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Permit Where a Certificate of Occupancy,s Required,such Building sh,all�Not_be Occwpied until a Final.lnspection�has"been made.N , .. f Permit No. B-19-4060 Applicant Name: William Callahan Approvals Date Issued: 01/02/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 07/02/2020 Foundation: Location: 9 MARIE-ANN TERRACE, CENTERVILLE Map/Lot 189-100 Zoning District: RD-1 Sheathing: Owner on Record: HARRIGAN, KATHLEEN M ESTATE OF ,.Contractor Name: EFFICIENT BUILDINGS LLC - Framing: 1 Address: 9 MARIE-ANN TERRACE Contractor License: 169.944 2 CENTERVILLE, MA 02632 Est Project Cost: $4,000.00 Chimney: Description: Attic Insulation Permit Fee: $85.00 Insulation: Fee Paid $85.00 Project Review Req: Final: r Date. 1/2/2020 Plumbing/Gas Rough Plumbing: e _ � g Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within�six"months afterkissuance. All work authorized by this permit shall conform to the approved application and,the{approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by-1 aws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for p=public inspection for the entire duration of the Final Gas: work until the completion of the same. I o Electrical The Certificate of Occupancy will not be issued until all applicable signatures byithe Building grid Fire Officials are provid,`ed onthis-permit: Minimum of Five Call Inspections Required for All Construction Work: Service: . 1.Foundation or Footing Rough: 2.Sheathing InspectionI 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical;Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT pwLj-,Jac GMaTL. SEr�'T Application nurn.be' . ........ F Fee.. . 'Yf i .:. :............. .... ... ... ... 1. NAM Buildm ector�Ins - _ r s Initials . ' �16 Date Issued. .�.. . �b*� 6Map/Parcel v........ ...................... . a TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: NUMBER`� ' STREET VILLAGE ' Owner's Name: lA�.�ES �J�1 FLIE Phone Number ``• nn - RA Email Address:�- Q--A-0 Cm " Cell Phone Numb Project cost$_ LOW Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize .. to make application for a building permit in accordance with 780 CMR Owner Signature: Date: ' s°. TYPE OF WORK . s , © Siding 0 Windows (no header change)# Insulation/Weatherization 0 Doors(no header change)# Commercial Doors require an inspectors review Roof(not applying more than 1 layer f shingles) Construction Debris will be going to ' CONTRACTOR'S INFORMATION s 6 .y Contractor's:name Home Im rovement Contractors Re istration if applicable)# (attach c oPY) Construction Supervisor's License# p 0q. I(o] (attach copy) 'Email of Contractor ,�i*QQL \L 1 c-L')J Phone number �� ' SO b ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY-IS IN A HISTORIC DISTRICT,YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X, X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No R. . Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or>Yes No if yes, a gas permit is required. Natural Gas Yes No ,if yes,a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval '*WOOD/COAL/PELLET STOVES'* Manufacturer# Model%I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. f The Commonwealth of Massachusetts Department of Industrial Accidents s I'Congress Street,Suite 100 Boston,MA 02114-20I7 r www mass gov/dia Workers'Compensation Insurance Affidavit:Bwlders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY: A0plicantInformation Please Print Le M Name (Business/Org ization/Individual): Address: Las City/State/Zip: OA Phone#: 4bLW Are you an employer?Check the appropriate box: Type of project-(required): f. am a employer with ` employees(full and/orpart tune) 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working'forme in $, E].Remodeling any capacity.[No workers'comp.insurance..required:] 3.Q 1 am a homeowner doing all work myself.[No workers'.comp.insurance required.]t 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property: I will 10[:]Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 LE]Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet 1`3. toOf repairs These sub-contractors have employees and have workers'comp,insurance.*- 6.Ej We are a corporation and its officers have exercised their right of exemption per MGL,.c. 14.❑Other 152,§t(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box ill 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 hue: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 proyide their workers'comp.policy number: I a»i_an employer that is pro iding workers'compensation insurance.for my employees. Below,is the.policy andjo&site information. Insurance Company Name: Policy#or Self-ins:Lia#: v l Expiration Date:� `k Cif° 0 Job Site Address: 60—G 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. 1,52,§25A is a criminal violatiompunishable by.a fine up to$1500.00 and/or one-year imp.nsonment,.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. 1 do hereby cet 'y under the pains and penalties of perjury Mat.the infot niadon provided.above is true...af�n}d_correc 2 Signature: v Date: Phone#: ADO( Ofcid 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#: Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual OLIVER KELLY Registration: 128957 8 RHINE R Expiration: 06/13/2021 D YARM OUT HPOR T MA 02675 Update Address and Return Card. SCA t u 20W05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. if found return to: Registration. Expiration Office of Consumer Affairs and Business Regulation 06/13/2021 1000 Washington Street -Suite 710 OLIVER KELLY;___' :' Boston,MA 02118 OLIVER M.KELLY r 1S 8 RHINE RD. :-'..:.:-:-.` �•��`k" -� YARMOUTHPORT,MA"`02675 Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Professional Licensure ' Board of Building Regulations and Standards ConstructionSdoettilsor Specialty CSSL-099167 Expires:09/28/2021 OLIVER M KELLY 8 RHINE ROAD YARMOUTH PORT MA 02675 Commissioner I ACC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `^ 09/03/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Linda Sullivan DOWLING &O'NEIL INSURANCE AGENCY PHONE 508 775-1620 a No: ADDRESS: Isullivan@doins.com 9731YANNOUGH RD INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B KELLY ROOFING INC INSURERC: INSURER D: 8 RHINE RD INSURER E: YARMOUTHPORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 443771 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYRE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MM/D LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1-1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any oneperson) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION V PER OTH- ANDEMPLOYERS'LIABILITY YIN /� STATUTE I ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ SOO,000 A OFFICER/MEMBEREXCLUDED? WA WA WA 6S62UBBH08580919 05/10/2019 05/10/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE1$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached it more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insufance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN David Chino ACCORDANCE WITH THE POLICY PROVISIONS. 111 Nantucket Avenue AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 �"'� C Daniel M.Cr v4y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014✓01) The ACORD name and logo are registered marks of ACORD KELLY ROOFING PH. 508 509 4640 8 Rhine Road MA C.S.L. #099167 Yarmouthport MA H.I.C.R. # 128957 MA 02675 INSURED Dec. 18' 2019 Proposal submitted To Mr. Charles Juffre of 9 Heather LaneCenterville MA We propose to supply all materials and labor required to remove and replace the existing Double Layered Asphalt roof at the address above. Protect all walls, Windows, shrubs, plants etc. during roof strip. All debris to be removed to town transfer. White Aluminum Drip Edge to be installed on all eaves. Ice and Water damage protection membrane to be installed over first six feet of all eaves in all valley areas and around all protrusions Remainder of Roof Deck to be Covered with Synthetic Underlayment Install Certainteed Landmark limited lifetime warranty Architect style Shingles, Using all Certainteed Starters and Cap Shingles to maximize available warranties, (Color to be Specified) All shingles to be storm nailed (6) Repair all flashings as necessary, including chimneys Install Certainteed Filtered ridge Vent on All Ridges with hand Nailed Caps Replace all Plumbing Vent Pipe Boots With new. Complete Clean up off all areas including all gutters and all nails after project complete. Obtaining Of Town Permit At a total cost of$11,900 Payment Schedule; Balance upon Completion Proposal Submitted by: Oliver Kelly. Proposal accepted by: Date. �Z / /2019 Best Contact Phone umber: This proposal is valid for 45 days from date above, please call to verify thereafter. of of Barnstable *Perm s Expires 6 n ihs from issue date 01-479VIU11-latory Services Fee z-------010 BAItNSrABLE, �. 1 �� 9cb , °�0 ® `�®Richar -t calf,Director RFD MA'I � P�G � •1�, C. � � "wilding Division Tom Perry,CBO,Building Commissioner �Q 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 _I TA - (O Q Property Address c1 MWi t Ann l rrn e,e- Residential 11 Value of Work S 1413 f`j — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address_Kx4l leer l4q,I'ir i Set✓1 Contractor's Name W DW L00A J/ he S Telephone Number 7�f� of t3m-10N Home Improvement Contractor License#(if applicable) f!o'(a Oyu Email: Construction Supervisor's License#(if applicable) 87 Z-'7 2L [ KVorkman's Compensation Insurance Check one: ❑ I.am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 1409T 9& 4-ym- wSuiZA� Workman's Comp.Policy# .ZZ W F-C,4-T 2-4 3,! 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) side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc- ***Note: Property Qwner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: C:\Users\Decol i . jta\ Microso rndows\Temporary Internet Files\Content-Ouilook\2PIOlDHR\EXPRESS.doc Revised 040215 1 "Window World of Boston,_LLC MA HIC Registration Offices&Showrooms Number, 166025 t1.i5A Cummings Park Q 2m Oid.OakStreel Woburn MA 01801 Pe)nbroke,MA 02358 Federal to : ds "Simply the Best-for Less" (7.81)932-4805 ., (7811)82&8281 27a4ais PY www.Windoi!W dofBostdn.com �YL,�A1 f/.4XT1 Customer. Parana(n);„ -3 Install Address: /�iq/�C/E' /✓ Phone(wi Clty:r�,Gc/Ffji��LLF State:MA Zip Z E mail WINDOW WORLD, GLASS OPTIONS 1000 Series Single-hungAAANeld Slog /0 SolarZone:Elite $9g. 990 ,. 2000 Series DH MechJWelded Sash 5195 �Trlple.Gkized TG2• $175 �(4000:S$Aes OH All•Weld 5205 p (•series e000 0rdy), _6000 Series DH All-Weld $240 WINDOW OPTIONS ' r _2 Ute Slider $334 amass Breakage Wana.my. 315INGIUpED _3 Lite Silder na a u»_tie iz i 552!k /2 Saeims $9 M2M Picture/Feed Uw S334 72Foafn Insulation on Jambs and.Head $1I INCLUDED _Awning $250 l Double Strength Glass SISINCLUDED Casement $280 . Double Locks(>261 SS INCLUDED _2 Lite Casement $575 TFull Screens $22_ _3 U[e Casement (on,10.1m tH:,,2 ! S660 CWoniaf Grids(CtulttwredtFlal) $45 easement Hopper S334 _Oriurle(3ilds. $51 ay wfridow•Solrrt Mount J INS Seat$2660 -Diamond Grids` $69• B :. , $782 _Bow Window•SoHrrtintMo /INS $27f15 Simulated DividedUte.Tempered DH Sash(BSO)(TSO) so _Garden Window .81880 Obscure Glass(BSO).(TSDI $35 Spectalty'Window . _Offal Style(40166 or f�j40) $30ii Beige I Almond $40'.. _Foam Enitariceil From535' _Wood Grain interior(Series 4000 J rm00 oay)$t OP PRE>1978 BUILT HOMES(Federal Lead ConlainmeiR taco) (lightDaAlDarkOaA/Cherry:/Fax Wood` /4 Lead Safe Practices Required $25. Rrrh Maple) MY HOME WAS BUILT IN THE YEAR�� IniUrst _Brown Exterior(Ards.Brune I American Teoa)$100 _Designer Color Extenor 11155 MISCELLANEOUS: Custom Einenor Aluminum Cladding Window Color {V 1 1- Cl Textured$75 1Q'Smooth G tT$75 S .rosree WSW Facing_Color _Metal Window Removal ISIM CUSTOM DOORS- New Construction Wrryl Removal, $175 .. _Ynnyl Rolitng Redo Door 5n:or 6!L 5995': _Spew ity Window Exterior Trim s Vinyl Rolling Polio Door at $1095 Mullao Form MullfUnit $30 _Add to hale price for CuslomRdfng Paco Dow 511541 Instafl Interior/Exterior Stops. 550 nds Rail Sliding Patio Dow Sit,or off. St295 ^Install Interior Casing. :Starts At $95 :: f _French Rail Silding Pado Doonaft. Stan _ Insulate Weight Bozos: $20 ,_French Ran Siding Pago:Doorlik .S1495.......;. .Roof tor.Bay/Bow Windows. $S00 _Custom Exterior Gadding. 5t5o _Exhaling New Cona EA:Ratio Fit 5150 _$olarZene Elite or ETC Giasa: S175 _ :Removal otEzisdng,Bay/Baw I ;.- Grids Patio Door: St29 ..,;.'Repair Sill;Jamb or replace sill nosing $56 . Exterior woodgr00sg 1g,- ors 5295 Z.Full Sub•Sil(Single);replaeemenp $150 _ nor Colors 5395 erlorCasing 2--3r ; St75 - MWIionFlerrloval. $30 Int :,- HwMltrsei'Oplmn_s g BOA30WCottversion!.Fxt.Rebb.Fit I:(New Siding Will Not Match) y 'BuildingP.armlt $1S 150 Door Color / QROUMf141P FOR WIND=WOIMO CARM rnstae oucaee. i_ r :. r 6E�911►gailekYta = i c. .pax Customer dedines.exterior wrap and understands painting and/or may be required lntdal Customer declines grids on windows/doors Initial DISCLAIMElk Cushinar is raspambie fo ale roes in car recaw with th conhM Pandinp,SWAM Alarm systemilltoimtah=nind:toAdhot po nm leas in excess bl 125.00,Hameamer and of Chi*Association APWWA 14sfatk Ols6kt Approval.City of Bolan patkyp&afnra➢tPermit fan in earn ection riot Inmaon.. ; NO.DCTRA WORK IF NOT IN WRITiNG1. Customer agrees to a termsio payment as f0 lo►ys: Extra Labor at Matediffs $ �K/90 Site Set Up,:Disposal,9 Derrvery Fee $ Total Amount•S�..�t _... Custom-Order Deposit50%.S 7192 Ck#' Balance Paid to Installer upon completion $Z/9'� Amount Financed $ WuMow World at Bn�9on ar taipates spiting Ops wmit ai` and stmstmt0a0r completed yr-zdeys Setnylttteresl:Yes No Anny 40aft reipdre0 in advance at the start of the We* L e=nd iAA of ftre total eonsau Ithes at the aeWal cost of MY material wiiiiirtert a-Ta Special ado,or custom nadenab^Whlth must be ordered in advance of the SWft of die work to assure:dot the proled will proceed an schedule No nnatpayrneht >. shelf W demanded unto the contract is contp,eted to the safl5lanxidn Of boUt p906. ; An home unproven act conbradois and subcontractors shah be registared and dial any In411111 s abed a eutdrad or kfta dractbr relating to a regisbadai sloxgbe. .dkMW to:.Umce of Consumer ARd st n and flatri Regulation,Tan Park Plan;Stubs 5170 some,FAA 0211&Pbow(&t7)gn4700 No vault sinU-begla prior to the slgoine of the txrmectfunt haaxmand to oast of a copy of tech centred. ` iYt1t�JJ World of B&tt00 t61dEi prevision of Chager 142A of me getters latie IS fEQltifad G apply tot atM obtain ae an$iuctlarrih WIT65.Wmdow World at Boston shall not be deemed responsible for delays in the work describea in sea at>ramerd dosed by iepWatory,Permit Wanting ape tles.:authodtles of iedMdi als. tlialle;If fM PURCHASEHIS)oDWpt his vivo conxtrufaim Minted Permits for the work dvsrued under this 80"meat of date with tmepsgsted ai nevctim tiro PURCHASERS)is hors advised(hitIn me met o1 a tUftluh,ladeemem and not�papmerd,the PgRCIIASERISt into eat be.s to nine a dalm atIU ,.. eouedtalt from lne pgantay nil eAablitdied O ebaptar t4sn,aLtLL. You the buyer M cance s transat on at By, me r t0 m 1 the( 8r Ike Ot this a115 On. No o(eaneeilatlon must be in writing postmarked no later Nan tnidnigbt of the toiloraGJq third_baskrow day. MIN IS. _ .. ... ..- _.:This Whdom.Wald•RvodISOIS ownedand om#W IN-Window Wo tat Boston U.C:under knees from whgow.wakt.Dr. .` Owner:no tartdgrt .%taro-erry.tr6nk.specea a . aslesrnan:Do net.. erean spaesa- ales� - Owner:-Do mtsFgn'H ihwe.-xa OWhlanliepatas. Data ' ... .. _ rice r Niassachusens Department of Public Safety Board of Building Regulations and Standards _c nse:CS-072772 .r 4�`,a JEFF C STEELE 24 SHERWOOO AVE DANUERS MA 01923 Ccmmissioner 0 410 712 01 8 - -Off ice of Consumer Affairs&Business'Regulation HOME IMPROVEMENT CONTRACTOR Registration: 166025 Type: Expiration: 4/122018 LLC WINDOW WORLD OF BOSTON,L-C. JEFF STEELE 24 CUMMINGS PARK SUITE 15-A WOBURN,MA 01801 iUndersecretary i i License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 ;Not valid without signature The Commonwealth of Massachusetts Massachusetts Department of Industrial Accidents Office o.f'Investigaations 1 Congress Street, Suite 100 \9� Boston,M102114-2017 www Maass gov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Augficant Information Please Print Leggb!1 Name (Business/Organization/Individual): WINDOW WORLD OF BOSTON LLC Address:24 CUMMINGS PARK SUITE 15-A City/State/Zip:WOBURN, MA 01801 Phone#:781-932-4805 Are you an employer? Check the appropriate box: 'hype of-project(required): I.0 I ar;h a employer with 20+ 4. ❑ I am a general contractor and I 6 . ❑New construction employees(full and/or part-time).* _ have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These.sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.., required.] 5. ❑ We are a corporation and its 10.7 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other i,J.nd o� comp.insurance required.] J I *Any applicant that checks box#1 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 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 nay employees. Below is the policy and job site information. Insurance Company Name:HARTFORD FIRE INSURANCE COMPANY _ Policy#or Self-ins. Lic.#:22WECLJ2635 Expiration Date:01/27/2017 Job Site Address: n!'l e, it nn —If Cog',« 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 t;violator. Be advised that a copy of this statement may be'forwarded to the Office of Investigations of the DIA forffisura9ce cove erification. I do hereby certi,fy sander t pa' and p a 'es q f perj that the information provided above is true and correct. Si tore: Date: - Phone#: 78 1-932 Official use only: Igo 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 Ct�eE'SOII�- --Done • — - WINDO-2 OP to-WI CERTIFICATE OF LIABILITY INSURANCE 0312112016° 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 endorsemen s. PRODUCER CONTACT COME; C.Timothy Ward,CPCU,CIC Senn Dunn-GSO 3626 N.Elm St PHON;Ell,336-272-7161 a No:336.3464397 Greensboro,NC 27455 E4MAODR�,Ss award nndunn.com C.Timothy Ward,CPCU,CIC INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Citizens Ins Co or America 31534 INSURED Window World of Boston,LLC 118 Shaver Street INSURER B•Afterfes Financial Benefit North Wilkesboro,NC 28659 INSURER C:Hartford Fire insurance Co. 19682 INSURER 0: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBRPOLICY EFF POLICYEXP LTR TYPE OF INSURANCE POLICY NUMBER MMI M LIMITS A X coMMERGAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0001 CLAIMS-MADE 0 OCCUR OB6790252707 04/01/2016 04/01/2017 pREMISEs Esoaiurence To RENTEEF— $ _ 500,00 Business Owners MED EXP(Anyone person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 RPOLICY❑JECT LOC PRODUCTS-COMPIOPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LI - $ 1,000,00( accident 6 X ANY AUTO AW68757615 06116/2015 OW1612016 BODILY INJURY(Per person) $ ALL OWNED. SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY PE DAMAGE $ HIREDAUTOS AUTOS X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 11000,00 A EXCESS LIAB CLAIMS-MADE OBS790252707 04101/2016 04101/2017 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER O AND EMPLOYERS'LIABILITY STATUrF- ER C ANY PROPRIETOR/PARTNER/EXECUTNE YIN 2MECU2635 01/27/2016 01/2712017 EL EACH ACCIDENT $ 5001 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 500,00 If yyea descnbe under DESCRIPTION OF OPERATIONS Wow E.L.DISEASE-POLICY LIMIT S 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional RemaAts Schedule,may be attadced B more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD y 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION bfz�f)(A ql )'00 , I Map Parcel Application # s „? .�.g, 9 .� � ''A Health Division F! 0 Date Issu Conservation Division Application ee Planning Dept. : Permit Fee' Date Definitive Plan Approved by Planning Board Oirc. !I2i. Historic.- OKH _ Preservation /Hyannis Project Street Address 046f le,- 4ltilil, ►-�C-e� Village Owner 5 Gt(lrb W Address Telephone (I 77) Permit Request � � � �f7 n 1 �'3�� 55 G�P�6(tilDYI A0 176 ® h Q ace.,, M/ l tie ow o rvc �t015 4ce_ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain // Groundwater Overlay Project Valuation 96 r Construction Type 1*4 l� �101ilJ Lot Size / Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family O' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing_new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes C�No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 1 ` � , I Name �GL Telephone Number �d0 "-7?5 �Z� Y Address K5` ` Q�1MQ?,{,7�L KA1 License# y� Home Improvement Contractor# ��✓� �b 7 Worker's Compensation # A)C A 14 2 59 61 . ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE I �� FOR OFFICIAL USE ONLY c ;. APPLICATION# ` DATE ISSUED _o-t MAP/PARCEL N0. ADDRESS f VILLAGE E OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION 3 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH ._ FINAL ,..FINAL BUILDING- DATE CLOSED OUT ASSOCIATION PLAN NO. _-~ " _ 10 Park Plaza - Suite 5170 , Boston, Massachusetts 02116 Home Improvement C'c.pq,actor.Registration. Registration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INCt HENRY CASSIDY tY f 455 YARMOUTH RD. HYAN N I S, MA 02601 - !'' — -=— ---- ..____----- ---.- -- t A ;Update Address and return card.Mark reason for change. ( %U Address Renewasl Employment ❑ Lust Card PS-CA1 0 50M-04/04-G101216 Office+ ' o`s mer Affairs Bus'nc Regulation License or registration valid for i;divide!use en!y HOMPaO`�/`E`{ `fYT�11TLO�Ld� before the expiration date. If found return to: Registration: 153567 Type:' • Office of Consumer Affairs and Business Regulation Expiration: 1�/15/2012 Private Corporation 10 Park Plaza-Suite.5170. Boston,MA 02116 „ OD INSULATION INC... HENRY CASSIDY 455 YARMOUTH RD HYANNIS,MA 02601 ; t Undersecretary Ad it4si ure IVl.issachusetts - Department of Puhlic Safct'l Board of Buildin;l Rc'.;ulatious and Standards Construction Supervisor License License: CS 100988 HENRY CASSIDY ' , 8 SHED ROW WESTYARMOUTH, MA 02673 Expiration: 11/11/2013 (<u nmi issiune r Tr#: 7620 M r 1 -� KOrJ 12 i'5. G Gray .LRS. - __.._ Y Client#: 4597 CCINSUL A CQRD,M CER 'NFICATE dF LI BILITY INSURANCE DAI�(MI�„uo,YYY,, 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),AUTHORL?ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, 1MPORTAN7:1f thr Certificate holder is an ADDITIONAL INSURED,thz palicy(iesj roust he endorsed.If SUBROGATION IS WAIVED,suhJjecl lu Ihd rcr'Irlu and conditions or the policy, Certain policies may requira an andorstment.A statement on[his certificate does not comer riUhls to the i:al'llhcute holder'in lieu of such undonament(s). _ rHUUUCtR - """CT i2oilurs s Glay Ina. -Su. Daru)is NtE_ Margaret Young PNONE -. ...._,.__ - s 1 f L1utG 13 1 h1Au�e 1:5Q8.7fi0 4602 —_------- F "q1-50fl 258AIC 2102 o liux I601 Aoalves5 youngnla(Nrageisgray.Gonl _.__�...__-_- RODUCER - ------- ------ �uuan Uennis, NIA 0266D..16D") - CUSIOMERIUB• , .._........_..__....___.____.._..__..._...._..._..__—.__.--_..._, INSURER(S)AFFORDING Gl]VE(tAGti Ir;;UKcU • __ NAIC_8_ Czlpe C.00I Insulatlorl Inc INsupeRA:peerless Insurance — 18333^ INsuiiERa:OhioCasual Insuranc.aCompany - 455 Yarmouth Road Casualty � Hyannis, NIA 02601 INSURER C.Atlantic Charter Insurance -- - - ..._._...... _._ insuRERU.Commerce Insurance Company 34754 . .. INSURER F __---'-- C�U�r_I<AL CERTIFICATE NUMBER' - - rt THE�gLICIES Or INS E.URANC LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A00V REVISION OR THE P Ot ICY PERIOD d I +1 L.li IIU11 ITHS1 iUVI:)IING'TINY REOUIRLMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUNIENT WITH RESPECT TO WHICH THIS 1,1 ri Ilrl(.:;1TE MAY 8E ISSUED OR MAY PERTAIN,THE IN5URANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 10 ALL,THE TERNIS. ' -uJS1 Ah1U CONr)I"PIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSR — IH - TYPt Qr IN5utWNCIw POLICY EFF 1 POLICY E O POLICY NUMBER A YWOOIYYY Y RENTED LIIY_II_I Z CBP8263063 0401/2011 Q41p11201 EAcna(;CUKRLNCe $1 000 00 0 ._X PIR NNI IGT C $10U,000 MFOr (rliy unq pvls 4 000 _._........_ T.__.__ - ._ AA)VINJURY _Y7_,000,000_ GENERAL AGGREGATE; i<2,DQQLQQQ-_ r- rooucrs cbNrmr_ru;21 t12,000,000. ,a p AulOrauuR.I LIABu.rrr 11MMBCKVMK 04101,12011 04101,12012COMBINEDSuVC3CELIMIT . kN AU I(I (Ea acoaa"q BODILY INJURY Por i rLl,ivVNl:O ALIIO$ r .' ( PG,:SUn) I-A ',.'I R:001.L-U AUI 10S - F BODILY INJURY(Pai au:4g,II) $ .X r i,.+UI1Ir; PROPORTYDAMAGC `--— - _ (Par t]c6da o r �' I XI r+vrri.r+t'NI_II IjUTUS B trr,CLl S LA b X occur; UU01254514645 4)0112011 0410112012 FACHOCCURRENQ c a1 000 000 ... - CtAIIVISp roWDF. - - AGQRELAI'E ` 0 000 000 . - urunlION n 10000 C I''"i"KERS CONINkNSATION ' t ANU eNIt'LQYEks'LIAau,n-Y WCA00525902 06/3012011 06/30I201 X W YIN YTAT- ol'rL VY Yh�)YK'CIUWYAf'ZI Nt WEAECU'riv' _ VFI ttLML: IBCR FACLUDED? N N/A. -W NH) L=L.EACH ACCIDENT t15 QQ,QQQ ,I 4 luutury .y- ° - _---•--. If"" Icp+.(rtbd unuer ..-: E I..DISEASE-•EA CNIPLOYEE: $500,000 III. tt;r'I'I(71V r%'OI'f;kAlitlNS alnw E.L.OISFASE POLICY LIMIT 1$500,000 wxnlrilUN ur urtlWIION5fLOCATIC)N$IVkt11CLE5(Attacp ACOR01U1,AdtlM1ional Remancs Sanetluk,amore Space is rrquirrtl) . �� bNorkers CORT In Included Officers or Proprietors (SeaArtaehed Dozicriptions) CERTIFICATE HOLDER CANCELLATION 10 Da sfor Non-Pa ment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORL'EO REPRESENTATIVE (01988.2009 ACOR0 CORPORATION.All rights Iesar;ved, 1COk0 25{20U9I09) '1 of 2 .The ACORD narTle and'logo are registered marks of ACORD 9368575IN168179 MEY Th.e'Cominornvealth of Massachusetts. D'epartrrient of Industrial Accidents Office of Investigations I' 600 Washington Street t� l Boston, MA 02111 i wwiv,rnass.gov/dia " Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians(Plumbers Applicant Information r Please Print Legibly Name (BusinesslOrganizatiorJlndivdual): rA V (,a Address: City/State/Zip: � �(.. ,'Phone #: I_ Are you an ernploye-re?'Check th appropriate box: Type of project (requited): 4. I am a general contractor and I 1 am a employer with'^�_ ❑, 6. ❑ New construction eiriployees(full and/or part-time).* have hired the sub-contractors . - _ .-- _,....- 2.L] I ain a sole propriator.ar partner listed on the attached sheet. 7. ❑ Remodeling shop and have no employees These sub-contractors have 'g, ❑ Demolition workuag for.mc in any capacity.• employees and have workers', ❑`guilding addition [No workers' comp. insurance comp• insurance.$ required.) . 5. ❑ We area corporation and its . 10.❑Electrical repairs or additions 3.❑ I am a homeowner,doing all work officers have exercised their l l❑PlUmbing repairs or additions myself. [No workers' comp. right of exemption per MGL 11❑ goof repairs wired. t C. 152, §1(4), and we have no, insurance required]] 13.❑ Other&� ,#q4 14i4i2ttrn+ employees. [No workers'' - comp. insurance required] 'Any applicant that cheeks box#1 must_also fill outthe section below showing their workers'compensation policy information.. t Homeowners who submit this affidavit indicating they arc doing all work and then hire,outside contractors must submil a new affidavit indicating such, lContractors that cheek this box must attached m additional sheet showing the name of the sub-contractors and state whcthcr Of not those entities have employees. If lha sub-contractors have employees,they must provide their workers'comp,policy number, _ T f am an employer that is providing workers' compensation insurance for my employees. Below is the polic) and fob site inforvnadorr 1 Insurance Company Name.:_ t � ATVt (� �!/l Z 1—. Ce 12 Policy# or Self-iris, Lic. #: bU iA 00, 7, 9 Olt } Expiration Date: _�DJL� -77 ,� ._ Ile o 3 Z Job Site Address: ' L�� � Cih'lSlatelZip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date failure to secure.coverage as required uoder,Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fuse up to $1.,500.00 and/or onc•-year unprisozunent, 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 inay be forwarded to te Office of lnvcstigations of the DIA for insurance coverage verification. I do hereby certify w- e pa C ' and penalties of perjury that the information provided above is trcre and correct. Date: Phone#: ,Q 7 �5 Official use only. Do not write in this area, to be completed by city or iowri official City or.Towri; Perinit/License# w, Issuing Auth6rit-y.(circle one): 1. Board of Iiealth' 2. Building Department 3. Cite/Town Clerk 4,,Llectricm Inspector 5.Plumbing Inspector b. Other _ ontactl'erson; y Phone#: . . — OWNER AUTHORIZATION FORM �er's Name owner of the property located at .1 170 �P�rA T e-e (Property Address) (Prope Address) hereby authorize COc 17?v L+ p (Subco ctor) - an authorized subcontractorior RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.- . Owner's Signature Date oh 216-IIZ CAP .� O�� . 5 1NS.ULATION M r' 6 F - 3. E.� i l FIBERGLASS SEAMLESS SPRATTOAM SUSPENDED • ' • BAITS GUTTERS INSULATION CEILINGS '} - r17800-696-66114 . id ;, Town of Barnstable - Regulatory Services F 4 Building Division , 200 Main St Hyannis, MA 02601 I, • ` p Date: Jan 30,`2012 Dear Building Inspector Please accept this Affidavit as documentation that Cape"Cod Insulation, Inc.performed'&' completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications`listed on the building permit k application. All work has been inspected by a certified Building Performance Institute, (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements.,` Property Owner ;Property Address'. Village, ' O. Susan Harrigan ` 9 Marie Ann Terrace 4 Centerville Insulation Installed: Fiberglass , Cellulose • R-Value , Restricted ' " Unrestricted Ceilings ( .) (X ) ( 35 ) '(. ) ( X ) . u - Slopes ( ) ' L'~ ,( Y ,( 19) •, } (� ). - E ( ( ) Basement ` .. _ !; s 'a � • " , Walls Since y He E Cass dy Jr,President Cape Cod Insulation, Inc. QyoFTHETo�` TOWN OF BARNSTABLE z6RX3T"AELt,: 0 IAO& "a*1639. ift?MAI BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... TYPE OF CONSTRUCTION ........................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...7...... . .... ..... . ................................................................................................ ProposedUse ........................................................................................... ZoningDistrict ....../?..p......I...........................................Fire District .............................................................................. Name of Owner `.'..................Address....................Address Name of Builder .......... ...... ....................Address I'V ....... .......................................................... Nameof Architect ..................................................................Address ..................................... ............................................... Number of Rooms .............................................Foundation ............................ Exterior ..........................Roofing . . . ..... ........................................................ Floors .: ............................................Interior .................................................................................... Heating .... t ....................................................Plumbing ..................................................... Fireplace .....................................Approximatt- Cost .......... .................................... ................... Difinitive Plan Approved by Planning Board -----------------I---------------19--------- Diagram of Lot and Building with Dimensions Fee 7 iTHEP'RORDSED SANITARY W T-EIR ANDDRAIN T V Bik!-UN STABLE, 6,0 A RD F I-1-E Pk L I A LICENSED INNSTALL_E-�p, AND l ',S'T;�',LL SEYVAGE: 10" 000 "'1 7110 I hereby agree to conform to all the Rules and Reg ulations of.the Town of Barnstable regarding the above construction. Name ...... . ..... .... ... ... . ... Lovering, R. R. DEC 311971' 13558 gargge & No ................. Permit for .................................... breezeway ............................................................................... 9 Marie Ann Terrace Location ............................................I..................... Centerville ................................................................................ Owner ...........R....R....Lov.e.ring........... ... .... Lowering........ .............. Type of Construction .......frame ................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ..,December...29. .............19 70 ............. Date of Inspection ..../.4-.P.. 19 Date Completed ...........19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ....................................................................... Approved ................................................. 19 ............................................................................... ............................................................................... ?,`W­, n�.'neer4,De0. (3rd floo.r) Map Parcel D Permit# 72 4 House# Date Issued `- :r��- Board of Health(3rd floor)(8:15 -9:30 0:00-4:30) Fee Conservation Office(4th floor)(8:30-9:30/1:00*2:00) Planning Dept.(1st floor/School Admin. Bldg.) IMF Tq,_ Definitive Plan Approved b Planning Board 19 PP Y g .. BARNSTABLE, ` TOWN OF BARNSTABLE, Building Permit Application ! Project Street Address ro rU -TO-12. Village M A Owner 4ano-A Address Telephone Permit Request S - .First Floor do� square feet Second Floor square feet m Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other .Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ .Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name FRASER GONSTRUMON Telephone Number Address 71 WAGON GIR License# COTUIT MA 02635 Home Improvement Contractor# '(508) 428=2292 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �� DATE ��S BUILDING PERMIT DENIED FOR TH LO ING REASON(S) FOR OFFICIAL USE ONLY ` PERAMz,IT No. q DA ISSUED MAP/PARCEL_ NO. t ADDRESS ' VILLAGE OWNER Y i DATE OF INSPECTION: FOUNDATION ' FRAME ` INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL GAS: 1 ROUGH FINAL FINAL BUILDING DATE CLOSED OUT t • } 1 ASSOCIATION PLAN NO. • The Town of Barnstable 1 Department of Health Safety and Environmental Services Building Division 367 Main Sheet,Hyannis MA 02601 Ralph Crosson Office:e: 508-790-6m Building Caramissio::: Fax: 308-790-Q30 For otIIce use only Permit as Date AFFMAVIT HOME nUROVEMENT•CON'TRACI'OR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 14.A requires that the "reconstruction, alterations, renovation, repair, modernirssion. conversion, improvement, removal, demolitiong or construction of as addition to any pre-existing owner occupied building containing at least one but not more than fbor dwelling anits or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions.along with other requirements. Type otWork: ' /� Est.Cost Address of work: Owner's Name Date of Permit Appilcation• 7 aS g I hereby certify that: Registration is not required for the foilowing reason(s): ._Work excluded by taw _Job under SUM Building not owner-occupied Owner palling own permit Notice is hereby given that:OWNERS PULLING ?HEIR OWN PERMIT OR DEALING WrrH UNREGLSTERED CONTRACTORS. NI APPLICABLE _ _ WORK DO 140T � AC TO THE ARBITRATION PROGZAAI OR GUARANTY FUND UNDER MGL 142A CF�S SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a.permit as the agent of the owner. f)., ) a- <�, jkc 0— Diak 1, Contractor Marne Registration No. OR Date Owners Name a lk IN, Nzi c -- GCE. A��"� / 4 /V//V Ll 1d.G_7./ 0