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1HE Town ®f Barnstable *Permit# 60055D�,
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Regulatory ServicesExpir Feees6monihsjromissuedate
BARtvsTABCE. Thomas F.Geiler,Director
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Buildin Division
Fo��
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 , (p q�7
Property Address C Z ; r-1 C' t PC1 (2
esidential Value of Work ydcic� Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address;S'U Z r1
G- C
Contractor's Name- ( I j?ii Telephone Number l " q_2—Z_Z11
Home Improvement Contractor License#(if applicable)
❑Workman's Compensation Insurance � �� �� ®��
Check one: PERMIT
❑ I am a sole proprietor
❑ I am the Homeowner AUG 22��8
[__gave Worker's Compensation Insurance
Insurance Company Name / w hz//tq TOWN OF BARNSTABLE
Workman's Comp.Policy#. �� boa 6—
Copy of Insurance Compliance Certificate must be.on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑l Re-side
P Replacement Windows/doors/sliders.U-Value rl a
(maximum.44) , cii
.�
r;
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Hisw c,Conservation,etc.'"__,
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License is required.
;-V;
SIGNATURE: `
Q:Forms:buildingpermits/express
Revised 123107
Department of Industrial Accidents
W� Office of Investigations
a 600 TVashington Street
y�
Boston, MA 02111
i-vww.mass.gov1dia
Workers' Compensation Insurance A'fldavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): NEWPRO .
Address: 26 CEDAR STREET
City/State/Zip: WOBUR.N,MA 01801 Phone#: 781-932-5300
Are you an employer? Check the appropriate box: Type of project(required):
1.X I am a employer with 50+ 4. ❑ I am a general contractor and I 6. ❑ .New construction
employees(full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. X.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. workers' comp. insurance., 9
[No workers' comp. insurance 5. o We are a corporation and its ❑ Building addition
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL l 1.o. Plumbing repairs or additions
myself. [No workers' comp. c. 152, § 1(4),and we have no 12.❑ Roof repairs
insurance required.] + employees. [No workers'
13.❑ Other
comp. insurance required.]
*Any applicant that checks box 41 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.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
1 am an employer that is providing workers'compensation insurance for my employees,Below is the policy and job site information.
Insurance Company Name: ARBELLA PROTECTION INSURANCE
Policy#or Self-ins.Lic.# 90967005 Expiration Date:
Job Site Address: fz_ City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). .
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of.criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. e advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insuranc erage verification.
I do hereby certi�dee and penalties ojperjury, at the information provided above is true and correct.
Signature: FOR NEWPRO Date:
Phone#: 7 -953-8146
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):
I.,Board of Health .-Building De artmen 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
I
MA Reg. #146589 54230
CT Reg: #0605216 O
0 Ira
RI Reg. #26463 FITHE!RFEPLACEMENrwwoOWPEQPLE federal ID#20-2625129
Corporate Headquarters:26 Cedar St.,P.O.Box 2696 Wobum,MA 01888 (781)933.4100 1-800-342-2211
2
THIS CONTRACT MADE THE.. . . 200 between.'. . . . .h> day of. . . . . . . . . . . . . _ . . . . . . .
.7 Or Y . . . . . . .
(Home Owners) (Honme Ph, e)�.. �(B,u/s,/�Cell Phone)
(Address) '(state) (Zip Code)
the "Owner' and NEWPRO Operating, LLC, "NEWPRO".
NEWPRO hereby agrees that it will for the consideration hereinafter mentioned,,furnish all labor and material necessary
to install the following described work at the premises located at
(Job addressf (E Mail Address)
TOTAL. Additional TOTAL CASH M
NEWPRO Style . Oty
-10 Windows Purchased c'� - Work PRICE
Window Color S eci Sliding Glass Door DEPOSIT
Capping Color Specify Oty Steel Security Door WITH ORDER ( TbO`-
Double Hun -t; T_ to "
Picture Window Obscure Glass TOP BOTTOM BALANCE (I
(1 WO
Stationary Casement Screens I FULL DUE AT
Casement- Model # INSTALLATION
2 Lite/ 3 Lite Slider NEWPRO® does not do any painting or
Bay/ Bow Frame staining.. CASH
Garden Window NEWPRo® is not responsible for conditions Balance Paid t0
or circumstances beyond its control Including 9 Installer at Installation,
Awning condensation resulting from or due to pre-
Other existing conditions. Bank Completion
GRIDS Colonial Diamond Form Signed at Installation
DESCRIBE /,
n,ork o4 e>a li e,.0 (1•. to c
All steel security do willihave El 3/41'aluminum threshold installed over existin thres old.0 Customer Initials
Est. Start..®ate: o' Est. Comp. Date: o
It shall be the obligation f NE PRO to obtain any and all permits necessary nder t i- agreement,as the Owner's Agent. The Owners who secure
their own construction-related permits, or deal with unregistered Contractors will be excluded from the guaranty fund provisions of MGLC, 142A.
All Home Improvement Contractors and Subcontractors shall be registered by the Director and any inquiries about a Contractor or Subcontractor
relating to'a registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301,
Boston, MA 02108, (617) 727-8598.
If the Owner is obtaining financing by way of a Retail Installment Sales Agreement,such Agreement shall include a time schedule of payments to be
made under said contract and the amount of each payment stated in dollars, including all finance charges. The Retail Installment Sales Agreement
shall be incorporated herein by reference. If the Owner is obtaining a revolving credit line to pay;in whole or in part, for the contract amount herein,
the terms of the revolving line of credit including interest rate and payment terms, shall be clearly set out on the credit application.The portion of the
credit application referencing a time schedule of payment,to be made under this contract,and the amount of each payment stated in dollars, including
all finance charges,shall be incorporated herein by reference.
NEWPRO represents that it carries Workmen's Compensation and Public Liability Insurance in the amount of'$100,000-$300,000.
If the Owner refuses to permit NEWPRO to proceed with the work herein,or in the event of any breach of the Owner of this agreement,for any reason
whatsoever shall cause the owner to pay NEWPRO a sum of money equal to thirty-three and one-third percent of the price agreed to be paid,as fixed,
liquidated and ascertained damages, and not as a penalty,without further proof of loss or damage.
NEWPRO shall not be held liable in damages for delays in the performance of this contract due to causes beyond its reasonable control.
Owner warrants that he is the owner of the property on which the work is to be performed or that he is otherwise authorized on behalf of the owners
to enter into this agreement.
This contract represents that entire agreement between the Owner and NEWPRO and cannot be changed except by a writing signed by both the Owner
and NEWPRO.
You are entitled to a copy of the Contract at the time you sign. Keep it to protect your legal rights. We, the aforesaid
owners, certify that immediately after the signing of the aforesaid agreement, a copy was furnished to us.
You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,
which may.be his main office, or branch thereof, provided you notify seller In writing at his main office or branch by
ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the
signing of this agreement. (Saturday is a legal business day).
See the attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
The Owner.-has seen "sample" Warranties that will be,provided by'NEWPRO upon installation.
Sample warranties provided to Owner.
IN WITNESS WHEREOF, the parties have hereunto signed their names thi A., 200
EIN# Signed
M rketing Repre ative Printed Name Owner
Accepte 0 Operating; LLC
Signed
Marketing Repr Signature Owner .
WOBURN BRANCH OFFICE SHREWSBURY BRANCH OFFICE WARWICK BRANCH OFFICE
26 Cedar Street 151-153 Memorial Drive Business-Park 45 Gilbane Street
Woburn,MA 01801 Suite B-C Warwick,RI 02886
TEL:781-932.8300/EXT:330 Shrewsbury,MA 01545. TEL:401-732-2407
800-242-9974(FROM NE) TEL:508-842-6876 800-356-3312(FROM NE) ,5
FAX:781-933-0717 800-456-0555(FROM NE) FAX:401-732-1371
FAX:508-842.9248
WHITE: Branch Copy YELLOW: Customer's Copy PINK: File Copy GOLD: Finance Copy
US-15 100/PKG. 11/05
I
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f1CPLACCMGNT'.+�r I4OUW C�OPI&
CUSTON�'IEf? _ 0(_ 'r S,4
DATE _ "' _.3._JADDRE
..__� � ---..,------- ----- C;�.ol
1 / GE:T DAY fG IN;;TtaLt_: M T lM TH F
(P/ao.?e rirtile one)
r ROOUCT SPECIALIST_ __ BRANCH: _-�'� -- P-Sl IMA.TED START DATE
TO'iAL <t OF tt OF DOORS WINDOW COLOR
VANDOWS #OF ROWIPAYIhARDEN Storm„tel,ratio _ Inslnn/Uut:ac CAP CC)I_Gf�
_ w��
ITZe
J
OPENING SIZE STOPS CUTNO. STYLE W x I-I U.I. LOCATION GRID:- SCR IN OUT ACDDITONS OPENING
X.
-73
v H 77 x x
a �t y�x
o � y 77 '' � _ � x x
/�^ x x
fuN0rcLr14,-$ `*)SL x x
x x
x x
x x
x
Measure - < l � "�
ItitT� _
ni1i818M Dale Crow Size Needed rime Frame to t.OntFacle Job C<,pping Type
^PerialInslalfationlnstruc;ions: UJ$ 6C _�C�GI../CItW�o`�
Dlrerhonn io mio -- --._..._.,-----
pgmca u0t
Board of Buald3n;Rzgulation
"W s and standards
H01 9Yti3PR0VErVIEHT CGN7,ACT-0R
M :
"'= Registration:• �: ' t_ 140089
kxpiration: .5/5/2009
TYFe:_,.SuPPlement Card
NEWPRO OPERATING,LLC-.
TOM PEACOCK
26 CEDAR ST.
WOBURN, MA 01801
Administrator
' �� :,,i .:f:�3 C4`i?.li?C"1!r;wSa7,t l G:;'��".�1/! tG c�:.��✓:r f,
Board of Building g g Regulations and Standards :•
Construction Supervisor License
r �6 License: CS 96093
�a ...
�3:
� t3inthdate:-'.4/8/1965
Ex'pirat tow. 4/8120,10 Tr# 96093
Restriction: 00
THOMAS PEACOCK.JR
s
38 OAK LAND AVENUE.:r::''
SEEKONK, MA 02771 Commissioner
r
05/02/08 10:26 FAX 16177709683 AMERICAN FIRST INSURANCE
Q 001
a.
DATE(MhVDD/YYYY)
g OP ID DC
�I�, �8 �� � LIABILITY
T��SURA S ISSUED AS A MATTER OF INFORMATION
/OS
'ROOUCBR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
�asLezican First Ins Agency Inc ALTER T}iE COVERAGE AFFORDED BY THE POLICIES BELOW,
122 Quinc'Y Shore Drive NAIC#
North QTainay MA 02171 INSURERS AFFORDING COVERAGE
P1lone: 617-770-90DO INSURER A: Arb®lla Protection Ins. Co
INSURED INSURER Bi
INSURER C:
Newiro pp"rating LLC INSURER D:
PO ox 2�96 tNs
Woburn MA 01801 uRERE
COVERAGESPERIOD INDICATED.T`IE POLICIES OS RA CCE LISTED
BELOW HAVE BE
ION OF ANY CO TRACT OR OTHER DOCUMENT UED TO THE INSURED WITH RESPECT TO WHICHITHIS CERTIFICATE MAYBE IO EO OR DING
A''I'f REQUIREMENT,
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCHLIMITS
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
LTR NSR
TYPE OF INSURANCE POLICY NUMBER DATE }pMlDD/YY DATE MMlDD EACH OCCURRENCE $1,00 0,0 0 O
GENERAL LIABIl.1T'Y S50,000
01J01/08 O1/O1/09 PREMISES S 5j000
A X COMMERCIALGENERALUABILITY 850000010649 MEDEXP(AnyonePelson)
CLAIMS MADE ®OCCUR PERSONAL&ADV INJURY $1,D OO,000
GENERAL AGG REGAT E
$Z,000,0O0 '
PRODUCTS-COMP/OP AGO 52,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POUCY PRCO LOG
COMBINED SINGLE UMIT $ 10000,000
AUTOMOBILE LIABILITY 12/31/0 7 12/31/0 8 (Ea accident) `
A' ArrrAUTo 81037400001
BODILY INJURY $
ALL OWNED AUTOS (Per person)
X SCHEDULED AUTOS BODILY INJURY $
X HIRED AUTOS (Per accldent)
NON—OWNED AUTOS PROPERTY DAMAGE $
(Per accident)
l AUTO ONLY.EA ACCIDENT 3
i GAFIAGE.UABIL11TY OTHER THAN EA ACC $
!.I 'ANY AUTO AUTO ONLY: AGG $
EACH OCCURRENCE $5,0 0 0,000
E7(CESSrUMBRELLA LIABILITY S.5,0 0 0,0 0 0
A g • OCCUR CUUMSMADE 4600010709
O1/0'- 01/01/D9 AGGREGATE $
DEDUCTIBLE
RETENTION $ X TORY LIMITS ER
WORkERSOOMPENSATIONAND 05/01/09 E•L.EACHACCID£NT- SOO,QOO
EMP1_OYER•S'LIABILITY 90967005. 05/D1/08
A ANY PROPRIETOR/PARTNER/EXECUTNE E.L.DISEASE•EA EMPLOYE $ �J O O r ono
OFFICER/MEMBER EXCLUDED? EL DISEASE.POLICY LIMIT $500,000
p yes,describe under
SPECIAL.PROVISIONS below
OTHER -
DESCRIPTION OF OPERATIONS LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
OC
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CANCELLATION
CERTIFICATE'IIOLDER ' SPnC0O1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BI-CANCELLED3B0OREDAYSWR1TTEN
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO1V L
NOTICE TO THE CERTIMCATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHAL.
• ,• IMPOSE NO OBLIGATION OR LIABILITY OF AN
PON THE INSURER,ITS AGENTS OR
SPECIMEN
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
James 0, IPasrea CPCU ®A ORPORATlQN 1:
ACORD 25•(2001108)
f
P�pFTHE rp Town of Barnstable *Permit#-/0
Expires 6 months from issue dale
U RNSTABt.E
Regulatory Services Fee 00 `
,q' 0� Thomas F:Geiler,Director X-
TEC MA't Building Div1S10II
Tom Perry, Building Commissioner NO V 2
200 Main Street, Hyannis,MA 02601 1-®w� ® Z��Z 1)t-
Office: 508-862-4038 - - OF�q��sT�B`
Fax: 508-790-6230 E
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number ry� ' J U 9 P C1091
Property Address U
[\Residential Value of Work► n
Owner's Name&Address
Contractor's Name Telephone Number I I 0 41E;
Home Improvement Contractor License#(if applicable) 1 lJ d
Construction Supervisor'•s License#(if applicable)
❑Workman's Compensation Insurance
Che�tic one:
[y'I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance.,Company Name
Workman's Comp.Policy#
Permit Request(check box)Van T 14 A-t O q /0 ��D� Sstc` 3G°3. •1
esSq•
dRe-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roofl
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
❑ Other(specify)
'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
Signature
Q:Forms:expmtrg
Revised121901
1
�oFT�ero�y TOWN OF BAR.NSTABLE
EAEBSTADLE. i
"b 9 a' BUILDING INSPECTOR
�EQ YPY
APPLICATION FOR PERMIT TO ..... . . .... .... ...... . skit ..... . .. ................ .............................. .
TYPE OF CONSTRUCTION .. ... .. /'
.... .. ............ .. e......19.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby app ' s'for•-a permit according to the-.following information: /V
Location .`.... ...(........... .. C, ...rAn-4............ .. . .. . ... .. . .... . .... ..............
ProposedUses✓.° :.. ... .. .. ....................................................................................................
ZoningDistrict ..............................................Fire District ..............................................................................
Name of Owner ... �... . . ...`. A..Address ..,�J.... ....... a !4,�
14.. A,*-4-010"
Name of Builder ...............................................Address ,l/
....................... ....................................................................................
c C_ L r
Nameof Architect ..................................................................Address ....................:...............................................................
Number of Rooms .......... ......................Foundation ........
Exterior ...........Z.. .. e.....................Roofing ............�.. .. .....................................
Floors ................ .... .......... .................................................Interior ....... . . . .... .. .......................
Heating .....6-.. j...r...54J.4.................................Plumbing ..........�......................................................................
Fireplace ............./..................................................................Approximate Cost ...... ...740.. ....................................
Difinitive Plan Approved by Planning Board ________________________________19________ . ..
qq ST
Diagram of Lot and Building with Dimensions S-
X -4
O �
00
11A-
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�;CL� Win]
30
a 4
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(Olt
hereby agree to conform to all the Rules and Regulations of th jowofarnstable rp r he above
construction.
Nam .. ...... .......
Dacey, William E. Jr.
DEC 3 11970
No ...13438.. Permit for ......one. s C 017!........
single family dwelling.............................
.................. ....
Location Lietrim Circle
............... ...............................................
Center-%ille
Owner Wil.liam..E....DagVA..Jr.
...... ........ .... .....
Type of Construction ...........frame
...............................
................................................................................
Plot ............................ Lot ..........#34...............
Permit Granted .....Oct�obber 22.......:.....19 70
Date of Inspection .... .vs....4.........19
Date Completed ......................................19
PERMIT REFUSED
....................................I............................ 19
...............................................................................
1
................................................................................
...............................................................................
...............................................................................
Approved ................................................ 19
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