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HomeMy WebLinkAbout0097 LIAM LANE �� A y�„ . . � � �oFt Teti Town of Barnstable Permit# Expires 6 montlhsfrom issue date Regulatory Services Fee * BARNSTABLE, + 9�'pre a Thomas F.Geiler,Director s6 /o7 g �� Building-Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 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 1 (2- 5 l Ca rope P7Address YZ Z_IIhlVl.' ! A CG/��l fit' ��2 di 0)_c Residential Value of Work ? 7 Minimum fee of$25.00 for work under$6000.00 n Owner's Name&Address it l( vivy, J VP-( /Vi`e- Contractor's Name- /n i�S lazV Telephone Number 40 Home ImProvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance X-PRESS, PERMIT Check one: 13 F G16 2009 ❑-I am a sole proprietor � havethe HomeownerTOWN OF'BARNST`AaL Worker's Compensation Insurance Insurance Company Name e/_Ca,/I/ Workman's Comp.Policy# gsl Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles). All construction debris will be taken to ❑Re-roof(n6t stripping. Going over existing layers of roof) ❑ Re- e #of doors Replaceme Wind ws/doors sliders U-Value �. 5 (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: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is c required. SIGNATUR - QAWPHLESTORM&building permit forms\EXPRESS.doc Revised 090809 The Commonwealth of Massachusetts Department of IndustrialAccidents Off ce of Investigations #s ,€ 600 Washington Street Boston, JV4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiecti-icians/Plumbers Applicant Information Please Print Legibly Name (Business/OrgaiuzationlIndividual): ff�p,)_ �Ss�gee Address: v'�e4 0,0 .: . City/State/Zip:� os" Phone#: Are you an ent61oyer?Check the appropriate box: Type of project(required): . . wit 4.°,❑ I am a general contractor and I 1. I am a employer h. 6. ❑Npe6 construction employees(full and/or part-time).` have hired the sub-contractors 2.Q I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, Q Demolition workingfor me in an capacity. employees and have workers' yt 9. Q Building addition, [No workers' comp. insurance comp.insurance. 10. Electrical re airs or additions required.] 5. Q We are a corporation and its ❑ P 3.Q I ani a horiieowner doizig:aIl work officers have exercised their 11.Q Plumbing repairs or additions Myself [No workers' c,omp. right of exemption per MGL 12.Q 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 91.must also fill out the section below showing their viorkers'compensation policy uiforination. T Homeowners who submit this.affidavit indicating they are doing ail work and then hire Outside contractors must submit new affidavit indicating such. Tcontractors that check this box`must attached an additional sheet showing the name of the sub-contractors and state'w•hether or not those entities have employees. Ifthe sutrcontractors'have employees;they must provide their"workers'comp,policy number. Lam an employer that is providing workers'compehsadon insurance for my employees. Below is the policy and job site . information. Insurance Company Name: P Y Policy T or Self-Ms.i Lic.4: o� il _ Expiratiori Date: Job Site Address: / / ���/1� LAI City/State/Zip:'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 the pains andpenalties ofperjury that the information provided above is trice and correct. . Date: Phone+: 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 9: rq (utp :. . t# T. on M @NA 90-C1 • ��-�-�: ; ��� �"'�i,''�,y.�-�.,� fd1RIYI�B iY��kl� ���VT{, a _ s Undersecretary Mit es u i sir`a e �k.a onm F ' ady 4 N&hoA ems ` , Ar � moo n r From:Snaunna Robinson, Hunter Insurance At:Hunter Insurance,.Inc. axp: TO:Denise Clode Date:923/09 09:45 AM Page:2 of CORD CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE(.MM/DD/YYYY) PRODUCER - MOONA-1 05/23/09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON-THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Manville RI 02838-0001 Phone: 401-769-9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE NAIL INSURED Moon Associates Inc. - DBA Gutter Helmet INSURER A: National Grange i—mane Co 14788 DBA Renewal by Andersen of RI INSURER B: gear_on tntta�al Ins uzance co, DBA Gutter Helmet' Roofing, DBA Moon Works - INSURER C 1137 Park East Drive INsuRERO: Woonsocket RI 02895 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 SUBJECTTO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - 7FF SURANCE POLICY NUMBER DATE(Peet/DD/YY) DATE(MM/DDlYY) LIMITS EACH OCCURRENCE $ 1000000 NERALLIA3ILITY MPS26619 09/16/09 09/16/10, PREMISES(Eaoccurence) $ 500000 DE OCCUR • - _ MED EXP(Any one person) $ 10 0 Gi 0 PERSONAL&ADV INJURY $ 10 0 0 0 0 0 GENERAL AGGREGATE $2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER:- - PRODUCTS-COMP/OP AGG $2 0 0 0 0 0 O POLICY PRO- - JECT LOC AUTOMOBILE LIABILITY - COMBINEU SINGLE LIMIT A X ANY AUTO BIS26619 09/16/09 09/16/10' (Ea accident) $ 1000000 ALL OWNED AUTOS --� SCHEDULED AUTOS - BODILY INJURY BODILY INJURY HIREDAI,TOS - NON-OWNED AUTOS - - BODILY INJURY - $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY - - AUTO ONLY-EA ACCIDENT $ ANY AUTO - - - OTHER THAN - EA ACC $ LE AUTO ONLY:, AGG $ EXCESS/UMBRELLA LIABILTY,, EACH OCCURRENCE $ 10 0 0 0 0 0 A X QccuR CLAIMS MADE. CU526619 09/16/09 09/16/10 AGGREGATE $ $— DEDUCTIBLE - $ X RETENTION $10 0 0 0 WORKERS COMPENSATION AND _ X TORY LIMITS ER B EMPLOYERS'LIABILITY .. ANY PROPRIETORIPARTNER/EXECLMVE 28586 10/01/09 10/01/10 EL EACH ACCIDENT $SQQQQ.Q OFFICER/MEMBER EXCLUDED? ` If yes,describe under E.L.DISEASE-EA EMPLOYEE $5 0,0000 SPECIAL PROVISIONS below - -THER E.L.DISEASE-POLICY LIMIT $-9 0 0 0 0 0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES•/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS - CERTIFICATE HOLDER CANCELLATION BUILDIN SHOULD ANY OF THE ABOVE DESCRIBED:POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 .DAYS WRITTEN Building Cont. Reg. Board NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dept. of Administration One Capitol Hill IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Providence RI 02908 LR�EPRESENTATWES. D REPRESENTATIVE ACORD 25 2001108 ( ) ©ACORD CORPORATION 1988 �-�g C R>2v 1/lE o 2G3 2 a® Cuseoaner 31amr tafthtitt: f 8_ &aM�t ansm of RIW&UL%.d& gp� �rDma iD#.- o'�ttGnewaa Sales Agreement Ad.71p: , �sLc�Numba: _� City.Sere.73p: � �Oi�! � 17 ?Psidc&xa iJrl>•r by 1' n. rpw,er-Ho,tee: o Gov n,RI OZ895 waoaw aa.ut:areat s,anara+c Mwnc 36arlt, �i d �of 1)asc 6cian9e r it].30939 IU-12259 MA Email: 119$35 c-T-562725 1�115 tadei®/ltt�wa 6RiUES DiiteaMm c � S A oil v i Aff .� - tr dt�• +� �F' d°I w� w Jc-I ac-9 O QaC d �� - �� q SO rr l f Sa 1 f L i 50 71•7 ' 11 d s �' 19 $ropr.tl:wBoduaaae.aoeo.t +oF.�pa+�tti(m lbr SehhtWaoa FW�pnetetf�8atltod - tary.,dril,alattts98fs�? D Ef+ f3.Dco.m Ll� �Nb�Y Madah'Rtl _ i;T "� n` Q �a TA�ic VAR p� ood �!J � t--�-'' "�4- -- sW carol o a� Cl ova CAM C,`.uetatmet t tYw ms Mtn tdp�rmmti6wTddsa a196�.s+pegarotunmg&�dw �J.t�° �1�� �1/!.�•+� �'Croft a � - y nesa bA.la?188xx .�+a:wwfw do menor.+-„M�g.�,�an,ae+.rcnbsm.t+.nm 1A..�mt n R by See 1Prverae Side(or Cor" C9ndi unit of;Q6 Yan1,the btwer,array cancel � Chia wwaacdou at"W dtne Dp night of the third 6uainbct�l9ry �T d�sAaattrY tbcdate of Mmiction. t�we are Atrr+aiehed nadoc of state e8a rn for an _ �� tluploo aka/�.• Tw�L Mka name 6 ecdtn os Pa 'yok Pbft*c - dd�Rwaa .lacsp..a ►/]7C '.a++x sv rod to ml�aw�et a+pD,ot a;o�a cal f y}py se�earltotgd6 ►�Gae� t Rom,aow Iwo tear �nnA�gm r9 5pedd Oder t4mm _ fatd aLaosM ai rmpud tl°x kmaW br.v..k+Ac=> -'« �h�ultad 7 Med.sl�Me. +uaearm cawrertr se.wa�aoaste. few fse -.i:=vg+aaawmae*a elafMtao®t�csrptetk;= atahaoP Oats1 ar A w av+mAccR•t�eul4Dsderaa y a nwidffi+w n6�hr ea NUman a� 4ot w0 . l ,Y.vdatmm"Z000m - ;-pie m&.�e Mbmr.owermk mgvgu&n. ao �ehrere..M+ ma.aau�n w�tlaeR tv .ap°o,Otn s.a c+watbme .a.mo .an.rrn<w iawrr�ertt���9v n s>!Li -r anddar.,.,ta0ryodra.nyiw�d. /(+ p �ksdwileryte.wwnm6wss8 typ'p-etP4aaltgWdt�J�ttoz,a•lon Rot-kb.+xaatr roatafc 1/� ? Lvdmk a� ma �oFt Teti Town of Barnstable *Permit# O Expires 6 n10 2 s fr m issue date Regulatory Services Fee MASS Thomas F.Geiler,Director '7 6, V6 1639 �� / J ArFD MPS A l 1 Building Division c�h LyloXPRESS Y Iom Perry,CBO, Building Commissioner ® 200 Main Street,Hyannis,MA 02601 NOV 2 4 2009 www.town.bamstable.ma.us Office: 508-862-4038 pp,��ff � Fax: 508-790-6230 TOWN OWN 0FA6ft'§ PE&T APPLICATION - RESIDENTLA.L ONLY Not Valid without Red X-Press Imprint Map/parcel Number I0 V/ 0O Pro rty Address L y,&)1 l/Vf�V1 �/1 2r t/n� A. 0 W7 Residential Value of Work /" 0c/ Minimum fee of$25.00 for work under$6000.06 c Owner's Name&Address 11 /" /y7 -e Contractor's Name. Telephone Number �01-Cli Home Improvement Contractor License#(if applicable) Construction Supervisor's License.#(if applicable) POO XE c ❑Workman's Compensation Insurance �� ERIV��T Check one: N2009❑ I a sole proprietor the Homeowner TOW TABLE I have Worker's Compensation Insurance 4 Insurance Company Name Re/IC Al Aly/Y Workman's Comp.Policy# .� Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque (check box) Re-roof(stripping old shingles) All construction debris will betaken to ❑Re-roof(not stripping. Going over, existing layers of roof) ❑ Re-side #of doors 0 Replacement Windows/doors/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: 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 090809 The Commonwealth of Massachusetts . Department of Industrial Accidents Office of Investigations .600-Wash-ington-Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): 00 v S,�Oc /V 0 . 4 Address: A '� % M ars Or f 1 (1� City/St to/Zip:i'�11f�1��'(�G`t�l- Phone#: . �V C' G '7/ 6 Gl Are u an employer?Check the appropriate box: Type of project(required): 1. I a V i m a employer with 4.,❑ I am a general contractor and I employees(full and/or part-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 g, ❑Demolition workingfor me in an capacity. employees and have workers' Y p tY� 9. ❑Building addition [No workers' comp. insurance comp. insurance. _' required.] 5. ❑ We are a corporation and its l0.❑Ele ical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their • 1 L❑ umbin repairs or additions myself [No workers' comp. right of exemption per MGL 12. Roof rep"airs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp:insurance required.] *Any applicant that checks box##1 must also fill out the section below showing their workers'compensation policy information. 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.-Pf fhe subcon-tractors have employe,tlteTtruisrpravift-their-workers-cz*p-.polrcynumber- - - - - - - - - - -- - - - - - - I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /' Insurance Company Name: efic ov (jF� N 5 (i(7 . Policy#or Self-ins Lic.#: � :Expiration Date: / t/ 3 JbSite Address: City O�(o Attach a copy of the workers' compensation po icy 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 the pains andpenalties ofperjury that the information provided above is true and correct. 9 Signature: Dater Phone#: go �00 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#: rk -ore the OBIS IMPENT of rotra'jim A*WW6 12 y w OM Not wO oh, L U tiersecr� aty RFWS it ii-tilih..an Y LOOP; t � . A64 � * � actT ig's mtmk ' 43 PAINP- cum .: �`. t I OW- - z From:Shaunna Robinson, Hunter Insurance At:Hunter Insurance,Inc. FaxID: To:Denise Glode Date:9/23/09 09:45 AM Page:2 of -C RD CERTIFICATE OF LIABILITY( INSURANCE OP ID .S DATE(MWDDYYYY) MOONA-1 09/23/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON-THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 Phone: 401-769-9500 Fax:401-7691-9502 INSURERS AFFORDING COVERAGE NAIC9 INSURED Moon Associates Inc.DBA Gutter Helmet an INSURERk national Grange Insurance co 14788 DBA Rene-oral by Andersen, of RI INSURERS: seacon Mutual Insurance co. DBA Gutter Helmet Roofing DBA Moon Works INSURER C: 1137 Park East Drive INSURERD: Woonsocket RI 02895 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 SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(M19MlDD/YY) DATE(MMIDD/YY) LIMITS GENERAL LIABILITY ? EACH OCCURRENCE $ 10 0 0 0 0 0 A X COMMERCIAL GENERAL LIABILITY MPS26619 09/16/09 09/16/10 PREMISES(Eaoccuu ce) $S00000 CLAIMS MADE � OCCUR i _ MED EXP(Any one person) $ 10000 PERSONAL&ADV INJURY $ 1000000. GENERAL AGGREGATE $2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 0 0 0 0 0 0 POLICY M PEa LOC - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANYAUTO B1S26619 09/16/09 09/16/10 (Ea accident) $1000000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIREDAUTOS - BODILY INJURY $ - NON-OWNED ALIrOS - (Per accident) - PROPERTY DAMAGE $ .(Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - _ OTHER THAN EA ACC $ - AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY _ EACH OCCURRENCE $ 1000000 A X OCCUR EI CLAIMSMADE CUS26619 09/16/09 09/16/10 AGGREGATE $ $ DEDUCTIBLE $ X RETENTION $10 0 0 0 $ WORKERS COMPENSATION AND X TORY OMITS ER B EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE 28586 10/01/09 10/01/10 EL EACH ACCIDENT $500000 OFFICER/MEMBER EXCLUDED? If yes,describe under - - • E.L.DISEASE-EA EMPLOYEE $500000 SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS[LOCATIONS[VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION BUILDIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED_ BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Building Cont. Reg. Board NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dept. of Administration One Capitol Hill IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Providence RI 02908 REPRESENTATIVES. AUTyfl D REPRESENTATIVE ACORD 25(2001/08) OACORD CORPORATION 1988 ok , newal n���J 4xoua�HOME Agreement /'Gutter byAndersen MOONWOORKST,MPFtO.VED V -leimet .wixoaw xreuerwrnr mML,..nGyuq NEVER CLEAN MR GUrrERSAMIr RI License 30839&12259 MA License 119535 Job# CT License 0562725 R.. p- x�.W : R -H Installation Address: X,t ze?_l COn 6L( p M4\_ n Street City State Zip Purchasers: Home Phone: Cell Phone: v ys sas Billing Address: yCD/_) e r--- -- (If different from Installation Address) Street City State Zip E-mail Address: Project information: We/You("Purchaser"),the owner of the property located at the above installation address,offer to contract with Moonworks to fumish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet # !l'//?I-- incorporated herein by reference and made a part hereof. Moonworks res rves the right to cancel this contract if,upon re-inspection of the job,Moonworks determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Agreement. DEPOSIT/PAYMENT OPTIONS AGREEMENT AMOUNT $ (Subject to fund verification and/or credit approval) I.Check,Cashiers Check or Postal Service Money Order LESS DEPOSIT$ $ a. (Madepayabie to Moonworks) CA-, 2. Credit Card*and/or other payment options-(circle one below) BALANCE DUE ON COMPLETION $ 6 visa MasterCard Acet# Exp Date Security Code _ Minimum 33%of Contract Amount due upon Acct# Exp Date security code execution of this contract. 3.Financing Indicate Payment Method For Acct# Approval Code- , BALANCE DUE ON COMPLETION:. *I/We agree t.allow Moonworks to charge the above referenced credit card for the deposit indicated.Balance to be charged to credit card upon completion of installation. Purchaser agrees that, immediately upon completion of the work,Purchaser will pay.any balance due to job foreman. A Completion Certificate will be executed for financed jobs.Purchaser also agrees to be jointly and severally obligated and,nnliIble hereunder. NOTICE TO PURCHASER fit '( acjG3fw_9.4d Do not sign this contract before you read it.You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights.Do not sign a Completion Certificate before this project is complete.Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract.In the event of damages,defects or manufacturer's error or delaysi no more than 10%of the remaining balance to be withheld by the homeowner remainder to be paid upon completion. A service charge at the rate of 1-1/2%per month will be added to the entire balance outstanding if not paid when due as specified above.All costs,disbursements and attorney fees made or incurred in collecting this account shall be included and paid as part of the debt due. You may cancel this transaction any time prior to midnight of the third business day after the date of this contract.See Notice of Cancellation for an explanation of this right.There will be a service charge equal to 10%of the contract amount if job is cancelled by Purchaser AFTER the third business day,bpt BEFORE materials are ordered.There will be a service charge equal to 50%of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW,I/WE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE MOONWORKS TO VERIFY AND REVIEW_MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNATURE BELOW,I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. UWE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCE ON: SUBMITTED BY: Date: s .onsu t l ACCEPTED BY: Date: ` Purchaser - Date: Purchaser f,< Home Improvement Contract f For Massachusetts Residents Only Contractor Arbitration: The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor.However, the same right is not afforded to a contractor. The contractor would have to resolve any dispute he/she has with homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree, in advance, that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in Massachusetts General Laws,chapter 142A Homeowner Signature Contractor Signature NOTICE:The signature of the parties above apply to the agreement of the alternative dispute resolution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by both parties. Homeowners Rights: A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL :hapter 93A) may not be waived in any way, even by agreement. However, homeowners may be excluded from certain rights if the :ontractor they chose is not properly registered as prescribed by law. Homeowners who secure their own building pen-nits are automatically excluded from any Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for :ompleting the work as described in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the :ontractor guarantees or provides an express warranty for workmanship or materials.In addition to guarantees or warranties provided by :he contractor, all goods sold in Massachusetts carry so implied warranty of merchantability and fitness for a particular purpose. An ;numeration of these matters on which the homeowner's basic consumer's rights.If you have questions about your consumer/homeowner -ights,contact the Consumer Information Hotline(listed below). Kxecution of Contract:The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced iocuments have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or marked as loid,deleted or not applicable.One original signed copy of the contract with attachments is to be given to the owner and the other kept by he contractor.Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin mtil both parties have received a fully executed copy of the contract. lcceleration Payments: A contractor may not demand payments in advance of the dates specified on the payment schedule in cases vhere the homeowner deems him/herself to be financially insecure.However, in instances where a contractor deems him/herself to be financially insecure,the contractor may require the balance of funds not yet due be placed in a joint escrow account as a prerequisite to ontinuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. ldditional Information:If you have general questions or need additional information about the Home Improvement Contractor Law or -ther consumer rights,or if you wish to obtain a free copy of"A consumer Guide to Home Improvement Contractor Law"contract the ;onsumer Information Hotline at: Executive Office of Consumer Affairs One Ashburton Place,Room 1411,Boston MA 02108 (617)727-7780 f you want to verify the registration of a contractor or if you have additional questions or need additional information specifically about fie contractor registration component of the Home Improvement Contractor Law,contact the Director of Home Improvement Contractor .egistration at: Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston,MA 02108 (617)727-8598 or assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaints Division Office of the Attorney General (617)727-8400 UBMITTED BY: DATE: Sales Consultant UBMITTED BY: DATE: Purchaser DATE: Purchaser Town of Barnstable Op THE Tp� Regulatory Services do Thomas F.Geiler,Director Building Division SARNSTABLE, v� WU Tom Perry,Building Commissioner 1639. iOTEp Mp`l 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax�508-790-6230 Approved:' r/� Fee: o 0 Permit#: HOME OCCUPATION REGISTRATION Dater I(�-/ AQ Name: l D R_� E S AU F/Z&_F_ / Phone#� Address: 7 �, Ifs Village: CE-11(EIZ V( LC L= Name of Business: ' Type of Business: /<.`FS�12CH'/kC H,gTolz v OA Ma /Lot: V I S-H71 1 r W ! Ci �4-r- AiS LOCA_7ti INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the.Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: Homeoc.doc Rev.5/30/03 i TO ALL NEW BUSINESS OWNERS DATE: los r. Fill in please: ma meg M V- = t—/ APPLICANT'S ; ` N^ YOUR NAME: i✓�orzai i<� S,4()E1_13 C BUSINESS „" } s YOUR HOME ADDRESS: Q La,c�,M L.�411IE TELEPHONE ,WW,.. , Tele. hone Number Home NAME OF NEW,BUSINESS 0�J 1S7o TYPE OF BUSINESS Glfi r IS THIS A HOME OCCUPATION? YES NO Vcwh ash n 9 I q Have you been given approval from the b.yit�1ing division? YES NO �+ boat l DGAfiO�'7 "l ADDRESS OF BUSINESS hvrne" 01-d0freSS abOVG MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be iri compliance with the rules and regulations of the Town of Barnstable. This form is.intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below,you may apply for.a business certificate at the Town Clerk's Office (Ist floor-Town Hall). 'You MUST go to the following office to make sure you. have all the required permits and.licenses.. GO TO 200.Main St. - (corner of Yarmouth Rd. & Main Street) and you will find the following offices:. 1. BUILDING COMMISSION FFIen This individual ha ee or d of l y p mit requirements that pertain to this type of business. #rri9d Signatur **. COMMENTS: - -� - 2. BOARD O H This individual has .re-Informed of t permit require is that pertain to this type of business. Z:_ A rized Signature* Lf COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has en informed of the Koantw irements that pertain to this type of business. Authorized Signature** COMMENTS: Business certificates (cost$30.00 for 4 years). A business certificate ONLY'REGISTERS YOUR NAME in the town (which you must do by M.G.L. -it does not give you permission to operate-you must get that through completion of the processes from the various departments involved. **SIGNIFIESAPPROVAL FORA BUS/MESS CERTIFICATE ONLY. �f � t' A iap and lot numberA �Z74.....9��— Or/< ssessf z 12,f>4— 0*TNE Sewage. Permit number ..... .............................. STABLE, House number ....I......:. d 1 sMAO& t639-AF TOWN OF BARNSTABLE BUILDING INSPECTOR .��� APPLICATION FOR PERMIT TO ................. ...............;.-�/............. ........... O/It/ 5 ................. ....................................... TYPE OF CONSTRUCTION ..... ......................Z, .....(7)o ................................................. z: ............. ............ ................................................ TO THE INSPECTOR OF, BUILDINGS: The undersigned hereby applies for a permit according to the following information: .7 Location .......................................z e/l.j ................................................................... I. .... .............. ................ .............. 4 Proposed Use ......................I........................ ........9 ;.............. Zoning District ...............1(� f) — I .......V................................................Fire District .............C........ ......................................... Nome of Owner ... 0a./Address ..................................................................................... Nomeof Builder' ............................ .................Address .................................................................................... Nameof Architect ................ --Address .................................................................................... Number of Rooms .............(-." ....................................................Foundation ............. .......................... ..... ...4. ..... ......... ... Exierior ............... Roofing ............. ..........z. . .............. ............................... ...................... .................. L- '1711-Floors ............................. ........ ..........1 .......................Interior ................... ?..,......a............................................. i, / . -/ y Heating ............... i ...................................................................Plumbing .................................................................................. Fireplace ......................... Approximate Cost ........... . 7, (-) 0 L) .................................................. 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 Tow of B stable,regardi ng,'-the'a bovet��— construction. 01 `?/7 Name ........... . ................. V .................... .............. GREENBRIER CORP. A=167-16 Cb� 24383 One Story No ...'.............. Permit for .................................... ingle Family Dwelling ...................................................................... Location Lot #2 0, 97 Liam Lane Centerville ............. .................................................................. Owner ...Greenbrier. . . . . ...Cor.p.. .......................... .. .... ....... .. .. ....... .. . Type of Construction Frame ................................................................................ Plot ............................ Lot ................................ Sept. 20 , 82 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 o o % I seasor's-map and lot number q TH E rp� SYSTEM Sevliage Permit number ......��-$o�.....�..................:..... . C�NS7"e4LLE� N �US� ,'. C<+ ._ [�T7 f6o®� � I: 33 SeTa LE. i House number ...............L.../.........................:... ... ..... ... WITH TITLE 90 039, ENVIRONMENTAL C� '�OMPVa' TOWN OF BA'RNS X'"BLE BUILDING INSPECTOR �, '`�% APPLICATION FOR PERMIT TO ................... ' �J d TYPE OF CONSTRUCTION ..........................G . ......[........... ��.�...... ......................................................... ........ /,r....... ..........19.... TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies`for a permit actor ing to the following information: Location ........................................`.. .� :. .... .. ... � ............................................ Proposed Use ................ ................5.teI/7'.......... '-t.�.t� ............. r. -) .Fire DistrictC �,/Zoning District ................ ....... ........ .................................... .. ............................................ . .Address Name of Owner .... .�.. Nameof Builder. ............................. ...........Address .........................:.......................................................... Name of Architect ..................................................................Address ...................... r' Number of Rooms ..............`�...............................................Foundation .......... � �. .7-e .. ..................................... Exterior ...............Y.41 . .......�`7r... . .. . .... ...Roofing .............. /�, .... �3... ......... Floors . ..... . ........ .......`. !...`••:..Interior .......................... .... 1.......t�.�.Q. iJ�� .... Heating :.......:..... {...'.. ... ...............Plumbing ....................f..... � '.C `� ... 1 Fireplace, .......................... Approximate Cost ................... ..�............:............... .............. ........... .. . Definitive Plan Approved by Planning Board ____°_____ 19__ Area Diagram of Lot and Building with Dimensions / Fee .............36-7S.................� � . .... SUBJECT TO APPROVAL OF BOARD OF HEALTH f-�d " q qK z q 1 J OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To o or t e construction. ` 00 l ' Name GREENBRIER CORP. 2,&.383 �,- o Permit for ...Oue...S.tcary......... ...Fam .ly...Dwelling............. ,r Location Lot #.2 0, 97 Liam Lane � Centerville t ............................................. ............................. } Greenbrier Corp Owner ... •........................................................... XI Type.of Construction Frame ........ . ......................... .................................... Plot ..'�..................... . Lot ................................ r r� Sept. 20 , 82 ►� ,,� �. t , Permit Granted .....................19 �* Date of Inspection t............. ` d / Date Completed ...... ........`..190 &7, ; f F � �A 1r - * •r. .� � r� f• �) _ Ire..- � ;^ ro` , {r �s 1 ' - P TOWN OF BARNSTABLE Permit No. .____2438 t 'Building Inspector Cash �e o'+orar ` OCCUPANCY PERMIT' Bond -- No building nor structure shall be erected, and no land,'building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." fc, c. Issued to Greenbrier Co py Address Brno 510, Cez'tervi.11P. lot #20 97 Liaa Dine, Centefyi,Ile Wiring Inspector r 'r`j� '� Inspection date Plumbing Dispector � `> Inspection date Gas Inspector ,h �� `: Inspection date f X Engineering Department 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. ` _.........._ ._, Building Inspector f.: LET 00 Z3 Z 4 a m 'j 3 _ a � r L o T- Z.oa_ I Z o, � a- ., _ f p Ito LoT OF cos �o CERTIFIED PLOT PLAN 77 2W4� CcNTE x iL LLif NEW CONSTRUCTION ONLY TOP OF FOUNDATION IS ` FEE % such IN ABOVE LOW POINT OF ADJACEN SAJIAS AWa 24 A ASS* ROAD. SCALE, /''_Sv ' DATE l 9i f/ 7/� 2- LO DOE ENGI EE l O l �����/'E32/�/Z I CERTIFY THAT THEF064'yy'9 220/v CLIEidT.,,,.�,::�,,.,_ SHOWN ON THIS PLAN IS LOCATED EOISTERED REGISTERED J0$ MO;92--o // ON THE GROUND AS INDICATED AND CIVIL LAND � CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BY'•. :_ ' OF BARNSTA E, 0. SS. ! 2. M A I N S'.T R E.E.T GN.®Ys `- -�_ q I'I 9�L . H YA N R I S, MASS.. : SHEET f OF DATE 0. LAND SURVEYOR ..I OF � . EW R'T loa 28874 hD 5 v UR 2i 3 0 28 2Lo fA c 14 r ..a 125 N;[ 1 ;...4 LEGEND �N °FM�ss CERTIFIED . PLOT PLAN EXISTING SPOT ELEVATION Ou0 ���' EXISTING CONTOUR --- 0 --- A LUT Z o %1 14 1`l Z A /VE FINISHED SPOT ELEVATION RSE .: y CT/v V'/ . L FINISHED CONTOUR 0 A p140:1095.1�Q�Q IN APPROVED , BOARD OF HEALTH 9°�FSSaN.-f DATE AGENT a SCALE$ ) �U DATEa L O RED GE ENGINEERING CQ IN GR�ENQ R,Eye CLIENT.._____., I CERTIFY THAT THE PROPOSED E(iISTERE RE01STEflED JJOB NO,..—?� I BUILDING SHOWN ON THIS PLAN CIVIL LANDCONFORMS TO THE ZONING LAWS ENGINEER RV BY I OF BARNSTAlLE , k1A88. 712 MAIN STREET CH. fly' N YA N N I S, MASS. SHEET.- OF Z DATE REG. LAND SURVEYOR