6li ,within this araitsaetiotl,without 8atlon.,. arty Penalty or obltgadon,witfttm `three business days from the date N jrou cancel,any i three business♦d from tthe abmre date,If you cancel,arty' >pt�operty:ttatded ln►airy Pal' rttade bJr you under the ! pertJtraded ,arryj:paYmtinft matk�zrfyou�tutdee thg Contracti or Bate'and an-:nego Jnstrument executed' I ontraict or$ale,and any negotiable tnstntmeriGexewted by you will be rot uvted within en`braless days(Wowing 1 by you'will bi redwned;within ten business days following" ;reset t the Seller of yourellapon notice,and arty sreceipt b e Sdkr of<your canoeitatfon notiaand ark_ =sec est a*y1n8 t tii: - tl iwitl b slit ttit� otff of dte3;'6 rttaedon,will Be;. 'ranceled•.If,you cancel,you must eke available to she Seller tatrtteled If you cancel you mustmake`av�abfe to tits Seller tat your residence in subst9+!ti as good condtdon as when i at your residence.in wbstantially;as good candttion as when 'i?eceivi�;dory Isootsdeltvefad to ` tinder his Contractor I ItteceitreA7,srty Soods delitared ybu tmdee this Contractor; Sale,or you may,,tf:you wish,ao ipy-anth ehI #iStruceions of Sak,or-''you may,rf you wish,comply with the mttructiom of,' �tlte Seller regarding the return pmertt of the goods at the the Seller regardinngg rile eewm shipmarttof the goods at the Seller's �, n�artd risl�If you males the,gg0000ds available Seller's; artd risk.N you do make the ggaaootltlss available' to'the Se and'tlie Seller do not pld'them tip=within r: to the Sand rile Seller does not pick them`up within; ertty'd of the date'of can Uatton,you.may retgtn or ! twenty d of:the date of cancollaenrq you may retain or tdtspose of fire goods without furtJeer obligation.If you I` di se o the goods without a' turtlter=obligation If gout fail to make file goods available the Seller,or if you,agree l. hto make tf+i3 goods available to the Seller,or if you agree: to return ttte gqo�o�ds to the Shca acid fail bo°do so,then you r i to return the good:to the Seller'and fatl•:to do so; "You: remain liable Torperforn+anc� fall obligations tinder eha_ 1' remain treble r perforritance of all obligation9 under the_ Contract To.caiseel this career n`;mail o►'deltver 3;slgrxd ContraetTo canoe!this'transactton,' "-- ar deliver a signed rand dated copy of flits cancel) on notice or any other 1 and dated copy of this,cancellation notice or any. odter. written notice,or,send A.''. to;Reriewal a of" ), written notice,or send a to to Reoewa144yAndenen of ,`Souther-,New Eng1and-at:2 -Al tsrt', ( 2865;. I'; Soutliervt Natty England,aeon Road'Lincoln ft102835 NOT LATEItTHI►N MIONIGH `OF NOT LATERTRAN MIDNIGHT OF (per _ Date jf HEREBY CANCEL __ GT10N.. i I HEREBY GANCELTHISTRANSACTtON. auyae's'stgiatia. - -� �t Hum oaa suyrs stolsein.; C haK llatn. Dw. 'MA Copy:White; Buyer C pi-*Yellow Buyer Copy:NO Southern New England Windows d.b.a Renewal by Andersen of SNE 4 Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor i 5 License: CS49M a BRLLN D DBNNMglbN 77/��I.�AM��B��S F(M Lit 9 Chariton MA 01597 f Expiration - commis 09/08MIG �i2e �pom�/r�2,a�ul1E� o�,��GG,66a�LffQ�l Office of Consumer Affairs end Business Regulation • 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement.Contractor Registration Regisfttim 173245 Type: supplonvaI Card SOUTHERN NEW ENGLAND WINDOWS LL. ton" 91192016 DENNISON BRIAN -- -- 26 ALBION RD --- LINCOLN,RI 02865 Update Address and return card Mark reason For change. SCA 1 o asuosm 0 Address E:neaewai Q Employment ❑Last Card *E of Comenmr Affairs&Bodeen Resalation Lieeose or registration raBd For individal use only IMPROVEMENT CONTRACTOR be[orclhe a:plratien date.Moved return to: Office of Consumer Affain and Business Regulation n: 173M Type. 10 Park Flares-SuW 5178 EnAnolon: Blivnit /SUPP1emeM';W Boston,MA02116 SOUTHERN NEW ENGLAND WINDOWS U:C. RENEWAL 13YANOERSON DENNISON BROW -� 26 ALBION RD ? 4o r c _ UNCOLN,RI t)2865 Uad---I y Not valid srilhoat sigaatere 1 he commonweatth of Massacnuseus - Department of IndustrialAccidents Office of Investigations i; 1 Congress Street,Suite 100 Boston,MA 02114-2017 '''''� www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDOWS Address:26 Albion Rd City/State/Zip:Lincoln, RI 02865 Phone#:401-228-9800 Are you an employer?Check the appropriate box: Type of project(required): ,4 ` 20+ 4. I am a general contractor and I I.n I�a employer with ❑ g 6. .New construction etr2ployees(full and/or part-time).*.., have hired the sub-contractors, ❑ 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' comp.insurance comp.insurance 10. Electrical repairs airs or additions required.] 5. ❑ We area corporation and its ❑ 3.❑ I am a homeowner doing all work officers have exercised their 11:❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per.MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no / employees. [No workers' 13. Other fn)/ D�l�'lQ comp. insurance required.] fiS *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 submits 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 %vorkers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:ARGONAUT INS. CO. Policy#or Self-ins.Lic.#:WC 928058352394 Expiration Date:8/21/2016 Job Site Address: " 1—R('G1-) �A/l _ 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_ 25k-,Pf 1TGL 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 ag civil-penalties in the form of a STOP WORK ORDER and a fine �I 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' urance coverage verification. I do hereby cerIM under the s and penalties ofperjury that the information provided above is true and correct: c Si afore: Date: _ Phone# 4012289800 Official use only. Do not write in this area;to be completed by city or town official. City or Town: Permit/License# r Issuing Authority(circle one) 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6:Other Contact Person: Phone#: f SOUTNEW-01 SHETTYSHT ACORO� CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 8/19/219/2015 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 CONTANAME: Willis Certificate Center Willis of New Jersey,Inc. PHONE FAX c/o 26 Century Blvd A/c No 6t:(877)945-7378 A/C No;(888)467-2378 P.O.Box 305191 A DRESS:certificates@willis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of Southeast 39926 INSURED INSURER B:OneBeacon Insurance Company 21970 Southern New England Windows LLC INSURER C:Argonaut Insurance Company 19801 D/BIA Renewal by Andersen 26 Albion Road INSURER D: Lincoln,RI 02865 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X❑OCCUR S 2029459 0811012015 08/10I2016 100,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY N JEOCT- LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: _ $ AUTOMOBILE LIABILITY EOa aBINED SINGLE LIMIT $ 1,000,000 A X ANY AUTO S 2029459 08/10/2015 08/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S 2029459 08/10/2015 08/10/2016 AGGREGATE $ 5,000,000 DED I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA 0000068028 08/21/2015 0812112016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under ' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Workers Compensation WC928058352394 08/21/2015 08/2112016 See Attached DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance /04 ©1988-2014 ACORD CORPORATION. All rights reserved: ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 Parcel .:'Application # Health Division Date Issued a1 Conservation Division ` Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 10�2��1 i ri Preservation /Historic - O KH Hyannis Project Street Address /� C- -LAI e-AV b Village Owner HewsoAj Address. Telephone Ise J� 7 Permit Request Lu /V �✓�✓ r r ✓USo7,4 io✓v Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.`. Dwelling Type: Single Family . Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other ,Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stogie: El Yes ❑ No Detached garage: ❑ existing 0 new size—Pool: ❑ existing ❑ new size _ Barn:`:q existing❑ net size_ rAttached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other Iw _ R. Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ � , Commercial ❑Yes ❑ No If yes, site plan review # rn $. Current Use - Proposed Use S'✓�- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - q!/ Name r C JOte P/�✓� Telephone Number '50�- Address ,�✓� US �a ! Rd License # 7 60,go � of 0 Home Improvement Contractor# ��41 o Worker's Compensation # W IJ1; T0g oc yg ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PRO J CT WILL BE TAKEN TO Wom f SIGNATURE DATE I 0 _�/ m FOR OFFICIAL USE ONLY y rj APPLICATION# DATE ISSUED _ MAP/PARCEL NO.: r ADDRESS VILLAGE k - } OWNER Ef R; DATE OF INSPECTION: k FOUNDATION" � ' y ' FRAME c INSULATION -, FIREPLACE '{ ELECTRICAL: ROUGH FINAL .k PLUMBING: ROUGH FINAL r GAS:•- ,U-,v- ROUGH FINAL a ;,FINAL BUILDING; .-A ` } = .DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachuseft Department of Industrial Accidents Offlce of Invesdgadom 600 Washington Street Boston,MA 02111 www.mossgov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information- Please Print Legpflbly Name(Bwinesa/Organizadodindividual): eO N Address: N Ci / ti:JV : /°/1 1 r!j Phone#, i� ,� - 0 Are n as employer?Chet a appropriate bom l. I am a employer with 4. [] I am a general contractor and I Type of project(required): employees(R�ll and/or p -time).• have hired the sub-contractors 6• (]New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet, 7. []Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' 8' ❑Demolition [No workers'comp. insurance comp.insurance.t 9• ❑Building addition required:] 5. C3 We are a corporation and its I0.C]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.(]P in g repairs or additions myself.[No workers'comp. right of exemption per MGL 12 oaf insurance required] t c. 152,$1(4),and we have no repairs ) 3a.❑ I am a homeowner acting as a employees.[No workers' 13. Other r' Srr/ p/1/ general contractor(refer to#4) comp,insurance ] Any epplisot that checks twat NI moat also fill out the section below showing&*workers'coMPnsadcdooucy intamadoo, r Homeowners who submit this amdavit indicating they are doing all work and then hire outside contntcton must submit a new atHdsvit indicatin such. tConeractors that check this boat must attached an a"donal sheet showing twe name of the sub-conhsMow and state whether a not twos entiti g es have employees. If the sub-oontrectas have employees,they must provide their workers'comp,policy number. I an an employer that Is providing workers eompenwdon b"arance for my crop/ inforsndtiaa °YM Below is the polky and Job site Insurance Company Name: edrl , //p Y Policy#or Self-ins. Lie.,#: Lt/ ��I Expiration Date: C-,?L? Job Site Address; A City/StatdZip: Attach a copy of the workers'compensation policy deelarsdon page(showing the policy number and expiration date). 3� Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties fine up to 31,500.00 and/or one-year imprisonment;as weir as civil penalties in the form of a STOP WORK ORDER and a of 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 Invesdgadons of the DLVer insurance coverage verification. I do herby a der the p d penafto of pwIW7 ghat the In madew� provided about!,titre and eonertt sssss Shona#: O ldW use onilt Do not write in this arM'to be complet rd by city or town o,Q'lcia[ City or Town: Permit[License# Issuing Authority(circle one): 1. Board of Health L Building Department 3.CityfTown Clerk 4 6r Other • E[eeMcal Inspector S. PlumbingInspector p Contact Person: Phone#: a Information and Instructions 4 b&*av m eal , p Laws chapeau 152 mplirea all ampbyafs '& c� contact otbics` P=uad to this Stalin an M/b�is defined as"...awfY 1w 'express of implie4 oral or wrote." ,sock"cogwadofa or other laps endt o of my two or mats As aarpltya►is defined a"ss �� ots deceased ea4loya4 a the ofdw trsSbst 60510 d per !►srsocistiar err othst lepl seller.mod K�the not mars tip•�apsfUMON Said who a dam tiSSai; dboast of Saothst who ampio2s P�Oa 0o do ms CO��of t�wall on such dwegbq boost or on the p agod•or b tbrett shah notbeesm.otsrrcA ampbym�be domed to be as empbyec" MOL ch@PIW 112.425gd)AND SWO thr""My Sb"w'"d drop bg spary.Siar WUMM d tit bstset err a btdbar err to eeoslr+rt boubp In tat eo�warsalek dtrr asq restwai of a Beanies w permit to�a ^��d etoe4l�wNf1 tilt tas�aetst avarap n9�'�» applba�t wb br sttpr+sd�of "Neither the - ear eery otib politieai SubdiviSiona SbJt ,d�di inw a. pnza chapter p ! of do wort undt accepdbtt aridnw o(cosr�iasot with de iooecaaem eats IaL Ssy cooaaet cbR the P� Mvdrowaft of ells cbptst have bete promind to the comboadoll 301h 11Y• appYeaw tit boaw that Sppiy to year Sitwdos steel,u Please d>a nut he waist'co�arpa�dos afitdnit '��a witk tbir cerdAcab(i)d , bnteacto*)nmo* )r ad�ime(w)sea pttoao aetmba( )atom other dens do Wgurowa Limiled L.la ft Cosupaain(LLB at Liam od LiobWty Pamamiipa(ice*rid!ao emplsysas rdmbors at pwftwar M not MPMA to carry worbear con+p--AA�itioaaaea if LLC at LLl doss bavt engbyo%a pow it Be advised dh&die aAldoi may be submitted w the Depa UMM of indtrslriai Atom ob tt dmadort d bm--mp-covaafa Alto b•Snro 19210 sad dab tit alttiaviL 'i'ho afltidavit Sion d bt r-l— M d the cih er tows the tie"M ada lbr tie pawb or iieaest to bdsp dr ispo wo tb Accidsats� Should yen ham asy quesdow t tit law et VIM sat regeetead b obtds a wabSr�heir [nduserW Should eattt c�peaddott podgy,phew Bali tit DepsrdmSrrt�aerorbt listed blows Seltimw"caerpaaies Seighom arts Hesast anmbar oSr do Ctty a Taws O/Ada1S . Moos be we that tit affidavit V Sad Pry�t�• 'i3t 0°s��a Spaa at tie hams of tho dad"for you to bin t fm out In 68 evaat tie OfQet of investipdoer bas to conod yao repfp do aPP� Ptesst be Sort b p �bnr wbkk wilt bo rued a a ret6eeaes MMISts Gs addWW%M plat o beSubmit nd�b P�°�� is my tin Y�0ed Gully Sobadt ono a@idtivit indicating cum polity td subsb(i<are OR and r'�"lob Sir Adrk+e a the applicant dMid writ"tit iocaduee tn_JctY a cows}"A copy ddw adkkvit fist bw bete oMdWIF sm4od a MN&Bd by tM ciW or loam any bt prvvWod W the appagod'r peoddod s valid addsn►k 1002 fill tier b ptrnals or 1lsUMS A now at'lldavit mmt be 81Yd out to h to yew.%I a boars' oars owarr of cubes It obubft a I OMO er permit Munch"IN Say busbao of coa®freiel Vewwo (i.e.a do{Beans-or permit to burs leaves ttS.)Said person is NOT requited to conIlets this afdtwL Tttt OQios of iavadpeiow would lib at thank you is Sdvaes its yaet eooperados Sad Should yet haw say"lion piton do not b"008 Is ph"a a call. efts Des ad&M tdePbono Sad deer n- That CO tb at MatswARMtb Oep t of I wkWd Acaldetnb Office of faw"Pdow 600 Was &910o SWd Boston;MA02111 Tel. 0 611-7214900 ext 406 Ot I'V"'NfASSAFB Fax is 611.721.1749 Revised 1 t•2246 w"num pv/dIs n3 � DATE(MMIDODIYYYY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE He3tvER-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 kn REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. a 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 13 NAME: AOn Risk Services Central, Inc. PHONE FAX Southfield MI Office (A/c.No.Ext): C866) 283-7122 Arc.No.): (847) 953-5390 3000 Town Center E-MAIL O suite 3000 ADDRESS: Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE HAIC# INSURED INSURER A: Old Republic Ins Co 24147 �, Builder services Group, Inc. INSURERB: ACE American Insurance Company 22667 d/b/a Quality Insulation & Building Products INSURER C: Indemnity Insurance Co of North America 43575 A-Masco Corporation Company INSURERD: 2 Industrial Road Milford MA 01757 USA INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:570043004588 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. Limits shown are as requested ADD POLICYFXP INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDPOLID/YYYY MMID Y EFF LIMBS A GENERAL LIABILITY MWZY 1M/30/2011-66/30/2012 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTO X COMMERCIAL GENERAL LtAmu-rY PREMISES Ea occurrence $2,000,000 CLAIMS-MADE X❑OCCUR MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $2,000,000 m GENERAL AGGREGATE $5,000,006 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $10,000,000 7XPOLICY MPRO- M LOC - o JECT n A AUTOMOBILE LIABILITY MWTB 18398-11 '06/30 2011 0 30 2012 COMBINED SINGLE LIMN u' (Ea accident) E5,000,000 XANY AUTO BODILY INJURY(Per person) , 0 ALL OWNED SCHEDULED BODILY INJURY(Per accident) 01 . AUTOS AUTOS NON-OWNED - PROPERTY DAMAGE -M X HIRED AUTOS X (Per accident) t AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS UAB CLAIMS-MADE AGGREGATE DED I IRETENTION - C WORKERS COMPENSATION AND WLRC46480648 06/30/2011 06 30/2012 X TC GTA MIal ETM EMPLOYERS'LIABILITY YIN Deductible - ADS ANY PROPRIETOR I PARTNER I EXECUTIVE a N/A SCFC4648065A 06/30/2011 06/30/2012 E.L.EACH ACCIDENT $1,000,000 B OFFICERIMEMBEiEXCLUDED? (Mandatory In NH) Ret ro - AZ,HI,MA,OR,WI E.L.DISEASE-EA EMPLOYEE S1,000,000 IT yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Excess WC wcuc46480624 06/30/2011 06/30/2012 Retention $2,000,000 Self-Insured States statutory Included SIR applies per policy terns & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,B more space is required) - THD At-Home Services, Inc. and the Home Depot are included as Additional Insured.with respect.to the General Liability policy, I as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE v� POLICY PROVISIONS. THD At-Home Services, Inc. AUTHORIZED REPRESENTATIVE dba The Home Depot at Homes Services 2690 Cumberland P suite 300 Atlanta USA Atlanta GA 30339 USA .TCJs�EO ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I �la.,;tchuvlt, I)clearuncnt of Ntihlic N:ticl. Beard ui' Buitdinu Res-sulatia#n, and slanilard. �tl Construction Supervisor Specialty License License: CS SL 104189 Restricted to: RF,WS,SF,IC THEODORE PLONA CL _ 18 THAYER AVE AUBURN, MA 01501 EApirattom 9A312012 1 ..nNni..i„Ha r Tra: 1001419 Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 no Home Improvement Contractor Registration Replstraticn: 153418 Type: Private Corporation Expiration: Ilr'=012 Trf 206907 BUILDER SERVICES GROUP INC. THEODORE PLONA 2339 WALLE RD DAYTONABEACH, FL 32119 to Update Address and return card.Mark reason for change_ Opg�, Addrw Reoetrat Emplopatant Lost card UD a W4.o4XWot0if16 t m in ® ,,,� C.. OUkc of at alit Beinaw 1 "N Licowor reostrasien vatitfor lndhidut use only 40ME IMPROVEMENT CONTRAGTOR before the expiration date. irround return to: R*1110 ratilcm t53418 typo: 001ce of Consumer Affairs'and Rusloess Regulation Expiration: 11J30124t2 Private Conwatian 10 Park Plaza-Suite5170 Roston.MA 02 1116 m VOWUL'itt SERVICES GROUP*X. ® THEODORE PLONA .Z 2INDUSTRIAL RD. OF to i1IM!FORD.M&01737 N. UodernrreU�y Hof valid vriAroatsigrtatYre N 1 4; �1HE,q,�ti Town of Barnstable Regulatory Services MASS g Thomas F. Geiler,Director 1639. �0 Building Division Tom Perry,Building Commissioner 200 Main Street,`Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, .Z/1f' as Owner of the subject property . hereby authorize eo op P/O/V A to Y behalf,. act on ray f,. _ in all matters relative to work authorized by this building pemsit 71 L14rch t/l/ (Address of Job) **Pool fences and alarms are,the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Si tare of Owner Signs e of Applicant. Print Naive Print Name to- Date Q:FORM&O W NERPERMIS SIONPOOLS THE T Town of Barnstable Regulatory Services anaxsr" E Thomas F.Geiler,Director y arnss. �A 1639. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides.or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered'a homeowner: Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance.with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness.often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt r s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION o p e 01.- Map b Parcel 0 6 PXt 00 b Application # 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 L MoY—On L m Village Ca nag(` Owner E4 I c, PC_(os n r) ---Address Telephone Permit Request D1 awn A4�ic JZ - 36 (,Jaj1 12 - t5 �lo�r c� ( �uase Square feet: 1 st floor: existing proposed _2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type j g Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. ri Dwelling Type: Single Family lip( Two Family ❑ Multi-Family(# units) Age of Existing Structure 19 81 Historic House: ❑Yes ❑ No On Old King's Highway:�0 Yes ❑ No Ln j � Basement Type: � Full ❑ Crawl ❑Walkout ❑ Other 0 � Basement Finished Area(sq.ft.) n Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: 3 existing — new Total Room Count (not including baths): existing q new First Floor Room Count Heat Type and Fuel: 29 Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes a 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:Aexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION , (BUILDER OR HOMEOWNER) Name ►��a Iv ICG- S"e,. Telephone Number 509 ` 3 l 0 03 9 o t Address k4i� 6n kv� License # C 110 Home Improvement Contractor# b Worker's Compensation # 5530951 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 1 aM ot)4 SIGNATURE DATE r� f FOR OFFICIAL USE ONLY w, APPLICATION# r` DATE ISSUED MAP/PARCELNO. ! j ' I ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL'; PLUMBING: ROUGH FINAL' , GAS: ROUGH FINAL" FINAL BUILDING DATE CLOSED OUT i ASSOCIATION PLAN NO. t , E I c The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): M I C. E( C 1 iis i(" D1181A J^ ; iA Address: -l-C. City/State/Zip: S YP iz4mosm A one#: Are you an employer? Check the appropriate box: 4: I am a general contractor and I Type of project(required): 1. I gin a employer with 6. ❑New construction employees(full and/or.part-time).* have[aired the sub-contractors . 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [] Remodeling ship.and have no employees These sub-contractors have �. [].Demolition working for me in any capacity. employees and have workers' 9. [] Building addition [No workers' cotiip. insurance comp.insurance.- required.] 5 We are a corporation and its 10.0 Electrical repairs or additions offieers.have exercised their 3.❑ I am a homeowner doing all work I I.[] Plumbing repairs or additions myself. No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] c. 152,§1(4),and we have no employees. [No workers' 13.0 Othcr )yt 5 y �6�or comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check.this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site information. Insurance.Company Name: ki S�A Policy#or Self,-ins.Lie.M. G 3.- 6-9 Expiration Date: Job Site Address: "I l �0&c h L Wf1� City/State/Zip: GA-It Me, tA Q b 3 d. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the.imposition of criminal penalties of a . fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine: of up to:$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of. Investigations of the DIA for insurance coverage verification. I do hereby certify under:thepaiiis,,andRenaltiesyfRerjury.that the information provided above is true and correct. 4 Si ature: Date: Phone#: Official use.onlp. Do not write in this area,to be completed by ch),or tosen official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk '4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE 1/1. 201.0- 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 ON CT Shannon S NAME; perrazzat Risk Strategies Company I PHONE (781)986-4400 F Do A (781)463-44e0 15 Pacella Park Drive ADRESS:sperrazza@risk-strategies.com Suite 240 R PRODUCE RlogDO018476 Randolph MA 02368 INSURER(S)AFFORDINGCOVERAGE NAIC# INSURED INSURERA:Seneca Specialty Insurance Co _ INSURER B:Keating Group Ins Services Michael McCluskey, DBA: Cape Save INSURER C-Chartis Insurance 7 C Huntington Ave INSURER D INSURER E: ,—_ .• +� South Yarmouth MA 02644 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1011132675 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, LTRR' TYPE OF INSURANCE Lt I POLICY EF POLICY EXP i POLICY NUMBER i MMr D MMIDO/YYYY ; LIMITS j GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 XCOMMERCIAL GENERAL LIABILITY �� PREMISES(E� ooct ce) $ 50,000 A i ;CLAIMS-MADE X :OCCUR pnG1002608 ;10/16/2010'10/16/2011j MED EXP(Any one person) !$ 10,000 --- i i PERSONAL&ADV INJURY 1$ 1,000,000 ! GENERAL AGGREGATE is 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: j PRODUCTS-COMPIOP AGG $ 1,000,000 X POLICY" JECj LOC �.. --- :$ AUTOMOBILE LIABILITY t ; COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO �6208200 11/6/2010 11/b/2011 (Eaeccidenq Ti BODILY INJURY(Per person) i$ F_y ALL WANED AUTOS ; BODILY INJURY(Per accident)I X °$ _ ,SCHEDULED AUTOS PROPERTY DAMAGE i X ? HIRED AUTOS i (Per accident) '$ X'NON-OWNED AUTOS 1 � i I X i UMBRELLA LIAR I I OCCUR i ! 1 EACH OCCURRENCE y$ 1,000,000 1 EXCESS UAB ;CLAIMS-MADE I j AGGREGATE — $ 1,000,000 F DEDUCTIBLE B ; RETE14TION $ 1 023578601 10/16/2010 10/16/2011' $ WORKERS COMPENSATION ! VJC STATU- OTH- C T ! YIN Sichael McCluskey ! TORY LIMITS' i ER AND EMPLOYERS X lIAB1LITY 3 ANY PROPRIETORIPARTNER/EXECUTIVE i ]is excluded from coverages 500 000 OFFICER)MEMBER EXCLUDED? j.NIA E.L.EACH ACCIDENT S. (Mandatory in NH) I �9930951 10/21/201010/21/2011 -----�— ! If yyes,desaibe under I I E.L.DISEASE-EA EMPLOYE+✓$ 5QO L000 OESCRIPTtON OF OPERATIONS below i E.L.DISEASE-POLICY LIMIT!$ 500,000 . i I i DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Issued as evidence of insurance. Contractors-Executive Supervisors or Executive Superintendents. 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 Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ruth 460 West: Alain Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601-3698 Michael Christian/SMS �t ACORD 26(2009/09) 01988-2009 ACORD CORPORATION. All rights reserved. INS025(2oawg) The ACORD name and logo are registered marks of ACORD _d�T. • _+< f I '/p.po^nr"g4 Iq}.!_�,�qwp� �.sye+l �a*�'.', �� P �jSd m3�yg. 1;"}(.��qei �ys�p��q `� . Office of Consumer Affaiis and Business Regulation Rg 10 Pair Plaza.- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 164432 Type: Supplement Card CAPE SAVE Expiration: 1 0/6120 1 1 WILLIAM MUCCLUSLEY 8201 S. HOURD CT CHAPEL HILL, NC 27516 ---- Update Address and return card.Mark reason for change. L` >.•., ,_,,., Address ;- ' Renewal 7 Employment i : Lost Card f. :ihe {�o.�rtf z; {a7flsx-Ir r�" r•`�rrx,;• tdd�d? Office of Consumer Affairs&Business Regulation License or registration valid for indirldut use only '}�(t - before the expiration date. If found return to: it, ;HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation rtap + Registration: 164432 Type; 10 Park Plaza-Suite 5170 Expirationt..io/6/2011 Supplement Card Boston,MA 02116 . CAPE SAVE WILLIAM MUCCLUSLEY: , 7C HUNTING AVE.. 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Geiler,Director Fo� a, 1639.Y a Bll1lC11Ila Division Tom Perry,Building Commissioner 200 Main street,Hyannis,]AA 02601 v i",.town.barnstab le..ma.us Office: 508-862-4038 iFax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I> / r 'a ' , as O met of the subject property hereby T authorize Pf,• ;_ to act on m behalf, in all matters relativ8 to`work authorized by this building permit application for: 4Otd,ck C.N CPvi 4eg-\j (Address of Job) A3 Z 61Za- -�- Si.gn ture of Owner T3ate _ ! e A-' 'erse-';t) Print Name If Propea Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:ro7JAS:0W INi�RPERA4ISSi0:`3 i CAPEJO SAVE 1:'��r Weatherization.- 508-398-0398 December 14,2011 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 permit application#201101530, Status A, Parcel 189006008 at 41 Larch Lane, Centerville,Permit type: RADD, and issued on 3/29/2011 has been inspected by a certified Building Performance Institute(BPI) Inspector. R-38,R-18 and R- 10 Cellulose insulation was added to the attic.All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey 1/31►z " Cape Save 7 Huntington Avenue Suite C, South Yarmouth,MA 02664 �2�L3101 ,*'THE T Town of Barnstable *Permit# P�' 0 Fxpires'6 months rom issue date Regulatory Services. Fee • BAaxsrABLE, 59'1639. � Thomas F.Geiler,Director FD �=` �°'s� Building Division PER,,�>'3 ,, � �. S Tom Perry,CBO, Building Commissioner J. _200 Main Street;Hyannis,MA 02601 - C 2 Z009 www.town.barnstable.ina.us TOWN OF BARNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not:Valid without Red X-Press Imprint Map/parcel Number t/ 6 Property Address —` (Re idential Value of Work $31 C1 d 0 0 0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �j - - �Y J Contractor's Name v S _.Telephone Numberr� �- ""�S� Home Improvement Contractor License#(if applicable) > 0 �� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑.I am the Homeowner' I have Worker's Compensation Insurance Io— Insurance Company Name C2 UAIV, Workman's Comp.Policy# 0 " t,10 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 1 �� j�_ ��r O�i I tom(,( Y__&C-Iroof(stripping old shingles) All construction debris will be taken to V► S ❑Re-roof not stripping. Going over existing layers of r000 ❑ Re-side #of doors ❑ Replacement Windows/doo fs/'sliders.U-Value (maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pr perry Own must sign Property Owner Letter of Permission. op y of t me Improvement Contractors License&Construction Supervisors License is re uire SIGNATURE: Qr\WPFILES\FORMS\building permi fo \EXPPESS.doc Revised 090809 Board of Building Regulations and Standards License or registration valid for individ.ul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building regulations and Standards Reg1strtL9D; 100740 One Ashburton Place Rm 1301 �P1: :LST[Dt2 23/2010 Boston Ma. 02103 —S"U �Dlement Card CAPIZZI HOME>Mt ,F� N '� NARY GUSTAFSO4IyiL-= \-" 1645 Newton Rd. Cotuit,MA 02635 Administrator 1`Io vali itho,t nature ti- `.i.a+.,.tc'tDaa.+et#;- 1)�;aiartaiairDi of public S:afet� -- -- — B0;trti t l'Bj-.iltti,ag Regi.dadlons acid stlindards •.. Construction Supervisor License License: CS 74640 Restricted to: QQ 2 GARY GUSTAFSON ti� 8 SHORT WAYS M SANDWICH, MA 02563 i E at;`at;:;> : 11/29/2010 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): . a 2 Address: ��.t f�2f2_' . 44 City/State/Zip: Phone.#: Are,you an employer? Check the ap r priate box: Type of project(required):- )'�_tmnployees m a employer with 4. ❑ I am a general contractor and I(full and/or p rt-time). have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees,and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.$. required.] 5. ❑ We are a corporation and its' 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑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 showingtheir workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Z _ Insurance Company Name:_ 6, ! Policy#or Self-ins. Lic.#: G 6 9r✓ Expiration Date: Job Site Address: 1CAn t/ i� /j/H'C/h/�'��`C _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 ffisprance coverage verification. ' —I—do—hereby yi-d r-der is-and alties fperju-ry-that-the-information-pro vided-abav�e- -is-trueand-correct.f e nnn Si ature: Date: NPhone#: — S' Official use only. Do not write in this area,to be completed by city or town offcciai City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• ACORD. CERTIFICATE OF LIABILITY INSURANCE 0DATE 5/07/9Dmm PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers 8r Gray Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 1601 South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Insurance Co. Capizzi Home Improvement,Inc. INSURERB: NATIONAL UNION FIRE INS. Capizzi Enterprises, Inc. INSURER C: 1645 Newtown Road INSURER D: Cotuit,MA 02635 ' INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS POLICY EFFECTIVE POLICY EXPIRATION LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE(MM/DDrM LIMITS A GENERAL LIABILITY MPB1075H 06/08/09 06/08/10 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO ce $500 OOO CLAIMS MADE Fx_]OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1 1000,000 GENERAL AGGREGATE $2 00O 000 GEN'L AGGREGATE LIMIT APPLIES PER: < PRODUCTS-COMP/OP AGG $2 000 000 POLICY X JECOT ELOG A AUTOMOBILE LIABILITY BPOI0786 06/08/09 06/08/10 COMBINED SINGLE LIMIT $500,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS * BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY CUB1076H 06/08/09 06/08/10 EACH OCCURRENCE $5 000 000 X OCCUR F—ICLAIMS MADE AGGREGATE $5 000 000 $ RDEDUCTIBLE y $ X RETENTION $10000 $ TATU B WORKERS COMPENSATION AND WC006957000 12/25/08 12/25/09 X WC SLIMIT OER TH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below r:7 LICY LIMIT $1,000,000 OTHER £' DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S43470/M43449 KW © ACORD CORPORATION 1988 r Page 7 of 7 CAPIZZI HOME R PROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERNUT OWN THE PROPERTY LOCATED AT__�f' I L n INMASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING . CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS` STATE BUILDING CODE. SIGNATURE OF OWNER: J. OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE:. LESSEE'S ADDRESS: LESSEE'S TELEPHONE: = , APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS:, 1645 Newtown Rd.,Cotuit,MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: pe Assessor's map and lot number ... ....................... �O%TNEropy Sewa .............ge Permit number ........ ........ 33A"STAXLE, House number roVASIL O 1639- 101 M TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................... ......... ........... TYPE OF CONSTRUCTION ...................... ................................................................ L..........19. .�.6 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby, applies for as permit according to the'`following information: � ........� M. ........ ........................ .......... ........... ... ..... ......... ........ .. Location ................. Proposed Use ....................PAAP-:?J,.L�M. ........ ............... .................................................................................. P(,.......... ZoningDistrict ....................... ................................Fire District .............................................................................. Name of Owner .... ......7:/. Ajw)..-t...... ...................Address....... ......Te, ....... ±.Q.....13...... A Name of Builder .. ... CP� 0.,.q .....jc Address. ..................................................................................... P Name of Architect //. ........ ....... ...............VN..........Address ............. ...... a. Number of Rooms ..................... .........................................Foundation ................. Exterior ................... ....................................Ro ofing ........................G ............................................................ Floors ..................... ........................................Interior .................................,.................................................... .....................Heating .........................qKr. ..............................................Plumbing ............. Fireplace ..................... pl ...... ................................. ...............Approximate Cost ........................ .......................................... 1�' /5 Definitive Plan 'Approved by Planning Board --------19 Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ,Zzu/."Name ...... ... ........... Construction Supervisor s License ........(.0�w2 ...... S L S TRUST A=18 9-6,006 - 0 0 No ...R9.!QZ... Permit for ....112...S.t.ory.............. ............ y..,D.W ................... Location .....LQ.r..ft.a .....................C.P,.1fttgx.v.i11P................................... Owner ........$ t........... ... .......... Type of Construction ..........Fr=P....................... o ...................................................................... ........... Plot ............................ Lot ................................ Ma 7.....................19 86 Permit Granted .................y.. ...jl Date of Inspection .. .................................19 Date Completed ................... ............ ......19 P&RT- ® H. o �< �s As'essor's�rnap and lot riumber ... . ` ...�.... ...............Q SEPTIC STEM p{wpLIANC OF THE t0 o INSTALLED IN C Sewage Permit number ....�.�..'. 7.................... WITH TITLE 5 House number -..... �........ • /, " ENV ENVIRONMENTAL CODE A BASBSTAMLE, : TOWN REGULATIONS voA'�DypY.a\em� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........................................1.... ..:.. .................,........................... TYPE OF .CONSTRUCTION ......................:.��1�.....��............................................................. 21.......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereb applies for a permit a cording to the following information: /` Location .................. ......... .............. ........... .................!! .......... ... !`�` ......... �1/'!/1.2111�! .....:.......................... ProposedUse ....................1 Ae".. X4/.v.-.,.q.............................................................................................,........................... Zoning District .......................!` `.................................. ...Fire District ................ ................................................ Name of Owner .... .5..... .�/1��.�.........................Address ... .,13�..... .... .�� .�3 2.... .�7�.(.ti!!V'v5 GL h4 0W G� Name of Builder .................. ...........................�'��.:....'......Address ...............................................,.................................... / ►!W►cl> !?.....Q�- C� ...........Address ...�`�!. ...lo.t ...... fown"...V Name of Architect . .... �•• .. .•.....••. Q� Number of Rooms .....................ate...........................................Foundation ........................... �� Exlerior .................. ... 9.. ................................... RoofingP........................................................... Floors ;....................Interior ................. ......... . ................... .P 1�, . ................................................ Heating ..............................................Plumbing e'" / ................ � "u ........................ ..... ... .. .... C'��vl .. .........�G.. ....... Fireplace .................... .. ..................................,..............Approximate. Cost ...................... ............. ��............... ......... �p �,, S Definitive Plan Approved by Planning Board --� .^__ -�----____19_____--. Area ......... ................... Diagram of Lot and Building with Dimensions t Fee ....... .. . ....... SUBJECT TO APPROVAL OF BOARD OF HEALTH vl OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... P. /O r` ....... Construc"on Supervisor's License .......1 /�........... S' L S TRUST i ... Permit for ....Ia...S1:o y............... Single Familywe Dlling e Location ..... ...... �.......... - 'Centerv,ills.....................:::::._- r ......... Owner .......S. L S.....Trus.t................................ ; Type of Construction .....k X toe.......................... ..........:..................................................................... _ Plot ............................ Lot ................................ - r Permit Granted ......... ay... .....................19 86 _ Date'of Inspection ....................'......:19 --,Date Completed ..... .... . Z"5t .................igggloLZ . I r i } M ofTxero• TOWN OF BARNSTABLE Permit No. .2g3A')........ BUILDING DEPARTMENT { Cash ;;a I TOWN OFFICE BUILDING '�P�Dur HYANNIS,MASS.02601 Bond .... .V CERTIFICATE OF USE AND OCCUPANCY Issued to Address USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALIDtAND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED.BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ....... 5enteinbe ..?0D. 19... .......... t Building sp cto`r� TOWN OF BARNSTABLE Permit No. .....: FF BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash FIYANNIS,MASS.02601 Bond ....... ....... CERTIFICATE OF USE AND OCCUPANCY Issued to S L S TRUST Address lot #8 41 Larch Lane, Centerville USE GROUP FIRE GRADING OCCUPANCY LOAD . THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. September 29 19..86..........: �'!-. ?' . ........ ...., .. Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT _ ssaier % TOWN OFFICE BUILDING 039 �� HYANNIS, MASS. 02601 '''Eo r►,r►. MEMO TO: Town Clerk FROM.: Building Department r DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit $k..... Q.�� . ...... .................................................................................................._._.._...................................... issued to 47 -'�.......� .J5..%............. .: .. .. ��/...... !`�f. .... yc...» ......C------ Please release the performance bond. �„ '��b �r a r+�,p'� Far-fa '!>n�'`i � y,hl r �'t,, ♦ � � ;t ti t f _;a _ LtSi' T'' + t a• , t r f + {tti} 4.*�`.`n 'LG'"; .s ? V {,r G� n4 r { { -c^* � ��,41 � >"k w,X`:S��A'' �4�i•t M y ✓ r u�: AE�� rP��y��i^ .S ii3r�:.yti�,n.7L� 'S', � s ,a �isy�a� :"�.,.•c�, t y \,+ 5 ,a '� t+ r a F to ° r 4 �•' )+rf: TOWN OF BARNSTABLE, IvIASSACKUSETTS .` eye. :f tik 6 i�.,i. ry ;': '1 \-sa. FT° V Far"♦51,�er n i - t o etr r�r"3 ,; J ,B E A T H E R - a1 ' ADDRESS i, '+.,i� /"�i' { �{ .` F z I i -yt':• (NO )+ �, (STREET) ^ar IA '. y.y ` (CONTg S:CIC"Sam .�•`' � � 7 � � r ,, V ..i , . .• i .. j rXT� .,��'F�j,-{� ti r r�;:zti e NbP BER' OF 1Ff %: A riA PEP.MIT TO STORY. � .IC1/�' i :IOW LING 11N�TS I ITY PE OFv�IMPROVEMENT)'.r >,NO. s(PROPOS ED',USEI'�" °`" '•`' '•' ^� 14 77 a'. i f^''- fit. ♦' N S. P- r- r. Krw i,T.j!diy 1F k7rt{ /F°° :�=11t r`rA• 3O s �. AT(COCA ION) i kip \ +I �r ha ° '4 r` 1zksyb� OI TF21rr ) ."�f (N0, x.1/ I ✓ 19TREET)r e' ♦'�4 u + ` . c 4)' � ,(fir °. .,,i^G 1� v �°Y�-� i a r�, ti„at •.a q f,.. ,t� Oft 7� r !!I . .^Yp7p hve ►f'•!JC '+fk. i _ t s'• t rh'. :°°/.� 'J^a.°z�.:1'_�'r"'y3';.:i '.- gggg LOT 4 SU Sry <l y BDI' v LOT S� BLOC SIZE r �}•'J r ', 'li -. + l.• ve�•4' a " - 'l �: i u f `r Cj ti� �•,�,r- °>A[ d ��• .. � a. ^* rh �.l � ,� aI ,Y a BIPfLDIHG IS TO'BE ' FT WIDE BY FT LONG BV as "'r of } F -REIGN ANDI SHALLY a, C, NFORM.IN CONSTRUCTION r ,,{ yt '^^ � _ r',a,.l�S,v b rl rt j r '•f A ,n �" PTO TYPE USE GROUP BASEMENT WALLS OR FOUNOAToIONr it,. $"- { _s�. _ r a •k �t Sj'•c t' 'l'"'`�.:s' �riif^syL' T ti A M t `.c� ��5 W {S REMARKS Yal .t t a c o3wi . . 4X.t " ,i , r -Y IA /r�,>'34 ..}�``7� ,� ray ,'4"•S' - ',' r EftM1T AREA ORV- VOLUME; EST IMATEDCOST FEE = ' (CUBIC/SQUARE FEET) �• °.>, j� ♦a a I� '�t, e +- DOWNER, r'7 BUILDINQrDEPT: < • THIS PERMIT- CONVEYS-NO RIGHT. TO ,OCCUPY ANY'STREET;. ALLEY%OR SIDEWALWsOR kNY' PART THEREOF EifHER TEMPORARILY OR .PERMANENTLY. ENCROACHMENTS ON PUB LIC'PROPERTY,.-NOT SPECIFICALLY PERMIT TErD UNDER THE BUILDING' CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALL &GRADESS.AS WELL AS DEPTH AND•LO'CATION"OF PUBLIC SEWERS MAY OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.'THE _ CE OF THIS,PERMIT DOES NOT RE LEASE THE APPLICANT FROM.THE-CONDITIONS joti',OF ANY APPLICABLE SUBDIVISION RESTRICTIONS ' `.`%'MINIMUM OF THREE :CALL' APPROVED`PL'ANS MUST`'b E RETAINED•ON'JOB AND THIS WHERE APPLICABLE SEPARATE �w� INSPECTIONS REQUIRED,F_OR�- - CARD-KEPT POSTED UNTIL FINAL INSPECTION HASAEEN PERMITS ARE REQUIRED FOR ..ALL CONSTRUCTION.WORK.. . ELECTRICAL, PLUMBING AND I:.FOUNDA T IONS OR FOOTING.S.y,- MADE: WHERE A CERTIFICATE OF OCCUPANCY 'IS RE; MECHANICAL INSTALLATIONS. .2.'PRIOR TO COVERING` STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERSIREADY TO LATH)...", FINAL INSPECTION HAS BEEN MADE.- `3.,FINAL INSPECTIONBEFORE'; -.00CUPANCY. �a.� ., COST THIS CARD, IT i5 VISIBLE FROM STREET ' BUILDING INSPECTION-APPROVALS - PLUMBING.INS PEC ION A-PPROVALS. ELECTRICAL INSPECTION APPROVALS 7-- 4.,� I _ t i 3 HEATING 'NS.P TI G APPROVALS REFRIGERATION INSPECTION APPROVALS ' 'To OF TABLE ms N I ' 07HER 2 �. • 'NORK .'SpALLNCT ..'PROCEED 'JNTrt.--TNE .PERMIT w!LL BECOME NULL AND VOID IF CONSTRUCTION iNSPECTIONS INDICATED ON THIS CARD ! :INSPECTOR HAS APPROVED T14E VAPICU5 WORK 15 NOT STARTED WITHIN SI•R MONTHS OF DATE THE CAN BE ARRANG ISO.FOR By TELEPHONE STAGES;F CONSTRUCTION. 'PERMIT I$ ISSUED A$ NOTED ABOVE. OR WRITTEN NOTIFICATION. CSC 7 f. N r) 17oov lz V w\ I ,t CERTI I' I E ® PLOT PLAID L O C A T I O N: CIE ��Ie UIGG 4E" 4f/g455 . F O R 444044-S Go n� wT Coll?A. 3CALE: � -3o DATE: '9�2� 98� R E F E R E N C 8 ,9-n.,syDwN o 46 D A T o I CERTIFY TO THE BEST OF MY KNOW DG je KEG. LAND SU VEYOR AND BELIEF FROM ( NFORMATION ACO IR D, THAT SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. of JOSEPM sn M. v MONAHAN,At y J. M . MONAHAN , JR . & ASSOCIATES No• 13M PROFESSIONAL LAND SURVEYORS & ENGINEERS tg9fcis �`�°o� SUR�� TOWNE PLAZA - 900 ROUTE 134 - SOU ,SOUTH D ENNI_SMASS. �O SOIL LOG \ DA7E ' WITNESSED BY fe,� i G, Tom'. -ss, H =12 T" i=5 �H- 1 EL 3-4, 0 p TIC. � G C 4. 3e,'� 17` Aso' iAi►n C-.� =- M F n vr-, 3 L z 2 . 2 .sue ti G 1 a n AC _ / c V\/A4 7-A're Gpfl. ` pr�!• ��ntG► �, ' AAA NHOL£ S AND COVER TO BE BUILT WITHIN ELEv TOP OF FOUNDATION .�,= 1 2" OF FIN ( SHED GRADE , ---, I .r•: `}j� o - AAIN. 27° SLOPE iNISHED GRADE F , 1 ,M I!Z• i a 4''CAST I RO 4" PVC `SC SC 40 IST P VC H. 40 ,y /4 -T. ' 2� L E V E L 10,E AA 1 Nv �� L A Y E R • _ PITCH i • ti ' p. PITCH ems. M�✓ e, D I/8 , 1 2" PEASTONE FT �o` _ �.4Z ; a Fag '• k# tNVERT 3o• 6Z, GALLON INVERT DIST INVERT' o- � `I . AH� INVERT BOX �D D. 3 4 - t i 2��pIA SE PT ►CTANK INVERT �' ,� DV ASHED STONE ox fC� 1NVER`C ^9C3 w < O!: ALL., AROUND o LJ • r� t`�oo '7 � e, i0 GARBAGE MIN . _ _ — - - E L £ V. B O T T O A Jz Z,T;T v GR ; NDER a OF P IT 2 G? AAIN 6-0 D i A+� - - + E L E Vr.. s A -- _- P R O F I L E O F GROUND WATER TABLE SANITARY DISPOSAL SYSTEM f 1 NOT TO SCALE -DESIGN DATA BEDROOMS A DESIGN FLOW � � GAL .�DAY s` ,n/ ; ate" ! • CONSTRUCTION OF SANITARY DISPOSAL � �� , ' _ SYSTEM SHALL CONFORM TO MASS . ` k .0O . LEACH RATE ' -- MIN./INCH "Y ENVIRONMENTAL CODE TITLE V (REVISED 7- 1 - 77) ._ AND THE TO WN OF r3- PROPOSED LEACH CAPACITY : _ HEALTH REGULATIONS. z..� r f I • SEPTIC TANK, DISTRIBUTION BOX AND LEACHING w j PITTO BE OF REINFORCED CONCRETE MIN . CONCRETE STRENGTH 3000 PSI , GAL/DAY Y. MIN . STEEL STRENGTH 20,000PSI H 10 DESIGN LOADING14 ' • DRIVEWAYS NOTTO BE LOCATED OVER SYSTEM /&/D T-r- TOPJ PER P L c-,t J Y Lax r j F UNLESS H - 20 DESIGN LOADING IS USED. • ALL PIPES AND FITT I NGS TO BE WATERTIGHT AND TO BE OF CAST IRON OR SCHED 40 P.V. C. q: SITE PLAN SHOWING PROPOSED CONSTRUCTION SH . : OF ' SHS LEGEND L 0 C A T 1 O N '/�/ . -f ► _ �', i;�-,t Yi L rs�1�% t F O R p C o�? ;�. APPROVED 19 SCALE: =_._3�� DATES i,/ 'p BOARD OF HEALTH 4 BUILDING SETBACK REGULATIONS PER EXISTING CONTOUR - - -16--- REFERENCE: J BUILDING INSPECTOR OR BUILDING COMMISSIONER . �' �" <' PROPOSED CONTOUR 16 — %i- ZK 404 PCw .38 DATE AGENT r\/! I N FRONT SETBACK _ -= EXI STING SPOT ELEVAT( ON 17. 6 PROPOSED WATER SERVICE w OF . . MIN. SIDE SETBACK IG {' TEST HOLE LOCATION < ' MIN REAR SETBACK c' S i 2 F r CIVIL ell t,? .�. L J ..�- _� �C? v No. 27483 C . R . SHORT, I N C . EGISTE��``� x . PROFESSIONAL LAND SURVEYORS L ENGINEERS sfa"rfaLEN 1586 MAIN STREET (RTE. 6A) EAST DENNIS, MASS. 02641147 x • - i . . ,.... .- .... ....r ... .. -. ...., r .. ,. + g e 3 �. . .- k a.. •,. Cam.. 'i ..ti ..,- .. :.. ... .. 3.. . .. ._ ...xw.. .. ,G. ,. ., -do- i... '. : _ .,,. ,. .. .. ., _. _, .� �'.: .� %«... .., 'x .. .. F. .. .. .c fit, , _ a. ,- .. <- .c ✓ r.. _. f,..�+&.: .e � .. }} ,. .. .-. .1�' -1 w .. > t. .. .. , iY ,n .� .; « ''' d , 4 h C.." z .s«C e. ... .._. ,3 c. `�. - '#+, ,..F?. ..... ..Y-c .4.. ... �. �w .,. ,. .... . , '�+� .,�, .. '�'•�'."�".•., am._, �". `" '§,. ,1::�, i :: y ,fir n �^ °'''�' -'.�y` -7,...ac..r�r..� ?�� ror' •.,.e�e'+•.�L��s:i .... ,.t.�±N.1�..'�: -r�tt'?s.�� " :..�?lly k. f�+�eya. �!',dW"+�'ri'9d.. ;'... �:a�.S.a°..r�«.z..�_ v' ....a .1i