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I �." , �,, .!�;��,�,,�.�,�� �;,­­ , -. , -- ,� , a ., ��,:�l, �,�,, ,':,,�,,� �`��-��",;' .!.$',,���.1,"i"',t"'. s�.-I",­_�"! �,;;','ji"hj you?,JX!.'�, )"I'�;0I ioato,�WAOWkAhlosAA-N Am"'I'A -'! -�:,.',i�����,,,,,,i��p,��A�.�,�,',.I�,2�A,4�l.,4�:""��,���,,,,�"qDmuzN M RI ,-�,��- ",.., ,�� J , �,,!;��-,�,�,?�!, ,, ", -," "��::�,., �- ", � , , - �- � .i -, , , - "� 4: . ....... � �,.iii� oit ,_ �",�,­��', .`,��J;.,;!,`f��, ,,­:�,,,���,:.lh_ ",, "J.: � � Z,_��,,��,� , ,',� , , , ,"':,l"' , ,,,,�;T Of,,,� bl#'R'S'L�,i r � �,y Application numbe ................................................ Aff n Date Issued.. �jl3ll�9, MASS ®t1flFS�'.� $ .... .... .......................................sARNSTABLE, a 9 5 �;. ze 3. .0`$ a Building Inspectors Initials...... MAY 22 2019 Map/Parcel.......... 7:Z....� t :.1.......................... TO��NO� BAF�NS ABL ..... T® OF BARNSTABLE �3 EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 52,1 �/o/�„� �h�,, fir• �� r v'(/P NUMBER STREET VII,LAGE Owner's Name: So G►n �_�i a l f Phone Number S c��-�_ 7�l&cy Email Address: F g pyn p, n eeevA i-- Cell Phone Number Project cost$ /to, �—� — Check one Residential V1 Commercial OWNEWS AUTHORIZATION As owner of the above property I hereby authorize T to make application for a building permit in accordance with 780 CMR Owner Signature: 5-e p X-4,'t-a C'�-{cam-� Date: F- TYPE OF WORK = 'ding 0 Windows (no header change)# Insulation/Weatherization Doors (no header e char # Commercial g ) �_ al Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to lil sfe-/�')Gi1a ���� - �,1-�c o/r► /� CONTRACTORS I FORMATION Contractor's name I�t u n `7e nil;so✓� - SA-ern dJP ccr s Irvu4 Home Improvement Contractors Registration(if applicable)# 17 3 L.L,5 (attach copy) Construction Supervisor's License# 09 S 7 07 (attach copy). Email of Contractor aSLjea 9 q5d 6Mq; • C bM Phone number q0/- z 2 R - ROLE ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IIV 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. Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent 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 HOMEOWNEWS 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 PLIC 'I''S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal B Andersen of Southern New En land a Y g ., : John Gemeinhardt ���� Legal Name:Southern New England Windows,LLC. 54 Nottingham Drive ���i RI #36079, MA#173245,CT#0634555,Lead Firm#1237 'Centerville,MA 02632 WINDOW RE LACEMERT 10 Reservoir Rd I Smithfield,.R1'02917 - • H:5082807430 - Phone.:866-563=2235 1 Fax:401-633:-6602 1 sales®renewalire.com Buyer(s)Name: John Gemeinhardt : Contract Date: 05/01/19 . Buyer(s)Street.Address: 54 Nottingham Drive,.Centerville, MA 02632 - Primary Telephone Number: 5082807430. Secondary Telephone Number: emeinhCearlthlink.net Primary Email: p9 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,any:documents listed in the Table of Contents,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: $16#459 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: $0 Balance Due: $16,459 Estimated Starr. . Estimated Completion .6-9 weeks 6-9 weeks Amount Financed: $16,459 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'installat-►on datethat we are providing at this time is only an estimate..We will communicate an official date and time at alater date. Rain and extreme weather are the most common causes for delay Notes: 50% DEP 50% ON COMP TXS PD IN CENTERVILLE Buyer(s)agrees and understands that this Agreement.constitutes:theentire understandings between the parties and that there are no verbal . understandings 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 tight to cancel this Agreement. _ NOTICE TO BUYER: 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 05/04/2019 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 dba:Renewal,By Andersen of Southern New England Burr(s). r. Signature of Sales Person. " Signature Signature i • -Eric woods John Gemeinhardt , �.. Print Name of Sales Person Print Name Print Name UPDATED; OS/01,/19 ♦ - Page 2 / 10 t Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration = Type: Supplement Card Registration: 173245 10 RESERVOIR ROAD Expiration: 09/18/2020 SOUTHERN NEW ENGLAND WINDOWS LLC_ SMITHFIELD,RI 02917 SCA 1 20M•051 Update Address and Return Card. �� �1/T ._'�GB �GYJ7/72/YGC['P�.L!!J C�G'I�i-i�CLG1C`Gi . Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: ReuistikiOn. Expiration Office of Consumer Affairs and Business Regulation 1Z324b_=__ 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW'ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON ,g CC -- 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary ivv % without signature P - Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constr n 'Supervisor CS-095707 pa p i res: 09/08/2020 BRIAN D DENNISON l y' 8 BLACKWELL DRIVE CHARLTON MA-01507 C�L Comrrdssioner The Commonwealth'o.f tVIassacltusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,AM 02114-2017 www mzs gov/dia Workers'Compensation Insurance Affidavit.-Builders/ContractorsMectriciansMiumbem 9- TO BE FILED WITH THE PER�11'ITING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): S-11 1--th e r y, OL Lt� Address: U e r Vol r City/State/Zip:S 1-HiAl e�c�i Rl OLq l] Phone#: y0/-ZZ - 9 Are you an employer'Check the appropriate box: Type of project(required): I. lama employer with �f employees(full and/or part-time).* 7. []New construction 2 am a sole proprietor or partnership and have no employees working for me in 8: Remodeling any capacity.[No workers'comp.kwrm=required.] a Irl I am a homeowner doing all work myself[No workers'comp.insurance required.]* 9. ❑Demolition 4.[J I am a homeowner and will be hiring contractors to conduct all work on m I will 10 D Building addition ensure that all contractors either have workers'compensation insurance or are sole� 1 I. Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions S.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-coatractors have employees and have workers'comp.insurance.t 13. repairs r fi.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.ff0ther 4)Gft o e1.0 Or 152,§1(4),and we have no employees.[No workers'comp.insurance required,] r n Airy applicant that checks box#I 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 mast submit a new affidavit indicating such. =Contractors that d=k this box ttutst atmched an additional sheet Mowing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number I am an engiloyer that is pral iding workers'compensation insurance for my employees Below is the policy and job site information Insurance Company Name: rrnswalw- OF W Policy#or Self-ins.Lic.#:-"(, 31. Expiration Date: L.O Job Site Address: s`7 Al y•trtY►c Aa/,x� City/State/Zip: t�P� lri ell j A Attach a copy of the workers'compensa4oa 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 S 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 S250.00 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 ce under the p " penalties of pedury that the information provided above is true and correct t Date: Phione#: Fonly: Do Rot write in this area,to be completed by city or town offtciaL n: Permit/Licensehority(circle one): Health2.Building Department I Cityltown Clerk 4. Electrical Inspector 5.Plumbing Inspector son: Phone#: A66 or CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODNYYY) 12/28/2018 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 endomement(s). PRODUCER COMT NAME: CoCT Biz Insurance, Inc.-CO PHONE 303-988 0446 FAX 1401 Lawrence St.,Ste. 1200 aC No):303-988-0804 Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERcoot INSURERS:Firemens Insurance Company of WA,D.C. 21784 dba Renewal by Andersen of Southern New England Southern New England Windows, INSURER c:Homeland Insurance Company of New York 34452 em 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:787175890 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 SU R . POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MMIDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3155728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,00D CLAIMS MADE a OCCUR PREMISES a occurrence $300.00D MED EXP(Any one person) $10.000 PERSONAL&ADV INJURY $1,00o,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JEC LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 '1/1/2019 1/1/2020 COMBINED SINGLE LIMIT a accident) $1 000 0 4 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY AUTOS AUTOS (Per accident) $ X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident $ $ A X UMBRELLA LIAR X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DED I X I RETENTION$n $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X ST TUTE OT AND EMPLOYERS'LIABILITY Y/N IER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A $1,DD0,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE' $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000.000 C Pollution Liability 7930073340000 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Gafms-Made Policy Aggregate $2,000,00D Retroactive Date oaf20/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # _R_/ Health Division APR25 2017 Date Issued Y 51. P� Conservation Division 7*0V/N Ot=8ARAJ,9TA Application Fee Planning Dept. SI Permit Fee S- �b• Date Definitive Plan Approved by Planning Board Historic- OKH _ Preservation/ Hyannis 'IN 1 Zd Project Street.Address Village Pe,011Wv'((Y_ Owner Address 5y kAktl!�A h-a , 0r M.4 o3-&32. Telephone SOS- i W-?Y 3Z) Permit Request (0). T �a.a, ,,, �,t, /2-3 -7 Ca luos:, }a offer, --g �flc f I �x1►a,�b�s Lw� r-oJ_ Yhayn ., 1- ��/� � �ja{� ice„ �2j,��Tiv�2w�S (71e�.. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3'1 $�7'l w 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 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 ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Kd L ,k Telephone Number S-M'- Address YtO C�r&,e_ S-6- License # 1039 b( 1-2, 11 R 'kAZ M A d-I-7 a-O Home Improvement Contractor# 1,90 7 q 7 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO G-10A1,6 �r✓yces 1 o-o krezv-e ad L? l R,err/ MA nZ7�D SIGNATURE d'v� DATE FOR OFFICIAL USE ONLY APPLICATION # .y DATE ISSUED MAP/ PARCEL NO. { ADDRESS VILLAGE Y OWNER r t DATE OF INSPECTION: FOUNDATION FRAME J INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - c DATE CLOSED OUT 4 ` ASSOCIATION PLAN NO. i Tfae Cammanwea'lth of Massachusetts Deparlm5p entfh�rrd' straulAccide`nts 1 Ct►ngress Street,Suiae Ittt� en;MA 02- 14 201 7 ost www mussgov/dui hers'-Cor€tpensa# Insurace A€feiav�tt Borders/;Coz�tractarslElec#r�ciasfPtalfers TO BET-lit D� wit, tuit kki`TT':NG AU t:FiVRIT1' ApnhctntTrrf©katu►n' Please P.'rrnt..Le�abl Name Bustne t; ssJOr anizzttoti/£itdivrdua Insulate2Save.lnc;;` :Ad ress:410-Grove:Street:;; Glty/State/Zip Fali River MA 02720 Phone#. 508 567 67Q6 :Are you an employer'Check flee appropriate tiox Type ef:pro�ect:�reggtr 1 0-I ain a employer with 20 ,ymployaes.(full aadlor part-tmcs • 7 ❑New COnStrtlCtro l 2 Q T`um a sole:p ionctor or partrtersliip aad haue no employees'Wonting for iiie to 8 Remodeling any .capacity.:[No workers comp.insurance required:] 3.�Lam a homeowner doiog all work rnyselfjNo.workers'comp,,insurance required t.. 9 0 Demolition _ 10�Buildeng,addtttau - 4-- I am a homeowner and will be hiring coatractors to conduct all work on'niy property. Lwill. -. ,._ ' ensure drat all contractors etther,tiave workers'compeasaiion,irisurance,or arc-sol"e 11 [�.;Eleetncal repatrs.or additions:. proprietors with no employees: 12 P.Itunbingrepairs:or additions S.a i am a geaera!contractor aad I have It�red Slie sub contractors listed on the attached sheet ,13 Roof repairs These sub dontracton have empfoyees and tiaueworkers cornq rnsuranoi 6 a V�°e ace a corporation aid to officers have exeretsed Herr right of exemption per 1�fGL c Otkter Insulation' 152 §1(4j:nad we have no em to ees o;workers-co insurance tt tlutred. • P Y �' 'Anv app}icantthat.clrecks boxtkt must also fill out the section below allowing them workers'compensateon poilcy tnforsi+ahoa t Homeowners who submit this;afftdavit ndtcatrng'they are dotag alt•work and then brie outsn}e contiactors must submit a new affidavit tadtcattagsucla Contractors that check this bok tnntist attached an aadtnonl sheet showing the.nirte of f3re:strb contractors and state wheiiier or aotthose entities have _. employees, [fthesubcoatractbrshaveemployees;;tlreysmustprovrdetfietr,workzrs comp'polrcynuttrber R T 07k,an?empt©yer that esprovtctr workers'9arrperrsalon rnurance f©r my ernpinyees Belnly as the paltry anrt�ati site 'nfarrrrrtfmn. .` Tnsuranee Company Iqs Liberty Mptual Insurance x irat,on Date 12/10/2017 P ;Policy#.orSelf--tits Lic:# XWS 564t8741 : P Job Site. ddress� �t''�J'ns��i2r�r. ©r Gttylstate/Zip ,.�.vt�c�. M� czz(.3 Attac.h.a copy of the;workers',eompensation.polrcy decEaratrou page(showing the ptaltcy ntunber adexp%rahan date} Failure to secure coverage as required under MG.,D c 152 §�SA'is a cnmtnal vtolatton ptuiishable by a fine up to$j,500:40 andlor otie year=impi isonment,:as well as,civll.penahies in the form of a,STOP WORK ORDER and a fine of up to$250 0{I a day against the.:viotator::Acopy of this.statement may be forwarded to ti e Ofltce.of Investigations of the--D.. for insurance :coverage venfieatton. ,.: f do hereby certify uniter the s a es of p�rjar��tlrit the Mforra#P t6Oji e��bove is,true=and corree : ' Signature; — Phone#'i 508:567 6706 {©fficlal use arty �o not wptte in tfi area,to be ca»rpletect°by c�ty.gr town officat Crty;ar Town Permtt(tricense# Issuttg Asth'ortty(circle oneJ 1,,$said of E�ea}th 2,Bui)Edug H.epartment 3.City/lI own Clerk <4 Elecrcat'C�especttrr=5 Plumbing]Frtspector b• Other. ' Cari�act Pet on : <:_ . •• te ( f 0- 4& Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Mass' . usetts 021116 Horne Im r v p o eme �tractor Registration Type. "Corporation INSULATE 2 SAVE , INC. - Registration: 1$047 zpiratior 121 28/2018 410 Grove St Fallriver, MA 02720 scat 15 20wW11 - Update Address and return card. tdark.reason for change. _e.. _ C1 Ad 3r $s Q newa!Cl t-moloyms-nt C7,Los3 Card �f16 CYjJt$TL�TICLtCC{GffG Ci�C�FJ{tCJd{lcN3'�.lr: Uftice of Consumer Affairs&Business 11"uletion HOME IMPROVEMENT CONTi AC7Ol? Registration valid for lndlvlauaiuse only 'TYPE:CorporaZton before the expiration deta lf.foynd return-to: Expiration Office of Consumer Affairs and Suslness Regulation $u 7 n 1'2/28I2019 10 Park Plaza Suite 6170 Boston,MA 02118 INSULATE 2'SAV7 1 t �� Roland Langevin �. J� . 4f0 Grove St y Fallriver,MA 02 2Q., / J Undersecretary Not valid without signatut K MasSaChUslclts 0e;Partment of Public Safety- Soard of Su,ilding 116gulations and Standards° ' License:CSA03861 Construction Supervistur ' IkOIAND LANE VIN 54 H1014CR T OfiC} FALL i2lVER MA`fi27 i�C�nlntl�+5toi"rnr: U$12.?tl2ilf� DATE(MM/DD/YYYY) ,a�o® CERTIFICATE.OF LIABILITY INSURANCE 12/8i16 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 thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Anthony F. Cordeiro Insurance O�ONE ........0.......8.......).. _7--_..............-....._,-....------- — F - (-5-0 8->—6— 77-04097 _ . AA/XNo 171 Pleasant Street E-MAIL ADDRESS: hsouza@cordeiroinsurance.com. Fall River, MA 02721 _ ___ _INSURER(S)AFFORDING COVERAGE NAIC# INSURER Lib,erty,,._.-Mutual Insurance_-_.,,____ --...- _..- _,__.... .- _....................................... . INSURED INSURER B: Insulate 2 Save, Inc. INSURERC: 410 Grove St. INSURER D: Fall River, MA 02720 INSURER 1 NSU R ER 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. INSRI ADDL SUBR I POLICY EFF POUCY EXP LTR'I TYPE OF INSURANCE IN SR WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY i LIMITS A GENERAL LIABILITY Y Y BKS 56418741 12/10/16 12/10/171. EACHOCCURRENCE $ 1,000,000 DAMAGE TO RENTED I ,� X I COMMERCIAL GENERAL LIABILITY �'PREMIISES._(.Eacccurrence)�_ 300,000 F— J CLAIMS-MADE j X I OCCUR i I ME EXP(Anyone person) � $ 5,000 PERSONAL&ADV INJURY 1 $ 1,000,000 GENERAL AGGREGATE _ $ 2,000,000.. - - � GEN'L AGGREGATE LIMIT APPLIES PER , IPRODUCTS-COMP/OPAGG $ 2,000,000 I X POLICY I PRD LOC ! $ COMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY Y Y BAA 56418741 , 12/10/16 ' 12/10/171 (Ea accident)__ ____ $ 1,000,000 ANY AUTO I BODILY INJURY(Per person) 1 $ ALLOWNED SCHEDULED j BODILY INJURY(Per accident)! $ AUTOS X AUTOS NON-OWNED I PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS f Peramident $ A X UMBRELLA LIAB g OCCUR• Y Y USO 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 2,000,000 —{ EXCESSLIAB CLAIMS-MADE AGGREGATE i $ 10,000 DED RETENTION$ i $ WORKERS 1z/1o/16 12/10/17 OY_ JA W 1 RLIMIS_ -pE.R AND EMPLOYERS'LIABILITY I ANY PROPRIETOR/PARTNER/EXECUTIVEY/N N/A E L EACH ACG DE NT i $ 500,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) EL.DISEASE-EAEMPLOYEEI $ 500,000 If yyes,describe under DESCRIPTIONOF OPERATIONS below iE.L.DISEASE-POLICY LIMIT 11 $ 500,000 I I j v I ' DESCRIPTION OF OPERATIONS/LOCATIONS t VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) "For Insurance Purposes Only" 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: R[SE.;Eng'►rieeririg .6ppontAvenue,SquatY:armuuth,:A1A0266d fli 9 loo ENGINEERING 511&Sb8=192b.X=S19I TX3fl8�68;1933 PR()(C2AIVI`. • .TNLS CONTRAC7'IS Ei4'rERM:INTO BESY44dt RISE' ttcwHE§ EWINEE MG AND Tt{E.CIlsTOVER FORWORKAS' .. .'DESCRIBED SECDW .-. ...:. �.........:.:...: :-:..,. :.: ..:.... 4 ORDER -CUSTOMER - PNONE DATE John P Gemeinhar it (§a3)2�0=7430 0"i�Of7017 234013 07502 -SERVICE 87REET rb•8 .. . 54 J`Iottingt m Drtve 54:Nottntgt am Drive - ..,_,..., _.., ............... _.... _.... ......... . .. SERV3CE C"STATE.aP BHlii3G C"STATE LP - Cetaterutlle MA 02b32e` tatti ICA 02b�Z JOB DESCRIPTION HAZARD BARRIER'We have identtfred"that there are ancuvereti etecvicai junctan boxes present In vow home.These need to be covered prior;to the start ofynitr hatn�s;weatherixattbn work,and are'the:Psponsibihty o!t1i�homcowper IN CATWALK 4VAI tC AR JUST BEYQND:THE GARAGE` «irtttials>? , .AIR SEALING Provide labor an _ d materials to•sesi"areas of.yoitr hortte against wasteful;excess atr leakage. This'work wii!'bc pertnrmed 5800 00. in:ayncertwith the usebfspeciat,tools and:iltagnostk t r'rests to as 1. that your home wtil•be left wcth a fiea)tlzful`level of air exchange and;tndoor a r quality.:(vlaterials to be used:to st al y ur home can inci4 q caulks,foams,wmthcrstripbing and nthcr rtrodncts Pnmoiy; arm for sealing inclgde air leakage to attics basements,attached garages and other,unheated_ai. as('windows are:not generally, addressed).:{IU);working hours. A.rcduofion in cuhic,:ftdt per mmute�(cfm)of aic:infiitration will occur,but the actuabnumber of:cfm is not guaranteed. I DAMMING:',Provtde labor and inatenals to install a..12"'layer df R-38 uitfaceil fiberglass 0atts to p00)square feet for damming 492:00 I purposeg. - I rITTIC FLAT..Prowde;labor find materiatt-to inctall'a 10'layer•af R-32 Class 1 Cellulose added to(1300)square feet o!'opCWattic 52,028:00 space; ' VCNTILA;FfON,Provide labor and materials to install(2)insulated:czlaust;h0se vvtth roof aiounted.tlappeT vent'to ex}iapSt future $23750: bathroom;fag(s). VENTILATION'Provide labo;::and'materials jo msfati ventilation chafes at(1b),rafler bays°to maintittn air flaw; $2b5 2 • vl ��� 3� 20�7�: Mr, En neerang ' 5 Dupont Avenue;South Ytirmouth MA 026". �8 ENGINEERING' Lag i1T4r 508 ab$-1926 X4197' FA]t 50$-,b8'T933: ,.. . Page 2 PROGRAM T p CONTRACT.-IS ENTERED,iNTO BETVIM RISE. CLC-IESa+NEERSNu Auo neE aus:ora£R w :iaocRs; :oFscRtu£neEtow ... _ PNONE. :DATE .. CUENT9, VAMORDER. CIISTOMM John P Gemeinhardt (508)280-7430: 03130120'17- 234013 07502' SERVICE.STREET S1wN6 STREET S :Nottingham Drive: 54;Nottingham Drive .......... .. : .._ ..........._ .._. .. SERVICE CITY,STATE, Si IMO Cn'Y,STATE.2iP: Centerville;MA 62632 Ce it&Qle;-MA 02632,' J. im-SCRIPTION lNChNTfYE:RISE Engtneenng-vvtli apply all appllcshle eltgitle incentives to this contract. You will he bdled.anlY the�ei.amottnt, $ib5.Ot1 Currently,for ellglble.nicasums,.`the Gaps Light Conipact o#Ters-7a°/s incentive,not to�xd dS4,000 iu:r csilendar year.o-uTd'ars incentive of I00°1o;foi:ttie%iicS�ling measures.: FOr;the safety and•heaith ofyour home's indoor air quality,we might be Conducting a blower dons diagnostic of the avallatiie air flow iIi your home tiottt.beCore;the work is begun,,'end after the,weathetizsltion wvrl.Ts corgotctc(got;to bg conducted li asbestos Is.pr t) 1Vc wily.als&cond i diagnostic:assessment cif the cordbustion:fumes iri the exhaust-flue of yaur heaung_system Mill`water heWr,'t'W has s ll "value of390 and is;afno.eost tD:yoik. The.Permit will be secuied by the'imulation;contracfor.This:his a value of$'75.and ls'at.no ciist to yaii.'it Isthe homcotvners r, nsibili}io close out-thins .rmtt by contacting.theiT mun c patlt}::at;the compietlnn oft_is rvo;k Total:. $31987.7 Pro ram Incollove::_ ; 3 232 06, lrustorner,Towl. $755:C8 WE 11GRt E HER£t3Y TO FtlRNi$N SERV;CES,COMIPL;ETE iN;ACCORDANCE WITN ASOVE SPECIfiCA3TONS:Fqk TtfE.SUTA;OF' even Naandrea Fifty Flue&8 1900 ballar $75.5.5$ UPON F1t+lAAe iH9pECTtON;ANO, 'AL BY RISE EdtGtNE£R@dO CUSTOA�R ACroREESTO;REAiiT AMOf*:DUE�tN,FtR.t:WTEAE3T;0i 1?4 YdiLLBE CHARGE6�?.tONTIfLY,OM'dtJY - UNPAH18AiANCEAFTER SO'C, FOR{3APCdtTAAET WFORMATION ON 6UARANTECS RiCSHTs OF REG3810N SCHEDUuNc AND-CONTRACTOR-RE618TRATtOH, _ ....., w_... .._,_.... ............AUTH ... ,. SE WTTi MRAWN SY lit IF NOT EXECUTED bitR'►itN - DATE Of'ACCEPTANCE - - ACCEPTANCE OF CONTRACT.=.;TH,E ASOYE PRICES,SPECIFICATIONS AND.CONDrTfDN9'ARE, BATWACTORY,To us,'AND ARE-HE1tESYACC,£PTED,,YOU ARE:AUTHORIZED TO DO:THE WORK' .AS SPECIFIED.11PAYMENT WIU:B£'MADE AS OUTUN£D ABOVE . � a RegulatoryServices. . Town Pefry, ofl L;ra assic ner, ?�d}I��1a3a �.rt;T�yaauus,��LA D�6�P:I` wwwAlow�r. arnsi gas;: C}1icc-: $€18,8.61-63.9'. .Fax: 56,9779676236 IWPp Ay��e .us e e n Sigh l,,his Scc tioi iu-III matrdrs,M ve tta work.autzor z"a l�: �is�tafl � 11 'M Dt'1V: s� w 1?c cal.f n axe respt�sx5a sih the pp i a a i o filled «r iz d-l*fore I. in m&aUi iz pea ans r perfra e antf ac gptec r i az ttt£e o C nor S air z cif; plicwwl. 'rin i`d .�n nt N a . P ' Town of Barnstable *Permit Expires 6 months from issue date XMPR_ AIT Regulatory Services Fee �C °7 Thomas F.Geiler,Director MAY 3 u 2007 Building Division TOWN yr ►dARNSTABI.�.TomPerry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 ©� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-7.90-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY t L Not Valid without Iced X-Press Imprint Map/parcel Number 1 7,;� Property Address 5 7 MResidential Value of Work 530• °� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address U,0 N Sy /(! 2 �93 V Contractor's Name 2 l 1 1� � _ �MtG��JCr`S�S l��lTelephone Numbers.SBA) Ll Z 0" 9.3 3 v Home Improvement Contractor License#(if applicable) 13 gLjy 3 Construction Supervisor's License#(if applicable) [ Workman's Compensation Insurance (` Check one: ❑ I am a sole proprietor I am the Homeownerti I have Worker's Compensation Insurance � ' .vJVY'ovv� e e- Insurance Company Name /��L� '�Y';'i V'''.Ay e-1 Workman's Comp.Policy# W C 2 3 1 S 3 Ya IN 7- " Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to P,7yA S/fi/) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,.Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. co y of th o Improvement Contractors License is required. SIGNATURE; Q:Fomvs:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents = d Office of Investigations a + d 600 Washington Street "~ Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please/Print Le 'blv Name(Business/Organization/Individual): . c i Address: ©• 13 tY M City/State/Zip: Ce A-,P 'V 1 a,_ . �Z hone.#:�� Y20 " J1g31l Are you an employer? Check the appropriate box: Type of project(required):, 1. I am a e to er with � 4. 1 am a general contractor and I � Y 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 workingfor me in an capacity. employees and have workers' Y P tY� $' 9. 0 Building addition [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.❑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 MG 12. Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 3.0 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 job site information. Insurance Company Name: L t ✓ � �t.syR t=� �0 . Policy#or Self-ins.Lic.#: 1�1 C 2 -3 1 S - �j�U $ Z D (O Expiration Date: Job Site Address: -sY Na (P hO1'�'t Oar V-� City/State/Zip: Cie'K�W y i'U4 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 In vestiQations of the DIA for insurance coverage verification. I do hereby certifyder the in nd penalties of perjury that the information provided above is true and correct Si ature: Date: zo Phone#: Official use only. Do not write in this area,to be completed by city or town of tcial City or Town: Pernut/I.,icense# 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corpora 'ion or other legal entity,or any two_or more of the foregoing engaged in a joint enterprise,and including the legal repr entatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal ntity,employing employees. However the owner of a dwelling house having not more than three apartments and w o resides therein,or the occupant of the dwelling house of another who;employs persons to do maintenance, co truction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of ch employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local lice sing agency shall withhold the issuance or renewal of a license or permit tt*operate a business or to constr t buildings in the commonwealth for any applicant who has not produced cceptable evidence of complia ce with the insurance coverage required." Additionally,MGL chapter 152, §2k(7)states"Neither the co nvvealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until a eptable evidence of compliance with the insurance requirements of this chapter have been�F sented to the contra c ' authority." Applicants Please fill out the workers' compensation affiavit completely, y checking the boxes that apply to your situation and,if necessary,supply ply sub-contcactor(s)name(s), a ess(es)and p one number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC) Limited Lia ility Partnerships(LLP)with no employees other than the members or partners, are not required to carry wo ers'comp ation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that affidavit ay be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. so be s re to sign and date the affidavit. The affidavit should be returned to the city or town that the application for e pe t or license is being requested,not the Department of Industrial Accidents. Should you have any questions r ard' g the law or if you are required to obtain a workers' compensation policy,please call the Department at the er listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed leg' ly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of ves ations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which wi be us as a reference number. In addition,an applicant that must submit multiple permit/license applications in an given ye ,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Addy ss" the app 'cant should write"all locations in (city or town)."A copy of the affidavit that has been officially st ed or marke by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future ermits or lice s. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license r permit not rela d to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person s NOT required to omplete this affidavit. The Office of Investigations would like to thank you in adv ce for your cooperati and d should you have any questions, please do not hesitate to give us a call. Department's address telephone-and fax number:. The Departm p theammonweal of Massachusetts Department of In _stxiai Accidents Office of Inve figations 600 Washingt ' Street Boston, MA Q Ill Tel. 617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax 4 617-727-7749 www.mass.go-v/dia Town of 13arnstabie 04 Tam _ o� Regulatory Services Thomas F.Gengr,Director L to ldiug DIVISIOU sx TOM-perry, Building Commissioner 200 Main Street, Hy=tis,MA 02601 . wwW,town.barnstable magus --. Fax: 508-790-6230 Qffice: 508=862-403 8 - :Y. .- PropertyOwnetMust -Complete and Sign' hb Section _.. If Using A Builder 1 Aed YE 2 I ,U Owner of the subject propeity 1 -to act on my behalf; _ 1 - hebY autlzorsze . • matters relative to ,.rlcauthorized by�diis binding permit application for - in �� VL _ _- {Address of Job) - L Date of Owner H 2 69 - ? Print Name -� - - �-�� • .�. a arr'1 rir- LrlZ)=K.1t I F-HX P. ALiberty Liberty Mutual Group mutwu. P.O. Box 7202 Portsmouth,NET 03802-7202 Telephone(800)653-7893 Fax(6)3)-431-5693 May 22,2007 T0*rN`QF CHATT3A 1 (J 261 i`EURGE RYDER RD CHATFdAYf; BSA 02633. RE: Certificate of Workers Compensation Insurance ' insured; I<-El'fli C GILMORE ENT'E.RPRISES LLC PO BOX 17 CENTERVILLE, MEA 02632 Policy Number: WC2-31S 3408#2-U'i7 Effective: z 1/4 ,'2007 Expiration: 2 ,%4/2009 Coverage afforded under Workers Compensation Law of the following state(s): MA a e P nrie°oriPartrer Couerage utgion• Bodily.injury By Accident: $10000 Each Accident Bodily Injury by Disease: . $ 100,000 Each Person Bodily Injury by Disease: .500,000 Policy Limits i I i As of this date,the above-referenced policyholder is insured by Liberty!Mutu listed above. al Fire Insurance Co under the paiicy The innutaace afforded by the listed policy is subject to all the terms,exclusions and conditions,and is not altered by any rectturernent,team or conckf)n of any or other documents vinth respect to which this cee-ificate maybe issued. This certificate is issued as a matter of information only.and Confers no rigbt upon you, the certificate holder. This certificate is not an insurance policy and does not amend,extend,or alter the coverage afforded by the Policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual vx ill endeavor to notify yor, of such cancellation. AUTHORI2ED REPRESENTATIVE LIBERTY"MUTUAL INSURANCE GROUP T,»;Cerificate is executed by LZBER.1y MUTUAL IN&L' 14CB GROUP ai respects 91ch i Lurance as is at3erdad 1y tltose:ompenies. Ct:: 1nSUred: KE.ITH C GILMORE ENTERPRISES LI,C Producer of Record: PO BOX 17 MARS[fALL K LovEirETTE INSURANCE CEVTERVILLE, till 02632 P O BOX 836 EST YAKMOUTH, NL� 02673 i l— 'Beard of Building Regulatietis a*rWstandneds License or registration valid for in dividul use•on�y 'HdmF I.MpROVElWtNT CONTRACTOR 1 before the expiration date. If found.retuin-to: Rtlgi9ttat(oh;: :134443 j Board of Building Regulations and Standards patrOn �P/,20/2007 ); One Ashburton Place Rm 1301 Boston,Ma.02108 aTypetd;l iability Corporation I ENTERRRISE.S�LiG� Ki_ITW..GILMOR '26 HIDMNVALLEY �}� G-a — i ci✓.i l% MAROTONS MILLS,MX 02648 Arlm;nistrator Not valid without signature OpTME Tp,t, Town of Barnstable *Permit# &33o Expires 6 months from issue date 0-0 • iAS[ABLE. Regulatory Services Fee >� S RN v MASS. Thomas F.Geiler,Director �p i6g9. A�0 'fDMtO� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyamus,MA 02601 X-PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 JUL 3 O 20OZ EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint TOWN OF BARNSTABLE ✓lap/parcel Number Ila 0 1 ,A f 'roperty Address esidential Value of Work Ob )wner's Name&Address r r 1 j W —To it V, —A 6 U�e A 15�Y Mo ry) Ae C�_4 jcc 1z I contractor's Name!'0%ZZI L4 Doty�Jh��(/t t�l Q n� Telephone Number Home Improvement Contractor License#(if applicable) /02 7-/0 Construction Supervisor's License#(if applicable) C6 057 0,3� orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner C�Khave Worker's Compensation Insurance Insurance Company Name /► �-�t �/ I n GC. ����L!>�Ct/'1 G�, �/^CJ—_��D Workman's Comp.Policy# Permit Request(check box) Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) QP'Kee-side ❑ Replacement Windows. U-Value (maximum.44) [Other(specify) tep gi�U �An'�- cx3 *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revised 121901 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I '� "" C51 '�' `�`0' OF* Eh"ki f. 57� OL Permit# :D V � Health Division �s � Date Issued 22 f V2 4 AN 14 AN 10: 15 Conservation Division 1 < Z Fees Tax Collector Treasurer C1 DIVISION 9�. fi ,r ' @t 940 , -9-TH d @ t L 5 PlanningDept. Date Definitive Plan Approved by Planning Board Jp � 4L�L of '�4:iU LA7 0hI-S Historic-OKH Preservation/Hyannis Project Street Address q Aio tt-t'm I �?qm Village (C�ei e+`rJ Ile, , (n'A Owner ToW er Address Sy N614 N D) R1y Telephone ® � Fr r S6,: �c-I m r Permit Request t, r4(1 Q ®R-T . Square feet: 1st floppoxisting proposed 2nd floor: existing proposed Total new O Valuation Zoning Districtke-S— Flood Plain t Groundwater Overlay Construction Type W0 0 A Lot Size -3 ? acre. Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family , Two Family ❑ Multi-Family(#units) Age of Existing Structure s'3 Historic House: ❑Yes Alo On Old King's Highway: ❑Yes Ao Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Q Half: existing new Number of Bedrooms: existing_ new ' t Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes XNo Fireplaces: Existing l New Q Existing wood/coal stove: ❑Yes NO ,,Detached garage:❑existing 0 new size LUb Pool: ❑existing ❑new size Barn: ❑existing ❑new size Attached garage:"Lexisting ❑new size/,fix gq 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 NamedAl 1691--1 2 Telephone ber Address /[�® 771 , 1,-7W ense# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESU G FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /� ✓�l�l/ o��0 z z FOR OFFICIAL USE ONLY } PERMIT NO. %. DATE ISSUED ! ' MAP/PARCEL NO. _ ADDRESS VILLAGE t OWNER -` DATE OF INSPECTION: FOUNDATION FRAME ' i INSULATION a FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - C GAS: ROUGH FINAL FINAL BUILDING' 1 t DATE CLOSED OUT 3 _ ASSOCIATION PLAN NO. ' 4 3 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions, $50.00 - Alterations/Renovations $25.00 . Building Permit Amendment. $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE t square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) 4 ACCESSORY STRUCTURE>120 sq. . 190 >120.sf-500 sf $35.00 >500 sf-750 sf 50.00 ' >150 sf- 1000 sf 75.00 >1006 sf-1500 sf .100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS , Open Porch x$30.00= (number) Deck x$30.00= - (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool . $60.00 Above Ground Swimming Pool $25.00 Relocation/Moviug $150.00 (plus above if applicable) Permit Fee pmjcost r The Town of Barnstable 5 o ; .s�►sivsres� g Regulatory Services &es9. �0 4'"ren►r►A��. Thomas F. Geiler,Director Building Division Peter F. DiNlatteo, 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 as 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. a� Type of Work: �1412 PO R'T Estimated Cost # ^3/®a 0 Address of Work: J-t-I (� l I ,I Ns I`,ArA �iQ 11 2Ldci��14- Owner's Name: To f) ROLL e-t' Date of Application:— 14-j 6/1 I hereby certify that: Registration is not required for the following reason(s): FlWork excluded by law QJob Under$1,000 []Building not owner-occupied ZOwner 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 q:forms:Affidav:rev-070601 r r'o of1r+E goy, Th � SZAB e Town of Barnstable MASS. � Regulatory Services Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 . TEce: 508-S62-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 4— JOB LOCATION: number street village "HOMEOWNER": 701-/A,11 name home phone# work phone# CURRENT MAILING ADDRESS: ��?�(l o T%AA—,64,2v-7i Pe_ city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage andridividual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Si cure of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states.that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN /2L III _ rF 1_OCA'1rIC)N OF RRC)RER-TY I-ONES MAY N ®-F 13E ACCQ_PQ2A-1r0= STANDARD LEGEND 40 NOTE:not all symbols will appear on a map AP 172 'Z!-Z� GOLF COURSE FAIRWAY OrY ' EDGE OF DECIDUOUS TREES 50 ^^ ^^ EDGE OF BRUSH 4 r i ORCHARD OR NURSERY P-77-7 EDGE OF CONIFEROUS TREES MARSH AREA — EDGE OF WATER DIRT ROAD DRIVEWAY F—PARKING LOT PAVED ROAD f — — DRAINAGE DITCH PATH/TRAIL Y �J \ PARCEL LINE MAP 72 MAP I10--.- MAP# 21 EPARCEL NUMBER #1860 F—HOUSE NUMBER 4 \/ � 2 FOOT CONTOUR LINE 7 ill 10 FOOT CONTOUR LINE MAP 1 / 2 Elevation based on NGVD29 4.9 SPOT ELEVATION 212 STONE WALL 1041 -X—X— FENCE RETAINING WALL RAIL ROAD TRACK — STONE IETTY SWIMMING POOL _ -------- PORCH/DECK C� BUILDING/STRUCTURE DOCK/PIER HYDRANT e VALVE OO MANHOLE 0 POST p FLAG POLE T -O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T ,p SIGN ® STORMORAIN N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES:Planimetrics(man-made features)were interpreted from 199S aerial photographs by The lames ❑ TOWER 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD o .UTILITY POLE " E 0 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards s I INCH=40 FEET* enlarged scale. on the mop. at o scale of 1"=100'. Parcel lines were digitized from 2001 Town of Barnstable Assessor's tax maps. O LIGHT POLE O ELECTRIC BOX F (cam 9, f�l rna o2X `f lJ.)AL� Lk !sRAF i�c yc� 'Sh ZAT14 I lz;i r , ., � . F , 5`1 old �f tNj,�hfim Dt�t� 7ex�lt��-cr I. t J side e�4� �/X',� �!� �=r�.��' l����. lt.J t Tt� V�fug•�, C-'o v��r� - , N ��� t' � m «1P-FT �� o , Town of riarnstadte Building Department Complaint4nquiry Report 1 L4 Date: Rec d by: Assessor's No. Complaint Name: 0���'� Location .�ti2�� Address: M/P Originator Name: Street: Village: State: Zip: Telephone:.D/C Complaint Description: 4��lf Inquiry Description: For Office Use Only Inspector's _ 62 c j� Action/Comments Date: - Inspector. J Z-" Follow-up Action Additional Info. Attached Copy Distribution: White-Depa=cnt File Yellow-Inspector Pink-Inspector(Return to Office Manager) Engineering Dept. (3rd floor) Map Parcel ( _Permit# 0 02— House# 5q ' Date Iss Fd 9 U Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) �/' v'�` eZ,&Fee Conservation Office(4th floor)(8:30-9:30/1:00-2:00) SEPTJC Sy Planning Dept.(1st floor/School Admin. Bldg.) 'NSTALLE® � a PUSS"BE Definitive Pla pprove y Planning Board 19 ENVIRON - � 7'®@N� p Ai°� TOWN OF BARNSTABLE m _ Building Permit Application Project dress ­57 /�� /I�� �� cpuy U7-4t Village 4 Owner/% &ZZ2j� iV O t/�� Address Telephone Permit Request 4C49AJ-T—Pe(l First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 2� a� 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 p.Nfo On Old King's Highway ❑Yes QL e 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 A-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 2110 If yes, site plan review# - Current Use Proposed Use Builder Information Name /o,,07 d4L.VX�2-M Telephone Number Address /fc f"Is J G, 6 /77— License# Home Improvement Contractor# Worker's Compensation#o�ii/,8,FZ NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRI RESU ING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 7 DATE BUILDING PERMIT DENIED FOR THE FO OWING REASON(S) r FOR OFFICIAL USE ONLY - PERMIT NO. DATE ISSUED - w MAP/PARCEL NO. r• ADDRESS VILLAGE� _ OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH_ FINAL - GAS: ;TROUGH, FINAL ' FINAL BUILDING; ': DATE CLOSED OUT + ASSOCIATION PLAN.~NO.'-- r - �THE r, The Town ®f Barnstable Department of Health Safety and Environmental Services ` 679- Building Division 367 Main Street,Hyannis MA 02601 Ralph Crosser. Office: 508-790-6227 Building Cc=;-, Fax: 508-790-6230 For ofrice use Only 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,least one but not tion moref an than fouron to any dwelling anl�aring to owner occupied building containing tared contractors, with structures which are adiacent to such residence or building be done by regis certain exceptions,along with other requirements. Type of Work: x ` �� Est. Cost l Address of Work: owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s):. Work excluded by law _Job under 51,000. 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 OGRAM OR G HOME UARANTY FUND UNDER MGL WORK Do O 14ZA � ACCESS TO THE ARBITRATION SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. r�.,rr-tctnr?Vsamr• OII No. Regist=ti PLOT PLAN FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) ED Well I I 1 (lot. . . . . . .. . . . . . . . .ft. rear) Abuttor s Abuttor's Name Name Lot # I Lot # REAR YARD If this is a If this is corner lot, . . . . . .. . . . .ft. corner la write in name write in of street. � name of 1-----. Q, other ) street. SIDE YARD SIDE YARD HOUSE Q I SET BACK : � I (lot. . . . . . . . .. . . . . . . . .ft. frontage) \ (NAME OF STREET) / Information ��.�� / \ \ Supplied by MARK NORTH POINT or . -• yxG P7' post • S •�� r oc � •P r,L • �•nftiarta+� \ �2 x Iry 07 cl. CS. a J O r BCZP!r s,� .a► a or/s A,,P T ZIAAC S - $MC SYSTEM MUST BE� V 1 / INSTALLED IN COMPLIANCE WITH ARTICLE It STATE SANITARY CODE AND TOWN f?EGULATIONS. TNET��� TOWN OF BARNSTABLE Z BAWSTABLE, i "6 9 �Y �•� BUILDING INSPECTOR � PY a' APPLICATION .FOR PERMIT TO ... .... ..!l..... .Ne... . iwekp .................................................. TYPE OF CONSTRUCTION WP..P.II.:... A M. C............................................. ................ ... ....................................... .............. ...............1 9..7.3. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......1-4t. ... .........MtN. l! ffi.... oi.a�........................................................................................................ ProposedUse ............ReAl?'efi—ti- ............................................................................................... ................................... Zoning District ..............1 .:h.:..a.............................................Fire District ....Lr�!v���tl.!��g.......0S.k!r.y!J.Le................ Name of Owner .......Nl f's�Y'.C:ST....d6v�? 1G...�P a ......................Address �l t°! ,� 1 2�1�CtV. Nameof Builder ....................................................................Address .................................................................................... Name of Architect ...................................................................Address Number of Rooms ..................................................................Foundation ......f•-R... .....�i�%!t!Ge.................................. Exterior ..............sad. .p ,�9.....................................................Roofing ...............0.'.S�(!!'t' .............................................. Floors ►,✓./?.`b ................................................ ��s/t�u.a .Interior ..:.......�1 "�. .6.1 : �? LI Heating / ...........................................Plumbin � VAT/�J' Fireplace ............... Ji/e'......`.........................................I..........Approximate Cost .......::.... �.d' :. ................................ Difinitive Plan Approved by Planning Board ---------------_---------------19 . - • .� �• W/ Diagram of Lot and Building with Dimensions 00 Ob Al l � �r) v� too hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .........`�: z.... .c4"�t ,to :........................... Normest Homes, Inc. 16375 Permit for o storg No ............. .......................... single family dwelling - ............................................................................... Location .,Nottingham give Centerville ............................................................................... Normest Homes, Inc. Owner .................................................................. Type of Construction game ° ........................................................ ................... Plot ............................ Lot ........#4.................... r cat r � Permit Granted 4A-0. ....19 73 Date of Inspection 19 f X Date Completed 73......19 PERMIT REFUSED ................................................................ ........... ................................................... ............................................................................... ............................................................................... I i Approved ................................................. 19 ............................................................................... ...............................................................................