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0056 LIAM LANE
�� � � �� t �, '� Town of Barnstable -Permit#. Expires 6 monftrs front issue date Regulatory Services Fee o BARNSTABLE, s �^ 9�A ie�3g.. `0$ Richard V.Scali,Interim Director rFD AAA A Building Division APR 2 9 2016 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601TOWN OF BARNSTABLE www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 - ]EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number 1670 O Property.Address 64, Lh4fft L- U. • v� JkResidential Value of Work$ aai 7S-6 Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address_ (emit}-u- &OGe- 5 b 14v, C��erv;ll�, /✓1/-� o� � BR,AkI Contractor's Names" t wS a l g0tj Telephone Number 101-27-r-f'cft Home Improvement Contractor License#(if applicable)_7�Z'_J Email: Construction Supervisor's License#(if applicable) 0 SW 7 AWorkri►in's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Q.0A)AI tom( l,t)S j 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 wily be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side 0 , Replacement Windows/doors/sliders.U-Value a 3 (maximum.35)#ofwindo #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,Gtinservation,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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 ' Renewal MA Ciuenx+�t i 32a3 w�w,�^w RENEWAL.BY.AMERSEN _ ��3 Cr u«nx uos34335 �A 26 Albion Road .Lincoln,RI 02865 cod ttrm tit ear uursotr avatentntr WA.A_C..VM Phone 866.563.2235-.Fax 401.633.6602 nadtt+t rmc m ass:ossssso Southern New P.aglsnd Windows,LLC d/b/a fo 7 0 r t'O O genewsl by Andersen of Southern New England CUSTOM WINDOW AND DOOR REMODELING AGREEMENT fItClog . dz— �s� "t(Q SuteAaMan.Ga Sate:me rep Code f PO.:B= EMtliAddac V v !�"FlaneTe Num - ..Nu,,Z. Buyer(a)hereby jointly and severally agrees to purrltase tice products.and/or services of Southern New England Windows,iAb d/b/a Renewal by Andersen of Southern New England("Contractor) in accordance;with the terms and'conditions described on the froni'and the reverse of this agreement and on the attached speascation sheei(s)(collectively,this"Ag cement)• D Hlatorle O Condo O.HO AT_ ' agti: Esgrtnced sisrtiiv Date, Method of Payment: t]Check O Cash jj minced Tool jobAmount�� :' ... Deposit Received(33%} 1 0'/1l . Credit Cards are accepted for deposit only-rnaxlrtium I/3 of the project cost(Plem see Credit Card P gmetit Coati)By sirlil this Balance at Stare of Job(33%) Estimated Ganpltiton Dace; A te,you acknowledge that the Balance at Stan of job and:the Balance on Substur<ial CompW6n of lob,cannot be ttnde by cretin Balance on Substantial//7 q card and must bi mida by personal ched�bank deck or cash.` Comptedw of Job(3MY /a7Mfflw B er(s)agrees acid 6nderssaads that this AgreWment eonstitatea.the Andre understanding between the parties,sad;that there are no verbal aaderetandinp ch�BiOS any.of the'terma of this Agreemmeni.Buyer(b)admowledges drat Bnyer(s), (1)has mead this Agmemeot,.uAderstands the terms of this Agreettneat�:arid bat mewed a completed,signed)and d kny cepyof this Agreement,including'the'- -attached Notices of Caacelladon,on the date first written above and(2)was orally iafornteil of B, s sight"to eaatcel this Agreement.DO NOT SIGN THIS CONTRACT IF:THERB ARE ANY BLANK SPACES. (RAodg I,.I.d Swles ON1y)Notice to Buren(I)Do not sign this Agreement tf.any.of the spaces.intended,for the:agreed terttts to the e=teat of then available Information ass IA blaalt:,(2)You are entitled to s SPY of this Agreemetst at die tune you sign" it: 3 You off the full unpaid balance:die"aader thia Agreement..and in,so doing you maybe tX;d1ited to ( } may at way tisae pay.- receive a partial rebate of the fivaace Arid insurance charges.(4)The.seller has no tight to.unlawfopy enter your premises: or commit any breach o!the peace to repossess goods'purchased Hader this Agree:beat.(5)Yon may cancel this Agreement tf it iia4:itot been sighed at the main office or a branch ofHee of the sellers Peeyided you notify the seller at his or her main office or branch office shown in"the Agreement byregistered or certified mail,which shall be posted sot later dhimmidoighi of the ttiud¢alendnr day after the dsy,on which Jib' fin buyer s><gas the 7lgseement,e:el6tdimg Sundiajr sad'aay hoflday as wliieh regnlaT ttiail deliveries araaotmadei Seethe iutios>s+paayin6rsotice of caatxllaoion fosat for.aa explanation of bayer'srig6ta.. Buyer(s)received the consumer education materials Provi d by the Rhode Edand Contractors Rcgjttrapon Board,, (Birydt Initiaw" Renewal esiseo-e oath ew England Hnyei<{s} Buyers) By. gnatitre:of Product Manager, Signature Signatum 1Rjnt Nance o£riodutx Manager Print,Nama . Pnnt:Naitie: YO%THE BUYER($), MAY'CANCB'L THIS.TRANSACTION,AT ANY"TIME PRIOR TO NIGHT OF.THE THIRD BUS1NXWDAY AFTER THE DATE Off:THIS TRANSACTION.SEE"TM ATTACHED NOTICE OP CANCgS.t;1►TION FORME _FORAN,EXPP ANATION OFTHISAIGNE jjQE{ � 'NOTICE OF CANC LLeT10N - Date of Tiartsacdon :You:map cancel: I Date.of Transaction,. ...You may cancel thin transaction,without arty penalty or obligation,within I this transaction,without any penalty or obligation,within three business dais from the above date;if you cancel,any three business clays from the above daft.If you•cancel;any ptvrpbrty traded in,:any payments made by you.under the I property traded tit;any payments made by you under the Contract or:Sale,and any neJIotiabre instrument executed I Contract or Sale;and any negotiable inatru`ment executed by you will be returrie d within ten business days fallow j by raj will returned"within ten business dads following receipt by the Seller of your cancellation nottce,'anil airy I receipt by the Seller of your cancellation notice,-and sihy, secuntjr tnferest arising,,out of the transaction will be I security iinterest arising out of'the transaction will`be canceled,Npou eoncef.yo!+must malae sviil4bia eo'dte Seller, canceled.If you cancel,yyoou��must make available to the Seller at your.residence;In substantially as good condition as when � at your residence,in substantially as good tondjiion as when received;arty goods delivered to you under this Contract or I received,any goods delivered to you under this Contract or" Sa1Gor..you may,if you w comply witb:the iratrucdons al'. I Sale;oryou miry,rfjrou wish,comply.with the instructions of_" . the Seiler regardie8 the ret iivt sh(pmetre of drE go6dilYt the;:; ''Hie Selter'regatrdirtg lfiei return shipment otf�ie=goods is the Selle i ea xper��and risk.if you do make the gg0000ds'available Seller's ex Anse and rick If you do make cite goods available alp d►e Seller acid the Seller does not pick them up within to lfie Seller"and the Seiler dtus not pick.them up within :twenty of the date of cancellation,you may retain or' I tvreritJi of the dace of cancellatonh;you may retain or h r° t4ee goods'witfiout any Wrdter'obligadon If you,I, ditippoose of titer 800ds'without arty further obligabort if ruu ` I to manse the floods available to the Seller,or if yea agree,I tail to make the goods available to the Seller,ar if you agree to;i etuM-the to-the Seller•and lidl_to do3o;tlhen,you I 'to roturn tlhe g ad to tits Seller' fall tiii do so,then you remain,liable kr pertom+�a of all obligations tinder the I'.remain liable"tor performance of all.obligations under the, 'Contra&To cancel this.&w ctld,%mail'or deliver a signed Contract.TO cancel this transaction,mail or deliver a,signed and dated.copy of this cancellation notice or any,.other I and.dated copy of this cancellation notice or any other Writtennodce,or send a tole to Renewal rsen of I Written notice send a telegram to Renewal byAndersen of Southern New England at 2 Albion R" U l 02965, I Southern New and at 26 Albion Road,Lincoln,RI 02865, NOT LATER THAN MIDNIGHT OF- I NOT LATER"T T. MIDNIGHT OF (Date) . I HEREBY CANCELTHISTRANSACTION. JJI_ i HEREBY CANCELTHISTRANSACTION. X etcyars Mtrt Nuns Dab Buyr4 6lpt+pw Aittc Nuts, paN RbA Copy:White Buyer copy Yellow Buyer Copy:Pink Southern New England Windows dabea Renewal by Andersen of SE Massachusetts-Department.of Public Safety I Board of Building Regulations and Standards Construction 5uperl-isor I icense: CS41195707 1 MUM 1)D N - _ Charlton KA 915b7 !- Z'`+ ..i ,Sit Expiration ! CameTiissiotser i Office of Consumer Affairs And Business Regulation 10 Park Plaza-Suite 5170 . Boston,Massachusetts 02116 Home Improvement.Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9/1912016 SOUTHERN NEW ENGLAND WMDOWS LL DENNISON BRIAN 26 ALB ION RD -- LINCOLN,RI 02865 Update Address and re rro card Mark reason for L ❑ � ( Address Renewal Employment Lost Card su I a lTirx at Coa.emer wttal+.8 gatiaess Rel:alarioa License or registration valid for indhidul nse only E IePROVEM@(T CONTRACTOR before the esp'astiao date.1f found return W.awii=of Coasnmer.Aff.eirs and 8aftom Regoiatioa V-.6irptradon: Inn on: 173245 Type. 10 Park Pim-.Suite 5170 9119=16 SuMlemerd Ord samn.:i9A 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. . RENEWAL BY ANDERSON DENNISON 9RIAN � _ 26 ALSION RD LINCOLN.RI 02065 Not valid without signature The Commonwealth ofMaassachusetts Department of Indaastr ial Accidews Office of Investigations Il Congress Street, Suite 100 _y 1 Boston,MA 0211 4 2019 www mans&gov1dia Workers'Compensation Insurance Affidavlt:Bualderrs/Contractors/ERec cians/]?Iumbers ARIg Iitcant Information Please Print L2gLbly Name (Business/Organization/Individual): SOUTHERN NEW ENGLAND WINDO S Address:26 Albion Rd City/StateiZip:Lincoln, Rl 02865 Phone#:401-228-9800 Are you-PIA employer?Check the appropriate boz: Type of project(required): ''' 20+ 4. 1 am a general contractor and I 1.0 I amp a employer with � g b. ❑New construction 2. (full and/or part-time) = have hired the sub-contractors 2.❑ I am a sole proprietof or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-:contractors.have g. E]Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp.insUrance.t. :< required.] 5. We are a corporation and its 10.C1 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 1 L[]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 Window Replacement employees. [No workers' I3. Other comp. insurance required.] °Any applicant that checks box AI must also fill out the section below showing their workers compensation policy information: Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their xvorkers comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.' mployees' Below is the policy and job site information. Insurance Company Name:ARGONAUT INS. CO. _ Policy 9 or Self-ins.Lie.#:WC 928058352394 Expiration Date:8/21/2016 Job Site Address: -//97n GNU . City/State/Zip: &a&e ��l p Attach a copy of the workers' compensation policy declax Lion page(showing the policy number and expiration date). Failure to secure coverage as required under Section°25AFZT 1VIGL 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 W6RK 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 ofthe DIA for"..surance coverage verification. I do hereby certi Bander the ' s and penalties ofperjury that the information provided aab ve is true and correct Signature: Date: Phone 9: 4012289800 Official use only. Do not write in this area,to be completed by city or town official. ,City or Town: Permit/License# 4suing Authority(circle once): A.Board of Health 2.Building Department :.City/Town Clerk 4.Electrical inspector 5.Plumbing bwPeator 6.Other Contact Persona: Phone#: I SOUTNEW I SHETTYSHT s- =IATEPNYM ,4C® CERTIFICATE OF LIABILITY INSURANCE 15 �..� 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: ff the Certificate holder is an ADDITIONAL INSURED,the policypes)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 Willis Certificate Center PRODUCER NAME $$$ 467-2378 Willis of New Jersey,Inc. PHONE 945-7378 ,No)-t ) y ac No.Ext: 877 t ) C/o 26 Century Blvd aDo�ss:certificates@Willis.com P.O.Box 305191 NAIL# Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE INSURER A:Selective Insurance Company of Southeast 21970 INSUREDINSURER B:OneBeacon Insurance Company 19801 70 Southern New England Windows LLC INSURER c:Argonaut insurance Company DIBIA Renewal by Andersen INSURER D: 26 Albion Road Lincoln,RI 02865 INsuRER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS GATED. NOTWITHSTANDING THAT T THE POLICIES ANY REQUIREMENT TERMOF INSURANCE IOR CONDITIONSTED BELOW AOF AhVE YCONTRACTT OR ISSUED TO EOTHER INSURED OCCUMENT WITH RESPECT TOED ABOVE FOR THE LIWHICHRTHI3 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. POLICY EFF POLICY EXF LIMTTS ILSSR TYPE OF INSURANCE NS WVD POLICY NUMBER MMIDD MMIDDIYYYY 1,000,00 A X COMMERCIAL GENERAL LIABILnY TR EACH OCCURRENCE _ 0 0811012015 0811012016 Els 5 100,000 S 2029459 PREMISES Ea oxurrence CLAIMS-MADE ®OCCUR 10,000 RiED EXP(Any, person) 5 PERSONAL'&ADV INJURY S 110001000 GENERAL AGGREGATE s 3,000,000 GEWL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG s 3,000,000 POLICY®JECTT LOC Is OTHER COMBINED SINGLE LIMIT Is 1,000,000 AUTOMOBILE LIABILITY Me accident S 2029459 08110/2015 0811012016 BODILY INJURY(Per pesos) !S A ANY AUTO BODILY INJURY(Par accident)1 5 A O AUTOS SCHEDULEDPROPERTY DAMAGE AUTOS NON-OWNED I IS (Per accidentl I S HIRED AUTOS AUTOS EACH OCCURRENCE S 5,000,00 X UMBRELLA LIAR X OCCUR 015 08/10/2016 AGGREGATE is 5;000;000 A EXCESS LIAB CLAIMS-MADE S 2029459 08110/2 1 Is pEp RETENTIONS X ISTATUTE ER WORKERS COMPENSATION 1,QQQ,OO AND EMPLOYERS'LIABILITY 0000068028 08121/2015 08121/2016 E.L.EACH ACCIDENT 15 B ANY PROPRIEMRIPARTNER(EXECUTIVE Y(pI j NIA EL pISEASE-T�4 EMPLOYE-5 1,000,00 OFFICERIMEMBER EXCLUDED.) L'� (Mandatory in NH) it yes,descr(be UndeC El DISEASE-POLICY LM[T S 1,®Q ' 000 DESCRIPnoNOFOPERATIONsbelow C928058352394 0812112015 08/2112016 See Attached C Workers Compensation DESCRIPTION OF OPERATIONS I LOCATIONS I 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, NlS]SICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A4 Evidence of Insurance Q 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD L f/ 5 0 Town of Barnstable Permit; R'On Expires 6 months front issue dale Regulatory SerAces = Pee saxxsraBM ti mad BU M . q0� Richard V.Scali,Interim Director Building Division X-PRESS PERIVII Ti Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 NOV 0 4 2015 . Nvww.town.bamstable.ma.us Office: 508-862-4038 TOWN OF E�Ikg-"�ALIL3j10 - _ EXPRESS PER112IT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number J(p d Prope4gkddress 5 & kiQ,*g 1..417*.60— [Residential Value of Work S.�N�(o`�__- Minimum fee of S35.00 for work under$6000.00 , Owner's Name&Address_ /YW C�a1 t' I A . e f o s Contractor's Name r F ern a .� tJWzYA S / {��,G,1 to ni snei Telephone Number001)7 Z2 -q k C`C� Home Improvement Contractor License-'-"(if applicable) /7 3 2 y S— Email: Construction Supervisor's License s(if applicable) 0 5.5 7 0 EgWorkrhan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I°am the Homeowner I have Worker's Compensation Insuranc: Insurance Company Name w n G u'j' :1:.nS u C q yt C2 .�6 c rA Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑Re-roof(hurricane nailed)(not stripping. G El Re-side oing over existing layers of rood Q"Replacement Windows/doors/sliders.U Value 3 Q (maximum.35)s of windows z of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. '. Note: Propertyjpwner must sign Property Owner Letter of Permission. A copy o the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Nkhp. QAI TFILESIFOU4%uilding permit fotms\EXPRESS.doc Revised 061313 WAL BY x "ERS ciitoemesasusss nerr�aara► at mo o •.: 26 Aibton Road • xutcobi,RI 02865 `•+' `� ! wa rum uiz�t Phone 866.SS&2235•Fax 401633 6602 .. �: teOeitlT�tt) Soathera.itfew t AOvMd Windows,lyCdTb-a Rdewal bjA=IwWaa of SeudkwuNewZmosiod (,ALA CT$TOM.WIND4�1/AND DOOR ItBikODffi2NGAt#t8B1Y�LN1' ► '_ n � GMyw(Q N o m ate:" aas _n+azb as ao,� /c21 GfJ Ed4llAdaacc , (��f'�j�L'Ll/1��Ti�r2LL� �M Nt �iQ/OIN1v4 '�`;17/T7'�U BuYci{s)"hertbp jaindy and acuerally ag�ges oo�rurdiaae t8e pmduc s audlor se�v oes of Southsrn New England Windows,U deb/a Renewal b)'AAdeiscn of Southetri NEW tractor"),uraccordance with the'termr aAd:conditwns desc ibcd ea the llich and the eeyersrnJ Z. agnetff►ent asd on the: non al�eec{s)(oolleaively�t)us g azennt^) p.Histarkr O Con4o Tote!Job Artroum ad�rm 'Cme Method of t'aytinitt" O Check O Cash Deposit IlaceMed(9396): }cdemt.Carat aye ood accepaec o�dli-matamtrn'i!3 ofthe: t3alance at Snrte4 Job(33At) pn)cetr (fe.m Ct:CmePoyrtkmc j.ij,s�bg d�k p. °" flgsthtcthesrStaaofJcbandthe, tnca on sterra;►>itt.���� _l on Sut+ nttal Cample[ion or Jab eta be rtade by uedEt Caiirptrrlon of mm be made. P +dteck bardcclrcdc or cash Bayer(.)agreeo;ead amdeetina e6at ttiii'Agr�ent coasi3itacee<ttte eatire'atuieragesdiag Uetsysea,etie paet�s,,aid`,�t there are>to va6ai.mdao aaY:of,the tam. .BaPee(s).::ativ :.etswt saher{e} (1)has read We Aft,IMAMand/the 4esius of R6i%Agssee►aas,and Las aeoelved a ;mod,ae3 dw�ed ooppof ua.ASaeameat,inclodfsg the.twostwfched Notiessaf Cassy puehtdatq 8estiraittmeabtiwe and:(Z)wits Y`' iafaxaae�!�Bayer's rigiyt:ta eaaeel'thiaAgt+Qenmrt.D0 Nt1T`$ItiNTl�B COl�iTRAQT 11rTHEREA18EilNYBI:AIHK�'AC88. lRfastd Swfita testy)Nutlet saStayen(1)Do aotsige,ehisAg+reesoeat iF,army'o!`da?'spaees iteed.lOtr`d sSeeed arms 04 the emeet eel dues w+ btu io6u�mstiaaii re LeB Wtaali.(x}Yen ars.aattetad to seopy of tldfAgreamkeaR at tare tlaie Ton si�a it.(S]Yon may ru nay time psi oa$the aapriid bahuaee dae tmderthiaAgrent,asul is so doiag.yon may,tie eatitisd`to reaivr a parttai rebate a[the Stainee asid; cbai�e .(4)The;aeller,6as ao to iufia+vftiliy-,eater 7r P"e1° or osmanit ssy f>rea�ei the psaoe'to a eposssw&eDd!par ehued ender this Aga, sat,(5)Yoe maY saacel thisAgnsmeat' attixhe .nt bes;signed of bk.. her rode` office or bamdh affim shown iu*eAgrepo""by rtieKisaened;or ceed>&d email,wbdchatiiII be posted tmottifter thaw mid #et. fY rise tt>ud oaiesaaw dsy alter A dsY om riff the'bnyes ms the Snadny sad say holiday oa..6iri regalarsiasr� iverieaane'aatmada8esfheamompasym;-ai+�iceetYformEsstuo7. aaoaper�yrigits. 13uger(r)received tfie educatian fnart lisle 1 -by rite Rhode Itlt+rut CaAaactosa Regtacrauon Board (Bayne hdtiais) Renewal by Br. of INW. Stgriatun S>gnatetre Print Name-of Product Managa, Pant Name' Ptittf Name i TM; TM I BUM(S), MAT CANE_$L THIB TRANt&14�ZODt AT ANY.T.iIMI�.p7�QA'1'U.bIIDNttiHT OF M THIRD T ATTA D NOTI�QF C44 LLA''i ON PORT �J$1NBSBtDAYA1PP&R;TAB'DATBOFTIi38TItANBACTION.88B , FOR, OR AN 8M'LtNATION OF TM IUGi 747, mdmcE bF CaNCnt t arrnrr Dam of Tnutm ttlon Yet rtnq can�i.' Date:of 7Finsacdon. R Xou tttagr-t totl Mrs transaction,withotR paef ttY or oW�adon,wMMas Mrs ttrtn f,whhofst atW : pa obligati n,wltl ehtnee but lefess daYs teem+the abort date.N pea ctarcel,anti ' Mtree;bt nd"id "M the s��N pea caesotl,any pop"traded 6y aesy tisYments.?inade by pert tteMer Met tradod snr wstrMWil+tmtyle by utter t* t„aatract or Sete,and s rtlr. babtimernt e�tswoed f or Sale,and'ant► eotaww tl by Matt wits bs neta.rnsd ter+bste6fa:s dqs 't by Yot+wNi be:returned vrttjj* sbsaititasss+ (� reaetpc py Me Seiler.ot pqur�,.etotlee;;arfd tseY •i Irl► Setkr of pear,eaeftelladon eiotice,tufd:arry' ' saan#jr �sr�t`aeistnll ;apt Of`,td a trau eeht Will be .. ! caefeeteds ltyuu ru*4 Want esstilae aara8rbfe to the Stl�r''� wed.Hyeou cancel,A�t�gtu+rtnssk eriekd Seller atysiff r in it► good oorf�alon'M when t at roar rosidei t e,to suMantW.lY as gt - cat W*h sa when ram,, W ti to Yon untlar tills Contract ar+1 reoeiwd,sney Soeds,detivee eel fa tmu taw this Cosftraet:or, fau nsq,i<You whin whh the of I Salet:or YoU t K you whh, rirld�Me ieati+teti d #lte.Seller r+egartifing the rehsrn�pttsetrt oi'the goods 3ti tine Me Sutler sit+garding:tlte return Fsffesft of the goods at tin►`. Sailer'a " , IMW eii&if you do make Ilse�`. gNattebte � Seller's nse and rhk.if you der tnsspe,eisa�atraSa9ls; 0o tlw.Se�and the Sapier dew tuft pidt item up w&!de ao the Salter and the Seller does noR ;twoeeep` of'"daoe,ot�ina OkYou MW drys Pk WP wftlwi, eetshs or ! trrsntjr d`at tir dale of eaixetlatLtpf tbu nigr nsgin;orti the goods wltlMut�►Asrdfer abligatton.K pea i Me Soods wltleout anY furdfer obt'egft if Ysu failbo nits tlfe goo&a araihb�do.dfe Ss .for Ktiou OAP"_ I tu.make the good avaifabie to tie"W'or Krov agues to rewrtf the goods Lo the'Seller d bii�:do m. !pw i >n return the.' bn`Me Soper and�bo do so},f&M'"U. eerstaief liable for fdrireanEe.of a8 oMi Lions under Me ; eemetn Ihsbto far oof ell ob�gad useder tho CotsZlaet.Te tonest lids Win.trail or dethntr a tlgned Conerece.7br taetael Mls tt l ar daitver s and Bawd eogp.o!tills aatfcNlation notice or any oMer'! and Basal of this cancNlaeion n.0t" ..-L .-otlOW wl vreito6n nobkt►,orsend a tm Renewal by of°1 weilben ssogte; sated sy tb Rt>eeewrd bYAetdersatf' , 3oudfsrn Nqw at bim� 0 Soud esss iravr nerd at Apdaai Road,Lincain,Rt q:W;,,: NOT LATER T iIiGHT'Oft ► NOT LATER Tl MIDNIGHT OF (Date [per) I" RUY CMCELTH."*I NSACTION t HERBY",Ncw no ,TRANS0.GTItpN. r moos.ftn- tt+e HMO tsa�e iwt.r'i t> na were tom. toil. .F- . ' t1bA Copy Whine Buyer Cs-Yedow Copt" k f Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License:CS4095707 BRIAN D DN ' 71 AMIBS POND C s s Charlton MA 015067 tr�1&1 Expiration Commissioner 09/08=16 Office of Consumer Affairs find Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement,.Contractor Registration r Registration: 173245 Type:. Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL,`" Expiration: 9/19Q018 DENNISON BRIAN - ��- 26 ALBION RD LINCOLN,RI 02865 Update Address and return card.Marls reason for change. set 1 O22~1 I]Address C Renewal Employment ❑Lost Card ee of Couseaur Again&Business Regulation License or registration valid for Wdividui use only IMPROVEMENT CONTRACTOR before the expirathm date. If found return to: Office of Consumer Affairs and Busing Regulation ogistration: 77� Type. ra• 10 Park Pu -Suite 5170 Expiration: g/11021116 Supplmnerd and Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD LINCOLN,RI 02865 U , �esri Not valid without signature The Commonwealth of Massachusetts • Department of IndustrialAccidents Office of Investigations p - I Congress Street, Suite 100 Q Boston, MA 02114 2017 www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/o{gat,ilatiot,nndividuat): 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): 1. I grit a employer with Zp+ 4. ❑ I am a general contractor and I * have hired the sub-contrdctorsi 6• ❑New construction employees (full and/or part-time). listed on the attached sheet. 7_ ❑Remodeling 2.❑ I am a sole proprietor or partner- ship and 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.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL I2_❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp. insurance required.] re �Iac Pn'� *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:ARGONAUT INS. CO. _ Policy#or Self-ins.Lic. #:WC 928058352394 Expiration Date:8/21/2016 11 Job Site Address:'S l �--►a (�/� City/State/Zip: 6n lam✓l j(e MA 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'UfMGL 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' urance coverage verification. I do hereby certifx under the andpenaldes ofperjury that the information provided above is true and correct: c 4 / 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# 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#: SOUTNEW-01 SHETTYSHT ,acoRo® CERTIFICATE OF LIABILITY INSURANCE FDAT D/YYY1O 81191219/2015 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 CONTACT NAME: Certificate Center Willis of New Jersey,Inc. PHONE Fax c/o 26 CentIL urryy Blvd EVC Ne Exc:(877)945-7378 ac No):(888)467-2378 P.O.Box 305191 nD� ss:certificates@vAllis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Selective Insurance Company of Southeast 39926 INSURED INSURER 13:OneBeacon Insurance Company 21970 Southern New England Windows LLC INSURER C:Argonaut Insurance Company 19801 D/B/A Renewal by Andersen 26 Albion Road INSURER D Lincoln,RI02865 INSURERE: 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 TYPE OF I ADDLSUBRNSURANCE POLICY EFF POLICY EXP LTIRINSD WVD POLICY NUMBER MM/DD MWD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE 10 RENTED— CLAIMS-MADE a OCCUR S 2029459 08/10/2015 08/10/2016 PREMISES Ea occurrence $ 100,000 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 T JECT a LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANY AUTO S 2029459 08/10/2015 08/10/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S 2029459 08/10/2015 09110/2016 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N❑N NIA X 0000068028 08/21/2015 08121/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 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 08/21/2016 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 `�D ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD f Town of Barnstable P� o Regulatory Services a�xxsT�s�e, � Thomas F. Geiler,Director � -71 j f 0? 9� MASS. � Building Division ny Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www,town.barnstable.ma.us Office: 508-862-4038 Fax: 508-190-623( PERMIT# FEE: $ SHED.REGISTRATION 120 square feet or less D Location of shed(address) Village �z0 `7z`l� Property owners name Telephone number P rh' P /0 V 147 -- 16 / c� C Size of Shed Map/Parcel# . m ,.. Signature Date c/ c.? W .Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? �v Conservation Commission(signature is required) Sign off hours for Conservation 5:00-9:30&3:30-4:30 ,PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE. COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. i PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS ]CORM. MUST BE ACCOMPANIED BY A I PLOT PLAN Q-forms-shedreg /A \\31� REV:042506 ff id r + f on Z rj 1,9181 S 07 �bT • CERTIFIED PLOT PLAN L- NZZ. � R4BERT J yy CONSTRUCTION ONLY o pRIN TOP of FOUNDATION IS . FERTl -,�,�► ,� Ae ABOVE LOW POINT OF ARJA�ENT isrE�' AND SU ei p A T E ROAD. SCALE ! = So ENQ! EE I -' ' I CERTIFY THAT THELO Fa a NDA7td/t T 0N.OwN AN THIS PLAN ICAT C M EALSTERED REQLSTEREID 61 ON .THE AROUND AS IN �{ LANDCIV Jt1 ��� -� COMFORTS TO THE ZONINQP '.' ENGINEER SURVEYOR ;QF {� 712 MAIN 'S T R E E7 ' E � i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- A Parcel e : ® / Permit# `78134 Health Division �j� �{ �"�' }"b r, `�'a, BLE Date Issued conservation'Division a �, /� O ?` �rlfJUL j 5 FM E j 0 Application FeeX2 H Tax Collector_ j �`� — D L Permit Fee ? 00 Treasurer /,D, yli��:ON . EEPTIC SYSTEM FRUST BE Planning Dept. I.N TALLE®IN COMPLIANCE Date Definitive Plan Approved b Planning Board f VWTF;T E 5 pP Y 9 l l RO IMENTAL CODE AI'4po Historic-OKH Preservation/Hyannis `'' REGUU',YIox Project Street Address ��o �l��YI �✓�r�� Village ����r�2 i/L � , 6 Owner ��d✓�'2J ,�ia� rd �t Address d�� IcA-"75ftY V } Telephone ��1� 9� s o /OP� 1*6lSy® Permit Request 2 e jo, SIC ,g �X 1 8 C1 a.V y lZo 7tFQ Square feet: 1.st floor: existing_%2-Y proposed 2nd floor: existing proposed Total new . Zoning District Flood Plain Groundwater Overlay Project Valuation " Construction Type Lot Size cIIJl�C� Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure v Historic House: ❑Yes 4Ne" On Old King's Highway: ❑Yes ULNe------ Basement Type: UA__ E]Cra ❑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: O Oil ❑ Electric ❑Other Central Air: ❑Yes ®-PJv'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:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ - - " . Commercial ❑Yes O-Pd�f'yes;site'jifan review"#`"- - Current Use 10�_'5 c0`;i i 1--J Proposed Use j, BUILDER INFORMATION i Name Telephone Number f Address License# I Home Improvement Contractor# 4._ Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO = - \,SIGNATURE, DATE FOR OFFICIAL USE ONLY ` - 4 PERMIT NO. DATE ISSUED F ' V ` MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 6 2-"1) 5- FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH/ FINAL FINAL BUILDING { DATE CLOSED OUT ASSOCIATION PLAN'NO. _ r - Town of Barnstable - ,� o� Regulatory Services • 3 ThomasF.GeilersDirector Building DiviSlOn prFD µPy Tom Perry,Building Commissioner . 200 Main Street, Hyannis,MA 02601 • Fax: 508-790-6230 Office' 50S.S62-4038 ' permit no• Data ' AFFIDAVIT p[OME ZNIPROVRMINT CONTRACTOR LAW SUpPLF,MMNT TO PERMIT APPLICATION conversion, o er-occu ied • r construction of an addition-to any pre-existing w�. P MGL c.142A requires that the"reconstructiory alterations,renovation,repair,modernization- •�provemen removal,demolition,o units or to structures which are adjacent to b g containing at-least one but not more than four dwelling esiGO or building b o done by registered contractors,with certain exceptions,along With other such r �^ requirements. � / rk b Eck-- Estimated cost z°o Type of Wo j ork: Address of W Owners am Date of Application: I hereby certify that: geistration is not required for the following reason(s): Dwork excluded by 1aw []1ob Under S 1,000 []Building not owner-occupied MGWV,—r pug own permit Notice is hereby given that: OR DEALING WITRUNREGISTERED OWNERS PALLING THEIR OWN '..RNIIT CO�gA CTORS FOR APPLICABLY,TiOME IlY>P GUARANTX FAD CTNDER M L c 142A, ACCESS TO THE ARBITRATION PRO GRAM OR SIGNED UNDERPENALTIBS OF PERJURY I hereb Iy for permit as the agept of the owner: Contractor Name Registradonl�Io. .ate • OR 5 ;_ ot,. .The'Corn n 'ea th of Mas'tsachus'etts Department of Industrialeeidents' ' •' • 6�Was - • Boston,Mass..0-7111 • '44ror�ers'.C m ensation. nsce�ffidaylt-Genera]•Businesses ►.aaa acidness: ,, i•. �^ 21 h�gp�e • '•'• Seta•. , !•t� � ,W- , work site iocatioll full address one ' Biz�es e: (�Retail [�Restaurant s�;ntos etc.)' ain•a sole propnetox and hav Q OCe[ Sales(incla g , ..r. W.Orldng in any capacity . .. em to Cry etri to ees(fu11&' art tlme /%///l�%%/%%/////�//�///% %/%//H// �sation for my emfloyees workin g on this 9 •. . ��1 y providin vla f r.; • ,': :!• . f/1 g kers�cbmv,...�' • : t �' ':' h:t;.•t' �.' .i::`�:;�.;'; '� ari] all o " +" •t' •: r; •=' '. `� Y�,.F a.a•'!•.�!'' r' .•rti'�w:7• •t .rrt'tt•r51••tf}+ 'r • •' .•. jr t>.:V L:'•.- '.`i:ti.•1. 5 r�•t-1.�a;t•�' ,y'��? •5'.... �''•• t ta:fr.•:.1•:.f;{.y.t.:' t i:; '.�13s:r+•r`,,{, ':r.. ..+•,� • • f:L� ,i',r'ti; ,.•7'Y.t:'j,t�.�., :5 'r .. � :• ' ". ,. ,.ti;i"•• . •j'r,•,..':l:.. r v. ' w t•' i,� ' ' +p t ti�' 't��••. r. �. �r +• .r y.. Y ,, {,i•:. 'S ,l,,;•r �a: r�''r' '+, fit. i t t:t:s ti t}••••ty LS a COISl-eA t•��e!- 5. ;;r'•a�? .;; �I:s•It t;.'.:};ii: Ii' � :.� ! it is v y.'.r' + •i.l..:ti:�r5 JIraS'get.r:� :� 7'•t••*.,' -,i '. 'K7' ..3••4' .,h5 . S •p,' �' S .. 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'; t1•�t:n''1rtiRi,v:'•,i J'' S '+ ' ., •• ' � 5 ;h,.. eh,,.,! •L a .•(.: 1 "4 K:'0.' rt.f• ^i 5••.•• ••.}'t •�f�• ''�•. . j•. •s ..'t•. s;' rs• •t s� i.tiy.�5.:,y'..+.L'. O71 r a' t.. �. �/ •{'_�`N. :. :ten.a•�:M''• �''•. 5 •6'Jr r'' r.,S1 'I.s'y.''• .• rr_ .,.J?: f. ';r j:r:,, :�;;a'' e to$1,500.00 an or insiirariG-br osition of crimfnsl peneYnes of a un op,FaDur to aecllre coveraga as required und.r Stection to ?3A of IM 152 can lead to the imp a verification• + ant as v+a]1 as ottdlp the fo' oft STOP WORK ORDFiR and a fiao of$100.00 s'day against ma, T underatan t X orie years'imprlsonm ded to the Office of Tnvrsflgat ,of tie DlAfor aoverag . c this statr meat maybe forvrdr ' copy t f er u that the inform ation above isfrue and Correa under a pains a d penalti b ) rJ' I do hereby a Date a 5i�oature A hone# l/ 11riat name j o{�cL11 use only not trite in this area to be t:oxnpleted by city or town official ❑Building Dapartmant permftlllcanse# ❑Licensing Botlyd sty or toQvn: ❑Selectmen's Oifice C3RZ &,Department (].rheckif mediate response is required 00ther�_. phone#; contact pt�3)' • Znformafzon and Znsfxuetfons• ' r G al Laws chapter 152 section 25 requires all employers to provi�(workers' comperes tidi�for their. Massachusett$ • • '' .•`:;� oted'fromthe£`law", an employee is.def ed as every person in the service o another under any contract employees, .As d; of Vie;express or inol? a oral or written, e joyer is def'iired as an mdmdual,partnership, association, corporation or other legal entity, or any two or mare of An p ed.in a�jviut enferprise,and including the legal representatives of a deceasedymployer, or the receiver or the forego.ndivi artnersbi association or other legal entity, employing employees. 'However•the owner of a •trustee of an individual,P . P> ' 'not'more than three apartments and-who resides therein, or the;occupant;o�the dwelling'hotrse bf• dwelling boos a baying•.,. ' another who.emple'3'sFersbns to do main�kepance,construction oz repair work ok such�welImg houae,rnr on the grounds or errant thereto shall notbecausa of such;eriiploymentbe deemedtob@ail employer. ,.1 .building.spvrr •.. ,., ,;; , chapter.152 section 25 also''states fhat'ever. state or Ibcal&nsing•agency shah withhold the Ssuance or renewal M P Y applicant of a license oz•pe?'p??f to operate a business or to construct buildings in the.commonweaIth for an a Iicanfi who has fthe not produced acceptable'evidence•of coirnplian6e with he into anurany cofrtracgfar thee re' �erforrnanc of public workwork unt}7,' of its political subdivisions shall y P coirmaonwealth nor.any• P acceptabledence of eomplianbe with to insurance requirements,of tins chapter•have been presented to the contracting . _ authority. . ' %% Applicants Please thew as' eompmsatim affidavit cor�letely,by checking the box that applies to your sitdation., Please su ly comp anY name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted PP to the Aepartment'of yndustrial Accidents for coniiTrnation of insurance coverage. Also be sure to sign and date the affidavifi. The�davrt should returnedto&e city or town that the application for the permit or license is being re nested, not the Ueparhneit o Industrial Accidents. Should you have any questions rekardirip the'°law"or if you are q /� a•wcjrkers'.compensgionpglicy,please call thel?epaTtment at the number listed�elov�r. , required to o(n�tam , , h 1 . ' • . i 1. City or Towns . • , P leasebe sure 11�at the affidavit is complete and Department has legibly. The Depar has provided a space at fad liottoni of the affidavit for you to 01 oft in the event the Office of Tnvestigatxons leas to contact you regarding the applicant Please f the permit/license nuu?ber which wM be used as a reference numbed '1'b e.affidavits naay.be returned tq, be,sure to , , ' ariangements have been made,' `''' ` '. the D ep artment by. or l AX unless other . old like id thank ou in advance for you cooperation and should you have any questions, The Office of lavestigations wo Y . . please do uothesitate to give us a-cat. ' / ent's address,telephone and fax number: • ' , The Dep • - The Commonwealth Of Massachusetts Department.of Industrial.AccS.den#s • . �e oI�esli�ena . 600 Washington Street Boston,MR. 02111 fax#: (617)727-7749 } L�'ey vr�4}�§ 'k."�{�,^i�ti ��S'"tcd.�}�,�4���. '���,.K ''°F'dr��"1F •tts ` ''�s �♦ t��N" ,1^# e.¢s f ;.• -A. k'-B,' A F s xSS vim. .wv i. j„° +}� a a ♦'�., ..af. i -v •, � S.� MS. 6"� ,_u ' c b yr ' tr^„ M1'ryi pe` +✓'r .♦Yy Pik!?,,,'i.+ i.ry 5 5` +� ,c.3C a -33f a}..;,� S J ♦'- F .t v c.;- iz t i Z :k' 9 s '3 `l♦,a r. t +i" F '' 5� n !♦' K..y:T.,1� ,� s �.. �} K- a ?, f�RK ,:� °' -�t'q F s P Aw ^it3 'J4 "#`. �* T '� .� y �7`� 1�.. #p�` "Es*'s1 7 IJ F g'r t+ :y ♦ Sri= $. t r. `'. ;< b ''ya sr t'::5.r�. ,♦1.3. W. m S� r. ?sdi?' ,., s.;r a � ,.� ,� ��.: r Ft6:.f;e e�' '�`' v. >3 i.E4z ,•� ,'�k �.i.,(- { �4.p„ �Fi. 't e�yt �F ;�T �'-•�:5 r 3,SR�'i �t � �",��`v hii!t '£.. yv A, <;�{� .c z , t sl.+1r,� ° ' �. .♦�} �}�i i... 4 i w ` .'� w .r#� a.♦ v °4RY ,'6 '. .". r.`, tg�13'd + .� K t a- "�"}' n A,♦ '.,� r �''o- .,` .,,�' �,� ,'.� .d- ?; 4# y ,�, H �°'w:F 7 � 0t� S�i�� � a '�` �s9 vd�i u.-di ♦ ♦{ " a: •s .. ♦� F ,$ 5{ ��. t 4d'# 5, * Mi � ~ uuE�� � Sja •��$�^ !^t „�k y sw , k �LL. k 7Cown `of Barnstable k k , �J` _ ..a; J"MFX' ( •. ~� +sB.'. .''J y r. A d, YSYZY'. Retosto c ', J .n ry Services _ � , .. �,, , : Thomas F.Geller,Director gip' �a3s. ,• - Building Division TEo • Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www,Aown.b arnstable.ma.us Office: 508-862-4038 Fax:.508-790-6230 HOMEOWNER LICENSE EXEMPTION .Xf"" ' /�A Please Print DATE:✓ �i��' JOBIOCATION: t2 //�✓.�? �C �rN�C�'Llfs'//lt number q street village "HOMEAWNEIt':l`� �ZI� �G cJ name home phone# work phone# %2 7`CURRENT MAILINGADDRESSi ZA"el— .�eX"I'1S a� O cr /town - state zip code.... , The-current exemption for"homeowners"-was extended to include owner-occupied dwellings.of six units or Its to allow homeowners to:engage an individual for hire who does not possess a license;"provided that the owner'acts as _ supervisor. DEFINMON O$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 inimum inspection procedures and requirements,and that he/she will comply with said procedures and Si lure of Ho eowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required-to complyvith the.- State Building Code Section 127.0 Construction Control . HOMEOWNER'S EXEMPTION The Code sta_tes-that: "An homeowner perfom ing work for which a.building permit is required shall be exeriapL fro4tYhe provisions_ �;of.this section(Section 109.1'.1-Licensing of construction Supervisors);provided that if the homeowner engages a liersori�srfoi hire to do such work,that such Homeowner shall act as supervisor" - Many bomeowners-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) Tbis 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 veral towns. You may care t amend and adopt such a form/certification for use in-your community. w 97 2 ,p S,F 46 L m � 19484 w I LdT Ms (��p 7iv CERTIFIED PLOT PLAN �1H of Jw�ss9 !lg.W CONSTRUCTION ONLY. Fa � u TOP OF FOUNDATION ISM r7 FEET °R IN ABOVE Low POINT of ADJAC NT , ,STD o� ROAD.� sub 86ALEi.l'� 5'p r DATEr Of QNGIN f CERTIFY THAT THE ��1lT BHQMtN QN THIS PLAN 1$' LOCATEr gGlSTEREO REDISTER�6i Q. �! Q:I��,THE GROUND AS INDICATED CIVIL LAND COMFOtMB PTO THE ENSINEER SURVEYOR Rksy y ,gyp T 712 MAtN 'STREET HYANRtS, MASS. i1 " „ Q� 'E '; REDLANQr�9U144 .. . .. ,A i�F✓� l_ ' T k; d Town of Barnstable IMME'0''ti° Regulatory Services Thomas F.Geiler,Director • BARNSTesIZ, • sM�9. � Building Division ArEo MAC° Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINTANOUIRY REPORT Date: 7 -/7 -110, 2- Rec'd by: Complaint Name: �� Map/Parcel AL -G le -Z"14 Location Address• 0 , Originator Name:- Street: Village: State: Zip: Telephone: Complaint Description: FOR OFFICE USE ONLY Inspector's Action/Comments Date: 7-/ 7 —,:7 2— Inspector: Additional Info.Attached Q:forms:complaint p Vj `; Jo2mwrther--spool - iriot. , i °Cis (iVt.0 • �� 1� + � f. � ili � 1 Town of Barnstable A Regulatory Services Thomas F.Geiler,Director • saxxsxnai.E, • M' Building Division 1639. �0 7 _P/J'J Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINQUIRY REPORT Date: <�>A ast r Rec'd by: �Ms Complaint Name:. .C sz�� L4ez a S Map/Parcel c Location Is Address: �� �. i t�ll �Q r, �-e^n���� o zG 2- Originator Name: Street: State: Zip: Village: ' Telephone: Complaint Description: . csfl G�YJ <6 Un FOR OFFICE USE ONLY Inspector's Action/Comments Date: :51 . as—oa Inspector: h p Ye s q w � -'aQexor 14LA-e r 'hp I�P�n✓1�aka, N 1.)C d 12 cgs : ��y r '3r � —� �� ��a ���- "ems-►��a„-� e� ���.�� en ill T�iM1� Liss nn� �GJSa �i,aQl tn/ \w.r n1 its Gy.QlVt�altq YOt-y Additional Info.Attached 12 Q:forms:complaint I 1 s ,.:;+►•..+�,r'8�" tij' 'a. .saw ,._.s ??;, -77 iA �• h ..! u a A'' •r. f +.: .;,��;• r: ��"`_ '� •. .fir N V3 1K`'s•e '�Yt ir'(1:�'+ ,'"q,g rt ys. ar Y- #." �3•� _,gyp+�"� `„, ���•�43a n Y�. 'i.� +��'f i. 4�. �1�, r� •� :.w 7�, ��c. ``�; _ �d'� ��""a $`« t'�y-�g,,;�bud'rr'a 6 .,..ar.y�y�U� � x• �� �._q4 � t�n; ,f 4 �f _ e t �� r t a 4�s 4 o I+ r t P ' 1 a. — . t . . wn may. u - n R 3•lr + a s / .,•.p t l" ;,�.✓:Lf` 5� jr�4Ft'�i .42v, N+ Complaint Number 1672 Taken V. SIaRVICE �� e:„.G,u «v. Cv r 7,3�t.,..+'r � a�'Y •� r� � +,1` r e..cr t a«i,c, X"t '4 SIFx = nag x =4 r 24 20001 ' +,�'�tines Referred i toILDI1G ®; r a ,y"`,r',•F"1" X� p Y k sa4 '�''+..1 4�c; x�'^ r ..�, 'f1 �§§��'ri�"Ys.. .r itik�'"a`x�s`�' 7"'� 'rai"a�.'" �r b.`�, 4 -A e�, � �"v •�rh v�" :3 `k�� -_ .iS vsjv°>~ r�'-•>su SUBJECT OF COMPLAIlV'I' w; Y BMlli COY- usiness/Occupant IN; 1ggg ,3 ANumbe '- Stree .'LIAM LANE r Vill ,• � CTELZV_IL ` rro7t �.c.,�-,i,��x4'' a7 t�'3�� ,�?b�� ''� r�� .1.4' to �'Y •��f, - COMPLAINT INFORMATION _ Yam` "'"l" ``�'<-7+'y, 'cjol ' '`•3kfl# lam',� Q.,tx, :'• , ''- y. L Complauiarit's Name NEIGHBOR z � . Telephone Nu mber � �; _ > ��- •r . C.omplainV escnption , x ALSO RUBBISH ALL OVER.HOUSE— " � ; rq t �. g : . � `�'L • '�i'a� 1 '�t��1' xaiFc"�..�5-r;"� - $:�tr, y�ro">� xr�ra'_�a�•� � ME, ,� WIN i Acttons�- G. U. HAS—AND WILL CHECK. �•'���?: ° ��• r er �j�, �'�'����'�• "fit -_ i�„Ys¢`� `t"'�"''�.�µ�,.r41" _ • � 3° �a •'Y�,4 .'F r add.+-�a'f �7" �h1 Assessor's map and lot number � SewagCPermit number ........ ................... A4L r BJBBSTABLE, House number "� tD ! � ^ 9 YAO&-....................:..,..:........................................... i6 q. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO a , TYPEOF CONSTRUCTION ...................................................................�.................................................................. r / =z TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .........................( 0—( / Z-- C r, - ,� z. ti' t_.. ................................................. .................................................................. ................................... Proposed Use ....................................... ' (,r r. -r. .... .'�.*'`� r-r a.. .. ..................... . ......................................................... ZoningDistrict ........................................................................Fire District ............�............ ............................................. /IF Nameof Owner ........�..,.... ..........................:.....�.......Address .................................... ✓7 Nameof Builder" ....:..................: . ......................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... r- Numberof Rooms ............. ��.....................................................Foundation .....�....................................,................ —.. ........ Exierior .........74... ... Roofing .........../'Y ............................................................ Floors ............ w! .:.-!..... 1 �" `� -� `�,f-0, ....................................................../ @.................................Interior ...................., Heating .......................:..r�/.r. ��.................... ~, .. .....................:.:............................Plumbing ....................... ..,......................... Fireplace ............................. ...................................................Approximate Cost . � C ... �� I } Definitive Plan Approved by Planning Board _____A�_'�_F_ ______19_g�. Area ...:5. Z r .. . .........p.. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �? �? X K 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. /� r / `f_� Name ................................. GREENBRIER CORP.Pt (J� A=167-16 24508 13-2 Story— No ................. Permit for .................................... Single Family,,,Dwel,ln ,,,,,,,,,,,,,,, Lot #12 56 a Loca ion ....................i..............�...aM...Iaan.e..... Centervi.l (.................................. .... Owner ...Greenbrier..Cor ' ...................:....... .......S-f..................... Type of Construction ...... :x'.dme........................ ............................................................................... E Plot ............................ Lot ................................ Permit Granted ..........Nove�}................tber.....2...1.....19 82 Date of Inspection ....................................19 Date Completed .......................................19 jAsseoor's map and lot number A.'Oell .. �✓... � THE t PLO O�y Sewage-' Permit number ............. ............. ... .... .............. Z EJEH9TULE, i House number ..... .... . .............. ...:... ' rasa Ar- TOWN OF -BA-RNSX1 h *1E hil" -` - ;IISTALLED IN COMPLIANCE WITH TITLE 5 BUILDING, r , AA1ENTALC0"I!•/0w�7S- PE � LI [ E{ Lpp 41 `eA 'APPLICATION FOR,PERMIT TO ................................... ........... ... .......( ...i-r.......r.. ......................... TYPE OF CONSTRUCTION '`�..................u... .....� ....... ......................... ........................ ..............5....1J ,. ...19 ... -I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: O location ................................�.........�....................... ......................................................................... �� ...................... ProposedUse .............................(�l ,r/.. C...........F�,"!..t.t(.�1...... .................................................................................. Zoning District ......Fire District Name of Owner .......�.� y.... l.. 2 ......Address ........... b. ...... ..(.0....... C........ ... Nameof Builder" ........................ � ::..................Address ...........................:........................................................ Nameof Architect :.............................:...................................Address .................................................................................... r Number of Rooms . �.1���r ..........................s......................................Foundat.ion ..... ....L/.......................... a-!�' ..... Exterior .......!i! :.G:...... .......... Roofing ...........� � .............................. .................... Floors ............ �� ...4.....v.l.. . . ...................Interior ... ................. ................................ Heating ..: .I....Y ., ..... . l '....: .........Plumbing ...................��C f�a.......... ............. .. ti Fireplace ..................:...:....................:......................................Approximate Cost ............: .... .{....�...41..:(-).................. . Definitive Plan Approved by Planning Board _____ _ ------19_Z_ Area ' 74f Diagram of Lot and Building with.Dimensions Fee' ........ SUBJECT TO APPROVAL .OF BOARD OF HEALTH Z ��Z F(UO/L3 Aid 6,iA j, -e yr3. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstobte regarding t above construction. ' Name GREENBRIER CORP. 24508, No .............:�.. Permit for ... ...Story.................... .... Angle Family Dweliing ...................................................................... Locaflon .....Lo.t...#12.........5.6...L.i am...L.ane.. .. .. .. .... .. .. ....... Centerville ' ...........:............................................................ Greenbrier Corp. Owner ................................................................... Type of Construction` ....Frame.................I........... 11 . .... ....... 4 .............................................................. .................. Plot .............................. Lot ................................ Permit Granted ..............November ........ .....2............19 82 Date of Inspection .....................................19 3 ,Date Completed ....Z X-......... .19 ell x�• 245C� TOWN OF BARNSTABLE Permit No. = Building 'Inspectors - --- — `Cash ..Wa - 1e39 � d r, F OCCU PANCY PERMIT Bond ---_----------_y---'--_------- Greenbrier Co ' Issued toa v • ' {fAddress lot #12 5&'Limm Lane. Cento-,vi 11P Wiring Inspector / / Inspection date Plumbing Inspector � Inspections date Gas Inspector � � Inspection date - /Engineering Department ,�' ,r,. .r' f` Inspection date_u:' Board of Health f E^ s C -�'* Inspection date / ! ? �--' 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 t0 OF THE MASSACHUSETTS STATE BUILDING CODE., — ......... ............................._..., 19JLt:� ...................................................:.........�.!!.........G'1�--- U Building Inspector a� /9 Y S t ?E t C�ETCa IM�1 •r_: TcF�A. AST co��E `.CrJ`i5. M tt iC OF AN 3 y t ND SUPS L`.V, 4-7 //89.01 �tw 2 1 f 4' hh eat 0 {V . � � o r��,.,A r f•a2 ae�wkv.,., `�3 �Z 5,�.� � m- � . • • 30` � �. rs. v LEGEND 434 CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION-, 0x0 ��:�V\ Mr EXISTING CONTOUR '0. — FINISHED SPOT ELEVATION w. �'��/TE_r 1%/ L L FINISHED CONTOUR -.0 MciRSE N IN . No 10951 O APPROVDs BOARD Of"HEALTH' � _. �.� ,� 't � � p� 15T �� # SSSIL9 MASS ONAI.'��� f` e TE t /G7 1_.f D . DATE AGENT ti.= SCALE / - Sv DA ; LDREDGE ENG N O CLIENT- I CERTIFY THAT THE PROPOSED EdISTIERE S. REaI�TE�R:EO �' 'p� N®. 2 a°l : BUILDING SHOWN ON THIS PLAN t CIVIL �ANDI CONFORMS TO THE ZONINd LAWS �' DR. ►Yt � '; OIL RARNSTA E , Al ENGINEER U - 712 MAIN STREET NYANNIS, :MASS•:a`"� MEET, OF A E R d. L.AND SURVEYOR S y , ........ ....._,. ...' ..._......_.,...........»....._«.._-.._—_-_....--..-...s.,.........J..."•.-<.t-...-e.•..-..-..z!1.n-.re•Kh:•!»e.nn.MP•^+_fi-. 'w-..,..5. , .+,.. .,r-:....,...M. _n. .. ..... . - _.., ,.. .. R ff 87 °4!, '3 z L 0 T c C o t.. O TM �r CERTIFIED PLOT PLAN �s MAQ F: q� Lim 4AAI ROSER T G NgW CONSTRUCTION ONLY Ruce y €' 6 DR IN TOP OF FOUNDATION IS l,'L..,, FEET A .` ABOVE LOW POINT OF AWCENT ISTE O ROAD. -/ 4 No sub! SCALES — ,S'p DATE / " C-rEq/' C l ' _ o u N6 7' /V EN Q/ EE l y H k I CERTIFY THAT THE f 8NQMIN ON THIS PLAN IS� LOCATED- ERED REAISTERI�D }' L8 8T ON .THE''GRQUND AS INDICATED AND CIVIL LAND CONFORMS TO, THE ZONING LAWS ENGINEER SURVEYORS., DR.QY,t OF `OgI ;NSTA$LE MASS 712 M A I N 'S T R E ET C�.pYo �l;'jt',t ` HYANR'S, MASS 8HE.BT F �._, - +y TE'' REGO LAND SURVEYOR #b .- qti