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0103 LONG POND CIRCLE
k '�,��`es � t3'�36at'.•sit't+���.e�,it<y�trt4K .�9#I�t➢ 15)`c,�:�d 6"t,;tfli^ .','�`"�'�-a'�,i �'axry 'ltba� s�4::tA•e.gA��111'+k�t,'f4y'?7Y' .l�kt^t �*a�i;xi�1 .k4"tiid+ .�Fr,'�Mi t; +;'ff�;�a e e et e e a 0 e r . a " 4 " L 6 9 n i O " Town of Barnstable *Permit# - p Expires 6 months u o issue d e Regulatory Services , Fee .152 saxxsrnais, • 9� 1659. Richard V.Scali,Director .� Building Division Tom Perry,CBO,Building Commissioner FEB .2 3 2017 200 Main Street,Hyannis,MA 02601 g www.town.bamstable.ma.us TOWN 0� BAMSTABLE Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid tvit/iout Red X-Press Luprint Map/parcel Number Property Address [ (Residential Value of Work$�� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name E e/aiA2,.%r / ,rsp/( Telephone Number 0 Home Improvement Contractor License#(if applicable 2 L/S' Email: Construction Supervisor's License#(if applicable) S 707 CKorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ' ❑ the Homeowner L!rl have Worker's Compensation Insurance Insurance Company Name Cjr?%`,`/;L017fAe�!s4/'n L• s lf(� Workman's Comp.Policy# tiac--� 3 1 3620f 1 Copy of Insurance Compliance Certificate must accompany each permit. .ir Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value • �/ (maximum.32)#of win , #ofdo ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e-Historic,Conservation,etc. ***Note: Property caner must sign Property Owner Letter of Permission. �A copy the Home Improvement Contractors License&Construction Supervisors License is require - SIGNATURE: C:\Users\Decollik\AppData\LocallMicrosoft\Windows\Temporary Intemet Files\ContenLOutlook\2P101DHR\EXPRESS.doc Revised 040215 ` r 1 CEnD Renewal A reement Document and Pa ment Terms byAndersen. dba:Renewal B Andersen of Southern New En landY g Barbara and Bo VW Legal Name:Southern New England Windows,LLC 103 Long Pond Circle RI#36079, MA#173245,CT#0634555, Lead Firm#1237 Centerville,MA 02632 wiNoow RE LACEMENi 26 Albion Rd I Lincoln,RI 02865 H:(508)775-2254 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:(508)685-9898 Customer(s)Name: Barbara Enos and Bob Enos Contract Date: 01/31/17 Customer(s)Street Address: 103 Long Pond Circle, Centerville, MA 02632 Primary Telephone Number: (508)775-2254 Secondary Telephone Number: (508)685-9898 Primary Email: bbenos103@gmaii.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,Notice of Cancellation,Itemized Order Receipt,Terms and Conditions of Sale, Sales Cost Savings Program (SCSP),Lead-Safe Form(CT&MA),Important Project Information,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $19,999 By signing this agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $9,999 Balance Due: $10,000 Estimated Start: Estimated Completion: Amount Financed: $19,999 6-8 Weeks 6-8 Weeks Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that Notes: 50% deposit-GREEN SKY we are providing at this time is only an estimate.We will communicate an official date 50% balance due upon _ and time at a later date. Rain and extreme weather are the most common causes for completion-GREEN SKY delay. Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understanding changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO OWNER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 02/03/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC Customer(s) dba:Renewal By Andersen.of Southern New England / , Signature of Sales Person Signature Signature Chris Hutson Barbara Enos Bob Enos Print Name of Sales Person Print Name Print Name 01/31/17 Page 2 / 10 7 , z Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-095707Construction Supervisor Supervisor f' e BRIAN D DENNISON ' 7'LAMBS POND CIRCL CHARLTON MA 0150T rrd , s�3�yt e.,a C//�� A, Expiration: Commissioner 09/0812018 o�G� Office of Consumer Affairs nd Business Regulation WE 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvemt Contractor Registration Registrabon: 173245 {� Type: Supplement Gard w � r G Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS- kL-LAW BRIAN DENNISONV a I 26 ALBION RD Efr LINCOLN,RI 02865 °} - J I yr Update Address and return card..Mark reason for damage. —` Address 'Q Renewal .�Em to Lost Card' P Yitn. sca i u 2arravn �/ [y V IC.T(' .%/10//%iiC!/IIf O�dIT.//JJ(/C�liJC7d - -ifus-of Consumer Affairs&Business Regulation Registration valid for individual use only before the OME IVIPROVEMENTCONTRACTOR expiration date.If found return to: Office of Consumer Affairs and Business Regulation Registration-jy32A$. TAM: 10 Park- -Suite 5170 rati.. Expion 9/19/2018 Supplement Card .Boston,MA02116 WWISOUTHERN NEW DOWS.LLC. RENEWAL BY ANDERSON `� BRIAN.:DENNISON 26 ALEION RD t .:r , LINCOW;'R102865 l'3Jadersec ry ,Not valid without"signature i I -` The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia SV «'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): St_4V_4�n h Ie� �✓14 OG/1 J JA)t n J Z)LAJ Address: a& Al A;Q►-N (tM City/State/Zip: L;/Ic /n . r Phone#: (401, 2,2 _ 9 8 DO Are you an employer?Check the appropriate box: Type of project(required): 1.�am a employer with--, employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.a I am a homeowner doing all work myself.(No workers'comp.insurance required.]t 10 El Building addition . 4.O I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repair These sub-contractors have employees and have workers'comp.insurance.t 6�N< 14. Other 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 5�P_(r In 5 Co — Policy#or Self-ins.Lic.#: G 1 Expiration Date / Job Site Address: G3 lil/ o City/State/Zip �/V Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 p I s and penalties of perjury that the information provided abov is tru and correct. ' ZZ signature: Date: Phone#: 01Q.1 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#: I SOUTNEW-01 UOLLINGER CERTIFICATE OF LIABILITY INSURANCE. DATE(MMIDD/YYYY)�� 6/29/2016 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 tem►s 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: CoBiz Insurance,Inc.-CO PHONE 303 988-0445 FAX No: 303 988-0804 821 17th St (At No Ext:( ) ( ) Denver,CO 80202 E-MAIL ss,CoBizin;3urance@!Dobizinsumnce.com INSURER( AFFORDING COVERAGE NAICS INSURER A:Continental Western Insurance Company I10804 INSURED INSURER B: 1 Southern New England Windows LLC INSURER C: DIBIA Renewal by Andersen I wsuRER D 26 Albion Road I Lincoln,RI 02865 INSURERE: s 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'SY THE.POLICIES DESCRIBED HERON IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ ILTR I TYPE OF INSURANCE - I INSD'!ADDLUB POLICY NUMBER iRI �AUUDD >� I.MMID o� LIMITS A I X I COMMERCIAL GENERAL LIA81LrrY EACH OCCURRENCE 'S 1,000,000 I� ! ICPA3136080 0710112016I 0710V2017 i I s 100,00 CLAIMS MADE OCCUR i i PREMISES Ea occrarenw MED EXP(Any one person) !S 10,00 PERSONAL&ADV INJURY I S 1,000,000 I C,EN1 AGGREGATE LIMIT APPLIES PER: I !GENERAL AGGREGATE j S 2,000,000 j�x!I POLICY j jE I I LOC I ; I PRODUCTS-COMP/OP AGG I S 2,000,000 ! OTHER: i ! EMPLOYEE BENEFI !s 2,000,000. AUTOMOBILE LIABILITY - ; I - I EOMB�1NdSINGLE LIMIT I s 1,000,000 I I A X ANY AUTO _ ! CPA3136080 07/0912096 10710112017 BODILY INJURY(Peroerson) I S_ I ALL OWNED SCHEDULED IAUTOS - ; I I BODILY INJURY(Per aaSden[) S AUTOS ---i NON—OWNED I MAGE 5 ! P.E PerHIRED AUTOS AUTOS is X UMBRELLA LIAB i X OCCUR I i I I EACH OCCURRENCE I S 5,000,000 p, EXCESS LIAB ' � !CLAIMS-MADE (CPA3936080 � 07I0112D96;07/01/2017 AGGREGATE j s DED I X 1 RETENTION S of I I iAggregate is 5;000,000 WORKERS COMPENSATION ! I ! I I PER I EERY AND EMPLOYERS LUUBILI7Y Y l N! A gNYPROPRIETOR/PARTNER/EXECUTIVE ❑)NIA �WCA3136089 07/01/2096 10710112017 E.L.EACH ACCIDENT S 1+000,00 OFFICERIMEMBER EXCLUDED? 1,000 000 (Mandatory In NH) ! I EL DISEASE-EA EMPLOYEE!5 , . It yye describe nd 1,000,6 CY LIMB S 00 DESCs,RIPTIONu OFer OPERATIONS t.l. I i E.L.DISEASE-POU DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additlonat Remarks Schedule,may be attached If more space Is mqulred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WrTH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE —. ._ - ©1988-2014 ACORD CORPORATION_ All rig hts reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD r X-PR PERMIT �® -Permit 0I oFs�p�aTown ®���.ri13t�.�1� C 14 Expires 6 month iss e Regulatory Services Fee N s s i TO i634 ��� STABLE, IZfehard V.Scai2,Interim Director Mp.:t 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 PEPUMT APPLICATION - RESIDE+NTLAL ONLY ( Not Valid without Red X-Press Imprint Map/parcel Number ;�C)Q 103(Q Property Address ®Residential Value of Work S L 8 7g Minimum fee of$35.00 for work under$6000.00 _ Owner's Name&Address-F )b i- 8mbam, end i k b((1C1PDT" Contractor'sNamelUifn n We W'I ews,/Rflan Telephone Number Home Improvement Contractor License+".-(if applicable) 17 33-15 Email: Construction Supervisor's License#(if applicable) ®Workcnan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ lam the Homeowner ` ] I have Worker's Compensation Insurance (' s Insurance Company Name ArOcn G i J—m ro Yl( (J Workman's Comp.Policy# U 719 3�?3 K�2 3 94 Copy of insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof{hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof). > Re-side epiacement Windows/doors/sliders.U-Value 3 0 (maximum 35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked writh red S and inspections required. Separate Electrical&Fire Permits required. $Whcre required: Issuance of dus permit does not exempt compliance with odrer to.n department regulations,i.e.Historic,Consen-ation,etc ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requ' SIGNATURES T:AKEVEN—DtBuilding Changes)EXPRESS PERIVET EXPRESS.doe Revised 061313 . Southern New ,Englan:d Windows , d.b.a Renewal by Andersen of SNE !�! Massachusetts-Department of Public Safety �f Board of Building Regulations and Standards Construction Supervisor License:CS419SM7 BRIAN D DENNZON 7 LAMBS POND LIIt s Charlton MA 015077 i Expiration j Commissioner 0910812016 I Office of Consumer Affairs find Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration 1 Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL, Expiration: 9n912018 ' DENNISON BRIAN 26 ALBION RD — LINCOLN,RI 02865 _.. Update Address and return card.Mark reason for change 7 SCAT 4 zae,oyn Address p Renewal D Employment f.nstCard ' c/i>I�n�a»nmonca¢///i�dunaeaa�eiioetla ,� *1E eeofCostumerAffairs&Business Regulation License or registration valid for Individul use onlybefore the e: nation date, iffound return to: IMPROVEMENT CONTRACTOR P Once of Consumer Affairs and Business Regulation r platratlon: 173245 Type• 10 Park Plata-Suite 5170 Expiration. 9,19/2016 Supplement ti,ard' Boston;MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. i RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD g LINCOLN,R102865 Uedarsrcrcury` Not valid without signature The Commonwealth of Massachusetts 1 rot, of Indrastrial Aceidents Office of Investigations 1 Con Bess ` Street,Suite 100 �oston,ll�A 02114 ZOl7 _ r ,w www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers .Applicant information Please Print Legiblv Name (Busmessiorganizationu/tndividim1): SOUTHERN NEW ENGLAND WINDOWS LLC Address: 26 ALBION ROAD City/State/Zlp- LINCOLN, RI 02865 Phone#: 407-228-9800 Are you an employer?Check the appropriate box: 1.0 IF a employer n th 20 4. ❑ I ama general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, El Demolition working for me in any capacity. employees and have.-vvorkers' [No workers` comp. insurance comp. insurance.# 9. FI Building addition 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 11.❑Plumbing repairs or additions myself. [No workers: comp. right of exemption per MGL insurance required.] c..152, 44),and we have no 12.❑Roof repairs employees. [No workers' 13M Other WINDOW REPLACEMENT comp. insurance required.] "Any applicant that checks box 1 must also fill out the section below shooing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a nevv affidavit indicating such. 'Coll tractors that check this boa 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 information. my employees Below is the policy and job site Insurance Company Name_ ARGONAUT INSURANCE COMPANY' Policy rt or Self-ins. Lic. /#: WC927938352394 Q8121J2075 . Expiration Date: Job Site Address: LQ City/State/Zip: Attach a copy of the workers' com sation 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 fonuarded to the Office of Investigations of the DIA for insurance coverage verification. t do hereby certify under the pains and penalties of perjury that the cnfonnadon provided abo ve true and correct. - 3 1 Signature: Z .- . . Date: % / Phone#: 401-228-9800 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: l CERTIFICATE �►TE��m ®F LIABILITY INSURANCE 08/12/2014 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: H the eertlBce%holder.Is an ADDITIONAL INSURED,the pottcy(ies)must be endorsed. if SUBROGATION IS WAIVED,eubject to the terms and conditions otthe policy,certain policies may require an endorsement. A statement on this aertiflcaEe does not confer rights to the eordlicate holder in Neu of such endorsenrmrt(s PRODUCERWillis of am'T ersay, rue. C/o 26 Century Blvd PHONE FAX P.O. IBM 305191 77- - 374 .888-467-2370 EMAIL _ Nashville, TN 37230SX91 USA :certifioateserillis.com AFFptDBEG COVERAGE NAX:• 0 A:8elsctiva Zasnranas of as 39926 OiSURED Southern Now Ragland Windows LLC OrBUREIE a The Be con Nm saanranes 24017 D/B/s Bsawal by Lndarasa 26 Albion Road INSiJREIRC zosurancs 19802 Lineala, RX 02065 SESURERD: SeRIRER E INSURER F: COVERAGES CERTIFICATE NUMBER.4e329160 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRBED HEREIN IS SUBJECT TO ALL THE TERMS, W7TH RESPECT To WHICH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS RAAS. SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. BLTR IER TYPE OF INSURANCE POLICY NUMBER D EFF PRICY EXP X AL GENERALUABwrY LEBTS CLAIdS4rADE X' OCCUR EACHi 1,000,000 A S 100,000 �� ane S 00,000 8 2029459 08/20/2014 08/20/2015 PERSONALAADVINJURY s 1,010,000 IGEPCL AGGREGATE uMITAPPLIEs PER: POLICY o PRO. o GH0 RALAGGRE6ATE $ 3.eee.0ee OTHER: P+ ICTs-COUP/OPAGG s 3,000,000 AuroaoeuELIABILITY a MIT` : 21000,0oo X ANYAUTO BODILYKWRY(pWp"W) S A - AUTOS 8 2029459 08/20/2014 08/30/201$ BODILYINAIRY(PbreoditQ S X HNNEDAIIrps E AUTOS PROPERTYtaAANAGE s A X. UNBM LLI LIAR J( OCCUR $ EXCESSLUIB OCCURREME s 5,000,000 CLMMS�E 8; 2029439 09/20/2014 0e/10/2035 AGGREGATE s 5,000,-00 OED RETBNi10N . YIfOR10ER8 GDATION i AND E NIPLOYM LIABILITY' X OTH- 8 Y"I Fr n ANY PROPRIETORIPARiNERIOOcCIJTIVE — 43FRCER MEluo3ER EXCLUDED? a NIA E L EACH AOCIDS17' a�) 0000068018 08/21/2014 08/11/2015 S 1,000,600 tlyBs,de�safturww E.LDISEASE-EAEMPLO s 2,000,000 DESCRI OF OPERATIONS blow C ork Casv/BL Covgt -�BEASE-POUCYLIMIT s 1,000,000 NC977938351394 08/21/3014 06/23/2015 -I, Ba. Accident - 01,000,000 tatneory Limits - We .z. Disease Policy tat - $2,000,000 •L Disease is. Replay" - $2,000,000 DESCRBPflON OF OPERATIONSILOCAMONS I VEHICLES(ACORD lOt,Addftlonsl Remarks SdMduk,nur a tmohW Nmors soen hf equltsd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 0i ACCORDANCE WITH THE POLICY PROVISIONS. southern NTe LLC IAUTHOR2ED REPRESENTATIVE Albion Road d Nola, RI 02965-0000 Ik7N�,y�J 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD OR IDr6629625 BATCBrBatah e, 79927 2Ot--.7fi_C4 CO29 HU15ou r796M?CW NOW—Z<M2 P 6/6 enewal R.Lz�FP•,ti1'r1L BY�rDFRSEN • anssW Rolle 30 26.%1=c Rr.d'• [i7tct lag ,R1 li`�H 5Paw-Rn, Phone tfil-%3,1235•i ucs N..E.OwA%U&..,I=u/bfa Re mwel by Ander"of 9oudwrn New'Rugiaed CUSTOM ltiLvtDOW A%D DOOR REtttODEe•if*tG AGrtFra rraf !13 tow1r, bjo ciz. e .ta - Slo3 6001• t_04 PW. -M-77 .0 %VMr eMfft r 8cM1•r'�'i ltrre�;p3se6l�r anti k+rta1���e+a r��,rcE,:te the prn�{�.-i�mul/or.erxia�E`actutl�rm tY,n,•ia�fiyxicf}litre&r,�s�LLt:tUf�/u Ttcnewai ., W,.%R&z,ea td S:,setxrn Nee Fngbm4 d''(:maxtw'p,cu&xrae+laax iwidi ihr.tetms attd cueditiom d i e%i ott the front and llie,rme,rW i.1' this getrnxcu uai�m the cwsx tteaF/k/r�s'if ua sAea9€tEcalkzti,rt}G eb_c:l�etlt6aent?. €I�lfidorie ❑Condo 11 1IM? t l 19 /1 E71i�o1LS1'5ttr>:t�j �tC 1�40W of t!�r Qe' cash J Rmced Teal ebNectmt.__ Cr�&CW&RM=VPWd ds Po*c*-mvttiitu Uloildie t rocatAartotiab 27�5 propacox�em sftCmACadf*irsri&.rm) f, ,tarttahrKat oa Labsvndit S hstarte ema c in�.�r (�7`�. . 1?70 . taraandniterae,rsd et,e marta+�car�t Boye (s)agrees and underatendti dmt this Agreement consdtates the eoth.a uudersiasding beew�een the planes,nod tint there are no Auf'of the term of this Agreeme at.Boyes(.)acLuanledges that Boperf s) (1)It1tB t"td rids Itleerxteut,'�det 'the terms of this Aantemmt,enter ban rrco.tid a cmmpleted,wed,and dated ewppof tftisAgseimeet,iuckd*tbe Me attaebedllietitesof Canbe&flw,an the date first Wanton above and(2)woes orally or�odof Buyer's rigbito•+�ctlthieAgFeemesGDONGrEGNTMSCONI'RA[rrIFTHMEdREAll1YYB"MESPAML (RJ1ode lalawdSotes On6)Nodee en Bays-(1)Do sot sign thisAgreomamt if any of the spaces inuen"-&r the agreed terrns to the talent of tbaa Wuldh io6pximAdam an ltdi) MIL(2)you ass eudded to a Waglr of Ods Agreement it the time you eism ; f- Yoaaara at tout ig1 y . lap psty ON the fulluapaid ballast due wader rids Wit,lad in so tT_oitrgytaa reap be ee<atitkd to meek*apst�plpl rebate of rise fine m and tAaigea.(�TM seIIerr]Wry ao to cater es 1�p or mmn iit any breach of the pesos m repossess pods per h&wd tinder d&AVeetueut.(3)'k o may camcd this Agree eat if it has ilat beau e3gasd at the rim office or a branch office of the#Qcr,provided you loft the ewer at his or her mein. thudea&Ailealiter l the Ageeementhyie&seredorcerdlledmail,which shABq posted-natiaterthae edldmght the ds yonetch lhebir rosins the As-one t,exclotgog$alloy and soy holidsp oo which ngulaeman deliveries are lot made,.Seethe naeamp"dotice of coaceDaf loin farm;forgo aapla tioa of 6aperh tigbis. 8usmr y v edwd the nsnRtmff edit-Ai6in amu%iob pnnaded by lice P.&Zc bhaad Canaarifus*Rgwtrstiun Wl.f 's/eaa�f RfatstlYlbp of AiewEsgland Baps) la1 84= _ 1-44 Lk h . f/��alotc f lkuducl fUaraa�t-, p��,��S�j�grtta4►ut PiEw Atmw or Pttwhwl Munagrt i Dint�t emr �nOfu;"M 1.m"C !z- aN.A . Tl: OR TO YMMCAU OF THIRD K%ff ASS W AFM nM VM OF'TM Ta"uS►ZMCn0N.1%1M �Afii'ACHXD Pt0nCE OF CRf=AT'i0N FORMS FOR A1+i� Tiox oF�s�eiGgr. .. - - NOTICE OF CAIYCELCAT�tON - - - - -. _ __,_ NOTICE OF CANCELLATION - - - ' Date ofTmMaedon V R You may carmel� Dabs ofWardaeaon Y.lrtayr CUK49 tl4k&WWWdee4 vdthout any or obligatron,within this>rarnuttonr without any pity or obligatIM vrfthin tlttiee.6111trad ll�rs tom fife date.if you Cancel,erry 1 tNteee business der fiorru the above date.if you camel,any property traded any peynteati nude by you tinder*e'.t propaq traded ut,arty 13"Ments Heide by you under the Contract or Safe,and any nejot6hte instrument azmftd i Contract or Sate,and& 1 naga"Ie itut nmd cxcmted by you:v4U be returned wAhtn ten'business digs fallming I•by you wit bi�;;termed withfn.ten lustness daps fallatwh g `iceie by tits Seller of your tsneekthm nohee,and am t.teoe+pt by die Steller of your'cailoelhiffon notice.and any se currtyt tom'ar6ina out,of.dye trnnmetion. will be security interest writing out of the t ansactfan will be tancaad Myna eanceLyou muss rnalae mrarlable to the Seger t"anceled if you c moek u moat MaM available to the Seller. at your re"wim.in su6st"ally as good wndttfoo as wam h t'at your residence,fn tubsstantta"as good Condition as when received.any goods delivered to you under this Cc-b art er i nm*hFeA any goeda delivered to you under this Contract or Sale:ar pal rrrsyr,dyou:wis♦acam wilt rile Oew}triredons of a.$a(et or you M1 if you wiser,eorrt�ly►WM rho ieservepons of. the Setter the return ehiprrserrt of the geode at the the Sellers snarl; the rearm iluprr,ent of the at the Saki acpai ana risk Ifyou do nuke tiro pods available � Sty expense.and rhk If you do CIS tic' good, to tfte Seiterof ohs dace Wane .and the SWIW does.Mt� �p witwer t to the Selter.a the Seller doer not pkk t up.widtin weray, eRation% the data of cancellatio m retain ar you may h"'entll n,ya+t may days dispose of Spods witfiout anp further ebt'tgatloe.If year I drmose of eh+e goods without:any ttia�thor obligatooa►.H u• . fsY �,fail to teaks the Goods®ridable to the Seller,or if you agree I eo ntaf a the ioO a.aitalKe m the Setts,a if you agree: two sawn the goods to ft Satter and fail to da m them you I to rettun the goods to the Seger and fart too do s%tf lilt you remain liable for paeramtance of all obiigasions under the 1 remain liable.for perkiwfance.of all obligations under that C atrae Te ebned eh's nnaR or delive'a signed CoattraeLTo wticel tfiis trartssWon,mat"f or deliver a signed and darted sopy of**a cartco9t don notice or any other t and dated copy of this a nnelbttlon notice or any odw. w6tbmiwtice.wrenda to RenewerWAjukrsenof I writtennodoe ret,orsendatelegramtoRecralby"irsenof SOutllern Ne+r at 3i W biOA ROed, aln. 15aulf tarn Nenr at 26 Albion Road a Rt 2"S. ;NOT LATER THAN M iDMGHT OF ' ' �f 1 NOT LATER THAN MIDNIGHT OF r Date) CM*W"lfTPAH$A4M*? f Y CAN TRANSAClIOK X air ratraaa. rtiecrr isa 02" aw.rtrtseea. wieteete.. Dow P3A Coots Whft Buren Gamy.Yeg0— &;W Gem_if'k 0 S�&gbo °RISE r Town of Barnstable *Permit# L Expires 6 months fro✓n issue dale Regulatory Services Fee, Thomas F. Geiler,Director ArED r,nry� , Building Division Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstab l e,m a.us Office: 508-862-4038 Fax:'508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY tVoi Valid lvithout.?ed X-Press Imprint . Map/parcel Number Property ddress -( esidential Value of Work � Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address %P r T' ��� es Q zo A,1, Ito/ r _ Contractor's Name vay Telephone Number Home Improvement Contractor License#(if applicable) / �got l Construction Supervisor's License#(if applicable) ' ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance X ^-PRESS PERMIT Insurance Company Name � � Gi�11Y 2 t1 7 9n . L Workman's Comp.Policy# �,/J C! �J�® 6,0/ PT(1►ff N OF BARNSTABLE Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) n e-roof(stripping old shingles) All construction debris,will betaken to Qfl Fj Re-roof(not stripping. Going over, existing layers of roof) ❑-Re-side #of doors .Replacement Wind ows/doors/sIiders..U-Value (rr akimum .44)#of windows *Where required:.Issuance of this permit does not exempt compliance with.other town department regulations,i.e.Historic;.Conservation,etc. w ***Note: ` Property Owner must sign Property Owner Letter of Permission. A cop of the Home Improvement Contractors License & Construction Supervisors License is. r fired: ,> ' SIGNATURE: r Ili O:\WPFILMFORMS\buildina oermit forms\ExPRESS.doc �. CH. A. R,. LES , - COR. Ey . Tr Supply and Install AIR VENT SHINGLE VENT II RIDGE,VENT on All of the Ridges. .TOTAL INVESTMENT with New Ridge Venting ---------------- $. 109675.00 POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards, Plywood Sheathing,Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$ 60.00 per Hour PAYMENT SCHEDULE: A Deposit of /-- his due at the Signing of this Roof Proposal and the. Final Payment for the Balance is Due Immediately Upon Completion. WORD SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 30 Days of Acceptance and Receipt of Deposit providing the Materials are Available. Please Make Checks Payable to: CHARLES COREY CHARLES COREY Warranties the Shingles and Labor for 5 years. CERTAINTEED Warranties the shingles and labor 100% for the First 5 Years and the Shingles your 30 Years if the shingles becomes defective. CERTAINTEED Warrants the Shingles up to a. CATEGORY II HURRICANE-110 MPH WIND WARRANTY . CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. This Proposal May Be.Withdrawn By Us If Not Accepted& Deposited Received Within Thirty ays Or Before The Next Price Increase In Materials . ' CHARLES CORE' carries Workman's Compen ation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: f ACCEPT x SUBMITTED BY: R CHARLE CO HOMEOWNER ROOFING CO CT'OR i�o6EIR i r` EIS The Commonwealth of Massachusetts Departrnent of Industrial Accidents Office of Investigations i 600 Washington Street r Boston, MA 02111 z 'Q' rvww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): b Address: 4W City/State/Zip: yy Phone #: Are you an-employer? Check the appropriate b Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).*. have hued the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ,❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.# required.] 5. ❑ We are a corporation and its ME] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myselffN_ o_workers_'_cozx?p,.....__ __-right of exemption per MGL p _ _ insurance required.] t J. 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. 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 joh site information. Insurance Company Name: �/�� [� — .Policy#or Self-ins. Lic.#: (,y L� `'..��. ��2��9 Expiration Date: / / Job Site Address: �'�,QJd/ 7 ' City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year-imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi r the pains and penalties ofperjury that the information provided abov is cue and correct. Date: zoo Signature: s 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 Phnne#: i� Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an eruployee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." A'n employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair.work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall n contract for the erformance of public work until acceptable evidence of compliance with the insurance enter into any p P P requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees other than the members o- partners,are not requiired to carry workers compensation insurance. If an LLC or`LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials r t Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as'a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents i E Office of Investigations 600 Washington Street Boston,MA 02111 , Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia ' Massachusetts - Department of Public Saf-- et. Board of Building Re" lations.and Standards + Construction w__ Supervisor License - " License: CS 2881 7k . o�,/Gl ooaclucaet Board of Building Regulations and Standards Restricted.to' 00 B - ' � , f HOME IMPROVEMENT CONTRACTOR CHARLES E COREY ;, t Registration 136066 1694 FALMOUTH RD#115 E 6/20 x i`ration 10 Tr# 268785 P _6/ CENTRERVILLE, MA`02632 Type DBA ZJ. - COREY&CO REY HOME IMPROVEMENTS Expiration: 2/14/2012 CHARLES COREY - �, Co Inn]issioner Tr#: 14793 j 1694 FALMOUTH Rb�#115 g i _ 0 CENTERVILLE, MA 632' Administrator I a License•or registration valid'.for•individul use:only h before the expiration date. If found return to: V Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 ` a yam: 1. 4 - t Not valid without signature THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A m / A, IL DATA i AC .ID DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 01/12/2010 RODUCER (508)997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Asurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 439 State Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# JSuRED All Cape Exterior Remodeling LLC INSURER A Arbel l a Mutual Ins Co 17000 640 Main Street INSURERB: AEIC Insurance _ Suite 3 INSURER C: Hyannis, MA 02601 INSURER D: INSURER E: 'OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR DD' Til`PEOGIN6UPrkN6E iPU41�Y N41l POLICY EFFECTIVE POLICY EXPIRATION h1Mii8 r1a 1®AIIE WI7MMU 1 DATE �IUERIutKnaalulTR 8500041933 O1/14/2010 07J14f207�1iHa7cou�leeNDE !� 1,000,00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) - 100,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 .11EWERALAGGRE.&T,E Is 2.WD,D" rl IGIEIVILAIG,Gf4 71Ft3r1111rAP'P-JESPEr3R.' 'PRODUCTS-COMP/OPAGG $* 2,000,000 POLICY PRO- L'OC JECT I IAVllffOtJIQBiLLE�-A�IIL1iFT � r I�C(7MI$ttMSrtV9L'EUNIT II Hooky XUT0 (Ea accident) 1 ALL OWNED AUTOS III LILY*UURY $ SCHEDULED AUTOS (Per pe-) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA.LIAMUTY EACH.OCCURRENCE ,$ (, J,OCCUR hI CLAIMSMADE I AGGREGATE $ $ DEDUCTIBLE 5 RETENTION 5 S WORKERS COMPENSATION WCCS007896012009 01 14 2010 01 14 2011 X W A AND EMPLOYERS'LIABILITY / / / / TORY LIMITS ER Y/N ANY PROPRIETORIPARTNER/EXECUTIVE" E.L.EACH ACCIDENT $ 1,000 B OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000, If yes,describe under SPECIAL PROVISIONS below OWNER INCLUDED E.L.DISEASE-POLICY LIMIT $ 1,000, - OTHER )ESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS el: 508-815-3099 ,ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPI DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WR NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO Corey & Corey The Roofers IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENT! 1694 Falmouth Road, Ste.115 REPRESENTATIVES. Centerville, MA 02632 AUTHORIZED REPRESENTATIVE Joanne Bretton +CORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights re! The ACORD name and logo are registered marks of ACORD T _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ! Parcel 03LQ Permit# L� Health Division — 01 Date Issued Conservation Division JO TZ . Fee Z E2(m c-4 0 _V �?X�r� Tax Collector ., U `d `•- �H t ! MAR 2001 AEPTIC SYSTEM MUST EE Treasurer a INSTALLED IN COMPLIANCE Planning Dept. `�* `' M. c ,;: WITH TITLE 5 Date Definitive Plan`A roved b Planning Board /�,� ENVIRONMENTAL CODE LAND Pp Y g TOWN REGULA TIONS Historic-OKH Preservation/Hyannis Project Street Address lA All j!�12LLE r Village � ��� LE Owner G .�l o`er Address ,/0 3 Ll Yajo Telephone C Permit Request ( t Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation -� � 9� Zoning District Flood Plain Groundwater Overlay Construction Typek�� nyi Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family *0 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ®No On Old King's Highway: ❑Yes 2 No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 7, new a Half: existing new Number of Bedrooms: existing new D Total Room Count(not including baths): existing new Co First Floor Room Count Heat Type and Fuel: YGas ❑Oil ❑ Electric ❑Other ., Central Air: ®Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ® No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:W existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes A No If yes,site plan review# Current Use Re-z;&on( Proposed Use 2z)1 BUILDER INFORMATION Name l `C)0 Telephone Number 7 5zl Address VD�11 1pne License# I_ /,, 1 V't Z Home Improvement Contractor# l 00(9 Worker's Compensation# I OoD l5� ALL CONSTRUCTION DEBRIS SULTING FRO ROJqWILL BE TAKEN TO SIGNATURE DATEr 01 i FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NOs ADDRESS ;' ` 1 `l •VILLAGE ' OWNER ti DATE OF INSPECTION FOUNDATIO' N f b f FRAME INSULATION t, ` FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH. r FINAL ` GAS: ROUGH= " " `3 FINAL rz FINAL BUILDING r DATE CLOSED OUT x ASSOCIATION.PLAN NO. 0i r ' s � r LONG POND •ter' ` h'.qr�� / \ s? O No. 103 / / PARCEL - A J � ul J ` LAND / W i STONE / ox �AN DRIVEu. 2v z I 159.02 2 LONG POND CIRCLE MORTGAGE LOAN INSPECTION WLI1137 SAGAMORE SURVEY ASSOCIATES SCALE: 1 IN.= 40 FT. P.O. BOX 28 DATE: APRIL 16, 2000 AGAMORE BEACH, MA. 02562 �� ,;' THOMAS 508 888 8667 ;N Q PONTg,AND I CERTIFY TO No.34314 THAT THE LOCATION OF THE BUILDING SHOWN HEREON CONFORMS 9 t. , TO THE ZONING OF THE TOWN OF BARNSTABLE CENTERVILLE �� °`fss,oa I CERTIFY THAT LOCUS DOES NOT LIE WITHIN THE FLOOD HAZARD ' 4'0 ZONE AS DELINIATED ON MAP p 05C MMUNITY NO. 250001 PLAN RE E ARN A LE REGISTRY BOOK/PAGE: PL BK 165 PG 85 Sc PL BK 212, PG 113 LOT NO.: LAND & PARCt'L A PLAN BY: BOTH BY NELSON BEARSE & RtHARD FLAW DATED: OCTOBER 11 , 1961 & JANUARY 4, 1967 THIS INSPECTION OT PADE FROP AN INSTRUMENT FOR FENCES, HEDGES OR SURVEY TO ESTABLISH LOT LINES. FOR USE OF BANK ONLY. { ESTIMA TED PROJECT COST WORKSHEET LIVING SPACE Value (high end construction) square feet X$115/sq. foot= (above average'construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet X$25/sq. foot= PORCH square feet X$20/sq. foot= DECK square feet X$15/sq. foot= OTHER square feet X$??/sq. foot= 50, q Total Estimated Project Value t�;�.�:tom:_ ..GONSU1V11�IItINFORi�� 1�0 SIINIZ;OOMS. � .T �:� ,s.�,� aches =State: aildin Co ON ` pen echo L lft The Massachusetts State Building Code(780 CAD?) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to,an existing house (780 CMR, Appendix J, Section J1.1.23.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom"of any size, configuration,orientation,form of construction or percent glazing,but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a"sunroom"addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/installation of"sunrooms", included below is a non-required, open-ended list of product and design considerations that a homeowner may wish to consider before actually constructing/installing a"sunroom"..It is recommended that consumers carefully review these options with -_ their designer, builder, or contractor, in order to minimize potential energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO"SUNROOMS" • Sour Orientation and Natural Shading • Type of Glazing • Insulating value • Solar heat in • Frame materials r - --.• -Glazing to frame sealing and gasketing materials/seal durability and/or weather tightness of the sunroom '�• -Adequate ventilation-Operable windows and fans • Applied Shading Systems • Insulation level in floors,walls,and ceilings - � ,4 . -_� -- • -Possible Sunroom isolation from the main house via a wall and/or door or slider -: `Heating and Cooling Methods: Efficiency,Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section J1.1.23.1, requires that the actual property owner(not the owner's agent or representative)acknowledge receipt of this CONSUMER INFORMATION FORM prior to - ~ -�- -issuance of a-Building Permit for a project that includes "sunroom" additions to an existing residential building. cordance with thi uirement, the undersigned hereby acknowledges, that she/he has read the ' io this um concerning sunroom comfort and energy conservation. i of A ding Owner Date } Vriy%(� Print Name Address of Permitt d Project Owner Address(if different than project location) Owner's telephone number = e�►atusreetE. _ e Town. of 13arnsta e �.ids Regulatory Services ��e Eo Thomas F. Geiler,Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction.alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: 11 '._IVWN Estimated Cost Address of Work: 10�� Owner's Name: 2.1 ` Date of Application: lr0 � �I I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law' []Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby appiv for a permit as the agent of the owner. 31ty io CIY,?A 15�(F!� Date Contra or Name Registration No. OR Date Owner's Name q:forms:Affidav ' The Commonwealth of Massachusetts = Department of Industrial Accidents • -= •:, , __� Of!!ca ollal�stlBatloQs '= 600 Washington Street • - �.� Boston,Mass. 02111 Workers' Cam ensation Insurance ATIdavit /%%//%/ %//%//%/i name: , location: qA?- - -!M LA�Jc-:�: city phone ❑ I am a homeowner performing all work myself ❑ I am a sole etor and have no one worlaag in any=acftv I am an employer providing workers' ens=on for ovees �Y on 'ob. ....... this ............. .}...... ...:::.: • .. ;..}v. ...::v-;.:...,: 4}'•• `:ii'Yiti�::v`:>:'+::n::,h.:...,,�$,.;,....,vw::::;.::?:i:}.:..:::::::::ivii>:�ii'4 i??:i.:;::�}ii:::�'ri:_i:�:cam any name.. ....... .. . .. ... .::>.:: ':• ...: .:. ..:.:.>:?. ..:. .. . . .... ..:, •.•;::: -. w:.v }:. ... .,v,.},. .:�Y:J^YY'':it....,;;.y..v;;:.4.iv'r•:{•:vi......::....:::.. { :f .i. n{{4hv� :'•. w.y ..........:::..::.:.• hoeeiE:.. ::.. ....:�.. ............. .. .- .. .. ....., .,1,. ...- ......... .. .v..:?:.,'•.:v....OJQfa•.dv..: ":::C:j::{{:;:;ii:.;.:iai L:�u;. .. ..:.. :• :are..;...x•.,:• ;3.:.}....... 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Faflrtre w secure eo.era;e as segsared amder Seetioa 2SA of MQ.1SZ�its.d to the impodiimof arfoe®ai pmaliiea of a fiae�to 51340.00 a1ldlc one yam'impd:offieel as weII as dtil penaitles in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I mtdmumd that copy o f this statemeat may be forwarded to the()aloe of of the DlA for coverage ver Ukadom. I do he rby carify and alpemuy tha the information prmm&d above u terup mud corm,: . Sigaatmr l Date d' S�®� . Print name Phone# otHdal use only do not write in this area to be completed by city or town ofildal dtv or town: permtUllce sco • C3Brtfldiae Depsrtitaeat. [3Liceasin`Board checjr if lmmedlate response is required ❑seleeuaen's Olflce ❑Ssalth Department contsct person: phoned; — ❑Other Ue+vm W9 5 P1 Ai • • . . �1• of •• 1• :1•!: • • of • 111 .1.) • I • 1• • •_ 1 - •J: • �411 Y. • • • • ti 1• • • • - • • • of• • • 1• • 1• •« .1• •U • • 1�/ •Y. �1/1• ./nu • 1• • �1•llf • • • • • • •.• • 1•• •• 1 k 11 PO/(slab/• • / ./• a I I _ .1•.• •/•w01•. .11 f ' 1 • Y • • �11• •) 1 - • •.#@jigs • • • 1• • •• • • /• .19911 • "OH9.16it 10 • • /t I/IIw1 ,It • •11 kle q If"" •11 •1 1 1 • •1• / • • Ir.1.10• .M.1 N71• 1 "II If) • • 11 wll • 4 •Pwt•i• • • f .//•U • w 1 1 1 1 � 1 1 • 1 1 1 1 ' 1 / • 11 1 1 / • Y11 �. / 11 1 / . 1 1 1 • 1 1 ME1 11 11 •• 1 • •• 1 • 11. •• 1• •.: • •1 Y •11 / � w•1/�/ 1111f .11 •1.1• • • • • / • • • • •. •11• • - • - ••- • •IAI• •.' •• Ut 11 1• 111=1•�' _. 111 wU1w 11♦ • • t. • ••) t . - • �•1/ • il•1 • • • •1.1• ••• •• -1• /• •••1•.1�1A •1••1•w• w,1• •11 •• • • 1 r•I.111 �11 1 • 1 .•111 • •1 •• / .f .•• • • of .I• •11 .1/ • •• •Iq1•.•• •.HI w ••1 •rY. .11 • • 1 u1. nu•• •w•, •n • ' 111 • • 1• •f .•• •1s:1(' • • • 1 • •1/w11 •1 • 111 •• ./M •w11•. I11 r•I1111•IIY.1• •1/ • 11 1• .1•.•- �•• �1 • 1�• 1 1 11 � •K• y1 w11 •1 11 •11 `11•% r« • •Ill 11 • 1 • •• / .11 1 w • •11 •111 • 1 •1 • • l• /• ••Y.•11 •'•11.•wA r•111/•w• `•'.1• •i1 1 • ► Icon , •Y.• •I•w•1 .t •• 1 •.• • i••. 1 «•1•n• a1 .11 • n.1•u_• y • 1 � • • • .7� •U p /1 wH /1 • %• r • •1 w • . •• /1 •M••111 rw• 111111 •w. 11 MI 1 1 1 11 11 1 1 1 1 •11 1 1 1 1 , - 1 1 1 1 I 1 1 I I 1 1 1 1 BOARD OF BUILDING REGULATIONS T 4 ;;<.. License: CONSTRUCTION SUPERVISOR Number: CS 051830 Birthdate: 02/03/1934 4 ,,+,.::..;;:•aye , Expires: 02/03/2002 Tr.no: 15652 Restricted To: 00 MICHAEL K SQUIER 582 BAY LN CENTERVILLE, MA 02632 Administrator Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 111006 Expiration: 11/18/2002 Type: PRIVATE CORPORATION SQUIER CONSTRUCTION,INC. MICNAEL SQUIER 582 3AY LN _ CENTERVILLE,MA 02632 Administrator j TOWN OF BARNSTABI:'EUILDING PERMIT APPLICATION Map _, a cI Parcel Permit# Health Division �� Date Issued ( Conservation Division e-b j, in 14 Fee Tax Collector �Treasurer e m a l t Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 103 Z y a �l, Village Owner Address 10-3 t''✓�f%0' f�`�?f Telephone Permit Request iK ` /,V,,ti c4s—t Ide _6.f4fA.►o 1 Z/r-o o Square feet: 1 st floor:existing proposed 2nd floor:existing d proposed /t'O Total new Estimated Project Cost 000' Zoning Distri Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family R,_ Two Family ❑ Multi-Family(#units) Age of Existing Structure 1 0t" Historic House: ❑Yes No On Old King's Highway: 0 Yes 0 No . Basement Type: Full ❑Crawl Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 3 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: RGas 0 Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing �_ New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:0 existing ❑new size Attached garage: existing ❑new size 2— Shed:❑existing ❑new size - Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name r�.t, �t S Telephone Number Address�6),(10 b R C_ License# 06�'(� Home Improvement Contractor# ® 7 Worker's Compensation#&epll"6/W ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOo � SIGNATURE (_ ' DATW/_7/9� 'a FOR OFFICIAL.USE-ONLY .7 t^ ' PERMIT NO. i► DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER kj DATE OF INSPECTION-; FOUNDATION FRAME - 1 "s. INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL :1 r. _ � K PLUMBING: ROUGH FINAL t --- FINAL `— i .^ ' ' 4 '' i - •- '' GAS: ROUGH _ FINAL BUILDING ` DATE CLOSED OUT k ASSOCIATIONTLAN NO. _ ; ,��_ -�a,,,,,, "_'_ The Commonwealth of Massachusetts ,-- 1 �' ? ' -:..= + = —� Department of Industrial Accidents Office 011MYOsti9200s 600 Washington Street Boston,Mass. 02111 ?:_ Workers' Comyensation Insurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole uroprietor and have no one working in any capacity I am an�emp�loyer providing workers' compensation for my emplovees working on this job. comnnnv name: - .. . .........:..:.::. ... .. city: cwC7zapJ t e— phone#: 7 '2 insurance Co. ���Gi v oiicv# `51 V-7 r ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the follonzng workers' compensation polices: company name: .... ....:::..:,:....:... address: city: phone#- insurance co. o tcv .. :. ,,;..:::•:>;;:;«•:>;;;::.;.,;.:.... company name: >:::>:.::: ... ... . .. :.::.:.... address: city phone insurance co. Palm# ;;>;;::;::::.;. ... Failure to secure coverage as requited under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a One up to 51.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verincation. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature��ec - Q Date Print name l Cv c-,)i Phone# 7 7 '—/Sce� ` ofOcial use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other w::..:..... (nww W95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any co=-" . of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of rP g the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive: c: trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews: of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither.the. . commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns a Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill mi the permitllicense number which will be used as a reference number. The affidavits may be returned fo the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. I The Commonwealth Of Massachusetts Department of Industrial Accidents 0mce of Investigations 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 k e Town of 13arnsta e e�arrscw� Department of Health Safety and Environmental Services Fo ' Building Division 367-Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date'E—l AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. i Type of Work:�pi-;M W VL CL L)e� Estimated Cost /e Address of Work: Owner's Name: Date of Application: 2—k I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR Date Owner's Name 1 g1orms Affidav -7 7-77777" GENERAL NOTES: OR CHEDULE and TYPE, HARDWARE 'Th '113eneral'Contractor shall be,f4miIiar:w' j th all existili shall,verify4all' ��SIZE �GLAZING MARK in -tweh Dumby Knobs wl,ball catch Exisiingwallsiore,ma, cis or iscrcpancies b�- dimensions relativ6 to'th&voik n c6hiati 6dh'rein.Anyc6nt1i6 X 13/$" Masonite Colonist NIA esign or these owner or s shall,be reporte isting nd ons,the.depicted d �catiion d to the ex architect for resolution ti6ii of work that can be changed with uf additional. Nqtv"in nis, installa 2 C Dumby"Knobs w/bal caw p,6cir M co S 1 60 61' 1 asonite olont N/A` D2 e owner.Thebontractdr shall ta precautions to,orevel �D V�60x��? 8" x asonitc o 66st to th _prior t the ke all the necessary' it any darna col,M .',rassageSet or or exterior ws":.x .I ; ,1 7 7 7 7 Cr 11- ystal Clear w em .' Manu ver i5`112!x27 Kohl&�Focal Neo-angle k-7ol6 /T facture 'Bng t Sil to'existing conditi�n omponent -for""', s during demolition and construction,All assemblies an c p d the project shown in the working drawings or peci led to be i talled complete according to Interior Walls--'2x4 wood frdmc construction 0--16*0.,C. with 3 IPT'uinfaecd fiberglass batt inquldtiori If Ills e DOOR StHEDME4�, norm ractice a a e 6 Colo'nist doors�shall'be solid,stylictoth finish 6�pancl doors. .'between studs. Finish both sides with 112" blueboard wI Skimcoat of plaster(BBSP). nd m of ood asonit al p ntenot him shall match the existing. The contract for this project shall be A.IA. Document A107,Abbreviated Form of-Agmement Exterior Knee Wall At Conservatory-2x4 wood frame construction 4 16"6.C.with CertainTeed R15 tw n bwner and Contractor dated 1987.' Hardware shall be by Schlage,Plymouth scriesk j�mlishedbrass. I kraftfaced fiberglassatt insulation,or equivalent,between studs., Finish interior face with BBSP, Exterior shall be completed in corriplian6c with local and stateplum ing,electrical,and safety b --.N/k�'Not:a:bvfi b1c All work ed and paid tractor on a time1v face'shall have 1/2"plywood sheathing,Tyv:k buildin aterial'and coursing g paper fully taped,and siding m codes.All required permits are to be secur for 6y the general con a ions. wa ris and o0crating basis.All certificates of inspection,approvals, i rianties,installation instructio shall match existing as indicated on exteriorclev ti literature shall be'tum' ed over tothe owner before final acceptance,of the work.. Floors Framing-Sizes as noted on framing'p an with CertainTecd 6 1/2" R22 khaftfaced fiberglass HNISHSCHEDULE an and free of any debris. Completion 6f the project shall I ind the premises broom cle 'If al ro gh -FLOOR BASE WALLS CEILING insul or equival t between joists vapor Wnier 0 Subfloor to he 3/4"plywood glued&nailed down Landscaping by others. Contractor shall backfi lex6avations ti� I y level with existing ROOM ation, en , BBS tojoist .-.Ceilin shall be patched e &finishcd'with BBSP to match the xisting on rA"i mensi 'If dimensions othe noted,foundation'dt a' to Bath I Ceramic Tile,,,, Extend/reuse existing BBSP grade unless otherwise indicated drawings Til BBSP, BBSP �-A are to the tough stud face unles, on re Bdth It' Ceramic I e , Extend/re c ti g use xis n Hardwood Extend/rcusc existing BBSP BBSP concrete. hcN Ki en Newbrkfast. Afea Extend/reusc existing BBSP NA Hardwood ADDITIONS: DEMOLITION: The General Contractor shall be responsible for the coordination with the sub-conti'actors for the, At the joint between existing and new framing, be sure to adjustIor newjoist shrinkage.by FINISH SCH -)o h shall EDULE: demolition and rcmoval of all debris.The Contractor is responsible for reporting to the'owner or installing newjoosts 114" to 3/8"higher than existing.Plywood subn( rofexisting ouse �BBSP-� V2"blue board with smoothskimcoatof plaster unless otherwise noted. 1/2" gypsum wall board onservtory a ition m6ets'the Architect any ha.7,ardous waste materials that may be encountered during demolition or construction.All be cut back 4'�O" (where possible)at all points where�the new L ddi fully taped and prepared for painting is an,acceptable su titute.- bs CX v6n shrinkage in accordance with state and local laws.All existing materials which are to isting house.,New subfloor to overlap across joint to minimizc'effect of any une ve finishes equal to the rooms thcV'serve. All closets shall ha; be salvaged,as indicated in the drawings,shall be relocated out of the work area to prevent damage. and/or settling between existing house and addition, Plywood sheets at joint shall be glued and -)ak with dark pieces culled,2 1/4" Hardwood shall be Architectural select grade red ,x 11/16"T&G strip. Where existing walls are removed,contractor shal I patch existing adjacent walls,fl, and ceiling as nailed to floorjoists. ata 1111shwith!"is of waterbased commercial c' Iv7tolsealer and 2 coats of Street Shoe floor finish q ired with finishes to match existing. re u availablefrom Basic Coatings,Dcs*Winesi,Iowa. (or others) t E;Y others. Carpe 1'BIDS: shall bc�*thjn set or mud set at contractor's option.' Each contractor is allowed a period of about three weeks to assemble a complete price for the project as -All new tub shower walls&ceilings shall be tiled over wonder board. framing, described herein, Questions can be directed to the Architect or Orwrier. Any answers which may have a pricing -Contractor shall consult owner in order to provide blocking for bathroom accessories dun consequence shall be coresponded to all bidders by letter. -A iesby.ow er,installed by contractor. ccc9sor n -The bids shall be broken down according to but not limited to the fo owing major catagories as follows: General conditions,excavations and foundation,rough framing materials and labor,conservatory labor,insulation, interior doors,interior woodwork materials and labor,flooring,plumbing and heating,electrical,painting -do allowance. Any similar formatted break wn is acceptable, f r C Dining Room Bedroom I Align neiN %vit h existin- Living Room Y-Y �T-2 3/4" 4'-3 no As existi -includin --From existing finish )i rection of hard"ood 'Linen -- ----- ---- D. 1��ble Douhle ---Nutone Mi tsb Ives A3 12 36 1 24 1 Is ound count& corners E -t(k-)r Nutone 26RNA N4ir, Kitchen med.cab. R.O.: 12 Y811 x 7—Ro d counter Bath 11 34 1 V x 3 VT 0 D Bath I Ceramic file surround D4 go A bower rod by owner L,:-Nutotte Mrador B med cah - ---- -- ----- ------ -- Foyer 19"&-ep b�e C ra 6' binets -11- Porch r47 Ref. to"A) =--Ceramic file surTound Single 7-Shelves Single le Tub:66" -V. &knee wall ----- --- - ---- Existing R.O. 2 2 Garage Cc6s panel NO WORK f6r whirlpool moAor -2 VT TO 4�2 VT T-0 or front panel Nil out unit lign new wall ngle Single with existing ShcIv T-3 -—-—-—-—-—-—-———————————— Bediroom 11 Recess conduits in wall 8"sh If Recessed header above:2-2x 10's (sec detail A2)'N -BBSII perimeter A knc�N%vll below ibL C(inservatory windows New Breakfast Ar6i e A3 See oonsemaloty not 101-4 518" pbs6d S n 13",',, Pm t Floor' 'Architects STREIBERT ASSOCIATES Enos/Lyons ditnicisions with r 4r Irc 0 afi6ns 103 in spccifi� a ng P9 d Ci le 241 W ]nut Street conserva,t ty A-3 D,N �2" scatew i An 1 o ervi Date:' June TC Wets -nt (0 Streibeit Awsociates Newtohville,, Massachusetts 02460 617-332-34621 Ce A N" 11'7 T 77r� 7; �,777 7F'r7� 7 ........ 7777777 4, "'V IF 4;� W n� _71_7 7 77 5.1 ,,p -4 ? �7 4�,�i W, V Vr VV 77" f # vt 4' lik, Fe rv� . - ��.,lil,1* 1 Tt'A', w lR Ae , "' "11,, �1,� - .—q 1 11,1'� Iz.I l i,ell � 1Y 1�, o� T i 120M �_j k, i, z 4.1 Y a W" 7i L V, I tT'A wm A-," , I- I 1CM IMO 'Cht 7 trims -�` i, _'. , �: % -j" "'�', —�4".1, _ �, �1'11�_,: —�.. . I � I'll, , "it,!�-,- , I, , I'll,"IF josclS 86 'J�' 4, "7 my, iple l�, N6W J101111W Too of 2i,4 k"W 61iiiet1upplier t� wall (jlai-�t 4 `7 Y —7 7 T�,t� iY -x kl� 4" 71� � -, or, t VA 0� by kitchen sbelf located as shown 6iiiei A, 39 Few �i�...... v� na two 7, Z,3 4 -x5, - ooU 4�4 `3 j k6' T�. '7 T' �3 36 all file' q �119 3!. Adjusta It Adjtista Haidw6W flbbring t'� , i ," ,, ;;,, V P -v, b shelves t 8 or- 'A J1191a C 3 vC§ a 61: hot, 4 t 4 -ij ... .... ...... space t: V Kitch V en E evation -roe ki 81 scale" itchenFJcvatiow� t-� "l� Vt ca S le; 1/411.,= 114' V 0' )14 inished First Floor- All-Kit& 66"1 Bath(%b nets installed plash bytMIneir witn Me % A j�, V` Pi -Align ined.cab. N, X_ with irinii > "Al �,O Nutone,263RNA "s" 5 % Mirador Vt-";- 60"AM' z;,7 K7 w utiderjoistg eod J�r6�i& 114.ply In Solid kit beard 4 p T�-3 equal drAwdmi V L'F� --01: 7 double single 18 �30 18 Seven shelves 33 L L on TOOM Bath Elevation Bathroom Elevati Scale: 147 1 4" 1%0" Scale: 114" V41 % 'Knee'Wall Detail Typical Closet Details .61 Scale: 114" F-0" ARCHITECTURAL WOODWORK:,. t trim,'mouldings,e'tc,that are expose to eas All'wood edges d the hand shall be' ed all be I x 12 clear pine or 3/4"�ACedgc banded Cl(ket helves uprights an&polc supports sh s pl�-woocl,sanded with all surface defects filled an re pared for painting. Pmvidebockjngfqr,t d p closevshelves,"standatdis and poles. Cabinet fronts,hardw all be lected and hased by'oWner,insta e are,mand counter t9ps sh se purc full shall be ylon bal I by contractor.Dralv`crs.shall have n -beating driwer slides. Hinges overla y turopean styl PAINTING NO E: f renovation.All new 6xtefl6r, and interior o Contractor shal I provide'allowahce for painting extcn,or rf s shall receive one coatof primerand two coats 6f high quality glms oi I based ho' se paffi� sti ace -t'smpedofoldpajiit,�' ew trim'.Al existing surfaces shall b color selected by owner.Back prime'all n hall receive one P% and primed.All intcri urfaces s s of latex paint,, coat of primer'and two coat oi�s ,eggshell,color selected by owner.MI interior ood trinishall be treated with oil/latex based enam s 47inal el/ emiglo�s. bidding shall be se red at instaillationorblueboard. 'W hal 1 s1i rotec m e s.-I s so protect a jacen wor 'his;�,ofk at all ti k The painting contractor' all p a] 11 ad' t -an� d irogress of work. pon compt tion of- I materials by suititbly,covering or by other means dring.p U oiher� rools glass an floor�,walls, 0, ,he shall remove any dripped or spilled paint from w rk surfaces.' He shall rem ris d accu lated materials no caused b�:oth&s and ove deb an mu t $ materials or, can and acceptable conditio ing shall be execu ted by n.Painti _Tt. leave his part of the work in a cl orderl y "T, -print ed urees d bl'dmcchanics onlyand in strict accordance with mandact skilled an capa. c pa prior o.,1 -no In Th inting contractor shall be responsible for imspi6cting the work of bthcis structions. urface is surfaces are in proper con t the application of any paint to confirm the dition'.If an),s ot t itcanh bepu inp per 6ondi tion by Cleaning sandii fig or fill ifig,the thorotighWdr' ti all sci ral ciontrattor in wrifing.The commencement of work on'; notify the gene pain ng contractor sh ptance of the surface as satis aktol'.`_,.� d tor-will b�'eonsitruc s acec ntrac Any surface by the Ointing'6o' d 41 Any defects to'his work resulting froin the accepted surface shall be cofirtted'aChis on re t Exterior wood,:at th' time of receiving paint.must not c tain m6 than 15%,moisture con ent as�, C en ng usi noi done:�Wh th6;p uijjti�g s�bccritractorls moi!ktiir6 meter."Eiterio"r painti m verified b� n s urfacc is dam ,during.co the temp6ratuief I ikely to d 0 n e 8 the ld rainy or frosty weather;wh6 P* 'the surface is to be exposed to the hot su. Prim hall be allowed t n be](oV ,"F;.or whei at least 3 to 5 days.Successive coa -be allowed to'dry at east oveivig t. s s all TZ t J� 2 .1 4, 1 0" 4 5, �A, Zl STRI it" EX-L qU )13 t: 1.�tinOr eV.9 6fis'&'So, bifi EIBERT ASSOCIATEg' 0 'Yolis 1�fV d ciidl� v�' --watifitit Stre6(, 103 1�on�P,6� ,o '332-3,462 24t 't, 4 D' iU t4l�tonvffle,, Mas &t9 02AW UenterVille siehui T 4, 4 Y At, '2 1 4t A A ,�-i,-�, -,1"j"�,"-,; ,,-,E.��,,",`, �_""W�,t I %, , � � I , A T�,.-��%,,�,'�.''s."� -I_q -�r- �,- . - I S -4, Al . , .1 I - ,�,, 11 11 , o 11`� ." v I� I " , ._ ��,�,�,i .�,�, . .", 11 � � �%,; ,,,, I �� �' - - I � I- "I �� ".,,,, �l 1111,�21111 17��T��,, -71,�,�L, � ,:�,e�l�",1,1�,1.�,',�,�,.', �- , � I 11 i: ; - , �0 PU � ,4 ,__M40777 1 I,1 17-1-m-0-77-0-77—=� I . 11 - 1- �*J " � Im.", - , ,�_, 1 1-04 nn�,I!1 ZVI.- �0�1 x � 11 � � , 1 --1 , mg, M! 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I � � , � 1,r i I I , I "L I -1:: �I I , , ,� . �:.,�!� � .� 1, I" I I.. :� . . � FOUNDATION NOTF:S:� I ' - '.�: , � . I . I - 1. 1, , ", .��� - ���1� � ""11;,�I , ,� �� �1 -."',,, -�,� I I I , I . I I - I I . - .. 4. '. � I ,I � , -1 ,�� , i . I - .1, . 1. � ,"�� ,� ,� �,11 I. I �% I . "I�-, , � �', � "- , . � _ � I,. ., :11 4. I .� � , .. I- � I � , - I . I � I � � � ,- � � � : 'r"�'�I__� :r - , r' 1� � I I , � � � I - , : � - , I I I - � I , , , �., ,1 -, �� - ` '' ' - I . � , .� - � , . , I � ': I 1, I I � r I I I . , .1 _ .� : , , � , ,� - . I I I I I I - �--i', � : � "" _,�7 ,�- 11 , ., I � I. � � i I I I I I I � � � I , � , I I ve pressure treated sill Stli ON at,all Avood/concr6te j6ints. , ��, ,7 ;', �; , . � ,I I I 11 � 11 - 1 � I - , - , , � , -,-; ,�` �, �, - I .� � , � � I " � ' 8'-O",o.6:with a minimtrm of 2 Per sill,And a maximum of T-O".from - � - �, , �,'. �,�, -� ,� :_1 "� _L,_� �,,: _�� � ' � � , � , � , - � 1 . r I I I , ,I- , , . - ,. . , . 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I - I,_ I , 4 1 � � :-. , -.: ; I -Traming lumber shall be#2 Spru - -� : � -1 . ,,, v ,.����; � - - :� Q - � � ' ,,� 1. r , . . . .. 11. I , � . I -� ,- , , . - , . , . , P.1�' - o�� '� ;I� ,� ;, "� , � , . I I _ , 11 , 11 �I . -,�� ;�, "-;�" I I . , � I � , I .�, ," , . � : cc Pine Fir.!': . ,� � I � � . I I � 1/2".holes T-07-ox.�' I . 1,1, I I ", -, .�� ,'r . � ,, , , - - , ��- I I ., - I I I , 7 " � , �t Wh� 1 ; 4 1A . � I I r - - �" n I �,.,: . . - . 1 1 -1, : , � , �_ _� , .". � , � - I 11 I ' I 1: � I I , �_ .F". &�, - � "' I ": ,-� I ��i i , t� 2�� �, , : , 'i ,� , * " , " " I .11 I I ' i � n � �� Q - . � ,, � I I . - e vapor '_ -- , V70 is: i�!,I� ��to� �Y7 , I 1 ,�I I , i I I -All 6x sting structures shall iye proper support as required to boinoet"the proposed I � � - tover-yk�6 il.polyethylen ' � ,1�.� I- -�1. , :, _'� I _.. ' '�' r'- __��', � ' ' �,_" 11 � ,� . � . I 1� ,� I r � ". , �:� , � - . 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